Steady

The pager goes off at 2:47am. Trauma incoming. You've been asleep for forty minutes on a cot that smells of bleach and someone else's exhaustion, and your body is vertical before your brain finishes booting. The ER is controlled chaos. Paramedics, nurses, the sharp metallic smell of blood mixing with floor cleaner. The patient is seventeen with a penetrating chest wound, car accident, steering column, partial cardiac tamponade. Conscious, which means there's time. Not much. Dr. Reyes is already at the trauma bay. Scrubs, gloves, the watch glinting under fluorescents. He's reading the portable echo with an expression of complete neutrality, which you've learned means the case is serious enough to require his full operating system. He looks up when you arrive. Assesses you in one glance: sleep-creased face, scrub top inside out, adrenaline making your pupils wide. "Dr. Santos. Glad you could join us." The sarcasm is a formality. He's already moving. "Right hemopericardium, probable RV lac. We're going up. I need you scrubbed in four minutes." He turns to the charge nurse. "Call OR three. Tell anesthesia if they're not ready in six minutes I'm starting without them." He says it calmly. Nobody questions whether he means it. The elevator to surgical is the fastest sixty seconds of your life. He stands on the opposite side, back to the wall, reviewing the echo images on a tablet. His mouth moves silently, running through the procedure before he makes it. He does this before every surgery. It is, you've realized over four months of watching him, the only ritual he allows himself. He looks up. Catches you watching. "Questions?" "If the RV lac is posterior we won't have access through a standard sternotomy." "Correct." Something shifts in his expression, not warmth, not praise, but the absence of dismissal, which from Kael Reyes is an ovation. "What's your approach?" "Clamshell thoracotomy. Wider field. Better exposure." He looks at you for two seconds longer than necessary. The elevator hums. "Scrub in. You're assisting." The OR is cold and bright. You stand across from him at the table, the patient's open chest between you, and his eyes above the mask are the only part of his face you can see. They are completely focused. Not on the patient. on your hands. "Retract. Wider. Good." His voice through the mask is low, steady, intimate in the way that only happens when two people are holding someone's life between them. "You see the lac? Posterior wall, just where you said." His hand moves to adjust yours on the retractor. Gloved fingers over gloved fingers. Clinical. Necessary. The contact lasts three seconds and your breath catches and he hears it, you know he hears it because his eyes flick to yours above the mask and hold. "Focus." One word. A command and a confession. The surgery takes ninety-one minutes. The patient lives. Kael strips his gloves with a snap and drops them in the bin and walks to the scrub sink without looking at you. His hands under the water are steady. His jaw is not. You stand at the adjacent sink. Water runs. Steam rises. The silence between you is full of the thing neither of you will name in a room with cameras. "Good call on the clamshell." He says it to the faucet. Then he's gone. The door swings. You stand at the sink with your hands under water that's gone cold and your heart doing something no amount of medical training has prepared you for.