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Code Black

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“Hi, I’m Doctor Lester. What seems to be the problem tonight?” Phil asked, clicking his pen open and smiling warmly at his patient.

The hospital was in code black, as it always was, code black being the busiest it could possibly be in the public, NHS-funded hospital. There were always new people coming in and out of the accident and emergency department at St. Thomas’, new young doctors called residents, temporary doctors and nurses, patients...but none of them had caught Phil’s eye the way the pretty doctor with the brown curly hair had. Phil was sitting in the waiting room taking care of the quick-fix patients when he saw the tall, lanky figure walk past. As he was trying to watch him walk through the door to the main section of the A&E, he leaned over to look at Pretty Doctor, and before he knew it he’d fallen off his chair and the young patient he was treating was laughing at him.

The attractive doctor he’d been checking out rushed over to help him, handing him the ID cards that had fallen off when he’d landed. “Are you alright?”

Phil snapped out of his little trance and shook his head as he sat back on the stool. “Sorry, yes I’m fine. Um, I don’t think we’ve met before?” Phil said, an unintended air of question in his voice.

“No we haven’t—today’s my first day. I’m Dan Howell, I’m the doctor they chose to fill the open attending physician spot,” Dan said, smiling at Phil. “And you’re Doctor...Lester right?” Dan asked, taking in Phil’s appearance. He was an attractive man, his high, sharp cheekbones and bright blue eyes framed by thick-rimmed glasses and capped off by box-dyed black hair that fell slightly in his eyes. His smile revealed itself as they talked briefly, lopsided and happy, with his tongue poking through slightly crooked teeth when he laughed.

“Present and accounted for. So, who’s showing you around? Is it the head nurse Anne or the director Doctor Green?” Phil asked as he and Dan walked back to the doctors’ station so Phil could log his patients into the computer.

“Anne, she wouldn’t have it any other way I’m sure,” Dan said. “She’s basically my second mother. About ten minutes after I accepted the position she was calling me crying down the phone she was so happy.”

“Well, before she gets here, let me be the first to say welcome to St. Thomas’ Memorial. Strap yourself in because this place is a wild ride on the best of days,” Phil said, shutting the file he was working on and smiling at Dan. “Let me give you a quick rundown of trauma one down here. See those three beds over there? That’s called center stage, that’s where people who’re at death’s doorstep go so we can bring them back. There’s a platform a few steps up above, behind the wall, where all the medical students and interns can watch what’s happening.”

“Stealing my tour from me, Lester?” a voice called from behind the boys. They turned around and were greeted by a stocky, middle-aged woman who was already bustling around the doctors’ station before even saying hello. She smiled warmly at Dan and opened her arms for a hug. “I haven’t seen you in almost five years and here you are back with me. Good to have you home, sweetheart. Now, come with me and I’ll give you the official tour. Don’t listen to what Lester said.”

“Hey, why not?” Phil joked along with Anne, pretending to act offended.

“Because you’re not queen of this A&E, Phil, that’s me,” she said over her shoulder.

“And I’m sure she reminds you lot of that daily,” Dan joked, bringing out Phil’s contagious smile.

Anne smiled at Dan as she caught him staring at Phil. “Phil’s a good kid, great doctor, and the sweetest person you’ll ever meet. A bit out of the box just like yourself—you two will get along quite nicely. I’m going to grab some of the residents and we’ll take a quick tour, sound alright?”

Dan nodded. “Yeah, perfect. How many are there?”

“Four, and as an attending you’ll be in charge of supervising them. This is a teaching hospital so we expect them to make mistakes and learn as they go. Try to steer them away from the delicate patients at first, just test the waters with them and see how they do. Follow me, we’ll go grab them now,” she said, bustling down the corridor with Dan in tow.

There was a group of four young people, two guys and two girls, standing over by the entrance from the employee area of the hospital to the accident and emergency department. "Welcome new residents, to St. Thomas Memorial hospital. I'm Anne Williams, the senior A&E nurse and assistant director of the residency program here, and this is Doctor Howell, one of our attending physicians. Over a thousand doctors applied for your position at this hospital and you are four of the lucky group chosen for these residency spots. We’re partners with the world-renowned Angels Memorial Hospital in Los Angeles, which Doctor Howell can tell you all about some other time, because right now, we get to give you the grand tour of the epicentre of the hospital, the accident and emergency department. Follow us.”

