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Today’s street team was smaller than normal, culled by the freezing weather and a bout of gastro that was working its way through the city. Robby had bought the team coffee, partly as a bribe, partly because they’d need the energy. “Huck!” he called out, handing over Whitaker’s coffee. “Cream, no sugar, right?”
“Right,” he answered, pleased that Robby had memorized his order.
The nickname “Huckleberry” had unfortunately stuck around after that first shift, but the street team had shortened it to Huck. After a life of being called “Dennis the Menace”, it was kind of nice to have someone call him a nickname affectionately. And his team members were slowly becoming his first (and only) friends in Pittsburgh. Kiara was there for every outing, but other ED staff rotated through—Robby and Jesse had been working with the team even before it had been officially adopted by the hospital, and had all the best stories. Cassie, Dana, and Langdon joined sometimes if they weren’t busy with kids, but the core of the team was the younger residents with nothing better to do on their days off—Samira, Santos, and Whitaker, along with nurses and some doctors from other departments.
“Okay, here’s the drill,” Robby announced. “Samira and Princess and I will handle prescriptions. Santos, BP checks.” She groaned, but Robby pretended to not hear. “Kiara and Whitaker, wellness checks. Be aware of the conditions—keep an eye out for hypothermia or trench foot. We’re spread a little thin today, so check-ins with me every fifteen minutes. Stay safe, stay warm.” They were set up on a street corner not far from the hospital, by an underpass that had spawned a small unhoused encampment.
Whitaker pulled his jacket tighter. It was high-quality fleece with the hospital logo, but it wasn’t doing enough against the wet, biting wind. At least he’d be moving; wellness checks involved going from tent-to-tent to see where he could help. Mr. Krakozhia was always his first stop. “Hey, Mr. K. How’s it going?”
“Hey doc, I’m doin’ alright. How are you?”
“Oh, hangin’ in there.” No one had discovered his 8th floor ‘apartment’ in the hospital yet, so that was the most he could ask for. “Learning buckets. Something new every day.”
“Good for you, kid. How’s your family?”
“Oh, they’re good. Yeah, my older brother got engaged. I’ll probably have to go home next summer for the wedding.”
“Good, good.” Conversations with Mr. Krakozhia were short and sweet, and mostly one-sided, but Whitaker found himself looking forward to them. “Robby’s got your prescription, if you want to head down to the corner.” Mr. Krakozhia huffed in response, and Dennis waved an awkward goodbye before he walked over to the next tent.
“Mary? You in there? Mary?” He took a step back, “Mr. K, have you seen Mary lately?”
“Yeah, she should be in there,” he called back.
“Mary, I’m going to come in!” He felt a thrum of anxiety as he pulled down the zipper. “Shit.” Mary was lying on her side, a syringe stuck in her arm, not moving but still warm. “Mr. K! Mr. K, go get Robby! Now!” He called shrilly. His hands were shaking as he climbed into the tent, trying to figure out what to do. He removed the syringe, but couldn’t find the cap anywhere. “Good move, idiot,” he murmured to himself. He set it to the side as his training kicked in—he didn’t know how far away Robby was. “Okay. Narcan, Narcan…” he was fumbling through his pockets before finally finding the spray. “Please, God, let this work.”
He delivered the Narcan and checked her pulse, beginning to do compressions when he didn’t find one. “Come on, Mary, please.”
“Huck?” Robby’s voice filled the tent.
“I gave her one dose of Naloxone, about thirty second ago, no response,” Whitaker said shakily.
“Good, you did good. Scoot over, give me some room.”
Whitaker shuffled to the side, but he froze when he felt it...the syringe that he had just pulled out of her arm, jabbing into his leg. The plunger was backed up against a milk crate, releasing the drug. He could swear that he felt it burning through his veins.
“CPR, Huck, what the hell??” Robby scrambled to take over, glancing up to see Whitaker’s shaking hands pulling the syringe out of his thigh. “Oh, fuck. Whitaker, don’t move. Kiara, call 911, Hucks’ been dosed.”
Distantly, Whitaker was glad that Robby had brought backup. He watched Robby pull a spare needle cap from his pocket and cap the syringe, and tried to make a note in his head—Bring spare needle caps—but found his thoughts drifting. “Huck!” Robby said sharply “How much was in the syringe?”
