Chapter Text
👣
Robby starts his morning the same way he has for decades — half-awake, groping for his glasses on the nightstand, blinking blearily at the glow of dawn leaking through the blinds.
The apartment feels cold and stale, the heat not yet kicking in for the day. His body feels heavy, as if someone has quietly filled his limbs with sand overnight. He moves with the slow, stiff shuffle of a man who’s worked too many twelve-hour shifts and sat through too many meetings on a cheap office chair. The floor is cool under his aching swollen feet as he pads toward the dresser, rubbing at the stubborn pain that blooms across his lower back. It’s that same deep, familiar soreness that comes from standing too long, lifting too many patients, twisting in awkward ways to reach monitors and ventilators — the occupational hazard of emergency medicine. He grimaces, rolling his shoulders, and tries to stretch it out, but the tension stays coiled there, radiating down to his hips.
He groans.
Robby flips on the light and stares into his dresser drawers with a growing sense of irritation. His top drawer is neat in theory — scrub sets folded in organized stacks — but none of them look forgiving enough. He pulls out a top, tugs it over his head, and immediately feels the hem snag on his massive gut. It clings across his belly, the fabric stretching taut enough that the seams cry in protest when he breathes out. It swiftly becomes a crop-top. “Fantastic,” He grunts, yanking it off again and tossing it aside. He grabs another set, then another, but each feels smaller than the last. He knows he’s gained weight — he’s been telling himself for months that he’ll start walking on his smoke breaks between Newports or at least stop eating the cookies left in the break room — but this morning the change feels sharper, heavier, as if his body has shifted overnight. His belly doesn’t just look big; it feels different.
He catches sight of himself in the full-length mirror across the room — tall, broad through the shoulders, but soft everywhere else, his arms still lean but his gut swelling forward like the letter B. The bottom part of his belly sits lower than he remembers, hanging almost pendulous, round and solid in a way that unsettles him. It’s dropped.
He presses his hand against it experimentally, as though to lift it up, and feels a strange firmness under his skin — not the yielding, cushiony kind of fat that has padded his middle for years, but something tighter. “G-d,” He whispers to the mirror. “You look like a hippo, Robinavitch.” His voice comes out flat and self-deprecating, more habit than humor. He rubs the heel of his hand into the small of his back, pressing deep into the pain that sits there like a boulder. Maybe it’s all connected — his ridiculous amount of weight gain, posture, and too many hours sitting at the hub. He’s been in medicine long enough to catalogue his own symptoms in differential form: lumbar strain, fluid retention, metabolic slowdown. Nothing mysterious, just middle age doing what it does. Still, the reflection in the mirror needles him. His belly strains forward, making the rest of him look shrunken by comparison — skinny wrists, knobby knees, limbs that don’t seem to belong to the same person as the beach ball torso they’re attached to.
Fuck.
The drawer thuds as he slams it shut.
He crouches down — grunting a little from the pressure it puts on his lower back — and digs through the bottom drawer where his oldest scrubs live, the ones he should have thrown out years ago. The fabric there is soft from hundreds of wash cycles, colors long since faded from black to a forgiving smoky gray. When he pulls them on, the waistband gives more than the newer sets, stretching without complaint to accommodate his size. The top hangs loosely enough to drape over the substantial curve of his belly, and for the first time this morning, he can breathe without feeling the tug of elastic cutting into him.
Still, the motion of bending to tie his shoes sends a sharp twinge across his lumbar spine. He winces and presses a palm there again until it settles. “I really need to go to the gym,” He groans under his breath, not for the first time. He’s said it every week for a year, but somehow there’s always another shift, another administrative meeting, another resident to mentor, another reason to push his own body to the periphery of his attention.
He leans on the edge of the bed, catching his breath. His stethoscope hangs from the closet door like a silent accusation — a symbol of everything he takes care of except himself. He pinches the bridge of his nose, blinking hard as his eyes start to sting. Maybe it’s the exhaustion, maybe the hormonal irregularities that have made his body unpredictable for years. He sniffles once, roughly, scrubbing at his face with both hands, then drags a sleeve across his eyes like a man too tired to care about appearances. There’s a lump of guilt and frustration somewhere deep in his chest that won’t quite go away — the slow, growing awareness that something about him has changed in ways he can’t control or explain. He’s sick, he just knows it.
But he doesn’t have time to be sick.
The clock on Jack’s nightstand glares at him in uncompromising red digits: 05:27. He’s going to be late. Jack will be waiting for him to take over the board. He can picture it vividly — Jack’s gray curls damp with sweat, the soft rasp of his voice giving sign-out reports while the desk phone vibrates on the counter. The thought stirs something tender in Robby, enough to push him into motion again. He forces himself upright, shoulders aching, belly heavy, and runs a hand through his salt-and-pepper hair. The mirror catches him again as he reaches for his stethoscope, and he almost laughs at the sight — Chief of the ED, who can intubate in under a minute and manage three codes at once, and yet can’t manage to keep his weight in check. He sighs, low and tired. “Fatass,” He grimly tells his reflection, then grabs his winter coat and heads for the door.
His walk to PTMC is usually his small act of self-discipline, the only real exercise he can claim anymore. It’s five minutes if he cuts straight through the park — ten if he lingers long enough to finish his travel mug of coffee. He tucks his hands into the pockets of his coat and starts down the familiar path, the one lined with benches and the occasional jogger, PTMC already visible between the trees.
Today, though, the short walk feels endless.
His body protests each step, a deep, spreading ache that moves through his back, hips, and even his thighs. By the time he reaches the midway point — the old oak that leans toward the fountain — his breath is shallow, and a fine sheen of sweat dampens the back of his neck despite the cool air. He lowers himself onto a bench, wheezing as the weight finally comes off his feet. His lower back pulses with heat, and he rolls his shoulders, trying to ease the stiffness. The world around him hums with early-morning life — dogs barking, bike tires on gravel, the distant wail of an ambulance siren — but all he can focus on is how utterly tired he feels.
