Chapter Text
This is John. He's a sports surgeon. He used to be a trauma specialist, but after finishing a double RAMC tour to impose western democracy upon Afghanistan (which didn't quite stick now did it) without a scratch on him, he decided he'd had enough of gruesome injuries. Besides, coming back to England would mean a practice safer and a lot more boring than wartime orthopaedics. For many war-weary army doctors, those would have been features instead of flaws, but John has a chronic craving for excitement and adrenaline he isn't always willing to admit to.
One of his army mates had been a professional athlete before joining the service, and he'd got John interested in the medical challenges of such a lifestyle. Instead of trying to get grannies to use their repaired hips at least a little, he would be trying to prevent professional athletes from putting their newly repaired tendons, muscles and bones to extreme duress too soon.
Sports medicine has brought him here, to a fancy London hospital in the private sector. Not by choice but because that's where his patients are. They are flown in with private planes to stay in hotel penthouse suites while recuperating. John knows these young men and women earn seven figures a year, and sometimes to has to work hard to not let it bother him. You see, he would freely admit to being a bit of a socialist when it comes to medicine: money shouldn't matter in getting the best care is what he's ranted about to his uni mates and fellow doctors many times. Some of them would laugh to discover what's become of him now.
Of course even John understands that normal NHS waiting times are simply too much for footie, rugby and ice hockey stars; a single season can be a career-breaking moment for them, and even a short absence a disaster. Getting treated at their clubs' expense in the private sector means that they won't be clogging up public healthcare resources. Still, John can't always push away thoughts of all those grannies at NHS hospitals waiting days for surgery for a busted hip. He's only one man; he can't fix a broken system single-handedly, but he can make sure that his patients — who are as worthy as all the public sector ones, of course, just with very specific and high-maintenance needs — get the best he can offer.
Occasionally, non-athletes show up at his appointment rooms. He enjoys that, too. If there's a new name on his booking list he doesn't recognise, he sometimes googles them and learns about sports he wasn't even aware of.
This morning, however, he's got no time for that. Rather than curious about new cases, he's annoyed, because someone has shoehorned in an appointment on his sacred morning paperwork hour. Instead of a leisurely cup of coffee while reviewing patient files and checking his dictated surgical notes from yesterday, he'll be trying to diagnose and plan treatment for someone without so much as access to their prior medical records. There is nothing on the patient in their system, and he won't have time to provide the calisthenics to get access into their NHS records with mere minutes to spare.
John straightens his M&S tie, painfully aware that it looks and feels so much cheaper than his colleagues'. He just can't bring himself to part with enough hard-earned cash to buy one from a proper gentleman's boutique. It would cost more than his dad had probably spent on money at any single occasion in his entire adult life; the whole family had to rely on thrift shops and hand-me-downs.
It's still four minutes to the scheduled appointment time when a sharp, demanding knock sounds from the other side of the door, accompanied by snippets of two men being snidely argumentative in the hallway.
"A moment, please," John barks at the door. In protest, he doesn't spring to his feet but takes his time to down the last of his coffee and to wait for his computer to reboot; the dratted calendar app has crashed again. The private sector may provide many cushy perks to specialists, but well-functioning, reliable IT is not one of them. Perhaps it's a pipe dream for the healthcare sector.
After deciding that two minutes of waiting is enough to demonstrate who holds the power over the proceedings this morning, John rises to his feet, squares his shoulders, snaps his jaw up into the same angle he'd use at parade rest, and begins his workday.
Upon opening the door, he discovers, that his ears had made the right diagnosis: there are two men in the hall, both dressed in long woollen overcoats, unbuttoned. One wears an impressive array of carefully curated tweed underneath, the other a sleek, black suit. John can tell which one is his patient — the black-suited, skinny one hasn't stuck his left hand in the coat sleeve at all, because his hand is in a white cloth sling tucked against his middle. Generally, when John's athletes arrive with upper limb injuries, said limbs are always strapped into fancy, colourful and ergonomically designed support slings, not what looks like something that's been dug up from someone's coat pocket or car trunk where it has lived for years as a part of those rag-tag first aid kits car manufacturers gift with new vehicles.
"Mr Holmes?" John starts, looking expectantly at the younger man.
He gives a glareish glance to his older, balder companion. "He's Mr Holmes." There is more than just an undertone of snideness in the declaration.
John's eyes flicker back and forth between the men. "Apologies. My list said wrist injury, so I assumed––"
The older man, an epitome of an Englishman whose hairline probably recedes faster than their patience, extends his hand. "Mycroft Holmes. This is my brother Sherlock. He is the patient, and prone to trying to distract everyone by being difficult when he's in need of medical attention. I am here to mediate the proceedings."
