A/N: Well this has taken me forever to write, apologies. I have to also say sorry, not sorry for the intense emotional roller coaster of this chapter. Hurt John and Sherlock, some comfort, angst and lots of medical stuff. A little shout out to Boton for always commenting something lovely and GracefulBlueCat who is always wonderful support. I have to say if your not medically minded and want to know a little more prior to reading (especially what REBOA is) then please feel free to read the medical definitions at the end of the chapter. Anyone in human medicine spot a mistake then feel free to flag it up, i want this to be as true to life as i can be. Thanks again and enjoy (if you can lol) sorry!

PS. I'm looking for some fan art for people to do to this, if you know anyone or fancy a shot please feel free.

Chapter 21: Descent (Part 2)

The sounds of the helicopter were deafening to John's ears, but not as deafening as the sound of the screaming ECG monitor beside him. The doctor's heart pounded wildly in his chest, the whooshing pulse in his ears only adding to the panic within him. He struggled to remain at least the tiniest bit calm and swallowed back the nausea as the chopper banked harshly again, its passengers thrown towards one side until it levelled out. The movement was doing nothing for John's dizzy concussion filled head.

"Sherlock!" He shouted over the din, grabbing his friend's hand in a death grip, the detectives appendage was cold to touch and the temperature sent a shiver down the doctors own arm in response. "Come on Sherlock, not this, not now." He shook his head defiantly.

The detective's eyes cracked into slits, half-moon ellipses and pupils vaguely on his friend's figure. "John..." a weak and barely audible moan came from his throat, muffled by the oxygen mask now strapped the detectives face.

"That's it, stay with me." John brought his face closer to his friend's; in his peripheral vision, he could see the medic working hard. The fluids hanging above them were racing into the detectives veins at terrifying speed that any doctor who did not work in trauma would have been uncomfortable with. "Sherlock, stay awake!" John brought his hands up so that he was now cupping his best friend's cheeks in his palms. "It's important, please."

John could see the medic pushing another drug through the IV line quickly, "noradrenalin," he said without question, John nodded in agreement, the drug would help Sherlock's blood pressures at least temporarily, and within moments the numbers on screen rose a little in response.

"Four minutes to Southampton general." The paramedic cried, "the trauma team is on standby, as is blood and a vascular surgeon." He jotted a few notes down on his pad hastily before checking the detectives pulses in his feet and then covering him with a blanket, John couldn't help the ghost of a smile at the orange 'shock blanket.' "Are you okay Dr Watson?" He asked, "Are there any injuries I need to be made aware of before we arrive?"

"I'm fine." He wave off the advances of the man, "just look after him."

Another moan and a gasp escaped the detective's lips and his eyes began to roll backwards, leaving only the whites of them visible. John could see his friend's arms shaking slightly, likely a side effect of the drug. His body in full flight mode now, cardiovascular system literally fighting to continue each beat of his struggling heart, muscles and organs screaming out for oxygen rich blood that was depleting fast.

"No, no." John gripped his friend's head and gently shook it. "Sherlock, come on." He looked to the monitors, still angrily screeching, the figures were dropping again, the ECG trace was now barely readable, pulse rate either too fast or Sherlock's heart muscle itself was not contracting properly. The detective's body took another great gulp of air, eyes slipping closed.

"We're losing you." John cried.

"Step on it Geoff!" The medic shouted to the pilot and John felt the aircraft quicken slightly. The man pulled his intercom out and barked into it, "This is Alfa Whiskey 189 coast guard contacting Southampton general accident department do you read?"

The machine crackled slightly, "this is Southampton general receiving, what is your position."

"Coming into approach, ETA 2 minutes." He looked out the window, "I need the team up here to meet us. Patient is extremely unstable. Middle aged male, approximate 50 foot cliff fall, pelvic and femoral fracture in severe hypovolemic shock and hypotensive, vascular team need to be prepped for potential REBOA."

"Message received." The person on the end of the line replied in a flash, "team being briefed, see you in a few moments."

The conversation with the ground crew barely registered into John Watson's ears, his attention fixed between his best friend's blue translucent pallor and the protesting monitor, the detective gave another abhorrent gasp. John read the ECG with utter horror, the trace beginning to lose its uniform shapes; Sherlock's heart was failing, not enough blood to pump anymore and acid imbalance taking their toll.

"He's in VF!" John shouted, his own heart in his throat, he was well aware that his friend's breathing had turned into agonal gasps, full cardiac arrest was imminent.

