2. Shep

TWO

Shep

8:21 pm

The waiting room is pandemonium. I'm the neurosurgeon on call this weekend. I never take holidays, but a last-minute change has me here on the fucking fourth of July.

As has been my luck recently, an emergency acute spinal injury came in. I've been here for five minutes, and it's looking like it will be a shitstorm of a Saturday night—big shocker.

It's my weekend with Opie, my four-year-old son. I wasn't originally supposed to be on call, but the schedule got moved around, and here I am.

His mom, Ari, and I have our co-parenting schedule down, and things typically are very smooth unless something outside of our control throws a wrench in them, of course. For example, she is out of town for the weekend, and I'm unexpectedly on call and have to go in.

Thank goodness his nanny, Cason, could come to the house on such short notice. I'm surprised she wasn't out celebrating like the rest of America. The fourth was Thursday, but so close to the weekend, it is like an extended firework show.

I had just put Opie to bed, so Cason really only has to sit on the sofa and scroll social media or whatever she would be doing at home. She is a very responsible person and is in grad school, so knowing her, she will study. Either way, she needs to be a warm body until I can get back home.

Now that I see what is coming into the ER, I feel confident I'll be here for a while. Fuck.

I scan the sea of panic-stricken faces as stretchers and wheelchairs are rushed through the double doors. The multi-car pileup on I-65 has the ER bursting at the seams—nurses and techs bark orders, trying to triage the infinite trickle of injured victims.

"Hey, Marcus," I call over to the emergency department attending. "Looks like you have your hands full."

"Understatement," he says as he rushes by. You couldn't pay me enough to run the emergency room.

I've been called in to attend to a fifteen-year-old girl who got impaled on a disconnected picket from a nearby fence. She was jumping on a trampoline when she bounced off and landed on the quaint, paint-flecked pseudo sword.

The fence that enclosed her friend's backyard, only five feet away from the death trap, is apparently in disrepair, and several pickets are coming off. She had the unlucky misfortune of landing right on the unconnected but erect post.

Who thought it was appropriate to put a trampoline so close to a line of wooden, pointy swords? Christ. The decisions some people make never cease to baffle me.

The patient, my patient, is awake and lying on her side, immobilized. She is able to move her extremities on command and is alert, but the scan shows that the picket was only millimeters, at most, away from severing her spine.

They called me in to make sure we don't paralyze this girl when removing the picket and to hopefully keep all the important nerves surrounding it intact.

There are no certainties with this type of injury, but I'm the guy to do the job. To give her the best chance of keeping her safe and walking at the end of this. She's lucky I'm the neuro on call today. I do not doubt that I can complete this successfully.

My last neuro fellowship finished just over a year ago. I've dedicated my entire life to school or training, starting when I was in kindergarten over twenty-five years ago. I went straight through college, then med school, residency, and two fellowships.

It feels good to put all that training to use as a neurosurgeon finally. I am revered in my field. I'm considered one of the best emerging neurosurgeons on the East Coast.

I love what I do, and I love cases like this. Yes, it is incredibly annoying when they come up at the end of the day on a Saturday or on a holiday weekend when I am with my son. But the precision and skill required to pull off a procedure like this give me purpose. I love this shit.

"Fancy seeing you here on a Saturday, Dr. D. I hope we didn't interrupt a hot date," says Carly Gunner, a sassy, no-nonsense ER nurse. She has been on my case since I broke her good friend's heart when I started back here at UAB. We've known each other since my residency days here, and she has no time for what she calls my "playboy ways."

I'm not really a playboy. I just have zero interest in commitment. I'm upfront and honest about it whenever I meet a woman. I'm all about enjoying the company of the opposite sex, but I keep it casual and unattached.

"If only I were so lucky."

"That's your problem. You have too much luck." With that, she is off.

This removal is a precarious procedure, but after looking at the patient's images, I feel confident I can safely get it done. And hopefully, she will never jump on a fucking trampoline again. But if she does, please God, make sure it isn't feet away from a fence.

They are preparing her for emergency surgery. It will take at least another thirty minutes to get the room ready and to get her set. I walk out into the main area to get a coffee before I scrub in and to get myself and my mind right for what will likely be a four-hour ordeal.

That's when I see her . My eyes lock onto a woman before my brain registers who she is.

She has a bloodied hand pressed against her chest. I can see fear and shock blend into those achingly familiar eyes, punching me in the gut with a force that takes the wind right out of my chest.

