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Pittsburgh in August was a wet mouth breathing on the back of your neck.
Yolanda Garcia had been awake for nineteen hours, and the air in the ambulance bay had the consistency of soup, and she was standing in it anyway because it was better than standing inside where she was.
Thirty-nine days. She hadn’t counted on purpose. The number had simply assembled itself in her head the way vitals did, the way a lactate trending the wrong direction did—she didn’t want to know it, and she knew it anyway.
Thirty-nine days since the Fourth. Since she’d stood in that hallway with sweat drying under her scrub cap and said the thing. You want to have sex and eat ramen in bed, I’m your girl, but if you want to talk about this Langdon shit again, call a therapist. She’d been so proud of it. Clean incision. Minimal bleeding. She’d watched Trinity Santos’s face do absolutely nothing—that trick Santos had, that shutter coming down—and thought, good, that’s handled, and gone to scrub for a splenectomy.
It had not been handled.
What it had been was the last non-hostile sentence they’d exchanged.
Since then: Santos calling for a surgical consult in a voice like she was ordering a hit. Yolanda telling her, in front of two nurses and an intern, that a first-week med student could have gotten a better history. Santos paging her at 3:40 a.m. for something that was absolutely, unambiguously an ortho issue and then saying my mistake with her eyebrows. Yolanda finding reasons to send Ellis down instead. Santos finding reasons to be off the floor when Yolanda came down anyway.
Thirty-nine days of it. Nobody had said anything, because at PTMC nobody said anything about anything, they just watched you like a monitor and waited to see if you’d alarm.
Her pager went off against her hip.
TRAUMA 1—PENETRATING CHEST—ETA 4 MIN—GARCIA.
She went inside.
***
Trauma One was already loud when she pushed through the doors, and the loudest thing in it—of course—was Santos.
“—two stab wounds, left anterior chest, fourth and fifth intercostal, paramedics had him at ninety over palp, I want two units on the rapid infuser now and someone get me the ultrasound—”
“I’ve got it.” Whitaker, moving faster than he used to, hauling the machine on its cart. He’d gotten taller over the summer, or had started standing up straight. R1 did that to some people.
Santos glanced at the door and saw Yolanda, and something in her jaw went hard. “Surgery’s here. Great.”
“Report,” Yolanda said, gloving up.
“I just gave it.”
“To the room. Give it to me.”
A beat, exactly one, the length of a pulse. Then Santos rattled it off again, flat and fast and correct: twenty-six-year-old male, altercation outside a bar on Carson, two wounds, GCS fourteen and falling, tachy to 130, pressure soft, no breath sound deficit on the left, so probably not a big pneumo. Neck veins up. Heart sounds muffled.
Beck’s triad, Yolanda thought, at the exact moment Santos said, “Beck’s triad,” like she’d pulled it out of Yolanda’s mouth.
“Ultrasound.” Yolanda took the probe herself, slid it under the man’s xiphoid. On the screen, the heart swam into view—and around it, the black crescent that was never supposed to be there. Fluid. A lot of it. The right ventricle bowing inward with every diastole like a hand pushing on a balloon.
“Tamponade,” Santos said. “Effusion’s huge, RV’s collapsing—”
“I can see it.”
“So we drain it.”
“No.” Yolanda handed the probe back to Whitaker. “We go upstairs. Now. Call the OR, tell them I’m coming with an open chest, I want a median sternotomy tray and the perfusionist on standby—”
“He won’t make it upstairs.”
“He’ll make it if we stop talking and start moving—”
“His pressure’s eighty—”
“—and that pericardium is full of clot, Santos, not champagne. You stick a needle in there, and you’ll aspirate ten cc’s of nothing and then you’ll aspirate his right ventricle. He needs a window. He needs it done in a room where I can fix what’s under it. That’s the plan. Do you understand the plan?”
Santos’s eyes over her mask were very dark and very steady. “I understand you.”
“That wasn’t the question.”
“Pressure’s seventy-two,” Princess said quietly.
“Move,” Yolanda said. “Everybody. Go.”
They got him unhooked. They got the rails up. They got him three feet toward the door.
“I lost the pulse,” Santos said.
