Disclaimer: I do not own any of the characters to Stargate Atlantis, nor am I making any type of profit from this story. It is a work of fan fiction, for enjoyment only.

SPOILER ALERT: Definitely spoilers for "The Defiant One". This story is set immediately following that episode, and refers to it frequently.

Author Note: I've edited this chapter to try and answer some of the questions/ comments posed by the reviews - I hope it doesn't get too expository.

Survival Course

By KerrAvon

Chapter 6

As the shuttle landed in the Jumper Bay, the activity around Major Sheppard increased. Grodin and Zelenka stood close to Carson, plying him with questions, in order to understand some of the ramifications of the situation.

Zelenka was surprised at the way Carson had been pushed to the sidelines by Dr. Lawrence. Shoving his glasses up onto his nose absentmindedly, he asked, "Dr. Beckett, are you not the Chief Medical Officer? Why are you not in charge?"

Carson was distracted from his own dark thoughts by the question. "Hmmm? Oh, because this is a surgical problem, and Derek is our chief surgeon." Upon noting Radek's continued confusion, he explained, "Dr. Biro is our pathologist, and a fine one she is, too. Now, while her training, like mine, included basic surgery, she found pathology to be more to her liking and probably hasn't operated on a living patient in a primary capacity since residency. Likewise, while I'm a decent diagnostician, I found research genetics and microbiology more my cup o' tea; while I could take out a spleen in a pinch, you're safer leaving it up to the person with five years of specialized training, and significant subsequent experience. That would be Dr. Lawrence."

"But…isn't this too long after his injury by the Wraith to be a ruptured spleen? I thought those had to be treated immediately to keep the patient from bleeding to death." Grodin appeared confused now.

Beckett straightened as he warmed to the subject. "Normally, that's true. However, you can have a small injury to the spleen parenchyma that is contained by the splenic capsule. When this happens, it's called a 'contained splenic hematoma', and can often be treated safely with bedrest followed by light duty. However, if the capsule starts to leak or ruptures completely, the patient is placed in a position that mandates surgery." His lips thinned into a grim line. "I should have picked this up on his post-mission exam!"

"But I thought you said that he didn't have any abdominal pain…"

"But you see, that's just it." Beckett was clearly angry at himself. "You don't have any symptoms, not until it starts leaking or gets so big that the capsule itself begins to hurt from the stretching."

Zelenka put a hand on the physician's arm. "Then, why do you feel you have done something wrong?" He snorted, "Unless you are psychic, there was no way of knowing that the Major had a problem until he began to have pain, and even that he hid for half a day."

Carson looked at the toes of his shoes. "Ah know, ah know. It's just that…I know Major Sheppard. Heaven knows he's been in the infirmary often enough. And I know that he tends to minimize any personal injury or discomfort to the point of trying to deny it altogether. I don't know if it's 'macho' or what, but this tendency is going to get him needlessly killed some day." He stared at the frantic activity around the gurney and concluded, "If it hasn't already. The point is, I should have scanned him, no matter what he said. It might have picked up the injury before he had any symptoms."

"Or it might not have." That was Dr. Lawrence kicking in his two cents as they packed up to leave the shuttle. "Carson, you need to stop beating yourself up over this. You're an Internist with a bent towards microbiology; you're not a trauma surgeon." He looked up at his boss with his brown eyes flashing amusement. "And, despite rumours to the contrary, you're also not God." His attention turned to the nurse, "Hey, that IV bag's almost out. You got another?"

As the Jumper hatch opened, they were met with a scrub-attired contingent that whisked the still-unconscious Sheppard and his attending surgeon off to the operating room, past a worried Weir who was just entering the bay. She watched them leave, then turned to Beckett. Her hair was still wet from the hot shower she had indulged in upon returning to base, and she absently combed her fingers through it to try and get it to dry. "What happened?" she asked directly.

"We think the Major has a ruptured spleen. He's off to surgery now."

Weir's brows creased in concentration. "How did it happen?"

He gestured for her to precede him out of the bay. "It's a long story. I'll tell you on the way to the infirmary."


There was a worried group hovering in Medlab by the time Dr. Lawrence made it out of surgery. Knowing how families examine the approaching surgeon's face for hints as to the outcome of any operative procedure, he plastered on a reassuring smile. 'And let's not kid ourselves, the Atlantis Base is Major Sheppard's family,' he thought wryly.

Weir, McKay, Ford and Teyla turned as one and converged anxiously on the surgeon, but he was aware of Beckett hovering just slightly in the background. "Don't worry, he's going to be fine." It had actually been pretty touch and go at first, until he got control of the splenic artery and vein. The injury itself had been relatively minor, and he managed to repair it without sacrificing the spleen. Still, the Major was going to be pretty sore for a while.