I'd know that heart-shaped face anywhere, those full lips I used to devour during our long nights together in college when only our love and passion seemed to be the most essential thing in the world.

Elle.

My Elle. Jesus, how has it been ten years?

I still remember the fight like it was yesterday: the shouting, the accusations, the finality of it all. We were in my apartment, boxes already half-packed with my stuff, ready for the next chapter of my life—med school.

Elle stood there, tears in her eyes, holding that damn job offer in her hand like it was a lifeline. And maybe it was.

She had this incredible opportunity to work for a marine biology company that would also put her through school to get her doctorate. It was her dream, just like becoming a neurosurgeon was mine.

We both knew what was at stake. I had acceptances from the University of Florida, UAB, and MUSC—all top med schools in the Southeast. If I chose Florida, we could stay together, she could take the job, and we could build our future in Gainesville.

But I had my eyes on UAB. It was the best fit for me, the best chance at getting the top Neuro fellowship. And I thought she would understand and follow me anywhere if she loved me.

But she didn't see it that way. "You're asking me to give up everything I've worked for, Shep," she said, voice cracking. "If you cared about us, you'd stay here, go to med school here. We could make it work."

"I've worked my whole life for this," I shot back. "You should be willing to move if you care about me. About us. Don't put all of this on me," I yelled at her.

The argument spiraled from there, each word sharper than the last. She accused me of being selfish and of not caring about her dreams. I accused her of not supporting mine.

It was ugly and messy, and in the end, she stormed out. We broke up that night, and I chose UAB. I left Gainesville without looking back. In my mind, I was following my path, my calling. But to her, I was abandoning her, breaking her heart.

Ten years. It's been ten years since that night, and we haven't spoken a word since I walked out... Except by text to ask her when I could get my stuff out of her apartment. I threw myself into my career, built my reputation as a top neurosurgeon resident, and became department head.

I've had a few quasi-relationships in that time, but nothing serious. The most significant was with Opie's mother, and even that ended before it really began. We co-parent, but there was never any real love there. Just two people trying to do right by their kid they didn't plan but love unconditionally.

Elle doesn't see me, but I can't stop watching her. The nurse pushes her through the double doors into the elevators. My heart is literally beating out of my chest. I've got to know why she's here.

Her clothes are pretty bloody, so I'm wondering if she is one of the victims from the car pile-up.

What is she doing in Birmingham? I realize I haven't breathed in the several seconds since spotting her. How can this woman from another lifetime have this effect on me?

Fortunately, she doesn't notice me. I am a voyeur, watching from afar as she gets further away from me. As creepy as it may seem, I can't pull my eyes away.

Memories bombard me as I head to the nurses' station to find an open computer. This is an ethically gray area. Should I be looking into the charts of someone at the hospital if she isn't my patient just because I have access? It is questionable but not a clear-cut abuse of privileges.

I walk over to the computer to pull up her name. Buster Hankel, a good friend from our college days and now a fellow general surgeon here, calls out to me, "How was that date last week? I told you not to mess with that girl!"

"Oh, dude, you know how it goes. Once you said that, you know I had to explore for myself. It's like telling a kid not to look in the box."

"I know how you work, Dr. Love. You're gonna have to clean up your act one of these days."

"That sounds more like the advice you got from one of your paramours."

He is one to talk. Before he got locked in with his most recent girl, he might have gotten around this town more than I ever did. And I don't mean helping patients.

Pledge brothers at UF, we have known each other for half of our lives now. We know more about each other than I would like to admit.

My mind wanders back to Elle. She might've been the one that could've tied me down. Instead, I'm in and out of relationships with no interest in any woman beyond a fling. I have no desire to settle down.

Could we have settled down? Maybe during a different time, but pre-med school, no way.

Now I have my work and my son. And that's enough for me. I don't see that changing anytime soon, if ever. At thirty-two, I find myself becoming set in my ways. I can't imagine having a woman, the same woman, day in and day out, dictating what I can and can't do and commanding most of my free time.

I pull up the information on Eloise Kass and realize that she is not part of the multi-car accident. It looks like she fell and injured her hand.

There is a chance I could be called in on her case if there is nerve damage, and this would not be appropriate due to our past together. Now, that is a clear medically ethical no-no. The thought of it causes my heart to race.

A tightness in my chest leaves me feeling forlorn. After the trampoline girl, I make a mental note to check in on this. I'll make sure she has a good surgeon on her case. It's the least I can do.

