I will be honest, this is a story that has been in my mind for so long. Over three years now. But I never had the guts to write it. I had always described it as a Grey's Anatomy or House MD, or Chicago Med type of thing when discussing with my friends. But to be honest, those shows are great. Each episode has a script thousands of words long and a team of highly skilled writers and doctors working towards making them the masterpiece that they are. FYI, I haven't watched any of the shows. Just the insta and youtube clips. And one episode here or there.
Meanwhile, I became a doctor just a couple years ago and am an amateur writer at best. Anything I create can never match up to that. That inferiority complex was tough to get past. But in the end, I love Carlisle, I love to write, and this story just wouldn't go away. So, here it is now!
Chapter 1: Edward
It was a bright and beautiful morning in the hospital and his batch of interns were miserable. To be more specific, one was tired after her overnight shift and the other two were hungover.
Dr. Carlisle Cullen conducted his morning rounds early and he expected the night, as well as the morning shift doctors present. Today, however, he did not start his rounds right away. Instead, he stared at his interns, hard.
"All three of you, step outside the ward with me please," he said, his voice clipped.
Perhaps it was the turn away from the norm, perhaps it was his tone, but the doctors under him stood up straighter and exchanged a nervous look before following him out of the ward.
He walked down the short corridor, turned a corner and pushed past the fire exit door, coming to a halt in the stairwell. The other three queued in behind him. Once again, he looked at them.
Dr. Fred Addams, Dr. Brett Freestone and Dr. Eva Paisley.
They were talented young doctors, Carlisle had to admit that to himself. And each one had a promising future in the field. But they also had the singular talent of finding his last nerve and tap dancing all over it.
This was one such moment.
"You two," he snapped at the two young men, "stand here. Dr. Paisley, perform the Nystagmus test on your colleagues."
Carlisle saw Fred and Brett exchange a panicked look before taking a deep breath. The mousy, young woman looked at her senior, and then at her colleagues and swallowed as she stepped up to do what she was told.
"Sit," she hissed at Fred quietly. The man, at least a head taller than her, was quick to follow her instructions.
Carlisle watched them like a hawk when Eva instructed Fred to follow her pen with his eyes. Left-right, up-down, and diagonally, Fred's eyes followed the pen without any abnormality or loss of focus.
She repeated the test with her other colleague and Brett's eyes were able to follow the object without any issue either.
"Romberg test," Carlisle ordered next and the two men stood, heels together, head straight, arms out and eyes closed. There was only minimal swaying.
"Finger to nose," he said and both dutifully placed their index finger on the nose.
He continued with a couple of other tests before he waved a hand and the three PGs stood back.
Carlisle took a steadying breath, ignoring what was to him, a pretty strong scent of alcohol. He knew it would be barely perceptible to a human. And the two young doctors had indeed passed all the field sobriety tests.
Being drunk on duty might be a crime, but being hungover was still grossly irresponsible and this was a habit that needed to be nipped in the bud.
He allowed his face to harden, letting some of his more…inhuman subtleties show through. Humans had an instinctual fear of their kind. It had taken him years of trial and error to set his face and body just right to convey trust and empathy and care through his posture. But the predator lay just within, and in moments like these, he allowed his pupils to catch a passing glimpse of it.
Three hearts simultaneously picked up their pace.
"I do not care to know what you all do in your off hours," Carlisle said, his voice grazing on the edge of being a growl, his eyes narrowed. "But if I get so much as a whiff of alcohol on you while you are in the hospital again, I will report you. This is the first time and you both are hungover, not drunk. That is why I am letting this go. But I promise you, the second time you enter the hospital in any degree of inebriation for duty, will be the last time you enter the hospital as a doctor."
To their credit, Fred and Brett's faces had as much shame as they held terror.
"Neither of you will administer any medications, alter any dose, start or stop any drug today without first checking in with me. You will not do any procedure today. You will not so much as look in the direction of the OT complex. You will not even breathe near a patient without my supervision until the end of your shift. Am I clear?"
Carlisle's glare was dark. Rare, but effective. Three sweating heads nodded at him.
