Chapter 5 – The Liver That Broke Us
Bellevue Hospital, 2:47 a.m. – Day 4 of Intern Year
The surgical floor is a war zone that ran out of morphine.
Every call room is occupied by residents who haven't seen daylight since June. The hallways echo with the squeak of clogs, the endless beep of alarms, and someone crying in the stairwell again.
Leo hasn't slept more than ninety consecutive minutes in seventy-two hours.
Asher's eyes are so red they look infected.
River has started stress-eating glucose gel straight from the packet.
Ezra hasn't taken off his lead apron in nineteen hours because ortho owns his soul now.
And Noah Kim, their tyrant senior, just paged 911 to the interns' group chat:
Liver transplant just rolled in from UNOS.
Stage 4 HCC with portal vein invasion.
55-year-old male, MELD 38, decompensating.
Donor liver ETA 30 minutes by helicopter.
One intern gets to scrub. The rest watch from gallery or do scut for the next 48 hours straight.
Fight for it.
Now.
The four of them stare at their phones in the dirty utility room that has become their unofficial headquarters.
Asher is the first to speak, voice raw. "I haven't seen a transplant since med school. I need this."
River doesn't look up from licking strawberry gel off their thumb. "Hepato-biliary is my future. I will literally kill for this."
Ezra cracks his neck. "Y'all are cute. I just want to hold a retractor for eight hours so Noah stops calling me 'useless bone boy.'"
Leo says nothing. His brain is floating in adrenaline and caffeine. He just knows if he doesn't get into that OR he will actually die.
They all turn to him at once.
Asher: "You already got a clamshell and a CABG, Leo. Give someone else a turn."
River: "Statistically, you've had the most OR time. Back off."
Ezra: "Pretty boy privilege only goes so far, Kang."
Leo's exhaustion flips into rage so fast he sees red. "I've been pimped harder than any of you, had my hands literally inside a beating heart while Rossi stared into my soul, and I still haven't slept. Don't talk to me about privilege."
Asher steps forward, chest to chest. "Say that again."
River wedges between them, tiny but feral. "Touch each other and Noah will make us all rectal exam the entire hospital. Focus."
The door bangs open.
Noah stands there in fresh scrubs, hair still wet from a two-minute shower, looking infuriatingly perfect.
"Time's up. Decision?"
Silence.
Noah smiles like a shark. "Fine. I'll pick. Kang, you're in."
Asher makes a broken sound. River's face goes blank. Ezra punches the wall hard enough to split two knuckles.
Leo feels like he's been punched in the sternum. "Dr. Kim—"
Noah cuts him off. "Don't thank me. The transplant attending requested the intern who didn't flinch during a clamshell. That's you. The rest of you: go update twenty-five patient lists before I finish morning report or I swear on my Stanford degree I will end you."
He's gone.
Asher won't look at Leo. River just walks out without a word. Ezra grabs a roll of Kerlix and wraps his bleeding hand, muttering, "Congratulations, golden child."
Leo is left alone under the flickering light, guilt and triumph fighting in his chest.
He pages Noah: Heading to OR 12.
The reply is instant:
Change into fresh scrubs first. You smell like death.
OR 12 – 03:14 a.m.
The patient, Mr. Anthony Russo, lies on the table already intubated, abdomen distended with ascites, skin the color of old parchment. His wife is outside the glass crying into a nurse's arms.
The transplant attending, Dr. Elena Vasquez, is a legend (tiny Latina woman who once transplanted a liver in the middle of Hurricane Sandy). She glances at Leo.
"You're Rossi's new pet?"
Leo flushes. "I—yes, ma'am."
"Good. He only picks the ones who don't break. Don't prove him wrong."
The donor liver arrives in a red cooler carried by a runner who looks twelve. Everyone claps when it enters the room (surgeons are weird).
They open Mr. Russo's abdomen. It's a bloodbath. Tumor everywhere. Portal vein thrombosed. The smell hits like spoiled meat and bile.
Leo gags behind his mask.
Vasquez doesn't blink. "Suction, intern. Welcome to the big leagues."
Hours blur.
They remove the native liver (huge, knobby, cancerous). It comes out in pieces, each one dropped into a steel basin with a wet thud. Blood everywhere. Leo's arms ache from retracting. His goggles fog with tears he refuses to let fall.
At one point the patient's pressure tanks to 50 systolic. Vasquez is elbow-deep in the hilum, voice calm.
"FFP. Calcium. Bicarb. And someone tell his wife he might die on this table."
Leo's hands shake so badly he almost drops the Bookwalter retractor.
Matteo's voice suddenly in his ear (he didn't even realize Matteo had come in to observe).
"Breathe, Kang. In for four, out for four. You've got this."
Leo obeys without thinking. The shaking stops.
They get the new liver in (pink, perfect, cold). Vasquez sews the vessels with speed that doesn't look human. Bile starts flowing. The graft pinks up.
At 09:42 a.m. they close.
Mr. Russo is alive.
Vasquez strips her gloves, looks at Leo.
"You did good, kid. Go sleep before you fall over."
Leo stumbles out into the hallway.
Asher is sitting on the floor outside, head in his hands, eyes swollen. River is asleep against the wall, cheek marked by the tile pattern. Ezra is gone (probably operating on someone's shattered femur).
Leo slides down the wall opposite Asher.
"I didn't ask for it," he says quietly.
Asher's voice is wrecked. "I know. Doesn't make it hurt less."
River stirs, murmurs without opening their eyes, "We're not friends anymore, Leo. At least until we've all slept."
Leo closes his eyes. The hallway smells like blood and despair and the faint hope of a man who just got a second chance at life.
He thinks: This is what we signed up for.
And somewhere down the corridor, Matteo watches from the shadows, arms folded, expression unreadable.