The medic reached forwards, pulling open Sherlock's now ripped and bloodied shirt to reveal his bare chest. He pulled up the defibrillator and quickly stuck the electrodes onto the detective's ghostly skin. "Oxygen off." He said and John pulled the mask away. "Charging." The machine whirred. "Stand clear."

A beeping sounded before Sherlock's body jolted and his muscles seized, his voice gave an involuntary groan, which made John want to vomit. Both trained physicians stared at the screen, but the rhythm on it remained chaotic.

"Charging again." The medic pressed the machine and it loaded up again.

John's urge to vomit was so strong that as Sherlock gave a groan after another the shock he actually heaved. With a hand tightly across his mouth he managed to hold himself together though, not that there was a thing left in his aching stomach to expel. He glanced up at the screen, swallowing hard, and feeling adrenaline rushing through his veins, the beats had evened and a more normal trace could be seen.

"Jesus." The doctor cursed, his voice broken. He tipped slightly forwards onto his arms and heaved in a deep sob, emotion welling towards the surface at an alarming rate. "Please... don't." He croaked, tears threatening. "I can't do this again Sherlock."

Paralysed by what could only be described as emotional shock John watched the experienced medic work on his best friend, pushing air into the detective's now static lungs with a mask and ambu bag.

"Tube?" John asked weakly, where the hell had all his energy suddenly gone, he was practically on the floor. His limbs were shaking, teeth chattering from the overwhelming surge of adrenaline in him.

"We're about to land Dr Watson." The man said, squeezing the bag with precise timing, not letting his eyes off the screen, "the team will be with us any second."

John wasn't sure what he expected to happen in the coming minutes, he was well are of how trauma medicine worked but found himself at a loss all of a sudden. His mind numbed to his surroundings. As the door of the helicopter slid open, the sound of the rota blades increased ten fold and a sea of doctors and nurses flocked towards them. The detective disappeared into the throng of activity within seconds. John stumbled out the door hastily after them, accompanied by a young lady he could only assume to be a nurse, a kind but panicked look in her eyes.

"Sherl..." he was unsteady on his feet and the young nurse took his arm gently.

"It's ok Dr Watson, he's in good hands."

"Can't leave him." He cried, swallowing hard, quickening his pace after the gurney which was clattering down the ramp towards the main hospital building at break neck speed. "Please, he's my friend."

"I know." The young nurse supported John's shaking form and they made their way towards the hospital doors, Sherlock had now disappeared from view. "We're under strict instruction not to separate you." She said.

John would have to thank Mycroft for that one later he thought. Finally, after some time they made it to the doorway and he was guided into a wheelchair, which he accepted gladly. Their pace quickened once wheels replaced his wobbling useless legs and the nurse did not hang around. The blogger wasn't sure how long it was but within a matter of minutes he was back at his best friend's side, his wheelchair now parked directly next to the gurney. They were now in the middle of the busy accident department.

John watched on for several minutes. The trauma team were working at full pelt, each member of staff moving like a well-oiled part of an engine, completing each job and each task quickly and precisely. John could not keep up with each and every one. Tubes and wiring were in a criss cross pattern across his friend's body, monitors bleeping out different tones and alarms. The doctor's had wasted no time in intubating the detective and John watched on while a medic breathed for his best friend through the tube. He grabbed uselessly at Sherlock's dark curls, his friend's arms both occupied at being pincushions for now, another IV was in and the doctor could see a flow of blood running into it. A member of the team was pulling arterial bloods from his friend's radial artery, John cringed, he hated taking arterial samples.

The lead doctor stepped up and spoke. "Ortho are being prepped, I want a FAST scan please." a medic had pulled up a portable ultrasound and the probe was already on the detective's abdomen. "Thank you Doctor Grant." Many eyes turned to the screen. "I need two units in and a pelvic X-rays stat please, if conformation of a pelvic fracture then placement a REBOA zone III is necessary considering Mrs Holmes's severe hypovolemia. Once in place we prep for a CT then straight to theatre."

This was not happening; John braced his hands on the side of his friend's bed and took a long inhale to regain control. "Come on Sherlock, just hold on a little longer." He whispered, his voice barely audible above the organised chaos of the room. "Please Sherlock, for me, just hold on ok?" He let his forgotten painful forehead rest against his friends dishevelled locks in affection and tears rolled down his pale cheeks. "I can't lose you again." His whispered into his friend's ear, voice broken. "I can't do it again."