Everything in the room turned to look at the monitor. The rhythm was still there, narrow and fast and stubborn—electrical activity, the heart trying its best, squeezing nothing, because nothing could fill.
“PEA,” Whitaker said. “Starting compressions—”
“Compressions won’t do shit with a tamponade,” Santos said, and then she had the probe in one hand and an eighteen-gauge spinal needle in the other, and Yolanda didn’t even see where she’d gotten it from.
“Santos. Do not.”
“He’s dead if I don’t.”
“He’ll be dead if you—Santos—”
Santos put the probe back under the xiphoid. The image bloomed on the screen. She angled the needle toward the left shoulder, forty-five degrees, textbook, the exact way it looked in the diagrams and almost never looked in life, and she pushed.
Yolanda watched the tip of the needle enter the black crescent on the screen.
She watched it stop.
She watched Santos pull back on the syringe, and she watched dark blood—liquid, not clot, liquid, Christ—flood the barrel. Twenty cc. Forty. Santos swapped syringes without looking, one-handed, and pulled another forty.
“I have a pulse,” Princess said. “Carotid. It’s—I have a pulse.”
“Pressure’s coming up. Ninety. Ninety-four.”
The right ventricle on the screen had stopped collapsing. It was filling. It was doing its job.
Santos pulled the needle out and taped a piece of gauze over the hole with a hand that was not shaking at all. She looked up at Yolanda.
“Now he can make it upstairs,” she said.
Yolanda looked at her for exactly as long as she could afford to, which was one second, and then she said, “Whitaker. Bag him. We’re going,” and they went.
***
The wound in the right ventricle was the size of a fingertip. She closed it with pledgeted 3-0 Prolene while the heart beat under her hands, three horizontal mattress sutures, and the anesthesiologist said, “he’s looking good,” and she said, “I know,” and she did know, and it didn’t help.
She’d been right about the clot. There had been a clot—a fibrous plug of it, packed against the left side of the pericardium, exactly where she’d said it would be. If Santos had gone in one centimeter to the left, she’d have hit it and drawn nothing.
She’d gone in where the liquid was.
Yolanda tied the last knot and thought:
She’d have been right if she’d been wrong, and she’d have been wrong if she’d been right, and the only difference is that this man is alive.
She had to hold her hands still for a moment before she could ask for the sternal wires.
***
Al-Hashimi caught her in the hall outside the OR at 8:15 a.m., after handoff, after everything, when Yolanda had just wanted to get downstairs and find a wall to stand against.
“Heard about your tamponade.”
“Repaired. RV laceration. He’s in the CTICU. He’ll be fine.”
“Heard your R2 stuck him against advice.”
Yolanda kept her face flat. “Your R2.”
“Mm.” Al-Hashimi’s expression didn’t shift. It never did, really. She had a way of looking at people like she was reading a chart she’d already memorized. “Good call, on her part. Gutsy. Would have been a different conversation if she’d nicked the ventricle.” A pause. “Are we having a different conversation?”
“No.”
“Then we’re not.” She started to walk away and stopped. “Garcia. Whatever’s happening with you two—and I don’t want to know, and I mean that—keep it out of my trauma bays. That’s all.”
Yolanda said, “There’s nothing happening.”
Al-Hashimi looked at her a moment longer and said nothing, which was worse.
She found Santos in the staff bathroom on the second floor—the single-stall one by the old radiology reading room that nobody used because the light flickered, the one they’d used before, twice, back in the spring when before had still been a thing.
Santos was at the sink with her hands under the water. She’d taken her cap off. Her hair was flattened at the crown, and her scrubs had a dark bloom of someone else’s blood on the left hip. She looked up in the mirror and saw Yolanda in the doorway, and the shutter came down.
“Occupied.”
Yolanda stepped inside and locked the door.
“Oh, we’re doing this.” Santos shut off the water. “Great. Fantastic. Let me just—” She yanked paper towels from the dispenser and dried her hands with unnecessary force. “Go ahead. Tell me I’m a cowboy. Tell me I’m reckless. Tell me I don’t respect the chain of command—”
“You don’t.”
“He was dead, Garcia.”
“He was in PEA for thirty seconds.”