Whitaker cocked his head, Robby’s words slowly filtering into his brain. How…much…syringe? He tried to remember. “Just…one…”
“One what?”
Robby’s face started fuzzing around the edges. “Syringe,” he slurred.
“Santos, get him out of here.” She ducked her head in and grabbed Whitaker’s hand, pulling him towards the tent flap. Whitaker’s legs felt like jelly, and he tripped into Robby’s chest. “We gotcha, Huck. You’re gonna be fine.”
“Got him—okay, have a seat here.” Gravity pulled him towards the pavement, but Santos controlled his descent. “Hey, Huck. Can you tell me where you are?”
Robby said from inside the tent. “Santos, grab a rescue breather from the kit and get in here.”
“Huck’s not looking so good, Boss.”
“He’s breathing, isn’t he?”
Whitaker listened to the bickering with fascination, the voices fading in and out. Kiara’s face swam into focus in front of him, and he reached out clumsily, trying to soften the worry lines that creased her forehead. “I’m…fine,” he said loosely. “Didn…you hear…Trin?”
“I did,” Kiara said soothingly, moving his hand away. “Dennis, do you know where you are?”
“It’s cold.”
“It is cold. Do you know where you are?”
He looked around him, lost in the freezing fog. “Omaha?”
Kiara gently grabbed his chin, turning his head towards her. “Can you look at me, Dennis?” He gazed into her eyes, smiling contentedly. “Robby, I think he’s overdosing,” she called calmly. “Pinpoint pupils, delayed response, clammy skin. Can I give the Narcan now?”
“Just…hang on. How’s his breathing?” Robby sounded stressed, Whitaker’s brain registered. He heard sirens coming closer, bouncing off the tall buildings and echoing inside his head.
“Shallow.”
“Damnit. She’s not responding to the Narcan, so we don’t even know that it’s opioids.” He was panting in between compressions. “How far away is the ambulance?”
“I can see it, a few blocks away.” Whitaker was feeling sleepy, and started swaying. Kiara grabbed his arms to hold him upright. “He’s losing consciousness.”
“That can happen. Make sure he’s got a pulse and is still breathing regularly.”
It was odd to be the one falling asleep while others panicked…normally he was the panicky one. He could hear the tension in Robby and Kiara’s voices, and Santos had been suspiciously silent—but he didn’t feel it. He just felt nice. Floaty. Warm. And Kiara was so kind…she reminded him of his high school biology teacher.
The sirens cut out as the ambulance arrived, and suddenly Robby’s face was all he could see. “Hang in there, Huck. Your breathing’s irregular, so we’re going to give you Narcan. You two, give us some room, he might try and fight it.”
The Naloxone hit him like a freight train, driving through his veins and lighting up his brain. It was like touching an electric fence turned up to a thousand. His limbs flailed unchecked, but suddenly hands were on him, trying to contain him. They pulled him up so he was sitting, leaning against Robby. “Son of a…Huck! Breathe. You’re okay, you’re okay.”
Whitaker’s head was spinning, and he couldn’t quite remember what happened, or why Santos and Kiara were staring at him with really freaked-out expressions. “Mary…is Mary okay?” He was trying to catch his breath, but his chest still felt tight.
“She’s okay. The paramedics are working on her. I need you to focus and answer my questions now, Whitaker. Do you know what day it is?”
“Uh, Thursday.”
“Good. What’s her name?”
“Trinity.” There was a massive headache coming on, and Whitaker groaned.
“What? What is it?” Robby’s hand was on his wrist, taking his pulse.
“Headache.”
“Yeah, that’ll happen. Hang in there, we’re going to get you to PTMC.” The paramedics had gotten Mary onto a gurney and were wheeling her into the ambulance, and Robby abruptly pulled Whitaker to his feet. “I’m going to go with Huck in the ambulance, you two get Samira and Princess and get the rest of the prescriptions out, then head back. Good?” Whitaker nodded, unsure if he was being asked.
“I’ve never been in an ambulance,” he murmured, and Robby cracked a smile, which made him feel warm inside.
