Chapter 1: Not fearless at all
Suddenly something has happened to me
As I was having my cup of tea
Suddenly I was feeling depressed
I was utterly and totally stressed
Do you know you made me cry
Do you know you made me die
And the thing that gets to me
Is you'll never really see
And the thing that freaks me out
Is I'll always be in doubt
It is a lovely thing that we have
- The Cranberries: "Animal Instinct"
Clare leaned on the depressingly grey basement wall, pushing a stray lock of sweaty hair back under her bonnet. She wondered if she dared to leave her Junior House Officer in charge of the bread-and-butter-appendicectomy they'd just put under. That would give her maybe forty minutes of potential sleep. Slumber. Coma. It was nearly midnight, and the hard mattress of the on-call room beckoned. The surgeons had just entered the theatre, meaning it would probably be a quiet moment for the anesthesia staff.
Her phone began to ring, cranking Clare's level of alertness several notches up. It could just be a difficult iv at the wards. Or Devendra from the theatre, wanting her opinion on some medication the House Officer was wondering whether to give or not. Or it could be a full-blown disaster requiring fast hands and a mind much sharper than the sleep-ridden, aching one Clare had to offer.
It was neither. Just a bored colleague from the neuro service. "Hey Lake." The warm male voice at the other end yawned. "Busy night?"
"Read all the papers twice. Now I'm sort of torn between Netflix and putting together the presentation I was supposed to give tomorrow. Can't seem to be able to sleep for some reason. You?"
"Appy. Overeager gastro registrar didn't want to wait overnight. Less hassle for the day shift that way or something. Devendra's on it, it's good to give her some space. She's assisted me with three of those already."
"Still, it'll be on you if she fucks up."
"No need to remind me. Burden of the consultant."
Silence. Smalltalk died down quickly when one was this tired.
Suddenly the comm system crackled to life. At night, it was rarely used outside of emergencies. "Rosemore-Harringdon to A&E." Oh right, she was still on the phone. They had probably tried to call her. "Gotta go," she told Lake, disconnected and began the short jog towards the Emergency department.
She was stopped by the A&E entrance by an orderly with her lap loaded full of blood bags. "Clare honey, could you get these, I have to run and prep the invasive rad suite."
Clare skidded to a halt and grabbed what she could carry. "What's going on?"
"This guy got shot in his right lung. Went asystolic during transport, 45 minutes of resus after which they called him. Then he just sort of, well, woke up."
Clare rubbed her temples. This was going to be a long night. Prepping the invasive radiology department likely meant a lengthy embolization procedure under GA. "What do you mean, woke up?"
"Well, he sort of wiggled his fingers and there it was, sinus on the screen"
Clare glanced at the blood bags. "These are all O neg. We don't have a blood type in the records?"
The orderly shrugged.
"It's AB positive," came a sudden, hasty reply from a few feet away, somewhere in the hallway. Clare turned.
"Oh my God, John Watson, is that you?"
The situation would not allow a catch-up with her old medical college comrade, so Clare had to contend herself with a sympathetic but confused nod to John Watson before hurrying to the resuscitation suite. For some reason, John followed her and lingered by the doorway. Clare figured he must've known the patient.
Clare turned her attention to the situation at hand. The patient was a youngish male, greyishly pale but the steady but frantic beep of the monitors meant that he wasn't a goner yet. A half-empty syringe of propofol meant they'd had to sedate him. No kidding then, about the waking up. Asystolic after a gunshot wound? How on earth had he manage to wake up after practically bleeding out?
The patient was slender, with sharp facial features and a mop of dark, curly hair. He looked familiar. Maybe she'd seen him in the papers for some reason. She didn't have much time to follow the news recently. A dark woolly coat lay on the floor, cut to pieces. The patient was mostly only wearing his suit pants, his white shirt hanging open and limp and his sides, drenched with blood. Someone was applying pressure onto the lower right thoracic quadrant.
