Chicago Med fic: In a Heartbeat (2/4)

[faye_dartmouth]

PART ONE
PART TWO
PART THREE
PART FOUR



-o-

The temptation to run was real, but there really wasn’t anywhere to go at this point. He’d been officially checked into the hospital. His name was in the system, and no doubt, everyone knew it by now. Rumors would be spreading beyond the ED at this point, and Will’s barely stitched together reputation would be pulling at the seams once more.

Six months of relentless hard work, and Will had sabotaged it all with a few things called chest pains.

Maybe this was karma for tanking a trial about heart drug meds. He probably deserved the comeuppance.

Even so, he didn’t much like it.

Jay was out of the room for only ten minutes, and Will fielded visits from at least 10 ED staff members. They all just wanted to see if he was okay -- but Will was pretty sure it was just fodder for their story about this latest fall from grace. Right before Jay came back, Ethan stopped by, and that just made things worse.

Ethan was his boss.

It had taken him some time to come to terms with that, but he’d worked hard to be nothing if not a loyal employee over the last six months. He’d gone out of his way to assure Ethan that he was a team player first and foremost.

This incident really wasn't helping his case.

Ethan, for his part, looked a little uncomfortable when he knocked on the door. In fact, he looked a little sheepish. “Sorry,” he said. “If you’re not wanting visitors--”

Will gave a small shrug to indicate the futility of it all. “There’s no stopping them,” he said, plastering a smile on his face. “I’m sure you remember how that goes.”

Ethan laughed good heartedly, stepping inside with a nod of commiseration. “I do,” he said. “Which is why I’ll also understand if you really would rather be alone.”

Ethan sounded sincere, and there was probably a reason for that. They had been on better terms lately. Will had worked to build up trust between them -- after all, resenting the fact that Ethan got promoted seemed a little foolish now. Will should have been fired six months ago. He didn’t belong at Med, much less as head of the ED. He’d felt genuinely bad for how out of sorts he’d gotten with Ethan leading up to that, and he’d dedicated himself to being Ethan’s right hand man.

Whether or not that was good enough was still up for debate, but Ethan’s concern seemed genuine.

“It’s fine,” Will said. He nodded to the equipment. “I’m fine, too. I mean, all this--”

Ethan glanced around, and no doubt he made out more of it than he let on. “The rumor is you went down during a basketball game.”

“Went down is a strong way of putting it,” Will said. “I just got lightheaded for a moment.”

Ethan looked at the monitors again. “Your BP?”

“I know,” Will said, shaking his head. “A little tightness in the chest, and you know the whole thing gets dragged out. But I’m really sure it’s nothing.”

“It’s good you came in,” Ethan said. “Because heart problems--”

“Are serious, I know,” Will said. He smiled. “But they’re also conflated easily with symptoms of other stress-related conditions. I probably shouldn’t have worked that double yesterday, trying to cover Maloney’s shift. I’ve been skipping a few meals, you know how it is.”

Ethan nodded, but he didn’t look particularly convinced. “How did the EKG look?”

It was Ethan’s attention to protocol that had likely kept him from just looking for himself. At least Will had garnered that much respect -- even if he was at risk of losing it all. “Crockett’s a little worried about a few things--”

“ST elevations?” Ethan asked, brow starting to crease.

“Again, easily conflated--”

“Is cardio on its way down?” Ethan pressed.

Will felt his frustration start to rise again as he started losing control of the narrative. “Of course,” he said. “So hopefully I can get this cleared, and go home, rest up -- and be back at work, bright eyed and bushy tailed tomorrow.”

He was being a bit aggressively optimistic, but since everyone around him seemed to think he was on his deathbed, he felt warranted. Ethan, however, seemed to be joining the chorus of reactive voices. “Well, let’s just wait for the test results to come back.”

“Ethan, really, I appreciate your concern, but I’m sure this is nothing,” he said. “I mean, if anything, I just want to get out of here.”

Ethan nodded seriously. “Will, I hope you’re right, I do,” he said. “But I’ve learned things the hard way this year. You can’t take things for granted. Sometimes the worst really does happen, and when it does, you can’t be ashamed to make time to deal with it.”

“And you’ve done it all so admirably, Ethan, you really have,” Will said. “But this? Is nothing. I’m fine.”

“Just make sure you’re doing it, too,” Ethan said. “There’s no shame in being in here. There’s nothing to feel silly about. I’m just worried about you -- you’re too valuable to this ED to risk for nothing. Too valuable to me.”

Ethan was trying to reassure him, but the only reassurance Will was getting was that staying a second longer in this hospital was almost untenable. He’d finally built a bridge with Ethan, and here he was, undermining himself at every turn. He had always been his own worst enemy; some things, it seemed, never changed.

Will didn’t look away, and he bobbed his head back. “You can count on me. I promise.”

