Chapter 23 – At the hospital (2016)
This is a short chapter and a not thoroughly re-read one.
I had a rough few weeks and a lot of health problems since mid December and was unable to type and even to concentrate due to the meds I had to take. I'm slowly getting better now.
I am very sorry that you had to wait so long for an update. I hope to return to regular updates soon.
Thank you for all who have waited patiently and who are still with me.
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John walked up and down the rather large space of Sherlock's temporary room.
They were in the emergency department of the hospital were Sherlock had been treated just over a week ago. After Smith had tried to choke Sherlock, Mycroft arranged treatment in another – more trustworthy – facility.*
The initial assessment had been finished just a few seconds ago.
It had been a brief affair that included John handing over the already prepped blood samples and giving a short report.
They were now waiting for the consultant. Meanwhile, two nurses were working on Sherlock, getting rid of his inside out pyjamas and preparing him for the examination.
Anthea was somewhere off doing the paperwork and Mycroft was stoically sitting in a chair nearby, both his hands resting on his umbrella. His stiff posture and his blank face were an indication for the same tension John was trying to work off by walking.
Mycroft hadn't spoken much since they arrived but the discountenance about John's hesitation to cart Sherlock to a hospital seemed to have worn off.
It was barely three minutes later when a doctor arrived with two more members of staff in tow, he introduced himself as Mr Walsh.
John hurried to describe the events of the previous night in detail, pulled into the assessment routine out of habit.
Short precise words flew through the room while Walsh and a nurse did a thorough exam. They made sure there were no undiscovered easily visible problems.
They also tried to rouse Sherlock and did a coma scale assessment, which left them none the wiser.
Sherlock didn't reply to their presence, pain stimuli or any other try to make him react. He just lay there. Limb and oblivious to the world.
The male nurse scribbled down a lot of notes and they exchanged a lot of medical jargon with John - so much that Mycroft started to tap his foot impatiently.
Walsh ignored him, but one of the younger nurses noticed it and tried to explain while Walsh continued to examine his patient.
"Although you have surveillance footage, we can't rule out anything at this point. He's currently looking for signs of physical trauma – Mr Holmes could have fallen without anyone noticing, could have had a seizure, used drugs, or had a stroke," the nurse informed the older Holmes. John couldn't shake the feeling they knew each other.
"Suicide attempt," Mycroft added to the list in a resigned tone.
Walsh stopped his movements and looked up, his gaze meeting Mycroft's.
"That makes the entire thing a whole lot more complicated – and more urgent. You should have told us before," Walsh stated.
"Bloodwork is already in the lab," the nurse offered.
"Good," Walsh murmured while he continued to soundly check the inside of Sherlock's mouth for damage that might hint towards an earlier seizure.
"I was with him the past days; there was nothing that hints at suicidal thoughts. We made sure our living quarters were free of any dangerous substances. Overall, Sherlock was suffering severely due to the withdrawal but he was neither displaying severe depression nor self-harming behaviour that aimed at ending his suffering.
"He did self-harm in another way then?" Walsh asked, noticing John's reluctance.
"He sometimes overdoes it with self-stimulation – stimming. But that is nothing to worry about and should not be mistaken for intended self-harm," Mycroft explained and now John raised his eyebrows.
"Look, I opt for making sure it wasn't a suicide attempt, but think it is very unlikely," John explained, not aware why he felt the needed to, it was nonsense at this point, it needed to be checked.
"You are absolutely sure he did not eat or drink anything?"
"We are. But my PA can provide you with surveillance video if you want to check for yourself," Mycroft answered.
"If he did take something, Oral ingestion is unlikely," John agreed.
"Alright," Walsh nodded. "When did you start the intravenous fluids?" he then asked.
They meticulously catalogued the timeline of events and medications of the past days after that.
Only once Mycroft interrupted them, wanting to know if Sherlock's issues were dehydration related.
"His level of dehydration is severe, but not severe enough to cause seizures or a coma. Dr Watson reacted fast and gave intravenous fluids," Dr Walsh explained.
Ten minutes later Walsh sent one of the nurses off to check when the next free slots for a cranial MRI and a PET scan would be available.
