westlife4ever80, thank you for your review. Cal definitely has completely messed up! Dylan probably came close to doing the same, but he's making progress now, luckily. He might need a bit of help though!
Bonnie Sveen Fan, thank you for your review. I think a lot of people would really miss Ethan. It's bad enough thinking that the Huntington's is going to shorten his life. Dylan is definitely going to do his best.
Guest, thank you for your review - I really am so happy you think this is a good story. I'm afraid there isn't any Zax in this chapter as Zoe has to talk to someone else, but I'll do what I can to bring Max into the story a bit more.
Tanith Panic, Cal did get it badly wrong with James and Dylan very nearly did too! I really hate it when I explain how you're feeling and the other person comes back with stock phrases. Dylan would never do that. His approach wouldn't work with everyone, but knowing someone heard you can make a difference. Thank you for your review.
X-Sammii-X, Cal was harsh, but I'm glad you liked it anyway. I wouldn't have written him like that if I hadn't already shown him doing everything he could to support his depressed brother. Cal doesn't want to be at work - like you, he just wants to wrap Ethan in his arms and hold him! Thank you for your review.
LoveFiction2016, thank you for your review. I'm glad you enjoyed the last chapter.
Ezeiel, I suppose it's difficult for Zoe not to be annoying when she's getting in the way of a potentially-good couple for no good reason! I think she's a bit more sensible in this chapter. I'm really glad you liked Dylan's scenes. Thank you for your review.
Thank you to RobynSOS for the favourite.
The man's expression was guarded, but he was still looking at Dylan. He hadn't turned back to the drop below. "The doctor I saw didn't help me."
"Who was that?" said Dylan. He knew some doctors would be less receptive than others. Even Zoe, who was very empathic, occasionally allowed her personal life to have an impact on her clinical decisions and she certainly wasn't at her best at the moment.
"I think he said he was Dr Knight."
Dylan was slightly surprised, but he didn't let it show. Cal was usually quite good with suicidal patients, but Ethan wasn't well and Cal had always been the type to become overwhelmed by his emotions. "Then Dr Knight made a mistake. We all do it, unfortunately. We try very hard not to, but we all have moments where we get it wrong."
"He said I'd wasted his time," said the man. "The mental health team told me to come here and tell someone. I did. He told me to go home."
"He made a mistake, as I said," said Dylan. "He misjudged the seriousness of the situation and that's obviously upset you, but that doesn't mean you have to throw yourself off a roof. Look, er, what's your name?"
"James."
"James. You came here asking for help. Dr Knight wasn't able to offer it, but I am. So why don't you accept the help?"
James stayed where he was, clearly wavering. Dylan knew other doctors in his position might have panicked that they hadn't got through to him yet, but Dylan saw it as a good sign. It showed there was hope.
Dylan heard the sound of footsteps behind him, but he didn't take his eyes off James, Nevertheless, he listened to the sound, braced for action. He didn't want anyone running onto the roof and startling James.
"Dylan?" whispered a voice from behind him.
Even when she whispered, he knew her voice. "He's here," he replied. "James, this is Angela. She's a psych nurse, which would put a lot of people off, but she's actually really good. I've talked to her about… about my problems and I've always found her very helpful. She's good at listening. Angela, this is James. He came to the ED following advice from his mental health team, but Dr Knight misjudged the seriousness of the situation and discharged him. James took this to mean that he'd be better off dead. I'm endeavouring to convince him otherwise."
Angela came to stand beside Dylan. She gave him a quick smile before turning to James. "Hi, James. I'm sorry you're having a bad day. It is always very difficult when you ask for help and there's nothing there. Even the best doctors make mistakes sometimes – but Dr Keogh hasn't made a mistake. You need help and we'd like to help you. I'm not trying to rush you and you should take this at your own pace, but I really hope you'll come down when you're ready."
James didn't speak, but he stayed where he was.
"James, is it all right if I tell Angela a little more about the history of what happened?" asked Dylan. "Or perhaps you'd like to? It will be easier for her to know what to say – and what not to say – if she has a bit more background."
James visibly tensed, but he nodded. In a low voice, he told them what Cal had said to him.
Angela's face filled with sympathy. "That must have been really hurtful. I know Dr Knight and I know he wouldn't have wanted to hurt you – he's actually a very kind man - but he's human like all of us and he made a mistake. He misjudged your situation completely and I'm not surprised you were hurt by the way he explained his reasons for discharging you. Dr Keogh and I agree he made a mistake. You aren't wasting anyone's time. You did the right thing coming here and I'm glad you did."