Ethan smiled back. “I know I can,” he said. He looked around the room in a final, anxious gesture. Then, he inclined his head to the door. “I’ll let you get back to resting, if you can. Let me know if you need anything.”

“I could do some charts while I’m laid up,” Will offered.

Ethan chuckled like he thought Will was joking. “Take care, Will.”

Will forced a smile as he watched Ethan retreat. “Sure, you bet.”

As Ethan left, Jay was making his way back in. They acknowledged each other with a brief nod before Ethan headed back into the ED and Jay came inside the exam room, shutting the door behind him.

“Okay,” Jay said, settling back into the chair while he kept his phone in his hand. “I talked to Voight and got the day. I also went ahead and gave him the heads up that it might be a few.”

“A few days? Jay, there’s no way I’m staying here for three days.”

Jay shrugged a little to show his indifference to the claim. “If it’s a heart attack, you are.”

“And if it’s a panic attack, then I’m going home today,” Will pointed out.

This was becoming a familiar impasse, but one that neither brother seemed eager or ready to yield.

“Will--”

Will wasn’t known for being the strongest will in the family -- he’d been more like his mom, letting bygones be bygones -- but he certainly wasn’t a without a backbone. He just knew to pick his moments, and if he wasn’t running from this disaster, he sure as hell was holding his ground.

“Jay,” he replied, matching his brother’s intonation exactly.

Jay’s eyes narrowed, and he was ready to snap, but just then, the door opened and saved them both from the inevitable conflict to ensue.

Will did a quick double take at the tall figure in scrubs and a white coat, putting the name to the face quickly enough. This was the cardio consult Crockett had called in: Dr. Latham himself.

Of course.

Crockett didn’t just get the resident on call. He went and called in the head of cardio. To come ASAP. He hadn’t even been in the hospital for thirty minutes -- Crockett had clearly tagged his case as an emergency, despite the fact that there was nothing emergent about any of it.

Just because of course Crockett did. With Maggie’s pressure, Ethan’s approval and everyone’s input. No doubt, this was supposed to be deferential treatment to one of the hospital’s own. Will should probably be flattered that everyone still considered him part of the hospital family. But it felt like overkill. Much ado about nothing.

Will had worked to keep a low profile lately.

One bad day on the basketball court, and he was upending months of dedication and self control.

Dr. Latham, however, appeared oblivious to Will’s speculation. Ever polite, he bobbed his head toward Will and Jay in equal turns. “Dr. Halstead, I wish we could be seeing each other under less personal circumstances,” he said methodically. Then, with another look to Jay, he added, “I understand you are Dr. Halstead’s brother?”

“Jay,” his brother said, getting up and offering his hand.

Latham took it, and though he appeared moderately uncomfortable with the gesture, he brusquely completed the handshake and Jay sat back down.

“For your edification, Detective Halstead, my name is Dr. Latham,” he explained, shifting his posture. “I am the Head of Cardiology here at Chicago Med. I have been a colleague of Dr. Halstead for quite some time. We have had the pleasure of working on many cases together, some of which have been quite memorable.”

All doctors had their version of small talk, and some were better at it than others. It was a nice gesture -- Will knew Isidore Latham well enough to recognize that. But Will had never been particularly friendly with Dr. Latham. Of course, no one had seemed friendly with Latham. He was just that kind of guy -- the kind that didn’t have friends. There was nothing especially off putting in his personality -- he was just odd. Will got the impression that social situations made him uncomfortable. Mostly, everyone knew that Latham just didn’t want friends, and most overtures were politely but irrefutably turned out.

Accordingly, despite being colleagues for all these years, there wasn’t much of a camaraderie between them. In some ways, that made it less awkward, though sitting there, gowned up in his own hospital, was uncomfortable no matter how he framed it.

At any rate, the small talk was over.

“Your preliminary blood tests have been completed, and I have fully analyzed those results along with the ongoing readout of your EKG,” Latham said. He always spoke in a perfunctory fashion; he didn’t mince his words. Will hadn’t decided if that was a good thing or not right now. Latham did not notice any potential distress and continued. “Based on my expert opinion, it is clear to me that you have suffered a heart attack this morning.”

Straightforward, to the point and spoken without emotion.

All like a punch to the gut.

Will froze, heart almost stuck in his chest now. He didn’t dare look at Jay’s expression next to him.

Latham went on. “Additionally, after reviewing your results, I am quite confident that there are ongoing signs that your heart is in some distress,” he said. “Absent signs of an active infection or other contagious markers, this indicates that you likely have early onset heart disease.”

Will chaffed immediately, and he shook his head. He was still recoiling from the shock of the blunt diagnosis with all the denial he could muster. “You can’t know that until we do an echo. And we have to increase the blood work to cover more of the autoimmune responses.”

