Title: And A Doctor
Author: Still Waters
Fandom: Sherlock (BBC)
Disclaimer: I do not own Sherlock. Just playing, with love and respect to those who brought these characters to life.
Summary: It was only when people actually saw John working as a physician that they began to understand: that it wasn't just about bullets and IEDs and trauma care under fire. That "doctor" actually covered a pretty wide field. And that John was bloody good at covering ground. 5 times Dr. Watson treated others and 1 time he treated himself.
Brit-pick: Many thanks to the wonderful mrspencil, whose help and support were invaluable during the writing of this piece.
Notes: My apologies for the wait – my eye condition was acting up, making the final editing process take longer than intended. Thank you to all who have reviewed, bookmarked, favorited, and put this story on alert – I truly appreciate your support. I will be slowly catching up on proper review replies over the next week or so, and have treasured every response. I truly enjoyed writing this series and I'm honored and humbled to have heard from so many readers who have been touched personally by some of these medical scenarios. As always, I hope I did the characters justice. Thank you for reading.
Sometimes John wondered if Sherlock wanted to be strangled.
There certainly was no shortage of people ready and willing to oblige him on that point; being the infuriatingly superior and smugly tactless prat he was, Sherlock tended to add to the list of those who'd gladly choke him as consistently and naturally as breathing. Hell, John generally wanted to strangle him at least once a day and he was his friend.
Sherlock was, in most respects, an observant genius. He not only recognized, but also freely verbalized, the fact that he had enemies and pissed people off on a regular basis; knew it and simply didn't care because all that mattered was The Work. Therefore, either he wanted to encourage potential asphyxiation or he was displaying further support for the 'spectacularly ignorant' label that he'd taken such offense to on John's blog. Another deletion like the heliocentric truth of solar system perhaps. It was the only way John could rationalize why a supposed genius going into a known, violent murderer's flat would still wear that bloody scarf.
The one that practically screamed, 'I've probably given you seven different reasons to want me dead just by looking at you, so here's a convenient garrote – come strangle me!'
The one their murderer, Victor Coller, was presently taking full advantage of, twisting the fabric behind Sherlock's head to compress his trachea.
Because of course the flat hadn't been empty, despite his accomplice having been arrested the previous day.
And not only was Coller home, but the third accomplice went from theory to fact.
A very solid fact, currently trying to bury a knife into John while Sherlock asphyxiated.
John ducked another swing as the man went for his carotid again, silently cursing Sherlock for showing up at the end of a short surgery shift and dragging him off without either bringing his gun, or allowing John to stop off and get it first. Because John could really use that gun right about now. Sherlock was almost silent, indicating severely restricted, and soon to be completely absent, air flow. This needed to end – now – and his weapon would have certainly helped speed that along.
On to Plan B then.
John planted his weight, jaw set with experienced determination as the man rushed him again. He grabbed the suspect's wrist and twisted sharply, forcing him to drop the knife with a snarled yelp. Keeping a hold of the wrist, John shifted forward and landed a clinically placed kick to the man's right knee, dislocating the patella with a sharp pop and dropping him to his good knee with a scream. Taking advantage of the man's unbalanced position, John got behind him, locked an arm around his throat – a choice that felt quite appropriate considering what his partner-in-crime was doing to Sherlock at the moment – and applied a quick, sure choke hold.
Pushing himself up once the man was unconscious, John rushed at Coller, who was so intent on killing Sherlock that he hadn't bothered to change position and investigate his accomplice's howl of pain; his back still to John. The murderer let out an angry, surprised grunt at the sudden restriction of his own oxygen as John grabbed him from behind, not expecting the physician to have been a threat. He dropped the scarf and shoved Sherlock forward, freeing his arms to throw a sharp elbow back into John's side. John grunted but held on, readjusting his grip. The elbow came back again, catching John's lower chest, causing him to loosen his grip a fraction as the air rushed from his lungs.