I watch as she is wheeled onto the elevator. Besides the nurse, there is a girl I vaguely remember from college with Elle. What is her name?

Elle and I were very close throughout most of college. We started dating when we were sophomores at the U of F.

I viciously shove it all out of my conscious thoughts. Lock it back up into the deep, dark chamber I've kept bolted for almost a decade. Now, I have a patient to focus on and the laser-precise extrication of a wooden sword from her back.

Part of my superhero talents is compartmentalization. I need to block everything out so my patient and work have my full, undivided attention.

The professional mask solidifies. I slip into doctor mode with a sharp inhale and head to the OR.

9:01 pm

There's a palpable tension in the operating room that crackles like electricity. Bright, sterile lights bear down on me, but I'm in my element. This is where I come alive, where the years of sacrifice and relentless dedication coalesce into something meaningful.

The sight of the girl's spine, barely spared by the intrusive, oversized splinter, is my canvas. A hush falls over the room as I begin.

"Hello, Elizabeth. I'm Dr. Duncan. I'm going to take care of you."

She replies in a whimper, her nervousness evident. "Thank you."

She's been given enough medication to numb the pain but not enough to knock her out. I want her awake while I perform the surgery to make sure she is able to feel the pressure and move on command.

She is lying on her side. An intricate contraption supports the board to ensure it doesn't move until we are ready. She has been lying like this since she came in over an hour ago.

The pointed piece of wood juts out menacingly, a cruel invader in her young body. Every fiber of my being is focused on it—the enemy that threatens to rob her of her ability to walk. I push away any thoughts of failure or complications. There is only the task at hand.

"Scalpel," I command, my voice steady and authoritative.

The instrument finds its way into my hand without me even looking away from my canvas. I make the first incision with a deep breath, my hands gliding with instinctual precision honed from thousands of hours in classrooms, labs, and operating.

"Forceps," I call out next, my voice clipped and professional.

I need to stabilize the wooden stake before I can even dream of removing it. My hands are steady, practiced from countless hours spent honing my craft. There's no room for error here; a single misstep could change this girl's life forever. The weight of that responsibility settles heavily on me.

"Slow and steady," I remind myself aloud, my eyes never straying from the delicate procedure unfolding before me.

My team moves around me in choreographed harmony, instruments passing back and forth in a well-rehearsed theater. The silence is punctuated only by the beeping monitors tracking her vitals and my commands.

The room holds its collective breath as I grip the wooden intruder with forceps. One false move could mean disaster. I feel the eyes of my team on me, trusting in my ability.

"Suction," I demand without taking my eyes off my task.

I have to create an opening around the stake without touching it. Sweat beads on my forehead, my concentration unwavering.

It's a game of millimeters now. The wooden picket, slick with blood, gradually loosens. I feel the collective relief in the room when it finally gives way.

"Elizabeth, can you wiggle your toes for me?"

She doesn't say a word, but a tiny movement on both feet lets me know she is registering my commands and is able to comply. My heart races, and I let out a sigh of relief.

"Great job. You're doing great. We are almost done. Can you wiggle a finger on your left hand?"

Her pinky moves ever so slightly. Bingo.

But the job's not done yet. The hole left behind needs to be cleaned and stitched up meticulously.

Sunday, July 7

12:59 am

I emerge from the theater, still humming with adrenaline. The wooden stake is out, Elizabeth will walk again, and I bask in the procedure's success for a moment. There is something indescribable about the feeling of a successful surgery, where I can do something only a small handful of people on this planet can do.

Her parents are waiting, their faces red and drawn in the harsh fluorescent light. I see the fear etched in their eyes, their bodies rigid with tension.

"I've got good news," I tell them as I approach. My voice is steady despite the whirlwind of emotions inside me. "The surgery was successful. Elizabeth is going to be just fine. She will be a little sore, and she will need some time to heal. Therapy will be a part of her journey, but she will make a full recovery."

Relief washes over their faces, followed by tears and laughter. The mother wraps her arms around me in a tight hug, which is part of my parting gift. I'm not a touchy-feely person, but sometimes, family members come at me quicker than I can head them off. "Thank you," she whispers into my ear, her voice choked with emotion.

Her father claps me on the shoulder, his eyes shiny with unshed tears. "You saved our little girl," he says. "I'll never be able to convey how grateful I am that she could come here and that you were on call. Thank you, Dr. Duncan."

