September 12 2020
NEURO ICU, EARLY EVENING
The buzz of alarms was faint but constant. AJ stood stone-still just outside Bay 3, arms crossed tightly against her chest, eyes unreadable. Inside, a team worked rapidly around the motionless patient on the table — 16-year-old Nia Chen, a post-op AVM resection.
Nia had been stable. Until now.
Until someone hadn't followed protocol.
And now she was coding.
---
FLASHBACK — FOUR HOURS EARLIER
AJ - It's a Grade III AVM
AJ had said, standing at the head of the table during rounds.
AJ- Delicate territory. Brainstem-adjacent. If pressure fluctuates post-op, you call me before anything. Got it?
April and Lexie both nodded.
AJ- I want constant vitals logged, no interruptions, and absolutely no off-label administration of anything until I double-clear it.
Lexie - Yes, Dr. Brewster
Lexie had echoed.
AJ's eyes lingered a moment longer than necessary.
AJ - I mean it.
---
NEURO ICU NOW
Lexie stood pale as the monitors screamed. April's hands trembled.
AJ - What did you give her?
AJ asked lowly, her voice dangerously calm.
April finally spoke.
April - We saw the BP climbing. Jackson was in another room. I remembered you said to avoid nitrates so I thought—
AJ - You 'thought'?
AJ snapped.Lexie jumped in
Lexie -She gave a small bolus of labetalol—just 5 milligrams—
AJ - You didn't page me
AJ cut in, voice sharp.
AJ -You panicked and dosed a patient with borderline perfusion pressure. You brady'd her into a brainstem ischemia.
April's face crumpled
April - I was trying to stabilize her—
AJ - You gambled. On a teenage girl. And now we have six minutes to stop her brain from herniating.
She turned to the nurse.
AJ - Intubate and prep for OR. We're going in. Now.
Lexie's voice cracked
Lexie - Can I—can we scrub in?
AJ's eyes met hers — fire and ice.
AJ - You're watching. From the gallery.
---
OR 4, TWENTY MINUTES LATER
The OR was silent, tense. AJ's hands moved quickly, her tone clipped but exact. Jackson was assisting.
AJ- Cushing response. Dura's tense. Get me a mannitol flush, stat.
Lexie and April watched from above, eyes red, silent. Below, AJ navigated the swollen tissue with breathtaking precision. Her voice never wavered. But every movement screamed: This should never have happened.
After an hour of decompression and resection, Nia's vitals steadied. Barely.
---
LOCKER ROOM, LATER THAT NIGHT
Lexie and April sat in silence, scrubs stained, hearts broken. The door opened. AJ stepped in.
They stood instantly.
April - We're sorry
April said, voice shaking.
April - We thought we were helping—
AJ - You didn't listen
AJ said.
AJ - That's the difference between doing what you think is right and knowing what's right. In neuro, that difference can be fatal.
Lexie looked down, ashamed.
Lexie - We understand if you want us off your team.
AJ stared at them, exhausted.
AJ - You messed up. Badly. But if I cut every intern who made a mistake, I'd be operating alone. What matters now is how you take this.
April swallowed hard.
April - We'll fix it. We'll earn your trust again.
AJ gave a small nod, then turned to leave.
AJ - Tomorrow, you report at 0500. You'll be shadowing—not leading. Earn your hands back.
And with that, she was gone.
---
OUTSIDE ICU WINDOW*
Dave waited in the hallway with Mateo asleep on his shoulder.
Dave - Rough night?
he asked gently.
AJ leaned against the glass, watching Nia.
AJ - They nearly killed her. And I don't know if she's going to wake up.
Dave didn't offer an answer. He just reached for her hand.
And for the first time in hours, AJ let herself feel everything.