Coller took advantage of the opening and extricated himself from the hold, side stepping John to grab an arm and throw him forward into the kitchen worktop. John's upper abdomen hit the blunt edge of the worktop hard, fingers scrabbling for a hold as his knees buckled with the violent loss of breath. He tried to twist aside as Coller came up behind him, stalking across the room with feral, predatory intent, but couldn't get enough air to complete the movement and was pulled back and slammed against the worktop a second time. His legs finally gave out, vision sparking, abused diaphragm desperately trying to pull in oxygen as he crumpled to the ground.
And then Coller was on the ground too, leaving John with the blurred image of Sherlock's pale form towering over him, swaying slightly, the long, steady fingers of his right hand gripping a heavy statuette from the mantelpiece.
"Are you all right?" Sherlock demanded, tossing aside the statuette and rushing into a crouch in front of John. He rapidly catalogued the immediate data - alarmingly unbalanced sitting position, legs folded under him, back curled away from the cabinets as he hunched protectively around his torso – and ducked his head to seek out his friend's face. "John?" he pressed, voice tight with worry at the lack of immediate response and continued wide-eyed struggles for air.
"Just…..need…..a….minute," John choked out, closing his eyes as his vision wavered again, forcing himself to override the panic of air hunger and regulate his breathing.
"Ribs?" Sherlock asked, reaching to push aside John's coat as if it were impeding his deductive x-ray vision.
John swatted his hands away, annoyance winning out over weakness. "Sod…..off," he gasped, a little stronger this time. "I'll check…..in a ….minute."
Sherlock looked him over, recognizing the 'back off and let me get myself together' need in John's tight features. He nodded once, rising with a grace that shouldn't have been possible for a man who'd just been choked, and stepped away, busying himself with restraining the unconscious suspects and texting Lestrade, surreptitiously glancing over at John to check on him at regular intervals. When he got back to his flatmate's side, the doctor was still pale, face tense, but his breathing was largely under control again as he ran a practiced hand under his jumper, palpating his ribs.
John looked up as Sherlock loomed over him, deductive eyes taking him in. "Ribs are fine. Just got the wind knocked out of me," John responded to Sherlock's silent demand for a diagnosis. He turned a clinical eye on Sherlock in turn. "You okay?" he asked, focusing on Sherlock's throat and breathing pattern; that bloody scarf, while loose and open, still in place.
"Fine," Sherlock dismissed.
The response was hardly unexpected even as John noted the rough undertone to that single syllable; the low voice scraped through a lingering external redness that would likely progress to impressive bruising later. But Sherlock was moving well, color normal for him, no accessory muscle use, airway obviously patent and body oxygenating adequately. He was stable – fine – for now, and so John accepted the response without his usual sarcastic argument; not having the energy for anything more than the immediate present.
"Good," John said. "Lestrade's on his way?"
"Right," John decided, dragging himself to his feet with a grunt. "Bloody scarf," he muttered, steadying himself against the worktop as he got his legs under him.
Sherlock rolled his eyes and huffed an 'oh, not this again' sigh before resuming careful study of his still unsteady friend, who was showing no signs of stepping away from the worktop's support anytime soon.
John tried not to bristle at the subsequent return of Sherlock's intense 'I'm reading your DNA' focus. He recognized that Sherlock was staying close for more than deductive clarity or potential physical support and chose to focus on the importance of that - and breathing - instead.
An hour later, they were back at Baker Street, Sherlock rambling about the history of the unique rope he'd found at Coller's flat and how it obviously explained the murderer's history and methods, when John stumbled, grabbing the banister with a sharp, bitten-back hiss.
Sherlock stopped, whirling around from his place three steps ahead. "You're still in pain," he noted, cataloguing John's vocalization, tight features, and the left arm that had gone to cradle his upper abdomen.
"And you're still croaky," John shot back at Sherlock's rough voice. He clenched his jaw and took a careful breath.
Sherlock tilted his head slightly, eyes raking over John. "You're sure your ribs aren't broken?" he asked, equal parts question and statement.
"Yes, I'm sure. Believe it or not, Sherlock, this," John briefly took his left arm away from his abdomen to wave a hand between his own body and Sherlock's throat, "is a normal human body's response to injury. It's going to bloody well hurt for awhile."
"My throat doesn't hurt," Sherlock half-dismissed, half-argued.
