The tones drop.
Three loud, dissonant beeps echo through the hospital PA system, followed by the voice of the operator.
“Code Orange. Mass Casualty Incident. ETA five minutes. Trauma Team to the Bay. Code Orange.”
The change in the air is instant.
The "slacker" part of my brain—the part that likes to annoy Maxwell—shuts off. The soldier turns on. The exhaustion that was dragging at my eyelids vanishes, replaced by a spike of adrenaline so pure it tastes like copper.
I turn back to look at Maxwell.
He’s frozen, a blue pen hovering over his desk. Code Orange means a disaster. It means the "clean" world of scheduled bypasses and valve repairs is over for the day. It means he’s in my world now.
"Showtime, Max," I say.
I don't wait for a response. I run.
Trauma Bay 1 is already swarming.
Rosa Ortiz—"Mama"—is standing at the command desk, a phone in each hand. She’s five-foot-nothing, sixty years old, and terrifying.
"What do we have, Mama?" I ask, grabbing a fresh pair of gloves from the wall dispenser.
"Twenty-car pileup on the I-5," she barks, not looking up. "Black ice. A semi-truck jackknifed and took out a commuter bus and half a dozen sedans. First wave is two minutes out."
"Clear the bays!" I shout, my voice booming over the chaos. "I want two lines set up in every room! Get the blood bank on the phone, tell them to thaw O-neg! Move that gurney—now!"
The residents scramble. I check the board. We’re short-staffed. It’s December, and half the attendings are skiing in Aspen.
"Where do you want me?"
I turn. Maxwell is standing there.
He looks ridiculously out of place. He’s wearing his pristine navy scrubs and his long white coat, buttoned to the chin. He looks like he’s arriving for a board meeting, not a bloodbath. But his hands are gloved, and his eyes are focused.
"You’re Cardio," I say. "You take Bay 3. If anything comes in with a chest pain or a rhythm issue, it’s yours. But don't expect a sterile field, York. This is going to be dirty."
He nods once. "I can handle it."
"We’ll see."
The ambulance bay doors hiss open. A blast of freezing wind and snow swirls into the heated ER, carrying the sirens with it.
"Incoming!" a paramedic screams, wheeling a stretcher in at a run. "Male, fortys, driver of the sedan that hit the semi! Crush injury to the chest and abdomen! BP is sixty over forty! He’s crashing!"
"Bay 1!" I yell. "On my count! One, two, three—lift!"
We transfer the patient. He’s a big guy, covered in glass and road grit. His face is grey. He’s gasping for air, choking on blood.
"Breath sounds absent on the left!" I shout, slapping my stethoscope to his chest. "Indira, get me a chest tube kit! Now!"
Dr. Singh, the nervous intern, fumbles with the plastic packaging. Her hands are shaking.
"Breathe, Singh," I say, my voice dropping to that calm, command register I learned in Kandahar. "Slow is smooth, smooth is fast. Give me the scalpel."
She hands it to me. I make the incision between the ribs. Blood sprays, warm and sticky. I shove the tube in. Dark blood rushes out into the canister.
"Output is massive," I say. "1500 ccs immediately. He’s bleeding out."