“He was dead with an effusion the size of my fist and a surgeon telling me to wheel him into an elevator—”
“Yes! A surgeon! That’s what I am! That’s the entire point of a consult, you call me down and then you listen to me—”
“I listened. I disagreed. I was right.”
“You were lucky.”
Santos rounded on her fully. “I was right. There was liquid blood in that sac, and I got it out and his ventricle filled and he got a pulse, and you went upstairs and sewed him up, and he’s going to walk out of here. Every single thing I said would happen, happened. You don’t get to call that luck because it embarrasses you.”
“Embarrasses—” Yolanda actually laughed, a short, ugly sound. “You think this is about my ego?”
“I think everything with you is about your ego.”
“There was a clot. Did you know that? A plug of it, left lateral pericardium, the size of a golf ball. One centimeter over and you’d have drawn air and lost forty seconds you didn’t have, and then you’d have gone deeper, because you always go deeper, and you’d have put an eighteen-gauge through the wall of his heart, and he’d have died on my table with your needle hole in him and your name on the chart.”
“But I didn’t.”
“You didn’t know that. That’s the point. You didn’t know, and you did it anyway because Trinity Santos is always sure, Trinity Santos never hesitates, and one of these days that’s going to kill someone, and it’s going to kill your career in the same breath. Al-Hashimi already has you on watch. You know that, right? You’re one write-up away from repeating R2, and you decided today was the day to ignore a direct instruction from the surgeon in the room—”
“Don’t.”
“—in front of an intern, in front of nurses—”
“Don’t you fucking dare stand there and pretend you care what happens to my career.”
The words hit like a slap. Yolanda felt her face go hot.
“Don’t pretend,” Santos said, and her voice had dropped, gone low and vicious, “that you give a single shit about me repeating R2, or what Al-Hashimi thinks, or whether I get written up. You made it real clear what you’re here for. Sex and ramen. Your words. Everything else is a therapist’s problem. So don’t stand in a bathroom and lecture me about my future like you have some stake in it. You don’t get to have it both ways.”
“That’s not—”
“You froze me out. You froze me out for a month, and now you want to be worried about me?” She laughed, and it was terrible. “Pick one. Either you don’t care, in which case get out of my way and let me wash the blood off, or you do, in which case you’re a fucking coward.”
Yolanda’s back was against the door. She hadn’t noticed moving. “Watch your mouth.”
“Or what.”
“Santos.”
“Or what, Garcia? You’ll write me up? Do it. You’ll ice me out? Already did. You’ll tell me I’m the problem, I don’t play well with others, everyone treats me like a pariah because I earned it? You’ve said that. You’ve said all of it.” Santos was in her space now, close enough that Yolanda could smell the iron under the hospital soap, could see that her pupils were huge in the flickering light. “There’s nothing left. You already used everything you had.”
“I haven’t used anything.”
“Then use it.”
Yolanda didn’t decide. Her hands were in the collar of Santos’s scrub top, and her mouth was on Santos’s mouth, and it wasn’t a kiss, not really. It was a collision, teeth and the copper taste where one of them split a lip. Santos made a sound in her throat like fury and grabbed two fistfuls of Yolanda’s shirt and shoved her harder into the door, and the handle dug into Yolanda’s spine, and she didn’t care, she didn’t care, she bit down on Santos’s lower lip and felt her flinch and press closer.
“Fuck you,” Santos said against her mouth.
“Fuck you.”
“That’s the plan.” Santos got a hand under the hem of Yolanda’s top, nails dragging up her ribs hard enough to leave marks. “Do you understand the plan?”
Yolanda turned them. It was graceless—Santos’s shoulder hit the paper towel dispenser, and it rattled—and then she had Santos backed against the sink, the edge of the porcelain against the small of her back, and she yanked the drawstring of Santos’s scrub pants loose with one pull. “Shut up.”
“Make me.”
She got her hand down the front of Santos’s pants, under the waistband of plain black underwear, and Santos was already wet—soaked, actually, hot and slick against Yolanda’s fingers—and she made a sound that wasn’t fury at all when Yolanda’s fingers found her. Her head fell back. Her hands scrabbled at the edge of the sink.
“That’s what I thought,” Yolanda said into her neck, and it came out cruel, and she meant it to. “A month of nothing and you’re like this in thirty seconds.”