“I agree. This is precisely why you are scheduled for one within the hour and I have put in the order for extended labs as well,” Latham said. He seemed to pause and reorient himself. He looked at Will with something of a smile. “However, I feel compelled to work under the most likely diagnosis within the differential in order to ensure prompt treatment.”

“Heart disease has to be low on the differential,” Will argued. “I don’t fit the profile.”

“There are mitigating factors both for and against,” he agreed, but with all obvious caveats. “Given your age and your lifestyle attributes, it does not seem like this condition was caused by diet or exercise. However, you have a reported family history of heart disease, which leads me to suspect that your case is heavily influenced by your genetics.”

It was a fact that Will had been conveniently ignoring, no matter how much everyone else tried to bring it up. He blinked his eyes, pretending like they weren’t burning. They weren’t. Just like his heart wasn’t thudding in his chest, beat after painful beat.

Dr. Latham drew his mouth into a line, and he seemed to muster what he could of empathy. “I understand this news is likely to be distressing, but I think there is reason to be encouraged. As I said before, you are young and fit, and with early treatment--”

Will shook his head.

Will had to shake his head.

“Genetics are just one factor,” he said, feeling desperately stubborn now. “I have no other risk factors. I think we’re jumping to this conclusion really fast.”

The interruption to the litany of support seemed to throw Latham off. He shifted uncomfortably, and made a visible attempt to get himself back on track. “Indeed,” he said. “Your case would not be a common occurrence, but it is certainly not unusual. I have seen many people who are otherwise healthy in their 30s--”

“I’m just saying, we have to wait for the echo--”

Jay drew a shaky breath next to him. He sounded as rattled as Will felt at the moment. “Will--”

Will shook his head again, even more adamant. “No, we have to do a thorough analysis,” he said. He still didn’t trust himself to look at his brother so he fixed on Latham instead. “I mean, there are other things to rule out -- viruses, infections--”

Latham was nodding along, even as he appeared disconcerted by the idea of an extended differential. “All of which I have considered in my diagnosis,” he said. “Dr. Halstead, I do not take pleasure in bringing undesirable news, especially to a respected colleague, but my main focus is treating you.”

“So diagnose me first,” Will insisted. He crossed his arms over his chest defiantly. “We need to do the echo, run repeat labs.”

“The diagnostic process takes time, Dr. Halstead,” Dr. Latham said. “My concern is that if we wait to treat you, you may suffer further complications.”

“I’ll take the meds, do the tests, whatever,” Will said. “I just don’t want to jump to conclusions when there are plenty of reasons for my cardiac function to be off-kilter right now.”

“Very well,” Dr. Latham said, though he didn’t sound like he felt very well about it at all. He managed a forced smile to Jay. “I will check back with you after I have the results of your echo and extended blood work.”

It wasn’t exactly a willing compromise on either side, but Latham was an innate professional. And Will was a stubborn bastard. So it kind of worked out in the end. Dr. Latham made his retreat with no further comment, and Will needed a minute to catch his breath.

And get his bearings.

It wasn’t what he’d wanted to hear, of course. He’d maintained all along that this was likely a panic attack. He’d been confident that his condition was spurred on by working too much and looking after himself too little. He’d pushed himself beyond his limits, it seemed. And apparently that mattered.

All this talk of heart attacks and heart damage and heart conditions -- it was looking in the wrong direction. Now he had other departments on his case, and pretty soon the whole hospital would be back to telling stories about Will Halstead and his perpetual screw-ups.

As if this didn’t just increase his anxiety even more.

And they really thought that simple BP meds and cardiac drugs would help? Will had been nursing an anxiety attack for six months. He had to ride this out.

He was grappling with these facts as best he could.

Finally, he looked at Jay.

Jay was stony faced. He seemed to be grappling with these facts, too, but he looked to be coming to different conclusions.

There was no reason to put it off. Will tipped his head in commiseration. “Well, I knew our cardio team had gone downhill, but I had no idea it was that bad.”

Jay didn’t reply, but he finally looked back and met Will’s gaze.

Will immediately wished he hadn’t.

Because face to face, eye to eye, there was no way to miss the expression in his brother’s hard expression.

Jay looked scared.

There was no way around it. His brother was pale and drawn, worse than Will had ever seen him. He looked worse than when Mom had died. The expression was more haunted than when they’d had to sit there and pull Dad off the vent. Maybe it was the look he’d had after coming back from the war -- Will probably should have been there for that -- but here they were. Will in the hospital bed, and Jay sitting vigil.

Will couldn’t do that.

Not to Jay.

Not after Jay had done it before -- and Will hadn’t.

“Look, Jay,” Will said, approaching the silence once more but with more purpose now. “Doctors -- they talk a lot. You’ve seen me do it countless times, and you always call me on it. We like to hear ourselves go on. But it’s just words. You can’t take it all so seriously.”

Jay looked at him in disgruntled disbelief. “Words? The head of your cardio department just stood there and told me you had a heart attack. And you don’t want me to take that seriously?”

