Chapter 28: From Bad to Worse

When John had texted about the new development, Mycroft had initially been in disbelief. He'd been certain there was nowhere left to go but up, but evidently, he'd been horribly wrong. He knew they'd put precautions in place to prevent infections, but they'd obviously failed. This is what he got for putting faith in others for the security of his little brother. If he wanted it done right, he'd have to do it himself.

Despite outward appearances, Mycroft cared deeply for his sibling and would do anything to protect him. Yet John had been absolutely right in his deduction of Mycroft's reluctance to donate bone marrow. He knew how most people already viewed him: callous and cold-hearted, yet always successful in whatever he set out to do. He didn't want to try and save his baby brother, only to fail, but it seemed that was exactly where things were headed if they didn't manage to get this infection under control.

The process of donating marrow hadn't been pleasant (Mycroft had never possessed his brother's indifference towards needles) and he'd hate to see that effort yield nothing. Worse, he'd hate to see that effort result in Sherlock's death. Anyone could have easily pieced together the different chain of events that may have resulted had Mycroft refused to be a donor. Since there were no other viable donors in the registry, they wouldn't have prepped him for a transplant, so they wouldn't have irradiated his immune system. Without that 'treatment' he might've had enough defence to fight off strep bacteria. Thus, Mycroft couldn't help but blame himself for the dramatic turn of events.

Though he did have work to do, he put everything on hold to visit his ailing brother. He'd used his job as an excuse to avoid reminding himself of his brother's precarious state enough times; he needed to face the music. He had his most trusted driver take him to the hospital. Upon arriving, he squeezed the handle of his ever-present umbrella tightly and braced himself. His shoes clicked on the stark tile floors as he made his way to the familiar room.

The sanitary measures were still in place, so he followed the instructions before cautiously entering the room. He'd been forced to leave his umbrella outside, and he felt naked and exposed without its familiar grip in his hand. Immediately, his gaze fell upon John, gloved and masked as per protocol, but with his head resting on the bed by Sherlock's side, clearly fast asleep. Based on his positioning, he'd evidently conked out grasping Sherlock's immobile hand in his.

Unsure whether to wake the doctor or not, he simply stood there watching the two of them for a few moments. He noticed a full oxygen mask had been placed over Sherlock's mouth and nose, fogging and clearing steadily with his breathing, which seemed awfully slow and laboured by Mycroft's standards. He knew Sherlock had been almost entirely unresponsive to verbal or physical interaction, but still thought it worth a try. If he'd answer to anyone, it would be his big brother, right?

"Hello Sherlock," he greeted a bit awkwardly. He had fundamentally no experience with comatose people, and was also unused to speaking through a mask. He didn't exactly expect an immediate response, but was still unnerved at his utter motionlessness. If it weren't for the slight rise and fall of his chest and reassuring beep of the cardiac monitor, he'd barely be discernable from a corpse. He took a few steps closer and took Sherlock's other hand in his own. He didn't know if he could feel it, but it was as much for his own comfort as it was for Sherlock's. As much as he hated to admit it, worry was eating him up from the inside out. He'd actually lost significant weight since this ordeal had begun, and was almost disappointed that Sherlock wasn't there to provide a snide remark.

"Yes, this is what it takes to actually get me to drop a few pounds," he chuckled to himself. Sherlock would have had endless fun poking fun at his lack of willpower. He circled his thumb over the back of Sherlock's hand, hoping the gesture brought some comfort—if the sensory stimulus even penetrated the thick fog of coma.

"Mycroft?" John's voice, hoarse from sleep, questioned. He slowly uncurled himself from leaning against the bed and stretched out his back.

"Yes?" he replied.

"Just didn't believe you'd actually go through the effort to be allowed entrance to this sanctum of sterility. Not that it did him much good," he remarked sadly.

"I'm appalled you think so little of me and my capacity for affection for my own family."

"You're not one to express anything resembling affection." Mycroft couldn't blame John for this assumption, but raised the hand clasped in Sherlock's as proof he did know how to 'caress' and whatnot. He lowered his brother's arm back to the bed, hating the lifelessness of the limb. John snapped out of his post-sleep tiredness and stood up hurriedly. He demanded, "Let me see that." He marched over to the other side of the bed and gently picked Sherlock's hand back up off the sheets. He stared at it intently, and Mycroft watched his eyes quickly change from displaying concern to terror. He followed John's gaze and his eyes picked up the purplish-black shade of his brother's fingertips.

