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The kettle is singing, and even though it’s Sherlock who wanted tea, it’s me who gets up to make it. Not much of a surprise, is it. Sherlock is sitting in his armchair, his fingers steepled, his chin up, his eyes glued to the ceiling. Don’t ask me why, I haven’t a clue. I know he’s got two nicotine patches on, which suggests there’s a problem to be solved, but there’s no case on right now. I haven’t bothered to ask him yet, though there are a series of newspaper articles torn from various papers resting on his knees. I could deduce.

I’m planning to ask about it when I bring him his tea. Place it on the table: then ask: what’s that you’re working on? And, genius that he is, he will take advantage of his ready and willing audience. Sometimes he can talk for hours, just connecting dots and musing on their meaning. A skull, you see, doesn’t ask. It just stares, unblinking. Me, at least: I make tea.

Two mugs, two tea bags: pour the water; most of the way to the top for him, an inch of space for me. Sugar in his, milk in mine. It’s such a simple process, I have no idea why Sherlock refuses to make his own. Probably because someone else will always make it for him. Why is that? What is it about him that makes the rest of us scamper around taking care of him? His genius, I suppose. And that he looks a little bit like a lost boy, gripping onto the only reality he can make sense of. Generally, when you think of the kinds of people others long to care for, the abandoned ones that get taken in, you think of truly kind people, people with great big hearts and a generosity of spirit, adorable do-gooders with big, teary eyes. Sherlock has none of these things, and yet everyone in his life (his brother, Mrs. Hudson, Lestrade, and of course, me) twist themselves into endless knots just to make sure he’s all right. That’s a special kind of gift he has, I think. Being all at once domineering, difficult, rude, thoughtless and sometimes straight out mean, but also earnest, confused, helpless and lost. Oh, don’t tell him I said “helpless”, he would flay me for that, no doubt. But I still think it’s true.

Set his mug beside him on the table. He hasn’t moved at all; fingers steepled, eyes on the ceiling, unblinking. I’m about to ask, what’s that you’re working on then, Sherlock? but instead I notice something.

A doctor is pretty much always a doctor, always mentally ticking off a list of signs and symptoms in the people he cares about. That’s true for me, at any rate, and every other doctor I know. We try to leave it at work, but it just doesn’t shut off. See a strangely-coloured bruise, or a limp, or hear a complaint about headaches a few too many times, you can’t shut off the part of you that starts looking for patterns, starts diagnosing. Most of my career has been about caring for extremely healthy young men and women with traumatic wounds, not run-of-the-mill family medicine, but the instinct, and the knowledge, is still there. If I’d been more like Sherlock I would have deleted large swaths of that knowledge once I accepted a commission, but I didn’t. I treasure it, I find it comforting. In the most dire and disturbing moments of my life I have retreated to it, mentally cataloguing the most mundane, ordinary signs and symptoms to keep myself sane and focused: there’s nothing like quietly diagnosing your captors with anemia, asthma, type 2 diabetes, hypertension, or hepatitis. I suppose it’s a means of feeling like you have some kind of control, or power, in a situation where you have none of either. At any rate: signs and symptoms of disease, any disease, are things I’m always unconsciously watching for.

So at this angle, leaning forward slightly to rest Sherlock’s cup of tea on the table beside him, with his head flung back and his eyes on the ceiling, I see something. A lump at the base of his throat, a protrusion. Something that shouldn’t be there. I stare at it for a second, the incongruity of it: his thyroid, too large, visible when his head is at an angle. How have I not seen it before? Immediately the causes rush into my head: iodine deficency? Unlikely. Hashimoto’s? Grave’s? Then finally: cancer? Unlikely. Rare. It’s probably nothing. Surely not.

He’s not a patient of mine, though we often act as if he is when it’s useful. He’s not my patient, he’s my flatmate, my friend, my best friend in fact, so my stomach does a little turn when cancer flashes through my head. But thyroid cancer is the “good” cancer, it’s the cancer you’d choose if you had to choose one. If he were my patient, really and truly, if he were just a bloke from off the street and I had my usual medical objectivity, I wouldn’t be feeling this spike of worry, this fear for him. I would know that the statistics are on his side. I would tell him that he’ll be fine, but he needs treatment. I would go back home and not think about him again. But he isn’t a bloke from off the street, and my objectivity is compromised.

The moment I opted to take the room upstairs, the moment I realized that Sherlock is not just my flatmate but is, in a way, my saviour, the cure for my depression and my psychosomatic limp and terrible nightmares, the deliverer of my newest purpose in life, the person around whom my life will now revolve; in that moment, I took on the job of making sure that Sherlock is all right, in conjunction with Mrs. Hudson and her biscuits and Mycroft Holmes and his formidable resources. That’s the trade off. Sherlock saves me; I save him in every way I can. I knew I’d have to save him from himself: keep him clean and sober, keep him from throwing his life away on pointless risks (like cabbies with pills and assassins with a penchant for throttling wayward consulting detectives). I didn’t realize finding and fighting cancer was part of the package.

