Chapter Text
Chapter One
Maybe it was the way Dr. Cox’s stomach churned when he pulled into his parking spot at his apartment complex, or maybe it was the tugging heaviness under his eyes that convinced him that there was something wrong. Something instinctual, animalistic almost, pricked at the hairs on his neck. He looked around the parking lot, searching for the embarrassing blue scooter that usually resides in the lot, but was now nowhere to be seen. Cox racked his mind for the memory that JD would be away tonight. As much as he tuned his partner out, he usually paid attention to his schedule, purely for logistical, carpooling reasons, obviously. JD hadn’t mentioned grabbing a drink with his scalpel-happy girlfriend, nor was he supposed to be at the hospital.
Perry emerged from his car in a flutter, a sickening gut feeling driving his urgency. He skipped the elevator, opting rather to climb three stairs at a time to his floor. His ears rang incessantly and his tongue was dragging against the roof of his mouth like sandpaper. He grabbed the door knob and stopped dead in his tracks when it didn’t open. If JD was home, the door would be unlocked. Light and music and the smell of delicious food would already be drifting under the crack of the door.
JD had left the hospital hours before Perry, and the circumstances were less than ideal, if Perry was being honest. If he was being completely honest, he’d pick quite the fight at work today. JD had been having a stressful go at it with the end of his residency, and Perry decided to push, even when JD had said stop. Before they’d gotten together less than a year ago, Perry would push and prod at JD as much as he wanted, calling him girls’ names and ranting for minutes on end about whatever forgettable mistake JD had made. Perry still did all those things now, but often knew when to stop.
Today though. Perry knew today was bad. He knew it when he was doing it, he knew it right after, and he knew it now, as he pushed his key into the lock and turned the knob. The apartment was dark and cold. Perry reached to drop his keys into the bowl next to the door, and there sat another set. They weren’t JD’s though. JD’s keys had goofy keychains and bobbles. These were sad. Lonely.
“Newbie? Are you here?” Perry toed out of his shoes and moved further into the house, “JD? Listen, I’m sorry, okay?”
The living room was dark, the couch empty. There used to be at least three blankets on the couch at all times, as well as coasters on the table and a taxidermy Labrador in the corner every other month. Considering he hadn’t recently witnessed a “custody transfer” of the dog, JD must have taken it out, along with the rest of the things that made this hellhole apartment into a home that Perry had begrudgingly come to love.
Perry rushed to examine the bedroom, finding only an empty side of the closet where cardigans once hung, an empty dresser that used to house pajamas and long-sleeve tees. He turned and stared at the large bed – neatly made, plain sheets, no throw blankets or stupid throw pillows that “pulled the room together.” Perry was panicking, feeling the emptiness drown him.
He looked toward the bathroom, fully aware that the counters and drawers were now void of hair products and “spa supplies.” The shower held but one set of soaps, none of the fruity “unisex” stuff Newbie used. God, Perry hadn’t realized how thoroughly JD had rooted himself into his life here. The apartment was so empty now. More than anything, it was silent. Perry sat on the edge of the bed, replaying the fight that had led him here.
—
Earlier that day
“Perry, wait up!”
Perry’s pace stuttered for only a moment, but he picked it back up when he saw how close he was to the elevator. JD hated it when he did this, but he couldn’t resist it — JD’s eyes always got so wide when the sliding stainless steel doors slammed shut in his face. Since they started dating, though, Perry had always hit the “open” button a second later to let the lankier man join him. He snickered as JD shuffled into the elevator and glared at him.
“I asked you not to do that. I’m always worried you’ll get my nose!”
“Then don’t have such a big nose, Lisa. There are doctors a floor up that’ll take care of that.” Perry flicked the tip of JD’s nose and smirked.
“Ow! You’re so annoying sometimes.” JD’s tone wasn’t as playful as it normally was. Nonetheless, Cox kept on poking.
“Just perfecting my ‘you’ impression.” He slouched his shoulders a bit and pitched his voice up before continuing, “oh gee, if only my hot older boyfriend would buy me a nose job, then he’d propose for sure!”
“Shut up, Perry. You’re being mean.” JD squared his body away from Cox and stared at the doors ahead of them.
“I’m just messing around Newbie.”
“Well I’m not laughing. You could have actually hurt me!”
“You’re the one who chased me down.” Cox mirrored JD’s irritation automatically, “What do you want?”
The elevator rang and JD crossed the threshold and started away before the doors even fully opened, leaving the broader man behind.
“Nothing anymore,” he shouted back. “You don’t listen to anything I say anyways!”
