A/N: Sorry it's taken so long. You all know how real life can intrude and it has. In this chapter, I've used quite a bit of jargon as Ray and Neela would when discussing a patient. For questions, please PM or email me if you have trouble. Of course, any other feedback/communication is also welcome.

Finally, this chapter is dedicated to V. because it's patients who make you into a doctor, not just the diploma. If you'd met her, I'm sure she would have made an impact on you, too as she did on everyone she knew.

Chapter 25 – Brother, What a Night it Really Was

Ray was back, except that he wasn't. Neela had actually been more concerned about his technical abilities at first; he was so different. But Pratt had assured her that if anything, he was a better doctor that before – more in tune to the patients' complaints, more insightful in his diagnoses and management plans, better equipped to instruct junior residents and students. She knew he was keeping up with the literature and all. He always had some sort of journal in hand, and he was very quiet. All the time. Yes, the iPod was always in his ears when she came in and he had been alone, but more often than not, the medium was a lecture, not any of the usual music that had always filled the room when he was around. He hadn't brought his records, either. She was worried.

So worried that she'd pushed her ortho schedules to cover the ER in order to keep an eye on him, but when she came down for her first consult, he wasn't there. Abby told her he had taken his PICU rotation that month, since he hadn't been able to complete it when the ER was closed. He hadn't mentioned this to Neela. Her hours were even crazier than his, and she still routinely ended up on q3 or 4 overnight call, even as a senior surgical resident, so they rarely saw each other at home. In certain ways they were more than roommates, but in other ways they still lived their separate lives in parallel with one another. She loved him and was so glad that he was back. She hoped he felt the same, but she wasn't sure what this man sleeping in her bed was feeling at all.

Without intruding on his privacy or whatever, she wanted to find out what was happening in his life. She struggled with how or even if she could accomplish this task. She had no idea what she should do. Luckily, she did know what to do about not knowing what to do. She drifted down to the ER without an ortho consult and found Abby and Pratt sitting at the desk arguing with Frank during an uncharacteristic lull in the action. Frank saw her first.

"Well, well, if it isn't our prodigal surgeon. Whatcha doin' down here?"

She smiled and shook her head. They'd shared a bond of sorts since she'd helped save Jerry's life some years before. He had been keeping an eye on Ray, too. She decided he'd need to be a part of this conversation.

"Things are moving about the same upstairs, too. My orders are in, and I thought I'd come see if you all needing anything at the moment," she tried.

Pratt pulled a chair up beside him and patted it. "Nah, we're good. Have a seat, though. You can hide out here for a while if you want."

She took the place he offered and the napkin-wrapped pastry Abby stuffed in her hand. She took a bite of the sticky sweet mess and sat it on the counter in front of her.

"That's disgusting, Abby."

"Sorry. What's up?" Abby grinned as she swiped the napkin into the trash.

"Um, well, I feel a little stupid about being here or asking you all this, but I didn't really know what else to do."

Pratt frowned. "What's going on, Neela?"

She ducked her eyes, feeling like she was tattling. "It's Ray." She looked up. The other three were staring intently back at her. She continued. "I'm worried about him. Obviously. He's been so quiet, and I hardly ever see him. He didn't even mention that he was starting his PICU rotation. Not that he has to explain or run things by me, but he's not talking to me."

Pratt and Abby exchanged pained glances. Frank rolled his eyes and took over.

"Well, these two aren't going to be any help. Her big daddy is still in Croatia," he started, pointing a thumb over at Abby before turning to Pratt. "And Casanova there can't pull the trigger on settling down with his lady," he mused. "I'm by no means an expert, but I have been married longer that you've been alive, so you're stuck with me."

Greg and Abby were too amused to be angry and decided to sit back and hear what Frank's advice to Neela could possibly be.

"Okay, Frank. Give me your pearls of marital wisdom." Neela realized she must be desperate if she was taking relationship advice from the curmudgeonly clerk.

Frank stopped shuffling papers across the desk and stared directly into her eyes. "You need to talk to him."

She nodded, waiting for the rest of his guidance. He made a little "hmrumpf" noise and turned back to the desk. She looked over at the other two who were sitting back in their chairs, amused smirks crossing their faces. She scoffed and shook her head in a gesture of futility. Pratt was barely containing his laughter while Abby dropped her head to the chart on her lap with a little snicker.

"What, that's it? I should talk to him?"

Frank nodded. "Yep."

"Right. Brilliant. Thanks for that, Frank, but I was looking for something more along the lines of how I should talk to him. What should I say without sounding like I'm meddling?"

"Well," Frank mused, scratching his head, "Don't do it here. Maybe page him and see what time he's planning on going home and be waiting with dinner when he gets there."

"That's actually a good idea," agreed Pratt.

"I was going to scrub in on a meniscus repair at 5:30," Neela thought out loud. The three ER employees glared at her. "Right. I know. I'll take my name off the board if he can come home tonight."

She glanced at the clock before paging Ray. About 10 minutes later, he returned the call.

"ER, this is Dr. Rasgotra," she breathed as she answered the phone beside her.

