Nameless

A/N: Another one-shot Hotch-centric fic! Big surprise, right?

The Washington DC emergency room at St. Sebastian's never seemed to experience any type of lull, and Dr. Erin Zwerling had done her medical internship at Vanderbilt University Medical Center and her residency at John Hopkins—so she felt she was qualified to know what 'busy' and 'not busy' entailed. Sebastian's was either tempered to a dull roar or full, high-octane controlled chaos, leaving her to feel as though she was a carnival barker at a sideshow, or a ringleader to a circus of the walking ill and wounded. Today was no exception to the rule. It was only noon and what was typically a mid-morning of directing the flow of patients to triage (mild sickness, drunks, overdosing junkies) or to trauma (work or traffic related injuries) had descended into a frenzied event she didn't see but on nights where the full moon was on display. She was elbow deep in a drunk's sloshy, reeking vomit when she decided she needed a break and asked her newest medical intern to take over for her for a few minutes (maybe not necessarily the status quo, as he needed monitoring for safety reasons, but cleaning up an alkie's puke and keeping him entertained really didn't require much training—it was more like babysitting than anything). She took a quick glance at the calendar on the wall near the nurse's station and let her eyes sweep the days, searching for the next lunar event and wasn't disappointed. Full moon tonight.

After ducking into the break room, Zwerling grabbed her well-worn coffee mug from the counter and only gave it a half-hearted rinse before dumping in the contents of what was left in the pot next to the sink. The brown liquid looked like tar, and had probably sat on the burner for the last four hours. She took a tentative taste and confirmed it—yep. Tar. But she wasn't feeling ambitious enough to make a new pot, and continued sipping away at it until the swinging door burst open and she startled, spilling her coffee down her sleeve. She expected it to be Nathan, the bright-eyed newbie intern, come to tell her that Drunky had developed tremors and needed a vitamin-rich banana bag (IV unit known for its bright yellow color), but instead it was one of the fairly seasoned residents—Dr. Tim O'Leary—with a look of alarm on his face. It was never a good sign when an ER doc looked that shocked.

"What's going on?" Zwerling asked, setting down her coffee and scraping the already soaked-in brown stains from her lab coat.

"Walk-in trauma. It's a couple of FBI agents. Looks like a pretty violent attack," he said.

Zwerling followed O'Leary through the mess of people to the two new faces, easily distinguishable from the rest of the crowd. One of the men was wearing all black and splashes of red on his hands and a bit on his skin, and the other man lying on the gurney was in what used to be a high-dollar blue dress shirt and slacks, now drenched in blood and sliced open in several locations. She chased after the gurney being rushed to the closest trauma room, assessing what she could from her vantage point.

There were several lacerations, what looked like stab wounds, which were relatively fresh and oozing. The man's pallor was not good at all—chalk-white, no color in his lips. His eyes were open to slits, but she could tell instantly that alertness was non-existent. However, she figured that was par de course with the level of hypovolemia he was experiencing.

"Sir? Can you hear me? Sir?" she barked into his face before he was transferred to the awaiting hospital bed. His appearance remained unchanged—but now that she got a view of his face, he was a good-looking guy with striking, sharp features, and a lanky, yet solid build—however, his gaze remained unfocused. Zwerling glanced up and around, and noticed that the dark-clothed associate lingered near the doorway. "Excuse me, sir, and your name please?"

The man's face was a mask of visceral ferocity and he was briefly transfixed on the patient as the nurses surrounded him after dragging in a crash cart and began snipping off his clothing with trauma shears. The agent regarded her with eyes that seemed to descend into dissociated stoicism, and she understood why he did that—she had to remove herself emotionally in the same fashion in order to function properly—but something in his expression gave her the creeps. Something that was unpleasant, even sadistic in nature. "Uh, yes. I'm FBI agent Derek Morgan. This is my associate."

"I just have a few questions for you, Agent Morgan," she said determinedly, snapping on latex gloves and gowning herself with an air of haste.

