Blackbird

by SpookyMormonHellDream

Modern AU, E/C. Dr. Erik Riley had always been alone, with few exceptions - he'd expected to remain that way indefinitely. However, an administrative error forced a young medical student into his life, setting in motion a series of events that would change the both of them forever, if only he would allow himself to overcome his own troubled past.

1. Just Medals and Scars

Author's Note: Hello again, my darlings, and welcome to Hell! Just kidding. Mostly. O_o Welp, here is my second novel-length PotO Phic, the culmination of many long hours of work, screaming, contemplating alcoholism, and above all: Feels. I sincerely hope y'all enjoy this one! It's my first modern AU, and while I'm nervous as fuck about it, I'm of course hoping that it proves to be an enjoyable story. I had initially hoped to have it posted on March 14th (Pi Day, officially, because I'm a fucking loser), but one thing led to another and that plan turned to shit before my very eyes. So here it is at ~12:01 on March 15th (*grumble grumble*). But in spite of that delay, please note that updates will happen every Tuesday, as I don't want to over saturate this story too much. But barring any major issues, chapter updates will be regular. Also, special shout-out to NewsieAndAGeek (Tumblr: phantom-of-the-keurig) for her support and the many, many conversations about how fucking awesome medical AUs are. XD Welp, I won't say too much more so that y'all can get right to reading and reviewing (hint hint), but I would like to make a note about what inspired this story to begin with almost two years ago. Once upon a time, I was watching the show ER, a medical drama that used to be on NBC and that was written by the wonderful and talented Michael Crichton (who wrote Jurassic Park, Timeline, Congo, etc.). There was one scene in an early-ish episode involving a helicopter that I thought was hella cool, and for no apparent reason I thought, "You know what would be fucking fantastic? A Phantom crossover! :D" So this was initially going to have some of those characters as well, but I didn't want the story to become too convoluted, so instead I focused mainly on PotO characters loosely based on Kay!Verse interpretation and adapted them to a modern medical setting. But I will note that as a nod to Michael Crichton, I left the setting in Chicago because I love that city and I love and respect him as an author. ^_^ The overall title of this piece comes from the Beatles song of the same name, and will be acknowledged further in time. Finally, the title of this chapter comes from the song "Hero of War" by Rise Against, which of course I suggest y'all go check out. It's a heartbreaking song, full of conflict and pain, and conveys some of what I hope to bring forward in this story, as y'alll will find out later. Some of (most of) the details of Erik's life are left vague on purpose at this time, and I hope that y'all will enjoy the journey of putting those pieces together as the story goes on. ;D At last, the traditional disclaimer: I own absolutely nothing of Phantom of the Opera or its adaptations, nor do I own the concept of Crichton's ER, and finally, I do not own any of the songs whose lyrics I used for the title of this piece and its chapters. That is to say, I own nothing, and I'm still fucking salty about it. Anywhoodles, I believe that's all. I so missed these long and pointless A/N rants. :P Remember to read, review, and enjoy!

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Chapter 1 - Just Medals and Scars

Erik

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can but I will always look for a path to a cure for all diseases.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

- The Hippocratic Oath, 1964

Present Day, Chicago IL - I was very distantly aware of the various pieces of medical equipment blinking and beeping within the confines of the small surgical suite, steadily alerting all in attendance to the continued signs of life of the patient on the table before us. People spoke in hushed tones around me, sometimes to me - but I responded only when necessary. Otherwise, I said nothing, my focus trained entirely on the task at hand, and that was the way I preferred it. As a surgeon, nothing else matters to me beyond those crucial moments, beyond each deliberate and long-practiced movement of my hands, playing at a game that I absolutely cannot lose. We had almost lost that patient once already, had a hell of a time urging his heart to beat again, and I didn't want anything or anyone to cause another potentially deadly setback. But in the end, it seemed he would in fact pull through. Technically speaking, it was a routine procedure - nothing I hadn't seen before. And so I continued working with the hope that it would remain that way.