It’s not cancer. This is a silly train of thought, and it’s time to hop off.

“Sherlock.” There’s a space for my own cup of tea on the table. I put it there, milky brown next to the filmy black of Sherlock’s. He takes a breath, but doesn’t move. “Sherlock.” Still nothing.

I move around behind him and put my hands on his shoulders. He starts. “You’ve got...” I’m not sure how to finish that sentence, so I don’t.

I don’t know which words to say; I’m a bit out of my element, standing here in my own sitting room, with my own flatmate. I’m wearing slippers, there’s no white coat, there’s no office around me, no receptionist giving me that look that means, can’t you move them through any faster? We’ve got a queue out here.

“I’ve just noticed something on your neck,” I try again. “I need to check it, okay?” He doesn’t resist. He relaxes, continues looking up at the ceiling, his fingers still steepled. It’s as though I’m reaching into his pocket to get his mobile, or some other oddly intimate thing Sherlock doesn’t think twice about. I move my hands up against his throat, fingers first against his clavicle, and feel.

His skin is warmer than I expect it to be; he’s so pale, so thin, I always imagine him being cold to the touch. Carved from stone. A perfect, marble impression of a man. But he isn’t; his skin is warm, soft like skin always is. I can feel his breath in, and then out again. I lean down and feel his hair on my face; he smells like shampoo (apparently he used mine this morning) and, strangely, gun powder. (What was he up to this afternoon?) I can smell his skin, a familiar smell that he carries around with him, impossible to describe. He smells alive. Whole.

I can’t imagine Sherlock being seriously ill. It’s as though there’s a part of me that doesn’t believe he’s entirely human, like he can’t possibly be susceptible to the frailties of the human condition. I smell the laundry detergent on his clothes, the smell of his skin, his hair, human, real, alive, I’m trying to put Sherlock and cancer in the same room and I can’t do it. If I have to take him through treatment, I think it might be the death of both of us. But no: it’s ridiculous to think like that. An inflamed thyroid gland is just an inflamed thyroid gland. It’s probably just a run-of-the-mill goitre. Maybe all the Holmes’ have one. It doesn’t mean anything. Why am I assigning him the worst possible outcome at a glance?

It’s unlikely. Not impossible, but highly unlikely. He will sense my concern; it will frighten him, even if he won’t admit it. Think of the statistics, not the fear. Not the concern. Reality. Shift fingers up from Sherlock’s clavicle: locate the gland, find its contours, feel for any abnormalities.

I know what it feels like, what I’m doing to him: it feels to him like I’m trying to choke him. I need to feel the edges of it, press in: it’s pressing against his trachea now, he’ll feel it, it’s uncomfortable, but he doesn’t move. I can feel him swallow once, twice: almost as if he’s trying to throw me off using only his esophagus. He sighs lightly, doesn’t move, doesn’t resist me.

His thyroid is definitely too large: about twice the size it should be, maybe a bit more. How have I not seen it until now? It’s been hidden by his tilted head, his chin dipping down toward his chest, behind a scarf, behind collars and fingers, but I should have seen it. Not paying enough attention. Damn it. Too large, and two distinct nodules. Hard; calcified? Can’t make that diagnosis now, need an ultrasound, a biopsy. Impossible to tell like this.

Sherlock rolls his head back farther and tries to look up at me upside down. He quirks an eyebrow. I take my hands off his neck and pick up my cup of tea, walk over to my own chair and sit down. I can feel his eyes on me the whole time. He says nothing, but his eyes don’t leave me.

“I think,” I say, trying to find the most neutral words possible, picking up a piece of newspaper that doesn’t appear to be earmarked as part of Sherlock’s current project, “I’m going to order an ultrasound and a biopsy of that, if you don’t mind.”

Sherlock stares at me, and I look back at him, but focus mostly on his right cheekbone. Ridiculously prominent. I can visualize his skull far too easily. He looks like an otherworldly creature, like a flower fairy, a Victorian etching. Maybe he’s a changeling, a fairy child added into the Holmes family, with magic in his blood. Would make him resistant to these human curses, that’s an advantage.

“Why?” His hand moves to his throat, he rubs the place where my fingers have been.

“Your thyroid is inflamed,” I explain, trying to keep my voice calm and certain. It’s much easier to do when I’m in the office, with a white coat on, with a stethoscope handy. “It’s probably nothing, but best keep an eye on it.” I take a sip of my tea, pick up the paper and pretend to read it.

“Right,” he says. A pause. “Will you do it?”

“No,” I say, glancing over a headline, trying in vain to concentrate on it. “Don’t have the equipment. Don’t know how to work the equipment, actually. I’ll write up a requisition for you. All right?” I look up at him. I can pretend to be nonchalant, I’m really trying, but I know he can see right through me. “It’s probably nothing. Goitres are usually nothing. Hereditary.”

“Right,” he says again. He closes his eyes, then re-steeples his fingers.

He never does drink his tea. It gets cold, and the following morning I pour it down the sink.