Title: And A Doctor
Author: Still Waters
Fandom: Sherlock (BBC)
Disclaimer: I do not own Sherlock. Just playing, with love and respect to those who brought these characters to life.
Summary: It was only when people actually saw John working as a physician that they began to understand: that it wasn't just about bullets and IEDs and trauma care under fire. That "doctor" actually covered a pretty wide field. And that John was bloody good at covering ground. 5 times Dr. Watson treated others and 1 time he treated himself.
Brit-pick: Many thanks, once again, to the wonderful mrspencil, who somehow manages to find time in her busy schedule to cheerfully look over my work and teach me new things.
Notes: This chapter is dedicated to all those who have walked the hospice path. I'd like to give extra thanks to mrspencil, who truly went above and beyond with this chapter, helping me adjust my knowledge of American hospice protocols to properly fit those in the UK. Thank you to all who have reviewed while following this story – I am trying to get the chapters out as quickly as I can, and so proper review replies have taken a back seat at the moment, but I will certainly be responding and truly appreciate your feedback and support. As always, I hope I did the characters justice. Thank you for reading.
3.
Phones ringing at 2 AM generally didn't bode well for John. When it was Sherlock's mobile at that hour, it was usually Lestrade with a case, which meant that John was about to go haring off after Sherlock on however little sleep he had managed to get, silently thanking both his military and medical experience for enabling him to be able to function in life-threatening and life-saving situations on an amount of sleep that the medical side of him would never allow in a patient.
If it was John's mobile at that hour…..well, at this point in his life, he automatically figured it related to Sherlock somehow: that the idiot had gone and gotten himself into a mess somewhere which required John's medical, diplomatic, or bail-posting skills. Or that it was Lestrade or Mycroft, phoning John because Sherlock was "thinking" and not answering his bloody phone. It was only after filtering through those that John's brain went back to considering more normal, pre-Sherlock possibilities: Harry was drunk or in hospital, or one of his mates still in the service was dead or injured. For a man others gravitated towards due to his warm smile and unassuming nature, John wasn't much of an optimist.
Instantly awake, he rolled over and grabbed his mobile, bolting upright, brows tight as Mrs. Hudson's name flashed on the screen. "Mrs. Hudson?" he answered, voice low, instinctively categorizing breathing patterns and searching for threats.
"Oh, John. I'm sorry to wake you at this hour."
He could picture the motherly guilt on her face. Tone sounded stable enough, background was quiet except…..was that a stifled sob?
"What's happening?" John continued to keep his voice low, so it wouldn't project far beyond the phone. "Are you all right?" he asked, firm and concerned, already getting out of bed and dressing one-handed.
"What's that? I'm fine, dear. Why….." she suddenly stopped, feeling ashamed. Of course John had been worried. The boys gave her that mobile for emergencies and there she was calling at such an awful hour. "Oh, there I go, not thinking properly, like some silly old fool. I'm sorry, John. I should've realized…."
"It's all right, Mrs. Hudson," John assured her, the soldier standing down a fraction with the knowledge that she was safe; no immediate threat present. He could hear her smile over the phone, followed by another soft sob in the background. "Where are you?"
"Mrs. Turner's." The name held a solemn sadness.
John closed his eyes briefly. "Danny's passed, then?" he asked softly.
"No, not yet. But he's…..well, he was breathing something awful and he's not waking up anymore. She rang me because she didn't know what to do, so I went over and now…." Her voice caught as the words got away from her.
"It's good you're there. She shouldn't be alone right now," John assured her. "Did she call the district nurse?" he asked, shifting the phone from hand to hand to keep it near his ear as he pulled a jumper over his head.
"I called for her when I got here. Held the phone up to Danny's mouth and everything so the nurse could hear his breathing. She said to give him the morphine first."
"Good," John agreed, holding the phone between his shoulder and ear as he leaned over to tie his shoes. "How much did you give?"
"A full dropper. That's what the nurse said. Seemed an awful lot."
John calculated the dose in his head: 20 mg. Good. "No, that's good," he assured her. "How's his breathing now?"
"A bit better, but he still just looks…..uncomfortable? I can't explain it, and I know it sounds silly. I mean, he's dying of course, but…."
"But it doesn't have to be uncomfortable," John both reinforced and agreed with her. That was the beauty of hospice care as opposed to traumatic battlefield medicine: the chance for a good death. "Is the nurse coming over?"
"Yes, she'll be here in half an hour," Mrs. Hudson fretted, hair crackling against the phone as she turned her head toward Danny's bedroom.
