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: 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.
4.
Sherlock was walking through Regent's Park, animatedly running through their current case data out loud, searching out connections by bouncing ideas and information off John, when he felt his flatmate's attention drifting; the nods, grunts, and occasional insights or opinions dropping off significantly. He allowed himself a breath and glanced over to find John's head cocked toward Sherlock, still listening with one ear, but his eyes focused on a young woman a few meters down the path, who was frowning worriedly at an elderly woman sitting on a bench. John pursed his lips slightly, then resumed his previous walking speed, Sherlock picking up right where he had left off, until John finally came to a halt, eyes fixed on the two women.
"Sherlock, give me a minute, will you?" John asked, angling his body toward the bench.
Sherlock's response was a put-upon huff. "Going to lend a gallant arm, Doctor Watson?" he sneered, a mixture of irritation at being interrupted and exasperation with John's incessant need to be helpful, particularly to pretty young women.
John's eyes narrowed. "No," he replied carefully, tone tightly contained. "I'm going to see what's wrong."
"The only thing that's wrong is that the young lady is out of training." Sherlock sighed at John's silent reply, his flatmate's face somehow managing to be blank while also shouting 'oh just get on with it' at the same time. "Her shoulders, John," Sherlock gestured toward the bench. "Clearly a competitive swimmer, but one obviously out of regular training seeing how she currently lacks the upper body strength to assist an elderly woman to her feet."
John tilted his head slightly, face tight with his 'I'm holding back exactly what I want to say to you' expression. "Right. And I suppose her shoulders are more important than her face."
"She's frowning because she's unable to perform a simple task," Sherlock dismissed.
"No, she's frowning because something's wrong," John corrected. "That's the third time the elderly woman's legs have given out while trying to stand."
Sherlock squinted across the way. "She's seventy-five years old, John," he said, not the slightest hint of uncertainty in that number. "Surely you've seen enough elderly patients with muscle weakness that this isn't news to you?"
John's eyes narrowed. "Yes, and when they're that weak they're in a wheelchair, not this far out in Regent's Park with only a walker," he shot back, feeling a small stab of satisfaction when Sherlock's eyes flickered over to verify that claim. He sighed heavily. "Look, I'm just going to make sure they're all right. I won't be long. Stay here, if you want, and keep at it."
Sherlock opened his mouth to reply, but John was already striding off. He blew out a breath that was half-sigh, half-growl. He knew he was close with the case; just another few minutes of working through it out loud and he'd have it. But while Sherlock certainly had no problem talking to himself in public, not caring if other people thought he was a complete nutter, he'd grown accustomed to doing it with John, whether John was actively listening and contributing, or silently acting as a sounding board to Sherlock's own conversant thought process. John's very presence somehow helped clarify the storm of data in Sherlock's head; illuminated hypotheses and conclusions that should have been obvious from the start, yet had somehow eluded him. So as much as he hated to be interrupted during a case, Sherlock decided to put active consideration of the data on hold until John's attention was back where it belonged, and strode down the path to observe John's distraction instead.
John slowed his pace, easing back on the purposeful, military-sharp stride as he got closer to the women. "Hello," he greeted them, eyes flickering to the elderly woman's lack of response, before settling on the young woman at her side. "Is everything all right?"
"I'm sorry?" the young woman asked, confused. Her gaze shifted over John's shoulder to take in the long strides of Sherlock's dark, approaching form.
John turned his head and shot a clear 'back off and shut up' look at Sherlock, before returning his focus to the young woman. "I couldn't help noticing that your…." He paused for a second, looking between the two women, "mum?" he asked, more with his eyebrows than his voice. At the young woman's nod, he continued, "seemed a bit unsteady on her feet."
The young woman deflated a bit as John's intentions became clear. She kept her eyes on him even as Sherlock arrived, assuming a looming position a step behind John's right shoulder. "Yeah, she's not usually like this," she worried at her lower lip. "Hardly even needs the walker most days."
