Chapter Text
~ Castiel ~
The heart is a dramatic organ. It is a fist of muscle, a battery of electric impulses, a fragile vessel that decides, sixty to a hundred times per minute, that a human being continues to exist or becomes a memory.
Castiel prefers when the heart is silent.
“Clamp”
The word is barely a breath, but in the hyper-pressurised silence of operating room 4, it sounds like a gavel strike. A scrub nurse, only her eyes visible above a tightly fitted mask, slaps the Hemostat into his outstretched hand. She doesn’t speak. In Castiel’s OR nobody speaks, unless a patient is dying. And his patients do not die.
He adjusts his grip and looks down into the open chest cavity of the fifty-five year old senator lying on the table. The bypass is complete. The sutures are microscopic works of art, the kind of stitching that should be hung in a gallery, not hidden beneath layers of fascia and skin.
“Releasing cross-clamp,” Castiel announces.
This is the moment. The terrifying, suspended second where the heart, cold and still for the last two hours, has to remember it’s purpose.
He waits.
He doesn’t pray — God has nothing to do with the precision of a vascular anastomosis— but he does hum. It’s a subconscious tick, a low, vibrating thrum in the back of his throat. Bach. Cello Suite Number 1 in G major. The prelude.
Thump.
A single, sluggish contraction.
“Sinus rhythm returning,” Dr. Bradbury states from the head of the table. She sounds bored, which is the highest compliment an anaesthesiologist can pay a surgeon.
Thump-Thump.
The monitor picks up the beat, transforming the silence into a rhythmic, reassuring whoosh-hiss. The blood begins to flow, pink and oxygenated, surging through the new vessels that Castiel has constructed. It’s perfect. It’s mechanical poetry.
“Flow is excellent” he says, keeping his voice flat. “Closing.”
Castiel steps back from the table, removing his bloody outer gloves with a snap, leaving the closing to his senior resident.
“Dr. Novak?” Alex asks, her voice trembling slightly. “Do you want to check the drain placement?”
“If you can’t place a drain in your fifth year, Dr. Jones, you should perhaps consider a career in dermatology.” He says without looking at her. He walks to the scrub sink, the adrenaline from the surgery already receding, replaced with the cold, hollowness that lives in his chest.
He scrubs out, the ritualistic washing of hands that strips away blood and responsibility. He checks his reflection in the steel mirror. His blue eyes are clear behind his black rimmed glasses. He looks like a machine, he thinks idly to himself as he dries his hands and checks the time. 11.45am. He has a department meeting at noon, followed by rounds, followed by a donor dinner that his father is forcing him to attend.
He pushes through the double doors of the surgical wing, expecting the hushed, carpeted serenity of the cardiothoracic department.
Instead, he walks into a construction site. A plastic tarp hangs from the ceiling, flapping in the draft of the ventilation system. The smell of drywall dust overpowers the scent of antiseptic. The waiting area — usually a sanctuary of beige leather and abstract art — is gone. In its place is a gaping hole in the wall and two men eating sandwiches on a stack of drywall. Castiel stops dead. A piece of tinsel, cheap and silver, has been taped to the tarp. Merry Christmas, it mocks.
“Dr. Novak!” Castiel turns to see his administrative assistant, a woman who usually posses the calm demeanour of a bomb disposal expert, looking frantic. She is holding a cardboard box.
“What is this?” Castiel gestures to the destruction with a hand that is worth $5million a year to the hospital.
“The renovation timeline was moved up.” Hannah says, breathless. “Dr. McLeod sent the memo this morning. The east wing’s foundation needs reinforcing before the blizzard hits next week. They’re condemning the offices.”
“Condemning?” Castiel repeats. “I have consults. I have charts. I have a succulent that requires a specific amount of sunlight to thrive.”
“We packed it,” Hannah says, shoving the box into Castiel’s hands. It contains his diploma, his Newton’s Cradle, and his succulent.
“Dr. McLeod said it’s just temporary, until the new year.”
“Where?” He asks, his voice dropping to a dangerous register. “Where am I supposed to work, if my office is currently a pile of rubble?”
Hannah grimaces, it’s the look one gives a patient before telling them their tumour is inoperable.
“The trauma floor,” she whispers, “ground level.”
Castiel stares at her. “Trauma is a zoo. It’s a bacterial Petri dish. It’s loud.”
“It’s the only floor with spare desk space. You’ve been assigned to office 104.” Hannah takes a step back, as if fearing Castiel may bite. “It’s a shared space.”
“Shared?” He says, testing the word like it’s burnt coffee. “With whom?”
Hannah doesn’t answer. She just points toward the elevator.
++++++++++++
The elevator ride down feels like a descent into hell. The medical centre is shaped like a hierarchy. The top floor is cardio and neuro — the gods, the intellects. As you go down things get messier. Orthopaedics, general surgeries. And at the very bottom, basement level, is the pit.
Trauma.
The elevator doors ping and slide open. The noise hits him first. It isn’t the hum of machinery; it’s the roar of humanity. People are shouting. A gurney rolls past at full speed. Somewhere, a child is screaming.
Castiel steps out, clutching his box to his chest like a shield. The air here is different. It’s humid, smelling of wet wool, floor wax, and the distinct, coppery tang of fresh blood. And the music.