"Good. Would Mrs. Turner like me to come by and check on Danny while she waits for the nurse?" John offered, knowing Mrs. Hudson was warring between her 'I don't want to bother you' nature and knowing what support her friend needed. The question was irrelevant, as he already knew the answer and was going to go over there either way, but he asked all the same.
Mrs. Hudson let out a relieved breath. "Oh, could you, dear? I know she'd feel better with you here to take a look. She knows you said she could call anytime, but she didn't want to wake you, what with Sherlock keeping you out at all hours."
John chuckled softly; such mothers, the two of them. "I'll be right over," he promised.
"Thank you, love. I'll tell her."
John pocketed his mobile, grabbed his kit, and headed downstairs. He had just opened the sitting room door, eyes on the stairs, when Sherlock's voice shot out of the dark room from the direction of the sofa.
"Is Mrs. Hudson all right?" Sherlock's tone appeared to be his usual, even, bored one, but John knew him well enough by now to hear the fine layer of concern underneath.
John frowned. "Were you listening?" he demanded. He hadn't heard anyone outside his door, and he'd thought Sherlock had learned his lesson after John's last ultimatum on eavesdropping, but Sherlock flouted basic privacy conventions even more than usual when he was bored and the man could be quite a stealthy bastard when he wanted to be.
"Don't be dull," Sherlock dismissed. "It's two in the morning, and you're leaving the flat with your medical bag. Someone phoned you for assistance, but you don't have far to travel because you walked past your coat without taking it. Conclusion: Mrs. Hudson requires medical attention," Sherlock sighed as if it was the most obvious thing on earth. "Is she all right?" he repeated.
John felt the full weight of Sherlock's gaze even before his eyes adjusted enough to make out the shadow of Sherlock's head and steepled fingers turning along the arm of the sofa to face him.
"She's fine." Another reassurance, yet so different than the ones he had given Mrs. Hudson moments ago. Both compassionate at the core, but honest, gentle emotion at the forefront for Mrs. Hudson, while Sherlock was favored with simply delivered facts; his doctor's training, always unconsciously assessing and adjusting his responses for different needs. "I'm off to Mrs. Turner's."
Sherlock was silent, mind working to hypothesize the emergency.
"Danny's getting close. I'm going to see if I can help," John offered a hint.
"Danny?" Sherlock echoed, looking at him blankly.
"Yes, Danny. Mrs. Turner's nephew?" John sighed, exasperated. "Surely you've heard Mrs. Hudson talking about him?"
The blank look remained unchanged.
John shook his head. "Right," he threw his right hand up, the left clenching into the handle of his medical bag. "Irrelevant. Deleted. Whatever." He sighed again and turned back toward the stairs. "I have to go."
"Danny is dying," Sherlock pronounced.
John instantly recognized that tone. That 'I've just discovered something interesting and I'm going to dig in and study it' tone. "Oh, no," he insisted, spinning on his heel to find Sherlock standing up.
"No, what?" Sherlock asked, petulant and oblivious in equal measures.
"No, you are not coming," John planted himself in the open doorway, holding his ground.
"Really, John. Within twenty-four hours of our first meeting, you were giving me your professional opinion on a corpse." He gave John an 'honestly, did you think a dying person would shock me?' look. True, he found the dead far more elegant and interesting than the messy humanity that complicated the simple science of dying, but he was bored. Surely there was something he could study. "Dead, dying," he waved a hand loosely, rationalizing the decision to himself more than anything, "it's all the same in the end."
"It really isn't," John stretched the second word, voice low and dangerous; a tone Sherlock didn't hear often enough to immediately recognize, yet one his brother had heard within minutes of meeting John. "And it's hardly your reaction I'm worried about," he huffed disbelievingly, giving Sherlock a 'how can you possibly be such an idiot?' look; one of the only people who had ever thought of, and gotten away with, doing so. "Sherlock, Danny is not a case, nor is he about to become one of your bloody experiments. He's a twenty-eight year old kid dying of cancer being cared for by his devastated aunt. The last thing either of them need is….."
"Me," Sherlock supplied, both a question and a statement.
"Exactly," John deflated slightly at the admission, a flash of guilt quick through his eyes even as the protective anger remained. He ran a hand over his face. "Look, I…." he sighed. "I really have to go."
Sherlock flopped back onto the sofa as John's footsteps faded beyond the front door, resumed his thinking posture, and went back to contemplating the ceiling.
Mrs. Hudson met John at Mrs. Turner's door, ushering him in with a hand on his back and tears in her eyes.
