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It was early February, and full-on winter in Pittsburgh. Because it was the height of flu season, Robby and Jack had worked opposite shifts in the ED for several weeks since New Year’s, not even seeing each other for those precious few minutes during hand-offs as Baran had taken charge of them.
They caught glimpses of each other in passing if they were lucky; once or twice they managed a quick hand brush in the locker room. Despite living together they rarely saw each other at home, sleeping and eating in shifts. So Robby and Jack were both looking forward to Valentines weekend, when they’d scheduled their four days off to coincide. Taking the weekend off just to reconnect, they made plans by text.
The hectic work situation continued until a few days before Valentines Day, when Baran asked to trade hand-offs with Robby to leave early for the night to attend her son’s Valentines play.
In the meantime, the cold winter humidity outdoors, combined with the dryness of the hospital air indoors, led to Robby’s lips becoming severely chapped. Robby was used to it in winter, had dealt with it all his life in Pittsburgh; but this particular winter he was too busy to do much about it, except half-heartedly apply lip balm when he remembered.
This time it kept getting worse, the delicate skin growing dry, itchy, scaly; Robby started to lick his lips constantly for relief, the worst thing to do with chapped lips. His upper lip developed a ridge of red, irritated skin just below his moustache; the corners of his mouth began to crack and split open, then his lower lip began to do the same, to the point that it almost hurt to eat or speak.
So it was, after Baran left at six-thirty and Jack showed up at quarter to seven for the patient hand-off, Jack did a double-take when he truly saw Robby for the first time in weeks in the locker room.
Robby thought they might have time for a couple of stolen kisses; instead, Jack grabbed Robby’s jaw and stared at his mouth, not in desire but in complete surprise.
“Robby? What the hell is wrong with your lips, man?”
Robby fought off a tiny surge of resentment that Jack didn’t even say hi.
“Hello to you too, Jack. It just so happens, I’ve got xerocheilia,” he answered.
Jack took a step back and crossed his arms over his chest. “Never heard of it. Is ‘xerocheilia’ even a word?”
Robby rolled his eyes, half in fond annoyance, half in grudging appreciation of the man’s folded arms.
“Yes, Jack, it means ‘dry lips’ in Greek.”
Jack looked and sounded doubtful. “If you say so.”
Robby gave him a pained half-smile. “Look, I really don’t need you to get on my case about it too. Dana’s been after me all day to put some Vaseline on them.”
“I bet she has.” Jack raised a disbelieving eyebrow. “Because that’s not just ‘dry lips,’ brother. That is one hell of a raging case of angular cheilitis. In both corners of your mouth. And your lower lip appears so macerated, your entire mouth looks swollen. It’s the worst case I’ve seen in awhile to be honest with you. I’m surprised you can still talk.”
Robby shrugged. “It’s winter, my lips get dry and cracked all the time.” He licked them absently and winced as his tongue dragged over a crusting fissure in the corner of his mouth.
“Not like that. You’ve licked them all the way to open sores, man. I doubt you’d be able to take a kiss, let alone give one.”
“It’s not that bad—”
Jack dragged a continually protesting Robby from the lockers into the closest open exam room and shut the door.
“No, it’s worse than it looks. I need a culture swab of your lips to test for Candida, strep A, and staph,” Jack said, already locked into work mode and pulling supplies out of a cabinet. “How long has this been going on?”
“It’s only the past few days it’s been really bad,” Robby admitted, trying not to wince at the pull of his mouth. He inhaled through his nose to distract from the discomfort. “I can swab them myself,” he muttered.
“No, let me do it,” Jack insisted, “it won’t take a minute.”
“What if I don’t want you to?”
Jack guffawed, his gaze eerily intense. “I don’t think you want me to kiss you with those lips right now,” he warned, “because you know I’ll do it just to prove my point that it’ll hurt like a son of a bitch.”
Robby glared at Jack for a moment, not believing Jack’s stubbornness over what he saw as simply a bad case of chapped lips. Then he sagged and relented, because Jack Abbot was a living Terminator who would not stop until he got his answer one way or the other.
“Fine. Go ahead.”
Jack pointed Robby towards the treatment bed. Robby obediently sat down on the edge and observed while Jack scrubbed his hands at the sink and donned a pair of gloves. He took one sterile, moistened swab and brushed it over the entire area of Robby’s lips from vermilion border to inner mucosal border; followed by the second swab, pressing a little harder in the corners.
“Ow! Fuck!” Robby gasped and turned his head away. That swab fucking hurt.
“Sorry,” Jack muttered, sounding contrite. “Almost done. I’d also like to draw some blood for assessment of iron, zinc, vitamin A, riboflavin, B12, and folate levels. And a tissue transglutaminase-IgA antibody test to rule out celiac disease.” Jack tilted his head in curiosity. “Is there a history of celiac disease in your family?”
Robby shook his head. “No to celiac disease. What if I promise to start taking a vitamin pill every day instead?”
Jack set the swab vials in a rack and entered something on the computer. “It wouldn’t hurt, but it won’t tell us where your levels are currently.”
Jack’s face and voice turned soft; he returned to Robby’s side and reached out to clasp his shoulder, angling to capture eye contact. “You work yourself too hard in this job, Robby. You’re probably just run down from lack of sleep and missing one too many meals. But we don’t want to miss anything that’s contributing to your condition, especially if it’s easily treatable.”
