Around noon, I'm checking Mia's oxygen levels when I notice something. Her breathing pattern's changed. It's shallow and quick, her neck and shoulders moving with each breath like she's working too hard just to get air. The monitor says ninety-two percent, which should be okay, but something's off. She's struggling in a way that makes my instincts scream.
I press the stethoscope to her back, listening carefully. The left lower lobe sounds diminished, almost absent. The right side is clear.
Shit.
"Mia, does it hurt more when you take a deep breath?" I ask, keeping my voice calm even though adrenaline is spiking through me.
"Yeah."
I check her temp. 101.3, fever's climbing despite antibiotics, despite everything we're pumping into her system.
Pleural effusion. Fluid is building in her lung cavity, compressing the tissue, making it harder to breathe. The antibiotics aren't enough; we need to drain it before she goes septic.
I find Kristin at the nurses' station, reviewing labs. "I think Mia's developing an effusion around her left lung.”
She looks up sharply. "You sure?"
"Left lower lobe sounds are diminished, respiratory effort's increased, she's using accessory muscles, and her fever's climbing. She needs imaging and probably a thoracentesis."
Kristin doesn't question me, just comes with me to reassess. She listens to Mia's lungs with her own stethoscope, checks the vitals again, and reviews the overnight notes.
"I'll page the attending," she says.
Dr. Moor arrives fifteen minutes later, an older guy with grey at the temples. He examines Mia with gentle hands, asks her questions in a soft voice, and orders a chest X-ray stat.
"Good catch," he tells me after, while we're waiting for transport to take Mia down to radiology. "We would've found it eventually, but you caught it early. Could've gone septic if we'd waited another few hours."
The X-ray confirms it within the hour: a moderate pleural effusion, visible as a hazy opacity along the lower lung field. That afternoon, Dr. Moor performs a thoracentesis, draining about two hundred milliliters of cloudy fluid, which is sent to the lab for culture. Suspecting infection, he broadens Mia's antibiotics and inserts a chest tube for continued drainage.
By evening, Mia's breathing is easier, oxygen stats climbing back up to ninety-six percent. Her mother is crying with relief, thanking everyone who walks past.
"Thank you," she tells me specifically, grabbing my hand with both of hers. "The doctor said you noticed something was wrong before it got bad."
"Just doing my job."
But it feels like more than that. It feels like proof that I can still do this, that Carson didn't break something fundamental inside me. That losing Lily didn't destroy the nurse I worked so hard to become.
My shift ends at 7 p.m., and I change out of scrubs in the locker room, exhausted and exhilarated in equal measure. My phone has three texts from Jackson, each one time-stamped hours apart:
How's it going? You okay? I'm in the parking lot when you're ready.
I find him leaning against his truck, still in practice gear with his hair damp from the post-practice shower. He straightens when he sees me, searching my face for clues about how the day went.
"How was it?" he asks.
I burst into tears.
He's here immediately, arms around me, holding me while I sob into his chest.
"Bad?" he asks quietly, one hand stroking my hair.
"No. Good. I did it, Jackson. I'm back, I'm actually back."
"Of course you did. You're brilliant."
"I was so scared. Walking in this morning, I was terrified I'd freeze, that I'd see Lily in every patient, that I'd..." I stop, wipe my eyes with shaking hands. "But I didn't. I did my job. I was a nurse again."
He kisses my forehead, both temples, and my nose, with gentle, reverent touches. "I'm so proud of you."
