A/N: I describe surgery in this chapter. If you are squeamish, give the last half of this chapter a pass.
The Royal Marsden, Fulham Rd. They won't start the procedure until I have someone to make sure I get home.
John's plan to just wander homewards in cab is ruined by the dragon-lady wearing scrubs. He glares, carefully to prevent her seeing it, out of the corner of his eye at the nurse that made him send that text and is almost glad that she'll find Sherlock heinously annoying. Almost glad because he is a doctor and knows how badly a nurse can fuck a recalcitrant patient over.
Now, he's nervous.
Be nice to the nurses when you get here. Keep your deductions to yourself.
He's pretty sure that won't work, but it was worth the try.
What procedure? –SH
You're at a cancer clinic. I'll be there.–SH
There is nothing for it. This will not go well. So John does what he has always done. He walks into the situation with his eyes wide open and his head held high.
"Can I get dressed for the operation? I've got someone coming to fetch me home."
Even as her face never relaxes its frown, John has the notion that the fierce lizard masquerading as a nurse approves. However, he does acknowledge that the fact that she's allowed him to keep his trousers on could be influencing his feelings on the subject.
Sherlock is there before John can even get his kit off. He's still standing in his vest folding his shirt when Sherlock bursts into the room. He just sighs, finishes off with his shirt and says, "What did I say about reasonable boundaries?"
"That they exist and I should respect yours." John can see Sherlock inspecting the track marks and bruises from blown veins on the inside of his elbows from all the blood and nonsense that they've pumped in and out of him in the last month. Those grey eyes also linger on the badly faded RAMC insignia tattoo inked high on the inside of his left forearm.
"We of the RAMC aren't, by regulation, allowed to carry regimental honours, so some of the fellows and I got our own after we got back from Kosovo. And how is this respecting my boundaries?"
"Hmm. Clearly you were drunk at the time and chose an inferior artist. I use the term artist in its loosest sense. You asked me to come."
"Yes, well, young and dumb." John lets go of a tight puff of air and braces himself. His vest has to come off and there is only one way he can do it these days. "I did not ask you to stand in the room while I undress." He grips the back of the neck of it with his right arm, pulls upwards and over his head and finally down his useless left arm.
He's not going to fold the damned thing. It will just have to tolerate being tossed on the pile of his other things. Actually, he doesn't know why he's so self-conscious about unable to remove his clothes like other men; he knows that Sherlock has to have noticed that he has a severely reduced range of motion in his left arm. Now Sherlock has an unobstructed view of the scar left behind by the bullet that took with it a part of his scapula and his entire military career.
"You were in the Army and before that you had PE showers in school."
"Doesn't mean I enjoy being gawked at." Sherlock hasn't contented himself with just the front of the scar; he's circling John.
He stops to catch John's eye. "You're offended."
John slides his gaze away. "Not offended, I'm terrified." What? No. This cannot actually be coming out of his mouth. There was some other word that would have worked just fine; a word that would have been far less vulnerable.
His shoes, they have to come off. "I'm becoming useless. I am useless." He hasn't even been given anything yet. Not even a valium for the nerves. That is supposed to come as a part of his sedation and they haven't started that yet. He doesn't even have a line in.
Socks, too, have to go. What if they need a distal pulse? Not likely today, but it never hurts to be prepared. "I became a doctor and a soldier so I could be anything but that and, now; my scar feels more like an omen of that every day." With that remark and the resolution to just stop bloody talking, John tosses his shoes with the socks tucked inside under the chair with his clothes and runs his fingertips over the white edges of the lividly purple-centred scar.
Suddenly, he's got a mouth full of cashmere scarf and wool coat scratching across his shoulders, arms and back. Sherlock has his arms trapped down and he can't take a breath that isn't swamped in the scent of Sherlock's soap and scarf fibres. It's disorienting until he realizes that Sherlock is, apparently, the worst hugger in the world. He tamps down laughter as he pushes out of the most awkward embrace of his life, including the one in third form with Hannah Higgenbotham, because he is not going to explain to his best friend and flatmate why his hugs are inherently hilarious.
