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It wasn't that she'd never seen death. Victoria had worked in a Tier One Trauma Centre for months. She'd seen death. She'd seen every kind of thing that a car crash could do to a human body. She'd seen overdoses. She'd seen stabbings and gunshots and cardiac arrests. She'd had to stop performing chest compressions on nursing home residents whose DNRs had finally been sent over. She knew what a flatline sounded like on a telemetry monitor; knew the quality of the echoing silence that set in once the monitor had been switched off. She wasn't any kind of baby anymore. She'd seen death.
She'd just never sat waiting for it before.
Nowhere in the ED was ever truly quiet, but with the door closed and the blinds drawn and the lights dimmed, Roxie's room felt insulated from the outside world. Everything muted and muffled. Everyone inside it focused on Roxie as she readied herself for that one last, great effort—that last letting go.
Victoria held firm to every scrap of professionalism she could muster as Dr McKay administered the extra dose. It was important for the patient to know what was happening to them, the pros and cons of every treatment, so Victoria heard herself say, as if it wasn't the point, "Your breathing will slow down. You may get very sleepy."
And then there was the wait.
And then there was the slow, steady decline of Roxie's vitals.
And then there was Victoria, knowing what was going to happen and not able to change any of it, not one little bit.
Dr Robby had once told her, after a particularly tricky save, that a hallmark of a good EM physician was aggressiveness. "Cases like this, we're fighting death, we're going toe-to-toe with the Grim Reaper on someone else's behalf. We do not back down from that fight. That's our duty. That's what we owe to our patients. If someone's not willing to give it everything they've got just so a patient can have even a chance at recovery, well, dermatology's also a perfectly respectable sub-field."
Victoria had written that down in her notebook at the time, underlined it with a bold stroke of her pen: We are who we are because we fight. It had seemed like important wisdom, passed down to her from an amazing doctor who'd been doing this work for longer than she'd been alive.
Now Victoria wiped the tears from her face and slipped as quietly as she could out of the room.
"What now?" she asked McKay once she followed. Victoria felt the overwhelming, incredible urge to do something, anything—she just couldn't think what.
"Now, we wait," McKay said as she stripped off her gloves.
"How long before..." Victoria couldn't quite make herself say it.
"I have no idea," McKay said, applying a squirt of sanitiser to her hands. "Could be hours."
Hours. Victoria's hands were clasped together so tightly she could feel the knuckles protest. "This doesn't feel right."
"Remember, Robby talked about—"
"It still feels wrong."
McKay had one of those looks on her face, the kind that Victoria always hated—the one that said, politely, you are very young. It was incredibly frustrating. Victoria was a grown woman, a college graduate, a legal adult for basically everything except alcohol and renting a car at this point, and she knew her own mind.
"Okay," McKay went on, "this is Roxie's decision. Everything else in her life is out of control except this. She wants to go out on her own terms. Very few of us get to do that."
Victoria couldn't look at her. "I should pick up more patients," she said, and walked away.
And she intended to do that, she really did, she even went by the board to find a new one—some new challenge she could take on to prove herself, to show that she deserved to be there, to show that she was better than fucking Ogilvie.
But Victoria found herself hesitating, reconsidering. Slipping back into Roxie's room. It was still quiet in there, everyone's attention rigidly focused on the unmoving figure in the bed.
"She's such a fighter, really," Roxie's husband said after a moment, in a voice thick with tears, "hanging in there after all this time," but Victoria knew what agonal breathing sounded like. She knew Lena did, too. And when the wait for the next breath stretched out, and out, and out, and Victoria knew there would never be another one for Roxie, she reached out blindly and grasped Lena's hand in hers.
Roxie's husband let out one great, wrenching sob when he realised she was gone, and then he went very quiet.
Lena squeezed Victoria's hand, gently, and then said, "I'm just going to go find a doctor. Excuse me."
Victoria stayed. She wasn't needed at all now, she knew that. But it felt important for her to stay, to be a witness. She wasn't a baby, after all. She'd seen death.
Lena couldn't find McKay, so it was Dr Robby who came in to make the required checks: no pupillary response, no response to a painful stimulus, no respiratory effort, no pulse, no audible heart sounds. Victoria mentally checked them off, one by one, as he worked, and then as he completed and signed the relevant part of the death certificate. This was the legal end of Roxie Hamler.
Dr Robby handed the clipboard over to her and Victoria stared down at it.
Next to "Cause of Death", Respiratory failure due to lung cancer. Next to "Manner of Death", a check in the box labelled "Natural." And then near the bottom of the page, a check in the box labelled "Pronouncing & Certifying", followed by the rounded scrawl of Michael A. Robinavitch, MD, and then Dr Robby's medical license number in neat print.
And that was that.
As if Victoria had never been in the room at all. As if she hadn't just stood there, and watched, and done nothing, knowing that what they were doing wasn't fighting death—it was just turning the other cheek.
But she had been here. She had. She'd stood by and watched Roxie die. Victoria looked up and met Dr Robby's eyes, which were dark and sad and full of something there was no check box on an administrative form for.
Maybe that was why he insisted so much on the fight, Victoria realised. She looked back over at Roxie's still, pale form. You fought because you didn't back down. You fought because it was your duty. You fought because it was what you owed to your patients. You fought because you'd seen death, and you knew it was waiting; you fought it for yourself.