He sits for a minute, then another, waiting for his heart rate to settle.
When he leans forward to catch his breath, his coat rides up, the hem of his scrub top rolling just enough that he catches sight of his own belly in the pale light.
Through the thick dark hair on his gut, he notices something new — a faint, straight line running from just below his sternum down toward his waistband, darker than the surrounding skin. He blinks, thinking it’s a shadow, but when he brushes his fingers over it, it stays. A narrow stripe, clean and definite, right down the middle of his belly.
“What the hell…” He murmurs. He leans over, squinting. It looks like a linea nigra, the kind he’s seen countless times on obstetric patients when they lift their gowns for exams. A pregnancy line. The idea is so absurd it jolts a laugh out of him, breathless and incredulous. “Yeah, right. Sure,” He says aloud, cruelly, shaking his head. “You’re a fifty-four-year-old infertile fat guy, Robinavitch.” He sits back, tugging his shirt down over his belly again, trying to ignore the prickle of tears in his eyes. He tried, they tried for so long, for the better part of a decade even. His body just can’t.
He’s seen that sort of pigmentation in patients with hormonal shifts, thyroid changes, adrenal issues — half a dozen benign causes. He’s probably just producing too much melanin in one spot, or maybe it’s nothing at all, just skin tone and poor lighting conspiring to mess with his head. Still, he can’t shake the image of that line, arrow-straight and deliberate against his skin. It lingers in his mind as he forces himself up from the bench, back twinging, knees popping in complaint.
He keeps walking, slower now, one hand unconsciously lifting his lower belly, where the ache has settled into a heavy, dragging throb.
By the time he reaches the sliding doors of the hospital and makes a beeline for the stairs, his breath is uneven again.
Jack spots him the instant he steps through the ED doors. It’s a kind of radar they’ve developed over the years — the way each can find the other across the chaos of triage alarms and overhead calls. The night shift is just winding down, the bright clinical noise of morning handoff already rising. Jack stands near the hub, stethoscope looped around his neck, posture loose but eyes sharp. The circles under his eyes are deep, but when he sees Robby, the fatigue gives way to worry almost instantly.
“Morning,” Robby tries, his voice coming out rougher than he’d like, his coat half unbuttoned, his cheeks flushed from the walk. He wants to stride up with the kind of authority that belongs to the Chief of the ED, but he feels lumbering, slow, heavy in his own skin.
Jack doesn’t return the greeting. He takes one look at Robby’s face — at the sheen of sweat along his temples, the way he’s holding his back too stiffly — and his expression changes from tired amusement to something closer to alarm. He closes the chart he’s been reviewing and walks around the desk, wiping his palms on his scrub pants as he goes. “What’s going on?” He asks quietly, coming to stand right in front of Robby. “You look like hell.”
Robby opens his mouth to deflect, to mumble something about bad sleep or back pain, but Jack’s already there, crowding into his space in that familiar, unembarrassed way he has when he’s worried. His hands find Robby’s hips, thumbs pressing just inside the waistband, fingers digging carefully but firmly into the muscles of his lower back. The touch is both grounding and unbearable. Robby inhales sharply as Jack’s thumbs hit a knot of tension that makes his vision pulse for a second. He groans before he can stop himself, head dropping forward.
“Fuck,” Jack hisses under his breath, frowning. “This is rock solid, baby. You’re clenching like you’ve been hit by a bus.” His tone is part professional assessment, part marital scolding. He leans in a little closer, “Go home, Rob. You shouldn’t be working today anyway.”
Robby shakes his head, slow and stubborn. “I’m fine,” He bites out. “I took some Tylenol.”
Jack gives him a flat look — that unimpressed, clinician’s stare he’s perfected over decades of triage and spousal caregiving alike. “Tylenol,” he repeats, dry as sandpaper. “That’s your whole plan? You’re sweating through your scrubs, you can barely stand up straight, and you think a couple of Tylenol are going to fix it?”
Robby shrugs, trying for humor that doesn’t come. “It’s working fine enough to get me through the day.”
Jack huffs through his nose, clearly fighting the urge to argue in the middle of the ED. “You can barely walk.” He says under his breath. His thumbs press once more into the hard ridge of muscle above Robby’s pelvis, and the way Robby flinches tells him more than any words could. Jack steps back a little, studying him the way he would a patient. His gaze tracks from Robby’s flushed face to his distended belly — the way the scrub top clings around it — and something like recognition flickers there, though he doesn’t voice it yet. “You’ve been off for weeks,” He adds quietly. “Not sleeping, not eating right. This isn’t just soreness, Robby. You need an eval.”
Robby waves his hand dismissively. “It’s nothing, Yankl,” He sighs. “I’ll stretch, hydrate. I’ll be fine once I get moving.”
Jack’s jaw tightens. “You said the same thing last month when you couldn’t get your ring off because your hands were so swollen. You know better. You’d never let one of your residents walk into a shift looking like this.”
That hits its mark. Robby glances away. “Don’t. Please. Not right now. Let me get through the shift, okay?”
Jack looks at him for a long moment, his expression torn between exasperation and tenderness. He reaches up and cups the back of Robby’s neck briefly, thumb tracing along the warm skin there. “Stubborn sonuvabitch,” He scowls.
Robby huffs out something like a laugh, though it sounds closer to a sigh. “You married me knowing that.”
“Yeah,” Jack grins wryly. “Every day I question my judgment.” He steps back, reluctantly, and gestures toward the empty workstation. “Fine. Sit down at least. If you’re going to ignore medical advice, you’re doing it off your feet.”
Robby nods, easing himself onto the chair with another quiet groan. Jack stays standing beside him, still frowning, arms crossed. He doesn’t say anything more, but the message is clear.