"Of course it doesn't," John muttered in his 'you may not eat or sleep like a normal human being but I don't believe a word you're saying right now' tone, maintaining his right hand on the banister as he resumed climbing the stairs.
Within seconds of entering the flat, John sat Sherlock down, insisting that he apply ice - just fifteen bloody minutes before you bury your head in that damn microscope – and submit to a proper examination of his throat. Once he was satisfied that Sherlock was all right, John swallowed two paracetamol with a full glass of water, grabbed a tea towel and another cold pack from the kitchen first aid kit, and informed Sherlock that he was going to have a lie-down and to let him know immediately if he started to have any trouble breathing. Sherlock acknowledged the statement with a non-committal grunt, immersed in his study.
"Seriously, Sherlock, I mean it. Immediately," John said firmly, standing stiffly in the kitchen doorway.
"Yes, fine," Sherlock's agreement was too quick to be anything other than a dismissive placation; attention still rooted to the microscope.
John turned and walked away, knowing he wasn't going to get any more than that and too tired to do more than hope it had actually got through that selective skull.
It was only when John's back was to him that Sherlock briefly looked up, following John's careful movement toward the stairs with an unwavering focus diverted from his tissue sample, and an uncertain frown.
While most people would consider living with Sherlock to be a nightmare of its own, John's nightmares had decreased significantly since moving in with him. So when he bolted awake a little over an hour after falling into an unplanned sleep, heart pounding and breathing rapid as familiar images exploded him into panicked consciousness, it was a bit of a surprise.
A surprise that may just have saved his life.
Because when John snapped into a sitting position, expecting an unpleasant roll of nausea under burning eyes, what he got was a sharp flash of pain on his right side that threw him back into a supine position and left him gasping even harder. His left arm instinctively moved to guard the painful area, splinting it as he struggled through deep breathing exercises to control the nightmare-induced panic. Shivering, he pulled the duvet up and over his cold left hand, then tucked his right in as well, anxiety clawing at his chest as the images faded under feelings that cruelly persisted. He forced himself to count, measuring the length of each inhalation and exhalation in a now ingrained coping mechanism and treatment plan, but found that the silent numbers, so often a comfort, kept getting away from him.
Time was an odd thing during these episodes: while it always felt like it took hours to regain control, part of John was also hyper-aware of the true passage of time; enough so that he recognized that this particular episode was off. John had a set, proven method of dealing with panic and nightmares; implemented it unconsciously and knew how long he needed to get back under control. He pulled his left arm out from under the duvet to check the time, having already instinctively glanced at it when he first woke up. Fifteen minutes. It never took him more than ten anymore to get his vitals back to normal, to at least look like he wasn't being crushed by fear and memory. But here he was now, fifteen minutes later, no better than he had been when he'd first launched back into consciousness: heart racing, breathing shallow and rapid, anxiety like an electrified predator, snapping and snarling at the edges of his shaky perimeter, making his skin crawl.
John carefully moved to a sitting position, fingers digging into the sheets with a white-knuckled grip as he swayed under a nearly capsizing wave of weakness. He gave himself a moment, waiting for his vision to clear, then attempted to stand, hoping a few splashes of water on his face would set him right.
No such luck.
His legs immediately buckled, dumping him back onto the bed, upper body twisting with the force of the drop, pain and nausea flaring dangerously. He weakly lowered himself onto his left side for the nausea, before quickly shifting onto his back again as his abdomen violently protested the pressure of lying on any side with a fresh, agonizing wave of pain. His left arm moved back to its protective cradling position, abdominal muscles tightening at the contact, whole body shivering at the chill of his bare forearms through the thin cloth of his vest.
What the bloody hell was going…..
And there it was, everything coming together in a nearly Sherlockian-speed, diagnostic rush.
This wasn't lingering post-nightmare anxiety and pain from deep bruising.
It was so much worse.
Persistent tachycardia and tachypnea. Cold, clammy skin. He lifted his right hand to his face and pressed on one fingernail: delayed capillary refill. Weakness and anxiety.