“Which a vitamin will do.”
Jack sighed. “How are you feeling right now?”
Robby shrugged one shoulder. “No different than every other day.” Aside from his sore lips, he thought to himself.
Jack continued to peer at him, weighing his answer, but then it was his turn to relent. “Okay. No blood draw for now, but I will insist on one if I see any hint of a sluggish recovery after treatment.”
“Deal.”
“Good. Now hold on, I’ll be right back.” Jack grabbed his swabs and opened the exam room door to catch Olive walking past.
“Olive! Can you run these cultures to the lab for a rapid ID please?”
Olive stopped mid-stride and joined Jack in the hallway. “Sure thing.” She took the samples from Jack and read the labels on the culture tubes. “Who’s the patient?”
“Shit, yeah, the patient,” Jack muttered, loud enough for Robby to hear; Robby had to stifle a chortle. “Give those back to me for a sec please?” Jack added.
Olive handed them over, and Jack scribbled a name on each label with his pen. “Good catch. Here you go. Thanks, Olive, I appreciate your attention to detail.”
Olive checked them again. “Gotcha,” she said on reading the name, “I’ll tell the techs to rush it if they can.”
“You’re fantastic,” Jack said in approval. Olive sprinted off and he stepped back into the exam room.
“Most of the time you can give an antifungal cream for angular cheilitis,” Robby said casually, trying not to wince. “It’s usually Candida.”
“Which won’t work for a bacterial infection as you well know.”
“Unless you use miconazole which has some antibacterial activity. And which will also tide me over until the cultures come back with a definitive result. Then we can switch as needed.”
“Better to wait for the cultures so we know what we’re dealing with for sure.” Jack regarded him fondly.
“That’ll take at least one day if not two.”
“I know. Either way, brother, your lips are too inflamed to kiss. Vaseline won’t cut it. You need a prescription-grade lip emollient, plus a steroid cream, and—”
Robby darted his tongue out to try to relieve the sting in his lips again.
“Stop that! You especially need to kick the habit of licking your lips when they’re dry as the desert.”
Robby scowled at Jack for a moment, his arms folded in mirror image to Jack’s, then looked down at his shoes and shook his head.
“Also, no kissing allowed for you until those lesions are fully healed.” Jack was casual enough, but Robby heard an undertone of disappointment. “Or other activities that will aggravate the healing of your labial commissures.” He gave Robby a meaningful look.
“So the wild sex weekend is out,” Robby said, partially needling Jack to avoid his own letdown.
Jack huffed. “Afraid so. We’ll have to figure out something else for Valentines.”
“The chapped lips happen every year when winter sets in,” Robby said, “just not this bad.”
Jack grew concerned again. “You sure you want to skip the bloodwork?”
“Yeah, I’m sure. How about going with the miconazole for now?”
Jack grunted in agreement then checked his watch. “My shift’s about to start. We should go through the hand-off quick before the evening rush starts. Anything I need to know?”
They left the exam room and headed back to the central hub, where Lena had already relieved Dana at the charge nurse station. Robby ran through the notable patients left on the board, finding it more painful to move his mouth as he kept talking. Lena frowned at him in sympathy.
“You should go home, Robby. It looks like it hurts to speak.”
“I’m waiting on my prescription,” he replied, ignoring the sting to stare right at Jack.
“Some people are just too impatient.” Jack had already entered his prescription in the exam room computer; he printed it out at the central hub and thrust it into Robby’s hand.
“As soon as your cultures come back, we’ll re-evaluate. Meanwhile. Miconazole plus hydrocortisone cream for presumptive Candida. Lip emollient for the chapping, use liberally as needed. Tylenol or ibuprofen for pain; and I will be checking our medicine cabinet in the kitchen to make sure you picked up the vitamins when I get home. And get some rest. Turn off your phone tonight, we got it handled here.”
“You know I can’t do that.” But Robby was smiling as he donned his winter jacket.
Jack walked Robby out of the ED into the near-freezing ambulance bay despite being only in shirtsleeves; where, outside the view of the staff, Jack pulled Robby against the wall and into a hug. Robby’s arms encircled Jack immediately and they relaxed against each other for what felt like their first real moment together in weeks.
“All this for xerocheilia,” Robby complained against Jack’s hair. “Chapped lips, Jack, it shouldn’t be this big a deal.”
“Chapped lips complicated by angular cheilitis,” Jack corrected him, “which can indicate certain serious health issues for someone your age. Someone’s got to keep an eye on you, man, it may as well be me. Make sure you go to the pharmacy and pick all that up tonight, alright? Dinner’s already in the fridge waiting for you at home.”
Robby felt his stomach rumble at the words. “So what did you order us?”
“It’s a surprise. Don’t forget the vitamins.” Jack drew back a bit, went to kiss him on the lips, then sighed and caught himself. He pulled Robby’s head down to kiss his forehead instead, then let him go.
“I gotta go back to work,” Jack said, pointing his thumb behind him at the door of the ED.
“I’ll try to catch you tomorrow morning for hand-off then,” Robby said. “And. Uh, thank you.”
“Not a problem. See you at hand-off.” Jack nodded and headed back inside the ED, the automatic doors swishing closed behind him. Robby watched until Jack rounded the corner towards the hub; stopped himself from licking his cold sore lips again, and headed towards his car, already planning an alternate itinerary for their weekend at home.