At the same time, an alarm on one of the monitors sounded, causing both Mycroft and John to startle. John dropped Sherlock's arm in his fright, and it dropped to the side of the bed, hanging limp like the arm of a ragdoll. Mycroft and John both turned their gazes to the blaring monitor, and Mycroft heard John curse heatedly under his breath. Several nurses burst into the room at the racket of the machine and quickly assessed the situation.

"Oxygen saturation has fallen," John said breathlessly.

"He's not moving nearly enough air," one of the nurses remarked. "I think we need to intubate."

Mycroft knew enough about medicine to deduce that this was not a good thing. He knew intubation was a pretty drastic measure to aid a failing respiratory system. He and John were forced into a corner of the room as the nurses took action. He watched helplessly as the rather invasive procedure was conducted. The oxygen mask was taken off and Sherlock's mouth was forced open. The nurse worked efficiently, her practised hands expertly manipulating the tube down into his brother's throat.

"I think he needs ITU," another of the nurses said. "And I am not liking the looks of that scalp wound."

John further evidenced her claim by pointing out the blackening of his fingers, "His skin looks like it's starting to necrotise."

"Damn, we need to move quickly. Isn't he already on antibiotics for strep A?" she asked.

"Yes, but obviously they're not good enough," the nurse in charge of intubation stated. "We can get him on a vent when we get there, let's go." She'd attached one of those large, balloon-shaped bags to the endotracheal tube and rhythmically squeezed it as the other nurses unlocked the wheels of the bed and promptly exited the room.

Mycroft and John were left standing bewildered and shaken at what had just occurred. A quick glance passed between them, and Mycroft read the panic etched on the doctor's features. They were in for a long ride.

~0~

When he first heard his brother's familiar voice, Sherlock groaned. The last thing he wanted when he was trapped inside his own body was Mycroft and his ceaselessly irritating mannerisms. Even if he could, he didn't think he'd want to answer to his brother. As it was, he was helpless to resist as another hand—no doubt belonging to the British government himself—picked up his free hand. He wanted to yank his fingers away, but knew any attempt to communicate with his body was futile. He resigned himself to focus on his left hand, still clutched in John's grasp. Knowing the doctor, he'd fallen asleep at Sherlock's side. Sherlock hoped he would wake up before his back became too sore from the awkward position.

"Yes, this is what it takes to actually get me to drop a few pounds," Sherlock heard Mycroft say. He wasn't sure if that comment was made under the assumption that Sherlock could hear him, or that he was completely dead to the world. Had Mycroft actually lost weight because of this? Sherlock didn't believe it, but he couldn't open his eyes to assess his brother for himself.

"Brother, if this is what it takes, I should get leukaemia more often," Sherlock muttered to himself. "Those god-forsaken diets never did you any good."

A short while later, Sherlock heard John wake and a curt conversation pass between the two men. His left hand felt cold without John's clasped around it. As they talked, Sherlock's mind began to go fuzzy. The surrounding mind palace blurred in and out of focus, and he felt like he was going to faint. He faintly heard an alarm blaring in the distance, probably another part of his worthless body ceasing to function as it should. He heard frantic voices, but could no longer distinguish what they were saying. The fogginess in his vision increased, and he collapsed to the paper-strewn ground. He felt his hands and legs literally sinking into the floor as if it were quicksand—anything was possible in the mind palace. He'd sunk through the hardwood up to his neck when he felt a sharp stabbing pain in his throat. They must have done something drastic to his real body, most likely an endotracheal tube. His mind-palace-self gagged, feeling like his airway had entirely sealed up. He coughed and heaved violently, but knew this action would not translate into his real form. That body was failing, totally unresponsive to whatever his brain told it to do. He had a faint sensation of the ground moving beneath him, like the beginning of a roller coaster ride, before he fell through the floor completely, descending into a deeper abyss of his mind palace.

~0~

John futilely attempted to steady his breathing as he and Mycroft followed Sherlock and his cortege of nurses to ITU. He'd seen Sherlock's fingers, and he knew how quickly necrotising fasciitis could spread, and how much devastation it could wreak. He'd ditched the mask at the door to Sherlock's old room, his panicky breaths not drawing enough air through the fabric. They waited outside the entrance to ITU and were met by Dr. Janssen.

"What happened?" he questioned unhesitatingly.