He then turned to the woman fidgeting beside her colleagues. "Dr. Paisley, I understand you wish to go on leave for a few days at the end of the week. But you will no longer be doing your co-workers' night shifts consecutively. Spread out the shift exchanges so that you get proper rest in between and do some duties after you come back. Being sleep deprived is as bad as being drunk, and not a valid legal defense if something happens to your patients because of your irresponsibility."
Eva nodded just as fervently and with a satisfied sigh, Carlisle bade them all to follow him back to the ward.
The nurses were curious, he could tell that when he started the rounds. But they held their tongue, instinctively wary of him and Carlisle did not elaborate. They went to each of the eleven patients under him one by one. The three PGs took turns presenting the cases, including the history, new test reports, any fresh complaints, ongoing medications, etc. It took a while. And he did not necessarily need to have them present the entire case every morning. Just the new reports or fresh symptoms would have been enough. But he wanted them to have the practice. By the time they left his unit, he wanted history taking and case presentation to be second nature to them. So he made them do it, every single morning.
Only when he saw the nervous fidgeting of his newest, and youngest, patient did he allow his face and body to relax, to soften up and convey a little warmth.
"How's the vomiting now?" he asked the young man sitting up in the bed.
"Better," he replied. "But my throat is still sore. And I feel dizzy every time I get off the bed."
"Don't worry," Carlisle promised him with a smile. "We will make sure you feel better as soon as is possible."
He then turned to the patient's mother. The woman was pale, with exhausted circles under her eyes. Her lips looked parched and her hands trembled as she stood beside her son.
"You look exhausted ma'am," he stated the obvious. "When was the last time you had something to eat, or got some sleep?"
The older woman smiled but it did not reach her eyes. "I am fine, Dr. Cullen…but Derek here has been in the hospital for four days now and he still isn't getting any better."
Carlisle dipped his head and smiled at her. "I understand ma'am. I will look at Derek's case myself and make sure he gets better. Meanwhile," his eyes scanned around at the bunch of people following him until he saw a housekeeping staff. "Ashley, here, will accompany you to the canteen. Ashley, dear, please take ma'am down to the cafeteria and buy her something to eat. Tell them to put it on my account."
He waved away the protest just as it was starting and her son piped in too.
"Mom, go, please. I'll be fine," the teenager implored his mother and Carlisle watched her give a reluctant nod before she was guided away by Ashley.
After a quick scan at his vitals, Carlisle stepped away from the patient. His PGs and nurses followed him. It was Brett's turn to summarize the case.
"17 years old male, came to the hospital with complaints of sore throat, headache, weakness, dizziness and seven episodes of vomiting. He was admitted under Unit 2 and was there for four days until yesterday evening when his mother requested a transfer to your unit. He was earlier ordered a culture and sensitivity test of throat swab. It showed an E. Coli infection. I changed his antibiotics to a stronger one yest-"
Brett stopped abruptly when Carlisle frowned. "What exactly was he being treated for?"
"Upper Respiratory Tract Infection, sir," Brett answered. "It's going around actually. Seasonal flu. The walk-in clinics are full of them."
"URTI would not explain the vomiting," Carlisle shook his head. They were missing something.
"Actually…" Brett hesitated and Carlisle raised an eyebrow.
"He had been drinking the night before," Brett admitted sheepishly. "He had requested that it not be written down, given that…well…he's underage. That is why he was vomiting."
"Because he was hungover?" Carlisle gave him a pointed look and Brett had the good grace to look chastised.
"Yeah," he admitted.
Carlisle looked through his charts again. His vitals and history. Something caught his eye. "This is not his first such complaint? He has been having this issue for the past two years? Vomiting and dizziness?"
"Every time he was drunk or hungover," Eva spoke, equally contrite. "He has been raiding his parent's cabinet for a couple of years now."
"And of course, this was not written down," Carlisle sighed.
"He didn't tell this to the Unit 2 team. He told us last evening when he saw his mother getting worried, just in case it was relevant," Fred piped up. "But his throat swab culture report came. Turns out it was just an infection."
Carlisle looked around at the people surrounding him, a look of simple satisfaction on their faces and he sighed. Derek was the last patient in the ward he had to see. That meant he had half an hour of break before he would go sit in the walk-in clinic.