He held his hand up and fished a cell phone from his pants pocket, pushing a button on the small device. "I need to take this, I'm sorry. I'll be right back. I promise, I'll answer any questions you have as soon as I'm done talking to my boss."

Zwerling watched in disbelief for a second, then followed him a few footsteps from the trauma room. "But I need his name! Agent Morgan!" She almost chased after the man, but O'Leary reeled her back into the room with a shout.

"Erin! Let him take the call, we need you to assist!"

Zwerling swiveled in her sneakers and turned back to the task at hand, allowing the unease to roll off her shoulders until she could unleash her irritation on Agent Morgan later. She had no way to ID the poor guy on the table, no knowledge about any potential allergies, medical conditions—she felt a little like Sir Isaac Newton at the prospect of going in to treat the unnamed agent completely blind. And she was sure he had a wife and kids out in the real world that needed to know he was seriously wounded, and judging by his poor responses to verbal stimuli, she doubted the team would get any answers from him. When she returned to the gurney, the man was stripped naked and on full display under the bright overhead lights—any shred of dignity flew straight out the window when dealing with trauma, as everything had to be examined, poked, and prodded—and electrodes had been taped all across the man's torso, carefully avoiding the gaping stab wounds. O'Leary had ordered oxygen by mask, but she figured it was only a matter of time before that came off in favor of a ventilator.

She counted the wounds—nine total—mostly confined to his upper body, with a couple of slices down both forearms, and one deep laceration graced his left clavicle. Zwerling let her hand creep down both of the wiry arms, checking the depth of the cut before pressing her fingers into his left wrist and then his right. "Distal brachial pulses are good with palpation. Tim, check out his midsection for me. The abdominal wounds look like they're the deepest. And someone get a cath in him and cross your fingers." If the guy showed any blood in the foley catheter, his problems would probably only start there. The aorta—the large artery that ran down the center of the body directly from the heart—was what she worried about the most.

While her colleague went to work on tapping his chest and belly, she leaned down into his face, hoping that his narrowed, vacant stare would show some kind of awareness, something to put her mind at ease. It would just be too tragic for the man to be dumped off by his co-worker without anyone to comfort him, and not even a name to go by except for the requisite title of 'John Doe.' She came about an inch away from the oxygen mask until she could see the warm chestnut color of his eyes.

"Sir?" she shouted, then made a fist and raked her knuckles into his breastbone. The soft grunt was encouraging, as was the loose flailing of his bare limbs. "Sir, can you answer me? Come on, buddy, talk to me."

Her palm went to the thick, nearly coal-black strands of hair, petting his head in a comforting gesture, still bent halfway over his prostrate form. "Can you tell me what your name is, sir? It sounds a lot better than Agent Doe." The dramatic dark brows dipped into a pained, aggravated grimace followed by a deep groan, but he still could not say anything intelligible to her. "Sir, are you allergic to anything or are you taking any medications?"

Brown eyes blinked open for a moment before closing once again. "There we go," O'Leary smiled, moving a stethoscope in various places across the expanse of his bleeding chest and abdomen.

"Okay, help me turn him to his side. Let's see if there are any other knife wounds."

O'Leary and two nurses—Gabi and Tatyana—positioned themselves at the man's head and feet respectively while the male doctor pushed his shoulder and helped Zwerling rotate the patient to his right. The movement generated a distressed cry from the agent, a good sign really, but his movements weren't as purposeful as she wanted them to be. The blood loss was causing some confusion, and she'd seen it before in others. Pain, trauma, shock, and fear combined to make a victim's world quite scary, so she bent down again and came within a centimeter of his available ear. "I know it hurts, buddy, but we've got to look. Almost over—you're doing great."

O'Leary shook his head. "It's clear. Looks like the wounds are centralized to the front torso."

"What's his pressure look like?" she asked one of the young women. Gabi had looped a blood pressure cuff around his left arm after pressing on the laceration with a gauze pad.

