Chapter Text
Living at the Wayne Manor was weird.
Not in a bad way. Tim loved his new foster family (even though he still missed his parents at times). It was just so different compared to his previous living conditions. Bruce, when he was home, checked on him constantly, especially during his vest treatments. Dick and Jason were always making fun of him for being such a mother hen, but Tim didn’t mind. It felt nice to have an adult around to help him.
It had been six months since he’d called 911 on himself. Since then, Tim’s life had been filled with countless doctors’ appointments and new routines. His portable oxygen concentrator had become his constant companion – his lungs were just now improving enough to allow him periodic breaks from the nasal cannula. He did sessions with his CPT vest and nebulizers three times a day, oral meds in the morning and at bedtime, and special pancreatic enzymes with every meal and snack. Bruce and Alfred had him on a strict feeding schedule as well. He ate three high-protein, high-calorie meals per day with at least two or three snacks on top of that. Tim felt like he was always eating.
Though his new, chronically-ill lifestyle was overwhelming and more than a little scary, Tim couldn’t help but be amazed at how much better he felt. He had gone so long without proper treatment that he’d forgotten what it felt like to actually be able to breathe. He could feel the difference in every aspect of his life: his sleep was better, he could walk up and down the stairs without gasping, and his thoughts came faster and clearer. It was really amazing but proper oxygenation could do for a person.
“Eat shit, Dickface!”
Tim’s favorite part of living at the Manor, however, was having brothers.
They were currently in the game room playing Mario Kart. The three of them were all piled onto one of the couches with Ace sleeping soundly on the floor in front of them. His nasal cannula was currently set at 2L/min. He’d been off of it for most of the day, but Tim had just finished his afternoon treatments. He usually needed a boost for an hour or two afterward. His lung doctor, Dr. Holt, had explained that his lungs had a lot of catching up to do since he’d gone so long without treatment. At least both of his hands were free so he could participate in the game.
“Language, Jay,” the eldest Wayne boy replied mockingly.
Tim smiled to himself as he pulled into the lead ahead of Dick, just in time to win the round. He was actually pretty good at Mario Kart thanks to all the practice he’d gotten. He used to play all the time by himself whenever he was on break from school and his parents were too busy to hang out with him. Which, of course, had been most of the time.
“No freaking way!” Jason cried indignantly. “The shrimp won again?!”
Dick laughed and ruffled his little brother’s hair. “Don’t be bitter just ‘cause you came in last.”
“I’m not bitter!”
“Oh please, you’re so bitter, I’m surprised Ace isn’t alerting a low blood sugar.”
Jason rolled his eyes. “Wow, how long have you been waiting to use that one?”
“Not as long as it took you to cross the finish line!”
“Dickie, I swear, I am this close to yeeting your crutches out the window.”
The eldest Wayne tackled his little brother in an big hug. “Now, Ursuleț, there’s no need for that. You know I was just messing with you.”
Dick often referred to his loved ones using nicknames from his two native languages. His favorite one for Jason meant “teddy bear” (Tim had looked it up using Google Translate). Jason pretended to hate it, but Tim could tell it was quite the opposite.
“Get off of me, ya big octopus,” the younger teen complained, though he made no move to push his brother off. Dick was one of the very few people that was allowed to touch Jason like that. Tim wasn’t completely sure why. Bruce had just mentioned that the boy had some trauma from his upbringing and to be mindful of his personal space. Figuring Jason would tell him when he was ready, Tim had no plans to push the issue.
“Tell me you love me, and I’ll think about it.”
As the two continued to bicker, Tim felt a tickle building in his throat, as if something was stuck in it. He coughed a few times, but that only made it worse. Then, something moved, and suddenly, Tim couldn’t breathe at all.
Someone was yelling at him, but he couldn’t tell who it was over the roaring blood in his ear. When he opened his mouth, no sound came out. He couldn’t even cough anymore. He was like a fish out of water, desperate for oxygen but unable to obtain it. It was terrifying. He was terrified.