John nodded, eyes moving carefully over the older woman, already assessing, humming to himself as if he'd already noted something of particular significance. "Maybe I could help? I'm a doctor," he added in quick explanation. "John Watson," he offered a hand. "Would it be all right if I examined her?"
The young woman shook his hand warmly. "Oh, yes, please. That would be wonderful. Lucy," she introduced herself. "And my mum, Marjorie."
John could feel Sherlock's eye roll without looking and promptly ignored it. He crouched down in front of Marjorie, getting a closer look at the bruises on her left hand and inner left elbow that had caught his eye earlier, nodding to himself. "Marjorie, can you hear me?" he asked.
She nodded, a bare fraction of movement.
"Can you tell me your full name?" John asked, noting the saliva at the corner of her mouth.
She made a weak attempt to speak, but was unsuccessful, eyes squinting tighter despite Lucy's new position shadowing her face from the sun.
"Does your head hurt?" John read the deepened furrows around Marjorie's eyes.
Another weak nod.
"Does she usually have any difficulty speaking or swallowing?" John asked, glancing up at Lucy.
"No, never," she said nervously. "She was fine, just ten minutes ago."
John measured her pulse and respirations, then took a small torch from his pocket and shaded Marjorie's eyes. "Marjorie, I'm going to shine a light in your eyes for a moment," he explained, moving the improvised penlight across each one. He hummed to himself, moved to do something else, then suddenly stopped, emptying his pockets and removing his coat to lay it across Marjorie's lap.
Lucy's eyes widened. "Oh, you didn't have to…." She gestured at John's coat.
He shook his head. "It's no bother, really," he said, assuring Marjorie as much as Lucy.
"I suppose it's a urinary infection then, yeah?" Lucy asked. "She's lost bladder control and gotten confused and weak with them in the past, although never this bad. Maybe it's just a really bad one?"
John shook his head. "No, it's more than that this time."
Sherlock's ears perked up at the unwavering confidence in that statement; a trait practically synonymous with his own voice, yet this manifestation uniquely John. The sound of a man who truly knew what he was doing. Intrigued, Sherlock moved from his place behind John to a position along his flatmate's left side, to better observe his face as he worked.
John took Marjorie's hands in a light grip. "Marjorie, can you squeeze my hands?" he asked, firm and clear, yet with an undercurrent of gentle compassion. He watched as her hands began to move. "Hard as you can," he encouraged, squeezing them once himself. "Good," he nodded, observing the response. He moved down to her feet, lifting one off the ground and placing one of his hands underneath the sole of her shoe and the other on top of the foot. "Now, push down on my hand, hard as you can," he instructed. "Good, again," he switched to her other foot. "Very good, thank you."
Sherlock catalogued what data he could gather. Elderly woman, right-sided weakness, saliva spilling over the sides of her mouth where Lucy was now wiping it, inability to speak, sluggish response to commands. What more did John need? Clearly the woman had had a stroke.
Lucy gasped as Sherlock muttered the conclusion under his breath. "Is that what it is, Doctor Watson? A stroke?" she wrung her hands, twisting the napkin she'd used to wipe her mother's mouth.
"Clearly," Sherlock rolled his eyes.
Lucy's own eyes widened as she pulled out her mobile; a swift, trained action.
"No, not clearly," John corrected Sherlock firmly, eyes remaining on Marjorie as his body language radiated a sharply unmistakable demand of 'you need to shut up now.' His voice softened for the two women, a jarring juxtaposition to the tight lines of Sherlock-induced muscle tension. "But Sherlock is going to call for an ambulance while we keep talking," he acknowledged the sight of Lucy's mobile in his peripheral vision; good to know that someone was paying attention to all those adverts about dialing 999 at the first sign of stroke symptoms.