Jay was on the verge of completely freaking out, and Will couldn’t just sit there and let it happen. “The tests aren’t complete -- and the results certainly aren’t incontrovertible,” he said. “And yeah, the head of cardio. You don’t think that every discipline has its biases? If you ask for a consult, they’re going to see their own case before they see the possibility of anyone else’s. There’s still a differential to work here, and there are plenty of other reasons that justify my vitals.”

Will felt he was being quite reasonable, but Jay did not look like reason was what he wanted right now. Or, at the very least, he didn’t want it from Will while he was on the monitors. “Will--”

“Jay, I’m serious,” Will said, as readily as he could. He wasn’t good at a lot of things in life, apparently, but he was still a damn good diagnostician. He stuck to that. He had to stick by that, now more than ever. “We have to wait for the other tests.”

Jay’s jaw was tight, and he shook his head tersely. “I was sitting right here, man. They did the other tests,” he said. He glanced around the room, as if that proved some kind of a point. “And they all said the same thing.”

Will sat back, stubbornly crossing his arms over his chest. “No, not all the tests.”

Jay gawked at him, as if Will might have grown horns during his stay in the hospital instead of spiking an irregular heartbeat. “How many do you need? I mean, I saw you go down, man. You were clutching your chest--”

Will shook his head again, refusing to allow this to go on. It didn’t matter what Jay said. It didn’t matter what Latham said, or Crockett or Maggie or anyone. Will was stressed out. He was overworking himself. He was tired, exhausted -- all of it. He hadn’t been listening to Dr. Charles when he talked about mental health. He was too young to even entertain the idea of a heart attack. He worked out; he ate healthy. And frankly, he had too much to do to be laid up in the hospital with a heart condition.

Honestly, he had half a mind to get up and walk out of here, just to prove his point to Jay.

If he wasn’t worried about giving Jay a heart attack in the process, he might just. As it was, for all Jay’s tough guy talk, his brother needed finesse. “Jay, I’m not half-assing this. I swear.”

“No, because you’re not assing this at all,” Jay snapped back. He leaned forward, lowering his voice. “Come on, you don’t think it’s even possible? Dad had a heart attack, and Grandpa probably did, too. Hell, not many Halstead men are known to live very long, and you’re not even going to consider it?”

As if Will needed Jay’s laymen perspective on the Halstead family tree. As if Will needed Jay to dredge up Will’s own family medical history. As if Will needed any of this--

He heard his heart rate spike again on the monitor, and a fresh pain flared across his chest. It took all his resolve not to reach up and massage it, and he worked to quell the pang of anxiety he felt.

Panic attacks.

Same symptoms.

Still on the differential.

He exhaled, working to keep himself calm and steady. “Jay, just -- I need you to go with me on this.”

Jay sat back, looking visibly deflated. He lifted his arms, almost in futility. “As long as you promise me that when push comes to shove, you’ll deal with this. No matter what it is, you’ll deal with this.”

“Of course,” Will said. “It’s probably indigestion and stress--”

“Will--”

Will held up his hands in effectual concession. “No matter what it is.”

Jay wasn’t exactly satisfied with the concession, but he seemed to recognize that it was as much as he was going to get.

-o-

Will had resisted much of his so-called treatment in the hospital, but he was eager to get the echocardiogram out of the way. In his mind, this would be the key piece of the differential. With the ultrasound scan, they would finally get a clear look at Will’s heart and arteries. Once the images showed that Will’s heart was healthy and working fine, then the doctors could scrub the whole heart attack angle and start looking for simpler diagnoses.

It might actually make his conclusion of a panic attack seem more viable. And he could get to actual solutions to cope, and they could abandon this whole, ridiculous and distracting course of action.

As the patient, Will had a limited view of the monitors. He tried to position himself for a better angle, but the tech quickly reminded him that the quality of the visual was more important than anything else. It was frustrating to sit so still, feeling the wand press over his chest. While the tech checked each angle, Will could feel his heart, beat after beat, hammering inside his chest.

So he was nervous.

So he was even a little scared.

This year had been hell for him, but he wasn’t naive. He wasn’t stupid. He’d done it to himself. It had been all his fault, and he had to own that. He had to take control to get things back on track. So, yeah, it made him nervous. And sure, it had him a little scared. It was a tall task, coming back from his mistakes. This was the first time in his life he’d stuck through something, when he’d faced real hardships and not given up. His default was to run.

But he was staying.

For each painful beat of his heart.

For each strained breath of air.

Will was staying.

To do the job. To be the brother Jay deserved. To be the best doctor he could be.

Will was staying.

-o-

After the scan, he had barely gotten settled back in his room when Dr. Latham was already knocking at the door. Will had just been assuring Jay that everything was fine when the other doctor entered, and Will knew immediately that something was wrong.

