Work Text:
Trinity Santos hated her uterus.
All it had ever done was cramp, bleed, and cause her pain. It wasn’t just a mild discomfort either, no, but the kind that radiated up your back and your legs, wrapped around your belly and squeezed you from every side. And judging by the fire currently nesting in her abdomen and distracting her from getting report, today would be no different.
The IUD, of course, was supposed to fix that, but it’d been placed a mere two days ago, and so for the moment she would remain in myometrial hell. The back-to-back days off she’d wiggled into her schedule had already been a stretch, and even if that stupid OB/Gyn doc had given her real pain management options, it wasn’t like she could pop Narcos at work.
After report finished, she made a quick detour around central for her work bag. She seized her prize—a well loved, bulk bottle of ibuprofen—and took two, a quick squirt from her water bottle washing them down.
Another cramp rolled through her as her uterus rang itself out like a towel, and her breath hitched. Fuck. She forced herself to take a long, steady breath, briefly letting her eyes fall closed and a long sigh escape. The wall was cool against her head.
“Can’t be sleeping yet, Dr. Santos!” a gruff voice called.
She shook her head, blinking her eyes quickly as Abbot’s face came into focus. “Some of us just got here, y’know,” she called after him, pushing off the wall.
Abbot turned around for just long enough to respond, continuing to walk down the hallway with surprising speed. “And some of us got roped into a day shift, so look alive.”
She took another stiff breath, chuckled dryly, and followed him towards central.
The constant drone of beeping and ER bustle faded away as Santos pushed into the bathroom. Her stomach roiled as she bolted towards a stall, hands fumbling to close the lock behind her before she could lunge towards the toilet.
She barely had time to take a breath before her stomach twisted, squeezed, and vomit spewed forth from her mouth. Her hands dug into the cold porcelain as she clung onto the toilet, chest heaving.
The vomit in the toilet was only bile. She didn’t even have anything left to throw up.
Her stomach flipped again as every muscle in her abdomen contracted. She groaned weakly as the vomit came again. There was nothing she could’ve done to stop it. Her throat burned, eyes water as she stared down at her own stomach contents. The smell was rancid, pungent and personal, but she still couldn’t quite bring herself to reach up and flush it.
Just one more moment, before she had to go back out there.
“Dr. Santos?” A voice from outside the stall said.
Trinity jumped so hard she almost hit the ceiling. The voice was too young and too upbeat to be anybody else. “Hi Crash,” she sighed, pulling herself up from the floor.
“Are-are you okay?” She asked. Why did it have to be her? “Do I need to get Whittaker? Or-Dana?”
She scrubbed her face as she finally flushed the toilet. “Because I dropped something on the floor? Sure, you can call Huckleberry if you want.”
Javadi was waiting for her right outside the stall door, and Trinity shouldered right past. “I just wanted to make sure that you were okay,” she said.
“I’m fine.” Her tone was short as she washed her hands, not lifting her head up to meet what had to be Javadi’s gaze riveting into her from behind.
She opened her mouth to speak again, but Trinity pulled the bathroom door open first. “I’m fine, Crash. I’m always fine.”
“You look like shit, kid.”
Santos’s eyes flickered up from her workstation, squinting into the harsh hospital lights to find Dana was standing over her desk, eyes peering over her glasses and tablet braced against her hip. “Thanks, Dana.” Trinity sighed, a chill shuddering through her. “I assume you’ve got another for me.”
As she moved to stand again, pulling her badge down to lock her computer, her joints protested the movement while her stomach lurched inside her belly. Still, she managed to keep a mostly straight face. It was only eleven am. The rush hadn’t even really hit yet. They couldn’t go without her.
Dana’s eyebrows raised as she set her tablet to the side. “No, I don’t, actually.” She stepped closer, voice lowering. “How’s about you go to the break room, and take fifteen, yeah? Close your eyes for a bit.”
She shook her head, nausea spiking again as acid rose up her chest. “I’m already behind on my—”
“Your charting will be here in fifteen minutes,” Dana said, tone final but eyes soft. “C’mon, kid. I ain’t really asking.”
She sighed, pushing herself up with her hands, smiling with her lips pressed together. “See, Dana, I’m going….”
As she turned around though, a wave of dizziness rocked her, cramping radiating up through her back and down her legs. She forced herself to breathe again, the sensation of vomit crawling up her esophagus making her walk faster. Maybe Dana hadn’t been all wrong, about a break.
