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The pain is all in his head.
When John was in rehab, he heard the words so often they became a mantra, one that echoed in his mind from the moment he woke up to the moment he fell asleep. At group sessions, the leaders would impress the importance of mind over matter, of conquering the physical and ‘rising above’. As drug users they'd all been tricking themselves, see, convincing their weak minds that they just needed another fix to dull a pain inside them that didn't actually exist.
For a while, he'd resisted. He tried to explain that he was different, that his pain was real, but showing his scars earned him nothing more than the same patronising remark:
“We all have scars, John. But we can't use them as an excuse.”
And little by little, over the weeks, he began to doubt himself. Perhaps his pain wasn't real. It was all in his head. He'd seen many drug seekers in the ER, right? What set him apart from them, lumbering along in search of the next hit of dopamine?
He came back different. After attending the meetings with Mark and Kerry, agreeing to all the drug tests and the limitations to his work, he settled back into life as an ER doctor and tried to ignore the lingering looks he received, the whispers he overheard in hallways.
Wasn't he the guy who got stabbed?
I heard he got addicted to fentanyl. Someone found him shooting up in the trauma room.
No, I'm sure it was a bathroom. He was totally out of it. Security had to drag him out.
Really?!
It didn't matter. None of it mattered.
Except now he's sitting on a bench outside of the ER, curled into himself because he hurts, and for once, he can't be convinced that the pain exists only in his head. Something is wrong. He doesn't feel right. His skin is prickling with sweat; his stomach is rolling. There's an ache in his gut that won't ease no matter how many inner mantras he recites, and it's been worsening for days.
He digs his fingernails into the fabric of his pants and bows his head, breath misting in the biting air.
God, John. Always so dramatic. You're fine.
It's all in your head.
The wailing of a siren pulls him from his stupor, and he forces himself up onto wobbly legs. He's lasted this long without buckling.
What's another eight hour shift?
Halfway through working up a patient, John gets hit with a wave of nausea so severe it makes his head spin, and he has to excuse himself to the bathroom immediately in fear of losing his meagre lunch in front of everybody in the ER. The second he kneels down in front of the toilet, he's retching. Hard.
It's not exactly an unfamiliar situation he finds himself in, of course- over the span of his medical career, he's probably spent a few hours praying to the porcelain gods thanks to his sensitive stomach- but the sick feeling in his bones is definitely unique. He spits. Flushes. Leans against the wall, chest heaving, and pulls his arms across his torso as shivers start to wrack his frame.
Chills. He got them when he was in withdrawal at rehab, but never with the impending doom that races through his veins now. And the pain that still pulsates in his abdomen, even stronger now? That can't be right either.
Maybe he should call somebody.
Yes. Yes, he should get help. Since the intervention, Mark and Kerry have been harping on and on about John getting the right support, about him knowing that they're here for him. They'll understand.
With great difficulty, he drags himself up from the bathroom floor and stumbles out of the stall, only pausing to splash some water on his face. The reflection that looks back at him through the mirror is haggard, sweat beading at his temples. He looks about as rough as he feels.
Upon exiting the bathroom, he's unsurprised to find himself the object of more than a few pairs of eyes. Since returning to work, it feels as though there's never a moment where he goes unwatched. He does his best to ignore the stares, but the closer he gets to the break room (he's hoping he'll find somebody in there, at least, who might be able to help him), the more their gazes bore into his very soul.
We see you for what you are, John.
It's another phrase that lives in his head from his rehab days. It was often spoken with gentle intonation, but there was no escaping the implication- we know you're an addict, even if you don't. We know you better than you know yourself.
What if they're right this time too? How can he even trust his own body when it used to scream at him for the very medications that would have led to his death?
His hands meet the panelling of the break room door. Before he can ascertain its occupants, he's already inside, and then he's looking straight at the three horsemen of the apocalypse around a coffee table.
Mark. Kerry. Anspaugh.
They're talking about him- they must be, because their conversation comes to a sudden halt at his arrival, and his cheeks grow pink with embarrassment. Anspaugh frowns. Mark cocks his head.
“Carter? You alright?”
He swallows back another wave of nausea.
“I’m…”
Their eyes are all watching him. They can see him for what he is.
“I’m just feeling a little sick.”
It takes great effort for the words to even leave his lips, but the relief that follows them is immense. He's said it. They'll know now that something is wrong, and they'll be able to help him. He's reaching out for help. He's following the steps that were laid out for him, and this way he can-
“Have you been taking your Naltrexone?”
His train of thought rapidly screeches to a halt. His stomach sinks.