He straightens the minute Jack is out of sight, forcing himself to focus. The ache in his back is still a live wire under the surface, but for now, he’s holding it together.
👣
The last wave of the PittFest shooting victims is a convoy of ambulances stacked three deep at the bay doors.
Robby hasn’t stopped moving since it began. His badge has migrated sideways on his chest, his scrubs are damp at the back, and his lower spine feels like it’s being pried apart one vertebra at a time. He keeps telling himself it’s a pulled muscle, dehydration, maybe a urinary tract infection — something irritating but benign. He’s been peeing constantly all day, every half hour at least, and the pressure in his pelvis makes him want to lean forward just to relieve it. He tells himself it’s from holding his bladder too long during the rush, maybe irritation from the near-constant caffeine, the stress hormones, his smoking, the sheer exertion.
He knows how a UTI presents: dysuria, frequency, and suprapubic pain. He can tick off the symptoms in his head, textbook-perfect, except they don’t quite match. The ache isn’t sharp or burning. It’s deeper, dull, rhythmic — something he can’t quite categorize. Every so often it pulses into his lower abdomen and radiates outward in a slow wave. He presses his palm against the top of his scrub waistband as if he can hold himself together by force of will.
The noise around him is relentless. Jack came back in, but they’ve barely seen each other beyond quick glances across trauma bays, each too busy to stop. But once, between patients, Robby caught Jack watching him with that same worried crease between his eyebrows, the one that says I know you’re not okay. Robby ignored it, because there’s no room for personal weakness in an ocean of red bracelets.
Now, the halls have begun to quiet. The acute saves are done; the losses are being counted. Overflow patients are being stabilized in radiology, outpatient surgery. The cafeteria has turned into a waiting area for families, the very walls heavy with grief. Robby keeps working on autopilot, checking vitals, cleaning blood from his hands until the skin between his fingers stings. But underneath the routine, something in his body is unraveling. His belly is tight, distended even further; every movement sends a pulse of pain through his core. He catches himself gripping counters for balance, waiting for each wave of discomfort to subside before moving again.
At one point, he bends to check a patient’s airway and nearly blacks out from the pressure that floods his pelvis. When he straightens, the room tilts, and something in him falls into a new position. He steadies himself on the bedrail, blinking hard until the edges of his vision stop shimmering. “You good?” Perlah asks, passing by.
“Fine,” He barks automatically, throat dry. “I just need water.”
His body feels hollowed out, his brain running on fumes and cortisol. Jack’s somewhere down the hall managing transfers; Robby catches a glimpse of him talking to Walsh, face drawn but calm. The sight of him — competent, calm in the wreckage — gives Robby just enough courage to move again. He climbs the stairs to Peds, where the overflow morgue has been set up. It’s quiet there, mercifully dim. The small, bright murals of cartoon animals on the walls look surreal in the half-light, cheerful faces staring over rows of covered gurneys. He walks past the closed doors and stops near the end of the hall, bracing one hand against the wall as the ache in his abdomen intensifies again.
It’s not sharp pain now; it’s an oppressive, dragging weight that fills his pelvis and lower belly, radiating into his spine. He knows the pattern of this kind of pain — visceral, cyclic, diffuse — but he can’t make it fit any differential that makes sense. Appendicitis? No, wrong quadrant. Diverticulitis? No fever, no tenderness pattern. Renal colic? Too central, too constant. He presses the heel of his hand just above his pubic bone and feels the strange firmness beneath it, not quite muscle, not quite swelling.
He’s a physician; his mind catalogues possibilities even as he trembles with exhaustion. Urinary retention from infection or obstruction. A bladder wall issue. Maybe his testosterone gel absorption is off, throwing his system out of balance. But a part of him, the quiet, frightened part he’s ignored for weeks, whispers another possibility — one so biologically absurd he refuses to say it, even in his own head.
He sits down on the floor, half-falling on his ass, and drops his head into his hands. His pulse hammers in his ears. His own body feels foreign to him: heavy, uncooperative, unpredictable. He’s supposed to be the one who knows what’s happening, who can name every sign and symptom, who finds logic in chaos. His breath comes fast and shallow. Every inch of him is slick with sweat. The pain that’s been circling his pelvis for hours has reached a breaking point — no longer the dull pressure of fatigue or infection, but something bearing down, rhythmic and commanding.
His hands tremble as he fumbles for the gold chain around his neck. The small Star of David feels cool against his skin. He presses it between his palms and closes his eyes, murmuring the Shema through clenched teeth. The words are instinctive, ancient — Hear, O Israel… — a way to center himself, to find order in the incomprehensible. “This is a panic response,” He tells himself between breaths. “Psychosomatic. Cortisol spike. Adrenal overload.” His brain keeps trying to fit the data into something rational, something that belongs in a textbook and not in his own body. But the next surge of pressure hits him like a wave breaking from the inside out, and his reasoning shatters. His pants are dripping wet. His belly hardens beneath his hands, and somewhere deep in his core, something primal takes over — a command his body obeys before his mind can catch up. Push.
It’s the strangest, most alien sensation he’s ever felt — not pain exactly, but force. He gasps, one hand gripping the edge of a cabinet, the other still clutching his necklace. His brain is running differential diagnoses at high speed, discarding each one faster than he can name it. Bowel obstruction. No. Pelvic mass. No. Neurologic event. No. Every explanation collapses under the weight of the impossible truth that’s taking shape in his periphery.
