Thanks to Brighid45 who helped me along with this one.
He ignores the late evening hustle around the hospital and decides to walk home, clear his head.
Away from the hospital, the streets are almost empty now. He walks faster and faster, and before he knows it, he is running.
He ends up taking the longer route through the park.
This is like nothing he has ever experienced.
Sure, he has lost matches, lost friends, lost bets – he's lost plenty. According to John House, losing builds character. As does winning, apparently. An adage for every situation. His father is reliable that way.
Usually, he is well aware what his chances are. Sometimes the odds are in his favor, sometimes they aren't. He generally doesn't enter into the game if they aren't. Why bother if you knew chances were you'd lose?
But this time, there had been no sign at all of what lay in wait. It doesn't make sense.
Just another regular weekend shift.
The patient had been like many others before her. What was different this time, was that he alone had been in charge of treatment. His boss was as overworked as everyone else and preferred to spend his weekend on the golf course. He was happy enough to leave everything to his most capable resident.
That's him.
Or was, until tonight.
She wasn't pretty and for all he knows she wasn't particularly smart - hard to tell when all she did was either moan in pain or throw up. But she was barely over thirty and probably someone's best friend or a good neighbor to an old lady or a fucking crossing guard at the local kindergarten where she'd be missed.
Point is, she shouldn't be dead.
Not because she was too young or too popular or meant the world to someone somewhere but because he never had a chance to figure out what it was that was killing her.
The patient had originally presented in the ER with a dislocated shoulder but later mentioned abdominal and lower back pain which had gained her a referral upstairs.
He had run all sorts of tests. All inconclusive, at least the ones that had come back.
Distracted by the moaning and constant alarms going off in the room, he had finally grabbed the file which was getting thicker by the minute and sat down with it in the only quiet corner he could find – which turned out to be a play area in pediatrics.
But even there, perched on a tiny chair, he hadn't been able to get his head around the rhythm of this.
In his lectures, Old Washburn would rabbit on all afternoon, but occasionally he could come up with a nugget. According to him, Novalis had said that "every disease is a musical problem. Its cure, a musical solution." He had never bothered to check if this was an actual quote or if Washburn was just making things up as he went along.
He hadn't bothered because, until today, he hadn't even thought about it again. But suddenly, it made sense to him.
He had tried to get a more accurate history from the patient, but whether it was due to the fever she was spiking or neurological involvement, she began to contradict herself. To understand what was going on, you needed to know the patient's normal, her body's rhythm. But he couldn't access that information.
There was an aunt, she had said, somewhere out west he remembers. And a cousin in Florida. He had considered trying to trace them somehow.
But this disease, whatever it was, had moved too fast to waste precious time. And then again, it had moved too slow. It had been too erratic. There didn't seem to be a rhythm, just a big, loud mess. This patient was a cacophony.
Had been.
Because after her kidneys had shut down there was a final crescendo: She had struggled to breathe, her airways had closed up, and he had to put in a trach. No hesitation, there was no time to wonder if he was doing it correctly – he knew he was.
He hadn't even fully inserted the tube yet, the last note: a seizure.
And then: nothing.
Under the continuous beep of the monitors: silence.
Death.
It had been a struggle; ugly and desperate and, ultimately, so easy. There had been no final warning, no 'this is it'. No further tests necessary, no procedures. End of. He had felt stunned, cut off mid-sentence.
A novel, and frightening, cold had crept through his bones. Disbelief had flooded him, mixed with disappointment. And a good measure of annoyance.
Mourning the inevitable is a waste of time – people die. She isn't the first of his patients to die.
But he doesn't know why.
He never got answers to his questions, and now only the autopsy can provide them. It has to.
Not only has he contravened hospital rules by hastily making a copy of the patient's file and stuffing it into his bag, he has also checked tomorrow's schedule before signing out. Keller is doing autopsies first thing in the morning. Keller is an early bird; he always starts well before 8 am. He could be early. He doesn't expect to sleep anyway, hence the reading material in his bag.
Keller also never allows an audience at his autopsies. Hospital rumor has it that the pathologist keeps a hip flask in his back pocket. Not only will he have to be early, he will also have to bring a mighty good reason to convince the man to let him stay and watch. He's got all night to prepare the right questions.
He can see his building in the distance now and slows down. For once, he hopes there is no music tonight. His housemates can be fun, and he is always up for fun. But not tonight.
When he enters the apartment, there is no sign of either of them. The living room is the usual mess of everyone's unwashed clothes, guitar cases, textbooks and empty take-out containers. Nobody ever cleans around here. With all their different rotations and schedules, someone is always trying to sleep, or study, or have sex.
In between the mess, he spots something he had hoped not to see. Stephanie's coat.
He is too exhausted to eat and too exhausted to shower. He is too wired to sleep. And he is definitely too distracted for sex.
But his room is quiet when he slowly opens the door. There is a mess of dark curls on his pillow and a foot sticking out from the covers. Like a cat, she loves to stretch out and occupy maximum space.
The darkness is silent. The difference between this room and the one he just left couldn't be greater.
Carefully, he sits down on the edge of the bed and curls a strand of hair around his finger. There is light snoring coming from the depth of the pillow.
Stephanie shows up like this every once in a while. She's a student nurse, and his place is about halfway between the hospital and her apartment. Sometimes, after a shift, she'll just stop off here and stay. To sleep, mostly. If they don't get up to other things.
He considers crawling into bed just to breathe in her vitality for a while. But then he catches a whiff of himself. He reeks of sweat and blood and other things even worse.
He toes off his shoes and sees a dark spot on the left one. It's too dark to see clearly. Not that he needs to; he knows what it is.