"80/55. Pulse is 130."

Tatyana was the reigning champ when it came to setting up IVs, and Zwerling noticed the woman had hooked the agent up in record time. Zwerling nodded, taking a quick deep breath. "Okay, hang a couple of units of O-Neg and squeeze them in. Get an ultrasound in here—STAT. We'll type and cross match as soon as we can get his pressure up. Tim, you think we can get a chest and abdominal series before he goes up?"

"Erin," O'Leary said in a warning tone. "We need to transfer him soon or he'll bleed to death even with the transfusions."

She paused to glance at the monitors surrounding them. "You're right. How about his SATs? Where's his pulse ox? Ladies?"

The pulse oximeter was clipped to his right index finger as soon as Zwerling mentioned the device. She didn't have time to scold them for their crappy timing, instead watched the monitor next to the bed flicker erratically with the man's thready pulse rate. O'Leary answered after careful observation. "93. Think we should intubate yet?"

"Not quite, I want to give him a chance to come around, maybe give us a few basic descriptors before we send him up to surgery."

O'Leary had a stack of large-sized sterile gauze pads and began mopping up the congealing blood around the wound sites. He examined them by gently pulling back the skin, revealing the pink flesh underneath and the blood that welled up was quickly wiped and then inspected again. "Since his co-worker decided to abandon his friend, here, we have no way of knowing how long the blade was."

"What does it look like to you?" Zwerling said as she palpated the man's bleeding collar bone and down his left arm. "These upper chest wounds actually look more superficial now that I've had a better look."

O'Leary scrutinized the abdominal stab wounds carefully, pressing a gloved finger into the injury closer to the man's diaphragm, a sharp moan surfacing before tapering off with a quick toss of the agent's head.

"Sir? Sir!" Zwerling pushed her palm into his forehead, leaning toward him. "It's okay. Relax, relax. Gabi, push in a milliliter of fentanyl so he's not in so much pain."

"I'm thinking about a four to five inch knife. Erin, there are two deep lacerations near the aorta, possibly hit something gastrointestinal, and I'm concerned that his left kidney may have been affected as well. With his pressure as low as it is, this is what I'm most worried about."

She nodded. "I think you're right. Is the foley in?"

Gabi nodded. "There's about 200 cc's output."

"That's better than I thought," Zwerling sighed, pushing at her brown hair, which was in an unruly ponytail after almost two days of non-stop emergency room chaos. "Okay, now that the kidneys have been ruled out, let's get him hooked up to an NG tube." The pain medication had rendered the agent motionless, and she knew that while he was no longer in a great deal of agony, his breathing, which was already diminished enough, would falter even more. "Laryngoscope, please, Taty." The nurse handed the female doctor the metal device, then immediately afterward an intubation kit.

"SATs are down to 88."

"I know," Zwerling mumbled, angling the man's head back as far as possible and wrenching his mouth wide open. "Tim, help me out please." O'Leary ripped open the package and shoved the plastic tubing into her hand, then watched her feed it past the agent's teeth and further down his throat. "I see the cords."

"Ease it in."

She wanted to tell him to back up a little, that he was crowding her and making her nervous, but she forced herself to zone in on the patient, making a healthy outcome her mission, and effectively tuned him out. "Got it. Start bagging." Tatyana hooked up an ambu bag to the tube after winding tape around it and securing it to his face, then began squeezing a regular rhythm. The doctors watched the pulse ox monitor closely.

The numbers reacted right away, continuing to climb into positive regions. "What's his BP?" O'Leary asked.

"95/60 with one unit in," answered Gabi.

O'Leary clicked his teeth in dissatisfaction. "The bleeding is coming from somewhere. Where is the NG tube?"

Zwerling instantly began routing the other much longer tube into the agent's nose, pushing until she felt resistance—past the esophagus and in the stomach. They surveyed the equipment for a moment—really, that's all it would take to determine a GI bleed—but they were satisfied with the lack of the substance crawling up out of his nostril through the duct. Small victories.