“Oh… oh, shit,” He whispers, eyes wide, shoving his pants and underwear down his thighs because he has to catch soon. The logic he’s clung to for thirty years, all the biology he’s taught and practiced, crashes into something his body knows that his mind refuses to accept. His breathing turns shallow, his vision tunneling. He takes inventory, the way he would with any patient in crisis: airway intact, breathing rapid, pulse thready but strong. Pain scale? Unmeasurable. Mental status? Disoriented, overwhelmed, but aware. He’s operating now on the same autopilot that’s carried him through every resuscitation he’s ever run — clinical detachment layered over panic. His training takes over because that’s what keeps him alive.
He braces himself on his elbows and draws in a long breath through his nose, forcing his diaphragm to expand, forcing control back into his body. “Okay,” He coaches aloud. “Stay present. Assess. Prioritize.” It’s the voice he uses in trauma bays, calm and directive. He leans forward as another involuntary contraction seizes him, the pain blooming and fading like lightning under his skin. Fuck it hurts.
Somewhere in the back of his mind, he hears his own voice from earlier in the day — You’re just tired, you need water, it’s nothing — and the absurdity of it almost makes him laugh. He wants to call for help, to reach for his phone, but the next wave leaves him breathless. His body knows what to do even as his mind protests that it shouldn’t be possible. When the next contraction comes, he stops fighting it. His body bears down on instinct, muscles engaging with mechanical precision. He hears himself make a raw, startled sound and clamps his jaw shut, riding it out with both hands braced on his thighs. The wave passes. He’s panting, shaking, but alert. Some deep, stubborn part of him registers that he’s crossed a threshold. Whatever is happening, it’s happening now, and he has no choice but to follow through.
He whispers the Shema again, quieter this time. His eyes sting. The room blurs around him sickeningly. The clinical part of him — the part that knows vitals, stages, physiology — starts making a plan even as another voice inside whispers that none of this should be possible. He can’t have babies, they tried so hard. He doesn’t let himself think about that. He just breathes, times each wave, and does what he’s trained his entire career to do.
The next contraction feels worse than all the rest, like the ring of fire. His body is trembling, his breath shuddering in and out, the ringing in his ears almost deafening. He roars, bearing down with all his might. The silence breaks with a small, wet cry as a little body tumbles into his hands with a bloody gush. His eyes fly open. He scoops his newborn up with both arms, pressing her small body instinctively against his chest for warmth. Her baby’s skin is slick, flushed an alarming shade that’s already changing, the color deepening toward pink as the crying strengthens.
His own shock recedes behind the wall of training. He doesn’t let himself feel. He just assesses.
“Airway patent,” He whimpers aloud. “Strong cry. Spontaneous movement.” He tilts his baby girl slightly against his forearm, clears her mouth and nose as best he can with a corner of his undershirt, and keeps talking — the way he does in every delivery, narrating each step for himself and for whoever might be listening. “Heart rate… above one-fifty. Respirations good. Tone good.” His voice shakes on the word, but he continues. “Color improving. Reflexes intact.”
He runs through the APGARs from muscle memory: Appearance — pink, 2. Pulse — over 100, 2. Grimace — responsive, 2. Activity — flexing, 2. Respiration — crying, 2. Ten. Perfect. She’s perfect. She has red hair. Red hair like Jack. His mind acknowledges the APGARs number but refuses to make meaning of it. He focuses on his baby’s chest rising and falling, on the small warmth seeping into the crook of his arm. He presses his newborn closer, his own heart hammering so loudly it fills the space where his thoughts should be. “Good,” He warbles. “You’re okay. You’re okay.”
He glances around automatically, scanning for a towel, a blanket — anything sterile. There’s a stack of pediatric sheets nearby, thin cotton printed with cartoon whales. He grabs one, wraps his baby carefully, and tucks the edges tight. His baby quiets, eyes fluttering open to reveal a light blue, unfocused gaze. So beautiful. Robby feels something in his chest twist so sharply it’s almost in pain again. He keeps his attention on his infant, because the alternative — looking down at himself, at the scene around him, at the implications of what just happened — is too much. His entire being narrows to the steady, minute-by-minute work of stabilization. Assess warmth. Maintain airway. Ensure bonding. She needs him.
“Strong tone,” He slurs again, just to hear the sound of his own voice, to keep himself tethered to the clinical rhythm. “Normal reflexes. Good respiratory effort. Good.”
He adjusts his hold so his baby’s head rests under his chin, her small heartbeat thudding against his rounded chest, full of milk. Fuck, how didn’t he realize?
Robby stares at the mural of cartoon foxes, his eyes unfocused, his face pale with shock. He can’t think about what this means, how this could have happened, what comes next. All he can do is hold his baby girl close and keep her breathing, because that part he knows how to do. That part is simple. Everything else, not so much.
👣
Dennis heads right for the supply cart in the makeshift morgue, double-checking his list. He reads it under his breath — “two 18-gauge catheters, suture packs, saline flushes, sterile drapes…” He turns and freezes.
Dr. Robby is sitting on the tile floor, staring at him, back against a storage cabinet, black scrubs drenched in blood and amniotic fluid. His arms are cradling a newborn, slick, pink, alive. The umbilical cord still connects them. Dennis’ brain refuses to process the image for a beat too long. His first thought is that there must have been a delivery upstairs, and Robby found the baby here — but no, the cord runs straight to him. It’s attached to a spot Dennis can’t see. Then the clinical know-how in his head, slams into place: Term neonate, spontaneous respirations, attached cord, maternal collapse. Dennis drops to his knees beside them. “Dr. Robby, sir, are you hurt?” His voice cracks. The baby lets out a thin, wavering cry, tiny arms flailing. The sound cuts through the stunned quiet, shrill and perfect.
Robby’s voice is faint, ragged from exhaustion. “She’s okay. She’s — I’m sorry, I didn’t know this could happen. I thought—” He doesn’t finish. His head lolls slightly; sweat beads along his hairline, skin pale to gray. Dennis feels for a carotid pulse — weak, rapid. He glances at the blood pooling beneath them, dark on the tile, too much to ignore. Postpartum hemorrhage. Retained placenta until proven otherwise.
