Work Header

In Treatment

Chapter Text

“Good morning. Welcome to the Presidio Clinic and Heat Spa,” Isaac says with the same droll yet annoyingly awake timber he saves for every early morning, probably just to annoy Stiles. Granted, it’s actually ten o’clock, but Stiles is on a post-treatment day and his coffee maker has been in a fitful death spiral for the past few weeks.

“Calm yourself, you baby-faced menace. It’s just me. We’re not Walmart. You don’t have to greet everybody.”

Isaac, as usual, ignores the insult and instead tosses Stiles a chart, which he fumbles in a flail of limbs that has Dr. Deaton raising his eyebrows from the waiting area. Deaton’s patient, a painfully thin girl with a headscarf and permanent IV port, forgoes subtlety and all-out snorts at Stiles’s antics.

Was a big enough idiot to make a cancer patient laugh, Stiles thinks. Good deed for the day accomplished.

“So, Isaac, what have we got?” Stiles asks, once a surreptitious glance reveals that there are no more patients lurking on the waiting area’s fluffy purple sofas.

“Four patient debrief sessions and a new intake. Also, you’re behind on your claim forms. You know that the new Obamacare billing procedures require a two week turn-around, right?”

“Yeah, yeah, I’ll get on it. Just don’t nag me.”

The lights of the clinic’s front area are calming and the warm wood paneling, copious orchids, and small fountain are all designed to soothe nervous or strung-out omegas. Today, however, everything is setting Stiles on edge. He wants to uproot a few ficuses and strangle Isaac with his newest rendition of the hipster scarf. Stiles’s body yearns to lounge in bed, curl up protectively around his recently-bred omega, and snarl at any who dares threaten.

Except he doesn’t have an omega. What he has is a job. The omega he’d mounted for the past three days is just a client undergoing a routine medical procedure -- not being bred, not his to claim. Stiles feels empty, bereft, and anxious even though he knows it’s just withdrawal from the pheromone high of the past few days.

“Hey, I managed to schedule all your admin work for the month today. If you finish the claim forms, you won’t have to come in other than for treatments.”

Stiles knows he should say thank you for the extra days off, but his last client’s heat came late so he’s here bright and early after only having finished a three-day fuckfest six hours ago. Stiles just waves in a way he hopes Isaac takes as a compliment and tries not to growl. He normally schedules himself a full post-treatment recovery day for a reason.

“Okay, still Aping?” Isaac remarks, like Alpha Post Estrus Syndrome is just some quaint monkey business and not pure physical torture. “Sorry.”

“No, I’m sorry,” Stiles replies, pressing at the headache forming between his temples. “I shouldn’t snap at you. You haven’t done anything wrong.” Isaac had started out as a court-mandated patient, Stiles reminds himself. When Stiles did his initial intake interview, Isaac had been terrified of his own heat, yet rabid for it. His alpha father had locked him in a freezer during heat until Isaac escaped and killed the man in a knot-denial frenzy. Allison had worked miracles with the kid before she left to help run the family business.

“Thanks, but don’t worry about it. I’ve been an employee at a heat clinic long enough to know when an alpha’s Aping.” He grins boyishly, still scared to be proud of himself. “Your new intake is waiting in your office,” Isaac adds. “He was scaring the other patients so I let him back early.”

Stiles fixes Isaac with a stern, if somewhat uncomprehending, look. “Scaring them how? And why would you let someone unstable back in the private areas?”

“Not scary unstable,” Isaac says. “Just scary, like he glares a lot.”

Stiles rolls his eyes, looking down at the chart as he makes his way around Isaac’s circular reception area and through the frosted glass doors to the back. Derek [last name expunged]: 32 year-old omega, in excellent physical health, no listed medical history or court mandate, insurance declined medical coverage, no listed referral. Already paid for treatment and left a deposit.

“Another lazy rich guy hiring a licensed hooker for his heat,” Stiles murmurs to himself. He hasn’t seen one of those in years. The non-medical cases usually end up with newbie heat therapists who have only the basic certification. Stiles is overqualified, but the guy is just coming off suppressants so his heat could crop up any time. That means that he’ll get assigned to the senior on-call therapist and with Stiles opting for the triple overtime for on-call over the holidays, likelihood is that he’ll be saddled with the guy. Strangely, that’s not the reason Isaac booked him for this intake interview. According to the file, Derek requested Stiles specifically by license number. This isn’t uncommon: Stiles has training up the wazoo and excellent patient reviews. But Derek doesn’t appear to need any of that training, at least on paper.