The large, bulking ultrasound machine lumbered into the trauma room and it was up and running in no time. The Doppler device was immediately placed onto his abdomen, and the doctors quickly determined the reason for the low pressure. The aorta was indeed affected by the knife wound, swollen (which could easily be controlled) but damaged which made the situation much more life threatening. This meant regardless of their efforts in the ER, he'd bleed to death at a fast rate if they did not move him to surgery ASAP.

"We don't have time for x-ray. Let's get him up to the OR, now." Zwerling threw a glance at Tatyana, who stood patiently on the opposite side of the man, waiting for instruction. "Taty, go rouse the vascular team. I think Rebecca crashed in one of the vacant private rooms on the second floor. Can you page her to the OR? Oh, and make sure you contact the FBI headquarters when you get the chance. Somebody's got to know who Mr. John Doe is."

The male doctor ran a hand over his face which was developing a pretty decent amount of growth from the lack of contact with a razor in the past two days since he'd been on call. "I'll try to hunt down his colleague and talk to him about what the prognosis looks like."

"Thanks, Tim. All right, let's get going!"

Tatyana rushed to the wall where one of the corded hospital phones sat languishing on the wall, and O'Leary threw a drape over the man's lower half so other patients wouldn't get the opportunity to stare at the man's genitals on his way to the elevator. The gurney swiftly maneuvered through the maze of the ER, winding around the general swarm of doctors, nurses, patients and their concerned family members and into an available elevator once the doors swung open. Zwerling boarded with Gabi who continued to pump the bag and O'Leary bade her well, then peeled off the blood-soaked gloves and dumped them into a nearby biohazard container.

Tatyana did manage to call the OR to alert them of the incoming emergency surgery, and had followed through with contacting the lead vascular surgeon and his team of intricately trained professionals, but she had gotten pulled away by another trauma that embraced the St. Sebastian ER doors—a thirteen-year-old boy who had been hit by a car while he crossed the street. The paramedics had not sounded very optimistic over the radio, so all of the responding medical staff made themselves that much more determined to help the boy. With kids, it was so much more emotional, more involved. Made personal because many of the people that worked in the ER were of course parents and saw their kids' faces in each boy or girl that cycled through.

The FBI was never called to inform them of the lone, unnamed FBI agent. Dr. O'Leary never succeeded in finding the mysterious Derek Morgan, but he did traipse back into the room where the sanitation crew was working on cleaning up the mess that the trauma team had left in their wake. On the tiled ground lay the shredded remnants of Agent Doe's sky blue shirt and dark pants lying in an untidy heap near the wall where it had been kicked to make a path for the gurney when they'd decided to move him upstairs. The waste basket designated for biohazard dispensing was overflowing with splotchy gauze, tape, wrappers, packages, and tubes. A deflated blood bag lay over the top of the pile of trash while an unused second bag dangled uselessly from a lonely IV pole.

O'Leary grabbed the man's destroyed clothing before the ladies got a chance to pick them up and toss them into a plastic bag, and the doctor noticed a black billfold underneath the pile. He opened it, hoping it would be the man's ID and that the John Doe designating was simply an oversight in their zeal to treat his injuries and then send him on his way to the OR. However, he realized as he studied the ID that it was Agent Morgan's FBI credentials, the man who had bailed on his partner. Dr. O'Leary thought it strange that the man would just leave without staying to find out how his buddy was doing, even weirder that he left his identification. He imagined that being so sloppy would raise a few eyebrows at the bureau.

Something didn't sit right with him, so he balled up the clothes and threw them in a patient bag, then placed the billfold in a small manila envelope and sought out Tatyana. She proved difficult to find at first, and he finally caught sight of her after a good twenty minutes of peeking in trauma rooms and nurses stations and a half a dozen 'sorry's and 'excuse me's.

He sidled up beside her as she signed a few charts at the nurses' station just outside a triage room. "Did you get ahold of the FBI about our guy in surgery?" he asked. She looked beat and ducked her chin.