“Whoa, down Lassie. It was just a joke!” Cox chased after his partner and nearly body slammed the ICU door when JD shoved it shut behind him. He growled and rammed into the ICU like hell on wheels. He whistled and everyone turned towards him, but all he could see was red and the man he loved glaring right back at him.
“I’m not a dog, Dr. Cox” JD spoke with a teeth-clenched professionalism that said we’ll finish this later but Perry wasn’t one to run from a fight.
“Well you sure follow me around like one.” He stuffed his hands into his lab coat and waited. He waited for the explosion from the man in front of him, but it didn’t come. Instead, JD looked defeated.
“I am so tired of you being such an ass to me.” JD turned to lean on the nurse’s station. He rubbed at the bridge of his nose and sighed. “Just leave me alone. I can’t do it today.”
Perry straightened his shoulders, brushing his thumb under his nose before folding his arms across his chest.
“Well aren’t we Susie Sensitive today,” he sneered and scoffed, “why don’t you go fix your mascara and get back to work. You’re a doctor for Christ’s sake, buck up.” Perry started to turn but stopped when he heard a chart slam on the counter. Ah, there it is.
“Perry I’m done! I’m sick of you treating me like shit! I can’t keep working with you if all you do day-in and day-out is ignore and belittle me. I’m worth more than that and you know it.” JD gasped and froze, but stared Perry down, both of them equally enraged and surprised at what just came out of his mouth. Everyone, all of the doctors and nurses and patients, had stopped dead in their tracks to watch this unfold.
“How could I ever ignore you when you never stop talking?” Perry slumped into his JD impression again “Dr. Cox, you're so smart! Dr. Cox, come hold my hand while I read labs! Dr. Cox, can we get one big lab coat that we can wear together?” He felt his face grow hotter as he continued to rant. “So excu-use me if I need to force some peace and quiet every now and again!”
“You make me out to seem like such a clingy little girl —“ JD took a step towards Cox.
“If the princess heel fits—“ Cox interrupted and met JD halfway, stepping into his personal space.
“I’m a grown man Perry! A fully grown adult doctor and I need you to respect me.”
“I’ll respect you when you prove you’re not completely clueless!”
“Oh like you’re so clued in? What about us then, huh?”
“What?” It was more of a grunt than a word, but that’s all Perry could push out from the lump that has now lodged itself right behind his tongue.
“What about the fact that you’re so emotionally stunted you can’t even say ‘I love you,’ what about that?”
“Danger, Newbie—”
“I don’t care! You’re just as immature as me, the only difference is I’m self aware. You just think you’re so much better than everyone.”
“Because I am better!”
“No you’re not! You are just another doctor and just another man. You think you’re God’s gift to medicine and you’re not. You’re just an asshole.”
“If I’m such an asshole then why are you with me?”
“I-“ JD’s eyes flickered “I don’t know.”
They stared at one another like a bomb had clanged to the floor between them.
“You don’t know?”
“No…” JD blinked and took a step back. Perry absorbed the rage that JD left behind and fought the growing combustion.
“Then what the hell are we doing?”
“I don’t know.”
“Is that all you know how to say now Tabatha?”
JD didn’t speak a response, offering a weak shrug in its place.
“That’s just great. You’re completely clueless again.”
“I guess I am.” He looked back at Perry and blinked slowly, like he was triple checking himself. Like he was making sure he meant the next thing he said. “We’re done.”
“Oh, we are, are we now?”
“Yes,” It was softer. Somber, yes, but certain. Perry’s jaw dropped. JD started in the opposite direction, chart still in hand, hoping to escape the staring with some dignity intact.
“Newbie, you can’t just —“ Perry was so confused. “It was a joke! You know I’m an asshole, you knew it long before —“
“You keep saying it’s a joke and that you’re messing around but you always just keep going, even when I ask you to stop.”
“You can’t be serious, all of this because of an elevator?” Perry was chasing JD around the ICU floor, the men making a loop of the place in their fighting.
“It’s more than just the elevator, Perry. You don’t respect me. You don’t respect anyone and it’s not okay anymore. I used to put up with it because I thought you’d change, I thought that eventually you’d want to be different for me.”
“You got what you signed up for, Newbie. I can’t fix what I don’t think is broken.” A nurse gawked when Perry said that. Even JD let out a small gasp, like he took a punch to the gut, and halted in his attempted evasion.
“You really don’t see what’s wrong with how you treat people?”
Of course he did. Perry was well aware he was an asshole. But he doesn’t know how to be anything else. He’s tried, and over the year or so since he and JD had gotten together, Perry had softened quite significantly. Not at the hospital, but behind closed doors he was a different person.
“No. I really don’t.” He growled and stood his ground, vomiting words before he could filter them, “It’s not like there’s anything worth changing for.”