A quick survey of his abdomen immediately gave him the etiology. Pain and tenderness after two blunt force blows into a worktop. Careful palpation around his left arm – guarding behavior – yielded unmistakable rigidity. Right upper quadrant pain diffused throughout the rest of the abdomen.
Internal bleeding, most likely originating from the vascular liver.
Diagnosis: hemorrhagic shock secondary to intraperitoneal bleed. Initial injury over two hours ago.
John fumbled for his mobile on the bedside table, shaky fingers dialing 999. He mentally ran through his symptoms, struggling to control his skittering mind. The human body could lose about 15% of its total blood volume without an overt change in status, so he'd lost at least that much so far. Startling at the dispatcher's voice, he dragged his attention to the phone, relayed his emergency and address and hung up, drifting back to his previous line of thought. Probably between 20-30% loss at this point. More than 30% and he'd get more confused, closer to unconsciousness and full circulatory collapse.
And while John may have been able to diagnose himself and call his own ambulance, he couldn't perform CPR on himself when it, inevitably, came down to it.
It took him several tries, struggling with blurry buttons and uncoordinated fingers, but he finally got a text off to Sherlock: open doors for amblnce come upstaisr
Sherlock had barely received the text before he was pelting up the stairs, the order to open the doors ignored. But in a typically Sherlockian defiance of convention, he wasn't alarmed at the mention of an ambulance, like most people would have been; he was reacting to the spelling errors.
John still displayed an undeniable military precision in everything from the organization of his room to the buttoning of his shirts; a meticulousness that transferred to his texting as well. He always used proper spelling and punctuation. So two dropped letters in 'ambulance', a lack of punctuation separating that word from 'come' in the absence of a connector like 'then' , and an inversion of the last two letters of 'upstairs?'
That was all the data Sherlock needed to know that John was seriously compromised.
He burst into the room to find John lying on his back, skin frighteningly pale, chest heaving with rapid, shallow breaths, left arm curled protectively against his upper abdomen, still clothed but for his jumper and button-down which he had removed before lying down to ice his injury.
"Doors, Sherlock?" John asked immediately, voice weak through the knowledge that Sherlock couldn't possibly have done it with how fast he got upstairs.
Sherlock pulled his mobile from his pocket and stabbed at one of the speed dials. "The doors need to be opened for the ambulance. Send them to John's room when they arrive."
"Ambulance?!" Mrs. Hudson gasped on the other end of the line. "Sherlock, what's happened?"
"The doors, please, Mrs. Hudson," Sherlock was striding across the room to John's side, eyes narrowing as the picture worsened.
It was a testament to Sherlock's regard for Mrs. Hudson that he hadn't immediately hung up after telling her to send the ambulance crew upstairs. His voice was cold and low, but the reply itself, especially with the significant addition of the 'please', said it all.
And Mrs. Hudson knew him well enough to take that regard for what it was. "Of course, dear," she replied hurriedly, worried and gentle all at once before hanging up.
"Diagnosis?" Sherlock demanded, stuffing the phone into his pocket as he came to a stop next to the bed, shifting his looming position in order to maximize the late afternoon sunlight for better analysis.
"Shock. Intraperitoneal bleed. Probably hepatic," John closed his eyes, voice trailing to a whisper as if that had taken all his energy.
Sherlock's eyes flickered as he recalled John's pain and stumble on the stairs earlier. "You've been bleeding since Coller's flat," he realized. "Why didn't you call an ambulance then?" It was equal parts demand, frustrated incomprehension, and desperate searching for what he had missed.
"Didn't know it then," John nearly whispered, squinting up at Sherlock, trying to bring him back into focus. "Peritoneal cavity can hold a lot of blood before any symptoms start."
"How much have you lost?" Sherlock asked; a seemingly ridiculous question in the absence of a direct measuring apparatus, yet one he was somehow confident that John could answer.
"Probably about 30%," John's eyes were closed again.
"What do you need me to do?" Sherlock asked urgently.
John was silent.
"John!" Sherlock barked.
"Hmmm?" John moved his head weakly on the pillow.
"John, open your eyes," Sherlock demanded, grabbing John's face to force his focus, alarmed at the coldness of his skin.
