Karl De Raad appraised his newest non-patient: he looked like hell. Robert Romano was several years Karl's junior, and he had always appeared even more youthful than that. But he seemed to have aged ten years in the past two. He had been practically mute through lunch. Fortunately, the kids were out and Celeste was adept at dealing with whomever her husband brought home.

After lunch, the doctors retreated into the den, where De Raad took Robert's blood pressure and they discussed sleep aids. Romano was, predictably, terse and defensive. Only with much prodding did he admit that nightmares played a role in his sleep disturbance. Once they had settled on a tentative medication plan, De Raad tried to open a dialogue with, "So, how are things going for you otherwise?"

Robert replied suspiciously, "You said I didn't have to talk about my life."

"I lied."

Robert looked at De Raad sharply, at which point the psychiatrist grinned, "I'm kidding." Then, seriously, he added, "I will do my best to help you with the insomnia, even if you never say a word about other issues. And I won't nag. But you can't expect me not to ask how you're doing."

"Fine," Robert said, with a trace of a smirk, "I'm doing just swell."

"There, was that so hard?" Karl replied, his piercing look softened by a good-natured smile.

*****

A week or so later . . .

Neela Rasgotra, on the third day of her surgical rotation, was feeling a bit harried. She stepped off the elevator and walked toward the ER Admit area, smiling as she saw the face she was looking for.

"Hey, stranger," Michael Gallant greeted Neela, "How are things in the wonderful world of surgery?"

"Fine. Interesting. Hectic," she replied, "I'm almost as discombobulated as I was my first day down here." Despite the ubiquitous noise and activity, the Emergency Department had become home during her stint there. 'A certain kind, soft-spoken resident might have had something to do with that,' she thought, suppressing a fond grin.

"Do you have time for lunch?" Gallant invited.

"I'm afraid not. Actually, I came down here to see if I could get your opinion on something." Neela proceeded to outline a case that she was working on, under Dr. Edson's supervision. She finished with, "He insists that it's a pyogenic liver abscess, but I'm concerned that it might be an amoebic abscess. Dr. Edson didn't seem interested in discussing the matter any further. I don't want to step on any toes, especially since he's probably right. What do you think?"

"I think I'm out of my league," Gallant admitted, "Both diagnoses seem consistent with the symptoms and physical exam. I suppose you'd get the differential from the ultrasound, but I can't make a call on that."

Neela looked disappointed, but not surprised.

Gallant continued, "Why don't you ask Dr. Edson to explain to you why he thinks your diagnosis is wrong?" Then he added, "This IS a teaching hospital," parroting the trite phrase with mock enthusiasm.

"I think he's getting rather tired of my questions already, but, yes, that would be the sensible thing to do . . ." Neela trailed off, watching as Dr. Romano crossed the Admit area and entered Exam 2.

Following her gaze, Gallant smirked and said, "I see you're considering a more extreme measure."

"I don't know," Neela added, "Is he still . . . ?"

"The walking dead? Yep," Gallant replied, not unkindly. "But on the plus side, that means he's less likely to yell at you."

"Unless, of course, you're Dr. Pratt," Neela grinned. Dr. Romano had been eerily quiet since the incident with the motorcyclists. He spoke softly, only when necessary, and he made eye-contact rarely and fleetingly. On occasion he would say something vicious to a consulting surgical resident, but for the most part he was just utterly withdrawn. Pratt was the one reliable exception to this behavior pattern. The brash resident seemed to draw forth venom from some reserve in the ER chief's psyche unaffected by depression. Neela smiled, remembering Dr. Lewis teasing Pratt:

"If he stops insulting you, then we're really going to worry."

Pratt had grumbled in reply, "Why do I have to be the litmus test for Captain Hook's mental health?"

Gallant wished Neela luck, giving her a grave salute and an encouraging smile. As she made her way over to Exam 2, she felt ambivalent about disturbing Dr. Romano. He seemed so sad, lately, and, regardless of how unpleasant he had been, she didn't want to do anything that might make that worse. She wasn't sure if asking his opinion about a surgical case would do so or not. Since she really wanted an expert's perspective, she convinced herself that it would be alright. Surely, people must occasionally seek his advice on such matters, though Neela had never seen it happen. 'If he doesn't want to talk to me, he'll let me know. Probably rudely.'