Thunderstruck by AC/DC is blasting from the nurses station. Not playing — blasting. The opening guitar riff reverberates off the linoleum floor.
Castiel clenches his jaw. He navigates his way through the chaos, dodging a nurse carrying a tray of urine samples and a police officer taking a statement from a man with a knife wound. This isn’t medicine; this is air traffic control during a crash.
Castiel finds office 104. It’s located directly across from the main trauma bay, separated only by a wall of glass.
The office is small, it was clearly designed for one junior administrator, but two desks have been jammed together in the centre, creating a battlefield of territory.
The desk on the left is empty, save for a layer of dust. The desk on the right looks like it was hit by a mortar shell.
Stacks of paper charts lean precariously like the Tower of Pisa.
Empty cans of overpriced energy drinks form a pyramid. A stethoscope is tangled with a phone charger. An half eaten blackberry pie lies open, spilling crumbs and dark purple filling onto a medical journal.
He feels a twitch develop in his jaw.
“Hey. You must be the squatter,” The voice comes from behind Castiel, scratchy and amused.
He turns.
Standing in the doorway is a man who looks less like a doctor and more like someone who was dishonourably discharged from a pirate ship.
He is tall, would be taller were it not for his bow legs, slightly broader than Castiel with the kind of functional muscle that comes from lifting heavy things, not a gym membership. He wears Ceil blue scrubs that are wrinkled and stained with something dark that Castiel desperately hopes is iodine. Under the scrub top, he wears a faded black tshirt with a barely noticeable Led Zeppelin logo.
His hair is cropped short, soft from a hand that is currently holding a half eaten bagel running through it. He hasn’t shaved in at least three days.
“Dr. Novak.” Castiel says, drawing himself up to his full height. “I assume you are responsible for the noise pollution in the hallway?”
The man takes a bite of his bagel. “If by noise pollution you mean the sweet, sweet sounds of Brian Johnson, then yeah. Guilty. Helps keep the rhythm, y’know? Keeps the blood pumping.” He extends his free hand. “Dean Winchester. Trauma.”
Castiel looks at the hand, there is a smear of dried blood on the cuticle of the thumb.
“Castiel Novak. Cardio.” He says, keeping his hands firmly on his box.
Dean grins. It’s a lopsided, boyish grin. It is infuriatingly charming. “Yeah, I know who you are, Princess. Everyone knows the ice king. Didn’t know you came slumming it in the dungeons.”
“Princess?” Castiel’s voice drops by fifty degrees.
“Figure of speech, buddy.” Dean walks into the room — struts actually — and tosses his bagel on to his disaster of a desk. “So, McLeod said I gotta make room. I cleared off the left side for you.”
“You call this cleared? Castiel walks to the empty desk and runs a finger along the surface creating a long smudge of dust.
“Dude, I’m a surgeon, not a maid.” Dean says, dropping in to his chair. It squeaks in protest. He kicks his feet up onto the desk — right next to the half eaten pie. “Look, we just stay outta each other’s way. You do….whatever it is you do. Knitting arteries? And I’ll handle the meat and potatoes.”
“Meat and potatoes.” Castiel repeats, horrified. “You are referring to human beings.”
“I’m referring to the guy who just came in with a fence post through his abdomen.” Dean says, gesturing to the glass wall. Through the window, Castiel can see into trauma bay 1. A patient has just been wheeled in, thrashing and screaming. The paramedics are shouting vitals. The monitor is alarming.
The casual slouch disappears from Dean’s body immediately and he is up and out of his chair before Castiel can even blink.
He shouldn’t watch. He should unpack his succulent and set up his computer. But he can’t look away.
He watches Dean Winchester enter the chaos.
The change is instantaneous. The pirate is gone; the soldier appears. Dean doesn’t shout, but the room orients around him. He moves with a brutal, efficient economy. He cuts the patients shirt away with shears, his hands moving so fast that they blur.
Through the glass, Castiel sees the problem. Tension pneumothorax. The patient is suffocating, his chest cavity filling with air.
Standard protocol requires a sterile field, a scalpel, a chest tube kit, and anaesthesia.
Dean doesn’t wait for any of that. He watches, his breath catching as Dean grabs a large needle from a crash cart, pours a bottle of betadine over the man’s chest — splashing it everywhere — and stabs the needle between the patients ribs.
A hiss of escaping air is audible through the glass.
The patient’s thrashing stops. The vitals on the monitor stabilise. Dean pats the man on the shoulder, says something that makes the terrified patient nod, and then turns around.
He looks through the glass straight at Castiel.
Dean winks.
Then he wipes his bloody hands on the front of his scrubs, and walks back towards the office.
Castiel feels a strange, uncomfortable sensation in his chest. It’s a flutter, an arrhythmia.
Dean kicks the office door open. The smell of copper follows him in.
“See, Cas?” Dean says, sitting back down and grabbing his pie. He shoves a large forkful into his mouth, speaking as he chews. “Meat and potatoes.”
Castiel sets the box down on his dusty desk. He takes a deep breath, inhaling the scent of dust, floor wax, and this infuriatingly chaotic man.
“Dr. Winchester,” he says, pulling a container of disinfectant wipes from the box.
“Yeah, Dr. Novak?”
Castiel snaps the lid of the wipes open. “Stay on your side of the room.”