Stiles makes his way back to the consult office, holding his breath by the treatment rooms, because the last thing his raging APES needs is to catch a whiff of omega heat pheromones. He’s so busy trying to hold his breath that Stiles trips over the welcome mat at the front of the counseling room and nearly rips the door off its hinges.

Derek does nothing but raise a pair of ridiculously attractive eyebrows, but Stiles feels his judgment anyway. It’s unprofessional as all fuck, but Stiles just stares at the omega sitting there like a greek statue on the office’s pale green sofa. Derek shines like the world’s most awkward beacon in the overdesigned, homey environment of the consult room. He doesn’t offer Stiles a hand up, just looks expectant until Stiles stumbles to his feet and retreats behind the battlement of the wide cherry-wood desk.

The thing is, sitting there in a gray Henley and skintight jeans, Derek is a more attractive omega than Stiles could ever hope to entice into bed out in the real world. He’s the kind of omega that would spit in the face of a clumsy, hyperactive mess like Stiles before he’d consent to hang off his arm. With that artfully crafted stubble, those wide shoulders and narrow waist, the aristocratic cheekbones and the sculpted pecs and the perfect combination of masculine strength and omega beauty, Derek could have sex with any alpha he wants. And that’s before taking into account that positively heavenly smell. It’s like fresh baked bread and Christmas and warmth and sweetness and fertility, all rolled up into one neat, perfectly balanced package. Why in the hell is an omega like that in heat therapy?

Luckily, Stiles manages to hang on to enough professionalism to not blurt that out, but rather asks, “So, Derek, what exactly do you hope to get out of your treatment?”

“Aren’t you going to introduce yourself?” Derek responds. He crosses his hands over his chest, making his biceps bulge. Stiles’s mouth goes dry and, despite having had sex with more omegas that the vast majority of alphas, he might as well be that bumbling, overcompensating, awkward high school kid all over again, because he’s never been good at dealing with attractive people.

“Sorry, sorry. You’re absolutely right. I should introduce myself. I’m Stiles.” Even after years of giving this spiel, it feels wrong not to offer his last name, but rules are rules and it only takes one stalker to realize that they’re in place for a reason. “You can reference my license number on our website. I’m a senior heat therapist here. Certified in literally everything, from hebestral non-partnered therapy to accommodation for extreme physical limitations, neither of which you’d need. Obviously.”

When Derek deepens his angry frown, Stiles backpedals. “Which is not to say that you don’t deserve one of our senior therapists. Just that you don’t seem in need of any specialized training or really any help finding a heat partner. We run a few medically supervised heat rooms for two non-licensed consenting adults to get down in ... if you’re looking to save money. And we partner with a heat matching service, if anonymity is your thing. I personally teach seminars on partner heat accommodation and am totally up for private consults and-- Dude, if you keep staring at me, I’m just going to keep talking and neither of us will benefit from that, so, why don’t you put me out of my misery and tell me why you’ve requested me specifically when there’s nothing I can give you that a friendly stranger with a knot can’t?”

Derek smirks a little and says, “No.”

“No?!? What do you mean, no?” Who in the hell says no to a simple, clinical question like that?

“I requested you. That’s all you need to know. You don’t have to take me on as a patient, but I’m here to see a heat therapist, not meet a partner. I have the money to pay for your services. You don’t need to worry about what would be cheaper for me.”

Stiles doesn’t care about Derek’s financial situation, more about the fact that it’s such a waste for someone like Derek to pay for Stiles’s time when there are omegas out there who actually need Stiles’s training to be able to survive their heat. Derek is cutting into their time. Stiles’s last patient was a quadriplegic who’d spent her whole heat in a fancy sex swing. The patient before that was covered in burn scars and was working with Stiles and a psychotherapist to build self-esteem. The one before that had been a young girl with a suppressant allergy who Stiles showed how to use a dildo.