My job theoretically ends after surgery, but I always follow up, at least initially, the next day or two. The residents and PAs handle the cases post-op, working with setting up rehab, adjusting meds, and monitoring vitals. I'm only brought back if there are major issues or unique or unexpected results.

As I turn to leave them with their relief because of the successful surgery, my eyes fall on the stunning woman sitting up in her bed in one of the rooms across the hall. This time, she sees me. Our gazes meet, and my heart skips a beat.

Her hair is pulled back from her face, her eyes wide and vulnerable as they lock onto mine. She's talking with the nurse, and the familiar woman is no longer there with her. Her lips part in surprise as she recognizes me. Everything around me disappears for a moment, and there is only her and me.

My pulse quickens, and once again, I'm transported back to another time, another place—back to when she was everything to me.

It looks like she has a new dressing on her hand, and she now has on a hospital gown. She doesn't look as gory as when I first saw her being wheeled through the emergency room.

I will clean up, but I should speak to her now that she has seen me. It would be awkward at this point not to. I know she is up and awake, so a quick hello might be good for the both of us.

I pop into the nurse's closet and remove my bunny suit. Then I take a deep breath, head back to her room, and knock on the doorway, my knuckles rapping lightly against the frame.

My heart is pounding in my chest, an unexpected and unnerving feeling, and I'm suddenly self-conscious she will pick up on it.

As I step into the room, I see her lying in the hospital bed, her hand bandaged, looking as beautiful as ever. Maybe more so.

Her eyes meet mine. For a moment, I'm twenty again, and we have some fraternity events to attend. Everything was more uncomplicated then, and the future seemed full of endless possibilities.

"Elle," I say, my voice sounding steadier than I feel. "Wow. It's been too long. How are you? I mean, in general. It looks like currently, you could be better," I say, gesturing toward her hand.

She looks up, her expression a mix of surprise and something I can't quite place. "Shep Duncan," she replies, her voice soft but guarded. "I thought that was you I spotted a little while ago. You haven't aged a bit in ten years."

"Yeah, it has been a minute," I say, taking a step closer. My usual confidence with women seems to have evaporated, replaced by a jittery, almost teenage nervousness. "When I saw you, I had just gotten out of surgery and needed to wash up. But I couldn't leave without checking in on you."

"Thanks," she says, shifting slightly. "It's... it's good to see you."

Her words catch me off guard, and I can't help but notice how the years have only made her more beautiful. "What happened?" I ask, more to fill the silence than anything else. "I mean, to your hand?"

God, I'm a bumbling idiot.

"I was helping set up for my friend Isabella's engagement party," she explains, her eyes dropping to her bandaged hand. "I don't think you ever met her."

"Name seems familiar," I fib. I have a terrible memory with names. "Who is she marrying? Anyone I know?"

"No, a guy named Mark. He didn't go to Florida."

"Nice. So it was a dangerous party, huh?"

"Well, not for everyone. I fell off an eight-foot ladder and grabbed a huge crystal vase on the way down. I cut my wrist pretty badly. Looks like I'm going in for surgery in the morning."

"I'm sorry to hear that," I say, feeling a pang of guilt. "Are you in much pain?"

"A little," she admits, "but they've got me on some good meds. I'll survive."

We fall into an awkward silence, and I can't help but feel like a fish out of water. I can't figure out why I'm being such a bumbling idiot. I've been with countless women since we broke up, but none of them have ever made me feel this way—like my heart is about to burst through my chest cavity.

"Look, I'm here all week. I was on call today and tonight and I'll be back tomorrow. If there is anything at all I can do for you, ask your nurse to contact me. Sometimes, when you namedrop, you'll get extra TLC." Why am I such an arrogant prick? Goddammit.

"Thanks, Shep. That is good to know. I appreciate it."

Another silence falls between us, and I can see the questions in her eyes, the unspoken words hanging in the air. But it's late, and this isn't the time for deep conversations. "I should let you get some rest," I say reluctantly. "But I'll check on you tomorrow if that's okay."

She nods, her eyes never leaving mine. "Looks like I'm not going anywhere, so I'll be here."

I am not getting the warm fuzzies from her. But that is understandable after things ended as they did. Now, I'm kicking myself for never reaching out all these years. As usual, I was wrapped up in my own life, unable or unwilling to venture out of my bubble.

As I turn to leave, I feel a heady mix of emotions—anger, regret, longing—swirling inside me. Seeing Elle again has stirred up feelings I thought I had left behind long ago.