"No, I got pulled away. But I can do that now if you want."

O'Leary's mouth flattened to a grim line. "Don't worry about it, I'll do it."

The desk girl sitting a few feet away turned hurriedly, as she had been eavesdropping while conducting her task of completing a patient registration during their conversation. "Oh, my gosh, Dr. O'Leary, I forgot to tell you or Dr. Zwerling. Somebody called about our John Doe."

His interest increased. "Really?"

She pushed her horn-rimmed glasses up her nose. "Yeah. A woman called us from the FBI asking if a man had shown up, named—" she dug through a stack of loose pages, then found what she was looking for and squinted at it. "—Aaron Hotchner."

O'Leary sighed in exasperation. "Why didn't you tell me when this happened?" He smacked a palm to his forehead.

The desk clerk's mouth hung open. "I-I'm sorry, doctor. They literally just called about two minutes ago. One of his teammates will be here pretty soon."

The man grabbed the paper from the clerk, smiling humorlessly. "Well, at least we know what to call him now. I'm going to take this upstairs. Let me know when his colleague arrives."

"Okay, doc. Sorry again."

He waved at her as he tore off for the elevator.

The woman who strolled into the ER was starkly out of place with her surroundings—screaming babies, wandering drunkards, dusty looking construction workers holding cold compresses and gauze against their bloody injuries. A drugged out woman shifted her body back and forth to a syncopated beat that existed only in her head, and two others lay like the dead, spread out across the chairs in the waiting room. Dr. Zwerling—fresh from checking in on the guy from earlier, now identified as Aaron Hotchner—knew that this young woman was here for their agent.

She was a stunner. Tall, willowy, shock-white skin with deeply contrasted jet black hair and wide, dark eyes to match. She held a jacket in a death grip as she stood in the middle of the room, seeming briefly unsure of herself until Dr. Zwerling moved toward her, and the woman's face morphed into a trained mask of cool indifference.

"Ma'am?"

She failed to respond right away, until the doctor reached out and touched the immaculately dressed woman's arm. The female agent reacted as if her skin had been burned by fire, starting in surprise, then taking a step backward.

"Yes," she said in a voice that betrayed her physical confidence.

"Are you here for the FBI agent?"

She nodded and took a calming breath, then smiled cordially and shook Zwerling's hand stiffly. "My name is SSA Emily Prentiss. I'm part of Agent Hotchner's unit." The corners of her mouth fell in apprehension. "How is he?" Her brows tilted nervously, but that was the only outward indication of worry that she displayed.

"He's still in surgery. He's holding his own. I have to say, we were kind of worried about him for a minute there."

"Oh, God," she murmured, letting her eyes shutter. "Did he say anything about what happened? Anything about a man named George Foyet?"

Zwerling shook her head. "No. He wasn't very coherent when he came in. Even when we were able to bring up his blood volume, he had to be intubated to help him breathe and to prep him for surgery." The doctor frowned, directing Agent Prentiss away from the pedestrian masses and toward the elevators. "I'm a bit surprised Agent Morgan didn't inform you guys over at the FBI of the circumstances surrounding Agent Hotchner's attack. Didn't he try to contact anyone?"

Prentiss crossed her arms uneasily, appearing small beneath the rigid layers of her power suit. "Actually, the man who ID'ed himself as Derek Morgan was Agent Hotchner's attacker. He took our colleague's creds and used them so he'd get through security without anyone asking questions as to why he was there or wondering who he was. Nobody would think twice about a man dropping off a wounded agent when flashing FBI credentials."

The doctor's face drained of color when she realized that a man of such violence and depravity had been within a couple of feet from her, and then the unsettled feeling she'd been consumed with during her stare down with the man made sense. "Who is this man?"

The female agent gave the doctor a long hard look, appearing to gage her reaction to whatever she had to say. "He's a serial killer that Agent Hotchner was tracking—Foyet became fixated on him after the original investigator of his case died. He loves to psychologically torture people, be it a victim or the authorities. He escaped federal custody, and we've been attempting to locate him since then."