The phone which connected the various departments of the hospital to us was ringing in the distance, but I paid it little attention. Answering it was someone else's responsibility - my only task then was to ensure that my patient didn't have another close-call before his surgery could be completed, and that nothing I or my colleagues did during the procedure would open the doors to complications later on. The severity of his injuries alone was enough to keep us wary as it stood. Keeping my focus was imperative by nature, and as such I ignored the nurse's steps toward the phone and focused on removing the last of the bullets from the young man in front of me.

I knew very little of him beyond the facts necessary to keep him alive, although I had caught portions of a conversation between a nurse and the resident assisting me before I entered the surgical suite; the kid, no more than sixteen years old, had been caught in the crossfire between rival gangs - some turf war or another, a bitter reality of urban Chicago life. But that much would be all I ever would know about him. In the end, I've found that it's better for me to remain distant - distant from the patients, their families, their friends, from any connection to their life outside of this hospital. More often than not, the patients come to me already unconscious; whether because they had made it to my department to be sedated first, or went under while still in the emergency department downstairs was of little concern to me - as long as they ultimately survived their ordeal. Either way, I never made it a habit to get to know my patients. Though outwardly discouraged, it is not an uncommon practice for surgeons, for better or worse, and by nature I'm grateful for the traditionally detached mannerisms of my chosen specialty. One benefit of being a surgeon is that I rarely - if ever - have to interact with patients. I can simply focus on repairing whatever it was that brought them to me to begin with, and that's enough.

That level of austere clinical focus is something that I desperately need in order to function, to cope with the realities I face in this hospital every day; I always have needed it to a certain extent, but now more than ever it's imperative, now that my enthusiasm and naivety has been thoroughly chipped away by too many years and too much experience. I can sincerely say from fairly recent past experience that I cannot be trusted to be left to my own devices for long. There was once a time that I left myself prone to dwelling too much about circumstances beyond my control, and I learned the hard way that deliberate detachment is the key to my overall wellbeing. When I operate, I think only of the operation - of everything I've learned and perfected and applied to my career - and I have thus far excelled at that career because of this. My patients are almost always guaranteed to survive, and I am in turn granted some peace of mind.

The nurse's voice broke through my thoughts, "Dr. Riley?"

"What is it?" I responded, never taking my eyes from my work as my hands moved in their rhythmic patterns.

"Dr. Khan, from the emergency department - "

" - I know who he is."

She cleared her throat awkwardly - if not annoyedly - and continued, "He wants to remind you to meet him there this afternoon, and to ask for him at the admit-desk."

"You can tell him that I haven't forgotten, just as I hadn't forgotten the last thousand times he's called me about this today."

She turned away quickly and spoke softly into the receiver - I was certain she didn't relay my response to Nadir verbatim, though he certainly knew me better than to take offense had that indeed been the case. I just shook my head at the exchange. Of course I hadn't forgotten Nadir's insistence that I talk to him this afternoon. I had no idea what about, only that he was adamant that the meeting absolutely had to be today as he hurried off in another direction that morning. I could only think that he assumed that I had missed the importance of his words in his haste. I hadn't, but my unnecessary employment of sarcasm coupled with several ignored calls to my pager were certainly not the most effective way to convince him of that fact.

We worked in near-silence after that inconsequential interruption, the wordless air broken only by the continuously steady sounds of machinery monitoring the patient. I strictly refuse idle chatter when I am put in charge of a surgical case - doing so ensures the most advantageous and efficient patient care. But moreover, it prevents me from adhering to the arbitrary rules of social decorum that would otherwise demand I forge some sort of superficial relationship with my colleagues. I'd just as soon avoid the ordeal altogether - I loathe small-talk.

"Dr. Riley…?" said an unsteady voice beside me.

I sighed impatiently, "Yes?"

"I don't feel well. Um, I'm not sure if I can - "

"Go to your happy place, Dr. Morris," I said emotionlessly, "Or step out. Your choice."

I tried - very amiably, I would say - not to let my frustration show in my voice. I didn't necessarily want to lose my temper with him, but I found his lack of preparedness more annoying than was strictly called for - and beyond that I simply had no patience for consoling any med students that day. I rarely do, and I absently wondered why his mentor wasn't handling his obvious distress then. I am no longer obligated to have med students assigned to work under me, and as such I'd been enjoying the relative freedom. For the moment, I only wanted to do my job and make my meeting - the last thing I needed was a squeamish participant getting sick and contaminating the surgical suite, potentially harming the patient and delaying the surgery that much longer. Rationally, I knew that every last one of us had once been in his position, whether we cared to admit it or not - we had all been afraid and overwhelmed and almost entirely without real-world experience. But even so, I didn't feel generous enough to grant him that small understanding, even silently.