“Get him to CT, find me when he gets back,” Jack Abbot called as he weaved out of trauma two, pulling his gloves and gown off while the twenty-something car crash victim was shuttled away behind him. He didn’t look back at the room, heading back towards Central and its permanently lengthening board.
Dana met him halfway, face turned further down in a frown than normal. Her eyes locked onto his, and she started walking faster. That was a woman on a mission. “Dr. Abbot?” She called.
“Another incoming?" he said, gesturing back towards the still blood stained, gauze covered tile of trauma two. There was a reason he didn’t work day shifts.
She shook her head, stepping closer into whispering range before staying anything. “Something’s up with Dr. Santos,” she sighed, unfazed by the tight gaze Abbot was now raking over her. “Looks like hell. Got her in the breakroom.”
Abbot’s eyes raised, then furrowed. Santos wasn’t a breakroom type; most ER doctors weren’t, but Santos especially. She seemed to visit only for the occasional snack, and even then, not really. “Should she be in a bed?”
Dana shrugged. “That’s above my pay grade. And, between you and me, you’re lucky that I got to go anywhere but another patient.” She paused, looking out towards the ER, then back to Abbot. “Either way, you should know. She’s your resident.”
He hummed, the anxiety factory starting to churn away in his gut. “I’ll go check on her.”
“Good,” Dana nodded. She stepped away, but he knew she would linger. Santos was his resident, maybe, but this was very much Dana’s ER.
It took him a little longer than he liked to get to the break room, but he did get there, after a quick detour to discuss a patient with King. He knocked on the door, more out of habit than anything else, then shouldered it open.
What he saw made him stop in his tracks. It was for only a moment, but he did. Santos was keeled over the table, panting heavily, head in hands, a puddle of vomit pooled on the table beneath her mouth. Her skin was sweaty, hair plastered to his forehead and neck. “Dr. Santos!” he called as he moved to her side. “What’s wrong?”
She glanced up at him, eyes half lidded, mouth open. “I…uh…I…mmmm,” she mumbled, wincing in pain as she shifted.
Something was wrong with Santos. Something was very wrong with Santos. Abbot turned back, throwing the door open. “I need some help in here! And get a gurney!" he hollered into the hallway, before turning his attention back to Santos.
He dug in his pocket, finding a wrinkled pair of gloves and quickly pulling them on. “Talk to me, Santos.”
“‘M fine,” she said, weakly trying to push him away and stand up.
His hand came gently to a rest on her shoulder. “No, you’re not.” Behind him, the door slid open, and he turned back just enough to see Dana with a gurney, eyes tight, and a worried looking Perlah behind her. “Can you walk, Dr. Santos?”
She paused, then tried to stand up, failing under the light pressure of his hand on her shoulder. “‘M…fuck…’m dizzy.”
“Dana and I are gonna help you up,” Abbot said, waving Dana in. As she moved, he gave a quick report. “I found her like this, just now.”
“I’m fine,” Santos repeated again as Dana parked herself across by her other shoulder, across from Abbot.
Dana ignored her. “Up on three.” She counted down, and Santos was quickly hoisted from the wiry plastic chair over to the gurney. Her head fell forward when they moved her, as blood pressure bottomed out and her consciousness vanished. “Get her lying down now!”
Before Jack even had time to deposit her on the gurney and grind his knuckles into her sternum, her eyes popped open again and she made a pained noise, wrapping her arms protectively around her abdomen. “Fucking hell,” she groaned, while Dana tossed her feet onto the gurney and slammed the rail up.
“Trauma two is open,” Dana announced, eyeing the definitely altered, vomit-covered resident below her. “Perlah, Princess, Dr. King, with us!”
Abbot stayed by her head while they ran towards the bay, trying to assess her as best as he could. She was talking, at least. “Can you tell me your—”
“Trinity Santos…uh… ’s Wednesday, July 2nd, 2025….and…’m at th’ Pitt.” She winced as the passed over the threshold and into the room. Her belly must’ve really been hurting her. “...And ‘m fine. Just a stomach bug…no trauma two necessary.” She tried to laugh.
Jack didn’t smile back. “You’ve got severe abdo pain, vomiting, and I can feel the heat emanating off you from here. You’ve just passed out. Let us help you, alright?” She sighed, curling further in on herself, but she didn’t say anything in response. “Transfer on three, one, two, three!”
