Chapter Text
This is a non-commercial transformative fanwork based on ER. I don't own the series or its canon characters.
Mark’s answer should not have surprised him. That was the part Doug found most irritating as he turned away from the desk and started down the corridor without any clear idea where he intended to go. He had known, before he had even asked, that Mark would hesitate once he heard Ricky belonged to Genetics. He had known that the agreement they had made earlier that day had changed the rules, even if only on paper. Schedule II narcotics now meant another signature, another person standing between Doug and whatever decision he believed needed to be made, and Mark had been clear about why.
Doug had agreed to it, and that was what he kept reminding himself as he walked. He had done it without an argument, without turning the restriction into another battle with Kerry or accusing Mark of siding with administration instead of him. He had given his word that if he wanted to prescribe something like Dilaudid or Fentanyl, someone else would sign with him. It had seemed almost laughably simple when they had laid it out. After everything that could have happened following his last confrontation with Genetics, one extra signature had felt like a concession he could live with.
Now Mark had refused to give it not because he thought Doug was wrong about the pain medication, or because Ricky should not have it, but because Ricky belonged to another service. Doug pushed through the doors leading away from the central desk harder than he needed to and heard one swing back behind him. He could still hear Mark’s reasoning in his head, calm and irritatingly sensible. Genetics was responsible for Ricky. They needed to authorize the medication. Doug should have gone through them from the beginning.
He had gone through them. He had found Julian in the cafeteria and tried.
For several minutes Doug had stood there, surrounded by people carrying trays and drinking coffee and discussing cases that would still matter a month from now, while Roger Julian explained why Genetics would not send Ricky home with the pump Doug wanted. The conversation had remained maddeningly professional. Julian had not raised his voice. Neither, for most of it, had Doug. There had been no dramatic declaration that Ricky should suffer, no cruelty Doug could point to afterward and use as proof that the entire department had forgotten why any of them practiced medicine there had only been policy, liability and responsibility, each word delivered calmly enough to sound reasonable on its own. If Ricky’s symptoms became too difficult to control, Julian had said, he could be admitted. The hospital could manage the pain here. The service could monitor him here. On paper, it was an answer. It was also the exact answer Joi had spent the day telling them she did not want.
Joi did not want him admitted. Doug understood why. She had already watched one son spend his final days surrounded by machines. She had told him what Michael’s last week had looked like, and Doug had seen something change in her face when she said it, a kind of exhaustion that had nothing to do with how many hours she had slept. She knew what was coming. She knew Ricky was dying. She was not asking Doug to pretend otherwise. She was asking him to let her take her son home.
That should have been possible.
He turned another corner and realized where his feet had taken him only when he saw the partially closed door ahead. Ricky’s room. Doug slowed, then stood in the hallway without going any farther. He could hear Joi speaking softly inside, though he could not make out the words. There was another voice with her, probably one of the nurses. The sounds coming from the room were ordinary: the faint rustle of sheets, the soft mechanical rhythm of an infusion pump, shoes shifting against the floor.
There was no childish voice among them. There had not been for some time.
Doug stared at the narrow opening between the door and the frame. He could keep walking because there were other patients waiting for him, paperwork to finish, labs to check and charts to sign, and County was particularly good at providing a doctor with enough work to avoid thinking for an entire shift if he really wanted to. He could also find another way. That thought came easily. It always did.
There were home-care agencies in Chicago, pain services, hospice programs, private physicians and pharmacies that had solved harder problems than this one. He had spent years arguing that children were undertreated for pain and months putting the current PCA study together carefully enough to satisfy people who distrusted the idea of giving a child any control over narcotics. He knew the drugs. He knew the equipment. He knew what could be done in the right setting. If Genetics would not authorize the pump, perhaps another service would; if Mark would not sign because Ricky technically belonged to Genetics, perhaps the pediatric clinic could become involved. There was almost always another door if he kept looking long enough, and for most of his career that conviction had served him well. It had also brought him close enough to losing his job that Mark no longer treated it as an admirable personality trait.
Doug lowered his head and rubbed a hand over the back of his neck. He had promised Mark, and irritatingly, that mattered more now than it had when the promise was easy to make. Earlier, with Kerry in the room and the consequences of the study violation still hanging over him, agreeing to another signature on Schedule II narcotics had sounded like a restriction he could live with. The promise had not really been about signatures, though, and both of them knew it.