“Fine,” Stiles spits, caught somewhere between anger and arousal. “You’re rich. I get it. I’m the on-call therapist for the two weeks over the holidays, so there’s a good chance I’ll end up with you even if we don’t schedule you for an induced heat, but no promises.”

“I don’t want an induced heat,” Derek says almost instantly.

“That’s understandable. I’ve seen enough induced heats to know that you’ve got to be crazy or an insurance company to think they’re a good idea.” Induced heats are brutal: a hormone shot and a single day of frenzied, animalistic fucking that the omegas rarely remember. Stiles wouldn’t wish one on his worst enemy.

“I’d cut off my arm before I’d do another one of those.”

That’s when Stiles notices it: a near-imperceptible tremor that Derek is neatly covering by keeping his arms tucked close to his body. Despite all the glaring, there’s an undercurrent of fear beneath the bravado. Derek may have dressed provocatively and he may have affected indifference, but Stiles is suddenly aware that it’s all a shell covering a scared, damaged soul beneath.

Stiles recalls what he learned in his very first training session: people don’t see heat therapists without a reason. Most of the rich assholes who hire them don’t look like Derek - they’re the kind of guys who’d probably have to pay for sex if they wanted even an alpha like Stiles. Derek must know exactly how attractive he is. He’s here for a reason and the reason is probably trauma. Good job, Stiles, Stiles thinks, way to act like an asshole to an already scared-shitless patient who has probably been raped or has PTSD or something.

“Okay, so we’re not inducing. Unfortunately, that means you can’t reserve a particular therapist. Odds are that it’ll be me, but if I’m not available when your heat hits, we should talk options.”

“I think it’s too late for that,” Derek says dryly.

Stiles wants to kick himself for not realizing sooner, because that heavenly smell isn’t just the smell of attractive, fertile omega. It’s attractive, fertile omega in heat. If Stiles hadn’t been so busy holding his breath in the corridor or too flustered by Derek’s sheer hotness to sit next to him on the couch, he would have already smelled it. And now that he’s conscious of it, his instinct is telling him to claim this gorgeous omega right this instant. Stiles shifts a little in his seat in a practiced move to reposition his sudden erection.

“Okay.” He schools himself back into professional demeanor. “How long have you been experiencing symptoms of pre-heat?” At Derek’s blank look, Stiles rolls his eyes. “You know: slick production, skin sensitivity, pupil dilation, temperature flashes, all around general horniness?”

Derek shrugs. “Since last night.”

“Jesus.” Even if Derek is on the outside of average, he’ll be in full active estrus within the hour. It’s lucky that he’s even in control right now, especially considering that he’s coming off of long-term suppressant use. “You know we have a procedure for these things. You’re supposed to call in at the first sign so we can schedule a therapist and prep a room for you.”

Stiles opens the desk drawer to pull out this month’s schedule to check who’s on-call.

“I figured I was coming in today anyway. I didn’t want to call in the middle of the night.”

Stiles shakes his head at the idiocy of it. “We have medically overseen heats going on here 24/7. There’s always someone to take your call. Now, no thanks to you, I have to call in Erica at the last minute.” And Stiles knows for a fact that she and Boyd headed out to her Aunt’s place in the mountains three hours away, figuring that she’d have the usual minimum of six hours notice. What a nightmare.

“You can’t just do it?” Derek looks legitimately frightened for the first time that he’s allowed Stiles to see. His skin has gone flushed and small beads of sweat are forming on his temples, but it’s not the heat that has him spooked. It’s the mention of Erica.

“I’m coming off a three-day shift and I have admin appointments for the rest of the day. If Erica can’t get back in time, we’ll call in one of our affiliated freelancers. Don’t worry, they’ve all been thoroughly vetted.”

Derek starts to look panicked now, pulling at the collar of his Henley enough to expose the faint traces of a faded mating bite. By the size of it, Stiles assumes the past alpha that has Derek so spooked was a girl.

“I take it you’re not comfortable with female alphas.”

Derek nods.

“Okay, I need you to be straight with me, because we’re running short on time and I want to find you the best partner possible: what do you need?”

Derek’s panting, near hyperventilating. Stiles rises to offer him a glass of water almost on instinct. His scent is heady and Stiles feels a spark of electricity where their fingers brush on the glass. He hasn’t been this affected by an omega in a long time. This is one of the many reasons why he usually stays away from the clinic when he’s Aping.