Oh.
Oh no.
We see you as you are, John. We know what you are. You're an addict. You haven't changed at all. You're right back where you started, aren't you?
“No, I- I have. I have, I swear.”
But he's shaking, and there's sweat beading at his brow, and with the suspicion in their eyes John feels his own certainty crumble. Maybe he missed a dose. Oh god. What if he missed a dose? What if he took something by mistake? Could he be high right now? Why is he here? They'll kick him out, they'll strip him of his license, they know what he is.
He scratches anxiously at the back of his neck. “It's- it's alright. I'll be fine. I just- sorry for disturbing you.”
Before any of them can utter another word, he's out the door again.
He starts to feel as though he's moving through treacle. When he tries to assemble a laryngoscope, his hands don't obey the commands he gives them, and the metal pieces clank as they slide uselessly against one another. All the while, he can feel Abby frowning at him in concern.
“Carter? Everything okay? You look a little...”
When he turns to meet her eyes, the trauma room tilts sickeningly. There are other nurses around her too- Chuny, Haleh, Lydia- and their own expressions don't exactly speak to their confidence in his abilities right now.
Still, he pushes down the urge to vomit and tells them he's fine. Just tired. Just a little under the weather. Just don't tell Mark and Kerry and Anspaugh or they'll throw him out, alright? Not that he says the latter. Only chants it in his own head, another mantra to add to the steadily growing list that keeps him from bowing out.
He gets the intubation after a few attempts, then hastily excuses himself, this time retreating to an empty exam room and rummaging around for a thermometer. Places the tip under his tongue and waits impatiently for the reading to complete. Shadows move within the gap beneath the door, and he watches them warily, knowing if he sees one get too close, he'll have to abandon his mission and make up some excuse for being in here.
After a few moments, thankfully, the thermometer releases him from limbo. His relief doesn't last long, though.
104.6.
Not good. Not good at all.
He screws his eyes shut and tries to think of some way this (and the pain, the unbearable pain) can be explained, but his head is swimming and nothing comes except fear and guilt.
Have you been taking your Naltrexone?
It's all in your head, John.
Mind over matter.
I heard he got addicted to fentanyl.
Have you been taking your Naltrexone?
John? Everything okay? You look a little…
He was totally out of it.
It's all in your head, John.
Mind over matter.
A small whine escapes the back of his throat, and he clamps a hand over his mouth. Forces himself back to his feet. Everything warps, his steps unsteady- it's like he's walking on the deck of a ship instead of solid ground, and it's making him so nauseous he can't think.
He's going to vomit again.
He staggers out of the exam room and doesn't stop moving until the edges of his vision are darkening, and he's falling to his knees in front of a toilet.
The men’s bathroom at County is a place that Mark avoids as much as he can help it, ever since becoming far too acquainted with its floor a few years ago now. But being human means he can't banish himself from it entirely, and right now he just needs to take a leak. So that's exactly what he does. And after that-
Well, it's only an odd instinct that makes him hesitate before he turns back to the door.
Something… something isn't quite right.
The stall on the left is occupied, but there's no movement from within. He calls out. Asks the person if they're alright.
Nothing.
So he ducks down, half expecting to find that actually there isn't anybody in the stall, and the door has been locked for some other reason beyond his knowledge. Instead, he finds a shadow sprawled out on the floor.
And, even worse, it looks like-
“Carter?!”
No response.
“Carter, is that you? Talk to me.”
Still nothing. Mark pushes himself to his feet and slams his fist against the door a few times, ear pressed against it in the hopes he might make out even a faint groan, some sign of life. When this fails too, he takes a few steps back from the door, and kicks.
It takes three attempts, but eventually the hinges relent. He shoves his way inside and tries to take in the array of information he's met with at once.
Carter is here. The sprawled shadow on the floor is him, curled on his side in front of the toilet. His eyes are closed. He's pale. Diaphoretic. He's been vomiting. He's breathing, but respirations are quick and shallow.
It's obvious at once what's occurred, as much as the realisation makes him sick. He stumbles away to the exit and pokes his head out of the door.
“I need a gurney in here! Now!”
Several heads swivel in his direction, and as they dart away to grab supplies, he returns to his charge (still curled up on the floor. Still barely breathing).
“Alright, Carter.” He says, teeth gritted, rolling the resident properly onto his back and pressing two fingers to his carotid. “Alright, I've got you.”
Thready pulse, but he has one. At least he has one.