"Doctor Watson?" The nurse was by his side again, her eyes betrayed her worry and she gently pulled at his upper arm. "We need to move now?"

"I can't leave him..." John cried, sudden panic gripping his chest, he held fast to the bars of the gurney as they tried to wheel him backwards. "No."

"We need to take an X-ray, you can't sit there for a moment, we'll only be minute I promise."

John's head bowed and he relented, letting his arms fall from his grip to his sides. He looked over his best friend. Sherlock was barely recognisable on the bed, most of his clothes were now gone, he would not be impressed to see the expensive attire in scraps in a pile in the corner. A new pelvic split was in place as well as a leg splint. His alabaster bare skin was a shocking contrast to the many wires, tubes and patches across his body, the blood from his neck wound glistened in the strip lighting, despite the attempt at a light dressing, it was still oozing. John could only think of how small and vulnerable the detective looked laying almost lifelessly before him, unable to breath for himself, heart still struggling against the ongoing blood loss. As the doctor was wheeled backwards and his friend disappeared from view nausea rose back up into his throat and he swallowed hard.

"Would you like something for the pain Doctor Watson?" A different nurse this time. John looked blearily to his injured elbow to find a neat and thick bandage there, and his very own IV catheter in the back of his hand. When had this happened? His breath hitched quickly in panic, what else had happened that he didn't remember?

"Doctor Watson?"

"I'm fine!" John spat angrily, "I...I... can't." His voice broke and soften apologetically at his outburst; the sound was so pitiful it made the young nurse cringe. "He doesn't do well with unfamiliar company."

"It's ok." She replied, "you can sit with him, but he's probably going to surgery soon and you need some treatment yourself."

"I'm really fine." The doctors sighed "I'm sorry I just.." he bit his lip hard, angry that every last shred of despair was escaping him, when had he become this emotional? He took a long deep breath and immediately regretted it by the pull of his broken painful ribs, he stifled a moan. minutes passed before John was wheeled back to his position and as he glanced across the working trauma team he was sure he caught a glimpse of Mary's sad eyes. John shook his head, no, she was gone, she was not here, he pulled his thoughts away from her and tried to concentrate on the situation at hand. He looked up to the small screen at the end of the bed and the X-ray image now displayed their, two doctors were discussing the findings but John could clearly see the fractures to his friend's pelvis. It would need surgery to realign and repair, at least the blood loss was explainable. A second image clicked up and the doctor cringed at the sight of his friend's broken femur, another source of heavy bleeding, there was no wonder his friend had gone into shock. The monitors were less angry now, the doctor read the numbers which were slightly better than earlier, although Sherlock's blood pressure was still dangerously low.

At any other time John would have been interested in what the trauma team were doing, John was well aware what a REBOA was but had never had the chance of being involved in one. During his time in the army he had never had the luxury of being able to use the procedure which may have saved many lives out in the field.

John ran a hand through his friend's hair as he watched them work quickly. A nurse was now prepping the inside of Sherlock's groin area, John could see the heavy bruising now mottling the detectives other leg and he cringed, berating himself for missing the obvious break in the bone. The vascular surgeon moved into the nurse's place and quickly cut down into the detectives flesh locating the femoral artery before he began inserting the catheter stylet. John hoped to God this would buy his friend some more time because clearly the haemorrhage was uncontrolled and wasting more time would only risk another near cardiac arrest or worse. The procedure was not without risk though, if left in for too long Sherlock would lose the use of both his legs, he shuddered visibly at the thought.

"Beginning balloon inflation." The surgeon said, bringing John's attention back to the present. He stared up at the multi parameter screen as the blood pressure cuff began to whir, waiting with baited breath to read the measurement and hoping that it would rise to more than its current 65 systolic. His own heart pounded loudly in his own ears, practically in time with his friends own racing beats ringing out. It seemed to take an age before the numbers flashed up 86/58.

John breathed a quick sigh. "That's it mate, more of those numbers would be great." He rested his head on his friends shoulder and exhaled. His doctor's brain trying not to think about the potential irreversible damage to Sherlock's kidneys or worse his genius brain from the lack of blood pressure and oxygen. John breathed past the panic, now is not the time, he closed his eyes and tried to remember a happier moment but all he could see was his best friends bloodied face below Bart's.

