Very rarely, I have moments where I just don’t want to help. My enthusiasm for doctoring is nearly unflappable, but once or twice a year, the right—or wrong—mood hits me, and I want to leave a shift. As I wait for the line of ambulances to bring my suspected spinal cord injury, that’s exactly where I am.

Landon’s out there somewhere. I need desperately to find him. I can’t imagine what he must be feeling, and I hate myself so much for not telling him sooner. He deserved to know. He deserved to know before now, regardless of how little his knowing would have changed things, or how much it terrified me.

I deserve this, I think with a knot in my throat. I’ll deserve whatever happens to us.

I keep texting him, and I know he’s really upset—obviously he is—because he hasn’t even looked at my texts.

I’m gritting my molars as yet another stretcher comes in. I hope my guy—or gal—with the suspected SCI isn’t last in line. I need to get them stable, pass them to the night floater, and split.

I hear shouting as the automatic doors swish open, and three EMTs bustle in with another person on a backboard—this one held down low, as if he’s heavy. With my eyes still on the doors, I listen idly to what they’re telling the ER attending, noting something about a mean right hook.

“—wild and talking crazy,” one of the EMTs is saying.

A second later, I hear a low shout echo down the corridor: “I SAID I WORK HERE!”

Cold sweat washes over me, but I stay rooted to my spot for the next few minutes, still watching the doors as my brain fails to connect the dots. And then I do connect the dots, and I am flying toward the private rooms because I know that voice, and that was Landon.

That was Landon on the backboard. Oh my fuck, he’s bleeding! As I near the private rooms, I hear him snarling, “I can move my fucking feet. Unstrap me, man, I’m not gonna fucking punch you.”

EMTs are gathered ’round the entrance to his room. I can hear the nurses talking heatedly over his low voice.

“You’re going to have to calm down, sir, so we can validate your—”

“I’m checking your lung sounds,” another interrupts.

“BP’s through the sky.”

“There’s no way he works here,” says the EMT in the doorway.

I squeeze into the room and—oh God. Landon’s lying on his back atop a railed bed, still strapped to the ambulance backboard. His head is bleeding, his mouth and nose are covered by an oxygen mask, and his chest is bare and mottled with bad bruising. Even so, his shoulders lift up off the board, his biceps straining as he fights the thick, leather restraints around his wrists.

“I fucking told you I’m a surgeon—”

“We have no ID,” an EMT cries, at the same time someone else says, “You’d better watch those wrists, then.”

“Quiet—so we can triage, doctor! Catie, do you have that Nitropress? We’re almost to minute five with numbers like this—”

I step closer to the bed, and Landon sees me. “Evie…oh God. Please.” He just lies there, panting and groaning as he tries to free his arms by force. I remember what he said—about the group home.

“Get rid of his restraints. Take them off, right now,” I tell the nurses.

“He hit one of my guys,” an EMT calls from behind me.

“He’s a surgeon. If he used his fists, your guy probably earned it.” I turn toward them, my heart pounding wildly. “I want everybody out. Dr. Jones is my colleague. I’ll triage him.” No one moves. I throw my hands up. “I said everybody out!”

Landon’s eyes shut as he struggles to breathe, gasping on the inhale, moaning on the exhale. Shit. The right side of his chest is so bruised, there’s no way his ribs are all intact.

“Blood pressure is still high,” one of the nurses says as she goes. She hands me a syringe: the Nitropress.

The EMT mutters something as he leaves, but I don’t even stop him for a report. Landon’s chart will be in my tablet, sent wirelessly from the ambulance to our ER. My hands tremble wildly as I pull it up. I don’t look at him, but I can hear him panting—breathe, then moan; breathe, then strangled moan. I can tell he’s trying not to make noise, but he must be in awful pain. The thought of that is almost my undoing.

You don’t get to fall apart. You deserve this.

With my leaking eyes, I scan his chart and call for the portable CT scan. Then I move slowly over to the bed, holding my stethoscope to his bare chest while I look down at him. My throat knots up as I hear abnormal chest sounds: evidence of a problem. Tears spill down my cheeks, because I hate this so damn much. I hate myself.

With shaking fingers, I reach down and touch his hair. His gray eyes are wide, the pupils slightly dilated. He looks dazed—but when my thumb brushes his forehead, he groans softly.

“Hey there…let me—”

“Go,” he mumbles.

“What?” My heart is beating so hard that I feel faint, but Landon doesn’t need to know. I use my softest voice when I say, “I’ve gotta check you.”