The student left quickly. I shot a glance at his resident, Dr. Lucas - a resident physician that I genuinely did not enjoy having to work with. He was a hard enough worker - but he was arrogant as hell, and never in a way that did anyone any good. When I insisted to my superiors that I was correct about some detail or another regarding critical patient care, I supported my assertions with sound reasoning that in the end always proved to be in the patient's best interest. I was almost never incorrect - and if I was, I had the good sense to alter the course of treatment as the situation demanded. Dr. Lucas, however, had never perfected the art of balancing skill, intellect, and instinct, and did not handle being corrected well; those factors in combination with his undeserved sense of pride had harmed patients in the past, and were bound to actually get someone killed sooner or later. Considering this, coupled with my general annoyance toward the man, I confronted him rather tactlessly.

"Was this your student's first day observing?" I asked, not allowing him to respond before I continued, "If so, you didn't prepare him very well for this procedure."

"I did," he said defensively, "He was doing fine there, for a while."

"He should have left a lot sooner. This isn't a good teaching case, and you should've known that. Those bullets ripped this kid to shreds. The last thing I need is for him to go septic because your student threw up in the field."

"I'll talk to him. We've all been through this."

I allowed him that, simply because I had just been thinking the same thing. But something in me wasn't quite ready to give up.

I paused before speaking again. "Your student shouldn't have been asking for my dismissal at all, you know."

"This is a teaching hospital. Your input is as beneficial as mine."

"He's your student."

"And you are the attending physician on-call. To him, you're running the show, and for all intents and purposes, you are. He hasn't yet learned that this specialty encourages a team-effort," he said, then added smugly, "Apparently, you haven't either."

I wasn't willing to respond to that, opting instead to glare at him across the table amid the questioning looks of the nurses and anesthesiologist, before saying pointedly, "I believe we can proceed closing up now. Do you concur, Dr. Lucas?"

"Of course, Dr. Riley."

"Thank God."

I was relieved when it was over, simply because the energy in the room had turned so abruptly tense. But on the whole, there was success to be considered, and it would be unwise to dismiss that fact. The patient had survived, and my duties then concluded the moment he was wheeled into the surgical ICU. He was the last case for me of the day - and barring any post-surgical complications that could occur within the next hour or so of my shift, I likely wouldn't see him again. I nodded at his departure - mostly indifferent - as Dr. Lucas went to talk to the family members.

It was another job well done, but a case like that always left me uneasy - in considering the big picture, I regarded it to be somewhat of a hollow victory. There would be countless more like it in the future. There always were; for every shooting or stabbing victim whose broken body I repaired, ten more came rolling through the doors of my department, just as years ago a grenade or a roadside explosion always preempted too many of the same occurrences to count in their wake. When I stepped back and really examined the nature of my profession, it occurred to me that it had been a long time since I felt like I was truly healing anyone. Rather, it seemed that I was only one of many ordered to mask one problem in the same breath as the dregs of humanity contrived a million new ways to create more. Sometimes I had to wonder if that line of thinking - that peculiar sensation of mingled indifference and despair - is what the road to burning out as a surgeon looks like. And a burn-out does not an effective doctor make. But I dismissed the idea for the moment - there were never any clear solutions, and at any rate, dwelling on the faults of mankind more often than not only proves to be a useless endeavor.

Once I left the suite and removed the bloodied gown and gloves, I immediately exchanged one sterile mask for another. Even outside of the OR, I never go without one beyond the relative privacy of my house, and I haven't done so for quite some time now.