“You’re one to—” Santos’s hips bucked. “—ah—one to talk—”
Yolanda pushed two fingers inside her, no ceremony, and Santos’s whole body clenched around her, and she swore, a filthy, breathless string of it, one hand coming up to grab the back of Yolanda’s neck hard enough to hurt. She dragged Yolanda’s mouth back to hers and kissed her like she was trying to win something.
It was fast, and it was mean. Yolanda fucked her with her fingers curled and her thumb grinding hard, no rhythm, no build, and Santos rode her hand and bit her shoulder through her scrub top and got a hand into Yolanda’s pants too, clumsy with the angle, her wrist bent wrong, and it didn’t matter, her fingers slid against Yolanda and Yolanda’s knees nearly went. The dispenser rattled. The faucet, jostled, dripped. The light overhead buzzed and flickered, and neither of them looked at anything but each other, close, too close, eyes open.
“You don’t get to do that to me,” Yolanda heard herself say. “You don’t get to—in my trauma bay—you don’t get to make me watch—”
“You made me watch,” Santos said, and her voice cracked, and Yolanda didn’t hear it, not yet. She was too far gone. “You made me watch you walk away—”
“Shut up—”
“—for a month—”
Yolanda shoved her top up and got her mouth on Santos’s breast through her sports bra, sucked hard, and Santos arched, and her hand faltered between Yolanda’s legs and then found her again, rougher, three fingers, and Yolanda groaned against her skin. Santos was tight and hot and clenching around her, close, Yolanda could feel it, the way her breath had gone jagged, and her thighs had started to shake. Yolanda pressed her thumb harder, faster, and looked up to watch her face because she wanted—she wanted to see it, wanted to see Trinity Santos lose, wanted—
Santos’s face was wet.
Yolanda’s hand stopped.
Not the sweat that beaded along her hairline, not the flush spread down her throat. Her eyes were closed, and her jaw was locked, and tears were running out from under her lashes, steady, silent, tracking down past her ears into her hair. She wasn’t making a sound. She wasn’t even breathing like someone who was crying. Her hips were still moving against Yolanda’s stilled hand, small, stubborn movements, chasing it, as if she could get through this too if she just didn’t stop.
She had been crying for a while. Yolanda understood that with a sick lurch. She had been crying for a while, and Yolanda had been too busy winning to notice.
“Trinity.”
Santos’s eyes stayed shut. “Don’t stop.”
“Trinity. Hey. Look at me.”
“Don’t—” Her voice broke in half. “Don’t stop, just—just finish it, just—”
Yolanda pulled her hand out of her, slow, careful, and Santos made a sound like she’d been hit. Yolanda took Santos’s wrist and gently drew her hand out of her own pants, and held it, and Santos let her, and then Santos’s whole body did a thing Yolanda had never seen it do, which was fold. Her shoulders came in. Her chin came down. She turned her face toward the wall, away from the mirror, away from Yolanda, and pressed the back of her free hand against her mouth, and stood there shaking against the sink with her scrub pants loose around her hips and cried without a sound.
Yolanda had done a thoracotomy on a fourteen-year-old once. Had cracked his chest in the ambulance bay in the snow. She had felt more equal to that than to this.
“Okay,” she said. Her own voice sounded strange. “Okay. Hey. Come here.”
“Don’t.”
“I’m not—I’m not going anywhere. I’m right here. Come here.”
She got Santos’s pants back up and tied the drawstring with hands that were not steady. She pulled Santos’s top down. She did these things the way she would do them for a patient, carefully and without commentary, and then she put both arms around Trinity Santos and pulled her in, and for a moment Santos was rigid as a board, and then something in her gave.
She didn’t crumple gracefully. She came down like a building. Her forehead hit Yolanda’s collarbone hard enough to bruise, and her fists twisted into the back of Yolanda’s top, and the sound that came out of her finally was awful, a cracked-open sob that she tried to swallow and couldn’t, and then another, and Yolanda held her up and held her still and thought, with perfect clarity:
I did this.
Not Langdon. Not Robby. Not the whole hostile building full of people who thought she was a snitch. Yolanda had watched all of that land on her, month after month, and thought, not my problem, and then when Santos had finally turned to her and said, help me carry this—because that’s what it had been, in that hallway, that’s all it had ever been—Yolanda had looked at her and said, call a therapist, and walked away.