He forces his voice steady. “You did great, sir. She’s breathing. She looks so good.” His hands move automatically: rub the infant dry with the cleanest part of a drape, stimulate the skin, check tone and color. Her cry strengthens. Term female, vigorous, no cyanosis. He mentally assigns Apgars: 9 or 10. He grabs two Kelly clamps from the cart, clamps the cord about three inches from the baby’s navel, and again near Robby’s end. He cuts between with sterile scissors, the cord snapping with a soft pop. The baby wails in protest — reassuring, normal, alive. Dennis wraps her in a warm blanket from a heating pad box and sets her on a clean field nearby.
Then his focus shifts fully to Robby.
“Okay, we’ve got to get you stable,” He says quietly. Robby blinks, eyes unfocused. Capillary refill: delayed. Pulse: thready, maybe 130. Hypovolemic until proven otherwise. The placenta hasn’t delivered, and blood still seeps steadily between Robby’s legs. Dennis’ thoughts spiral for half a second — You’re an MS4, you can’t do this alone — then clamp shut. You’re the only one here. He tears open an IV start kit, slides an 18-gauge catheter into the antecubital vein. Flash of blood, good. Secures it, flushes with saline. He hooks up the nearest bag — normal saline, wide open — then digs for oxytocin. By some miracle, there’s a vial left over from OB consults. He draws up ten units, injects them into the saline bag, and hangs it from a cabinet handle, squeezing it for a fast flow.
“Stay with me, Dr. Robby,” He coaches. “You’re doing great, just a little longer and you can hold your baby girl.”
Robby gives a weak, almost dazed smile. “Didn’t… think I’d ever get to say I delivered my own kid.”
Dennis manages a shaky laugh. “You did all the work, sir.” His hand moves to palpate Robby’s belly. The fundus feels soft, doughy — boggy. He applies a steady, firm massage. The uterus contracts under his palm, and a gush of clotted blood follows. He keeps massaging, rhythmic, methodical, as if he can push his own fear out through his hands. Stimulate contraction. Control the bleed. Don’t freeze now. The placenta still hasn’t delivered. He checks the cord — slight traction meets resistance. Incomplete separation. He knows enough not to pull. Keeps the massage going, steady, circular, until the uterus firms further. “Sir, you might feel pressure,” He warns gently, still working.
“Feels… like labor all over again,” Robby moans, grimacing.
“Yeah, that’s the oxytocin and me being annoying. You’re doing amazing.” Minutes drag by, Dennis keeps one hand on the fundus, the other maintaining cord traction when appropriate. Then, finally, a shudder runs through Robby’s body — a reflexive contraction — and the placenta slips free with a soft, wet splat on the tile. Dennis scoops it up, spreading it on a drape. He examines it quickly, clinically: cotyledons complete, membranes intact. No retained tissue. Relief hits so hard he feels dizzy. He reassesses: fundus firm at the level of the umbilicus, bleeding now minimal. Robby’s color improves from gray to chalky pink. “Placenta’s out. Bleeding’s slowing,” Dennis reports, as though a team were listening. His voice steadies by pretending there’s backup.
Robby closes his eyes, breathing evenly for the first time. “You’ve got good hands, Whitaker.”
Dennis exhales a laugh that’s half-sob. “You’re not allowed to compliment me right now, sir. You’re supposed to let me panic quietly.”
He checks the newborn girl again — breathing regular, heart rate fast but strong. He dries her tiny feet again, feeling absurdly protective. Apgar ten, stable.
He scoops her up and lays her back on Robby’s chest. “I’m gonna try and get us some help.”
👣
“Come on,” Dennis chants, pressing redial. “Someone pick up, please—” But the hospital’s completely shuffled around after the MCI. Behind him, there’s movement — a rustle of scrubs, the squeak of a shoe on tile. He turns, and his heart lurches. Dr. Robby is trying to stand. One hand still clutching his belly, the other braced weakly against the cabinet. His movements are sluggish, uncoordinated. “No, no, no, no! Hey, don’t, don’t move, sir.” Dennis crosses the few feet between them immediately. He grabs Robby’s shoulder, steady but firm. “You’re going to sit down right now.”
Robby blinks at him, pupils blown wide, face washed out. “I can’t — I need Jack.”
“I will get him for you,” Dennis insists, voice sharper than he means. He forces it softer. “But not if you pass out on me.” He feels the tremor in Robby’s muscles — exhaustion, shock, blood loss. The saline bag is still dripping fast, half-empty now. He guides Robby carefully back to the floor, leaning him against the wall. Robby’s breath hitches; his hands shake as he presses one palm against his own swollen belly, the other instinctively cradling his baby girl, wrapped in warm blankets. Dennis kneels beside him, trying to keep his tone clinical to hide the quake in his chest. “Okay, deep breaths for me. You’re pale as a ghost. Let’s just stay still, all right?”
Robby manages a weak grin. “Stop panicking, Whitaker.”
If I’m talking, I’m not panicking, Dennis thinks, but his hands betray him — trembling as he checks a radial pulse again. Still tachycardic. Systolic probably in the 90s, if that. “Yeah, well,” Dennis wavers, rechecking the fundus. Still firm, midline. Bleeding minimal. “If you code on me, I’m never getting an attending letter out of you.”
Robby’s laugh sounds wrong. “Fair.” Baby girl stirs at the sound — a soft, hiccupy cry — and Dennis checks, respiration unlabored, color healthy. He tucks the blanket more snugly around her in Robby’s arms. His heart hammers in his throat. He’s running contingency scenarios in his head: if no one comes, what next? He can’t leave Robby alone to fetch help; he can’t carry both. Okay. Prioritize. Airway, breathing, circulation — all stable enough. Uterus firm. Fluid running. Monitor for rebound bleeding. He grabs a new liter bag of saline, spikes it, switches over the line, and keeps it running fast. Then, because he can’t stop his brain, he starts whispering his plan aloud — a habit from simulation labs: “Estimated blood loss seven hundred, placenta complete, fundal tone good, continue oxytocin, monitor vitals, keep patient supine.” His voice steadies as the words come. “If hypotensive, bolus next liter, call for O-negative transfusion.”