The promise had not been about narcotics. Not really. It had been about the moment before them, the moment when Doug became so convinced of what a patient needed that every person who stood in his way became part of the problem. Mark had seen it happen too many times. So had Carol. So had Kerry. Doug himself had become very good at seeing it afterward. Beforehand was harder.
He looked toward Ricky’s room again. Something inside him had been wrong from the moment Joi brought the boy back. At first he had told himself it was the obvious thing Ricky was suffering, and anyone who saw him would be affected by that. His contractures were worse, his seizures more frequent, his awareness diminished beneath the relentless progression of a disease that had already taken his brother. There was nothing mysterious about Doug wanting to help him.
Except that he had treated dying children before. Too many. He had watched parents beg for another option after there were none. He had sat beside children whose bodies had stopped responding to every treatment medicine could offer. He had delivered terrible news and watched mothers fold around it, watched fathers become angry because anger was easier than grief, watched entire families turn hospital rooms into temporary homes because no one knew how to leave. Those cases stayed with him.
Ricky was different. Doug did not want to examine too closely why.
He stepped toward the door. Joi was sitting beside the bed with one hand resting over Ricky’s forearm, her shoulders curved inward, her whole body angled toward her son as though she could shelter him simply by occupying enough of the space around him. Ricky lay on his back. His body looked too small beneath the hospital blanket and, at the same time, unnaturally rigid where the disease had drawn his muscles tight. There was no curious glance when Doug entered, no recognition on his face, no question about whether he could go home now. His eyes were partly open. They did not follow Doug.
Joi looked up. “Dr. Ross.”
Doug managed a small smile. “How’s he doing?”
The question was almost absurd, but physicians asked things like that because sometimes there was no better way into a room. Joi looked back at Ricky. “He had another one.”
“A seizure?”
She nodded. “Not as long as this morning.”
Doug moved to the bedside and put two fingers against Ricky’s wrist, more from habit than necessity, watching his face while he did it. Ricky did not react to the contact.
“How long?”
“Maybe a minute. The nurse was here.”
Doug nodded and checked the IV, then Ricky’s breathing, letting the familiar mechanics of examination take over. His hands knew what to do even while his mind was somewhere else. He asked Joi several questions, and she answered every one. When he finished, nothing had changed. There was no new finding that solved the problem, no mistake Genetics had made, no symptom Doug could treat and point to afterward as proof that he had done something useful.
He stood with his stethoscope still in his hand.
Joi watched him. “Did you talk to Dr. Julian?”
Doug looked at her. He could have softened it, physicians did that too, learned how to place bad news at a distance, how to wrap it in phrases about discussing options and coordinating services, how to make a refusal sound temporary even when everyone in the room knew it was not. Doug had never been particularly good at that kind of medicine.
“I talked to him.”
“And?”
“He won’t authorize the pump for home.”
Joi’s face barely changed. The lack of reaction bothered him more than anger would have.
“Why?”
“He wants Ricky admitted if the pain can’t be managed.”
She turned toward her son again. “No.”
Doug said nothing.
“I told him no.”
“I know.”
“I’m not putting him through that.”
“I know.”
“He doesn’t need another ICU.”
“No.”
“He doesn’t need people waking him up every hour, sticking him with needles, running tests that aren’t going to change anything.” Her voice thinned for the first time. She looked down at Ricky and shook her head. “I can’t do it. I can’t put him through that again.”
Doug’s hand tightened around the stethoscope before he could stop it. The words were ordinary enough, and he had heard variations of them from parents for years. Even so, something about the simple admission made it harder to keep the room where it belonged in the present, with Ricky, with a problem he was supposed to be approaching as a physician.
“No,” he said, quieter now. “You shouldn’t have to.”
Joi looked back at him then. There were tears in her eyes, but her voice remained remarkably steady. “You said we could get him home.”
Doug felt the words land somewhere beneath his ribs. “I said I’d try.”
“You said there was a way.”
“I thought there was.”
For the first time, frustration broke through her exhaustion. “So there isn’t?”
Doug looked at Ricky. There should have been an answer to that. There were always options in medicine if the question was broad enough for exapmle admit him, increase medication under supervision, consult pain management, transfer him, bring in hospice, keep him in the ER for now. None of those answers were the one she was asking for.