Garvey, a fellow anesthesia consultant who was stationed at the patient's headside, gazed up and noticed her. "Glad they got hold of you. I have to get to the HDU, one of our coronary bypasses is circling the drain." Clare wasn't trained in cardiac procedures so couldn't have acted as a substitute.
"I'll take over. What do we have?"
"Male, 34, history of substance abuse but no permanent damage, it seems. No knowledge of recent use. No blood-borne infections."
Behind Clare, John Watson seemed to be clearing his throat but said nothing.
"No allergies, no medications. Shot at close range but not point blank with a handgun, x-ray indicates the bullet's only entered the muscle layers but has torn an intercostal artery. They want to embolize it and dig the bullet out thoracoscopically. ROSC after 45mins." Garvey shook his head in disbelief. "We'd just taken our gloves off, heading out—" Garvey mused. He was saying they'd already decided it was moot to continue resuscitation. Meaning the man on the gurney had been dead. "Spontaneous return to sinus rhytm. I mean, we hadn't even gotten hold of any RBC yet!"
Clare glanced at the patient. She'd have plenty of time to marvel at this potential medical miracle later. Now she had a job to do.
Garvey disappeared out of the door, and Clare took his place by the patient's head.
John stalked closer. A nurse noticed him. "Sir, you have to step back. Unless you're his family or spouse we can't allow-"
"I'll be his bloody whatever! I'm not leaving!"
He sounded desperate, haunted.
Squeezing the ambu bag at regular intervals, Clare wondered why Garvey hadn't hooked the patient up to a portable ventilator yet. After ensuring that the intubation tube was still in place, she turned to the nurse trying to manhandle John Watson out of the suite."It's alright, he's a colleague. Just let him be." The nurse gave them both a glare, and then returned to hosing down a tubing full of Ringer's lactate to hook up to the iv.
John stalked closer, and to Clare's surprise grabbed the patient's hand. "Sherlock." He said, and realization and recognition dawned in Clare's mind. Right, Hat-man and Robin. Bless her sleep-lacking brain to forget what she knew John Watson had been doing recently, according to the papers. "It's him?" she asked, taking a closed look at the patient. John nodded.
Clare knew Watson John well. They'd spent great many nightly hours together during medical school interships, late night cram sessions and shared the other hardships of studying for their craft. John had shared a flat with Clare's brother. Clare hadn't been surprised to learn John had headed to Afghanistan after a short stint as a GP. Fearless, he'd always been. Determined. Never nervous – or maybe sometimes, but it never showed.
This John, however, was very different from the John of Clare's many memories. Pale as a ghost – nearly as pale as the half-dead patient on the gurney – with sweaty palms John was wringing together. A look of frantic but silent desperation was evident in his expression. This was John Watson, devoid of all but the most elementary self-control. John Watson, in such a state as Clare had never witnessed him in.
Suddenly, there was a groan, and something tugging at the bag Clare was squeezing. She moved her gaze from John back to the patient – and was met with a pair of slightly panicked, not-entirely-aware eyes. Surprisingly enough, her patient wasn't fighting the intubation tube. "Sixty milligrams of ethomidate and one point five milligrams of alfentanil, please, and fast," Clare told a nurse standing nearby. If he wasn't fighting the tube now, he would be soon.
John nearly leapt to Clare's side, trying to meet the patient' gaze. "Sherlock, it's allright, it's just, don't worry-"
John Watson not knowing what to say. That was a another new one for Clare. After an agonizing minute of shared stares between a doctor and her confused, lethargic patient – Clare mainly wondering how on Earth he was able to stay so still – the drugs kicked in. Sherlock Holmes closed his eyes, as though accustomed to the sinking feeling caused by a dose of such medications taking effect.
John let out a breath he probably hadn't been even been aware of holding. He grabbed the patient's hand, holding it between his palms.
Clare wondered what she herself would feel, what she would try, what she would want, if it was someone important to her on the table. She would have a very hard time being sidelined like John inevitably in this situation was. It was disconcerting to see someone she'd leaned on so many times come this unhinged.
After adjusting the ventilator, Clare turned to John. "Could you give me a hand, John?"