"His oxygen levels plummeted, and his head and fingertips are turning black," John explained. Mycroft just stood there looking lost and bewildered.

"Damn," Dr. Janssen replied. "I thought we would be okay, starting him on antibiotics so soon."

"Sherlock Holmes doesn't do anything by halves," Mycroft remarked.

"Evidently. I'll look into new drugs to try and combat this infection." With that, he promptly left the two men to their deepening anxiety. They waited for what seemed like aeons, tapping their feet, until one of the nurses told them they were allowed inside. She guided them towards Sherlock's new position in the extensive ITU ward. John rushed to his side, taking in the new machinery now keeping him alive. The mechanical hiss of a ventilator sounded menacing, like the breathing of a deadly predator on the hunt for its next victim. The endotracheal tube was securely taped to his face, which when coupled with the nasogastric tube still stuffed up his nose, almost entirely obscured his face from view. A twelve-lead ECG had been added to closely monitor his heart rate in case the streptococcus decided to strike there next.

John closely examined the wound on top of his head, finding the blackness indicating infection had spread almost all the way from his eyebrows to the small bump of the Ommaya reservoir. Knowing what he did about necrotising fasciitis, this expansion could have occurred in a very short amount of time. It had been the size of a dime barely twelve hours previously. He glanced again at his right hand, the smallest finger already deep onyx-coloured all the way to the second knuckle. If something wasn't done soon, his limbs would be eaten away as the infection advanced along them. John wasn't sure if he was hallucinating, or if the bacteria were actually so aggressive, but he swore he saw the black patches expanding before his eyes. Where it had barely been past the nail bed just a few minutes previously, the mark on his right ring finger had already reached the first knuckle.

"John?" Mycroft inquired. The man was usually so high-and-mighty, well aware of his superior intelligence. However, the field of medicine was one of very few in which John outranked him in knowledge and experience. He was slightly shaken at being addressed in such a tone by Mycroft Holmes, but turned his head regardless to acknowledge his question. "Can you explain what's happening?"

John had never heard him sound so helpless and confused before. Any doubt he'd ever had about Mycroft's sentiment towards his younger brother disappeared as quickly as a flash of lightning. He took a deep breath to steady himself and explained, "The streptococcus bacteria are essentially eating away at his body. You may have heard me use the term necrotising fasciitis, which means it's attacking the fascia, or connective layer that keeps the skin attached. The black colour is dead tissue: literally rotten flesh. It's also affected his lung function, which impairing his ability to breathe on his own." As John laid it all out, he choked on the last several words. He'd already known what was going on, but summarising the severity of his best friend's current state made it more real. The figure in the bed in front of him was teetering precariously on the edge of death.

Mycroft didn't verbally reply to his explanation, but nodded to himself and resumed staring into space. John wondered if he was figuring out how to deal with the familial matters should the worst happen. The two men sat in silence for hours, lulled into a trance-like state by the beeping of the cardiac monitor and hiss of the ventilator. Eventually, Dr. Janssen joined them and conducted his own assessment of the extent of Sherlock's infection. John violently shook his head to wake himself up and followed the doctor's careful movements. In that amount of time, the darkness had crept a centimetre or two up his fingers, and the splotch on his head had grown to reach the Ommaya reservoir site.

"As you can see, this is progressing alarmingly fast. The antibiotics are failing, and a lot of tissue had already died. I'm afraid there's not much we can do at this point beyond changing the medication and debriding," Dr. Janssen explained.

"Debridement?" John knew that was usually the protocol for dead tissue, but still hadn't wrapped his head around the concept that his best friend's flesh was literally being eaten away.

"Yes. Preferably as soon as possible. Since he was intubated, his oxygen levels improved dramatically, and if we can get an available OR, I'd like to have it done today before it advances any further. Our goal is to stop it in its tracks."

"Okay. Do you know how much tissue you'll have to take?" John questioned.

"That's up to the surgeon. I'm sure he'll do his very best to get all the infected tissue while preserving as much of the healthy part as possible, but I must warn you that it won't be pretty."

John had seen his fair share of devastating wounds on the battlefield of Afghanistan. Between burns, traumatic amputations, and gunshot wounds, he'd long abandoned any squeamishness around blood and gore. However, he'd never seen extensive debridement wounds in person before, only pictures in medical textbooks. He knew they often looked counterintuitive, opening up a gaping hole in the skin where it had once been solid, but he knew it was necessary. Leaving dead tissue behind would only result in more infection. Still, he wasn't sure he could handle witnessing such devastation on his Sherlock. His subconscious conjured an image of what it might look like when the surgeons cut away the dead flesh on his scalp, and he screwed his eyes shut in horror. Unfortunately, that did little to help, as the image resided inside his own head.