"What was that about?"
"I was trying to comfort you if you hadn't been so ridiculous and prevented me. I knew you wouldn't believe me if I said you weren't useless, so I resorted to the sorts of tactics that are employed by emotional people like you." Sherlock says with an insulted air.
John has to laugh at that. Well, giggle, really. "I think I would feel better about that if I didn't feel that 'emotional people' is some sort of slur coming out of your mouth." John waves off whatever Sherlock is about to say. "Oh, no, don't tell me what you really think. Just call the nurse back in. We can finish this conversation later, but I have to get this done today."
With a dramatic sweep of his posh coat and the door, Sherlock barks at the nurse to re-enter and then turns to John to say, "When will we finish this conversation? I want to be prepared for your logic errors, because you are clearly useful."
"A back-handed compliment. Again. You really should learn how to say truly nice things to people."
Sherlock sniffs. "I just speak the truth. Oh, and what are you having done today?"
"How nice of you to ask. Oh, it's just a port-cath insertion." John flourishes the insides of his arms back into Sherlock's view. "Chemo's hell on the veins."
"I noticed. I've seen coke addicts with far fewer marks." John tries not to cringe about what that could possibly mean coming out of Sherlock's mouth; that's something that they've never talked about and John is not sure he even wants to know.
"Dr Watson," says the nurse, voice prim, but carefully neutral, "I need you up on the table, so I can set your IV line."
"Oh, yes, yes, of course." John pushes himself up on the table and stretches back on it like someone well accustomed to it as Sherlock begins to pace. "Which arm do you want?" He twists his body to allow her to tap the veins with a practised finger. She chooses the un-bruised vein on the back of his left hand; the rest of them are passed over as ruined. Her voice is reassuring as she tells John when and where she's about to touch him, but he ignores it. He knows the routine anyway.
Once the vein is chosen and the tourniquet is tied, setting the IV is the work of seconds. John murmurs a small sound of appreciation to the nurse. He's had quite enough of being a practice pin cushion lately, thank you very much. The line is clamped shut and taped down in a loop; it's too early for fluids, but not too early for baselines.
The gentle clip that measures O2 saturation glows the tip of his right fore-finger red as it takes the initial measurements. Cold, soft fingers take his pulse, 50 beats per minute, and his respirations, 16 breaths per minute. The brief squeeze and wheeze of the cuff around his bicep gives the nurse his blood pressure as 119/76. He's disgustingly healthy.
"Sherlock, you know they'll not let you in the OR with me, right? You'll have to head to the waiting room."
The look of surprise on Sherlock's face is almost comical. "Why-ever did you call me down here, then? I had slides. Besides, I need to know all about that port-cath they're inserting."
"To take me home. Not my idea, by the way. They didn't think I would be capable of making it or calling for you afterwards when I was hopped up on an opioid."
"I was at Bart's with slides of selenium poisoned liver. You know how rare that is."
"The surgeon has prescribed 0.5 mg/L Midazolam in 5% dextrose for the operation," the nurse inserts helpfully.
"Well, then, high on a benzodiazepine and don't tell me you were at Bart's. I may not have your exhaustive map of London in my head, but even I know that you came from home."
"Have you learned my methods so well that you can now do it for yourself?"
"Didn't need to. I made the trip this morning and I've been to Bart's a few times."
"I should really see its placement. I'll need to know about it."
"We'll get instructions for its care later. You can handle sitting in a waiting room for 30 minutes. Think of all the people you can deduce."
"What I do isn't a game. I don't do it for fun."
"Well, while you're not having any fun, keep your deductions to yourself. Now off you go."
Sherlock doesn't go. The surgeon walks in before he can flounce out, so he sulks in the corner of the room while Dr Forsythe just tells John the same things he'd said earlier in the week during their surgery consultation. Instead of actually listening, John lets his mind wander and wonders how close Sherlock came to deducing the 12 and a half years of surgery this man has done and if he's discovered where he originally trained. He'll have to ask afterwards because Sherlock is bound to have discovered something amusing that he missed. Suddenly, the surgeon is done talking and John hears out of his own mouth, "Ready as I'll ever be. Let's get this done," and he's being wheeled into the OR and Sherlock is being shut out.