Ducking her head in the door, Neela asked tentatively, "Excuse me, Dr. Romano, can I bother you for a minute?"

Romano had a small desk tucked in the corner, at which he was seated doing paperwork. He looked up, his demeanor not exactly forbidding, but not exactly welcoming either. He nodded, and said quietly, "I thought you'd rotated elsewhere."

Neela entered and explained her predicament. Romano listened as she presented the details of the case. When she was finished, he asked a few questions about the bloodwork and studied the ultrasound pictures carefully. He seemed lost in thought and didn't immediately offer an opinion, so Neela prompted, "I'm not sure I understand why Dr. Edson reached the conclusion he did."

Romano replied, "If by 'I don't understand' you mean you think he's wrong and you're right, then you've hit the nail on the head. Nice catch." He favored Neela with a small smile, then went on to point out the subtleties of the chem panel, history, and ultrasound that supported her diagnosis. He ended with, "You can try again to make Dale see the light, but even if he doesn't, don't sweat it. Needle-aspiration with ultrasound guidance is the recommended course for a pyogenic abscess. While it's often unnecessary for an amoebic, it's not outside the standard-of-care for ambiguous cases and can be used to confirm the diagnosis."

Neela felt satisfied and relieved. "Thank you," she said sincerely.

Romano was more animated than Neela had seen him in a while. He regarded her with a teasing expression, "So, are you happy to be out of this pit of stench and despair?"

Neela laughed, "It's very different. The procedures are really fascinating. Though I sometimes miss the more collegial relations down here."

"Yeah," Romano snorted, "Surgeons tend to be assholes. We don't play well with others."

Neela prudently let that comment slide. "From my orientation, it seems that I'll be doing more fetching and carrying and getting less hands-on experience than I had hoped for, given what Abby told me about her rotation."

"Dumping scut on med students makes the world go round," Romano smirked, "But, yeah, Edson is kind of stingy with procedures. Too bad you didn't get Corday. Are you thinking about surgery as a specialty?"

"I'm really not sure," Neela answered thoughtfully. "I've always been interested in pediatrics, but then I enjoyed my ER rotation far more than I expected to. And now, well, there's something compelling about surgery . . . it's just so . . .," she trailed off, not sure if she should be enthusing about something that the man she was speaking to would never get to do again.

"Powerful," Romano finished for her reverently, absent his usual cynical posturing. "The patient's life is literally in your hands. And if you do your job right, you can mend him. You can cut and sew a path back from the brink of death, then send him home with a gift of ten, twenty, maybe fifty more years to live."

Romano had a far-away look in his eyes and Neela wasn't sure if he was talking to her or to himself. She had often seen his bitterness at the loss of his profession, but had never observed his passion for it until now. His face was unreadable for a moment. Then he snapped out of his reverie, adding, "Of course, you know, you don't necessarily have to choose between pediatrics and surgery. Pediatric surgery is an option, if you can get in."

"I've considered that. There's just so much to think about," she replied, sounding a bit overwhelmed.

"Well, there's no need to stress about it just yet. I'm sure Dale will keep you plenty busy for a while. Still, it might be nice for you to spend a day or two observing a pediatric surgeon." He continued with a wry grin, "Let me think - are there any peds surgeons who don't hate me? Nope, nobody local comes to mind. But I'm sure Dr. Corday can hook you up with someone. You can tell her I sent you."

Neela thanked him again, then glanced down at her vibrating pager. "It's Dr. Edson. And, although you wouldn't think one could discern it from a pager's buzz, he sounds cross."

"Go, Miss Rasgotra. Placate your taskmaster." Romano waved her away.

*****

A few days later . . .

Robert sat in the hospital cafeteria, drinking a cup of tea and nibbling half-heartedly on a bagel. It was well before seven in the morning, so the cafeteria was still quiet - no way could he tolerate being here at mid-day. Still, he was feeling marginally better than he had been. The combination of the sleep medication De Raad had suggested and cutting his caffeine intake back to a more sane level enabled him to get three or four hours of sleep at a stretch. It wasn't enough; he still felt wiped out and he still woke up screaming more often than not. But at least he had a little bit of control over the situation.

From his table in the far corner next to the emergency exit, Robert observed a gaggle of staff enter the large room, talking and laughing. He busied himself with the journals he'd brought and feigned invisibility. Out of the corner of his eye, he noticed Elizabeth. She was with the group, but detached from it. After a pregnant pause, she headed his way.