Sherlock stiffened in reflexive annoyance – a trait he firmly blamed on Mycroft's presence in his life – at being ordered to do anything. But John's tone held no trace of his previous irritation at his flatmate's conclusion; just a simple statement as to what Sherlock would be doing, voice calm and sure for an increasingly worried Lucy. As much as Sherlock generally bristled at being told he was wrong, naturally assuming that the other person was an idiot and therefore inconsequential, John's words actually mattered to him; rather than filling Sherlock with dismissive affrontedness, John's confident opposition to the stroke diagnosis made him curious. So Sherlock conceded to pulling out his mobile and dialing 999 while keeping most of his focus on John's continued assessment.
John's hands had moved to Marjorie's head. "Lucy, does your mum take any anticoagulant medications?" He paused, adding the more common lay term for clarification, "Blood thinners?" His fingers moved through Marjorie's hair, palpating her skull. "Warfarin, maybe?"
"Yes, that's exactly the one she takes!" Lucy breathed. "How did you….."
John gave a fractional shake of the head, a clear 'in a moment' gesture, as he continued palpating. "Why was it prescribed?"
"She has a heart problem. Atrial fibrillation," Lucy replied.
John's fingers finally hit a small, swollen lump.
There.
John felt the familiar rush of a confirmed diagnosis run through him. Even though he took locum shifts as a GP at the surgery, people, at least those who remembered that he was a bloody doctor to begin with, tended to see him solely as an army doctor; pictured him treating life-threatening combat injuries under heavy fire. It appealed to people's fascination with excitement and heroics, where anything worth something had to be some big, grand gesture on a massive stage. No one imagined that a simple observation in the park, followed by a calm, invisible-to-passersby assessment and diagnosis, could be just as important and lifesaving. That diagnosing a potentially life-threatening condition in a perfectly conscious elderly woman on a park bench could be just as satisfying, and impressive, as the adrenaline of battlefield trauma.
"Lucy, has Marjorie fallen recently?"
Lucy's eyes widened. "Yes, about a….." she thought for a moment, "…day and a half ago? She lost her balance and hit her head….." she suddenly realized where John's hands were, what he had found. "But she was fine," she quickly assured him. "A little bump, but she never lost consciousness. Hardly even had a headache. She was fine," she repeated, with the desperate edge of someone thinking back to see if she had missed anything.
"I believe you," John soothed, tilting his head slightly to focus on where Sherlock was in the 999 call.
"Oh," Sherlock breathed in sudden understanding. Stupid! How had he missed it? It was obvious now that John had known immediately, from the first time he set eyes on Marjorie, that he was looking at a brain bleed. The final questions about the warfarin and the discovery of the lump on her head confirmed it. But how? He dismissed the confused dispatcher's question as to his sudden vocalization, interrupting him with a curt, "suspected brain bleed."
"She's bleeding in her brain?" Lucy gasped, whirling to face John and crouching at his side, hands on her mother's face. "How is that possible? She was fine! She didn't even bleed from the bump, for God's sake!"
John shot Sherlock a 'thanks for that' look, reigning in his sigh and focusing back on Lucy. "Lucy," he said gently. "You asked before how I knew your mum was on warfarin."
"Yes, how did you know?" She couldn't help the resurgence in her curiosity, even while continuing to look worriedly at her mother.
John motioned at the bruises on Marjorie's hand and inner elbow. "She needs regular lab work to adjust her dosage and these are at sites where blood would be drawn. Warfarin affects the clotting process, which puts people who take it at greater risk of bruising and bleeding, especially the elderly, who are more prone to falls. When your mum fell, she began bleeding in her head, but because it was a small area and at a slow rate, she didn't show any symptoms of something being wrong until now, when it became enough to affect her regular functioning."
Sherlock listened silently. Of course! Obvious. So why didn't he see it when John did?
Lucy swallowed back tears. "Don't you need a brain scan or something to be able to see that?"
"They'll do one at hospital to confirm it," John said. "Has she ever had differences in pupil size or weakness on one side?"