What is still considered somewhat of an eccentricity of mine by others had earned me more than a few second glances and rude questions upon my arrival, as well as the following weeks of adjustment among my colleagues; but in general after that time, everyone in on the surgical service gave me a wide berth, for which I was silently grateful. For the sake of my sanity, I needed it to be that way. The mask coupled with my temperament made me an outsider, distant and unreachable, but I was long past caring. From the outset, I had made it explicitly clear that I wasn't there to make friends, that I had higher priorities. First and foremost, I needed the steady and somewhat predictable routine of employment to keep me out of trouble. But moreover, it was extremely irresponsible to allow myself time spent alone away from the demands of my career. Being a surgeon had become an entirely selfish endeavor by that point in my life - I needed my hands and my mind to be kept busy at all times humanly possible. And so, I while I certainly hadn't won the hearts of my peers, I had at the very least brought some semblance of contented normalcy into my life.

The locker room was empty by the time I got there, and I made it a point not to occupy that space for long. Keeping my meeting with Nadir in mind, I attempted to change quickly and leave the floor as soon as possible. I was mostly successful, only pausing when I caught a rare glimpse of myself in the mirror on the wall opposite my locker. I was no longer shocked by what I saw - certainly not as I had been in the beginning - but I narrowed my eyes as I considered my image just the same, experiencing what I can only describe as an odd and unexpected moment of clarity regarding the man I saw reflected in the glass. That happens every now and again, that strange sense of detachment from my own life, and this moment was no different from similar instances in the past; it was as if I was viewing a stranger far and away from myself, someone I barely knew nor had I expected to become.

I had removed my scrub top by then, noting absentmindedly how pale I had become this last year...too thin and too pale. In the far corners of my mind, I couldn't deny that I've gotten substantially better since I arrived in this city - but on the whole, I sincerely believed that I had to acknowledge that my hold on recovery was tentative at best. Not for the first time, I wondered how much longer it would last. I shook my head at that particular train of unpleasant thoughts. I knew that continuing would only serve to invite potentially devastating setbacks, and I couldn't afford to be thrown off course again - I didn't want to be. And so, instead I stubbornly decided to ignore the distinct flash of my arms' reflection as I began to put my regular button-up shirt on - tattoos on the left arm, savage scarring on the right...down my side, up to my face...But I didn't want to think any longer about their origins then. That was my cross to bear, that internal struggle of always fending off reminders of the pain and unpleasantness I wanted nothing more than to forget. If nothing else, doing so wasn't worth the anger anymore, especially when I still had tasks to complete before going home. The anger - the bitterness - surely needed to be dealt with, but they could wait. I would do well to remember that.

Still, shirt buttoned and properly tucked into dark slacks, I shut my locker harder than necessary. Slightly unsettled by my brief outburst, I took a deep breath to calm down, to brace myself for what awaited me downstairs, before I gathered my possessions and walked to the elevator bank.

~~oOo~~

It's rare that I find myself in the emergency department - only on the few occasions that I've been called down for a consultation have I gone there of my own free will, grudging though that action may be. Otherwise, I prefer to avoid it at all costs. There's something about it that grates at me, inspires a distinctly troubling feeling that lingers long after I've departed. Perhaps it's just too loud, or too chaotic, a far cry from the reserved stoicism that paints every day in the surgical service - though in being perfectly honest, I think I've just always found emergency rooms simply to be depressing as all hell. For reasons I can only barely understand, they affect me badly, and the one here in Chicago is no different - something about its inherently dispiriting nature pulls at darker corners of my mind, and I always leave that department unsettled and agitated and altogether possessing a more foul mood than when I arrived. I don't like being there - I can barely handle being there.

Sympathetically bearing that sentiment in mind, when Nadir needs to speak with me during work hours, he'll more often than not arrange to meet me in the relatively quieter areas of the hospital - the roof, the outdoor designated smoking sections of the campus, even the cafeteria during off-hours. The fact that he asked me to come down to his department told me that his schedule was more hectic that day than usual - had likely never quite settled down since I had seen him that morning - and that our meeting would be short. And, of course, I was grateful for that.

After asking for Nadir's whereabouts at the admit-desk - just as requested, I thought sarcastically - I was finally directed to meet him in the doctor's lounge.

"Do you want coffee?" he asked, motioning for me to join him at the round dining table and not wasting time with preamble. I liked that quality in him - he wasn't one to waste time and fill the air with empty words. More often than not, he was direct.

Cringing at the dimly lit room in desperate need of organizing, I simply shook my head at his offer before muttering, "Thanks, though."