"May we see him?" asked Weir.

Derek nodded. "He'll be coming out in just a minute. He's still pretty sedated; he won't know that you're here."

The base commander sighed. "That's fine. I just prefer to believe my own eyes - nothing personal."

Derek pulled off his scrub cap with a crooked grin. "I understand." Just then the gurney with their injured colleague appeared from around the corner, and the group trooped over to follow him to the infirmary recovery area, where traffic control was in the capable hands of Nurse Madison. Dr. Lawrence took a moment and meandered over to where Beckett was studying an empty beaker with ferocious intensity.

Laying a hand on the Scott's shoulder, Derek went straight to the point. "Excuse me, sir, but you do understand that this is not your fault, right?"

Beckett scowled at the glassware in his hand. "I should have scanned him when I saw those ribs. I thought about it, but didn't do it. I returned him to full duty with a splenic hematoma!"

"Maybe a CT would have showed something, or maybe not. If he was truly asymptomatic, he might have had a subclinical injury that didn't manifest itself until he started running around on that planet. Then we were dependent upon his reporting the new symptoms, which he didn't do."

Beckett narrowed his eyes. "Still…"

Derek threw up his hands in exasperation; it had been a long day. "Look, what are you going to do? CT everybody who gets a bump or bruise? I once had a patient with a ruptured spleen from his cocker spaniel knocking him sideways into the arm of his couch. He happened to catch the carved wood under his ribcage in just the wrong way and banged his spleen. He'd have bled to death if a friend hadn't dropped by and dragged him to the ER."

Beckett sighed and set down the beaker. "It's just so…frustrating."

"I know. Maybe after this we can convince Sheppard to be more honest about his symptoms following injuries."

Carson snorted derisively. "Right. Let me know when those Athosian pigs start flying, too."

"No, I mean it." A crafty look appeared on the surgeon's face as he changed the subject abruptly. "Despite all his complaints on the planet, did you ever find anything actually wrong with Dr. Kavanagh?"

Beckett rolled his eyes. "That hypochondriac? He might have a couple of minor abrasions, but that's it. He doesn't even have ligamentous damage, much less anything actually broken. I've got him cooling his heels in the infirmary until I'm good and ready to release him. He's raising the roof about it, too. Keeps claiming I've missed something." Carson's eyes widened, "You don't think…"

Derek snorted, "No, I don't. But he does. What if we kept him for 24 hour observation, 'just to be safe', since he is so certain that he is gravely injured?"

"Why in heaven's name would I want to do that?" Beckett blurted aghast.

"How do he and Major Sheppard get along?"

"Like oil and water." The light bulb suddenly went on. "Side-by-side hospital beds…"

"Dr. Kavanagh might think twice next time about questioning your medical judgement."

"And it will demonstrate the advantages of bedrest in his quarters over emergency surgery to Major Sheppard!" A smile lit the Chief Medical Officer's face for the first time in hours. "Doctor Lawrence, I like the way you think."


Sheppard heard the hushed murmurs before anything else impinged on his consciousness. 'What's going on?' he wondered. 'Why is everyone talking over me?'

"Major? Are you awake?" He recognized Weir's concerned tones and struggled to open his eyes.

"Yeah," he rasped hoarsely, "Sort of…"

After a Herculean effort he managed to crack open one eye, then the other. Around his bed stood a motley assortment of exhausted teammates, all of whom broke into smiles and cheering as they heard him speak. Weir calmed them with a whispered, "Ssshhhh," the turned back to John. "You had us worried there for a bit," she said with a smile. "Glad to have you back." She squeezed his hand so quickly that he was unsure whether or not he had imagined it, then stepped back so the others could greet him.

"Hey, sir. We missed you." Ford managed to put a world of feeling into those few words.

"Yes, very much," concurred Teyla solemnly.

"Well, you know, we need you up and healthy….to switch on the gadgets…and things," concluded McKay awkwardly.


"And things, yes." By golly, it might sound lame, but Rodney was sticking to it.

Sheppard nodded. "Wouldn't want to miss that." He started coughing and suddenly became aware of the fire in his abdominal wall. "What the…?" he began, as Beckett moved in with a pillow. Sheppard gratefully held it against his incision until the coughing bout was over, then fixed the doctor with a stare. "What happened?"

"Your spleen ruptured, probably secondary to injuries sustained in that encounter with the Wraith." Beckett snapped. "You're just lucky Zelenka had the good sense to call for help immediately."


"Oh?" Beckett was beside himself. "All you have to say is 'Oh'?" Teyla, Ford and McKay exchanged uneasy looks; this was about to get ugly. In the six hours or so after the successful completion of the surgery, they had each heard 'The Tirade' at least twice, and it had become more vehement, not to mention louder, each time. On an unspoken signal the three edged out of the room, abandoning Sheppard to Beckett's tender mercies. They figured that, as commander, Weir could fend for herself.