“Got it.” JD looked defeated again, he slumped almost two inches shorter and dropped the chart to his hand from where it had been tucked under his arm. He marched towards Cox and pressed the chart against Cox’s chest. Without another word, he left the ICU.
When Cox didn’t see JD again during their shift, he assumed the man went home early to pout.
—
Perry tried calling all night, and though the calls always went through, JD never picked up. Perry didn’t bother with voicemails at first, but after his first few glasses of scotch, he lived to hear the beep. He yelled, berated, begged, and wooed JD through the phone for hours.
Perry called in sick the next day, and when he didn’t show up for a week, Kelso finally called it a Leave of Absence. On day six of the first week, Carla stopped by. She didn’t bother knocking, having known Perry for a long time, she knew he was glued to the couch with a bottle in one hand and a graveyard of them on the table.
“Perry, I brought groceries. Real ones, not Scotch.” Carla went straight to the kitchen to unload the paper bag she brought. It was mostly full of ready-made meals and canned soups. When she was done, she poured a glass of water and brought it to the couch.
“Here, drink this, okay? Give your liver a break.” She wrenched the bottle from his hand and replaced it with the water glass. Perry did not move, besides a slow blink and a deep heaving sigh. Carla moved on to cleaning up. She cleared away the empty bottles and cans from the coffee table, picked up two pizza boxes of varying degrees of oldness to throw away, and carried a can of aerosol air freshener around the apartment to clear the “funk.”
“I’d light a candle if I wasn’t convinced you’d catch fire. You reek, Perry, when was the last time you changed clothes or bathed?”
Perry didn’t respond, instead he took a sip of the water, making a face when his body registered the liquid as “not liquor.”
“Are you hungry? Can I make you something?” Carla finally sat down on the opposite end of the couch as Perry had nested in. When Perry still didn’t speak, Carla sighed. She wanted to help, but her position was precarious. She knew where JD was, she’d been supporting him through this breakup as well. JD had moved back in with her and Turk for the time being, and had taken a similar disposition as Perry, with the small addition of loud rom-coms and colorful ice cream.
“Perry, how can I help? What can I do?”
“Where is he?” Perry grunted, voice broken with disuse and alcohol.
“I can’t –” she started, which earned a loud groan from Perry, who hurled the water glass across the room. It shattered against the wall and shards crashed to the ground.
“Then get out!” Perry roared, and Carla stood abruptly.
“I’m not leaving yet Perry. You’re going to drink yourself to death.”
“Don’t care.” Perry leaned forward and filled the vacancy in his hand with the same bottle from before. Carla shuffled to the kitchen and picked up the phone from the machine, walking away from the living room and making a call she knew would fix things, at least for now.
—
Perry’s ex-wife Jordan was there in an hour, and Perry was back at work by day ten. And so a pattern emerged. Perry would go to work, come home to Jordan, fight or fuck or both, drink until Jordan fell asleep, call JD again, then pass out on his couch. Jordan knew it all, of course. Drunk Perry had loose lips. She didn’t mind. Her thing with Perry was void of real attachment. The love was there, in a weird, noncommittal capacity.
Then their daughter was born. The hormones of the pregnancy drove Jordan up the wall, and she decided after a minor grievance against Perry to name their daughter Jennifer Dylan. The first time she called her “Little JD,” Perry didn’t speak to her for a month. They found a new normal. A fester of resentment boiled under throughout, and before Jenny’s first birthday, they’d split up again. Jordan needed Perry to be someone he couldn’t be.
And all along, JD was nowhere. Perry had assumed, though the assumption carried a cold weight that lumped in his throat, that their paths would still somehow cross. It’s a small world and all that bullshit. But it never came. They never passed one another in the bread aisle or patronized the bar around from the hospital at the same time. Hell, Cox didn’t even see him at any of the Turks’ parties.
He never heard where JD ran off to. Now, almost four years later, Perry still looked for him. Down every aisle of the store, he looked. At every conference he attended, he checked the list. In every dark corner of every bar within a five mile radius of Sacred Heart, Perry drunkenly (and soberly) prayed to see that mess of black hair atop the gangliest most annoying man he ever had the displeasure and privilege of meeting.
—
Four Years Later
St. Bartholomew’s hospital was an hour away from Sacred Heart, and catered to a different demographic. He found an apartment nearby, and after his year-long fellowship in differential pathology, JD accepted an Attending position at St. Bart’s.