What he also has, unfortunately, is a hell of a fever. Mark bites back a sudden flare of anger. How could Carter have been so stupid? He knows full well that taking opiates while on Naltrexone is incredibly dangerous, yet that's exactly what he's done, by the looks of things. And now he's landed himself in the middle of a full-blown overdose.
Footsteps fall in like drumbeats, and soon a whole litany of other voices are calling out. Kerry Weaver is here, ordering nurses to clear a trauma room, dropping to her knees next to Mark and frantically voicing his name until he looks at her.
“What is it?” She asks, eyes slightly wild. “Is it an OD?”
Mark nods and her face crumples. “Okay… okay. Let's get him on the gurney.”
Together, they manage to lift Carter, hauling the dead weight of his body onto the gurney standing by. Kerry’s cheeks are pale as she settles his arms by his sides, tugs his feet so that his legs are lying flat- no doubt she's reliving a day she hoped belonged only to the past.
On the way to the trauma room, Mark buries his knuckles into the valley of Carter's sternum.
“Carter? John? Open your eyes, bud.”
Lashes flutter, the whites of his eyes barely visible behind them, and by the time they pull to a stop in the trauma room, it seems like he's starting to come round. His heavy-lidded gaze sweeps around without seeing. He shudders, fingernails rasping against the faux leather of the gurney.
“Carter, I need you to tell me what you've taken.” Mark orders, looming over the resident while the others flit about setting up lines and cutting away clothing stained with vomit. “What did you take, John?”
He gets no response except chattering teeth and a barely audible whimper. Haleh, who must have materialised during the trip to the trauma room, places a hand on his forehead intended to soothe. Her eyes snap to Mark’s when she feels the temperature.
“Mark, he's febrile.”
“I know.” The attending responds, snapping on gloves. “You can tell me by how much in a second.”
He can feel her hesitation, and as she moves to grab the thermometer, he adds,
“Hyperthermia is common in opiate overdoses, Haleh.”
She pauses. Levels him with a glare while he turns Carter onto his side, ready for a temp check.
“I know that, but-”
“Not now. Just tell me what kind of fever we're looking at, please.”
Her eyes linger on him for a moment longer, but soon she relents, murmuring words of reassurance to the resident as she takes his temperature. While he's rolled over, Lydia tucks a nasal cannula behind his ears and encourages him to take nice deep breaths. Whether he can comprehend the command is unclear. His breaths remain shallow and quick all the same.
The thermometer beeps, and Haleh removes it.
“105.3.”
Kerry, occupied with performing a Babinski test at the foot of the bed, lifts her head as Carter is rolled onto his back again. “Haleh, get a line in him and bolus 500 normal saline. Mark, you want to administer IM Naloxone?”
“Sure.”
“Abby.”
The new nurse is connecting ECG wires, but she meets Kerry's eyes when her name is called. “Yes?”
“I want you to draw some blood for a CBC, chem 20, and tox screen. As soon as you've got it, run it down to the lab, alright?”
“Okay.”
“Good.” Kerry sighs, stepping back from the gurney. “Babinski’s negative.”
This, at least, is one good sign. There might be irreparable damage still to come, but so far his CNS seems to be working. Mark shoots Kerry a glance as he draws up the Naloxone. She looks about as weary as he feels.
Carter continues to shudder on the table, gaze still unfocused, teeth still chattering. His lips have started to move, but all Mark hears as he gets closer with the syringe is denial, pitiful and weak.
“Didn’... didn’ do ‘nything wrong… please…”
“Yeah, alright, bud. Sharp scratch.”
He jabs the needle into the resident’s thigh and pushes down on the plunger, closing his eyes momentarily so he doesn't have to see the distress on Carter's face. Instead, he hears the broken cries, and Kerry and Haleh’s attempts to remedy them.
“I know, baby. All done now.”
“You’re okay, John. We're taking really good care of you, I promise.”
When he opens his eyes, Abby is screwing the lid on a vial of blood and spiriting it away to be analysed, while Kerry studies the screen displaying Carter's vitals.
“BP’s 80/50.”
“The Naloxone and fluids should bring it up.” Mark murmurs. “How are his resps?”
Kerry glances down. Frowns. “He’s still tachypneic and tachycardic, and I'm not seeing any signs of respiratory depression.”
“That could change. We need to keep a close eye on it.”
“Of course… in the meantime, I'm going to call Anspaugh.”
Now it's Mark's turn to frown. “Why would you do that?”
The other attending doesn't even look at him as she hobbles over to the phone, and when she speaks, her voice is wobbling.
“Because, Mark, all three of us have been responsible for coordinating John's return to work, and evidently we've failed somewhere.”