Zwerling stood motionless, mouth ajar. "Oh, my God," she whispered, then cleared her throat. "Why would he bother bringing Agent Hotchner in after stabbing him? Did he feel remorse or something?"

Prentiss shrugged and the two women boarded the elevator. "Foyet has a desire to torment those closest to his cases, and I think bringing Hotch to the ER has to do with making sure he knows he had complete power over whether he lived or died."

"What, is it some kind of sick game that he's playing?"

"In his mind, yes."

The elevator slid open, revealing the much quieter and softly-lit surgical floor. The area off to the side revealed a smaller desk where a charge nurse sat, and behind her were a collection of chairs surrounding a TV against the wall mutely playing to no one. A couple of palm trees and a coffee table with a stack of magazines and medical brochures brought the scene together, inferring comfort and a way to distract from a loved one's grave reality. To the right were the double doors that led to the operating rooms, where carpet met tile and a Zen ambience turned into the harsh lights and cold sterility of the OR. To the left of the desk, the space descended into a hallway with dim rooms, each with white boards revealing the patient's name.

Zwerling stopped next to the desk and squeezed Agent Prentiss' arm. "I'm going to go check on his progress. As long as he doesn't need any kind of intestinal repair—that could take hours—he should be placed in recovery shortly thereafter and I'll come and grab you." She motioned at the waiting section. "Why don't you take a seat. I'll be right back."

Zwerling poked her head into the OR with a sterile mask covering her face and got the update from Dr. Mike Schuyler, the area's best vascular surgeon, of the agent's progress. His outcome was excellent, and this thrilled the ER doctor greatly. Even better, the surgeon's hands performed quick, expert work as they stapled the agent's abdomen closed, and promised he'd be done in approximately 15-20 minutes. From her past experiences with Schuyler, she knew he was not an exaggerator when it came to his swiftness and proficiency.

Agent Prentiss was sitting calmly in chairs, ignoring the TV and the magazines in front of her and instead choosing to examine her fingernails. The evening sunlight graced her features, making the color of her hair appear less of a true black and more of a dark auburn, which warmed her features into something less harsh and more friendly. Zwerling approached her in confidence, smiling as the agent glanced up, face still an impassive mask, but her back rigid.

"What's the verdict?" Prentiss asked, anxiety edging her tone.

"Agent Hotchner will be out of surgery in less than half an hour. The vascular surgeon, Dr. Schuyler, is quite optimistic of his outcome."

Prentiss visibly relaxed. "Thank God."

Eighteen minutes later to the very second, Hotchner's gurney was wheeled past the desk, snagging Prentiss' attention and she stood as if she had just shot out of a cannon. Zwerling tagged along, walking briskly at his side as she had done before under much different circumstances. This time she was more put together, hair brushed, clothes changed (no longer stained with coffee, blood, and vomit), and she had had a chance to eat something before coming back upstairs. The doctor waved Prentiss over and the orderly and Zwerling maneuvered the agent into the first room, then settled his bed against the wall and hooked up the electrodes taped to his body and the various instruments to the monitors eager to reveal his vital signs.

The indifference in Prentiss' eyes melted away to reveal a surprising tenderness that softened her features, and Dr. Zwerling watched the agent's lips lift in a tiny smile before she began explaining the procedures and what she should expect. Agent Hotchner, now extubated and without the intrusive NG tube once it had been determined there was no GI hemorrhage, still looked a bit pale, but considerably better. Prentiss only had eyes for the man lying in the bed, her gaze sweeping the machines spitting out sundry recordings of his blood pressure, heart rate, respirations, etc.—Zwerling knew she no longer held the woman's attention, so she told her he'd awaken soon, and then exited the room.

The doctor knew her night would only get more insane with the presence of the full moon, but with emergency cases that ended on a positive note, the chaos of the ER would always be worth her time.