Santos was unceremoniously dragged onto the waiting bed in trauma two, and the team got to work. The orders flowed from his mind to his mouth seamlessly. “Let’s get her on the monitor, and I need access. Dr. King, go ahead and E-FAST her.”
He unlooped his stethoscope from his neck, leaning over her to listen to her lungs. “I’m gonna lift your shirt up,” he warned, before placing the bell on her chest. He saw her flinch at the movement, but she didn’t say anything. Maybe he was reading into it. Afterall, at the same time, Princess was burrowing a twenty gauge into her left elbow, while Perlah got her on the monitor and King smeared cold ultrasound gel across her abdomen.
“Good lung sliding, no free fluid in the chest or belly,” she declared as she cleared the goo away with a towel. A decent start with that, at least. “I did notice a rash here on the chest and shoulder, erythematous, blanches with pressure.”
He frowned a little. Definite infection then, and one beyond some gastroenteritis.
“Vitals: hypotensive at 86/54, heart rate 116, SpO2 94%, respers 34,” Perlah called, a thermometer probe still in Santos mouth buffering. “And temp 102.4.”
“Let’s get a 500ml normal saline bolus on board,” he said while he looped a nasal cannula around Trinity’s ears, tucking the prongs into her nostrils. Her eyes were wide, following every motion of the team swirling around her. He patted her shoulder. “Let’s get a POC glucose, and then go ahead and draw a CBC, blood cultures, coags, CMP, CK, and serum lactate.”
“Mmmmm….’s a lot,” she groaned, shying away as he quickly flashed a light in both of her eyes.
“I know,” he nodded, hand still resting on her shoulder. “We need to figure out what’s going on, okay?”
“Capillary glucose is 75,” Perlah reported as she wiped the left-over blood from Santos’s finger.
“And fluids are in,” Princess added.
He nodded. “Alright. Let’s get her exposed, look for any obvious sources of infection.” He looked back down to her. “We’re gonna have to cut your scrubs off, alright?”
She weakly shook her head, trying to pull away. “No…”
The movement clearly pained her, from the way her heart rate and respirations spiked. “We’ll cover you up again as soon as we can,” he assured her. Princess was already cutting away her pants, while King sliced through her scrub top.
Santos went quiet when her clothes were removed, revealing a cluster of parallel scars on both her thighs. It was no secret where those were from, not at all. Abbot could see her muscles stiffen, brow stiffened in more than pain. Before he could respond, Princess said something to her in Tagalog, which Perlah echoed. Whatever it was, it seemed to help.
“Let’s cycle another bp,” he said, gently squeezing her shoulder again. “And get her a blanket.”
“Warm one?” she asked, voice stressed but hopeful.
Abbot hated that he had to crush it. “No. You’ve got a fever of 102.4, Santos.” She rolled her eyes at him, but didn’t complain further.
He looked over to Dr. King, ready to have her lead the history taking when her ASCOM started singing the same damned tune that he heard in his sleep. “I got to take this,” she said, turning away for a brief moment. “It’s a critical value I-um…”
“Go, I got her,” Abbot said simply. He could see Santos’s demeanor change as soon as she left. Her expression became less stoic, eyes more tired, muscles more slack. “Any allergies?”
“Jus’ sulfa,” she winced again, face screwing up. “An’ I take a hundred of sertraline every morning, and I’ve had 800mgs of ibuprofen today."
“Alright, Princess, start please 650mg IV tylenol,” he said, starting his physical exam by feeling around her scalp and neck. “Can you tilt your head forward for me?”
She completed the motion easily, but she stared at him the whole time. “I don’t have meningitis,” she murmured.
He didn’t dignify the complaint with a response. “Do you have any health conditions?”
“Not officially,” she grumbled. Abbot raised an eyebrow. “But, endo, probably.”
He nodded. “Alright. Does this feel like a normal flare to you? Or something else?”
“No..” she swallowed. “That’s what I thought, at first. But it got worse.”
“Okay,” he said, pulling his stethoscope out from around neck again. “Can I touch your chest and belly?”
She nodded, though her head was lolled to the side, eyes fixed on the floor beside him. Moving as efficiently as he could, he started to examine her chest, palpating before auscultating again, then moved on down to her abdomen, this time listening first. When he started to palpate, he started at the top, moving down towards the areas that would likely hurt the worse.