"If you're sure," he shrugged.

"What did you need to talk about?"

He spoke his next words with nonchalance - forced nonchalance, I noted, briefly redacting any kind thoughts I had so recently harbored toward his character, "I had a board meeting today."

"I know. You told me this morning," I said, "How bad was it?"

He shrugged again, "The usual. But we did go over some budgetary issues. How much have I told you about it?"

"Enough to know that this hospital is financially fucked. Is that what you wanted to talk to me about?"

"Yes and no. It's about your job."

I stiffened at that, briefly entertaining the unjustified thought that my employment was in jeopardy, and wondering how that might possibly be the case to begin with. As far as I knew, I hadn't done anything that would necessitate my name being brought up during any kind of staff meeting. If there were to be any disciplinary actions taken against me, I was certain that they were unwarranted. Beyond being short-tempered at best with my colleagues, I knew that I otherwise excelled in my department, in my field as a whole. I truly could think of no real reason to be involved in any discussions, and I was alarmed by what Nadir had to say on the matter.

"What about my job?"

He leaned forward and spoke almost gravely, "Alright, well...there used to be a fellowship in place for trauma surgeons in this department. But, because of budget cuts and various administrative issues, that fellowship is no longer available."

I narrowed my eyes, now admittedly confused, "Meaning?"

"Meaning, the trauma fellow had to be laid off, but we still need someone down here to cover the trauma cases that the position is in place to oversee. Your name came up as the one that would fill the position. So, you'll be working down here for a while."

I couldn't respond then, unsure how to immediately react as I attempted to comprehend his words - I hadn't been expecting that news at all. It was certainly within the realm of possibility for me or any other physician without tenure to be shifted from one department to another, that the hospital's over-worked administration could make these kinds of changes within reason when absolutely necessary. And apparently, the reassignment of certain staff members had very recently become necessary. But in those moments, it felt less like a practical response to a budget crisis and more like a demotion on my part - an insult in spite of my logic insisting that it was not meant as such. Even so, I didn't want it. I couldn't begin to guess then what the long-term effects would be on my career, nevermind my psychological wellbeing; if past experience was any reliable indicator of things to come, I didn't like the implications whatsoever. I'm not one to respond well to any unforeseen disruptions to my carefully planned and implemented sense of familiarity, nor to the feeling of a complete lack of agency where any aspect of my life is concerned. I had spent nearly a year managing to settle into a routine that worked for me - I didn't want to give it all up after everything I had been through to get to that point.

He paused, "There's more."

"Jesus Christ, Nadir - "

He held up a hand in a placating gesture, " It's not much more, I'm just warning you now. You're going to be on-call for the MediVac chopper for a couple of weeks, until they can find a suitable replacement for the flight physician."

"Fantastic. Well, I'm not accepting either proposal," I stood to leave, "Thanks, though."

"Sit down. This is not a request. Dr. Phelps is going to call you in tomorrow to talk over the details, but I wanted to warn you about all this at once, in advance."

"They can't just take me out of the surgical service," I insisted as I returned to my seat, still not quite willing to accept this unexpected turn of events.

"They can. We have to have a trauma surgeon in our department to remain open in this county, and you haven't been here long enough to gain the seniority to opt out of this. Besides, you're the best candidate. You're a trauma specialist, and you have the most experience. They know you've seen combat - "

" - I would think they'd want to keep me as far away from any reminders of combat as possible," I said bitterly.

"Psychologically, you're competent to handle this kind of position. Unless something's changed recently that I should know about?" he prompted.

"Nadir, I'm no less messed up than I was when I got here," I sighed, "But it's not worse, either. I don't imagine that I'll harm myself or others in the foreseeable future."

Pointedly ignoring my last bit of sarcasm, he said, "You'll do fine here, then. And you're much better now, you know. Whether or not you actively chose to believe it."

Dismissing his encouraging words, I said, "I don't want to be here, though. This isn't what I agreed to when I took my position in the surgical department. Besides..." I hesitated before speaking again, "You can't assume I'll do fine here. I know I won't be fine. There's too much for me to handle."

He offered a sympathetic half-smile, understanding the underlying meaning of my words, "I know, but it's either this or risk your position here altogether. We'll figure out everything else."