John shakes the hand, slightly disturbed by how this man is taking over all the attention by just, well, existing calmly. After releasing Mycroft Holmes' thankfully dry hand, John leans slightly to the left to focus on his patient. In contrast, Holmes the younger seems to want to exist anywhere else but in this hallway. "What should I call you, then, sir?"
There is an eyeroll so artful John is tempted to laugh. He suppresses the urge with the skill of someone who's had to stifle his amusement many times at the antics of patients and fellow soldiers.
"Anything but sir. Sherlock is fine."
"Sherlock it is, then. After you," John prompts, opens the door wide and lets the two men in.
* * *
John is proud of his rooms. They may be more spartan in decor than some of his colleagues', but they are still an entire ladder up from only having a banged-up locker to his name at his prior, public sector and army jobs.
There are two comfortable armchairs in front of his desk, but it appears that this Sherlock prefers to stand. He looks uneasy, and something about his skittish manner makes John suspect it's not just pain that's making him restless.
"You are a sports surgeon, then?" Sherlock asks, eyes roving the photographs and awards and orthopaedic textbooks on John's shelves.
"Yup." John wonders what options Sherlock thinks there are to what sort of a doctor he's arrived at. Something tells him Mr Holmes Sir the Senior has booked this appointment. How the hell has he managed to get John's secretary to shove it in against his explicit instructions that no patient should ever be booked on his paperwork time?
"You'll have to forgive my brother," Mycroft Holmes says, having taken a seat without prompting. He is leaning his palms on an ornate umbrella, the sharp tip of which will probably dent the maple floor. "He is not fond of healthcare facilities and isn't aware of how lucky we are to have this appointment. Mr Watson is a very busy man," he adds, now directing his words to Sherlock who is inspecting John's framed Imperial College diploma, "I have it on good authority that he is one of the best in his field."
"On whose good authority is that?" Sherlock snaps. "One of your athletic sportsman friends you do so terribly many daily sports with?"
It is easy for John to believe these two are brothers. The tone of the banter contains something intangible that resembles closely how John and his sister communicate.
A whiff of annoyance flits across Mycroft Holmes' expression, then settles like a wave on a pond. "Being a sports surgeon means he should be well equipped to consider your playing."
John perks up. Now they're getting somewhere in this discussion. "What do you play, Sherlock?" Judging by the man's physique, John would bet on tennis. Or perhaps he's a swimmer. Or maybe track and field. Running, maybe. Dancer? Then again, the term 'playing' is not associated with those. Beach volleyball? John rather thinks Sherlock would look most fetching in those outfits or tight cycling shorts, but such thoughts must be put aside, professionalism and so on.
"He's a violinist" is not the answer John was expecting. It is delivered by Holmes the balding-and-venerable.
"I'm a consulting detective," Sherlock corrects, taking his cape-like coat off with practiced flourish though he's only got the use of one arm as he lands himself into the other armchair.
John takes a seat across the desk. "Consulting detective? Is that like a private eye?"
Sherlock starts to protest: "I'm not some amateur looking for lost cats and chasing unfaithful spouses. I assist the police in matters of utmost importance––"
"It's a self-invented occupation," Mycroft interrupts dryly. "One that entails hurtling oneself out of windows and falling into skips."
The older Holmes pronounces the word 'skips' with such bewildered and disapproving superiority that one might think such things as waste management cannot possibly transpire in his sartorially elevated existence. John takes a moment to try to guess what the man does for a living. John doesn't follow politics, but if this was a cabinet minister, he imagines he would have heard the name before. Maybe he's some stuffy mid-tier official?
"I was chasing a suspect!" Sherlock hisses, then mutters something under his breath at his brother. "I haven't asked for your opinion on my profession before and won't be doing so in the future so save your jam tart -soured breath."
"I do believe that chasing dangerous individuals is a task for the police, not… an enthusiastic hobbyist."
This bickering is eating into John's precious time. He needs to take control of the proceedings. "Is that how you injured your hand, then, Mr–– um, Sherlock?"
Now that he has shed his handsome coat, John can appreciate the man's lithe physique even better. If he hadn't been told otherwise, John might still be convinced he must be an endurance athlete.
Sherlock shrugs. "The skip wasn't as full as I expected."
John grabs a pencil and notepad. He likes to do things the old-fashioned way instead of typing up notes during appointments to save time later. "Have you had any prior injuries in the same limb?"
Another shrug. "Bits and bobs."
"A comprehensive record of them shall be provided," Mycroft Holmes assures John.
"Anything with long-term consequences?"
"I've a finger tendon that keeps snapping," Sherlock says. "Anything you can do about that?"
"I'm not a hand surgeon per se, but I know many good ones. I can get you a consult."
