Rating: G

Author's note: Don't pretend to have ever done anything slightly medical in my life, so if I have stuffed this up I apologize. P.S please review.

Disclaimer: I do not take credit for any of the characters in this work associated with the show created by Joss Wheldon, and am not making any money from them. Summary: A medical lecture about our favorite boy.

There are certain things you will see as a doctor. There are people you will meet throughout your careers and many of them will live and some are certain to die. It is the way we learn to deal with this death that helps to make us good doctors. The compassion and empathy you develop whilst still remaining clinically detached is a hard practice to learn. It takes many, many years to acquire. Even then some patients are harder to remain distanced from then others.

The example I use today is that of Alexander Harris. Alex was twenty-one when he died and had been my patient for five years. As you are still pre- med I will not bore you with long-winded medical procedures and names, rather I would just like to tell you a story.

Alexander or Xander's death affected me more then that of any other patient I have ever treated. As soon as I saw Xander the last time I knew the young man would die. The wound he presented with was more severe than that which could be mended. I knew the second I peeled back the blood soaked rag covering Xander's neck that it was over for this bubbly vibrant young man.

I've worked in the emergency room at Sunnydale General for more than thirty years and in that time we've had the highest mortality rate of any hospital in California. The town of Sunnydale is extremely adapt at death and carnage.

I first treated this boy, as I still think of him, when he was sixteen or so. I remembered him not because of the frequency of which he came into the hospital. But because of his positive nature and the way he supported and stood guard at the bedside of his friends. Who I also saw on a frequent basis at my hospital. The frequency of his visits at first disturbed me and I originally suspected some form of abuse but I came to later understand he was in a gang. Sunnydale with her inept police force was a haven for street gangs. I had however never suspected Xander to be a member of one of these callous groups. His medical history however certainly supported his involvement in a gang. I'd set numerous broken arms and stitched countless cuts and at the end of most of Xander's treatment he would ignore my call of bed rest and disappear back into the night. Only to reappear some times as soon as the next day with a fresh wound.

The end though, the last time Alex would walk wounded into my ER was the only time he'd been carried. I'd seen him run, limp and been dragged through the doors and the minute I recognized him slung over the shoulder of another young man, I knew it would have to be bad and it was.

I rushed forward immediately, abandoning another patient I had been examining I could see blood from a wound on Alex's neck dripping onto the floor. I tried to gage how much congealing blood was on Alex's clothing and that of his rescuer and factoring in blood loss at a scene elsewhere I theorized that perhaps up to three liters had been lost. This did not include the blood that was sure to lie on various floors and car seats.

After overcoming a moment of panic we carried Xander into an examination room and fixed two large bore IV's and ran saline and blood through these and seeing the condition of his airway we inserted a chest tube to help with respiration.

The young man he was with, looked at me untrusting as I asked what had happened and commanded only that I should '' fix him. '' Then he moved off in the direction of the phones his shoulder and back stained forever red with blood.

Xander had looked up at me his eyes wide with pain, yet there was no fear and he actually smiled as he recognized me and mouthed a greeting. I smiled right back and held his gaze for a moment before yelling orders frantically at the staff around me. I liked this boy, though I knew I couldn't, I wanted to save him.

I didn't know anything about Alex actually. I knew his name, his height, and blood group. I knew vaguely the first names of his friends. But in five years I had never seen his parents or any of his family. My original questions into his home life had been met with silence and I had never asked again. The man he was with had returned and stood behind me silently in the corner of the room.

" Giles is coming, hang on. " I knew this Giles the first few years I thought that he was my patients Father. Now I know that why he may not hold the title legally or biologically he is regarded as the Man who leads this boy, comforts him and cares for him.

I ordered yet another bag to be attached to the IV and thought that if I couldn't save him I would at least prolong death until Alex could say goodbye to Giles.

There were possibilities running though my head on how to treat the boy. I realized there was simply too much damage. Alex's trachea had almost been severed and we had inserted a chest tube so that he could breathe. His only saving was that it was the Jugular, which had sustained the least damage, thus still allowing oxygen to travel to his brain. The interior and exterior Carotid artery were completely severed and his blood pressure was dropping as he bled into his body and over my hands pressed against his wounds and the table.

As I examined him further it appeared someone had tried and very nearly succeed in taking his head off with an axe. The gash split across the whole front of his neck and in reality the only thing still attaching his head to his shoulders was his spine, his spinal cord and a section of untouched skin about six inches across the back and around the left side of Alex's neck.