"You reduced one of my residents to tears yesterday," she greeted him warmly.

"I was way meaner to Abby and she never cried," he responded, "Besides, you don't seem too upset about it."

Elizabeth shrugged, sitting down across from him, and replied honestly, "I worry more when you send them back to me unscathed."

Robert looked away, thrown by her admission of concern. Elizabeth switched to a teasing tone, "I met your little protégé, Neela."

Robert replied diffidently, "She's got decent diagnostic skills for a newbie." Then he smirked, "Or maybe I just dig the accent."

Elizabeth laughed, the sound setting Robert at ease. After a moment of comfortable quiet, she said, "I'll talk to some people in peds, and coerce Dale into cutting her loose for a couple of days. I might as well use my power while I've got it."

In response to Robert's confused look she explained, "They're going to do a formal search for Chief of Surgery soon. As Acting Chief I've got an edge, but I'm leaning against putting my hat in the ring."

Robert was surprised, but didn't have the energy to prod her for more information. He waited to see what she would share.

Apparently apropos of nothing, Elizabeth went on, "I saw Peter Benton last week. He was at the A.S.M. workshop."

"What did he say about me?" Robert inquired.

"Because, of course, the universe revolves around you . . .," Elizabeth shot back.

"Did he laugh?"

"Oh please," Elizabeth returned snidely, "Peter barely laughs when something is actually funny."

As Robert snickered, she thought fondly, 'Nobody appreciates my bitchy side like he does.' Next, she reported, "Peter showed me a picture of Reese. I think he's almost as tall as you are now."

Robert "Hmpfed" in mock offense. Talking with Elizabeth made him feel more like himself, even if he couldn't quite keep up his end of the banter.

Elizabeth looked contemplative as she continued, "I've been thinking about Ella. She won't remember that her mother was always working when she was two. But she'll remember if I'm still never home when she's four or five. Peter cut back on his career for a few years while Reese was young. Now he's feeling out some more challenging positions, maybe for the year after next. And he's getting offers."

Robert shrugged. "He's a pain in the ass, but he's a good surgeon."

"My point is, backing off for a while wasn't professional suicide." Then she added, more hotly, "But it's different for a woman. We get categorized as not-serious if we put our kids first - the 'Mommy-track'."

After Elizabeth spat these last words, Robert put in lightly, "Lizzie, if you're looking to vent your rage on the male-dominated surgical profession, perhaps I should remind you that I'm not currently active in said profession."

Elizabeth felt the poignancy of his near-admission that he was no longer a surgeon. But she was on a roll and continued, "Well, screw them. I'm going to run my career as I see fit. If I decide to take a break from the fast-lane, let them try to stop me when I want to come back!"

Robert appeared to be enjoying her rant. After a pause, she asked him softly, "You're not disappointed in my lack of ambition, are you?"

"No. Of course not. You tearing them all a new one a few years down the line - that's worth waiting for." More seriously, he added, "I won't be able to help you, you know, but I doubt you'll need it anyway."

Elizabeth smiled at the pride in his tone. "No Robert, I don't need you to protect me from the good-old-boys club." Then, catching his gaze determinedly, she asked, "And you know what else I don't need you to protect me from?"

She answered her own question, "You."

He looked away awkwardly. "Elizabeth . . ."

"We haven't spoken in weeks. I miss you." Elizabeth understood that Robert wanted some space, and she had tried to respect his wishes. But frankly, that plan didn't seem to be working out for either of them: she fretted over the cryptic comments that floated up from the ER, and he looked terrible.

"I don't know . . ." he trailed off.

Elizabeth had never seen Robert so uncertain. Normally the most decisive, strong-willed, stubborn person she knew, Elizabeth got the feeling that right now she could easily push him into going along with her wishes. But she wanted it to be his decision. "Look Robert, I want to be your friend. That's all. Nothing heavy. How about coffee now and then? Maybe some malicious gossip about our co-workers . . . ?"

Robert cast his eyes down for a long moment. Coming to a decision, he looked up and smiled, almost shyly, "OK."

"Good. We can look for each other the next time we're here early in the morning," she concluded, deliberately leaving things open. She got up to go.