The doctors followed Anne around while she showed them center stage, the “sides” of the A&E where stable patients and others who were waiting to be seen were kept, and the waiting room where Doctor Lester was back out treating patients who needed minimal care. “Now, when that board behind the doctors’ station says ‘code black,’ that means all hands on deck. The color code system is how we keep track of how many patients there are compared to us. Code green means light traffic, yellow is moderate, red is heavy, and black means all bets are off. For right now, the only time you residents are allowed to be on center stage is when you’re called there by an attending.”

“How often do you go into code black?” one of the residents asked with an American accent.

We go into code black just about every day,” Anne replied. “Since we’re an NHS-funded hospital, legally we can't turn anyone away, which makes for some interesting days and nights here.”

-

About a month later, Dan was settling into the job much better than he’d expected. Everyone at the hospital was team- and patient-focused, the residents he was in charge of were attentive and intelligent, and of course, seeing Phil almost daily was a highlight. In getting to know Phil, they found they both had a lot in common. A few of their shifts each week lined up, and sometimes they would share a cup of coffee or an early morning breakfast together.

Phil stopped Anne one day as he continued to watch Dan working on some paperwork intently by center stage. “Anne, I just want to make sure I'm seeing this right. Does Doctor Howell’s mug say ‘male tears’ on it?”

She glanced at Dan and then back down at her own paperwork with a chuckle. “Yes it does. I’ve known him for a long time, and that’s a very good summary of his personality. He takes his work seriously, but he doesn’t take himself too seriously.”

“One more question, again I want to make sure I'm seeing this right, is he stirring his coffee with his finger?” Phil asked, his eyes falling to Dan’s long fingers and admiring how one of them swirled around in the porcelain mug.

“Hot chocolate,” Anne corrected, “he doesn't drink coffee anymore. And yes, I swear he's a superhuman that doesn't feel pain or something. He does that all the time.”

“He's an A&E doctor who doesn't drink coffee? In my world, that’s practically blasphemy.”

“It’s no secret around here that you ingest an unhealthy amount of caffeine. It’s a wonder your heart hasn’t exploded yet. Ask Howell about when he used to drink two quadruple espressos by noon when he did his work experience with a legal firm though.”

“Not a doctor’s office?” Phil looked down at her with an eyebrow quirked up.

“Doctor Lester, might I remind you that you did your work experience at a veterinary clinic, and you passed out on your first day of your residency here. Now if you've gotten all your questions about the pretty new boy you have a crush on out of the way, follow me—we’re on sides tonight unless center stage needs us.” Anne finished her sentence by smacking Phil playfully in the chest with a folder.

Phil could feel his face heating up with a blush. He stuttered as he followed after Anne. “What? I don’t have a crush on him!”

Anne laughed. “Sure you don’t,” she said incredulously. “I might be old, but I know you better than you think I do. I know and see everything my kids do before you do it. You’re acting the same way around Dan that you were around that nurse Josh you saw for a while—thank God that didn’t work out by the way. Dan’s much better for you. File I handed you is a tier three, female, 13 years old, broken left foot and sudden-onset bone infection at the break. Complaining of pain in the leg for a while as well.” Phil rolled his eyes at Anne’s playing matchmaker and nodded, opening the folder in his hands and glancing over it. He whisked back the curtain and was met with a pale-looking young girl and her mother.

“Hi there, I’m Doctor Lester. You must be Carissa,” he said, sitting on his small swivel stool and smiling at his patient and her mother. He pushed his glasses up a bit higher on his nose and looked back down at the folder. “So, we have a broken foot and some infection symptoms, huh? How’d this happen?”

“Um, we started learning how to go up en pointe at ballet class tonight, and I did it wrong and hurt my foot.” She sounded scared. She had to be in a lot of pain, especially because of the possible infection, and her mother didn't look too happy with her.

“How long will she be out of commission? She's got an audition coming up for the Royal Ballet’s Nutcracker. It's vital to her dance career that she get this role,” her mum asked, clearly upset about it. Tiger mums were always the worst to deal with.

“Well,” Phil started as he pulled on some gloves and examined Carissa’s foot. “Depending on how severe the infection and the break are, I’d say around eight to twelve weeks. From what I can see right now, the break doesn't look too bad. Nothing protruding through the skin, no major bruising, nothing that would tell me it needs any surgery. Based on where the swelling is and the way she was putting her weight on it, my best guess is that she probably broke it somewhere up in the middle of her second or third metatarsal, maybe in the growth plate as well. To know how severe the infection is I’m going to have to run an x-ray on her. We’ll get her queued up for one and have her patched up in a few hours.” He grabbed her file and gave it another quick look. “I just want to find out the source of the infection as well so I can know how best to treat it. Are you diabetic, perchance?” Carissa shook her head no. “Okay, so in that case the infection is probably bacterial. Anne, when I head off to call radiology could you pull some blood for me?”