"How are they?" John asked, both compassionate concern and clinical assessment.
"Holding on, dear," Mrs. Hudson replied mournfully.
John nodded and followed her up the stairs, turning right at the top, and knocking lightly on the open bedroom door. Mrs. Turner lifted her head off the edge of the bed and turned around, tears overflowing even as she smiled gratefully. "Oh, John. Thank you for coming. I didn't want to wake you, but…"
John, despite his overtly human and good-natured persona, was quick to avoid touch in most situations; John the soldier, when stressed or threatened, doubly so. But John the doctor instinctively understood and employed the therapeutic human need for touch without thought. He stepped forward and laid a gentle hand on her shoulder. "Mrs. Turner, you know who I live with. I hardly keep regular hours," he smiled lightly.
She chuckled wetly. "No, I suppose you don't," she agreed.
"And I don't tell people to call me anytime if I don't mean it," he reminded her with gentle firmness.
"Thank you," she reached up and squeezed the hand on her shoulder.
John nodded and stepped back, walking to the dresser near the foot of the bed and setting his kit down. Danny wasn't technically his patient, and John certainly wasn't a palliative care specialist, but he had kept up on the young man's condition through Mrs. Hudson and Mrs. Turner, and offered to help in any way he could. He pulled on a pair of gloves, put his stethoscope around his neck, and moved to Danny's left side. "Danny? It's John Watson. I'm going to look you over and see if we can make you more comfortable." He ducked down to look behind Danny's ears, then down to his chest. "How long has he been unresponsive?"
"About twenty-four hours now," Mrs. Turner sniffled.
"And how often is he medicated?" John looked up from his watch after counting Danny's respirations.
"He gets the morphine every two hours."
John moved his stethoscope from Danny's trachea to his chest, listening to his anterior lung sounds and heart. He glanced down at his watch to count Danny's heart rate, then auscultated his abdomen, before moving back up to pull Danny slightly toward him, on the young man's left side, to listen to his posterior lung sounds. John put the stethoscope back around his neck. "Does he have any lorazepam?" he asked, palpating Danny's abdomen.
"The anxiety liquid? Yes, we have some, but I haven't used any since he stopped waking up," Mrs. Turner froze with sudden worry, eyes wide, hand going to her chest. "Oh no, should I have been using it?"
"No, no, it's fine," John soothed, examining Danny's fingernails and checking the strength of his radial pulses, before gently laying his hands back down and taking up a crouch at the end of the bed, pulling the blanket up to check the temperature and color of Danny's feet and lower legs. "Have the Macmillan or district nurses given him any injections today?"
"No," Mrs. Turner replied.
"Right," John murmured to himself, rocking back on his heels.
"What do you think, then?" Mrs. Turner asked, dabbing her eyes with a tissue.
"I'll talk to the nurse when she gets here, as she knows his case better than I do, but I'd like to try a dose of the lorazepam in the meantime, if you have it."
Mrs. Hudson stepped away from the doorframe and headed to the kitchen, the refrigerator clicking open and shut as she retrieved the bottle and returned to the room, handing it to John.
"How do I tell when he needs it when he's like this?" Mrs. Turner gestured at Danny's unresponsive form. "Did I miss…."
"No, no,' John insisted, making sure she met his eyes, staying in his crouch to keep at her eye level across the bed. "You are doing a fantastic job with all of this. Really." He took the medication from Mrs. Hudson with a quick nod and muted smile and measured out a 1 mg dose, motioning at the skin around Danny's eyes and mouth. "There's a little bit of tension here," he pointed out as he eased the dropper between Danny's cheek and lower gum, slowly emptying the medication to be absorbed by the vascular tissue there. "Do you see it?"
Both women nodded.
"I think that's what I was seeing," Mrs. Hudson added thoughtfully, recalling her earlier attempt to describe how Danny still appeared uncomfortable to her.
"It probably was," John agreed. "Usually, if it's tension from pain, the morphine will ease it out, unless he needs a different dose or medication. Sometimes though, that little bit of tension can be the only sign of restlessness or anxiety, which is very common this close to death."
Mrs. Turner hiccupped. "So he's close then?" she choked. "I mean, I know he's not well, that he's…." she struggled to form the word, "dying…." She looked at Danny's pale face, then forced her eyes back to John. "But….." she worked to compose herself, to actually voice the question. "Will it be soon?"
John sighed softly to himself; always the hardest question. "Everyone passes in their own time," he said. "I can't tell you for certain when it will be, but I can show you what I saw."