“Dr. Dorian, there’s a patient inbound from the ER the chief would like your opinion on.” Brenda, the charge nurse, was holding a chart, and JD was already itching to open it. The fellowship had given JD a love of puzzles, and his competitive nature turned that love into a compulsive thing. His fingers tingled at the thought of cracking open that cold, metal clipboard. The slight squeak of the hinges, the flutter of the pages, the natural way his pen flipped between his fingers.
“What room is …” JD scanned the top page, “Amanda in?”
“She’ll be in room seven, she’s still pending portable XRay before moving.”
“What region? Her ankle?” JD read the initial incident report — 19yo female presents c swelling of the R sided LE after a fall down stairs.
“Her hip. Poor thing broke it in the fall.”
Further examination revealed swelling of the R sided pelvis and hip, symptoms are aligned with possible displacement fx of R hip.
“Holy crap, did she fall down the steps of a pyramid?”
“The set of a musical. Sweeney Todd.”
“Oh I love that one!” JD waved around his pen like a murderous razor blade, but Brenda did not laugh. JD dropped his arm and returned to his reading.
Internal Temperature: 101 F
“Slight fever, that’s odd,” JD furrowed his brow.
“Yeah, that’s about when Tucker downstairs called the chief, who called you.”
“Is it an open fracture?”
“Nope. Besides the patient’s age, pretty textbook hip fracture.”
“Gotcha. Page me when she’s in a room, I’ll do a full workup before I leave.” He shut the chart and stuck it under his arm. He was excited to hit the books and start looking at bone density disorders. A patient this young shouldn’t have broken her hip so easily. That happens to older people.
He entered the physician’s break room and settled at a table, opening the chart again. He chewed on the cap of his pen, a habit Elliot used to get onto him for. When they’d been chief residents together, she would throw the chewed up pens at him from across their shared office (which really hurt, considering their office was the size of a bathroom stall).
JD read through the basic demographics of the patient on the referral written by the ER: DOB, height, weight. He stopped at the insurance information, recognizing the company name as one of the Out of Network companies from Brenda’s list. As long as Amanda was at this hospital, the cost of treatment was entirely on her.
“Fuck.” JD rolled his eyes, cursing private insurance relentlessly under his breath. This happened a lot unfortunately. Patients show up to the nearest hospital seeking help, and they get turned away because of insurance. Amanda wouldn’t be admitted afterall, but something about her case made JD’s brain fizz like baking soda in vinegar. It was a chemical reaction that couldn’t be avoided when facing a puzzle, and JD was going to explode.
He lifted his pager and sent a message to Brenda, telling her to meet him in the ER. He stood up with Amanda’s chart in hand and made his way down.
–
“Ma! We've gotta invest in some drugs at home, this stuff is great!” Amanda raised her right arm, waving around the IV tube like a pool noodle. She giggled, then smacked her mouth. Her gums were tingling, and her teeth felt fuzzy.
“Morphine tends to feel pretty good,” her mom laughed, her face softening from the worried grimace she’d been wearing the last couple hours.
“I can’t even feel my eyelids, let alone my broken hip.” Amanda blinked drunkenly, one lid flipping before the other.
“Just wait until you have a jello cup on the stuff, it's transcending,” JD moseyed into the room, chart in one hand, the other raised to shake. “I’m Dr. Dorian from internal medicine, I was called to take a look at Amanda.”
“Will you be her doctor when we move her upstairs?” Amanda’s mom shook JD’s hand with a worried brow.
“I’m actually going to confirm with the charge nurse where Amanda will be placed, but I specialize in Differential Diagnostics. Some of Amanda’s symptoms are unusual for her age and health status, so I’m going to dig in and try to get you guys some answers.” JD smiled as he spoke, trying to alleviate some of the concern Amanda’s mother was showing.
“She’s always been accident-prone, but this feels different. I’m not used to things actually breaking.” Amanda’s mom took Amanda’s free hand, rubbing her thumb across it. Amanda returned the gesture with a small smile.
“Why don’t I have a look at her and see what we can figure out.” JD set the chart down on the nearby counter. He sanitized his hands before donning a pair of gloves. Sitting on the small stool, JD wheeled around Amanda’s bed to her right side. “Amanda, may I lift the blanket to look at your hip?”
“Go for it, Doc!” She lifted a thumbs up, still comically out of it.
JD pulled away Amanda’s blanket and gown and inspected the hip. It was already bruised and swelling considerably. As JD palpated the area, Amanda winced.
“Amanda, were you feeling any pain in this hip before you fell?”
“Not especially. I’ve been rehearsing really hard lately so my whole body has been sore.”
“Rehearsing, what for?” JD knew already, but he wanted to distract her as he continued to examine the area.
“Sweeney Todd. I’m Joanna, but I slipped and fell down the stairs during Green Finch and Linnet Bird.”