He tried forcibly to banish the thought, but every time he thought he succeeded, he caught another glimpse of Sherlock's pale form, which brought it right back to the forefront of his brain. He was so focused that he must not have registered the passing of time, as Dr. Janssen returned far too soon to announce that an OR was available and they'd be taking Sherlock immediately. John said his goodbyes as he was wheeled away, knowing this might be the last time he'd see Sherlock in one piece for quite a while.

John continued to sit in the ITU, staring at the empty space where Sherlock's bed had been. He found himself rooted to that spot, unable to move until Sherlock returned to him alive. Mycroft had left for a coffee break ages ago, and John suspected he just needed a break from the stifling hospital room. The agony of not knowing was far worse than any disfigurement they could inflict upon his best friend. No one took the time to update him, so for all he knew, they were sending him down to the morgue and arguing over who got the difficult and depressing job of breaking the news to the friends and family.

~0~

Sherlock awoke in another area of the mind palace. He vaguely remembered the illusion of sinking through the floor, and the fuzziness in his brain that had preceded it, but the feeling had vanished. He could tell that whatever had gone wrong with his transport had been fixed somehow. Waking up in another spot, he was concerned that he'd no longer be able to hear what was going on in his surroundings, but that worry was soon assuaged.

"John?" he heard Mycroft ask. He couldn't believe the vulnerability the presented itself in that one-word croak. "Can you explain what's happening?"

Sherlock listened intently, staring at the spot on the ceiling from where the voices seemed to be coming. He heard John detail everything that had gone wrong, and anger at his own body for failing to do its job so miserably rose up and threatened to burst from his every pore. He'd heard of necrotising fasciitis before, and he knew the kinds of wounds it could cause. He wished his mind palace extended to the rest of his body so he could find a bacterium and punch it into submission. If his immune system couldn't do it, then someone had to fight off the invaders.

The voices fell silent for ages, and Sherlock found nothing better to do than sift through the information stored around him. He found a folder labelled "Happy Memories with Mycroft" and rifled through its contents, smiling to himself as he recalled that simpler time. When he was little, before Mycroft went off to university, they'd gone on adventures in the woods around their house. Those were some of Sherlock's favourite recollections of his childhood. He didn't know how long he spent soaking up the joy of the past, but he was brought back to reality by the arrival of another voice.

"As you can see, this is progressing alarmingly fast. The antibiotics are failing, and a lot of tissue had already died. I'm afraid there's not much we can do at this point beyond changing the medication and debriding." Sherlock thought he recognised the voice as Dr. Janssen's, but he couldn't be sure without the visual of his face to match. He knew that whatever was happening to him was awful, and he wished he could see for himself what he'd become. On second thought, he was glad he was trapped on the inside. He didn't think he could bear to watch himself shrivel up and die.

John and Dr. Janssen started discussing the process of debridement and the amount they'd have to remove from Sherlock's body. Sherlock was mortified at the casualness of their discussion about ripping chunks of flesh out of him. He thought something so drastic warranted a less removed tone. They sounded like they were talking about rearranging furniture, or something equally less important than him.

"Okay. Do you know how much tissue you'll have to take?" he heard John ask.

"That's up to the surgeon. I'm sure he'll do his very best to get all the infected tissue while preserving as much of the healthy part as possible, but I must warn you that it won't be pretty."

"Hey! Don't I get a say in this?" Sherlock shouted, knowing his efforts to communicate were in vain. Since he was in a coma, all of his medical decisions fell to Mycroft. As much as Sherlock abhorred the concept of his big brother literally controlling his life, he knew that he'd defer to John the majority of the time. Sherlock trusted John to do what was best for him; to do what Sherlock would want for himself. If worst came to worst, John would tell them to pull the plug, while Mycroft would likely keep him on the brink of life out of guilt and fraternal sentiment.

He again felt the slight quake in the ground signalling he was being rolled somewhere else. He heard John deliver a choked goodbye, and wished he could reassure him that he'd come out the other side, even if he was hideously disfigured. After hearing John discuss the extent of his infected flesh, he was glad he wouldn't be able to see the horror that would remain once some insufferable surgeon chopped it away.