"No," Lucy shook her head.
"Well, she does now. Putting that together with the warfarin and fall, makes an intracranial bleed the best explanation for the sudden changes you saw." His face softened as Lucy began to sob. "I know it sounds awful, but it's not a death sentence," he assured her, nodding at the sound of approaching sirens. "The sooner she gets to hospital, the sooner they can operate to stop the bleeding and relieve the pressure."
He helped Lucy up as Marjorie began to list to one side, the young woman joining her mother on the bench, putting an arm around her to hold her steady. John took another pulse and respiratory rate, keeping a careful eye on Marjorie's ability to maintain her airway around the accumulating saliva.
"John," Sherlock said quietly.
John followed Sherlock's eyes to find the paramedics coming down the path. He stood from his crouch with a faint pop of cartilage and jogged to meet them. "Doctor John Watson," he introduced himself.
The paramedics nodded in greeting. "What've you got, doc?"
John joined in their brisk pace, giving his report as they walked. "Seventy-five year old woman," he realized he was taking Sherlock's word for Marjorie's age, yet couldn't find it in himself to argue the number, "with suspected intracranial hemorrhage. Her daughter states she's on warfarin for AF and fell approximately thirty-six hours ago at home, striking her head. There was a small area of posterior swelling, which is still present, but no LOC or noted deficits from baseline until approximately half an hour ago when she presented with generalized weakness. Initial assessment showed new-onset aphasia, dysphagia, anisocoria, and right-sided weakness. She is alert to person, unable to respond to questions verbally, and follows commands with some difficulty. Left pupil is approximately 6mm, round and sluggish to react. Right pupil is 3mm and responding appropriately. Peripheral sensation appears intact, hand grip and foot strength on the right side are severely diminished compared to the left. Last heart rate was 106, respiratory rate was 24. Patient's name is Marjorie, and her daughter is Lucy," John finished as they reached the bench. He stepped back and took up a place at Sherlock's side, hands clasped tightly behind his back while the paramedics worked.
Lucy ran over and kissed John's cheek once the paramedics finished their assessment and strapped Marjorie onto the stretcher. "Thank you," she whispered.
"You're welcome," John smiled gently. "Go on," he nodded her back toward her mother.
John stretched his shoulders, rolling the earlier tension loose as he watched the paramedics leave, hoping that the bleed had been caught in time to prevent permanent damage. As much as the final diagnosis was never one he'd want to give to a patient, the thrill of the diagnostic process was still thrumming faintly through John's veins. From the moment he'd laid eyes on those warfarin-induced bruises, he'd known – it had only been a matter of finding the supporting data. Most people had no idea that John liked the puzzle, the intellectual side of medicine, just as much as the adrenaline rush of battlefield trauma care. He figured it was probably one of the reasons he got on so well with Sherlock, actually. Sherlock's brilliantly analytical mind and rapid-fire deductions appealed to John's intellectual side, just as the breathless alley chases and lingering threat of danger surrounding the detective's work satisfied his adrenaline addiction.
"So, you work it out yet?" John asked, acknowledging the fact that Sherlock had been staring at him, eyes moving rapidly as he processed data, and deciding that his flatmate had had enough time to look through him while solving the case.
Sherlock looked surprised for a moment before recovering his usual neutral mask. "Neglecting the significance of the bruising being over the median cubital and dorsal hand veins was an oversight," he swallowed with classic 'I'm annoyed I got something wrong' reluctance. "But I have yet to determine how warfarin-induced bruises can be distinguished from those regularly produced by phlebotomy."