“I’m still looking.” It came out automatically. The instant he heard himself say it, he hated it.
Joi did not seem to notice. She reached for Ricky’s hand and carefully worked her fingers around his. “He hates hospitals.”
Doug’s eyes dropped to their hands. For a moment the room seemed to narrow.
“He always did,” she continued. “Even before he got really sick. Michael was different. Michael liked knowing what everything did. He used to ask the nurses what every machine was for. Ricky just wanted to know when he could leave.”
Doug swallowed. He wanted to tell her that Ricky probably knew she was there, that hearing might still be intact even if he could not respond, that she should talk to him, touch him, tell him they were going home. He wanted to make that last part true.
Instead, he pulled the chair from the other side of the bed and sat down.
Joi looked surprised. “You don’t have to stay.”
“I know.”
“I’m sure you have other patients.”
“I do.”
A faint expression crossed her face that might once have become a smile. Doug leaned forward, forearms resting against his thighs, and for a while neither of them spoke.
He did not know exactly why he remained there. There was no medical reason for it. Ricky was stable by the standards that had come to define stable for him. A nurse could monitor him. Joi had not asked Doug to stay. Still, he could not make himself get up.
His gaze remained on Ricky’s face.
Eight years old. He had spent the entire day avoiding the number, and now there was nowhere else to look. A child could change enormously in eight years. A newborn became someone who could read signs through a car window and complain about vegetables and decide he hated a particular baseball team because his father liked the wrong one. Eight years was enough time to develop preferences about cereal, cartoons, shoes and bedtime, enough time to learn when adults were lying badly, enough time to know hospitals by smell. Enough time to understand far more than adults wanted to believe.
Doug pressed his fingertips together. The sensation began behind his sternum, a pressure so familiar that for a moment he did not recognize how long it had been since he had felt it this strongly. He forced himself to breathe through it.
Not here. He had learned that much.
There were places in his mind he did not visit anymore, and he had spent years making certain that they stayed closed. It was not difficult most days. Life provided enough noise. Medicine provided more. Carol had once accused him of being able to run from almost anything if he kept himself moving fast enough, and Doug had laughed because accepting the observation would have required admitting she was right.
Ricky shifted with a small involuntary movement. Joi immediately leaned closer. “I’m here,” she murmured.
Doug looked away. Something old and vicious moved through him, the sudden urge to stand, find Julian again, and force the argument until someone surrendered. He could call everyone he knew. He could go above Genetics. He could make Mark sign. He could make Kerry sign. He could walk into the pharmacy himself and refuse to leave until someone put Dilaudid in his hands.
He knew how that ended. Not this case specifically.
Him.
That was the part he could no longer pretend not to recognize. Every obstacle became proof that he had to push harder. Every refusal made the patient more his responsibility. The more helpless he felt, the more certain he became that doing something, anything, was morally superior to standing still.
Doug looked down at his hands. He had spent years convincing himself that this instinct was what made him good at his job. Sometimes it was. Sometimes it was the worst thing about him.
He thought of the meeting with Mark and Kerry earlier that day, and the promise he had made without hesitation. If he crossed another line now, it would not be because he had not known where the line was. He knew exactly where it was. The realization made him feel sick.
Joi stroked Ricky’s hand with her thumb. “Do you think he knows I’m here?”
Doug lifted his head. This question he could answer. “I think he might.”
She nodded, staring at her son. “Michael knew. At the end, I mean. I could tell.”
Doug watched her. “How?”
“He’d squeeze my hand.” Her fingers tightened around Ricky’s. “Not every time. Sometimes I wondered if I imagined it.”
Doug did not tell her that perhaps she had. It did not matter.
“You talked to him?”
“All the time.”
“Then talk to Ricky.”
Her mouth trembled. “What do I say?”
Anything, Doug thought. Tell him about breakfast. Tell him about the weather. Tell him you are angry. Tell him you are scared. Tell him he does not have to take care of you. Tell him he is allowed to be tired.
Instead he said, “Whatever you’d say if he answered.”