And then spent thirty-nine days making sure she knew it.
“I’m sorry,” Yolanda said, into her hair. It felt like nothing. It felt like putting a Band-Aid on an arterial bleed. She said it again anyway. “I’m sorry. I’m so sorry. I’m—Jesus, Trin. I’m sorry.”
“You don’t—” Muffled, wet, furious. “You don’t get to—”
“I know.”
“You don’t get to be nice to me now—”
“I know. I know I don’t.” She got a hand into Santos’s flattened hair and held the back of her head, the way you’d hold something you’d almost dropped. “I’m going to anyway. You can hate me for it. Just—let me.”
Santos didn’t answer. But she didn’t pull away either. Her breathing came in pieces against Yolanda’s chest.
“You were right,” Yolanda said. “In there. You were right. There was liquid, and you found it, and you saved him, and I stood there, and I told you not to because—” She stopped. Made herself keep going, because she had a whole month of not keeping going to answer for. “Because I was scared. Not for him. For you. I saw you pick up that needle and all I could think was what happens to you if it goes wrong. What Al-Hashimi does. What that does to you, on top of everything else. And I couldn’t—I couldn’t stop it, I couldn’t get between you and it, and I hate that. I hate not being able to fix a thing. So I got mad. That’s—that’s what I do. You know that’s what I do.”
“You tore into me.” Santos’s voice was raw. “In front of Whitaker. In front of Princess.”
“I know.”
“Every time. For a month. Every time I called you down, you’d find some—some way to make me look—”
“I know.”
“Why?”
And there it was. The question she’d been standing in the ambulance bay in the soup-thick air avoiding for thirty-nine days.
Yolanda closed her eyes.
“Because you scared the shit out of me,” she said. “Not today. Before. You’d—you’d be in my bed, and we’d be eating, and you’d start talking about Langdon and Robby and how everyone looks at you, and I’d be lying there listening, and I’d realize I was—I wanted to fix it. I wanted to go find every one of them and fix it. And I don’t do that. I don’t get like that about people. I’ve never—” She had to stop. Swallow. “I told you to call a therapist because I couldn’t stand how much I wanted to be the one you called. That’s the truth. That’s the whole stupid truth. It wasn’t supposed to be like that with you, and it was, and instead of dealing with it like an adult, I just—I cut it off. Because I’m a coward. You were right about that too. And then I spent a month punishing you for making me feel something, which is—” Her laugh came out wrecked. “Which is fucking unforgivable, actually. So.”
Santos had gone very still against her.
“I’m not asking you to forgive me,” Yolanda said. “I’m just telling you why. You asked why. That’s why. I love you, and I handled it like a—”
She heard it a half-second after it left her mouth.
The bathroom was very quiet. The light buzzed. The faucet dripped once into the basin.
Santos lifted her head.
Her face was a disaster—red-eyed, blotched, her lip swollen where Yolanda had bitten it, a smear of Yolanda’s own blood at the corner of her mouth from the split. She looked at Yolanda like she’d just been handed a scan she didn’t know how to read.
“Say that again.”
“Trin—”
“Say it again.”
Yolanda held her gaze. It was the hardest thing she had ever done, and she had held a beating heart in her hands three hours ago.
“I love you,” she said. “I’m sorry. I love you. I think I have since—I don’t know. Since the Fourth, at least. Probably before. That’s why I said what I said. That’s why I’ve been such an unbelievable asshole. None of that makes it okay. But it’s true, and you deserve to at least know it’s true.”
Santos’s face did something complicated. Her mouth pressed flat, and her chin shook, and then it all just—went. Not the silent controlled crying from before. The other kind, the kind that didn’t care who heard it, and she put both hands over her face and bent forward, and Yolanda caught her, and this time Santos let herself be caught all the way. She sagged. Her knees went. Yolanda got them both down onto the floor of the bathroom, back against the wall under the sink, Santos half in her lap with her face pressed into Yolanda’s throat, and she just held on.