As a member of hospital staff, Will knew he was warranting a little special attention. He was getting faster access to tests, and his care had been exceptionally precise and prompt.

But for the head of cardiology to be there within 30 minutes of completing the test?

Well, either this was a social call.

Or it was something else.

And Dr. Latham didn’t strike Will as the type to make social calls.

“Dr. Halstead, I reviewed the results from your echocardiogram,” he said duly, without bothering to engage in small talk.

Will would have appreciated that in another context, but he was starting to feel a little queasy. He tried not to show it, but Jay had gone stiff on the chair by the bed anyway.

Dr. Latham drew a breath and seemed to hold it for a second. “Naturally, your case has caused many people great concern, and I was quite anxious to have these results to help confirm or deny my diagnosis.”

Will barely had enough of a voice to speak. “And?”

Dr. Latham pressed his lips together thinly, before lifting up his tablet and tapping it a few times. He produced the first image, which he turned toward Will, approaching the bedside anew. “These are your scans,” he said, holding the screen closer for Will to get a good look. “Usually, I would not show the patient the scan in this detail, but you are a trained medical professional. I am confident that you will be able to make sense of the images just as well as I have.”

It was a surprisingly astute professional courtesy, and Will found himself taken aback by the thoughtfulness of the gesture. But this kind of gesture was not without reason. It wasn’t just kindness.

It was to prove a point.

Will looked at the image of his own heart, feeling the way it froze up in his chest even while he scanned the static image. Next to him, Jay leaned forward to see, but the black and white scan was hardly simple enough for him to understand. No, you had to know what you were looking for. You had to be able to identify the landmarks of the heart and chest. You had to know the baseline of a healthy heart for comparison in order to understand.

In order to see.

And Will did. Will knew what a healthy heart looked like. He knew how to read an ultrasound. He knew all the landmarks, and he knew what to look for.

He was too smart not to see it. He was too experienced not to understand it.

But sitting there, looking at the images of his own heart, Will found himself at a total loss.

Finally, when Will managed to say nothing, Dr. Latham began his assessment. “We were able to secure very good images of the heart, and we can confirm the images from multiple angles, providing a comprehensive view of the heart’s chambers and the surrounding arteries,” he said. “I find that there is little room for ambiguity in these images.”

Will had been so sure.

Will had been so completely, 100 percent sure.

He blinked, trying to keep his eyes clear, but it didn’t help. At this point, nothing helped.

“Clearly, as the echo shows, there is significant damage to the heart and the surrounding arteries,” Dr. Latham said, gesturing to the image on the screen with some purpose now, indicating specific areas of concern.

Will had spent a lot of his life studying such images, but the contrast picture was hard to focus on suddenly. All his diagnostic skills were suddenly worthless, and Will fought against the rising nausea in his stomach.

Dr. Latham continued anyway. “Given your age and overall health, the results are surprising and moderately troubling. The amount of inflammation and your ongoing arrhythmias suggest that you are likely in the early stages of heart disease. If left untreated, you will develop heart failure at some point, though given the way your heart is functioning, I do think you are likely to suffer from another heart attack before the disease will advance that far.”

The blunt assessment was nothing short of what Will had come to expect from the socially awkward cardio chief.

He should have insisted on another doctor. Someone a lot less talented, but a lot less difficult to deal with.

He needed to think. He needed to slow this down -- now.

Blinking again, he tried to focus on the images once more. The damage -- highlighted in bright white -- was impossible to miss, but it didn’t make sense. Will’s chest tightened again, and he unconsciously rolled his shoulder even as his BP climbed again on the monitors.

“Dr. Halstead, I am sure this is not the news you were hoping to hear today, but the facts are the facts,” Dr. Latham explained. He withdrew the iPad with the images and shifted his stance to look at Will fully now. “While I believe the diagnosis is quite serious, I am encouraged by your age and your other risk factors. You are young and otherwise healthy. We can start you on blood pressure medication to try to keep your BP in check, and then we can schedule you for bypass surgery within the next few days.”

He said it just like that, simple and to the point, and Will’s jaw fell open. Across from him, he couldn’t see Jay’s expression -- he didn’t dare look -- but his brother had gone ramrod straight and unsettlingly still. They were both reeling badly by now, and whatever Will had left of his professional restraint was slipping fast. “Wait -- you’re already jumping to bypass? Open heart surgery? Just like that?”

Dr. Latham appeared vaguely upset by the question, but he was a professional as well -- and he had been doing this job longer than Will had. “It is the most invasive option, and I do not make the recommendation lightly. Your arteries have been compromised, and there are signs of stenosis already,” he said. “The heart muscle has already sustained damage, and I believe that bypass can allow you to stay off an electrical implant for the time being. If the surgery is a success and you maintain your health and medication regimen, then you may be able to avoid further complications for the rest of your life. I know it is a slightly aggressive approach, but I have thoroughly considered the cost-benefit analysis based on your health, your history and your lifestyle, and I am confident that this surgery will give you the best outcome.”