“Well, let’s get you in, then.” He was still wobbly his feet, so the paramedics pulled him up and Robby quickly followed, sitting Whitaker down on a bench on the side and quickly grabbing an oxygen mask and pulse oximeter. “Huck, how are you doing?”
“Uh…nauseous. Feels like…a hangover. But bad.”
Robby shoved an emesis bag into Whitaker’s hands. “We’re close to PTMC. Less than a minute, then we can get you on monitors and a drip and you can close your eyes for a bit, how does that sound?”
“Yeah. Is Mary okay?” The paramedics were still doing CPR, but Whitaker’s brain had recovered enough to realize that at this point, it wasn’t looking good.
Robby sighed and squeezed Whitaker’s shoulder comfortingly. “I don’t think so. She was probably too far gone by the time you showed up. But we’ll try everything, you know that.”
He tried to focus on what Robby was saying as they swayed back and forth, but was distracted by the nausea that was slowly building. “I don’t think I like ambulances.”
“Yeah, I’m not too fond of them either. We’re almost there.” The ambulance rounded the last corner before PTMC, but the spinning in his head reached a breaking point and Whitaker ripped off the oxygen mask and threw up into the bag, Robby grabbing his shoulder to keep him upright. “You’re okay, get it all out.”
They let Mary out first, and then Robby slowly maneuvered Whitaker to the door. “Dana, get a wheelchair over here.”
“Santos called ahead. How’s he doin’?” Dana asked, holding the wheelchair still as Whitaker dropped into it. Cassie McKay swept in with a warm blanket, smoothing it over Whitaker’s shivering frame.
“Breathing and heartrate better after one dose of Narcan but I want him on a naloxone drip with a bag of heated LR, 8 mg odansetron, and 30mg Toradol. Get a temp and a CBC and follow post-stick prophylactic protocols. I’m going to check on the other OD and then I’ll be right in.”
“We’re headed to south 14,” Dana said. “You’re comin’ with us, Huck. Anyone you want us to call for you?”
“Uh, not really.”
“Not your mom or dad? Roommate?”
Whitaker was still struggling to think straight; the words came out like molasses. “Mom’s in Nebraska. No roommate.”
“Well, you got us, kid. Let’s get you up on the bed…can you get into a gown by yourself? Or should I grab Donnie to help?”
“Oh, um…I’ll be okay.”
Cassie smiled and patted his leg. “I’m going to be right outside, just yell if you need me.” She pulled the curtain closed, and Whitaker sighed in relief as he was finally given a moment to catch up. It had only been about fifteen minutes between leaning in to check on Mary and ending up in a bed at PTMC, a dizzying transition for anyone. It was hitting him now—there was fentanyl running through his veins, or God knows what else, and he had just almost died.
“Yea, though I walk through the valley of the shadow of death, I will fear no evil,” he murmured, splaying his shaking hands flat on the bed. His mind was reeling. “For I know the plans I have for you…plans to prosper you, and not to harm you.” He gripped the sheets on the bed, feeling the starched folds under his palms. “Plans to give you hope and a future.”
“Dennis, you okay in there?” Cassie’s sweet voice asked.
“Yeah, just taking a second,” he called back. He closed his eyes for a second to ground himself, then began the arduous task of undressing with limbs that weren’t quite under his control. Someone had unzipped his fleece, probably Robby, so it was easy enough to shrug off, but his henley took a bit more twisting and pulling to tug off. And the button on his jeans was stubborn under his dull fingers, taking him way too many tries to get undone. But once he got it, he realized that his boots were going to have to come off first…and those seemed so far away. “Cassie?” he gulped. “I think I, uh, do need some help.”
She ducked around the curtain, smiling. Whitaker liked people with nice smiles. “Let’s get this sorted, then,” she said plainly. “Are these boots what you wear on the farm?”
“Oh, uh, yeah. So they’re kind of filthy, sorry.”
“At least you didn’t bring any rats with you, right?” She unlaced them easily and pulled them off, setting them in the corner. “Want me to help you with the jeans too?”
“Just, uh, pull.” He lifted his hips and let her pull the damp denim off him, but realized a second too late why they were wet…specifically around the crotch. “Oh,” he said in horror.