“Come on, Timmy, breathe for me,” someone (Dick, maybe?) ordered calmly, smacking his back a few times. The blows did nothing to dislodge whatever was blocking his airway.
He blinked, and then he was on the floor. Both Dick and Jason were hovering over him, but they were blurry. Everything was getting so blurry…
“Dad!”
Darkness.
Bruce was in his study getting some paperwork done for an upcoming hospital benefit when he heard Jason’s frantic cry for help. He immediately jumped to his feet and sprinted down the hallway to the game room, where the boys had been for the past couple of hours.
Tim was on the floor.
“H-he just started coughing, then he started making this horrible high-pitched sound, and then he stopped breathing entirely,” Dick explained shakily. “I tried banging on his back, but it didn’t do anything. Jason and I got him to the ground.”
Bruce dropped to his knees and immediately started assessing the boy. His radial pulse was fast and thready (but still present, thank God). His lips and nails were blue, signaling cyanosis. No noticeable chest movement.
“Dick, call 911. Jason, I need you to go get my bag from the foyer.”
While his boys scrambled to follow instructions, Bruce rolled up a blanket and put it underneath Tim’s shoulders and tilted his neck up to look inside his mouth. He couldn’t see any swelling or foreign objects, but that didn’t rule out an obstruction. He saw Tim’s pulse ox sitting on the coffee table and put it on the boy’s finger.
77%.
His stomach dropped. Tim was already wearing oxygen, so he cranked up the concentrator as high as it would go and waited a few seconds. No improvement.
Jason came running back in with Bruce’s emergency kit. Bruce ripped it open, grabbed the stethoscope, and placed it over Tim’s chest. It was completely silent. Next, he placed the bag-valve mask over the boy’s nose and mouth. When he attempted to give a breath, he was met with resistance. He tried tilting Tim’s head up further and performing a jaw thrust. Still no chest rise. Definitely an obstruction, then.
“Was he eating or drinking anything when this happened?” He asked as he got out the portable suction. He shoved the Yankauer into the boy’s mouth, but nothing came out. Whatever was blocking Tim’s airway was too deep for him to reach.
“N-no,” Jason replied. “He was just sitting there.”
His physician instincts told Bruce it was a mucus plug. Tim’s cystic fibrosis was improving every day, but he still had a lot of junk in his lungs, some of which was old and very thick. If a plug had formed and hardened before becoming dislodged, it very well could have gotten stuck in Tim’s larynx. And if that was the case, then they were quickly running out of time.
61%.
“Ambulance is less than ten minutes out,” Dick reported, rejoining the group.
Bruce cursed. Tim didn’t have ten minutes. If his brain didn’t get oxygen soon, there would be permanent damaged. He had to do something.
“Dick, take your brother out of here,” he ordered as he dug through his kit. He took out chlorhexidine wipes, a scalpel, his cricothryotomy kit, and some gloves.
“What the fuck are you gonna do?” Jason demanded.
“C’mon, Ursuleț, Dad needs to focus on Tim. Let’s go find Alfred then wait on the ambulance outside. Ace, follow.”
Calling on all of his years of training to remain calm, Bruce got started. He palpated the cricothyroid membrane just below the thyroid cartilage on Tim’s neck. Using the wipes, he disinfected the boy’s skin the best he could before wiping his hands off and donning the gloves. Then, he picked up the scalpel.
Now, it was time for the scary part.
Bruce had done a number of cricothyrotomies in his almost two decades of medical practice. Hell, he’d even taught others how to perform them. But this was different on so many levels. For one, he was in his house with very little supplies and equipment. Two, he was alone with no backup and no trauma surgeon to bail him out if things got messy. And three, this was not just another patient. This was his son. Maybe not legally (at least, not until the Drakes’ rights were fully terminated), but in every way that mattered. Normally, Bruce would never be put in the position to have to cut open his kid’s throat. But right now, he was all Tim had, and he’d be damned if he failed.
He started by making a small, vertical incision over the membrane. Then, he pressed the sharp tip into the opening until he heard a small whoosh of air. Blood and mucus dribbled out of both sides of the wound. Good. He was in the right place.