Mrs. Hudson moved to Mrs. Turner's side and put an arm around her shoulders, holding her close as John explained the mottling of Danny's extremities, the coolness and purple coloration indicating loss of circulation as the body began to shut down, keeping blood flow to the core; the weak pulses and slow respirations from the dying process and medication; the slowing bowel, and finally, how the unresponsiveness could last hours or days, but that is was well-believed he could still hear them talking.
"His breathing….." Mrs. Turner bit her lip, fixing her eyes on Danny's chest and the soft gurgling, wet sound on each inhale. "It's the death rattle, isn't it? Like the shows on the telly?"
John nodded, even as he simultaneously cursed the lack of thought that often went into medical programs; how often accuracy was sacrificed for drama. He refused to watch most of those shows now, especially since Afghanistan. While Sherlock yelling at crap telly such as reality programs and talk shows was entertaining for John, and a study in humanity's most ridiculous horizons for Sherlock, John could only be amused by medical programs for so long before the shaking head and snorted, disbelieving laughter became real, burning anger as he recalled actual cases and patients of his: those who had come to him with frighteningly harmful misconceptions of human health from those shows, and those who had suffered horrific diseases or injuries only to have their specific suffering minimized, improperly dramatized, or mocked in some stupid television show. "Yes, but it's not as bad as the telly makes it out to be. He's not in any distress."
Mrs. Turner's eyes widened in disbelief.
John smiled gently. "I know it sounds bloody awful, but it's just the sound of saliva in the back of his throat. The muscles have loosened and he isn't swallowing and clearing it away as he normally would. When I listened to his lungs, there wasn't any fluid in them. It may sound like he's drowning, but he really isn't."
Mrs. Turner's face crumpled. "Is there any way to….clear the fluid?"
John understood the fearful discomfort that the rattle brought. It was a terrible sound to those sitting vigil, even if it didn't hurt the dying person. "Suctioning it out usually doesn't help and can be quite traumatic for the person…."
"Oh no, I don't want that," Mrs. Turner was quick to interject.
"I know," John soothed. "But there are medications, like hyoscine, that can help dry up the secretions. I'll talk to his nurse about trying a dose from the emergency drug pack when she gets here."
"Thank you….oh, dear," Mrs. Turner interrupted herself, pausing in her readjustment of the blankets when her hand found a small circle of dampness. She moved to stand up. "I'll just get some towels….."
Mrs. Hudson, already halfway to the door to get some from the bathroom, startled at the sound of the doorbell and hustled downstairs to answer it instead.
"The nurse and I can clean him up," John said gently. "When was the last time you slept in your bed?" he asked, noting the well-worn chair she was slumped into.
"I had a brief lie-down when the Macmillan nurse was here this morning. It's just…..ever since he got like this, I'm afraid to leave him. I don't want him to die alone," she choked.
"Doctor Watson and I can be with him for a bit, Mrs. Turner. Why don't you and Mrs. Hudson have some tea, maybe get some air? We won't leave him alone," Diane, the district nurse, said from the doorway.
Mrs. Turner smiled, warm and watery, at the familiar presence. "Diane, dear. I'm sorry to drag you out too." She pushed on as Diane went to speak. "I know it's your job, but I'm still going to thank you."
Diane chuckled. "My pleasure. Mrs. Hudson filled me in on the way up, and if Doctor Watson here doesn't mind giving me another set of hands, we'll get Danny comfortable and see what else he needs."
John nodded his agreement.
Mrs. Hudson stepped forward and guided Mrs. Turner up by the elbow. "Come on, dear. I'll make you that cuppa."
Once the two women left the room, Diane stepped in and strode to John's side, holding out a hand. "Diane Weston. Lovely to finally meet you, Doctor Watson."
John shook her hand, firm and warm. "Same. And John, please."
"Right, then," Diane nodded, setting down her own bag next to John's and pulling out a spray bottle, thick disposable cloths, and gloves. "Shall we?" she motioned to the wet blanket.
Half an hour later, Diane went out to the kitchen and updated Mrs. Turner, who was then guided back into the bedroom to find Danny in clean bedding and pajamas, a urinary catheter in place for dryness and comfort, pillows placed under his heels and along his left side to ease the pressure on his body, and a fan gently blowing air across his face to manage any potential feelings of air hunger.
"Oh, he looks so peaceful," Mrs. Turner breathed, eyes shining at Danny's unlined face. "Even that awful rattling sound isn't as bad."