“It just happens,” she soothed. “Part of the overdose or the Narcan. Just a medical thing. Do you have spare clothes in your locker?”
“Yeah. Uh, they’re kind of just…jumbled in the bottom, but they’re clean. Combo is 1985.”
“I’ll be right back,” she promised.
Whitaker took the time to remove his wet underwear and fling it into the medical waste bin, resolving to not speak of it or think about it ever again. He put on the gown, then slid his legs under the covers of the bed so no one would see how naked he was. Cassie slipped his clean underwear through the curtain and waited outside again as he pulled them on. “I’m done,” he finally said.
Cassie came back in and started applying the monitoring stickers and leads, and Dana took his arm. “Sweetie I need to take some blood first, then I’ll get an IV going, okay?” He nodded. “How are you feeling?”
“Like my brain is full of mush,” he said. “And like…pointy things. But other than that…okay, I guess.” The prick of Dana’s needle surprised him. “Oh, geez.” The wooziness increased threefold.
His blood pressure dropped, and McKay was quickly laying him flat on the bed. “Really, you have a thing about needles?”
“Not usually,” he mumbled, rubbing his forehead. “I think I’m gonna be sick again.”
“Just one more, to get the IV in, and then you’ll feel better,” Dana said.
Whitaker saw Robby appear out of the corner of his eye. “I heard the beeping, how’s he doing?”
“Just a little syncope from the blood draw,” McKay reassured him. “Slightly tachy with sats in the low 90s, headache but no other symptoms.” Dana slid the IV in and Whitaker flinched, but at least he didn’t fully faint.
Cassie strapped an oxygen mask over Whitaker’s face, and Robby stepped towards the bed, close enough that Whitaker noticed a thin red cut swollen on Robby’s lip. “Wait, what happened?”
Robby touched his mouth like he had forgotten. “Oh, uh, that was…you kinda swung at me when the narcan kicked in. Caught me on the lip. It’s fine though.”
“Oh, gosh, I am so sorry, Dr. Robby.”
“It’s okay, it’s okay. I’ll take it a hundred times over if it means you’re alive. You scared us out there, Huck.”
“I know, I was stupid, I should have done something else with that needle. Or…left it in?”
“Shit happens,” he said simply. “You live and you learn. Have we talked about what happens next?” Whitaker shook his head. “We did a rapid test on the syringe and it was fentanyl. We sent your blood to the lab, they’re going to test the fent levels, and once we know the concentration we’ll decide how long we need to keep you. You’re free to fall asleep, but we’re going to wake you up every 15 minutes to check that you’re still conscious. Basically, we just need to make sure the Fentanyl’s out of your system and there’s not going to be a secondary overdose before we let you go.”
“Sleep sounds good,” Whitaker said, trying to get comfortable on the bed.
“We also need to talk about post-stick exposure. This was your first time, right?”
“Huh? Oh, yeah.”
Robby paused, noticing Whitaker flagging. “Let’s do this later.”
“What?”
“Just get some rest. We’ll check back in soon.”
Someone was shaking his shoulder. “Hey, Huckleberry. Wake up, we gotta make sure you’re not dead.”
“Trin?” She was the annoying old sister he never wanted.
“Yeah?”
“What’re you doing here?” He tried to rub the bleariness out of his eyes, but found his hand tethered to the IV.
“I came to lecture you about not being an idiot.”
“Santos—” Whitaker looked the other side of the bed, where Samira was leaning. “Hey Whitaker. How are you feeling?”
“My head feels like its full of sand…It’d feel better if you didn’t keep waking me up.”
“We need to check your pupils,” Santos flashed her penlight in his eyes like a strobe, and he flinched away.
“The hell are you doing?” he muttered, covering his eyes with his free hand. “You’re gonna give me a seizure.”
“Checking pupillary response time. Open up. If you don’t, I’m gonna tell Robby and he’s going to get allll freaked out. You don’t want that, do you?” Whitaker opened his eyes suspiciously, and saw Santos had lowered the penlight. “I knew it…guilt always works on you religious boys.”
“Just do the flipping test, Trin.”