The OR smells mostly familiar; it's almost too clean though. He takes that as a sign that he's worked for far too long in field hospitals where they can barely manage to keep the filth out. Part of him still misses those temporary structures, but, thankfully these days it's only when he's not chasing after Sherlock and his 'clever members of the criminal classes'. The tedious days of doing locum work are another story.
The nurse who hooks up his IV catheter to his drip is quick, but the midazolam is even faster. He can feel his anxiety about Sherlock's waiting room behaviour begin to slip from him. Granted, the medication is really supposed to make him amnesic and relaxed about the procedure, but he'll take what he can get.
Once his surgical isolation paper is taped down and they deem him properly sedated, John turns his head towards the screens to his left. He thinks he'll never get used to this side of surgery, despite the reconstructive surgeries he had on his shoulder the first few months back from Afghanistan, but he still likes to watch. One screen, the upper, is currently off, but John figures that just means it's for the fluoroscope used to set the catheter tube from the port to his vena cava.
The bottom one is the one he's interested in and is clearly of his iodined and shaved chest prepared for surgery. John's port-cath and Dr Forsythe's skills are being recorded so they can be part of a training video for the hospital. He signed the release last week, but he'll never tell anyone that he jumped on the chance to still feel like a part of medicine.
On the screen, John sees hands making two incision marks. One is short and just under his clavicle and the long one is 2 ½ inches lower on the pectoral muscle. The marker tickles as the hands mark around the device to delineate the pouch that should hold the port-cath chambers. He doesn't giggle as the meds make him feel like he can't be arsed to.
The lidocaine injections along the incision lines burn cold. The scalpel just feels like that same odd sensation of pressure as when John runs his hand over his lips when he's drunk. That thought almost makes him giggle.
Once the scalpel is through the layers of skin, the surgeon uses his latexed index finger to open up the area between the muscle and skin where the port-cath will reside. That pressure is different and John knows it'll be sore tomorrow, even if it doesn't hurt now.
The fluoroscope screen comes on; it's a confusing jumble of images then suddenly it's of the smaller incision mark on his chest. Sure hands and a scalpel open it up and the fluoroscope lens goes in. John and his surgeon can see some of what John is made of as it passes to the catheter's final destination. It's reassuring to see that he's still made of muscle and blood and connective tissue; lately, he's been half convinced he's made of broken plans bound together with disappointment.
Once the catheter is inserted into his vena cava, the surgeon pulls the supporting tubing that kept the catheter stiff enough for the operation back out, but leaving it on the exposed portion that will transverse across his chest under the skin to the port. That extra bit of tubing is swiftly inserted between the tiny incision and the port incision and it's a snap for the surgeon to trim the catheter and attach it permanently into the opening in the port.
It's time for Dr Forsythe to close John up. A butterfly closure holds the small incision. The port incision is a bit more work. The surgeon works the port into the pouch he made for it and sets the device in place with a few stitches of Prolene. Nylon sutures at precisely 1 cm apart close the incision and John is impressed by the exact evenness, at least, until he remembers that he was used to surface suturing in a combat zone.
It's a quick trip to Radiation to confirm with an x-ray that the catheter is correctly placed and then John is in Recovery with a pinch-faced Sherlock standing over him.
"What trouble did you cause?"
Sherlock's face shifts into something rather irritated and he says, "I caused no trouble. I never do."
John can't even begin to think of a safe way to comment on that, so he just raises his eyebrows in exasperation and disbelief. "Hand me my clothes. I want to go home as soon as we're done with paperwork and instructions."
Sherlock stands too close as he hands John's clothes over and John feels even more exposed than usual. That damn scar and the new marks on his chest need to be covered, but there is no way that John can get his vest over his head at the moment, so he's left to pull on his shirt without it. The button placket against his skin feels strange after years of wearing a vest under his PCS CU jacket, but the ugly truth is: this will be how he'll have to dress until this is all over.
Damn cancer. Damn chemo and damn this port.