“Excellent.” Robby watches him through half-lidded eyes, too tired to smile fully. “You sound like you’ve done this before.”
Dennis looks at him, equal parts awe and disbelief. “I’ve never done any of this before. I was just here for suture kits.”
Robby chuckles faintly, then winces, pressing his side. Dennis steadies him again. “Hey. None of that. You lose consciousness and I’ll intubate you myself.”
Dennis feels sweat trickling down his spine, his scrubs plastered to his knees from kneeling in blood and fluid. His brain keeps cataloging vitals, watching color, measuring respirations like he’s holding the world in place with data alone. When he dares to check the clock, it’s only been twelve minutes since he first walked in. Feels like an hour. He looks at Robby again — color slightly better, though his face remains chalky under the freckles. Dennis takes a deep breath. “Okay, I’m gonna try again, all right? Don’t move.”
“I’ll behave,” Robby mumbles, closing his eyes again.
Dennis picks up the phone, redials. Still nothing. He swears under his breath, checks his pockets for his phone — dead battery, because of course it is and the halls are devoid of anyone he can see. He glances at the newborn, then back at his attending. I can’t leave them. His brain is screaming don’t leave them. He kneels again, one hand automatically checking the uterine fundus again, the other stabilizing the IV line. “Okay,” He whispers more to himself than anyone. “We just… wait for backup. You’ve got fluids. Fundus is firm. Baby’s stable. You’re stable. We just wait.”
Robby opens his eyes again, heavy-lidded, studying him with the faintest smile. “You’re doing good, Whitaker.”
Dennis swallows, jaw tight. “Trying to.”
In his head, he’s still running through possible complications — secondary atony, delayed PPH, infection, neonatal hypothermia — but he pushes it back down. For now, both his patients are alive, breathing, present. He stays kneeling beside them, one hand never leaving that firm uterine ridge, the other keeping the saline flowing. That’s when he notices the change. Robby’s brow furrows. His hand moves instinctively, pressing against his lower belly just above the umbilicus. The gesture is so small that Dennis almost misses it — until the muscles in Robby’s forearm tense, and his breath catches sharply through his teeth. Every alarm in Dennis’s brain fires at once. Pain. Uterine tenderness. Possible re-bleed. Retained fragment? Infection? Uterine rupture? His pulse jumps to match Robby’s.
He leans forward, voice suddenly urgent. “Dr. Robby, is it hurting? Are you in pain?”
Robby’s eyes crack open, heavy-lidded and exasperated in a way that somehow still feels like him. “Yes, Whitaker,” He says, voice dry, frayed but unmistakably sarcastic. “I just had a baby.”
For a split second, Dennis actually laughs — too loud, too startled. They’re sitting on the floor of a makeshift morgue, under flickering fluorescent light, surrounded by bodies, sterile drapes, and supply bins, and his attending is cracking jokes through postpartum pain. He shakes his head, forcing a steadier tone. “Okay, yeah, fair point, sir, just making sure it’s the expected kind of pain, not the internal-bleeding kind.”
Robby exhales, a chuckle escaping before he winces again. “Feels like contractions. Cramps.”
Dennis nods, mind switching back into checklist mode to keep from spiraling. Postpartum afterpains. Normal uterine involution. Oxytocin at work. Keep monitoring tone. He gently palpates yet again — firm fundus, no rebound tenderness, no new bleeding. “It’s the uterus clamping down,” He decides softly, trying to sound calm, professorly, as if reminding himself of the physiology might keep him from shaking. “That’s good, means it’s doing its job.”
Robby hums, eyes closing again. “Then I’ll stop complaining.”
“Please don’t,” Dennis begs, almost reflexively. “If you stop talking, I’ll assume you coded.”
That earns another weak laugh. “You’re learning.”
Dennis presses gauze over a small trickle at the perineum — just oozing, no arterial spurting — and swaps out the soaked pad beneath Dr. Robby for a dry one. His movements are practiced now. But inside, he’s still reeling. His every heartbeat feels too loud. His brain keeps repeating, Dr. Robby just had a baby. He just had a baby. My attending just had a baby. He keeps his tone level anyway. “Pain on a scale of one to ten?”
“Six,” Robby says after a pause. “Maybe seven if you keep pressing.”
Dennis actually smiles this time, just barely. “Noted. Uterus firm, lochia moderate, patient sarcastic. That’s reassuring.”
Robby opens one eye. “Write that in my chart, Jack’ll love it.”
“I will, sir. Right under miraculous spontaneous term delivery in the makeshift morgue.” That draws the faintest grin from Robby before he exhales, sinking back against the wall. The color in his face looks better now — still pale, but less waxen. The bleeding has slowed to a steady trickle. The oxytocin drip is nearly through its bag. In the stillness, Robby speaks again, voice softer, almost wonderstruck. “She’s really okay?”
Dennis glances at the newborn in Robby’s arms, bundled tight, chest rising and falling in a steady rhythm. “She’s perfect,” He reassures. “Strong cry, pink, great tone. You did everything right.”
“Didn’t think I’d ever—” Robby swallows. “After all those years trying… I thought it wasn’t possible.”
Dennis doesn’t know what to say to that. He just nods.
The baby starts to fuss, tiny hands flexing in the blanket, mouth rooting instinctively against the air. Dennis glances between the newborn and Robby, pulse climbing again. The baby’s color is good — pink, well perfused — but she’s restless, searching. Robby is too tired to move.