Derek takes a few gulping sips of his water, hands shaking. “I need to be in control,” he eventually chokes out, fingers compulsively bunching in the supple fabric at the bottom of his shirt.

“Okay. You know that you’re in complete control over whatever happens here, right? Any therapist with clinical response training has to practice all kinds of things in a room full of pheromones. If you want me to pull out and do ten jumping jacks every time before I knot, I can.”

“I want to be on top,” Derek forces out.

Stiles marks that down on Derek’s chart. “Totally doable. That’s one of the most common requests from physically restricted patients. Anything else?”

“I would really, um, appreciate it if you didn’t touch me.”

Stiles raises his eyebrows, because that is a little...impossible.

“I mean, I’ll touch you when I have to,” Derek clarifies. Stiles wants to point out that he’s not the one who will be taking care of Derek’s therapy, but the more he hears, the less he wants to trust Derek to one of the freelancers. Most of them only have a basic certification. “And no more knotting than we have to.”

Stiles nods. Control of the knot is probably the top priority for qualification as a heat therapist. Stiles has all kinds of techniques to hold it off, like imagining his father and Melissa having sex, or telling his body it’s already knotted, and even a few New-Agey breathing techniques.

“Do you have an idea of how many times you’ll need the knot and when during your cycle?”

Derek looks bewildered, like he had no idea that people actually know those things.

“I’ve had a lot of clients with severe physical restrictions that make knotting stressful on the body. It takes a few cycles, but we can normally map out a heat plan that keeps knotting to a minimum. It’s easiest if we can hook up a few monitors to measure heartrate and hormone spikes. Would you like us to try for something like that?”

Derek shakes his head. “It’s not a physical problem. I just--”

“Don’t want to be physically tied to another person,” Stiles finishes for him when it’s clear that Derek can’t finish the sentence himself.

Derek nods. Jesus. Stiles isn’t a counselor (and he’s glad not to be), but even he can see that Derek has been through something awful. Stiles feels like even more of a jackass for misreading him. “Why did you request me, Derek?” Stiles whispers.

“I needed someone who can totally control himself.” Derek offers the statement like a prayer and Stiles can’t help the guilt flooding him. Yes, he wants nothing more than to go home and sleep off the last three days, but he got into this business to help people and Derek really needs his help. He picks up the phone and pages the front desk.

“Isaac, it’s Stiles. Clear my next three admin days and book me for clinical duty. See if you can get Erica to cover my next patient, since I’m doing her a huge ass favor by covering. Are any of the treatment rooms prepped?”

Isaac sounds surprised but stays professional, letting Stiles know that the Open Sky Suite is open. Of course. Stiles hates the fucking Open Sky Suite. Only the look of relief and gratitude in Derek’s gorgeous green eyes makes it worth it.

“Okay, so it looks like I’ll be your heat therapist for this cycle and we don’t have much time for negotiation, so how about this: you are totally in charge. When I feel the instinct, which is normally a pretty good sign of a hormone spike (I’m sensitive like that), I’ll just ask you if you want to knot. You say yes if you need it and no if you don’t.”

Derek nods, tensing when Stiles moves to sit down next to him on the couch even though he’s still a calculated four feet away.

“I just want to warn you; the literature is pretty clear - completely avoiding knotting at the beginning of the cycle normally leads to longer cycles and more knotting towards the end. I’ll do whatever you want, but I highly suggest a knotting within the first hour. If your body cooperates, you may only need one or two more per day after that.”

Derek nods again.

“Okay, I’ll get you a consent form and let Deaton know and then we can get this party started.”

Derek still looks unsure, completely devoid of all his previous aggression.

“Hey,” Stiles says. “I don’t know your story, but I promise I will do my best to make this as painless for you as possible. Pinky swear?”

Stiles isn’t expecting the soft guffaw when he offers his pinky. He certainly isn’t prepared for the barely visible smile that somehow manages to make Derek even sexier.

“Okay, let’s do this,” Stiles says with a slap to his own thighs. He knows he’s blushing under Derek’s regard, but fuck it, he’s a consummate professional, but he’s also human.