"Did you page me?"

"Yeah, are you busy?"

"Um, yeah, actually I am. Why are you in the ER, and why are you answering the phone?"

"Just came down to see what was going on, and I paged you. Frank's busy."

"What did you need?"

"Have any idea when you'll be done tonight?"

"Not really, why?"

"I thought maybe I could cook dinner and we could have time together. I know we've both been had really crazy schedules over the past few weeks."

"I'm in the middle of something right now, but can I call you back in a little bit. I'll know better what's going on here in about an hour."

"Sure, just page me."

"Okay. I'll talk to you later."

"Bye, Ray," she said into the phone, but he was already gone.

Pratt came up behind her and placed his hand on her shoulder. "What's the verdict?"

"Don't know yet. He said he'll call back."

"Well, I have a consult for you if you want it."

Her eyes widened and she nearly grinned. "Which room?"

"Trauma 2. Traumatic posterior hip dislocation."

"MVA?"

"Yep."

"Did you get a full set of films?"

"They're cooking now. What do you want for sedation?"

"Versed and Fentanyl, I guess."

"I'll get it set up."

"Okay, I'll go in and talk to the patient. What's his name?"

"Keith Hughes. Otherwise, he's checking out okay. Bruises and scrapes, but no other major injuries."

"Great. Thanks, Greg."

Neela walked through the double doors and introduced herself to the patient. She examined him briefly before Pratt brought in the x-rays. He stuck them on the light box and the two of them examined the films.

She pointed to a small line of black in the white cup where the femoral head, obviously dislocated posteriorly, was supposed to be.

"There's a tiny fracture in the rim of the acetabulum, but it's basically insignificant. I'd call it a Type I. We can reduce it here if he's sufficiently relaxed."

"Do you need flouro?"

She shook her head. "Nope. Post-reduction films will be fine."

The procedure was one that the ER often did without the benefit of orthopedics, but Pratt knew that Neela needed something to do. He stood back and watched her finish preparing the patient for the procedure. He pushed the drugs for her before he and Malik stabilized the pelvis and applied traction. Neela gently adducted and internally rotated the femur to achieve reduction. She then rotated the hip to make sure the head of the femur was completely in place.

"That should do it. Let me know when the films are back and when he's awake." She started out of the room as her pager began to beep. Pulling it from her waistband, she punched the number on the keypad of the first phone she came to in the hall. Ray picked up on the first ring.

"You still in the ER?"

"Yeah, I had an ortho consult after you called. It's pretty calm down here right now. I guess I should go back upstairs. Did you take care of whatever you had going on?"

"Yeah. Sign out is at 4:30, so I should be home by 6, I guess. Is that okay?"

"Sure. I'll see you then."

She called Harold and told him that she was leaving. It was only noon, but they would have to make do without her. Harold could handle any consults until the end of the day. She needed to be at home when Ray arrived.

Ten minutes past six, Ray stumbled through the door. Neela hadn't seen him in about four days, and it appeared that he'd been awake that entire time. His light blue scrubs were stained under his wrinkled, grimy, no longer white coat. An impressive growth of stubble covered his face. She dropped the spoon she was using to stir a pot of rice and walked over to him.

"What's happened?"

He shrugged off his coat and pulled the scrub top over his head. "Can I just get a shower?" he asked but walked away without waiting for or expecting an answer.

She started to follow him down the short hallway but stopped. "Okay. I'll be out here if you need anything," she called out to his retreating back before turning her attention back to dinner.

Neela continued cooking for about half an hour, hearing only the sound of running shower water coming from the bathroom, before she went in to check on him. She knocked on the door before entering but pushed it open when there was no response. The room was choked with steam, causing her to marvel briefly at the longevity of the hot water supply. Cautiously she pulled back the curtain and found him sitting on the shower bench against the wall asleep. He hadn't made it to shaving yet, either. She reached in and turned off the water, attempting to avoid becoming totally soaked before placing her hand on his arm. He opened his eyes slowly.

"Sorry," he mumbled. "It's been a long day."

"Four days," Neela corrected, "It's been four days."

"Yeah, I'll be out in a minute. Can you hand me the towel?"

She nodded and pulled the piece of terry cloth off the rack. "I'll be in the kitchen."

"Okay," he nodded.

She retired to the kitchen where she perched on the edge of a chair while waiting for him to appear. He took another 15 minutes to make his way back. She stood as he approached her, still looking amazingly tired. She pulled out another chair for him. He sat heavily and sighed.

"Do you want something to eat?" she asked, assuming that he'd given eating about as much priority as sleeping over the past week.

He was leaning forward, head in hands, but he nodded. She stood to get him a plate of stir-fry and rice, his favorite. She plopped a glass of water in front of him, too.

"Thanks," he mumbled, before picking up the fork and pushing food around the dish.

"Do you want to talk about it?" she asked.

He shrugged almost imperceptibly before sighing again. "We lost a kid."