“She’s probably hungry,” Dennis points out, more to fill the quiet than anything.
Robby’s eyes flicker open. He looks dazed, drained, but nods. “She’s trying to nurse. Help?”
Dennis automatically moves into motion — supportive, practical. He shifts the blanket aside, guides the newborn close, watching for rooting reflex, for that perfect alignment of head, neck, and chest. His voice steadies into the calm rhythm he’s practiced a hundred times in neonatal rotations. “Okay, chin up a little, nose to skin, let him find it.” It takes three tries. Each time, baby girl Robinavitch mouths clumsily, sliding off, crying in frustration. Dennis feels the tension winding in his chest; his hands are steady, but his mind is screaming. He adjusts again, supporting the tiny head, helping adjust Robby’s breast, whispering encouragement more for himself than the infant. Then, finally — a soft seal, rhythmic sucking, the faintest swallow. The baby relaxes, shoulders softening, the cry dissolving into small breaths.
Both of them — Dennis and Robby — exhale at the same moment. Robby actually smiles, small and victorious, something alive returning to his eyes. Dennis finds himself grinning back, against every rule of composure. “There you go, little lady,” He whispers, voice hoarse. “You figured it out.” He allows himself one heartbeat of relief before instinct drags his gaze back to the other patient in front of him; that’s when he sees it — how pale Robby’s become. The color that had begun to return a few minutes ago is gone again. His lips have blanched, the skin around his eyes gone gray-blue under the fluorescent light. The pulse visible at his temple is fast, thready.
Dennis’s chest goes tight. Oh shit. Oh shit oh shit oh shit.
“Sir?” His voice pitches up, thin with adrenaline. He leans forward, pressing two fingers to the radial artery — weak, rapid. “Dr. Robby, how’re you feeling?”
Robby blinks sluggishly. “Lightheaded.”
“Okay. Okay.” Dennis’s voice steadies by sheer will. He glances at the IV — bag nearly empty. “I’m gonna hang another liter, all right? Just stay right here, don’t move, keep the baby right there, you’re doing great.” He scrambles for another saline bag, spikes it with shaking hands, and flushes the line. Fluid resuscitation, stat. Monitor mental status. Reassess fundal tone. Get help, get help somehow. He keeps talking as he works, partly to reassure, partly to anchor himself. “You’re doing fine, sir, I’ve got you. You lost a lot of blood, so we’re catching up, all right?”
Robby hums faintly, eyes drifting closed. Dennis squeezes the IV bag with both hands, forcing it faster, feeling every beat of his own pulse in his fingertips. Baby girl makes a small, contented sound against Robby’s chest, oblivious to the crisis building again around her. Dennis glances at both of them — the baby flushed and thriving, his attending off-white and swaying on the edge of consciousness — and feels his throat close. He presses a hand to Robby’s shoulder, keeping him upright, watching the numbers in his mind slide between physiology and panic. Blood pressure probably dropping. Still bleeding somewhere? Delayed atony?
He swallows, forcing the tremor out of his voice. “Captain, stay with me. You’ve got to stay awake, okay?”
Robby gives a sluggish nod, whispering, “I’m… here.”
Dennis doesn’t believe it, not yet. He adjusts his stance, one hand on his fundus, the other on his pulse, scanning the room like help might materialize out of the walls. He keeps pressure on the uterus, keeps his voice steady, and keeps repeating in his head like a mantra: He’s alive. The baby’s alive. You can keep them both alive. Robby shifts slightly, the baby still tucked against him, when he mutters, “Ugh. Headache.” He brings one trembling hand up to rub his temple.
Dennis freezes. Every bit of oxygen leaves his lungs at once. Headache. His brain jumps straight to the algorithm he memorized for exams and hoped he’d never have to use in real life: postpartum headache, differential — tension, dehydration, preeclampsia, eclampsia, intracranial bleed. Oh God. “Sir, wait, how bad?” His voice cracks before he can stop it. “Are you seeing spots? Any visual changes?”
Robby frowns, squinting against the light, visibly woozy. “No, just a headache, Whitaker. I’m fine.”
Dennis can hear the edge of irritation — his attending’s dry tone — but the color in Robby’s face hasn’t come back, and that gray pallor around his mouth makes every nerve in Dennis’ body hum. “I need to check your blood pressure,” He blurts, already looking around for a cuff he knows isn’t here. No monitor, no vitals cart, nothing but the saline rigged to a cabinet handle and the supply bins. He scrambles through drawers anyway, desperate, ridiculous. His voice runs ahead of his brain. “You could be hypertensive, sir, postpartum preeclampsia can happen even without prior diagnosis, and eclampsia—”
“Whitaker.” Robby’s voice stops him cold. “I’m a fat old man. I have high blood pressure. It’s not eclampsia.”
Dennis turns back toward him, chest tight. “Sir, with all due respect, you had a cryptic pregnancy. You don’t get to say what is or isn’t possible tonight.”
Robby stares at him — half incredulous, half weary — and then huffs something that might almost be a laugh. “Touché.”
Dennis breathes out, a shaky rush of air, but the panic doesn’t fade. He crouches back down beside him, assessing the clues the way he was taught to do when you don’t have equipment: mental status, reflexes, tone, facial symmetry. He shines his penlight — pupils equal and reactive. No droop, no clonus in the feet. Robby blinks, annoyed but cooperative. Still, that headache. “Okay,” Dennis says, mostly to himself, “Until I get a cuff, I’m assuming you’re hypertensive.” He moves quickly, elevating Robby’s head slightly, keeping him upright but supported. “Keep talking to me, sir. Any epigastric pain? Nausea? Blurred vision?”
“No, no, and no.” Robby’s tone softens. “Whitaker, I appreciate the vigilance. Really. But it’s probably exhaustion, blood loss, and the fact that I’m having a very strange night.”