"I could just decline and hope for the best."

"It would be career suicide."

"Fitting enough choice of words," I smiled sardonically.

He flinched, "Don't do that, Erik."

I cleared my throat, immediately sobering and regretting my words, "Right. I'm sorry," I paused, "But maybe I don't mind going out like this anyway."

"You should mind. Other hospitals simply aren't hiring right now, and I don't want you to have to leave Chicago - "

" - I don't actually live in Chicago, to be fair - "

" - And I don't quite trust you enough yet to let you loose into the world," he held up his hand again as I was about to protest and continued, "You are doing a hell of a lot better than before, but I think it would be unwise to test the waters so soon - "

"And yet the powers-at-be still think it's a good idea to put me in a fucking helicopter - "

"Even so, you've made a lot of progress this year. I don't want to see you losing all of that headway now, especially not over something like this. At any rate, you need to remain in good standing with this hospital."

"I would prefer not to fold under these bullshit policies."

"You need to think this through," he said, speaking more urgently as his patience faltered, "Is this really a hill you want to die on? You could've been among the ones laid off instead, you know. If you don't pitch a fit over this now, you won't be one of the ones on the chopping block the next time something like this happens."

I rolled my eyes, attempting to ease the tension as I saw clearly that there really was no feasible way out of this, "I don't have much of a choice, apparently."

"Sorry," he sighed again, "Just accept this for what it is and work with it."

I was silent for a moment before ultimately deciding to accept defeat once and for all, "When do I start down here?"

"Next week. Three days on, three days off."

I scoffed, "At least my schedule isn't changing. Anything else?"

"No. Like I said, you'll have the official meeting about this with Phelps, someone will contact you with the exact time. I just wanted to warn you beforehand. I figured you'd probably appreciate that."

I laughed humorlessly as I stood, "Thanks. Well, it's been a delightful visit, but I think I've had all of the good news I can handle for the day. I'm heading out," I said as I walked toward the door, "I'm more than ready to go home, see Rex. Maybe sleep."

"Maybe sleep?" he asked in mock-horror.

I shrugged, conveying a calmer demeanor than I actually felt, "We'll see."

"I'll stop by later."

"That's fine," I called over my shoulder as I made my way to the exit.

~~oOo~~

When I opened the door, the sound of massive paws against hardwood and a blur of black and white immediately greeted me. In a rare showing of relatively carefree emotion, I smiled at my pitbull mastiff, Rex. At two years old, he was technically an adult, but I would not be convinced that he wasn't still a puppy in spite of his large size. Officially, he was my service dog, and in that capacity, he was damn good at his job. But when he wasn't wearing his vest, his stoic and professional demeanor instantly gave way to his naturally docile and even ditzy temperament each time without fail. When he wasn't coaxing me out of a panic attack - which had by no small feat become a rare occurrence over the time that I've had him - I simply enjoyed his company. He was one of the few genuine joys in my life. I scratched his ears in greeting, laughing at the sound of his tail pounding against the floor, as I walked further into my house from the entrance of the mud-room off the garage.

The house in Schaumburg - a suburb just outside of Chicago and substantially quieter than the sprawling city - is the first that I've owned in my life without the aid of family members. It had been relatively simple to purchase, even easier to move into after so many years as a self-imposed minimalist, and more often than not I could say that I was content there - even if I still didn't quite feel settled in entirely. It wasn't necessarily for lack of trying on my part, but rather a lifetime of experience telling me that I shouldn't expect to remain anywhere for long. To be settled anywhere only meant looming disappointment, I was sure. But this time should be different - would be, if I had any say in the matter - and with that resolve in mind I had compelled myself to believe that it was acceptable to live in relative peace day-by-day, until the moment arrived wherein I finally convinced myself that it would last.

That afternoon, however, I was decidedly more restless than I had been in some time, still upset by the shifting of my position between departments and the fact that the decision had been entirely out of my hands. It had distressed me far more than I had initially realized. None of my usual interests or constructive outlets appealed to me, no matter how determinedly or sincerely I attempted to become engaged with them - the piano remained silent and untouched in the livingroom, vinyl albums and books lay abandoned on their shelves. Nothing seemed inviting, nothing promised relief from that unwelcomed and consuming agitation. After wandering aimlessly around my house for far too long, a dark impulse within me wondered if it might not be for the best to simply abandon responsibility altogether and hole myself up in my upstairs office indefinitely, pathetically nursing and Jack and Coke, a Scotch, - anything really.