“Patient irritable…write that down Mohan.” She moved the penlight in a familiar pattern, Whitaker trying his best to follow it. “Pupillary reaction normal.”
“How’s your stomach?” Samira asked kindly. “Do you need any more Zofran?”
“I don’t think so. It’s been an hour, right? Did you get the results?”
“I think Robby probably has them, I’ll go find him.”
“Thanks, Samira.” Whitaker let his eyes close again, but Santos pinched his arm and twisted. “What was that for?!”
“It’s revenge. You scared me and made me look weak in front of Robby.”
“…Sorry?”
“Yeah, you should be. What a rookie movie, leaving an open syringe of fentanyl out. I mean I knew you were green, but I didn’t know you were THAT green.”
Whitaker groaned. “Santos—Trinity—now’s really not the time.”
“Relax, Huck, I’m just joking. Could’ve happened to anyone.”
“Yeah, well it’s not very funny. I feel like shit, you know? And I don’t need you, or anyone else, to make me feel like an idiot, because I already know how stupid it was. I screwed up, and now, God knows…” he stared at her. “Mary had HIV. I was bringing her antiretrovirals.”
“Oh…fuck.” Whitaker was picking at a hangnail, refusing to look at her in case he cried. She leaned back. “Well, the chances are like one in a thousand, right?”
“Closer to one in five hundred,” Robby corrected from the doorway. “How are you feeling?”
“Better. Tired. My head feels like it weighs a hundred pounds.”
“Are you up for a chat? We need to talk about the exposure protocols.”
Whitaker nodded, “Might as well get it over with.” Santos scooted her chair closer, laying a hand on his knee, and Whitaker could tell she was trying not to show her genuine worry.
“Mary was HBV and HCV negative, but as you know she was HIV positive. We’re going to start you on a course of PEP for 4 weeks, starting today. Common side effects are nausea, headaches, and mild aches and pains. We’ll test at 6 weeks, then 6 months, and then 12 months.” He paused and met Whitaker’s tired gaze. “Any questions?”
“She’s dead, right? Mary?”
Robby’s eyes softened. “She was gone before you even started CPR.”
“So it was all for nothing.”
“This time, yes. Next time, maybe you save someone’s life. We never know, and that’s why we always try.” Robby cleared his throat. “The fentanyl levels in your blood are lower, and I’d be okay with you going home, as long as there’s someone to keep an eye on you. I know how uncomfortable our beds are.”
Whitaker paled. “Oh, uh, I don’t have roommates, or anyone. If it’s all the same, I’ll just stay here. For a little while, until I’m…you know, fully cleared.”
“I could stay with you for today, if you’re comfortable with that?” Robby suggested.
“Or me,” Santos piped up. “If you don’t want your boss seeing your shitty apartment.”
Whitaker’s heart rate was rising, and unfortunately the whole room could see it on the monitor. “Really, it’s fine, I’ll just stay for a few more hours and then get out of your hair.”
“Huck, are you worried about leaving the hospital? I promise, you’ll be fine. We’ll give whoever’s looking after you some Narcan just in case, but it’s more for peace of mind than anything clinical. And you’ll be able to get much better rest in your own bed, with no one to interrupt.”
“I’m still tired. Just don’t really want to move.”
Robby rubbed his face. “We’re trying to discharge you kid. There’s no clinical reason to keep you here and…they need the bed. You know how it is.”
Whitaker went silent, his mind struggling to find a solution that didn’t involve directly lying to his friends and his boss. “I’m currently…between places.”
“What, you’re moving? Do we need to unpack some boxes? I think I can handle that.”
Whitaker looked desperately at Santos, waiting for her to understand and save him from confessing. She stared at him, and he saw the moment her eyes softened. “There’s no apartment, is there?”
Now understanding was dawning in Robby’s eyes too. “So where are you staying? In your car?”
“I’m in between cars too,” he said, voice quiet. “The eighth floor. It’s empty, so I’ve just been crashing in a patient room. I know that’s not really allowed, but no one’s using them. I’ve seen like two people up there in the last four months.”
“Four months?!” Robby exclaimed.