John took a few seconds to process that. "Wait a minute, you….." he shook his head as it became clear. Of course, Sherlock had made Marjorie his case, and of course he was annoyed that he had been wrong about the stroke, that he had missed some detail that John had seen. But as much as he was annoyed at someone knowing something he didn't, Sherlock was also curious. He knew when he needed more information, from someone with more in-depth knowledge on a subject than he had, and his outward musing just now was his way of asking John to explain, so that he could learn and incorporate that knowledge into his own for future use. "Warfarin doesn't change how a bruise presents, Sherlock," John explained, keeping his tone matter-of-fact, just as Sherlock would want it. "I recognized it because it's my job. I see an elderly woman with a sudden decline and multiple bruises and I immediately think 'warfarin' and look for sources of internal bleeding. It's no different than you looking at dirt and determining that it's actually some sort of exotic tobacco ash because your job somehow involves knowledge of two hundred…."
"Oh, that's it!" Sherlock clapped his hands into a prayer position under his chin, eyes moving rapidly as everything fell together. "John, you are brilliant!"
"Cheers," John shrugged. "What's what then?" he sought clarification for whatever it was that he'd just helped Sherlock figure out.
"The nicotine stains around the murder victims' fingers – all from the same exceedingly rare tobacco. Clearly, the murderer supplied all three victims and the supply was tainted….."
John couldn't help but smile as Sherlock went off at full speed, walking briskly at his flatmate's side and listening to the brilliant resolution, side-stepping wild gesticulations as the case was solved to the sound of increasingly distant sirens.
Back at the flat later that night, exhausted after a long evening of trailing Sherlock through dozens of tobacconist shops, John settled down to find a new comment on his last blog entry: Surgery for subdural haematoma was successful. Doctors believe she'll make a full recovery. Thought you'd like to know. ~Lucy
John smiled at the news, closed his laptop, and went to bed before Sherlock could harass Lestrade for a new case.
The next morning, John returned to the sitting room after signing for a package to find Sherlock reading his blog. On his laptop. "You do know that typing the address for my blog into your laptop brings up the same page, right?" he sighed.
Sherlock made a 'don't be ridiculous' noise and kept reading.
John shook his head and sank into his chair to open the package. Inside was his freshly laundered coat, a packet of chocolate HobNobs, and a note.
Dear Doctor Watson,
I swear I'm not a stalker or anything, really. I forgot to ask for your mobile number, so I looked you up online, which is where I found your blog and this address. I just wanted to thank you for everything you did for me and my mum. I know it's not much, but I had your coat dry-cleaned, and the biscuits are mum's favourite – she's quite a believer in gratitude via sweets, so it seemed right. I'll keep you informed during her recovery. Thank you again, from the bottom of my heart. You truly saved her life.
Regards,
Lucy Warren
John smiled warmly as he got up and hung his coat by the door, pocketing the note along the way to be added to the small scrapbook he kept from patients, both civilian and military, that he'd treated in the past. He went into the kitchen and put the kettle on, then strode over to Sherlock, holding out the packet of biscuits.
Sherlock glanced up with a 'well, what do you want me to do with that?' look.
John's eyes flickered to the screen to see that Sherlock had reached the comments section of the entry that contained Lucy's update. "Shut up and take one," he ordered, waving the biscuits.
"I didn't say anything," Sherlock pointed out with a petulant huff.
"Not out loud you didn't," John retorted, with an 'I know your looks' tilt of the head. "They're one of your favorites and you still haven't eaten since solving that case last night. It's this or a proper breakfast," he threatened.
Sherlock rolled his eyes, but snatched three biscuits.
"Don't get crumbs on my keyboard," John warned, returning to the kitchen and munching on his own biscuit while laying out the mugs.
John knew that Sherlock had read Lucy's comment by the time he handed him his mug, because Sherlock not only took another two biscuits without prompting, but his eyes flashed through a split-second expression that stunned John in its significance and familiarity. He sank into his chair with his tea as Sherlock switched to answering comments on his own website, rolling his eyes at the general stupidity of the world as a whole.
But for that split-second, Sherlock had looked at John, not just with one of his pleased flashes of pride, but the same way John often looked at him: with open admiration.