"We need to find out if there is a physical problem, for example tissue damage in the brain. I'll be back as soon as we have results," Walsh addressed Mycroft on his way out.
A few seconds later more nurses entered and asked both John and Mycroft to wait outside.
As a doctor, John knew what would follow next and indicated to the older Holmes to do as they asked. They would put in more catheters and take urine samples and John was sure Sherlock didn't want his brother to be present for that.
John's initial nervousness about having discovered Sherlock's issues too late hadn't worn off, yet, but Sherlock was in good hands. Nevertheless, he had not revealed anything related to the mind palace to any medical professional treating Sherlock. Part of him was afraid Sherlock might be categorized too early as suffering from mental health issues.
John was well aware about the depression and the withdrawal induced psychological problems, but he would not allow under any circumstances that Sherlock was not properly examined with all they had before they focussed on that idea.
In the past, Sherlock had suffered enough from doctors who had not treated simple and easy to diagnose physical issues because they first jumped to 'it must be psychological' before even trying to find other reasons. It was a sad truth that this happened regularly to neuroatypical people and those with sensory perception issues.
While they were waiting outside, John shared these thoughts with Mycroft who agreed. He probably remembered the undiagnosed – and for days untreated - broken bones in Sherlock's childhood John had only read about.*
When they wheeled Sherlock out of the emergency bay, John followed them to radiology. The nurses and techs were already aware that loud noises might distress Sherlock and that as his doctor, John was to be allowed in in case it reached a level that would interrupt the scan.
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A bit over an hour later, they all were back in the room.
The scans had shown nothing out of order, which was a great relief for John.
The lab results were also there.
No drugs in Sherlock's system and most of the numbers were okay for the detective's current state. The ones that were off were already known.
The detective was still dehydrated and getting fluids, but overall nothing had shown up that would raise any red flags.
After going through all the results, more tests were ordered. Once more, John and Mycroft waited with an unconscious Sherlock for the next round of poking and prodding.
After it was clear that nothing life threatening was happening things slowed down.
Much to the older Holmes' annoyance, it took almost half an hour until an EEG tech arrived with a cart full of equipment.
That was when Mycroft finally lost his patience.
"I will be back in a few hours, call me if something happens," he stood up, slipped into his coat and was out of the door before John had time to say something.
Meanwhile, the technician prepared the EEG.
John sat down into the comfortable chair Mycroft had occupied earlier, somewhat relieved to be alone with Sherlock now. Mycroft's presence had made him uneasy.
He watched the tech measure Sherlock's skull and paint on the markings for the placement of the electrodes with a special red pen, moving Sherlock's head this way, then the other.
His friend's lack of reaction was starting to get to John at that point, because during the proceedings, his friend seemed completely limp and John had now time to actually watch.
Earlier, Sherlock had displayed a certain kind of muscle tension, but now he just seemed unconscious. Seeing the tech touch him while he was so vulnerable did something to John he couldn't name.
Then the electrodes where glued to Sherlock's skull with a thick white plaster like substance, that was when things started to change.
John observed Sherlock's right twitch now and then.
Additionally, Sherlock's blood pressure started to slowly climb during the procedure, as was his pulse. Not significantly but the stats stayed that way.
The tech – completely unaware of this – finished his work by wrapping Sherlock's head in gauze to keep the equipment and the bunch of wires in place.
A few minutes later, the lights were dimmed and a period of waiting started, in order to give the patient time to relax. After the time for that was up, Sherlock was subjected to various kinds of stimuli.
On one hand, John was glad to finally see a reaction, on the other it was so subtle he wondered if it really could even be considered as one.
Sherlock seemed to try to turn his head away repeatedly, but the movements were tiny. Additionally, the pain lines in his face deepened.
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Almost an hour later Walsh was called in to see the results – mid process. They agreed that there seemed to be no easy to spot seizure activity, but the recordings were confusing and could be interpreted in a number of ways, that was where things got complicated. Some aspects indicated sleep and dreaming, others increased activity as if Sherlock was awake. The only other thing that was clear was that Sherlock seemed to be in pain and distress. John could have told anyone that just by looking at his friend.
Two more specialists were called who made things even more complicated. In the end, they all agreed to continue the EEG through the night and postponed more tests that might be insightful to the next day.