"When are the stronger antibiotics due to start?" he asked the nurse looking after Derek.
"Today, after breakfast," she replied. "The last antibiotic course still has two doses left though."
"Hold off the new one. Continue with the old, and complete its course."
"But…" Brett's protest was silenced with a single look from Carlisle.
"You three, come with me," he said, taking Derek's file with him. As much as he knew the nurse wanted to protest the file being taken out of the ward, they held their tongue and Carlisle easily walked down to the cafeteria with the three doctors following him. Seniority had its perks and Carlisle wasn't one to refrain from exploiting it.
The cafeteria was small, and this early in the morning, it was just getting restocked with the food. Only a few people sat around, first shift staff nursing their coffees before the morning rounds rush and a couple of sleep-deprived night shift staff grabbing a quick meal before heading out home. In one corner he could see Ashley sitting with Derek's mother.
He found a seat on the opposite corner of the cafeteria and once Fred, Brett, and Eva were seated, he placed Derek's file before them.
"There is a mistake we are making in Derek's case," he told them. "I am going to go order some breakfast for you three. By the time I come back, I want you all to figure out what it is and how we are going to rectify it."
With that, he left the three squabbling over the file and proceeded to the counter. The options were truly limited and Carlisle had an even tougher time than usual imagining any of the stale sandwiches as something appetizing.
But he had observed his trainees enough to know what they usually preferred.
"Three lemonades and three chicken sandwiches please." He smiled at the cashier who quickly entered the order with a knowing look over his shoulder.
"And…uh…one espresso," he hastily added. He needed to have something in front of him when he rejoined them.
He sat down at a table close to the collection counter and waited patiently while his order was prepared.
In their small corner, Brett, Fred and Eva were furiously hissing at each other, raising and cutting off the possible errors in the treatment.
"I started him on 3rd generation cephalosporins," Brett ground out. "That is effective in an E. Coli infection. I did not make an error there."
"Maybe it's resistant?" Eva suggested. In the verbal pause they flipped through the pages in the file till they found the sensitivity report. "Nah, it's sensitive."
"See," Brett slapped the table, "I told you I was right."
"I don't know where you are wrong, but that prescription was definitely wrong," Fred shook his head at his colleague.
"How are you so sure about that?" Brett bit back but it was Eva who answered.
"Because Dr. Cullen overruled and had it stopped. Now, can we try to spot where the error is instead of trying to prove there isn't one? He'll be back soon, and I honestly do not like the way he looked today."
From the corner of his eyes, Carlisle saw Fred shudder, almost imperceptibly, with silent agreement in the other two sets of eyes. They resumed their banter but Carlisle knew it would be to no avail. Their order was here and they were nowhere close to finding where they had gone wrong. He collected the tray, easily holding it in a single hand, and strode back towards the group pouring over the file.
They pulled their heads back and sat up straight once he took the fourth seat at their table and placed the tray in between them.
"I know you all prefer coffee at this time, but I will advise against it," he said, passing out the drinks and sandwiches to all three.
Fred took a sip of his drink but otherwise the eatables remained untouched, all three looking at him expectantly.
He mirrored their expression, waiting in turn for them to start talking. After a briefly exchanged glance, it was Brett who spoke up.
"I don't think there is anything wrong, Dr. Cullen. He has an E. Coli infection and we gave him antibiotics that work on it. We are also giving him medicines for his other symptoms…anti-emetics for vomiting, fluid for dehydration…all of it."
"E. Coli infection…" Carlisle mused, hoping they would get the hint. Fred and Eva frowned in concentration.
Brett…missed it entirely. Instead, he started furiously flipping through the pages. "Yeah, it's in the Culture and Sensitivity report and I gave him an antibiotic- "
"I have seen the report, Dr. Freestone," Carlisle cut him off. "And I am telling you he does not need that antibiotic. What I want you to tell me is why? Why did I ask the nurse to not start the medications that you prescribed?"
Doesn't need the antibiotics…Eva muttered to herself in thought while Brett only ground his teeth silently, glaring at the file before him.
"He doesn't need antibiotics because he doesn't have a bacterial infection? Maybe he has viral?" Fred squeaked out.