"I came all this way," said James. "I didn't want to. It was hard. But I thought… maybe this time. Maybe this time someone would listen. Sometimes I say things and no-one hears. They come out with their stock phrases that are meant to be reassuring, but how can they be when they contradict everything I say? It makes me wonder if I really said anything at all. Maybe I just said it in my head and that's why no-one heard. I heard my voice and I thought I was speaking, but I wasn't. These complete strangers who have never met my family tell me I'm wrong: that they do care. It doesn't matter that I was there and they weren't. They still know better than me. I'm so insignificant, my feelings and opinions and experiences don't count. I say the words and they hear something different. It makes me wonder if I'm even real. How can I be real if no-one can see me and hear me as I am?" He turned towards Dylan. "But you listened. You heard what I said about my family. So I know I really said it."
Dylan nodded. "You really said it, James."
"And we're listening to you," said Angela. "You've done very well. I hope that doesn't sound patronising – I think you've done well because what you've done must have been really difficult. Asking for help isn't easy. Even when you've made up your mind to do it, that doesn't make it easy. You have to find the right words that not only convey what you're feeling but convey that you need help and so much depends on the person you're talking to and how they interpret it. If they get it wrong, it's not your fault, but it can mean you don't get the help."
"We have so little time," said Dylan. "Our patients only have a few minutes to convince us. They're feeling unwell or in pain or both and they have to put how they're feeling into words. I get very impatient sometimes."
"But I'm sure Dr Keogh isn't impatient with you, James," said Angela. "Because he's here."
James lifted his head. "I think… I'm not sure, but I think Dr Keogh would have said if he was getting impatient."
"Oh, I would. Believe me," said Dylan. "If I thought you were wasting our time, I would have said so a long time ago. But I don't think that."
Zoe came up to Cal in the nurse's station and touched his arm. "Sorry, Cal. I know you're busy. But can I have a word?"
"Yeah, sure," said Cal, only to stop when he saw the serious expression on Zoe's face. "Is something wrong?"
"I'm afraid it is," said Zoe. "Would you mind coming to my office for a chat? It's really important."
Cal hesitated. "Yeah. That's fine. I'll come now." He looked at her in confusion, then a sudden fear gripped him. "Is it Ethan? Oh God, is he okay?"
"It's nothing to do with Ethan," said Zoe at once. "Or not directly. As far as we know, Ethan is fine. It's about a patient you discharged recently."
The relief that Ethan hadn't – to Zoe's knowledge – taken a turn for the worse was immeasurable, but Cal was still worried as they walked to Zoe's office. It sounded as though he'd made some sort of mistake in a diagnosis, which was always possible. It was quite odd that Cal had seen so many time-wasters and so few genuinely-unwell people who needed the services of the ED. Perhaps one of them really had been ill.
He hoped they were okay.
It upset him but didn't completely surprise him that he'd made a mistake. After all, his focus wasn't the best. Cal had tried hard to give his full attention to every patient and to keep Ethan out of his thoughts – he felt guilty for doing that, but it wasn't as though thinking about Ethan could help him – but it was possible he'd missed something.
"Okay, Cal, have a seat," said Zoe, when they'd reached her office. "I understand you saw a patient named James Colton, who presented with suicidal feelings?"
"Yes, I did," said Cal. There was a nasty feeling in the pit of his stomach. "I spoke to him for a while and then discharged him. Why? Is he okay?"
He didn't know why he was asking. Zoe wouldn't be speaking to him if everything was fine.
"No, he's not okay," said Zoe. "I'm afraid he's up on the roof now. We don't know if he intended to jump, but he was standing close to the edge. Dylan is talking to him and we've contacted the psych team."
"What? Dylan?" said Cal, his panicked brain clutching on to the wrong fact and not letting go. "How come he's doing it? Why not you or… or…" He stopped. Ethan would have been brilliant if he was well – not that Cal would let him go near the roof: he might have coped on the Ferris wheel, but Cal wasn't going to let him do anything like that ever again – but Ethan wasn't here.
"I don't know why Dylan wanted to go," said Zoe. "If it was anyone else, I'd think he was trying to impress the pretty psych nurse, but this is Dylan. Maybe he feels his OCD gives him more of a connection to mental health patients. Or maybe he's met the patient before – I don't know." Her confusion fell away as she faced Cal. "But we're not here to discuss, Dylan."
"No," agreed Cal, his head dropping. They weren't.
"Cal, it is very difficult to judge in mental health cases," said Zoe. "We can't help everyone who feels depressed – we just don't have the resources. All we can do is assess every patient and make a decision about how serious the situation is – and we're not always going to get it right. Also, discharging someone often does make them feel a lot worse. That can be the thing that pushes them over the edge, so it is a very difficult situation."
Cal said nothing. He knew he hadn't done his best.
"But this wasn't just a depressed patient who deteriorated following discharge," said Zoe. "This was a patient who presented with suicidal feelings. Cal, I am sorry to do this to you, but there will have to be an investigation. I am sympathetic to your situation and it's understandable that this would be a particularly difficult case for you, but we need to establish exactly what happened and I can't promise it won't be taken further."