Sheppard shrugged. "Well, that was one mean Wraith."

"John, you could have died." Weir quietly commented as Beckett spluttered.

His eyes narrowed and his brow creased in concentration as he looked between the two of them. "Clearly I'm missing the point…"

Beckett regained vocal capacity. "Major, do you remember the examination a few days ago?"


"And what happened at the end?"

"Ummm…you wanted to run some type of scan."

"And what did you promise to do if I let you out of it?"

Sheppard was unclear as to where this was going, but decided to play along. "That I would come back if I got worse."

Beckett threw up his hands in frustration. "Major, it doesn't get much 'worse' than a ruptured spleen!"


"Again with the 'oh'. I know your vocabulary is better than that." He rolled his eyes imploringly at Elizabeth, but she just smiled and nodded for him to continue.

Turning back to Dr. Lawrence's patient, he tried a new tact, "Didn't your stomach hurt?"

"Well, sure."

"Was it hurting when you came to see me?"

"No, not at all."

"Major, that was exactly the type of 'problem' I was referring to. Pain occurring where there hadn't been pain before." Beckett collapsed into the chair next to the bedside. "Oh, what's the bloody use? You'll just go right on ignoring common sense and doctor's orders the minute you get out of here."

Sheppard was surprised. "That was my spleen? I thought…I thought I'd eaten something I shouldn't have or had some kind of virus." Realization dawned, along with a degree of guilt. "That scan I begged out of…"

"Might very well have shown that you had an injury, yes. If we had known about it sooner, we could have prevented surgery by placing you on light duty."

"I'm sorry. I didn't realize…"

"Well, now that you do, I expect you to listen to your treating physician next time." Weir's tone made it clear that this was not a request. She touched the back of his hand lightly. "Now, try to get some rest. We need you back." So saying, she left.

John closed his eyes and let his head fall back to the pillow. They flicked open again, however, as he felt the blood pressure cuff inflate. He fixed Beckett with his most apologetic puppy-dog stare. "Sorry about that. I just didn't think…"

Beckett smiled wanly. "You never do, Major, you never do."

Sheppard relaxed and allowed his eyes to sleepily slide shut, only to pop awake again at the sound of a whiney, "Hey, how does somebody get some service around here?" Carefully turning his head towards the voice, he groaned.

He hid his dismay as he asked the occupant of the adjacent bed, "Hey, Kavanagh, what are you doing here?"

The pony-tailed scientist petulantly crossed his arms over his too-short hospital gown. "That quack won't let me leave," he replied.

"Now, now, that's no way to talk to your attending physician." Sheppard was certain that he could discern an undertone of amusement in Beckett's reply.

Turning his attention back to the doctor, he questioned curiously, "So, what's wrong with him?"

"He fell on our little exercise and injured his leg. Despite assuring him that nothing was seriously wrong, he insisted that he knew better, so we brought him back to Atlantis." Beckett conveniently left out the part about being captured by the 'Wraith'. "Now, I'm an intelligent man - I can learn from my mistakes. As my examination of you missed the splenic injury, it's possible that I'm missing a similarly serious injury to the good doctor's leg. Therefore, I opted to keep him under observation for 24 hours."

Beckett's face broke into a grin as he patted Sheppard on the shoulder and said, sotto voce, "This way, maybe you both learn a lesson. If not, then next time it'll be worse."

Sheppard closed his eyes once more and groaned. "You're heartless," he murmured.

The doctor's grin got wider. "Just look at it as my form of a 'survival course'," he responded.

Listening to Kavanagh drone on about the injustices of life on Atlantis, Sheppard murmured, "I think your version is tougher than mine." As he finally succumbed to the urge to sleep, he could swear he heard Beckett chuckle.

The End

Author's note: Remember that I initially wrote this story almost two years ago; at the time I assumed that the Atlantis expedition would deploy with a fair number of medical subspecialists, particularly as they might be on their own in another galaxy. As fantastic a microbiologist/ genetic engineer as Carson might be, he's way too young to throw 'trauma surgeon' in on top of those credentials, so I made one up. I know it's not the 'Hollywood' way of doing things, but they sometimes have female surgeons scrubbing for surgery in full-length ball gowns! (And if you don't believe me, check out the 'Doctor Who' movie Fox filmed a few years back - hat, mask, and ballgown; just the thing for the surgeon-about-town!)

Anyway, I hope the explanations didn't get too dry; I tried to make Carson a little angsty, too, but don't think I pulled it off very well. Still, practice makes perfect, so I'll try again sometime. Thanks for reading, and if you liked this, be sure to check out some of my other stories…