John's eyes slowly made it half-open. "Sherlock?" he murmured. "What…." He looked around, confused, eyes tracking sluggishly.
"Intraperitoneal bleed and shock," Sherlock reinforced. "What do you need me to do?" he repeated forcefully.
"I…." John swallowed thickly, a flash of panic surging through confused eyes as he realized that he was confused. He visibly struggled to focus, clearing his throat weakly. "Help me to the floor."
"The floor?" Sherlock echoed, trying to figure out if John meant it or had progressed to delirium. "John…."
"Now, Sherlock," John insisted, meeting Sherlock's deliberation with a frighteningly clear, serious gaze. "CPR on a bed is bloody useless."
Sherlock's eyes widened as he got John to his feet, moved him a few steps from the bed, and eased him onto his back on the floor. He had just finished elevating John's legs and covering him with the duvet per the physician's fading instructions, and was standing to get a pillow for his head, when John clumsily grabbed at his wrist.
Sherlock stilled. "John…."
John's fingers slackened, losing the energy to maintain his grip. He dragged his left hand up to his chest, holding two fingers at the lower margin of his sternum. "Xiphoid process," he identified the landmark. "Hand's length above that. Midline. Lock your elbows. Hundred a minute. Just compressions," he gasped, slurred and weak around shallow, panting breaths.
"I do know CPR, John," Sherlock's characteristically offended, smug tone was buried under raw concern, even as the words unconsciously left his mouth with the inherent, driving need to make the correction.
"Just a reminder, then," John offered with a weak tug of the lips that, on some other day, could have been a weary, indulgent smile.
"I won't need it," Sherlock dismissed. "The ambulance is almost here," he cocked his head toward the sound of approaching sirens.
The rapidly declining clinical part of John's brain wanted to tell Sherlock that over 40% blood loss, which he was surely approaching, would bring him to complete circulatory collapse, where CPR would give him just the barest chance of surviving the trip to hospital. The gallows humor that defined him as a physician-soldier wanted to sarcastically point out that his body wasn't likely to wait for emergency services before giving out; that internal bleeding tended to be beyond even Sherlockian-level powers of conscious control. And John, Sherlock's friend, wanted to offer some humor and comfort, to comment on feeling honored by Sherlock's faith in John's perceived ability to bleed slower; to see some of that rare, raw worry ease back behind a flash of amusement, a half-huffed laugh, or a low chuckle.
But John never got a chance to choose. The world faded out, achingly slow and terrifyingly fast all at once, leaving him with only the distant echo of Sherlock's sharp shout.
Amazing what emotion a self-professed sociopath could infuse into his name.
The first time John woke up, he wasn't quite sure that he was awake. He had a vague memory of the feel of an endotracheal tube, the mechanical push of a ventilator, a glimpse of red directed toward his subclavian – blood transfusion and central line? There might have been a voice, a presence greater than the all-consuming environment of intensive care, but sedation and exhaustion pulled him back down before he could be sure of anything.
The second time he woke up, the endotracheal tube was gone, and the logical, clinical part of his mind figured that he must have been awake at some point earlier for the extubation to happen. But he couldn't hold onto that thought, or any thought really; each one jarred loose and skittering away as his body shook, burning and freezing at the same time. He felt the icy, full body bite of a cooling blanket, swallowed against a nasogastric tube he didn't recall feeling before, and knew this feeling: infection. He instinctively reached for his shoulder, memory taking over, but his hand was caught and laid back at his side, fingers lingering at his radial pulse in a manner that was less clinically diagnostic and more grounding need disguised as scientific curiosity. He opened his mouth to give that presence a name, but all that he heard was his own spoken in a low, familiar voice. Quickly determining that listening took much less of his nonexistent energy than speaking, John gave up on attempting to speak, letting that familiar voice drown out the equally familiar calls for antipyretics and antibiotics as the darkness took hold again.
The third time that John was aware enough to recall, he woke up on the general ward, looking into the calculating intensity of Sherlock's full attention. He blinked sluggishly, slowly taking stock of himself and the room.
"John?" Sherlock asked as the silence stretched.