“No…you don’t.” His teeth grit as his face twists. “Please go.”

“You want me to go?”

He groans again, and when his eyes squeeze shut, a tear slips down his temple.

My heart shatters.

“I can’t go yet. Just tell me what hurts. Don’t talk to me like Evie, okay? Just let me check you like a doctor. When I know for sure about you after CT, I’ll shoot you full of morphine. Okay?” I stroke his hair again, and Landon’s lips form a tight line.

“I’m going to touch your chest,” I whisper. Most of the bruising is in a certain area. I hold my breath as I run the pads of my fingers over it. Landon grunts.

I shake my head as tears obscure my vision. “I’m so sorry.”

Just as I get ready to step back and make a more urgent call for CT, he grabs me by the shoulders, pulling me down on him as he starts trembling. “Evie…”

“God.” I stroke the only clean spot I see, near his neck, and Landon’s hand squeezes my shoulders.

I wet a cloth and wipe his face around the oxygen mask. He’s pale under the blood. As I clean him off, his eyes hold mine, and he continues trembling. I’m so intent on his face, I don’t even notice his BP until the monitor starts dinging. He’s at 80 over 40.

Shit!

I rush to push some Levophed into his IV and call for ICU. Fuck it—I’m not holding out for the CT. I want the urgent team.

In the seconds between my call and their arrival, I lean over Landon, pressing my lips to his forehead as a single sob slips out. “I’m so, so sorry.”

His hand grips my shoulder. As two nurses and the ICU chief burst into the room, his eyes roll and he says, “My legs.”

* * *

This is not real life.

Lee Peterson, one of the top attendings in the ICU, is not muttering about pneumothorax as he runs the portable CT over Landon’s supine body.

The images arrange themselves on the screen, and everyone talks at once until Peterson holds up a hand and tells the group, “We’ve got a minor pneumothorax from one of these cracked ribs. Hairline fracture of the clavicle, and most significant, a fracture of L1. Not looking too stable either. I’m going to page Billards,” he says as we lean in so we can see the images.

As I take in the pictures of Landon’s lower back, I feel like I might faint.

“Is Billards here?” I hear myself ask. He’s our most experienced neurosurgeon.

“He is,” Peterson says. He looks at me. “Did you hear what happened—to Jones? How bad was the wreck?”

Tears flood my eyes as I tell him I don’t know.

I’m such a liar. This is my fault. My fault. It’s because of me that Landon’s lying here straining to breathe, unable to move. His lower body has sensation, but it seems to be a little altered. If there’s pressure on his spinal cord…I wipe my eyes as I struggle to keep from sobbing.

Billards returns Peterson’s call, and Peterson steps into the corner with his phone pressed to his ear. “I’m no neuro guy,” I hear him say, “but L1 has an obvious fracture, and it doesn’t look stable to me at all.”

Blood roars in between my ears as I look over at Landon. At the mask on his face and the probes on his chest. I want to touch him…

“No, it’s not,” Peterson is saying. “That’s a lot of pressure on the cord.”

A moment later, Eilert bursts in. “How’s he doing?”

I guess someone called her.

I step over to Landon as I try to fill her in. I stroke his arm before I realize my mistake, but no one notices as Peterson catches Eilert up and we start stabilizing Landon for the trip up to the third floor.

Every minute, more people flood into the room. Billards, a nice guy about my dad’s age, arrives eating a granola bar and quickly reviews the images. He tosses his wrapper and tells us, “OR four is open. Let’s get rolling.” He looks to Peterson, and then Eilert. “More fluids. I want to know more about reflexes, spasms, weakness if he rouses.” Then he looks to me. “You’re in his cohort group?”

I nod.

“Okay. You’re scrubbing in. Sometimes you’ll find it’s someone that you know,” he says in cryptic tones. “This is good training.”

I look down at Landon. My head’s pounding, and my stomach’s twisting.

“Take some deep breaths,” Eilert says.

“What about the pneumothorax?” Prinz asks.

“I don’t think we’ll need a chest tube,” Peterson says.

I’m swimming through time. I’m moving, helping, but I’m somewhere else. In the basement of my parents’ house. In Landon’s bedroom here in Denver. On his cool, brown sheets. Back in the Lyft. All I can think about is the look on his face after we scrubbed out together, earlier today. The way he looks as he moves over me. His eyes and his mouth in motion.

I don’t want him to have an L1 fracture! He’s a surgeon, not a patient!