My instinct was to rush this man to surgery and attempt to carefully reattach his windpipe. To try and patch his esophagus back together but my heart knew he would probably die anyway. The edges of the wound were ragged and I could see traces of foreign matter buried within the torn skin. On the off chance, the millionth chance that this man survived a surgery that would last hours. Alex would certainly die when infection ravaged his weakened system.

Then what, Alex's voice box had been obliterated. His tongue cruelly destroyed. I knew I had to let this one go, to make a choice, and I know that this is what he would have wanted. Some of you may criticize me for not having had a go at saving Alex but I implore you to understand that the damage done to my favorite patient was simply too severe to be fixed.

Finally after what seemed like hours, Giles burst through the emergency room door and followed the blood trail to where the young man lay. Giles instantly recognized the fatal wound and his features fell. He moved me aside gently and placed his own hands on the gauze over the wound and blood now seeped through onto his hands and dripped against the leg of his trousers.

This strong man I had seen so frequently in my ER. Who had never looked overly concerned, leaned forward ignoring the blood around him and he rested his elbows on the young man's chest. Then Giles whispered so softly a conversation into Alex's ear that I never heard a word. I stepped back knowing he would speak to the boy until the end and I moved slowly across the room. After several minutes of watching the man and his boy I stepped forward and explained that I would turn of the ventilation pump. The pump allowing Xander to breathe. The pump keeping Xander alive. Giles nodded slightly as I programmed the machine to stop and I leant across the bed my self and whispered my own goodbye.

I thanked Alex for those days where just seeing his bright face had cheered me up. I thanked him for the time he rescued me from a mugger in the parking lot. And I assured him that he would be going to a beautiful place and that he needn't be afraid.

After I moved to the back of the room. Nearly crashing into the man still standing silently behind. The man moved forward and said his own sad goodbye and leant against the wall behind me. Giles held Alex while his breathing became more and more forced and ragged. Xander slowly swam through consciousness until finally his chest stopped rising and falling and his own hand went limp where it was clasp with that of the older gentlemen and the silent heart monitor drew across it's digital screen a long flat line.

Never again would this man walk lightly through my doors and present me with a cut or a gash or a broken limb with a smile through his pain. No longer would he stand guard at the doorways to his friend's room as they recovered from unknown battles. No longer would he seek me out whenever he entered the hospital just to say hello, or thank you.

Never again would I see his smile or his joyous eyes. I felt the most amazing empathy for his friends for if I could miss this man so dreadfully after only ever knowing him for a few minutes at a time at random intervals then there lives would truly have been blessed to know him consistently and there lives would now be filled with pain.

The man behind me summed up my feelings perfectly. Simply he turned and drove his hand through the glass door to the room we stood in. Then he swept a tray of instruments to the floor. Then he turned and walked away leaving Giles alone sitting still holding on to the bloodied hand of the young man. As the tears washed down Giles' cheeks and my own I realized why my lecturers did as I do now, tell you over and over.

Do not become emotionally attached to your patients. Though even in saying this I will tell you. If given the chance to go back and treat Alexander Harris again. I would, you couldn't help to get emotionally attached to Xander. He sucked you in with his extraordinary personality.

You too will meet extraordinary people when you go out into your various internships and move on to clinical experience. For some of your Alexander Harris's they will only ever meet you once in a professional capacity. But for those that continually return their stories may end happily with a full recovery. Mine however ended with the scene of a young man, lying blood covered in a trauma room and an old man that sat beside him blood soaked hand in blood soaked hand, speaking softly and wisely and retelling the story of a friendship. An image that I will no more forget then breathing.

As for Alex's band or gang of friends. I saw them just as often over the years until slowly but steadily they disappeared. One ended up on my table where she too succumbed to her severe injuries. She never looked frightened by what was to come though. Only excited about the prospect of meeting an old friend.

They once told me Giles moved back home to England and before I came here to tell you this I looked him up. My memory of that incident in the trauma room sparking an intense curiosity.

Giles is now fifty-seven. He is married and has a nine-year-old son called Alex. When I spoke to him on the phone he agreed that Xander was the type of person you never forget and after all these years he thanked me again for allowing him to have the time to say goodbye.

As I listened to this gentleman talk of my patient, as if he had only last seen him yesterday. I realized that while the good in becoming a doctor is the ability to help people survive the tragedy and misfortune in their lives. It is also to allow those whose lives have come to an end to be helped gently into the afterlife and to support and comfort the grief of those left behind.

Alexander Harris taught me that. And now I pass it on to you.