12. Shep

TWELVE

Shep

Thursday, July 11

6:08 am

I jolt awake, my skin prickling with an unnatural heat. Something's wrong. Turning to Elle, I'm struck by the waves of warmth radiating from her body. She's shivering violently, her face flushed and damp with sweat.

"Elle," I whisper, gently shaking her shoulder. "Are you okay?"

Her response is weak, barely audible. "I'm fine..."

My heart races as I press my palm to her forehead. It's scorching. Instinct takes over as I slip into doctor mode, checking her pulse. It's rapid and thready—a telltale sign of severe infection.

"Shit," I mutter, leaping out of bed. This could be sepsis. We need to move fast.

I grab my phone, dialing Cason as I struggle to pull on clothes one-handed.

"Cason, I apologize for the early call, but it's an emergency. My friend Elle needs to go to the ER. Can you come watch Opie?"

She agrees without hesitation, promising to be here in ten minutes. I hang up and turn back to Elle, who's drifting in and out of consciousness.

"Stay with me," I plead, carefully dressing her in whatever I can grab. Once she's somewhat clothed, I scoop her into my arms. She feels impossibly light and fragile.

I carry her downstairs, my mind racing through possible diagnoses and treatment protocols. As I ease her into the passenger seat of my car, Cason's headlights illuminate the driveway.

"Thank you," I call out to her as she rushes towards the house. "I'll call you as soon as I know anything."

With that, I peel out of the driveway, praying I can get Elle to the hospital faster than an ambulance. Every second counts now.

I grip the steering wheel tightly, my knuckles turning white as I weave through the empty pre-dawn streets. The roads are mercifully clear, and there is no traffic to slow us down. Every few seconds, I glance over at Elle. She's slumped against the passenger door, her skin ghostly pale in the dim light.

Keeping one hand on the wheel, I fumble for my phone and dial Charlie Hampton's number. An answering service picks up, and I grit my teeth in frustration.

"This is Dr. Shep Duncan," I bark, cutting off the receptionist's scripted greeting. "I need to speak with Dr. Hampton immediately. It's an emergency."

"I'm sorry, sir, but Dr. Hampton isn't on call tonight. I can connect you with?—"

"No," I interrupt, my voice sharp with urgency. "You need to get Charlie on the phone right now. Tell him to call me back immediately."

I end the call and toss my phone into the center console, muttering a string of curses under my breath. Reaching over, I take Elle's hand in mine. It's clammy and hot to the touch.

"Elle, can you hear me?" I knead her hand gently. "You're going to be fine, okay? We're almost there. Just hang on for me."

She doesn't respond, but I feel her fingers twitch slightly in my grasp. It's enough to give me hope.

"That's it," I encourage, pressing down harder on the accelerator. "Stay with me. We're so close."

The hospital comes into view, its emergency entrance lit up like a beacon in the darkness. I say a silent prayer of thanks as I screech into the ambulance bay, tires squealing against the pavement.

I slam on the brakes, run around to the passenger seat, and scoop her up in my arms. I carry her, her head resting on my chest.

I burst through the ER doors, Elle's limp body cradled in my arms. My heart pounds as I scan the room frantically.

"I need help here!" I shout, my voice echoing off the sterile walls. "Possible septic shock!"

A nurse rushes towards us, her eyes widening as she recognizes me.

"Dr. Duncan? What's?—"

"No time," I cut her off, gently laying Elle on a nearby gurney. "Patient presented with high fever, tachycardia, and altered mental status. I suspect sepsis secondary to a recent hand surgery."

I snap into doctor mode, rattling off orders rapid-fire:

"I need a full sepsis workup stat. CBC, lactic acid, blood cultures times two, urinalysis. Get a 12-lead EKG and portable chest X-ray. Start two large-bore IVs and begin fluid resuscitation with 30mL/kg of normal saline."

The nurse nods, calling for backup as she starts an IV.

"Let's get broad-spectrum antibiotics on board immediately," I continue. "Vancomycin and Zosyn. And I want continuous cardiac monitoring."

I grasp Elle's uninjured hand as the team springs into action around us.

"Check her surgical site," I instruct a resident who's joined us. "Look for any signs of infection or wound dehiscence."

I turn back to the nurse. "What's her temp?"

"104.2," she reports grimly.

"Okay, let's start cooling measures. Ice packs to the groin and axilla. And get me an arterial line for continuous BP monitoring."

My mind races, considering every possibility. "Order a CT of her hand and forearm with contrast. We need to rule out a deep space infection or abscess."

I step back, allowing the team to work, but I can't tear my eyes away from Elle's pale face.

I follow the gurney as they wheel Elle toward the ICU, my heart racing faster than her pulse on the monitor. The familiar antiseptic smell of the hospital hits me differently now—it's no longer comforting but suffocating.

"Dr. Anders," I call out as I spot the ICU attending. "I need you on this case. Possible sepsis from a recent hand surgery."