I think about the fix for his back and have to grab his bed rail when I realize we’re probably going to have to take a left-sided thoracolumbar junction approach. It’s a heavy-duty surgery with an absolutely brutal recovery. I can’t even stand to think about doing such a thing to Landon. Again, I’m on the verge of breaking down.

By the time we start to scrub in, everyone is discussing point of entry. I’m swallowing back bile.

I make it into the OR and see him spread out on the table, being shepherded through early anesthesia by Pat and Wynn, the anesthesiologist/nurse anesthetist pair we scrubbed in with earlier.

He’s positioned on his right side, with his arms extended straight out, zombie-style, and strapped down to a board. They’ve got his lower leg flexed, and a pillow between his legs, and his hips are being strapped to the table.

Wynn inserts a breathing tube while Billards gets another CT. I move with the pack, analyzing the results of this new CT, listening through a haze as Billards discusses his game plan, which I’m relieved to hear is a significantly less invasive VATS approach for L1 body reconstruction.

“Not every patient at this hospital gets the VATS treatment,” he says with a shake of his head. “Only the lucky ones when Dr. Briggs or I am on call.”

VATS is the ideal procedure for an easier recovery, so this news has me shaking with relief.

As Billards talks, I can’t stop looking at Landon. I hate the sight of him up on the table with that cruel tube down his throat and props and blankets positioning him so unnaturally. I try to tell myself that he’s asleep, and he has no idea what’s going on, but that thought makes me feel ill, as well. He doesn’t know yet that the car wreck—where he was a victim of a run stop-sign, I’ve heard—could end his career, even his life if something goes wrong.

I watch silently in my surgical getup as Eilert marks his torso in four spots, for port insertion sites. We’ll need a working channel, an optical channel, a traction channel, and a suction channel. Even though Billards is in charge, I get the sense that Landon’s surgery will be mostly Eilert’s—and I hate her for it. Eilert is one of our chiefs, but she’s a resident. I want Billards at the helm.

I listen as he tells us, “We’ll be using an expandable Synthes cage. It’ll be placed in the vertebrectomy defect, gradually distracted, and locked into place to stabilize the cord.”

He and Eilert discuss the four channels at length, as he explains pitfalls of the positioning to her.

“Rutherford, I want you to construct the suction channel. That’s your job here. You do that well, you’re scrubbing out if you don’t want to do more. How do I know Rutherford is uncomfortable?” He looks around the room as he points to his head. “She’s sweating. Pale. She looks like she’s the patient. This is why we don’t perform surgery on a loved one if that is an option. At a smaller hospital, it is not always an option.”

Somehow, I remain standing as Billard talks ad nauseum and Landon lies there, frozen by anesthesia, being hovered over, poked, and prodded. Prinz arrives in surgical gear as Billard explains that for VATS to be advantageous for the patient, the surgeon must be experienced in restoring the diaphragm with the use of an endoscope.

“This is a developing subspecialty of thoracic surgery. You master this, you’ve got a gold star on your resume.” Moving closer to Landon, he continues, “Decompression will be performed using laminectomy. We have one broken fragment we’ll push forward, toward the body, before inserting screws from the rear. In a more severe fracture, we might come back in a few days later and remove the destroyed body with thoracic endoscope, but in this case we’ll be doing all that now. If all goes well, our colleague will get his chest tube out in four to five days and be discharged in perhaps ten. Surgery like this might take a toll on a geezer like me, but Jones here is a young man.”

I hold my stomach as he explains routine opening procedures. Billard is too specialized to deal with first or second year residents much, and I can tell he views the situation as something of a novelty.

So much of what he says makes me flinch—things I hear daily without batting an eye, like the warning he gives us to properly restore the diaphragm in order to avoid pneumonia and herniation of the large intestine.

He means Landon’s large intestine.

Somehow, somehow, somehow…I stay on my feet for three hours. After the first two, I’m just watching—mostly watching Landon’s vitals and the mortal hands that work the gear that’s rearranging my love’s insides. Every semi-sigh from Eilert or grunt or complaint from one of the techs makes my head spin. Every spurt of blood and BP fluctuation make my knees wobble.

I’m standing near his head, wanting so badly to touch him—just his forehead—when Eilert takes a bathroom break, and grabs me by my elbow. She leads me gently from the room.

“Rutherford, scrub out,” she says, doing so herself. “You look like you’re about to collapse.”

I nod woodenly as she heads for the women’s room. I make sure I’m out of earshot before I start to sob.