Joi looked at him for a long moment, then turned back toward the bed. She began quietly, awkwardly at first, telling Ricky that snow had started again and that the car would probably be buried by the time they finally left. She told him someone from the neighborhood had called that morning. She talked about things that would have been insignificant in any other room.
Doug listened. After a few minutes, something in him eased and hurt more at the same time.
He stayed until a nurse came in to check the IV. Only then did he stand.
Joi looked up. “Are you going to keep trying?”
There it was again. Doug had spent his entire adult life making promises to desperate parents because sometimes hope was the only thing he could give them. He looked at Ricky, then at her.
“I’m going to figure out what I can do.”
It was not the promise she wanted. It was the most honest one he could manage. He left the room before that distinction could become obvious.
The ER seemed obscenely bright when he stepped back into it. For several seconds Doug simply stood outside the door while people moved around him. A stretcher went past carrying an elderly woman complaining loudly about the temperature. Malik called something toward the desk. Jerry was attempting to keep two dogs from tangling their leashes around a chair while Randi threatened to have all three of them removed. Life continued with its usual lack of respect for whatever had just happened inside a room.
Doug rubbed his hand across his mouth. He needed to talk to someone. That realization surprised him enough that he almost rejected it immediately. He could handle this. He had handled worse. The problem was that he no longer trusted what handling it meant.
His eyes moved over the department until he found Carol. She was near the admit desk, speaking with a nurse from another floor while writing something on a chart. Doug watched her for several seconds before she noticed him. Her eyes narrowed slightly. He knew that look.
She excused herself from the conversation and walked toward him. “What happened?”
“Nothing.”
Carol stopped in front of him. “You look terrible.”
“Thanks.”
“You know what I mean.”
He did. He glanced around. “Do you have a minute?”
Carol’s expression changed. She simply stopped being half-aware of everything else around her and focused completely on him. “Sure.”
Doug immediately regretted asking. She must have seen it.
“What is it?”
He looked toward the hallway behind her. There were a dozen ways to begin. I need to tell you something. Ricky reminds me of someone.
Carol waited. Doug could feel his pulse in his throat. This was ridiculous, he had told Carol things he had never intended to tell anyone. He had admitted failures to her, confessed fears, stood in front of her with nothing left to hide after years spent systematically destroying every chance they had of building something together. She knew his father. She knew what Ray had done to him. She knew how terrified he was of becoming him.
But she did not know this. Nobody here did. That had once been accidental. Then it had become deliberate. After enough years, silence acquired its own weight. The longer a truth remained unspoken, the more impossible it became to introduce into an ordinary conversation. There was no casual way to tell the woman you loved that before she knew you, before nearly anyone in your present life knew you, there had been a child.
A son. A whole person. Eight years.
And then nothing.
“Doug?”
Carol stepped closer. He realized he had been staring past her.
“I’m fine.”
Her face hardened. “Don’t.”
“What?”
“Don’t ask me if I have a minute and then tell me you’re fine.”
He almost smiled, because that sounded like Carol and because for half a second it gave him somewhere familiar to stand. The expression did not last.
“I just…” He stopped.
Carol waited again. Doug stared at her. If he told her, she would understand too much, and that frightened him more than being misunderstood. She would look at Ricky and know. She would look at every child Doug had ever refused to give up on and wonder how much of it had started there. Worse, she would look at him differently. Maybe not badly. That almost made it worse.
“Forget it.”
“No.”
“Carol.”
“You came over here.”
“I know.”
“Then talk to me.”
His chest tightened. He looked down. “I can’t.” The words were quieter than he intended.
Carol’s anger disappeared instantly. “Doug.”
He shook his head. “Not...” He stopped again. Not here sounded as though there would be another place. Not now sounded like a promise. He could not make either one.
“I need Mark.”
Carol studied him. “Why?”
Doug did not answer. For a few seconds neither of them moved. Then Carol gave a small nod. “Okay.”
The absence of another question almost undid him.
“Do you know where he is?”
“Exam Three, I think. He was looking at that janitor again.”
Doug nodded and started to leave.
“Doug.”
He turned. Carol’s face was calm, but her eyes were not. “Whatever this is, you don’t have to fix it in the next five minutes.” He stared at her. Under almost any other circumstances he would have made a joke. Instead he said, “Yeah.” They both knew it was not an answer.
Doug walked away.