"I gave him an injection of hyoscine, to help decrease the saliva in his throat," Diane explained. "It doesn't always stop it completely, but it should at least help."
"No, I understand. He looks…comfortable. Thank you both," Mrs. Turner looked from John to Diane with a warm, shaky smile.
They spent another ten minutes sitting together in the room, Mrs. Turner reminiscing about Danny's childhood, when Diane's mobile rang. As she excused herself to take the call, Mrs. Turner's cat trotted past her and slipped into the room for the first time that night. Diane turned around and shared a significant look with John before continuing to the stairs. When she returned a few minutes later, the cat was perched on the bed near Danny's feet, watching him intently.
"If you have another patient, I can stay," John offered, eyes moving to the cat, then back to Diane as she moved to the foot of the bed.
"They were just checking on a dosage. Should be all right," Diane said quietly. She moved to Mrs. Turner's side and began speaking softly, the older woman's eyes widening as she moved her chair up near Danny's head, touching his face lightly and speaking to him.
"What is it, dear?" Mrs. Hudson asked quietly, reappearing in the doorway after washing up the dishes and straightening the kitchen.
John crossed the room and explained the significance of the animal's sudden presence. He'd spent some time in a field hospital in Afghanistan that had a scraggly mutt that hung around. The dog seemed to have some sort of innate sense of infection control, never nosing around any bandages or tubing, and so the staff encouraged him to stay; his presence alone being soothing in a way that medicine couldn't always manage. And it didn't take long for everyone to learn that when he settled in at a patient's bedside, that death would occur within the next twenty-four hours. Always.
Mrs. Hudson stifled a sob and squeezed John's arm, walking over to gently stroke the cat's head before resuming her place at Mrs. Turner's side.
Fifteen minutes later, the cat let out a mournful meow just as Danny took his last breath, to the sound of his aunt's soft voice telling him she loved him.
After pronouncing the death, assisting with the phone calls and post-mortem care, waiting for the undertaker, and making more tea for Mrs. Turner and Mrs. Hudson, John didn't get back to the flat until 7 AM. Finding Sherlock gone, he gave the fridge a quick survey, decided he was too bloody exhausted to eat, and trudged up to his bedroom to sleep.
He woke up seven hours later to his mobile chirping: a text from Sherlock seeking support for digitalis toxicity as a cause of death, followed by a lengthy list of medications. John reviewed the list with weary eyes, sent a detailed, but pared down response that gave Sherlock everything he'd need, and snorted at Sherlock's resulting comment about Anderson's latest shortcoming.
So long as Sherlock was amusing himself with a case, John figured it was time to get up and enjoy the silence for a bit. Dragging himself downstairs, he found an envelope on the table, addressed to him. An envelope that, in a clear sign Sherlock had stopped back at the flat at some point, had already been opened, carefully slit along the top by a pocketknife. Anger swelled in John's chest, overpowering the weary resignation of this new normalcy. They shared living arrangements, food, acquaintances, Sherlock's work….the least Sherlock could do was leave his post alone.
John sighed and pulled out the card, a slow, soft smile smoothing the lines of tension on his face as he read Mrs. Turner's flowery handwriting, breath catching at her final sentence: I've always believed that God puts people exactly where they ought to be. He's brought you to Sherlock, and last night, He saw fit to send you to me. I hope Sherlock knows what a blessing you are. I certainly do, and I'll be forever grateful.
John reverently tucked the card back into the envelope; he hadn't been thanked so sincerely for his medical attention since the service. He'd almost forgotten how it felt, what he could do when he wasn't constantly being pulled away from that part of himself by Sherlock and his work. He suddenly groaned, remembering that Sherlock had actually read the card; imagined him muttering something about sentiment and caring too much, then wandering back off to the crime scene.
But when John went to put the kettle on, he found the worktop completely cleared and the kettle both clean and free from experimentation. Opening the fridge revealed a fresh carton of milk that hadn't been there when he first got home.
Sherlock would never be the card-writing type, nor was he prone to verbal statements of gratitude or praise. But that didn't mean he didn't have his own Sherlockian brand of approval and sentimentality. He would have opened the card out of a boundary-ignorant sense of curiosity, a need to know what happened at Mrs. Turner's, but if the contents of the writing had been nothing more than simple data that allowed him to put together a picture of the events, or worse, boring sentimentality, he would have simply dropped the card and moved on; the state of the kitchen would have remained unchanged.
So, with a pleased, private smile, John went about his unobstructed preparation of tea, knowing exactly what it meant.