She held on for a long time. She didn’t know how long. Long enough that her legs went numb. Long enough that Santos’s sobs slowed and turned to hitches and then to just breathing, ragged and warm against her skin. Yolanda kept one hand moving on her back, up and down, up and down, the way you’d steady someone coming out of anesthesia. She said things—she didn’t know what, mostly. I’ve got you. I’m here. I’m not going anywhere. I’ve got you. She pressed her mouth to Santos’s temple and left it there.
“I hated you,” Santos said finally, thick and hoarse. “I really tried.”
“I know. You were good at it.”
“I wasn’t. That’s the problem.” She shifted, wiped her face on Yolanda’s shoulder with a total absence of dignity. “Every time you came down I’d think, okay, this time I’ll just—not feel anything. And then you’d open your mouth, and I’d want to kill you, and I’d want—” A wet, humiliated laugh. “God. I’d want you to come find me after. Like this. I kept thinking, she’ll come find me. And you never did.”
“I’m here now.”
“You’re here because I disobeyed you.”
“I’m here because I couldn’t stand it anymore,” Yolanda said. “The tamponade was an excuse. I’d have found one eventually. It’s—I’m not proud of the timeline.”
Santos was quiet for a bit. Then, so low Yolanda almost missed it: “I’m so tired, Yo.”
Nobody called her that. Santos had, once, half-asleep, in the spring, and Yolanda had pretended not to hear.
“I know,” she said, and tightened her arms. “I know you are.”
“It’s just—every day. Everyone. And I did the right thing, and I’m the one who—and he’s back, and he’s fine, and everyone’s fine with him, and Robby’s off on his fucking motorcycle finding himself and nobody—” She stopped. Breathed. “You were the only one who didn’t look at me like that. And then you did.”
“I’m never going to look at you like that again.” It came out like a vow, which was what it was. “I don’t care if it’s Langdon. I don’t care if it’s every day. You want to come over and eat ramen in my bed and talk about Langdon for three hours, then that’s—that’s what we’re doing. I’ll listen. I’ll take notes. I’ll—I’ll help you plot his demise, I don’t know, whatever you need.”
That got a real laugh out of her, shaky and startled. She lifted her head. Her eyes were swollen nearly shut.
“You hate the Langdon shit.”
“I hate that it hurts you. I don’t hate you for saying it. I got those confused. That’s on me.” Yolanda brushed a thumb under her eye, catching the wet there. “I’d rather hear about it than have you sitting on it alone. I’d rather hear about anything than another month of that.”
Santos looked at her a long moment. Then she leaned in and kissed her, and it was nothing like the last one—slow, sore, careful around the split in Yolanda’s lip. She tasted like salt. Yolanda kissed her back like she was handling something that would tear.
When they broke apart, Santos didn’t move away. Their foreheads stayed pressed together.
“You love me,” she said. Not a question. Testing the weight of it.
“Yeah.”
“You said it in a bathroom.”
“I’m aware.”
“With your hand—”
“Trinity.”
“Just for the record.” A pause. Her voice went small. “I do too. Obviously. I wouldn’t have—I wouldn’t have let it wreck me this bad if I didn’t.”
Yolanda closed her eyes. Something in her chest that had been clenched for thirty-nine days let go all at once, and it hurt, the way blood coming back into a limb hurts.
“Come home with me,” she said. “Right now. Not for—not for anything. I just want you there. I’ll make you the good ramen. The one with the egg. You can sleep for fourteen hours, and then you can yell at me some more, properly, with a whiteboard if you want. I’ll deserve all of it.”
“You have a whiteboard?”
“I’ll get one.”
Santos laughed again, and then hid her face in Yolanda’s neck again, and Yolanda felt her nod against her skin.
They stayed on the floor a while longer. The light flickered. Somewhere down the hall, a cart went by, and voices, and the ordinary noise of a hospital at nine in the morning not caring what happened in its bathrooms. Eventually Yolanda’s legs would demand to be moved, and they’d have to stand up and look at themselves in the mirror and do something about their faces before they walked out, and there would be Al-Hashimi and a chart and a follow-up on the man in the CTICU with three pledgeted sutures in his heart, and there would be tomorrow, and Langdon, and all of it.
But for now Trinity Santos was warm and heavy and finally, finally quiet in her arms, and Yolanda Garcia—who did not get like this about people—held on, and kept holding on, and did not let go.