Finding Mark took longer than he expected. He was not in Exam Three anymore. Jerry thought he had seen him heading toward the desk. A medical student stopped Doug halfway there to ask a question about a pediatric chart, and Doug answered automatically before realizing afterward that he could not remember what he had said. Finally he spotted Mark near the end of the hall, reviewing something with Lydia.
Doug stopped several feet away. For the first time since leaving Ricky’s room, the idea that had been forming in his mind became concrete enough to frighten him.
Give up the case.
He had been circling it without naming it. Now there was no other honest description. Ricky needed another doctor because he cared in a way that had stopped being useful. The thought went against nearly every instinct he possessed. He did not hand children off because a case hurt. He did not leave when things became difficult. He had built too much of himself around being the doctor who stayed after everyone else had decided nothing more could be done.
That was precisely why he had to do it. He had promised Mark he would not cross another line. Doug knew himself well enough to understand what came next if he remained responsible for Ricky: he would keep looking, find another route to the PCA, justify it because Joi wanted her son home and Ricky was suffering and the rules were absurd and no one else seemed willing to do what was necessary. Every one of those things might even be true. It would not make him objective.
“Mark.”
Mark glanced up from the chart. “One second.”
Doug almost walked away. Then Mark looked at him properly, and whatever he saw made him hand the chart back to Lydia.
“What?”
“I need to talk to you.”
“All right.”
“Outside.”
Mark frowned. “Outside where?”
“Just ….” Doug looked toward the doors. “Come outside.”
Lydia glanced between them but said nothing. Mark followed. They did not go far. Doug pushed through the doors at the end of the corridor and stopped in the quieter passage beyond them, where the sound from the emergency department became blurred by walls and distance.
Mark waited for the door to close. “What’s wrong?”
Doug had prepared for this. He had gone over the words in his head while searching for Mark. I need you to take over Ricky Abbott. Clear. Professional. Nothing in the sentence required an explanation unless Mark asked for one.
Doug looked at him. Nothing came out.
Mark’s brow tightened. “Doug?”
He drew a breath. The words were there he could feel them waiting just behind his teeth. Take the case. He imagined Mark agreeing. Then he imagined Mark asking why, and there was no answer he could give that would satisfy him. Mark knew Doug too well now. Too many years had passed since they had been young doctors who could disappear from one another’s lives for days or weeks without explanation. Mark knew the difference between Doug being angry and Doug being scared. He knew the difference between obsession and panic. He had spent too many nights covering for him, fighting with him, drinking with him, dragging truths out of him after everyone else had given up trying.
Take the case would only be the beginning. Mark would want the reason.
Doug’s throat closed.
“What is it?” Mark asked.
Doug looked at the floor. He could still leave. The thought arrived with such immediate relief that he almost hated himself for it.
Mark shifted closer. “Is this about Abbott?”
Doug’s eyes snapped back to him.
Mark saw the answer. “What happened?”
Doug opened his mouth.
Nothing.
For one terrible second the hallway disappeared beneath another room, another bed, another boy whose body had become impossibly small beneath white sheets while adults discussed what could and could not be done.
Doug shut it down so violently that he felt almost dizzy.
Not now.
Mark said his name again, more quietly. Doug forced himself to meet his eyes. There were years in Mark’s face that had not been there when they first knew one another. Marriage, divorce, Rachel, Susan leaving, his mother illness, patients saved and patients lost. Mark had given him access to much of it, sometimes willingly and sometimes because Doug had refused to let him disappear behind work.
Doug had never returned that honesty equally. He had told himself Mark knew everything important. That was not true.
He inhaled. His chest expanded painfully.
Say it.
Nothing happened.
Mark’s concern sharpened. “Doug, what are you trying to tell me?”
Doug stared at him. He could not do it. Not even the easy part. He shook his head once, then turned and walked away.
“Doug.”
He did not stop.
“Doug.”
Behind him, Mark took several steps. The doors from the ER burst open.
“Dr. Greene!”
Doug kept walking.
“Mark, we need you.”
There was a short silence behind him, just long enough that Doug knew Mark was still looking after him. Then footsteps moved in the opposite direction. Doug reached the end of the corridor and pushed through another door without knowing where he was going.