Will wanted to laugh. No, Will wanted to cry.

The best outcome?

Heart surgery?

In his 30s?

There was no way this was happening. Will was on the cusp of rebuilding his career. Will was dredging himself up from the bottom here. He couldn’t be sidelined now. Not like this.

Even as he shook his head, the protest lodged in his throat, Jay spoke from the side. “And how soon did you say he could do it?”

“Jay--”

Dr. Latham answered the question regardless, addressing himself to Jay. “I would like to schedule it as soon as possible. Dr. Halstead’s blood pressure is not currently within reasonable margins, but I am confident that we can quickly manage that with medication and get him on the schedule within the next day or two.”

Will shook his head, even more determinedly now. “Just -- wait,” he said, drawing both the attention of his brother and his colleague. “I mean, this isn’t a no brainer--”

“Uh, if it can save your life--”

“--it’s major surgery, Jay,” Will said. He looked to Dr. Latham with renewed concern. “I mean, isn’t the standard care of treatment, given my presenting factors and assuming this really is heart disease, to start with less invasive measures first?”

“Under normal circumstances, perhaps, but you presented with an active myocardial infarction. Frankly, your heart function has not returned to levels that make me feel good about releasing you with a conservative course of action,” Dr. Latham explained. He was clearly starting to get a little agitated.

Will understood, in some respects.

He was starting to feel agitated as well.

Except that this was all insanity. He’d had an MI? They wanted to do bypass?

“Will, maybe you should listen--”

“Oh, now you want to listen to the doctor,” Will sniped, turning to glare at his brother. It was harsher than he’d intended -- he knew that Jay was scared and well out of his element -- but this was Will’s body they were talking about. It was his chest they wanted to cut open, and it was his recovery that would derail his career, so maybe he got to have the final say. “That’s convenient--”

“No, that’s called learning,” Jay said. “You were right before, every step of the way with Dad. I never wanted to listen, but I should have. With the surgery, the medication, the lifestyle changes--”

Flustered, Will blew out a short, barely tempered breath. “If it were necessary, then fine,” he said. He turned his fiery gaze back to Latham. “I’m not consenting to any surgical option until we take some time to see how my heart function responds to the meds. I mean, it’s only been a few hours. I’m still not even convinced we’re looking at early onset heart disease--”

This declaration seemed more than a little disconcerting to Dr. Latham. “Dr. Halstead, I assure you, my professional opinion can be trusted in this situation,” he said. “But if you require a second opinion--”

Will shook his head, trying to divert this train of thought. “No, not a second opinion,” he said. “I’m not questioning you. I’m just -- I want to give it time. You said it yourself, my BP isn’t even well controlled yet. To jump to surgery before my vitals return to a healthy baseline--”

“But you may not be capable of a healthy baseline,” Dr. Latham said, increasingly vexed. “Dr. Halstead, I have always known you to be a reasonable doctor and a skilled diagnostician who takes the advice of your colleagues very seriously. I find your resistance to the obvious course of action here to be confusing, to say the least.”

Will almost felt sorry for the man. In some ways, the confusion Dr. Latham was dealing with was understandable. As doctors, they worked with their own rhythm. The professional back and forth, the casual delineation of conditions and treatments -- it came with a coolness that you needed to do the job. Dispassionate compassion was a tricky balancing act, and Will thought he was pretty good at it most of the time.

He had his blind spots, sure. Everyone did. He had issues with DNRs, and he had never liked that pesky thing known as consent.

That was irony, of course. Since it was his consent that was being elicited, and he was holding out. Will might have appreciated that irony a little more were the stakes not what they were.

Therefore, sympathy for Dr. Latham’s position was limited.

Very limited.

Because Will couldn’t possibly deal with befuddled colleagues, a terrified brother and his own erratic vitals right now.

“I’m just saying I want to wait,” Will said, hoping that the air of finality in his voice was enough to counteract literally every other indication in the room right now. “I want to try the meds. I want to watch my vitals. I want repeat labs, repeat scans -- all of it.”

This was still not what Dr. Latham wanted to hear -- Will didn’t even bother to look at Jay at this point, because he was sure his brother’s disapproval would be scathing -- but the cardiothoracic doctor was not new to this time. Pursing his lips, he still looked disconcerted, but he bobbed his head accordingly. “It is a far more cautious approach, but I cannot wholeheartedly discredit it,” he said diplomatically. “I will want you to start a full round of heart medications, including additional drugs for cholesterol and blood pressure, and I do insist on admitting you to the cardiac ward to monitor your ongoing condition.”

As if sensing Will’s inevitable protest, Dr. Latham continued undaunted.

“Currently, your heart rate is too unstable and your blood pressure is uncontrolled,” he explained. “You are at a high risk for a secondary cardiovascular event, and it would be negligent to send you home without a definitive course of treatment at this juncture.”