That afternoon marked the beginning of three shifts off from work, three days away from the distraction of my profession; I had nowhere else to be and no one to visit, save for maybe Nadir - maybe. But I didn't necessarily feel up to seeking out or hosting company by then. I could feasibly disappear for a little while and allow myself to fall into the state of anxiety and mental turmoil that I was beginning to sense on the horizon - and I could in turn do something about that singularly objectionable internal chaos. I could employ any number of my old methods of calming myself down, forcing my mind to slow and quiet its relentless beating.

But I made my sincerest attempt to drive the notion from my mind - I knew better than to give myself to those kinds impulses, tempting though they were on days that threatened my carefully constructed routine of forced self-control.

After time, I ultimately decided to take Rex for a long walk. He needed a chance to be outside - really outside, and not confined to the backyard for entertainment - and it seemed a simple enough distraction even as much as I absolutely hated the ordeal of going out in public. People, no matter where I go, are simply too unpredictable for me to tolerate with any semblance of patience for long. Some only stare at me impolitely, but then there are inevitably the others that ask too many questions, that come far too close to me, and without fail I'm regarded either with superficial pity for my plight or with outright scorn - some instances even turning violent. But the weather that mid-August afternoon was still warm enough to be mostly uncomfortable, and I assumed that not many people would be very willing to go out in it that guaranteed discomfort; a walk seemed safe enough for me then. I donned the surgical mask again, a ritual of preparing for the outdoors that I never neglect. Doing so certainly draws its own brand of unwanted attention, as it does in the workplace, but going without it entirely is impossible - unacceptable. I feel far more exposed when it is solely my uncovered face that is presented to the world. But surgical mask or no, it is still a largely unpleasant experience for me to go outside.

But that afternoon, it was more than Rex's need to stretch his legs that compelled me beyond the safety and privacy of my home. It was imperative for me to redirect my attention away from my problems, past or present.

So I called him over to me, waving his leash with feigned enthusiasm to excite him for his journey. As an afterthought, I put his vest on - dark blue with service dog, do not pet in bold letters on the sides. I don't always make him wear that just to walk the neighborhood and surrounding areas - more often than not lately, it's truly not necessary. But in spite of my resolve to find a way to maintain my peace of mind without resorting to destructive methods, I was still feeling especially nervous, and instinct told me that I would likely have a panic attack before the walk was over. If for any reason I couldn't regain control of myself quickly enough, at least I could guarantee some modicum of safety. Rex would have to act in his official capacity sooner or later, I was sure, but I trusted him and therefore felt confident in taking the calculated risk of going out in my present state of mind.

Few people were out then, as I had assumed, and gradually I convinced myself to relax as I led us further away from my own quiet neighborhood. Initially, I forced myself to think of absolutely nothing beyond what was immediately relevant - cross the road here, turn left there, straighten Rex's leash...I had no true destination in mind at the outset; keeping track of my steps was simply a matter of preventing myself from losing my bearings. But that method did help to a certain extent, and slowly I began to feel some confidence and even relative calmness returning. Walking with a feigned casualness at a steady pace, head held high in a display of stubbornness in the event that someone did show up after all, I was aware of Rex pulling excitedly at his leash, only to hang back and dutifully return to my side when he remembered his manners. I idly tapped out seemingly-nonsensical rhythms on the leash's plastic handle, a habit that many years of musicianship had irrevocably instilled in me as I heard the notes drifting through my mind. Gradually, I deemed it appropriate to allow myself to reflect on the events of the day, assuming that I was calm enough by then to do so, to somehow make sense of it all.