A pang of guilt settles in his gut. Right.
In the relative stillness, otherwise only broken by the distant hum of Kerry explaining the situation to Anspaugh, he can hear Carter's continual slurred denials.
“No… no… ‘ve- ‘ve been good, ‘m… ‘m sick… m’sick, Mom, m’sick.”
Sick.
Mark feels sick too.
When Anspaugh arrives, so does Peter, shouldering past everybody just to get to the side of his former student. He doesn't wait to begin the interrogation.
“What happened? Where was he? You say he’s overdosing?!”
There's incredulity in his voice, and Mark can't blame him for it. He's loyal. He loves Carter, so of course he doesn't want to believe something as awful as this could have happened. But, like the rest of them, he'll have to come to accept it- they can focus on the ramifications later.
“I found him in the bathroom.” Mark explains gently. “He was unconscious in his own vomit. hyperthermic, delirious. He's had 4mgs of Naloxone IM and a fluid bolus, and now we're just waiting on lab results to find out… to find out what he took.”
Peter’s gaze snaps to him, fiery. “And who's to say he's taken anything, Mark?”
It's Anspaugh who replies. He gives the surgeon a slightly pitiful look and steps forward. “Peter, of course there are more tests that need to be done but surely you can understand why-”
“He’s tachycardic. Tachypneic.” Peter’s pointing at the monitor now, and his index finger is shaking with the force of his conviction. “What kind of opioid overdose is that, Mark?”
“We’ve given him Naloxone and-”
The surgeon cuts him off. Picks up one of Carter's limp hands (the one not cannulated) and shows the back of it to the doctors gathered.
“His skin is mottled, extremities cold… Where's the Foley?”
Haleh answers for him. “I’ll set one up now.”
“Please do. Because right now,” His voice is rising, and there's a flame in his eyes that seemingly won't be doused by anybody's placating voice. “All I'm seeing is a couple of doctors playing pretend because for some goddamn reason they think they don't even need to consult diagnostic criteria.”
“Peter.” Anspaugh barks. The room shudders back into stillness. “I think it's best if you leave.”
His addressee only crosses his arms, not moving a muscle. “I'm not going anywhere until I get proof that Carter’s being treated properly.”
The frustration that's been building in Mark crests. “Look, I understand you don't want to accept this, Peter, but I’m not going to stand here and let you question my competence as a doctor.”
In his peripheral vision, he barely notices Anspaugh opening his mouth to speak, or Lydia attempting to soothe Carter as he tosses and turns, or Haleh setting up the Foley. His vision narrows to the loudmouthed surgeon who suddenly knows everything.
“What I'm questioning, Mark, is whether you've considered all the options.” Peter shoots back.
“If you're accusing me of not being thorough-”
“I mean, did you even see any drug paraphernalia in the bathroom? On his person?”
“I was more concerned with getting him off the floor and into a trauma room, for Christ's sake, am I being penalised for that now too?! Why don't you go in there?! Take a look for yourself?!”
He's so furious he doesn't see Haleh’s frown as she examines the catheter bag she's only just fitted. He doesn’t hear the strained,
“Mark?”
“Don't be childish,”Peter continues, half a snarl. “You know my concerns make sense. You know you're assuming too much.”
Mark scoffs. “I'm assuming? I'm assuming?”
“Because of his past addiction-”
“He’s been back from rehab for a matter of weeks, Peter, and now I find him passed out in the bathroom? What the hell am I supposed to think?”
“Dr Greene?”
“You’re supposed to think like a doctor! You're supposed to be compassionate, and non-judgemental, and-”
“And you never judge, do you, Peter?”
“Dr Greene?”
“-not base your diagnosis on hunches!”
“Dr Greene?”
He whirls round to the source of the voice. “What?!”
It’s Abby, wide-eyed and breathless- she must have only just entered the room. Mark's shoulders relax slightly, and he's about to apologise for snapping when she thrusts a slip of paper towards him and blurts,
“Tox screen came back clear, but he's- he's septic.”
The room is silent. Mark blinks, colour draining from his cheeks faster than it ever has before, and when Haleh calls his name, he hears her this time. Forces his gaze towards her and sees at last the Foley bag she's holding up, the urine within tinged red with blood.
This has nothing to do with drugs.
No, he-
He has a kidney infection. One that's so severe it's now threatening his life.
In the brief moment before chaos breaks out, Mark hears the sick boy on the gurney mumbling his slurred denials yet again.
“No… didn’... didn't do ‘nything… ‘ve been good, Dad. Promise ‘ve been good.”