"I didn't come here to be referred to someone else."
John can't help but wonder why it is that Sherlock has come here, then, because he doesn't seem very enthusiastic about getting his current, acute injury assessed and fixed. Though it's hanging securely in the makeshift sling, he's cradling the limb as if trying to shield it from John's prying eyes.
"Any regular medications?" John asks.
There's a pregnant pause, during which Sherlock glares at his brother, who has raised his brows in what could only be described as an accusatory manner.
"No. Nothing," Sherlock declares.
"Allergies?" John asks.
"Penicillin."
"Good to know."
"Why?" Sherlock demands. "If it's a broken bone, it can't be fixed with antibiotics."
"No, but we often administer some at the start of an operation. Can you tell me how, precisely, you injured the hand, and what part of it is giving you trouble now?"
"It's my wrist. I landed arse-first, probably tried to cushion the fall by sticking my hand out. It hit a spot where there was nothing on the bottom."
"Typical story for a wrist injury, trying to stop a fall with an outstretched hand," John replies with a nod.
"I'm not 'typical'," Sherlock declares hotly, as if John's just called him something much worse.
"You certainly aren't," John mutters, and puts away his pad. He then shifts his gaze from Sherlock to his brother and back. "Would you prefer for your brother to step out while I examine you?"
"Yes, please," Sherlock says, and it's the first time he's sounded even marginally eager to participate in his own care. "Out!" he directs at Mycroft Holmes, making a shooing motion with his hand. "You've done enough."
"Very well. I shall wait in the hall. Do recall me when it's time to formulate a plan. I should want to hear it from the good doctor here, since you have a tendency to twist facts to your liking when reality inconveniences you."
"That's your MO. You fix elections to your liking when you get bored. Give the Taliban a bit of a boost just to enliven your lunch hour, hm?"
With pinch-blanched lips and a click of his umbrella on the hardwood floor, Mycroft Holmes makes a tactical retreat into the hallway.
John goes to the exam table set up in the corner, makes sure there's a fresh two metres of paper sheet pulled out to cover it, and pats it. "Shall we?"
Sherlock unravels the sling and unbuttons his dress shirt's cuff, but makes no move to rise from the armchair.
"I'll need to see more than just your wrist. Did you bang up anything else when you fell into that skip?" John interrogates. Perhaps Sherlock will be more forthcoming now that the brother has been evicted. John is reminded by obstinate teenagers who think their parents are too lame to exist.
"Nothing noteworthy."
"Just your pride, then?" John smiles.
Sherlock averts his gaze. "What do you want me to do?"
John pats the exam table again. "Take your jacket and shirt off, and hop on here."
"I have a wrist injury," Sherlock reminds him. "Wrist, as in the anatomical region between my hand and my elbow."
John thinks the patient could add "smartarse" to that list of anatomical features. "And they're all part of the same limb. I need to assess muscle balance, joint movement and how the entire limb functions in different everyday situations. For that, I need to actually see how the joints and the muscles look when you use them."
Sherlock considers this, and finally decides to look appreciative. "Logical. That's not what they did before, though." He starts removing his jacket, and John hurries to assist him since the wrist is obviously giving him some trouble.
"Who are you talking about?"
"People like you. At A&Es."
"Doctors, you mean? Staff? What did they do, then?"
"Do a cursory check that whatever I'd injured wasn't about to fall off or bleed me to death, then told me to piss off."
"Were you as polite at those times as you are now?"
A pair of piercing, green-blue eyes locks onto John's. "Does it matter?"
John sniffs and steps aside to let Sherlock climb onto the table. "You got me. It shouldn't. Mind you, NHS A&Es can get quite snowed under, especially in slippery weather––" his words trail out when Sherlock arranges his injured wrist to rest on his black trouser -clad thigh, and the movement and extends his opposite elbow. There's a trail of old, scarred marks there, their origin unmistakeable to John: intravenous drug use.
It all clicks into place, now: the awkward, angry exchange about regular medications, the reluctance to undress, the dislike of medical facilities. Sherlock Holmes doesn't look like he is uses anything illicit currently, though John is too streetwise to assume that someone who dresses well, puts product in their hair and enunciates like a scholar couldn't be a drug user. But these marks are old, and Sherlock seems to be… somewhat employed. Nothing in his eyes or behaviour or current neurological performance suggests intoxication. In his years as an intern, registrar and consultant manning London's various trauma departments, John has learned that it's best to be honest and open about these matters, to just go ahead and ask things instead of trying to avoid a topic such as addiction. Users are often much less awkward about it than other people are.
"Sober?" John asks simply. He gently cradles the injured wrist on his own forearm while testing the range of motion of Sherlock's elbow and shoulder joints.