He should shower. But now that he's sitting down properly for the first time in something like 18 hours, he doesn't think he has the energy to get back up.
He should eat.
He leans into a pillow he pulls from Stephanie's back and closes his eyes.
He should sleep.
But he can't.
The buzz in his head won't let him. The questions won't let him. He never got any answers, and now he has everything pinned on the autopsy tomorrow morning.
He takes a cigarette from Stephanie's pack and goes to sit in the old leather chair that's been here since before he moved in; it's a bit worn, but the upholstery is still good. Whoever bought it new must have paid a packet at the time.
He pats his pockets for a lighter. This is his first cigarette of the day. No smoking at work. Other people are social smokers. He smokes when he is trying to figure something out.
After weeks of drudgery, he had finally caught a case it was worth getting excited about. But then, exhilaration gave way to frustration about tests stuck in the lab – the waiting list was long, even for urgent cases. He was supposed to stabilize the patient so someone else could later run yet another battery of tests and figure out what was wrong. Except there was no time for later, that much was clear right from the off. He barely had time to draw enough blood to get the most rudimental stuff done.
Tests.
Some of the tests he had ordered had never come back.
Suddenly he can't wait until morning – assuming Keller will let him attend.
He switches on a lamp to find a pen in the chaos on his desk and starts making notes on the copies he brought from the hospital.
Dislocated shoulder – possible fall, patient woke on the floor
Bruises – some obvs predating the 'fall'
Low BP, POTS? – reason for fall?
Abdominal Pain
Lower Back Pain
Bloody urine
Vomiting
Half an hour later, he has a list of symptoms, some confirmed by nurses and himself, and others reported only by the patient. It's a list that makes no sense. There is still no order in this chaos, no rhythm.
If you believe the patient, that is. But he already knows she couldn't be trusted. There is only the patient's word for some symptoms. He circles those.
He'd had to make perfect decisions with imperfect information. Time to review what he knows to be true. So he goes back to the most basic questions she was asked on admission.
She had answered the very first one with no. Are you currently pregnant?
What if?
More circles go on the list.
He jumps up to find his shoes, blood be damned.
"Greg? When did you come in? And where are you going? It's the middle of the night!" He is remotely aware that Stephanie sounds upset under her sleepiness.
A pregnancy test had been on the list he had ordered. Standard. He hadn't given it any further thought because the patient had also had some slight vaginal bleeding which he had attributed to her being on her period.
But what if she hadn't been? What if she had actually been pregnant? Maybe she hadn't known, or maybe it was one of the things she lied about.
Just one of the many labs that hadn't come back in time.
Not menstrual blood but a miscarriage.
There had been so little time with this patient. Time he has now. Someone must know something.
Copies in hand, he ends up in a part of town he has never visited before. The streets are empty; it's almost midnight.
He isn't sure what he had expected. Definitely a residential area of sorts. Not this. There is a bar at one end of the street, still busy. Some small stores, now closed. A 24-hour grocery store is lit up further along.
467. Her address. Which looks like a slightly rundown office building minus the business signs at the door.
He presses the buzzer, not that it is going to do much good.
Unexpectedly, the speaker crackles. The voice is slightly distorted. "We're full, buddy" is not the reply anyone would give at this time of night, no matter what line of business they were in.
Unless…
"What is this place?" he asks, hoping whoever it is at the other end is still listening. He scans the door and front of the building again. "There's no sign."
A pause.
"That's as it should be," the guy crackles back. "We don't want residents endangered."
Residents.
"This is Nightline." A pause. "A shelter. But we're full tonight. You have to try again tomorrow, sorry." The intercom clicks. End of conversation.
He turns and slowly walks back towards the bar he passed earlier. He needs to think.
It's loud, and it's busy, and people are drinking and smoking, and it's just what he needs. He pays for a beer and elbows his way to a seat at the far end of the bar.
There must be a burger joint a few doors down. Watching people bring in greasy, calorie-laden food makes him regret not heading there first. But he is now too tired to get up again, and besides, his seat and drink would be gone by the time he comes back. Food later, he has more important things to do now.
His bottle is empty soon, and he signals for another.
He needs to reconsider everything in light of the new information he has just learned. What did the patient lie about to cover up being homeless? What if she was pregnant? But no matter how he twists and turns every bit he knows about her; he is no closer to figuring out what happened. And yet, there is something there, something he can't quite grasp. It's like one of those annoying dreams where something you urgently need remains elusive and keeps moving away every time you get a step closer.
It looks like he will have to rely on getting in on the autopsy after all.
His stomach rumbles, and he reconsiders his chances of getting a burger and keeping his seat here. They don't look good. All he has had today are candy bars and a banana he stole from the nurses' room, but he needs to drink and think more than he needs protein.
Protein.
Something.
He pulls the notes from his pocket, wondering if someone had looked at the patient's diet. Living on the streets doesn't make for great nutrition.
No, that's not it.
Protein.
When it hits, it's like an intricate knot suddenly coming loose, like finally being able to see both versions of one of those idiotic optical illusions at once.
A protein disorder.
One of the disorders on the Ehlers-Danlos spectrum.
Hypermobility, dislocations, bruising, pain, allergies, gastro issues, and those are just the ones he can reel off right here.
He will make sure Keller confirms tomorrow – he'll double check which tests exactly they need before he heads in. They'll also need a confirmation of pregnancy which probably kicked her EDS into overdrive.
A lot of things suddenly make sense. Certain symptoms weren't checked because she said on arrival that she was on her period – and there was vaginal bleeding. But it was from the pregnancy, possibly miscarrying, and not from her menses like they assumed.
Assumptions are dangerous things to make. One of the few things he agrees on with John House.
He slams down his empty bottle and gets up.
He can always stop for a burger on the way home.