Paul Anders nods, already reviewing the chart a nurse handed him. "We'll take good care of her, Shep."

"I want every possibility explored," I insist, my voice tight. "Full sepsis protocol, and I want updates every hour until we identify exactly what is causing her sudden and rapid decline."

"Of course," he assures me, but I can see the question in his eyes. He knows this isn't just another patient to me.

As they settle Elle into an ICU room, I suddenly remember my car. "Shit," I mutter, patting my pockets. My phone. I left it in the car, which is probably still running at the ER entrance.

I turn to Paul, torn between staying and retrieving my phone. "I need to grab something. You'll call me immediately if there's any change? I'll be right back."

"Absolutely," he promises. "Go. We've got her."

I sprint down the hallway, taking the stairs two at a time, with no time to wait for the elevator. My mind races with possibilities - what if Charlie called back?

As I burst out of the hospital doors, I'm relieved to see my car still idling where I left it. I grab my phone from the center console and see three missed calls from Charlie. I hope to move the car and press send on his missed call.

I rush back to the ICU, my heart pounding. As I approach Elle's room, I see a flurry of activity. Doctors and nurses surround her bed, their voices urgent and focused.

"BP's dropping rapidly," one nurse calls out.

"Start norepinephrine," the attending physician orders.

I freeze in the doorway, my medical instincts warring with the emotional turmoil inside me. Elle looks so small and fragile in the hospital bed, her skin ashen against the stark white sheets. Tubes and wires snake around her, the monitors beeping ominously.

The team works swiftly, inserting a central line to administer the vasopressors. I watch, feeling helpless and terrified. This is Elle—vibrant, witty Elle—now fighting for her life.

My chest tightens as I see her hand, the one that was operated on not only a week ago, swollen and angry red. How did I miss this? I should have been more vigilant and should have checked. What good is being with a surgeon to her if I'm not on high alert? Fuck. That's why she should have been in rehab, not fucking me in my bed.

I force myself to step back, knowing I'm too emotionally involved to be of use. The ICU team knows what they're doing. They don't need a distraught neurosurgeon getting in the way.

Still, it takes every ounce of willpower not to rush to her side, to hold her hand and tell her to keep fighting. I've seen countless patients in critical condition, but nothing could have prepared me for seeing Elle like this.

As the vasopressors begin to take effect, I lean against the wall outside her room, my legs suddenly weak. The realization hits me like a physical blow—I can't lose her. Not again. Not like this.

I see Charlie striding down the hall, his face etched with concern. He nods at me before turning to Dr. Anders.

"Give me the rundown," Charlie says, his voice terse.

Dr. Anders launches into a detailed explanation of Elle's condition. I listen, adding bits of information where I can, but mostly, I let them handle it. My mind feels foggy, overwhelmed by the last few hours' events.

"We've started her on broad-spectrum antibiotics," Dr. Anders explains. "The source appears to be her hand. We're running cultures now to identify the specific pathogen."

Charlie nods, his brow furrowed. "And the vasopressors?"

"Responding well so far. We'll continue to monitor closely."

As they discuss treatment plans, I feel a tightness growing in my chest. The sterile hospital air suddenly seems thick and oppressive. I need to get out of here.

Charlie turns to me, his eyes questioning. "Shep, anything to add?"

I shake my head. "No, I... I think you've got it covered. I'm going to step out for some air."

Charlie's expression softens slightly. He knows me well enough to see I'm struggling. "Alright. I'll be here if anything changes."

I nod gratefully and make my way to the elevator. As the doors close, I lean against the wall, taking deep breaths. The reality of the situation is hitting me hard. Elle, the woman I'd let slip away years ago, is fighting for her life. And there's nothing I can do but wait.

I sit alone at the rooftop garden, the same table where Elle and I reconnected just days ago. The early morning air is crisp, but I barely notice. My mind races, replaying the last few hours' events on an endless loop.

Elle's burning skin. Her weak pulse. The frantic drive to the hospital.

I'm a neurosurgeon, for God's sake. I've seen countless patients in critical condition. But this... this is different. Elle isn't just another patient. She's...

I run my hands through my hair, exhaling sharply. The emotions I've kept at bay threaten to overwhelm me. Fear grips my chest as I consider the possible outcomes. Sepsis is severe - I know the statistics all too well.

But I can't think like a doctor right now. I'm too close, too invested.

I stare at the skyline, remembering Elle's eyes twinkling as she talked when we sat together. How easily the conversation flowed between us, bridging the decade-long gap. Now, she's fighting for her life, and I feel utterly helpless.

I know she's in good hands. Charlie and the ICU team are among the best. But part of me wants to rush back down there to do something, anything.

Instead, I force myself to breathe deeply, trust my colleagues, and have faith in Elle's strength.

But as the sun slowly rises over Birmingham, I can't shake the gnawing fear that our story might end before it truly has a chance to begin again.