Before Carlisle could say anything, Brett snapped. "The reports say…"
Closing his eyes, Carlisle took in a deep breath. The scents of the hospital assailed him but the onslaught also distracted him enough to keep him from rebuking the young doctor before him. One tongue lashing a day was enough for him.
He held up his hand and Brett stopped speaking.
"Dr. Freestone," Carlisle looked only at him, willing him to understand. "Culture and Sensitivity is a very reliable test for detecting the presence of microorganisms, I concede to that. It, however, isn't a one-and-done diagnosis for a patient. Only a single step of many. And the first step of coming to a correct diagnosis is not any lab results. It is your skill as a clinician. Your ability to listen, observe and conclude."
He turned so that he could look at the other two present before him too.
"Derek has been on antibiotics for four days without any relief in his symptoms. I am telling you it is because he does not need antibiotics. Nor is his symptoms a classical presentation of viral infection, I'm afraid Dr. Adams. Young Derek does not have an infection at all. But, as Dr. Freestone has reminded us again and again, his culture reports says he has E. Coli in his throat. So, let us sort that out. Eva, what is a commensal?"
"Umm, a microorganism that is in the body naturally but doesn't cause an infection in a normal person?"
Carlisle nodded encouragingly at her response. "Excellent! Brett, tell me is E. Coli a commensal of throat?"
Brett shook his head and Carlisle gave him a brilliant smile too. "Fred, is E. Coli a commensal of stomach or intestine?"
Fred nodded and Carlisle shot the next question at all three. "Then tell me, how is a bacteria that is normally found in the stomach and intestine appear in a throat swab culture?"
Carlisle waited through a few mumbled umms and uhhs before he decided to give them another hint. "What is Derek's most consistent complaint after dizziness?"
"Nausea and Vomiting," Brett answered. "He has been throwing up despite extensive antiemetics that we have given him."
"Exactly!" Carlisle crowed at the three. "He has been vomiting. And every time he throws up…"
"His GI commensal would end up in his throat and mouth!" Fred finished his sentence for him, and three pairs of eyes lit up with realization.
Carlisle sat back in his chair and watched the three young doctors start to unravel the mystery of Derek's reports and symptoms.
Eva was the one to realize that Derek' sore throat wasn't due to any flu. Rather it was mucosal injury from throwing up so harshly. Fred wondered aloud about the vomiting happening due to excessive drinking the night before his admission but Brett corrected him with a snarky reminder that unless the young lad had been sneaking out of the hospital to join them in their late night drinking shenanigans, his vomiting shouldn't persist through four days of hospitalization. Brett suggested running some tests for stomach flu but Fred in turn countered with the fact that Derek had no other major symptom of that either.
After a thoroughly entertaining five minutes of bickering, the three once again turned to him.
"What do we do next?" Brett begrudgingly asked, with Eva and Fred looking back at him expectantly.
"You," Carlisle smiled and pointed at Brett, "will go back to the ward and get a nurse to give Derek 16mg of Betahistine to treat his symptoms."
"You," he next stared at Fred, "will personally call an ENT consult to have him evaluated for Meniere's disease. And you, Eva, will go home and get a full eight hours of sleep."
Carlisle waited only long enough to oversee Brett writing the new prescription on the file before he picked up his now-cold espresso and stood up.
"All of you, scram now," he said with an affectionate glare. "I promised a mother that I will make sure her son gets better. I want him symptom-free by the time I come out of the clinic for my lunch break."
He did not wait to see the three of them start the multi-task of cramming their sandwiches into their faces while running off to their respective assigned work. Instead, he tossed his untouched espresso into the dustbin and walked to the clinic.
Taking in a deep breath, he looked at the uncomfortable benches on either side of the corridor full of people coughing and sniffing and wheezing and groaning.
It was time for his annual date with the disease that killed his son. It was influenza season once again.
A/N:
I hope you enjoyed the chapter. This is just an introductory one, to set the characters and setting. A big hospital in a big city would have specialist doctors who would work only in their respective field. A smaller hospital in a small town will be more lax with doctors working across different departments and sending a consult only when a specialist care is required. This is the latter kind of hospital.
Shout out to my beta, Allison, who helped turn my ramblings into a proper story!
Do let me know what you think!
-ZQ