Dennis presses his lips together, trying not to argue. You can’t ignore a postpartum headache, his mind whispers, steady and clinical. You can’t miss eclampsia. You’d never forgive yourself. He glances at the baby again — sleeping soundly now, small chest rising rhythmically — and something in him steadies. “I’m still going to treat you like you’re at risk,” He says quietly. “You’re getting magnesium sulfate the second anyone with a license walks through that door.”
Robby’s mouth twitches — half amusement, half pride. “You’re not wrong.”
Dennis forces himself to breathe, one hand still at Robby’s wrist, counting his pulse under his fingertips, the other keeping pressure over the firm uterine ridge. Inside, his thoughts are racing through contingencies, emergency pathways, everything he’s ever read about postpartum hypertension and seizure prophylaxis. Outwardly, he keeps his tone even, soft. “Just keep breathing, sir. Keep talking. Don’t close your eyes on me yet.”
Robby hums, eyes half-lidded but responsive. “You know, Whitaker… you’re doing remarkably well for someone who keeps insisting he’s terrified.”
Dennis gives a tight, breathless laugh. “That’s because I’m very terrified, sir. It’s motivating.” Even as he says it, he’s listening to the rhythm under his hand — the rapid pulse, the uneven breaths — and praying for the sound of footsteps coming down the hall. Our Father who art in Heaven…
👣
Dennis’ thumb slips on the keypad from sweat as he dials the ED yet again. The old hospital phone clicks and hums, the ring droning through layers of static. He’s halfway through rehearsing what he’ll say when a familiar voice finally cuts in, calm and clipped beneath the chaos of background monitors. “Emergency, Dr. Abbot.”
Dennis almost sobs with relief. “Dr. Abbot! It’s Whitaker, Dennis Whitaker, the MS4, uh, I’m up in the Peds overflow morgue. Sir, it’s Dr. Robinavitch, he — he had a spontaneous term delivery, I’ve got a female neonate stable, but he’s pale, hypotensive, and now he’s complaining of a headache.”
There’s silence on the line for a beat. “...Robby?” The tone drops into something low, incredulous. “He what?”
“Yes, sir,” Dennis says, his words tumbling over each other. “Placenta’s delivered, fundus firm, oxytocin running, estimated blood loss may be eight hundred milliliters, but he’s still tachycardic and now he’s having a headache — I think he’s developing eclampsia. I don’t have a BP cuff but I think he’s hypertensive. I—” A noise cuts him off, sharp and sudden. Dennis turns just in time to see Robby’s face go white. His whole body goes taut, one hand flying to his belly, fingers clawing at the fabric of his scrubs. His breath hitches — once, twice — and then he’s dry heaving, chest convulsing. “Sir?” Dennis is across the room in two strides, the phone clattering against the wall, still live. “Dr. Robinavitch, Robby!” He sweeps the wailing baby into one arm and tries to slow Robby’s slump with the other.
On the other end, across the room, Jack Abbot’s voice roars. “Whitaker, what’s happening?”
Dennis kneels hard, one hand bracing Robby’s shoulder as his attending’s muscles seize. His right leg jerks, heel scraping against the tile, then starts to tremor rhythmically. Clonus. “Oh God — he’s seizing — clonus in the right leg.” Dennis’s words come fast, half to Jack, half to himself. “He’s conscious but barely, I think we’re about to lose him. Help me, please!”
“Whitaker, listen to me,” Jack yells. “Get him on his side, left side if you can, protect his airway. Keep that IV running, hang another bag if you’ve got it. I’m coming up there right now. Do not let him aspirate.” Dennis already has a hand behind Robby’s neck, guiding him down onto his left side, cushioning his head with folded linen. The clonus ripples up the leg, stops, then hits again. Robby’s breathing goes ragged, shallow. “Come on, come on, stay with me,” Dennis begs, adrenaline flooding his chest. “Jack’s on his way, sir, just hang on.”
“Whitaker!” Jack’s voice barks through the receiver, sharp enough to cut through the rising panic. “Is he protecting his airway?”
“Yes, yes, he’s still breathing, spontaneous respirations, no vomit yet, baby’s safe, away from him.” Dennis’s voice shakes but his hands are steady. He tugs the IV line to full flow, squeezes the bag hard enough his knuckles ache.
“Good,” Jack says, already shouting orders in the background to someone else. “We’re mobilizing OB and anesthesia. Keep him on his side, keep talking to him. If he stops breathing, you bag him. We’ll be there in two minutes.”
Dennis swallows hard, presses his palm flat against Robby’s upper back, feeling each ragged breath. His mind races through emergency protocols: magnesium sulfate loading dose, seizure precautions, airway management. All of it is academic without the supplies he needs. “Sir, come on,” He whispers, voice trembling despite himself. “You’re not doing this here, okay? Not on the floor, not in the morgue.”
Robby makes a low, guttural sound, somewhere between a groan and a gasp. The clonus slows, then stops. His eyes flicker open — unfocused, glassy. “F’ckin’ f’x.”
“That’s it,” Dennis says, almost to himself. “That’s it. You’re through it. You’re through it.”
He shouts at the phone again, breathless. “Dr. Abbot, he’s postictal but breathing. Hurry.”
Dana’s voice crackles through the line, he just manages to catch it. “He’s already headed to you, kid.”
Dennis presses two fingers back to Robby’s carotid. Still fast. Still there. He closes his eyes for half a second, fighting the dizziness of an adrenaline crash. The baby whimpers softly from the crook of his arm, alive, okay; her cries are the only sound cutting through the echo of his abject horror.
Dennis whispers to no one, “Just hold on. Please. Please.” Then the sound he’s been praying for, the best sound he’s ever heard — footsteps, a crash of wheels, shouted voices coming closer — finally reaches the door.
👣