It proved to be a mistake - the more I dwelled on it, the worse I felt. I could find no immediate answer, no way to make it all palatable. The fact of the matter was that the very idea of being confined to the emergency room indefinitely left me with a deep sense of foreboding; and tried though I did, I could not escape it. I knew exactly what to expect - every hospital is the same. I remembered all too clearly what the worst of humanity would bring through those doors, and I wanted nothing to do with that lasting reminder of cruel and compassionless people, their actions always raw and uncensored by the unstable nature of emergency rooms as a whole. I never wanted to be that deeply immersed in humanity - not at the outset of my career, and not again. People simply affect me too badly. Like it or not, witnessing the cruelty or suffering of others brings out the worst in me, compels me to believe that there's nothing good left in the world - it's a simple idea that's been steadily convoluted and dismantled. I believed that goodness was warped beyond repair in my mind now. I'd been through it before, that all-consuming mockery from deep within me, and that very isolating idea had nearly destroyed me more than once. Since then, I've done everything in my power to remove myself from that aspect of humanity, from the seemingly-endless barrage of cruelty and madness. I've chosen to separate myself from that madness in favor of the relative control I found as a surgeon. It ultimately became too much for my mind to take.

But I didn't have a choice in the matter this time - I had to find a way to cope with the often violent and usually unpredictable environment of the ER at the very hospital where I had initially sought my refuge. The problem remained that I didn't truly know how to cope in any positive way, and that terrified me.

Sensing my obvious distress, Rex began his skillfully ingrained attempt to indicate the stark shift in my emotions. Ideally, there would have been enough time between that initial signal from him and the anxiety attack itself to effectively do something about it. But on that occasion I was not given the chance. Without warning, a car backfired as it drove down a particularly narrow street, interrupting my thoughts as the cracking noise echoed off of the cluster of shops and office buildings around me, and I immediately responded with an almost violent intensity at the sound. Nearly losing my footing as I did so, I jumped back, hitting a wall behind me forcefully. Though I remained where I stood, I wanted so badly to run, telling myself to be ready to fight as I felt a terror so fierce and pervasive that I was quickly becoming paralyzed in spite of everything within me begging me to take action somehow.

Get out...get out!

It was just a car - I knew that, I knew that. Under any other circumstances, I likely wouldn't have even noticed it or paid it much attention if I had. But in my stress-addled mind then, I wasn't hearing the commonplace sounds of a relatively peaceful world around me. I was hearing gunshots, grenades…I was hearing the sounds of war, remembering images of bloodshed and urgent pain that I had assumed were long since buried. And it seemed so absurd that they should appear to me then, seemingly as if from nowhere - I was in my right mind and presumably had been for the last year at the very least, knew exactly where I was in space and time. But, I realized too late that as I had reflected upon the sudden change in my life and its distressing implications - its reminders of everything I wanted to leave behind me - I had allowed myself to become very vulnerable to internal forces that sought to betray me, had become distracted to the point of carelessness. So much so that I had inadvertently fallen prey to my old and all too familiar patterns of anxiety. I hadn't been expecting it whatsoever - it had all happened so fast...

It was a car, I told myself firmly, It was a car. Calm down.

But I felt like I was suffocating - drowning as I fought to catch my breath. Heart pounding so forcefully that I was certain that it would break through my chest, I slid down the wall that I had crashed against, falling crumpled on the ground like a helpless child. I was still holding the handle of the leash, but now so tightly that my knuckles had turned white. I was barely aware of that or much else around me, still very much in the throes of a powerful flashback. Rex hovered over me, nudging me and trying patiently to coax me back into reality. Countless moments passed before I mustered enough strength to respond to him, weakly drawing him close to me and patting his head to show that he had done well. It took quite a while to recover even after that, to convince myself of my own continued safety then, but after a time my heartbeat slowed, my hands stopped shaking. Without a second thought, I immediately stood and began to take the steps to return home, Rex continuing to act as attentively as he was trained.

I hadn't had an anxiety attack that severe in several months, and it was immeasurably unnerving to have had one occur then - it wasn't a good sign that I should have one that day. In those moments that followed the worst of it, I couldn't deny that something terribly wrong was unfolding before me. I felt like I was falling apart, that one decision made by a panel of people I wholly considered strangers should be so disruptively momentous for me, and as such I began to very seriously worry once again about things to come. I wasn't entirely sure how to go on from there, what decision would be most in my favor. All I knew was that I needed to get a handle on myself immediately, before it became too late to turn back.

History could not be allowed to repeat itself.