Mark stood still for less than a second before the urgency in Lydia’s voice pulled him back into the department. His patient had deteriorated. There was no choice after that. Medicine had a ruthless talent for narrowing the world when someone became unstable, and within moments Mark’s attention was reduced to blood pressure, rhythm, oxygenation and the sequence of interventions required to prevent a manageable problem from becoming a fatal one.
For the next fifteen minutes Doug Ross ceased to exist.
When the patient was finally stable enough to transfer, Mark stripped off his gloves and dropped them into the waste bin. He stood there for a moment, and then Doug came back into his mind exactly as he had looked in the hallway.
What bothered Mark was that Doug had not looked angry. He had seen Doug furious often enough that he could identify degrees of it at a glance; Doug angry at administration looked different from Doug angry at a parent, Doug angry at himself was quieter, more dangerous, and Doug on the verge of breaking a rule carried a particular restless energy, as though the argument was already over in his head and everyone else simply had not caught up. This had been none of those things.
Doug had looked as though the words themselves frightened him.
“You okay?” Lydia asked.
Mark looked over. “Yeah.”
She followed his gaze toward the hall. “Looking for Ross?”
“Did he come back through here?”
“Not that I saw.”
Mark nodded and left. He checked the desk first. Jerry had not seen him. Randi was too busy to care. Carol was talking to a home-care agency on the telephone, one hand pressed against her other ear to block out the noise.
Mark started toward her, then stopped. There was something in Carol’s posture that made him wait. She looked up. Their eyes met. Mark pointed toward the corridor and mouthed, Doug?
Carol ended the call a few moments later. “He was looking for you.”
“I know.”
Her expression changed. “You talked to him?”
“Depends what you mean by talked.”
“What happened?”
“He dragged me outside and then left.”
Carol’s face tightened. “He did the same thing with me.”
Mark stared at her. “He tried to talk to you?”
“He asked if I had a minute.”
“And?”
“And apparently he didn’t.”
Mark glanced down the hall. “Did he say anything?”
“No.”
“About Abbott?”
Carol hesitated. “He didn’t have to.”
Mark looked at her again. Something passed between them then, an understanding that neither possessed enough information to put into words.
Carol picked up another chart. “If you find him, don’t push too hard.”
Mark gave her a look. “That advice coming from you?”
“Yes.”
“That’s concerning.”
“I’m serious.”
“So am I.”
Carol held his gaze. “He looked scared.”
There it was again.
Mark nodded slowly. “That’s what I thought.”
He left the desk and checked the physicians’ lounge, then the hallway near radiology, moving without much urgency because he knew chasing Doug rarely accomplished anything. Doug had spent years perfecting the ability to disappear while remaining technically inside the same building. When Mark reached the pediatric rooms, he slowed. Ricky Abbott’s door stood partly open, but he did not stop. Whatever had happened in there belonged to Joi and her son, and if Doug had wanted Mark to hear it he had just been given every opportunity to say so.
He checked the treatment rooms, the lounge, the hallway near radiology. Nothing. Doc Magoo’s was possible, but somehow wrong; Doug had not looked like a man headed for coffee or a beer. Outside near the ambulance bay was more plausible. So was any quiet corner of the hospital where no one would immediately hand him another chart.
At the stairwell Mark paused. The roof was hardly an inspiring guess they had both ended up there often enough over the years when County became too loud, and Doug had always preferred cold air to the physicians’ lounge when he wanted to be left alone. Mark would ordinarily have taken that preference at face value.
Tonight Doug had come looking for him first. That made the difference.
Mark pushed open the stairwell door and started climbing, still with no idea what Doug had tried to say downstairs only the memory of the way the words had failed him and the unsettling absence of anger in his face. Julian could make Doug furious. Kerry could make him reckless. Rules could make him impossible. None of those things usually made him walk away without finishing an argument.
Whatever this was, Mark suspected it had very little to do with a signature by itself.
By the time he reached the last flight, the noise of the hospital had faded to little more than a vibration behind concrete walls. Mark slowed at the heavy door leading onto the roof, cold air already finding its way through the edges of the frame. Perhaps Carol was right and he should not push. If Doug was outside, he had gone there because he wanted distance from everyone downstairs. Under most circumstances Mark would have respected that.
But Doug had come looking for him first.
Mark rested his hand on the bar for another second, then pushed the door open.