After all except Walsh had left, John addressed the issue of Sherlock's food intake and they decided to administer parenteral nutrition to counteract the lack of food. This meant that after Walsh had left another nurse appeared and inserted another IV line, hooked the detective up to one more tube.
John was intimately familiar with all the proceedings, but it was something different to see a loved one in such a state.
That was when he finally decided to stay the night, Mycroft had offered it, mentioned that if he wanted to things were already arranged. So John called the babysitter and asked her to bring Rosie over to Mrs Hudson.
If Sherlock woke, he would certainly be not happy about his whereabouts.
If he returned to consciousness, slowly it could mean quite a bit of distress for all involved and John knew from experience that it was better for all involved if he handled things should it come to that.
It was almost 19:00 when John's boredom was interrupted by his phone buzzing. The caller ID said 'Mrs H'. He had briefly spoken with her earlier, while Sherlock was getting the PET scan, to tell her how things were going. That was when she had offered to babysit Rosie.
He picked up, not bothering to step outside. Even an annoyed reaction from Sherlock was welcome right now.
"John, you forgot Sherlock's phone. It's been ringing repeatedly since about four," the landlady greeted him.
"Any idea who it is? Someone we know?"
"How am I supposed to know? No name, just the number. I can read it to you," she offered.
"Yeah, please."
She did, and John scribbled it down into the small note pad he fumbled out of his jacket with one hand.
A few minutes later, he dialled the number and when a voice on the other end picked up, he was thoroughly confused.
"Hi John. What can I do for you?"
"Ella?"
"Yes?"
"Did you try to reach Sherlock?"
"Yes."
"Why?" John asked in confusion.
"I think that is between him and me. Is he there?"
"Uh, well... We are at the hospital. He is going through withdrawal and asleep currently. Thing is we have problems waking him," John slipped back into explaining things to her as he had done during their sessions. When he realised that, he bit his lip, understanding it was probably not the best course of action, he was not her patient any longer.
"So are you two on speaking terms again?" she asked bluntly.
An awkward silence followed. John's brain rattled with what the question implied. It meant Sherlock had had contact with Ella and she had been informed about John not speaking to his friend - and probably the background of the entire debacle.
"Yeah," John answered finally, insecure now.
"Are you there as his doctor or his friend?"
"Both. When did you and Sherlock last speak?"
"Three weeks ago," she provided and John felt a wave of relief wash over him. She didn't know about him beating Sherlock into a pulp. A second later, though he felt pathetic and shameful for this reaction.
"Is there anything you could tell me about his state of mind? Has he shown severe signs of depression lately?" John hurried to ask.
The idea that Sherlock had managed to do something to himself no one had discovered yet in order to commit suicide was bugging the doctor subconsciously.
What if Sherlock had used some little known and hard to (find) toxin on himself to make absolutely sure no one could revive him?
He had to remind himself that he knew this was rubbish. The EEG showed that Sherlock was in there and thinking. If he had decided to commit suicide, Sherlock would never be so stupid to take something that might not kill him but mentally impair him. As a chemist, he was more than capable to use something that would work fast and reliable.
If Sherlock wanted to kill himself they would be in the morgue right now.
When John noticed that the line had been quiet for several seconds, he asked her name to make sure she was still there.
Apparently, this time she was the one who hesitated.
"John, I am not sure you are the right person to discuss this with. What he told me is confidential and telling me on the phone that you're his doctor is not sufficient for me to reveal things."
John briefly thought about it.
At this point, they had to consider psychological issues. It would be one of the main topics the next day. If more of the tests for physical issues came back negative it would be the course of action to turn that way. Only a matter of time.
"Right. Talk to Dr Walsh then," John sighed and gave Ella the contact information.
When John rang off, the conversation left a very awkward aftertaste.
What had Sherlock discussed with Ella? What had he revealed?
Had he been so very desperate that he had turned to her?
The detective never seemed to particularly trust her, had only repeatedly uttered she got things wrong.
So why turn to her?
John sat there, in the semi dark, poring over the conversation while he watched his best friend lying unresponsive in the hospital bed.
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*This happened in my story 'Pain Management 2' in case anyone wants to read that.
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