Now, he needed to secure it.
He removed the scalpel and used the tracheal hook to open the airway. Then, he inserted the bougie down into the trachea before sliding the cric tube in over it. When he was sure everything was in place, he pulled out the bougie and taped the tube in place before attaching it to the bag-valve mask. This time when he delivered the breath, Tim’s chest rose accordingly. He looked at the pulse ox for an update.
68%…74%…80%…87%…94%…
Bruce shuddered with relief. The boy’s color was already improving. Using the Yankauer, he suctioned around the cric tube to ensure it didn’t become clogged.
“You’re going to be okay, son,” he whispered, carding his hand through Tim’s hair. “I’m right here.”
Alfred came rushing in, wheeling Tim’s oxygen tank behind him. “Master Dick and Master Jason told me what happened. How may I help?”
Bruce squeezed another breath into Tim’s lungs. “His airway’s completely obstructed. Probably a mucis plug, if I had to guess. I had no choice but to cric him. His oxygen is stabilizing now.”
“Thank heavens you were home,” Alfred said, kneeling beside his charge. “I have not performed a cricothyrotomy in decades.”
Bruce cracked a smile. “Oh, I’m sure it’s like riding a bike. Thanks for bringing the tank.”
The butler nodded as he connected the mask to the oxygen and turned it on. “Of course, sir. I thought it best to come prepared. Poor lad.”
“How are the boys?”
“I believe they are both quite shaken,” Alfred reported. “They are outside on the porch waiting for the paramedics to arrive.”
Dread settled in Bruce’s gut. “You’ll have to keep a close eye on both of them. This might be big enough to trigger a migraine or confusion episode for Dick. And there’s no telling how Jason’s PTSD is going to react to this –”
Alfred put a hand on his charge’s shoulder. “I will watch over them, Master Bruce, just as I always have. Would you like to give them a quick update before the ambulance arrives? I am more than capable of ventilating Master Timothy.”
Bruce was very hesitant to leave Tim, even for a moment, but he needed to check on his other boys and make sure they were okay. And he trusted Alfred more than anyone.
“I’ll be quick,” he relented, handing over the mask in between breaths. “Yell if he starts to get worse.”
“Of course, sir.”
After shedding his bloodied gloves, Bruce made his way out to the front porch. Dick and Jason were both sitting down on the steps. Ace sat next to his handler, laying his head on Jason’s lap to ground him.
“What happened?” Dick demanded immediately. “Is he–?”
“He’s alive,” Bruce assured quickly before sitting down next to his boys. “His oxygen is stable now. Alfred is with him.”
Both boys sagged with relief.
“W-why did he stop breathing?” Jason asked, his voice scared and small.
Bruce took a deep breath. “Tim’s disease causes mucus to build up in his lungs over time. He’s getting much better, now that he’s being treated, but his lungs still have a lot of old, leftover junk to get out. I think what may have happened is some of that old mucus got lodged in his throat after his vest therapy. When he wasn’t able to cough it up, it completely blocked his airway, so he couldn’t breathe. I had to cut a small hole in his throat and insert a tube in order to be able to give him oxygen. I didn’t want you to be surprised when you saw him.”
“You slit his fucking throat?!” Jason screeched, his hands shaking. Ace let out a small whine and nuzzled his charge with his snout.
Dick put his arm around his little brother’s neck. “Bruce saved his life, Jay. He did what he had to do to keep Tim safe. That’s what he does, remember?”
“Dick’s right. The procedure was Tim’s only option.”
Jason buried his hands in Ace’s long fur. Finally, he nodded. “I-I know you wouldn’t hurt him. It’s just… scary, thinking of him having a hole in his throat.”
Bruce agreed. It was very scary. “I know, buddy. Once we get him to the hospital and they’re able to clear away the obstruction, they’ll be able to remove it. For now, I need to get back and check on him. I want you two to take care of each other while I’m at the hospital with your brother, okay?”
“Of course, Papin,” Dick assured. “We can hold down the fort. You go take care of Timmy.”
Bruce stood back up. He intended to do just that.