Suddenly a twitch of muscles below him made the doctor snap his eyes open. Down the bed, he could see the detective's fingers stretch outward and John grabbed them in an instant. "Hey, it's ok." He soothed and when his attention finally landed on Sherlock's face he was both horrified and relieved to see his eyes open to slits. His pupils were staring listlessly at the ceiling above them.

"Sherlock?" John whispered standing out of his chair; he did not trust his voice not to break. "Sherlock you with me?" He doubted the detective was fully lucid but hoped his voice would at least bring some familiarity to the man's muddled brain. Sherlock's lips curled upwards and then against the unnatural plastic tubing. The doctor could feel his friend's arm tensing, trying to rise up but failing.

"Can we have some sedation please?" The lead doctor could be heard.

"It's alright." John ran a thumb over his friend's cheek and caught a stray tear which suddenly escaped the detective's pale exhausted eyes. "You're never going to remember any of this and you'll be asleep in a moment but I promise everything is going to be ok." The doctor swiftly blurted out everything he needed to say in a rushed stream of words. "You're going to surgery very soon to fix your broken bones and you might be asleep for a little while, but I'll ring Mycroft and I promise we'll both be there when you wake up again. Don't you do anything stupid while I'm not there ok?" John wasn't sure if he could see a ghost of eye roll under heavy lids and smiled in return. "Are you listening to me you cock. No dying ok?" The edges of Sherlock's mouth turned upwards slightly and John felt the grip on his hand tighten, this time a tear escaped his own eye. Sherlock's pupils rolled upwards and his lids slid closed back into oblivion.

John collapsed down into his wheelchair and let the floodgates open, burying his head into his hands the tears ran freely. He would not lose his friend again; he gritted his teeth and growled, not today!

Noradrenalin - a type of adrenaline hormone given to aid the raise of blood pressures, it has a more specific effect to just simple adrenaline which has a more general effect on the body. It is used in situations such as cardiac arrest, sepsis or drug reactions.

Agonal gasping/breathing - is a reflex the body does when the brain is not receiving enough oxygen, it is seen in extreme situations such as cardiac arrest and seizures. The patient will often gasp or take uneven deep or gasping respirations, it is often accompanied by vocalisations and myoclonus (involuntary muscle twitching). On a side note animals who are euthanized can often do this after cardiac arrest, it can be distressing for owners who don't understand it.

VF - short for ventricular fibrillation, in simple terms the bottom chambers of the heart quiver uncontrollably and means that blood cannot be pumped correctly around the body. It is caused by many things including electrolyte imbalances, long term cardiac diseases such as long QT syndrome, heart attack, drugs or sepsis (blood poisoning). It often results in complete cardiac arrest (heart stopping) if not corrected. They only way to correct if by shocking the heart back into rhythm.

Defibrillation (shocking)- is used to shock the heart back into rhythm, oxygen should be removed from the patient prior to this as oxygen is flammable and shocking can potentially cause ignition. As far as I understand (someone please correct me if I'm wrong) patients can occasionally groan or make a noise after a shock due to involuntary muscle spasm/pain.

Ortho - short for orthopaedics - doctors/surgeons who deal with bones and joints including surgical fixation

FAST scan - short for focused assessment with sonography in trauma - an ultrasound scan which doctors do quickly to check for major trauma - mostly bleeding or free fluid. In veterinary we sometimes split this into AFAST (abdominal) and TFAST - (thoracic/chest). There are certain areas and/or markers, which we use to find blood or effusions.

REBOA - short for resuscitative endovascular balloon occlusion of the aorta, this is a newish procedure when trauma doctors are starting to use. A balloon is inserted into the aorta (large artery running from the heart through the main body) and is inflated to occlude the artery and stop blood flow past it. This can be a life saving procedure because it stops bleeding below the balloon and in situations where a patient is bleeding to death. For example from a pelvic fracture, severe limb trauma (traumatic amputation for example), or bleeding from a stabbing or gunshot wound to the liver or spleen or the chest. There are three zones described in the placement of the balloon which correlates to a place in the body, zone I - in the chest, zone II - between the diaphragm (celiac artery) and renal arteries (which feed to the kidneys) and zone III - between the renal arteries and the where the aorta splits into the femoral arteries down the legs. The placement site will depend on what is bleeding, in Sherlock's case here his pelvis and leg are bleeding out therefore a REBOA zone III is needed. Due to occluding the blood flow the balloon cannot stay in place for long as starves oxygen to vital structures, it is a simple by for time before the patient can be taken to surgery to stop the main source of bleeding.