“I had an internal medicine rotation before this one.” He squished himself back into the pillows and rubbed his forehead. “Listen, I’m a med student, I’m literally paying to be here. Not paying you, obviously, but…it’s not cheap. My family is already overextended on loans for the farm, so…I’m just doing my part.”
“Well, it’s your lucky day,” Santos declared. “My asshat roommate moved out two weeks ago and I have an ad up on craigslist for the room, but every single applicant has been a creep. You’d be doing me a favor.”
“Okay, that is extremely generous, but no, I can’t afford to pay you rent right now.”
“How are you at cleaning and fixing things?”
“Grew up on a farm…guess I’m pretty handy? Cleaning…I know how to muck a stall?”
Santos looked like she was regretting offering. “If you keep to yourself, and don’t annoy me…you can move in.”
Whitaker swallowed. “I, uh…don’t know what to say.”
“Well, you can move in tonight.”
Robby was watching curiously, eyes flicking back and forth between them. “I can grab your things from the 8th floor, if that’s okay with you?”
Whitaker wanted to sink through the floor and never speak to anyone again. Now that the stress was fading, he was left with a residual sense of embarrassment about everything—the needle stick, the overdose, the homelessness—and now Robby was going to be picking up his dirty underwear? (Not literally, Dennis’ dirty clothes were already tucked in a tote for the laundromat tomorrow). “Fine,” he acquiesced. “I mean, I would, but I’m just…” Ashamed. Depleted. Numb. “…a little out of it.”
“How about I go up with Robby, then we can carry the things to my car, and then I’ll pull it around and we can come pick you up,” Santos suggested. “McKay can get you discharged while you wait.”
“Sure, yeah.”
“Santos, why don’t you grab Cassie, I want to talk to Huck for a second,” Robby said, sitting down on the edge of the bed. Santos pursed her lips for a second in displeasure at getting dismissed, but left with a not-so-gentle pat (more of a punch) to Whitaker’s leg. “Dennis, I’m, uh…I’m sorry that I didn’t notice that you were struggling with housing insecurity. I wish I could have helped sooner, and I’d like to offer my own guest bedroom if, for any reason, Santos’ apartment falls through.”
“Oh, you really don’t—”
“Please, let me finish. I’m in charge of this ED, and everyone in it, and I take that responsibility seriously. If you need anything, at all, please come to me. Even if it’s just someone to talk to, or a bag of groceries, or a hot meal…med school and residency can be a lonely business, hopping from department to department. From here on out…don’t let it be such a one-man show. You have a whole team of people in your corner—me, Kiara, Dana, Santos—and we’re here for you.”
Whitaker shifted uncomfortably. “I don’t mean to cause any trouble. Pop…he always said a man should be able to take care of himself.”
“Others would say…it takes a village.” Robby contested.
“Isn’t that about raising children?”
“The point stands. You’re not less of a man for giving your education everything you can, and getting nothing in return. Let us help you.”
“Yeah, okay. Uh, thank you. For all of this, and you know…saving my life.”
“Anytime, Huck.” Robby stood up and gave him a final, gentle smile, then waved in McKay as he left.
Cassie helped him change into the sweats from his locker, unhook the IV, and gather all of his things. She gave him a warm hug, then pushed him down into a wheelchair to drive him to the door. People stared as he was wheeled past, but Cassie was yapping steadily to distract him, requiring only a few affirmative hums to keep going. She took him out the back ambulance bay, where Robby and Santos were loading familiar boxes and his backpack into a car. “Here you go, Whitaker. Text me later so I know you’re okay. And hey…” she locked the brakes and walked around to face him. “Santos filled me in. I was in the same situation a few years ago. It sucks, but you’re gonna get through it.”
“Alright, Huck,” Santos called, “We’re all packed up. Get your ass in the car so I can go home and sleep.”
“Thanks, Cassie,” he said fervently. “I’ll be okay.” He slotted into the front seat, kicking some old coffee aside to make room for his feet.
“Seatbelt!” Santos chided, and Whitaker felt a small smile come across his face as he clicked the seatbelt into the buckle. She was bossy as hell, but evidently, she cared enough about him to argue about the little things. “Alright Huck. Let’s go home.”
And home sounded Pretty. Damn. Nice.