She showed Phil two vials of blood already drawn and labeled. “Always a step ahead of you.”

“Right, I forgot that joke is only half true,” Phil said with a smile. “Nurse Anne’s like magic, she knows everything we all do before we do it. I think she can read our minds or something,” Phil joked, hopefully calming Carissa down a bit.

“Alright, cut it with the jokes and just fix my kid. What is this, your first day?” the mum snapped.

Phil pushed his glasses up again and stared at the mum in disbelief. Anne cut in for him, as she knew Phil wouldn’t defend himself against a mum like this.

“He’s been an attending physician here for two years, and we’re the best Accident and Emergency department in England. If you’re questioning one of my doctor’s ability to do their job, you can kindly find yourself another A&E, or you can let us work. We could fix a broken foot with our eyes shut.”

After a few brief moments of silence, Phil awkwardly motioned to the phone on the wall behind the desk. “I’ll go get that x-ray queued up,” he stuttered, and when he noticed that Doctor Howell was using the phone, he almost tripped over his own feet as he walked over. Dan chuckled and hung up.

“Are you okay? That’s the fourth time you’ve tripped or fallen this week and it's only Monday,” Dan said, finger in his drink yet again.

“Oh, yeah, I’m fine. Me tripping and falling is a regular occurrence around here.” Phil tried to form a complete sentence as he stared at the doctor standing in front of him. One of the nurses, Louise, walked past the two of them and muttered something about what Phil said being an understatement, which made Phil’s face heat up with a blush and Dan smile after her. He looked back at Phil and glanced down at the shoes he had on.

“Cool shoes,” Doctor Howell stated matter-of-factly with a bit of a laugh.

Phil was a bit confused for a few seconds, then he remembered he’d customized his trainers and put ‘cool shoes’ on the tongues of them. “Oh, thanks. A bit of stupid humor on my part to brighten up my day I guess.” He set the file in his hand down on the doctors’ station, flipping through it as nonchalantly as he could manage. “I like your mug by the way.”

Dan laughed and smiled a lopsided, happy smile that made Phil’s heart skip a beat. “Thank you, that was a joke gift from a friend when I graduated from medical school. My entire life at this point is one big joke, so why not carry one around with me right?” he asked as he took his finger out of his drink and put it in his mouth, sucking the hot chocolate off of it. Phil had to remind himself that it was rude to stare, no matter how hot someone was. His mind jumped to places it really shouldn’t have in the middle of a shift, but he regained his composure rather quickly to answer Dan and finally call radiology to queue his patient up for an x-ray. What he actually said was beyond him, but as long as he didn't put his foot in his mouth too terribly, he was fine.

While he was on the phone, Dan’s pager went off, and he ran towards the ambulance loading ramp. Louise immediately took his place. She practically vibrated with excitement while Phil talked to radiology, and when he hung up the phone she grabbed his shoulders and shook him.

“My Philly’s got a crush on Danny,” she sing-songed at him, her pink curls bouncing a little as she did.

Phil tried to play it cool, but he always was a terrible actor. “No I don’t, what are you talking about?” he said, “and don’t call him Danny, he hates it.”

“I know, and you hate being called Philly too. That’s why everyone calls you that, Philly cheese steak,” she joked.

“I’m not gross American food, Louise, I’m a doctor,” Phil deadpanned while he logged everything that had just happened with Carissa into the computer. “Don’t you have patients to see or something?” he asked, looking at her over his glasses.

“You age yourself about ten years when you do that,” she said with a laugh, shoving his shoulder. “And no, I don’t, I’m on my break right now.” She sat in the swivel chair beside Phil, kicking her feet and spinning around a little. “But back to your crush–”

“I don’t have a crush,” Phil insisted as he pushed his glasses back up on his nose and turned back to the computer.

“Yes you do—stop denying it. Do you know if he’s gay too? Have you two met before or something?” she asked, looking over Phil’s shoulder at his computer.

Phil rolled his eyes where she couldn’t see. “Yeah, all of us gays have a special app on our phones so we can track each other and know where every other gay is in the world at all times. No, I don’t know if he’s gay, but I can appreciate an attractive guy when I see one—that’s all. I’m too focused on the hospital for anything else right now anyways.”