“Oh cool! I love that musical.” JD pulled her patient gown back down and moved to her ankle. “Did you hurt your ankle then too?”
“No, that’s been hurting a bit for a while. I rolled it in rehearsal about a month ago. I usually wear a brace, but we were rehearsing in our character shoes today and my brace doesn’t fit in mine.”
JD noted that Amanda’s ankle was also red, swollen, and warm to the touch. He took her foot in hand and started testing the range of motion, and Amanda winced again when he pressed back into the foot. He made another mental note to order an XRay when he knew where she was going next, and if that’s another hospital, he’d write a long note for the next provider to consider.
As he finished examining the ankle, Nurse Brenda knocked on the doorway.
“Hey Nurse Brenda, let me get un-gloved and then we can talk.” JD smiled, shielding his worry. If he was being honest, Amanda’s symptoms aren’t looking good. It could be an infection, a parasite, or even cancer considering how easily she’s been getting hurt. He stood up and pulled the gloves off his hands, disposing them in the medical waste bin. “I’ll be right back,” he assured Amanda’s mother, before washing his hands grabbing the chart. Exiting the room, he closed the door behind him.
“Brenda, we have an issue.” JD flipped the chart open and handed it to the nurse, “isn’t this insurance out of network?”
“Crap, it is. She shouldn’t have been brought here in the first place. I’ll call the chief and get him to work some magic on this ER bill for the mistake, but first, let’s go look at where we can send her.” Brenda shuffled around to the nearest computer, JD hovering behind her. She opened her network tracker and filtered it down to Amanda’s insurance company. “It looks like the closest hospital that will take her is Sacred Heart in San DiFrangeles.”
JD froze, a sharp intake of air his only perceivable reaction. “Would we be recommending her for the ICU?”
“That’s up to you, Doctor,” Brenda looked up behind herself and read JD’s face, “unless you know something I don’t.”
“No, no. It’s fine, I’m just familiar with Sacred Heart, that’s all.”
“Oh?” Brenda raised an eyebrow. When JD showed up for his fellowship, he was incredibly private and reserved. Brenda has been trying for years to learn more about his past. She’s gotten bits and pieces here and there – and when he met Kim, Brenda got to see a different side of the doctor to whom she’d gotten closer. He was kind, considerate, and goofy. A bit immature, sure, but he made up for it with his work ethic.
“I did my internship and residency there,” JD tried to be nonchalant, but something in his face revealed the long-swept-away hurt that accompanied his departure. He cleared his throat and reset his face – “it really is a great hospital. Dedicated staff in the ICU as well. Amanda will be well taken care of.”
“Great!” Brenda maintained her reading glare, trying to pull more out of the doctor, “I’ll put in the transfer request. Anyone I should refer her to in particular?”
“Yeah,” JD chewed on his cheek, “Dr. Perry Cox. I'll finish my exam and write down my findings in a letter for him. Cancel the portable Xray too, she can get that at Sacred Heart and have insurance cover it.” JD took the chart and returned to Amanda’s room. His heart was racing and his jaw clenched tightly as he finished examining Amanda.
—
To whom it may concern,
Amanda Lingsley is a 19 year old female presenting with swelling of the Right-sided lower extremity, localizing laterally along the fibula and talus. Range-of-motion limitations include both eversion and inversion as well as dorsiflexion. No bruising present at the site at time of examination, but potential for bruising remains if injury is exacerbated.
Additionally the patient presents with swelling and bruising of the right-sided hip. The site of injury is closed. No X-Ray was taken at the time of admission, but upon palpation the patient reported pain in the area.
Internal temperature at time of admission was 101 degrees F. No blood was taken for pathological testing at time of admission.
Recommended course of treatment includes: XRay of R Hip and R LE to determine possible skeletal injury (fracture is particularly suspected in the R hip), Blood-Pathology for potential infection, foreign body (parasitic infestation), or immune abnormality.
Potential diagnoses to consider include: osteomyelitis, osteosarcoma, multiple myeloma, leukemia.
Particular interest is to be taken in the root cause of the fever. Without conducting CBC, potential causes remain undetermined.
Patient history indicates the patient is healthy and active. Patient’s mother reports a history of being “Accident prone” without past fractures.
Although the opinion and consideration of a Differential Diagnostician would prove beneficial in determining the root of these myriad of symptoms, full confidence is held by the referring provider in the capabilities of the referred provider. The referring provider is available for consultation via email or phone (detailed in the letterhead) is needed. Complete patient history and demographics are included with this letter to provide the full picture.
Sincerely,
Dr. John Dorian, M.D.
Internal Medicine, Differential Pathology