She nodded, understanding it was more than that. Kids died in the ER as well as the PICU. It was always sad, a terrible waste, but not every death affected a doctor this profoundly. Every patient lost did make you stop and reflect on the person whose life was ending as well as your own mortality, but it simply wasn't possible to feel so deeply for each patient. Otherwise, the emotional toll of the job would be too high. There was definitely more to the story, and she knew she'd have to wait for him to be ready to tell it. She got her own plate and sat down beside him. She began to eat quietly, trying not to watch him. But she couldn't help it. Her eyes were drawn to his, and when a tear silently escaped from one, she placed her left hand on his right one. He pushed the plate back and pulled her hand to his face along with both of his. He wasn't so much crying as rubbing his eyes as though he were trying to erase memories along with his need for sleep.

"I'm just too tired to do this now."

She nodded as she reclaimed her hand, inwardly chiding her newfound surgeon-ness; however, she wanted to show him she was there to support him. "Maybe if you talk about it now you'll be able to sleep, though," she offered.

He considered this for a moment before he began talking. "Okay," he decided.

"It was a 17-year-old with Neuroblastoma. Diagnosed at age 7, initial remission with multiple relapses over the past 10 years that have all been responsive to chemo, mostly to platinum. He'd been on PO Etoposide for the past 3 or 4 months but started with episodes of uncontrollable pain in his groin and leg with muscle spasm about a month ago. He had PO Dilaudid, at something like 2 mg Q 4 that wasn't even touching it. Peds admitted him from the ER for pain control. We got a CT that showed liver lesions that hadn't been there previously. When IR biopsied them, heme/onc also got a bone marrow. It was positive with more than 50 percent transformation. He'd never had bone marrow involvement before.

"When we told him and his parents the results, he knew immediately what it meant – everyone he's ever know with the disease has died once the bone marrow was positive. Within months. He was really upset and mad at first, of course, but he reconciled it after a day or two. His parents were devastated and rightfully so. Things had been going pretty well over the holidays. He'd been in school and spending time with friends this semester. It was hard for them to process the new information. They'd been told after every relapse that he probably wouldn't survive, but every time he'd done chemo, the tumors had responded and he got more time. I guess they knew this time was different, but his dad, especially, held on to the hope that he'd do okay, that chemo would take care of it just like it always had before."

Ray shifted some in his seat before he continued. "The problem was it was his fourth round of Cisplatin. He weighed about 90 pounds when he came in. He just had no reserve to take over when the chemo wore him down. He took the 4 days of Cisplatin like a champ. But when his white count started to fall …" he trailed off. Neela squeezed his hand.

"I went in on Monday and he said he didn't even feel like talking. Something was wrong, but he couldn't tell me what. His vitals had been stable all day. No fever, a little tachycardic, BP holding. We were just thinking that the chemo had worn him out. He was having some mucositis pain, but not out of proportion.

"About 10 pm on Monday, he spiked to 38.2 with systolics in the 60's. Cultures grew Pseudomonas in 12 hours. We'd started Ceftaz and Zosyn, but the sensitivities showed resistance to both of them on Tuesday. We switched to Cipro and Meropenem, but by that point, he was maxed out on Dopamine. The echo showed significant cardiac dysfunction, his lungs were a mess, and he'd been altered on Monday night before we intubated. The only thing that was hanging on was urine output, but that slowed by Wednesday. They went to Epi and Milrinone before his parents decided that it had been enough. We sat down with them today, answered all their questions and they decided to stop support. He died this afternoon."

"Oh, Ray. I'm so sorry."

"His name was Wes Owens. I'd seen him a couple of times before in the ER, admissions for febrile neutropenia and stuff. He always had a really good sense of humor, so when he came in a few weeks ago, it got me to thinking about the PICU rotation. I knew I had to finish it up, so I worked it out to go up while he was there. We'd just been hanging out, playing video games and watching TV whenever I had some spare time and in the evenings for the past couple weeks."

"Had he been PICU the whole time?"

Ray grinned as he nodded his head, "But not on our service. He was followed by inpatient peds, but he basically had his own room in the PICU. They just admitted him there."

"I'm sure it was rough on all the staff. It sounds like everyone knew him well."

Ray nodded as he stared past her into the rest of the darkened apartment. "He was 17, Neela. He should have been worrying about basketball season and whether or not his prom date would sleep with him. It's so wrong."

"I don't think anyone has explanations for those things, Ray."

He turned to stare directly at her. "I can't do this, Neela."

"You don't have to Ray. After this month you'll be done."

He closed his eyes as he pushed back from the table. "Not that, Neela. This. Us. I can't do this."

"Ray, you're upset and tired. Why don't you lie down for a while and try to sleep? I took off tomorrow. We can do something fun together."

He rose from his chair and looked down at her with yet another sigh. "Yeah, maybe you're right." He turned around and walked through the living room into the bedroom where he closed the door behind him.

She stood alone in the empty kitchen, trying to take in what he had said. Surely it was all a by-product of the horrible tragedy he had experienced today. Still, as she glanced down at the table to begin clearing, she noticed that her hands were shaking. She wasn't sure how much longer she could do this, either.