John looked up at her, and Clare thought that there was a sudden flash of gratitude in his expression. Along with expectation. He let go of the patient's hand. "Anything."
Clare smiled. Something told her he'd really meant what he had said. "An arterial line, if you please, Dr Watson."
After a split second of hesitation, routine kicked in, John grabbed a set of gloves and together they set to work. Clare breathed a sigh of relief that her distraction had worked. To be honest, it was creeping her out seeing John like this.
Roughly forty minutes later things had calmed down considerably. Patient Holmes was under a carefully titrated infusion of anesthetics, looking rather peaceful lying on the operating table at the invasive radiology suite. Monitors indicated only a slightly elevated heart rate. Clare had placed a central venous catheter into his left internal jugular to allow large amounts of blood products to be infused quickly, restoring hematocrit and hemoglobin levels as well as the amount of circulating coagulation factors. Sherlock Holmes had, indeed, arrived at the trauma centre in the nick of time. Or maybe even a bit after. Luckily his implied narcotics history had obviously not affected his heart – only a healthy one could have made such a miraculous recovery from flatline.
John's fidgeting had subsided to a level which in Clare's judgement allowed for a cup of coffee, especially considering the late hour. They had both snuck in their caffeine doses into the observation area of the radiology suite. The taste was depressing, it had probably been left in the pan by the evening shift.
John sipped his foul beverage. "What do you think the chances are they'll have to go in for a thoracotomy?"
Clare shifted in her chair. Her running shoes had begun to chafe. Her legs were getting swollen after being on her feet for nearly twenty-four hours. "Intercostals are not too difficult to navigate and Langly's very good." She gave a nod to the radiologist, who was wrapping herself into a sterile gown. The bullet had penetrated deep enough to puncture the pleura but had not advanced to lung tissue. It had hit a rib on the way in, splitting into two fragments, one of which was the culprit behind the torn artery. There was a small hemopneumothorax which had been drained with a pleural drain.
John's shoulders slumped. He'd been standing by the doorway and Clare thought he saw a momentary sway, just a small one. She hoped she wouldn't end up with two patients instead of just one. He had to get John's mind off the medical facts, since those were seemingly disturbing him at the moment.
"Any next of kin?"
"Parents are in the US. He's got a brother, who probably already knows. Bloody CCTV, he's probably patched into these internal ones as well." John shot an indignant glance at a security monitor.
Deciding to ignore her old friend's strange new paranoid tendencies, Clare decided to be curious. "So, the two of you, crime fighters, eh?"
John smiled for the first time since Clare had run into him that evening. "Sort of. He solves them, I blog."
"I remember reading he's sort of brilliant, isn't he?"
John seemed to be lost in thought for a minute. "Well, yeah. Never a dull moment. Mind you, when he gets bored it's better to get out of the way. He's probably three times smarter than both of us put together. But he's also bratty, obnoxius, narcissistic, completely oblivious to anyone's feelings and cruel, beyond anything you could ever imagine."
"So your friendly neighbourhood psychopath then. At least that's what they say in the papers."
"Sociopath."
"What?" Clare dunked her empty disposable mug into the bin.
"High-functioning sociopath, he likes to tell that to people. He just doesn't get the rest of us", John mused.
"Nice sort of company you keep, Watson." Clare smiled, slightly annoyed that the suite hadn't been updated yet and she didn't have a remote monitor to follow the procedure.
John didn't reply. He seemed to be lost in thought.
"So, are you two then…?"
This shook John out of his reverie. He looked resolute. "No, I mean, I've got a wife-" A fervent denial which, to Clare, somehow sounded a bit rehearsed.
"I had no idea you got hitched. New thing? Congratulations!"
John seemed a bit absent again. "Two months," he replied, eyes locked towards the operating room again.
There wasn't much more for Clare to do apart from waiting, so she allowed herself to wonder a bit more about John. Did she look at his wife the way he had looked at a nearly dead Sherlock Holmes in A&E, with the sort of all-encompassing absolution that if Mr Holmes disappeared before their very eyes, John Watson would follow?