Her face screwed up when he pushed down on her lower quadrants, and he could feel the muscles stiffen with the pressure. “It is worse when I push down or when I let off,” he asked, removing his hands.
“Push down,” she gritted out.
“Scale of one to ten?” He asked.
She paused for a moment. “Nine.” He mentally rounded that up to an eleven.
“Alright,” he pulled his hands away, replacing the blanket that Perlah had brought in. “When did you last eat?”
“Th’s morning, hada protein bar with meds.” She shrugged. “Haven’t really been hungry.”
He began to inspect the skin on her legs and arms for any hidden wounds, ulcers, abscesses, or other lesions that could’ve been causing the infection. Between the temp and the hypotension, she already met SIRS criteria. “Have you had any medical or dental procedures recently?”
She paused, tucking her chin down into her chest. “I had an IUD placed two days ago,” she said quietly.
That could’ve been it. Fuck. He’d have to check. “Santos, I think it would be best if I did a pelvic exam, so I can make sure there’s no infection.”
He could see her tense up when he said it. “Mhm...okay.”
Princess turned away from the IV pump, resting her hand on Santos’s. “I can stay with you, if you’d like. No problem.”
Santos nodded tearfully, hand twitching as she held on to Princess like a lifeline. She looked miserable, and there was no good reason to keep her that way. “Perlah, let’s get some analgesia on board before the pelvic, fent, start with 25 mics but you can titrate to 50.”
“Thank fuck,” Santos mumbled, and Abbot knew he had made the right decision.
While Perlah went and pulled the medication, he pulled open his drawers until he found his supplies—a disposable plastic speculum, some lube, swabs for cultures, and a Kelly, in case he needed to remove anything—ignoring how his name came up in Princess’s Tagalog chatter. She was snapping gown sleeves closed around Santos’s IV, getting her covered up again.
Perlah came back quickly, slowly pushing the fent while he pulled the little rolling stool over and set up his light. “Before I have you put your legs up on the stirrups, I want to make sure you know that you can say stop at any time, okay? If something hurts, I want you to tell me. If you need a break, I want you to tell me. Make sense?”
She nodded, tension bleeding from her face as the meds kicked in. She looked exhausted, eyes half-lidded and mouth slightly parted. Princess was still stationed by her side, holding her hand while her eyes bounced between Santos’s face and the monitor. There was no reason to wait any longer.
“I’m going to start now, alright? You’re going to feel me touching,” he narrated as he parted her labial folds. So far, it was unremarkable. He pulled back, lubing up the speculum before turning back. “The speculum’s gonna go in now. Shouldn’t be painful, just some pressure.”
He carefully slid it in, eyes flickering over to monitor to make sure her heart rate wasn’t sky high. She seemed to be okay, for now. Slowly, he cranked it open, reaching up with one hand to adjust the lamp. Santos flinched back, muscles tightening. “I know it’s shit, we’re halfway there.”
He carefully peered in, examining the cervix and surrounding mucosa. A cream-colored, thick, foul smelling discharge ran along the IUDs protruding strings. “We’ve got purulent discharge from the cervix,” he reported, looking up to Santos. “This is looking a lot like toxic shock syndrome, and your IUD is probably the source of infection here. I need to remove it, is that alright?”
She responded quickly. “Get it out, please.”
With the Kelly clamp, Jack carefully grabbed onto the strings and gently started to pull, steadily extracting the device from the uterus guiding it out of the vagina, before swabbing and bagging it for culture. “There we go, it’s out. I’m gonna get some swabs, and then we’ll be done,” he turned towards Princess. “Go ahead and hang the loading dose of vanco, thirty milligrams/kg and then add 2g of IV ceftriaxone. I’ll get orders in for the next doses, and also for as needed pain management and some Zofran, alright?”
“I’d kill for Zofran right now,” Santos said absently, and Abbot had to hold in a chuckle.
Princess was on it. “We’ll getcha’ taken care of, sister.”
“You did great, Santos,” he said as he removed the speculum and pulled the blanket back down over her, then helped her to lower her legs. “We’re gonna take care of you, okay? Let us know if you need anything.”
He saw a tear bead in her eyes as he turned leave, the never-ending onslaught of the Pitt waiting beyond the trauma bay doors. Abbott steeled himself in the same way he always had. Santos could rest now. His people were safe, and he had made them that way.
If only they could’ve asked sooner.