John recognized that tone from standing with patients' families on the other side of the bed. It was the weary, hopeful pitch of someone wondering if their loved one was really awake this time; the trepidation of having asked the same question numerous times before. All in Sherlock's deceptively even tone.
"Sherlock?" John had to clear his throat halfway through, but he got it out.
Sherlock unfolded from the bedside chair, some of the tension hidden in that seemingly haphazard tangle of limbs disappearing with the movement. He leaned forward. "Do you know where you are?" he asked carefully. There was an overtone of disgusted guilt, as if he hated having to ask such an obvious, insulting question, but underneath was the pause of a man who had seen multiple justifications of its necessity.
"John Watson. Hospital. No bloody idea what the date is. Hopefully it's still 2012?" John grinned lightly at that last bit as he ran through the orientation responses before Sherlock had a chance to ask the rest of the questions.
Sherlock let out a breath and smiled – one of those joyfully honest, full smiles that not only reached his eyes, but shone in them. The relieved smile of a man who had long been waiting for good news.
"Finally," he huffed; an illusion of long-suffering, expected impatience. "Honestly, John. Three more weeks in this section of hospital and I'd have gone absolutely mad. At least the morgue occasionally has something to keep my brain from rotting."
John pushed back the half-curious, half-panicked part of his mind that started shouting a surprised, '3 weeks?! Bloody hell!' and snorted back a laugh instead; one that quickly devolved into a groan as he reached for his abdomen.
Sherlock thrust a pillow between John's arm and abdomen so that he could splint the incision; an action that made John realize some poor nursing staff had actually been giving Sherlock pre-discharge teaching. Poor sods.
"Thanks," John ground out, splinting his abdomen through the resulting pain and coughing.
"Are you all right?"
John immediately recognized the concern of someone who had seen too many things go wrong recently. Sherlock's eyes moved through a quick personal scan before meeting John's, waiting expectantly for the physician's personal assessment.
"Right now? Yeah," John assured him, easing the pillow to his side for later use. "You want to take me through it?"
Sherlock steepled his fingers, leaned his elbows on his knees, and began to talk. John let the words wash over him, painting a picture of classic decompensation: hepatic hemorrhage, multiple transfusions, full respiratory and hemodynamic support, central line infection and sepsis, re-intubation and full support for a second time, a running tally of vital signs. When Sherlock finally finished the detailed litany, it was with a minute jut of his chin and three confident words completely unrelated to what came before them: "I was right."
John was generally accustomed to sudden, non sequitur statements from Sherlock, whether out of the blue or in the midst of one of his deductive rushes. But he was already fighting a heavy resurgence of exhaustion while simultaneously coming to terms with just how bloody surprising it was that he had - for the third time in his life – actually survived, so he just didn't see the connection as he otherwise might have. "Right about what?" he asked, confused.
"I didn't need to perform CPR," Sherlock said, the smugness of being right weighted with something much deeper. "You didn't go into cardiac arrest until the paramedics arrived."
John swallowed at the raw truth in Sherlock's eyes: an open glimpse of the man who had been desperately afraid for his best friend's life and embarrassingly relieved that he hadn't had to manually act as his heart. A quick, honest drop of that all-consuming mask; an action that Sherlock rarely permitted others to see.
"Well," John cleared his throat roughly. "I'm chuffed that my timing managed to support your bloody ego."
Sherlock let out a burst of a chuckle, quickly suppressing the laughter, but leaving the smile. "Nice work," he said softly.
The hospital room faded away to the memory of a night sky, an orange shock blanket stark against flashing emergency lights, a dead cabbie, and the start of a friendship that defied definition. It was "good shot" all over again, in tone, eye contact, and significance. Layered and honest, with excited intrigue, surprised pleasure, and earned respect.
'Nice work holding back cardiac arrest.'
'Nice work treating your own medical emergency.'
'Nice diagnosis, Doctor.'
'Thank you for surviving, John.'
John smiled warmly, acknowledging all that was said and unsaid with a single look.
Sherlock nodded fractionally – message received and appreciated – and settled back in his chair, reaching for his mobile.
And so John finally allowed the exhaustion to take him, closing his eyes to the equally comforting sounds of a stable patient's medical equipment and Sherlock texting.