"Two years." Sherlock inhales through his nose. "Though…"
John looks up. "Hm?"
"Didn't have anything in the house for the pain. Well, except for…"
"Doctor-patient confidentiality, Sherlock. If you're worried about your brother, I want to assure you nothing you tell me leaves this room. Or enters his ears."
"Oh, he's probably got this room bugged. Had all night to do it."
At first, John continues his examination, but then stops, blinking, when nothing in Sherlock's expression shifts to signal he is attempting humour. "You're joking."
"Never, when it comes to him. He's the most dangerous man you will ever meet — and the most ridiculous."
Sherlock flinches when John slides his fingers onto the slightly swollen wrist joint. "Apologies."
"Do what you must." Sherlock looks like a man who's used to surrendering to his fate when it comes to medical care. "At least here I'm not being manhandled and ushered out the door at the first opportunity."
"I know there's some fucking winners with not very Hippocratic attitudes working at A&Es, but I promise you we don't work like that here. Even though A&E staff have to deal with aggressive users and drunken idiots every shift, you areright — it's no excuse."
John remembers occasions when he's been less-than-patient with people who've done dumb things while under the influence and feels a pang of guilt for all that now. They're all still his patients, and he was supposed to advocate for them. Not everyone has a dangerous and ridiculous brother to drag them to a fancy sports surgeon when they fall into skips. Some of them live in skips.
John is done with the larger upper limb joints and moves on to testing how the sensory and motor functions of Sherlock's fingers are doing. Next, he takes his time to feel the contours of each wrist and metacarpal bone. Sherlock has large but delicate hands, proportionally long fingers, and well-defined forearm musculature; it's easy to believe that he's spent thousands upon thousands of hours holding a bow to coax beautiful music out of a violin.
"Can't say for sure about the scaphoid since those fracture lines can be elusive and don't often cause much swelling, but I don't think there's a risk of any other kind of fracture. It's important to rule out a scaphoid fracture at this point so that we can get it operated on; those can fail to fuse well and could give you trouble for a long time."
He lets go of Sherlock's hand, and the younger man hops off the exam table to retrieve his clothing. "Because the scaphoid is poorly vascularised as opposed to its neighbouring bones?" he asks John.
"Precisely." John is impressed. "Is that something a consulting detective needs to know?"
"It's impossible to predict what knowledge could be useful."
"So you collect all sorts, then?"
Sherlock doesn't respond. John goes to help him, holding up the silk garment so that Sherlock can slide his slightly swollen wrist inside carefully. "Most likely what you've got is partly torn tendon without a fracture, but I'll need an MRI to be certain."
"I assume I'll receive a letter about the appointment time for that."
John goes to his chair behind the desk and start typing up an MRI request. "We can do the imaging right now, if you want."
Sherlock stops trying to wriggle back into his jacket. "What? I thought you said MRI? I thought the waiting times are months for those."
"This isn't the NHS." John tries to infuse the words with pride over the establishment he works for.
Sherlock's eyes narrow. "That bothers you."
Feeling caught out, John tries to look dismissive as he fires off the MRI request and looks up at his patient again. "What makes you say that?"
"Your tie is from a recent M&S collection, cheap but not as generic in colour and design as one might expect. For you, even such a relatively inexpensive accessory is a treat, unlike for your colleagues, though you must earn quite a good wage in your position. Your comment about the NHS was half-apologetic, not disapproving, which means you carry some kind of a torch for public healthcare. Your attitude didn't change when you saw my veins, which means you don't assign value to patients based on their lifestyles. Your office is furnished quite sparsely, with high-quality furniture but nothing flashy. You've hidden some of your diplomas behind potted plants, which means you hung them up because that's what you assumed was expected, not because you wanted to show them off. Your posture screams military, so you're used to living economically and sticking to routine; perhaps the freedoms and perks of private healthcare have not quite rubbed off on you yet. I hope they never will," Sherlock declares at the end of this analysis, and then crosses his arms and leans back in his chair, looking rather pleased with himself.
"Anything else?" John asks, a hint of a smile playing on his lips.
"You've an alcoholic brother."
"How could you possibly––" John shakes his head. "Sister. But that's not the point; we're here for you."
Sherlock sighs theatrically. "MRI up next, then."
"Would you like me to ask your brother to come back in? He wanted to hear about our plan?"
"You can tell him you've recommended an emergency fraternectomy with a side order of breast enlargement."
They rise to their feet, sharing a grin that's not entirely appropriate. John isn't certain anything this patient ever does would qualify as such; Sherlock seems quite the bohemian.
John gives him the printout his laser HP has just spat out. "Third floor, follow the red line on the floor and that'll get you to radiology."