Just as Elizabeth turned around, Robert inquired in an innocent tone, "Uh, we're still using the word 'coffee' euphemistically, right?"

*****

The following weekend . . .

Robert was beginning to think that his plan for the evening had been a mistake. He and Karl De Raad were watching the Terps play South Carolina on ESPN. Karl had been willing to help him deal with his sleep problems, even though Robert flatly refused to consider the psychotherapy, antidepressants, or anxiety medications that the psychiatrist wanted him to try. Robert actually did trust Karl's judgment. He knew that his colleague prescribed psychoactive meds sparingly, in short courses, as part of a more comprehensive treatment program. But he just couldn't bring himself to go that route. And therapy? Yeah, right.

The only thing De Raad had insisted on was that Robert see him for a few follow-up visits, "as a professional courtesy." Romano was reluctant to meet at the hospital. And he knew that Karl, like himself, was a baseball addict who subsisted on college basketball during the off-season. So, inviting the other doctor over to watch the game seemed like a painless way to discharge his obligation.

It started out pretty well. Karl was a good guy, surprisingly sane for a shrink, and Robert found his company agreeable. The only problem was the time. The game went on into the evening, and Robert's anxiety level was always much higher at night. He scheduled himself for day shifts at work, accordingly. But he had associated the night stress with his inability to go to sleep, so it hadn't occurred to him that it would be much of a problem when he WASN'T trying to sleep.

By the end of the first quarter, he was fidgeting restlessly. By halftime, he was having trouble staying in his seat for more than a few minutes at a time. Senseless feelings of unease and distress would well up in his chest and to tamp them down he needed to move, to walk - to the next room, upstairs and back, wherever. Fortunately, Karl seemed pretty tolerant of these disturbances. Robert felt sure that, were their roles reversed, he would have strangled such an irritating viewing companion.

At the halftime break, Karl addressed him, "Here's a silly question: are you OK?"

There was enough humor in De Raad's tone that Robert wasn't too put off by the question. "Yeah, I'm fine. Just a little antsy. I guess I'm getting tired."

"Want me to catch the end of the game at home?" the older man offered.

Robert sighed, "Yeah, I guess so. I should try to get some rest. I'm sorry."

De Raad's lips quirked briefly into a sympathetic smile, and he asked, "Do you really think you'll be able to sleep, or do you just not want any witnesses?"

Robert shrugged, flustered at the other doctor's insight. He started to get up to pace some more, when Karl told him firmly, "Sit," and guided him through a breathing exercise. Robert was desperate enough for relief that he did what he was told.

A short while later he was feeling somewhat less agitated, and more angry. "This is stupid," he fumed, "I'm in my own living room, not on the friggin' roof of the hospital! It doesn't make any sense!"

"Maybe helicopters aren't the only thing you're anxious about." Karl suggested quietly.

"OK, see, that's not helping." He sounded annoyed, but there was a trace of self-depreciating humor in his voice.

"Heh," Karl laughed gently, "How about this: the human mind doesn't make that much sense."

"You must be a lot of fun at parties," Romano mocked. "So, does that mean you shrinks can just make shit up?"

Smirking, Karl retorted, "Are you considering a career in psychiatry now?"

"Hmmm . . . well, that IS something I could do with only one hand . . .," Robert taunted. Joking around made him feel calmer. He guessed that De Raad had picked up on this and was playing along. But what the hell - it was working.

"Oh God, please don't," Karl shot back.

Robert continued, "Nah, it wouldn't work. I hate people. I couldn't stand listening to them whine all day."

"You must have to listen to your patients' health complaints in the ER," Karl reasoned.

"I just skim. You know, 'blah blah . . . fever . . . blah blah . . . lower back pain . . .'" Robert mimicked. As he finished, he noticed Karl was looking away, distracted. "What?" Robert demanded.

"Huh? No, I was listening: blah blah . . . hate people . . . blah blah . . . skimming . . ."

Robert let out a short laugh, then scowled and said, "Just watch the damn ballgame."

Author's notes: I hope my interpretation is consistent with what little we've seen of De Raad. If not, who are you gonna believe, TPTB or me? :-) Evilspoofauthor2Cassi, I don't have any immediate plans to let Romano slug Pratt, but nonetheless, I think you'll like the next chapter . . . Once again, thank-you to all my reviewers.