The idea of being admitted chafed at him, to be sure, but it was probably an apt compromise. Short of signing himself out AMA -- and facing his brother’s wrath -- it was really about the only compromise he was going to get right now.

“Fine,” he said. “I’ll do the meds, and you can put me in a room.”

With a fixed nod of his head, Dr. Latham agreed. “Very well,” he said. “I’ll have the orders drawn up.

With no further equivocation or salutation, Dr. Latham made his hasty exit, and Will was left alone with Jay once more.

He really wished his brother had just gone to work today. This would be so much easier to do if Jay hadn’t heard the differential discussed in front of him so openly. As a layman, Jay couldn’t differentiate between all the nuances. He couldn’t make sense of actual definitive diagnoses and aggressive treatment plans.

All he heard were heart attack and bypass surgery and went from there.

Drawing a breath, Will readied himself to calm his brother’s nerves. However, when he looked at Jay, the familiar look of fear and ire was gone now.

Jay looked like he was cowed. He had pulled back in the chair, almost pulled into himself. His expression was small and guarded, and the questions were raging in his eyes even as his mouth was clamped shut. The only discernible part of his expression was hesitation.

Will’s chest went cold again, but it wasn’t an arrhythmia this time.

He and Jay had never been hesitant with one another. They were brothers, and they had been in more fights than Will could remember -- physical and otherwise. They didn’t pull their punches with one another. Will had always kind of liked that about Jay. All the times he’d let Jay down, they at least had honesty to fall back on.

It made this brother thing work.

Even when Will was an idiot.

Especially when Will was an idiot.

He was too aware of how much experience he had on that front, and he didn’t want to do it now.

Jay couldn’t hesitate.

Not when Will had finally made the right choices. Not when Will had stayed the course. Not when Will had finally started to be the brother that Jay deserved all along.

They called it chest pain.

Will was pretty sure it could also be classified as guilt.

“Jay, you might as well say what you’re thinking,” he said finally, breaking the silence between them.

Jay looked at him, and the question in his eyes turned so hard that it looked like it hurt. In a split second, it was like someone punched him, and Will knew just how much his brother’s anxiety was peaking right now. “You know what I’m thinking.”

“I really don’t,” Will said.

Jay scoffed, short and hard. He was so angry that he looked like he might actually cry. “How can you not know?”

Will shrugged, because being flippant was his last defense. “Because I’m not a mind reader.”

“Will,” Jay said abruptly, sitting forward again. Will was the one with cardiac symptoms, but Jay seemed to be having trouble catching his breath, too. “Dr. Latham was pretty clear just now. He thinks you need surgery.”

“So?” Will asked. Jay acted like it was so definitive, but it wasn’t. None of it was. He just needed his brother to understand. That way Jay could stop worrying about Will -- and focus on things that actually mattered. Will didn’t have time for this; Jay had less time. Between his job and his relationship with Hailey -- Will and his stupid heart were a distraction Jay couldn’t afford. “A more conservative course of action is totally justifiable right now.”

Jay’s brow wrinkled. The tension in his face was unresolved, but the hesitation was back, taking the edge off his anger and softening his fear. “Are you sure about this? Like sure sure.”

Will would work with that. As much as he could, he would work with that. “Am I sure I want to make sure that I’m not getting major heart surgery unnecessarily?” he asked quizzically. “Yes.”

“No, are you sure it’s unnecessary,” Jay said, not so easily coddled. He pointed to the door again. “I mean, you heard him--”

“Jay, how many times do I have to tell you--”

But Jay shook his head and interrupted. “Will, it’s your heart, man. It’s your life,” he said, and it sounded a little like he was pleading now. “If you’re being stupid about this--”

Will was stupid about everything; Jay, of all people, should know that by now.

All the more reason to just let this go. “Let’s just give it time, okay? Wait and see. I mean, the scans -- they’re not great, but this could still resolve. My heart function could improve. The meds could work. It happens.”

Jay seemed reluctant, but he finally relented. He sat back, looking only partially convinced. The hesitation was willfully overridden, however, and he nodded stoically. “Okay,” he said. “But you need to promise me--”

“I’m going to be fine, Jay,” Will said, vowing it with every good intention inside his tight chest. “I’m going to be just fine.”

-o-

Will had resisted coming into the hospital by ambulance. He’d hated being checked into the ED. He had resented every nurse and doctor that handled his care.

So the process of being admitted wasn’t one he was exactly eager to undertake. He wanted this to be over, but everyone around him kept finding ways to extend this misery. Will already felt like crap. Being in the hospital under constant scrutiny just made it so much worse.

Still, Will submitted to it as best he could. He smiled and demurred, and he made small talk where appropriate. He met concern with cliched counterpoints, and while he assured everyone that he was fine, he always thanked them for their concern.