“Didn’t stop you with that nurse Josh,” she said, and Phil rolled his eyes again. “Weren’t you two engaged?”

Phil faked a retching sound at the second mention of his ex-boyfriend’s name. “God, that’s the second time tonight someone’s brought that train wreck up. Close but not quite. I had rings, but after I found out he cheated on me I called it off. Good thing too because he’d been cheating on me since the beginning with another doctor. Remember that surgeon, Doctor Strathmore?”

“Josh cheated on you with Bryce Strathmore?!” she gasped in disbelief. Phil nodded. “Is that why he left?”

“That’s why both of them left. I hear they're married now. Gross right? You better get up by the way—Anne’s coming, she’ll have your head if she sees one of her nurses sitting down,” Phil said. Louise rolled her eyes and bumped her shoulder into Phil’s. “Now if you'll excuse me I have to bring my patient up to radiology.”

-

Phil waited for the x-ray to appear on the screen in front of him after Carissa and her mum had been brought back downstairs, tapping his fingers rhythmically on the table. “I don’t know, I have a bad feeling about this one. A break doesn’t usually trigger an infection within just a few hours.”

“What if the break is a side effect of something else?”

Phil pressed his lips into a thin line. “Have you gotten the blood tests back?”

Anne nodded. “Yes, and they were inconclusive for an infection.”

Phil took his glasses off and groaned, rubbing his face and carding his hands through his hair. “Of course they came back inconclusive. Here, maybe the x-ray will tell us something. You can usually see bone cancer as white masses on the bones, right?” He put his glasses back on and clicked around on the screen a few times, pulling up Carissa’s x-ray. All the air rushed out of his lungs when he looked at where the break in her foot was. It looked completely normal, no signs of cancer or infection to be found, even though all signs were pointing to it.

“We’re missing something here. If it is sarcoma then we’re missing something huge,” he said, sitting back and motioning to the screen. After a few seconds he sat up so fast he almost knocked his coffee over. “Wait, the pain in the rest of her leg. She’s a dancer, so they probably assumed it was a muscle strain or something, but what if that’s where the something huge is hiding? You tested her blood for infections, not for cancer. Run the tests again and look for cancer markers. I’ll order an MRI on her too. On the whole leg, not just on her foot. It could be on one of her other bones, and we just missed the actual tumor itself. Sarcoma develops on larger bones, not small ones like metatarsals. Whatever this is isn’t in her foot, it’s spreading from somewhere else.”

Anne nodded and bustled out of the room, leaving Phil alone. He looked at the computer screen one more time and muttered to himself, “We’ll figure out what you’re trying to tell us, Carissa. I promise.”

-

After another three hours of trying to piece together what was going on, they finally arrived at a diagnosis, and it was cancer as Phil had thought. Having to deliver that kind of news to someone so young was heartbreaking, and after shift change he sat in the staff room trying to decompress and process his own emotions. After a half hour of being alone, the door opened slowly and a familiar face peeked in.

“Hey. I heard you had a bit of a rough night,” Dan said as he slipped into the room and gently hip-checked the door shut. He had two mugs in his hands, his own male tears mug and Phil’s mug with cat whiskers on it. “I know it doesn't solve all the world’s problems, but a spot of hot chocolate can't hurt right? I made it with almond milk, I hope that’s okay.” He handed Phil the drink and sat across from him, a soft smile painting his lips.

Phil couldn't help but chuckle and say his thanks. “Have I ever mentioned you're the best?” he asked, locking eyes with Dan.

Dan’s own smile got wider and he nodded. “Once or twice, yeah.” They sat in relative silence for a few more minutes, until Phil noticed something.

“Wait, you're not in your scrubs. What time were you done?”

Dan checked his phone and shrugged. “Like two hours ago. Anne told me what was happening with you and your patient. I figured you'd be wiped at the end of a diagnosis like that.”

“You were on center stage all night and you're worried about me being tired?” Phil said in disbelief. The fact that Dan was more worried about him after the night Dan had was beyond comprehension. “Are you secretly a superhuman or something?”

He shrugged again and smiled at Phil. “We’re doctors. Our job is to take care of others, and it seemed like you could use someone to take care of you tonight.”

“Well, Doctor, your prescription of a cup of hot chocolate with a friend is just what I needed, I think.”

Maybe Phil did have a crush on Dan. And that was fine with him, he was still sure nothing would come of it. He wasn't looking for anything serious, but having a friend around the hospital who he could be his genuine self around was more than he could've asked for.