They meant well, after all. Will knew that. He didn’t resent their concern. He just couldn’t quite stomach it. Every question was undermining his carefully constructed credibility, and every second he spent on monitors was another second he wasn’t out there doing what he needed to do. It killed him thinking about a bustling ED and having no way to help. There were real patients out there in life and death situations -- and instead of doing what he could to save lives, Will was taking up another bed.

As he expected, getting admitted meant that everyone in the hospital officially knew he was a patient now. The visitors came steady and consistently, and despite Will’s desire to make a good impression, it was wearing thin on his temperament. Every time they asked how he was, he assured them he was fine. And each time, without fail, they pinned him with a look of pity that made his skin crawl.

The fact that Jay seemed to relish each visitor, bringing up every aspect of Will’s case while Will tried to put the symptoms in context, did not help. He wouldn’t say that his brother was enjoying this, but Jay seemed to be seeking exterior validation.

In other words, he wanted more people to verify that his low assessment of Will’s judgement was correct.

It was only when his heart slipped into another arrhythmia that the resident on call put a limit on his visitor count, and Will had never been more grateful for an irregular heartbeat in his entire life.

In fact, he thought as he got himself settled in the bed anew, the idea of atrial fibrillation or another type of heartbeat irregularity was also a good explanation. People experienced arrhythmias in a lot of ways, and although presentation as a heart attack was not necessarily the most common, it was easily high on the differential.

There was just no need to assume that it was a heart attack. Or that the heart attack was caused by heart disease. That was the absolute worst case scenario, and Will wasn’t there. How could he possibly be there?

Jay was lousy company throughout the afternoon, injecting himself in every nurse checkup and doctor visit. Over time, he came to field Will’s guests for him, which was nice in theory, but now Jay was telling everyone that Will had had a heart attack, and all that did was make Will want to have another heart attack.

By dinner time, Will practically insisted his brother go down to the cafeteria. When he objected, Will reminded him of the perils of missing good, solid meals.

As if his admission to the hospital could be directly linked to the fact that Will hadn’t had breakfast this morning.

Or dinner last night.

Or whatever.

Jay agreed with some apparent hesitation, and Will relished the silence of his empty room for the first time all day. Sure, the sound of his own heartbeat was hardly much consolation now -- and his BP remained stubbornly high -- but at least no one was there, looking at him like he was going to die every second.

Though, sometimes, he wanted to.

He wasn’t sure what he wanted.

He wasn’t sure what he was doing. His life was out of control at the moment, and this time, he had no idea what he’d done wrong. He’d worked hard. He’d done the right thing.

Why was he here?

Why was this happening?

It was hard enough dealing with these questions on his own, so to answer other, less relevant questions -- well, Will wasn’t sure how to do it anymore. He was pretty sure he was going to lose his temper on the next visitor he had, except that next visitor turned out to be none other than Ms. Goodwin.

His boss.

The woman who had fired him.

The woman he was still trying to prove himself to six months later.

She knocked with a smile on her face, and she was politely demur and tentative in the doorway. “I heard you weren’t looking for visitors,” she said. “But I was hoping you’d tolerate one more.”

It wasn’t like Will was saying no to lots of people, and there was no way he was saying no to her. Will had forfeited that right quite some time ago, and his official probation was over, but Will wasn’t stupid. He knew he was always one mistake away from getting fired.

“Ms. Goodwin, of course,” he said, smiling wide despite, well, everything. He sat up, ignoring any tension in his chest and breathing through any discomfort. “There’s always time for you.”

If she suspected he was being somewhat false, she didn’t comment. Instead, she made her way farther inside the room, letting the door shut behind her. “I heard you were admitted,” she started.

Will didn’t see the need to play coy. “I’m sure you heard more than that.”

“Well, rumors are what they are, and this hospital can be worse than a high school,” Ms. Goodwin told him. She came to the foot of his bed, and he could see her eyeing the full range of equipment, no doubt marking his vitals as she did.

“I’m afraid I forgot to officially put in for sick leave,” Will said. “Sorry about that.”

“You’ve been a little busy,” Ms. Goodwin said. “Maggie had all your bases covered the moment you came into the ED.”

Ms. Goodwin knew that much. He suspected she knew everything. This exercise was just as a means of being polite.

“I’ve done nothing but lie around all day,” he said with a wan smile. “It feels like I’ve done nothing.”

“Which is sometimes the most important thing,” she said, looking at him once more. “You’re being treated by Dr. Latham, yes?”

This was a question he knew she knew the answer to. “Yes,” he said, anyway. He had to play her games; he had no other choice. “Dr. Marcel transferred me up to cardiology early today.”

Ms. Goodwin continued nodding. She seemed to hedge slightly as she considered that. “If you don’t mind me asking, did Dr. Latham give you a diagnosis?”

Will raised one of his shoulders in noncommittal reply. “A tentative one.”

He was clearly making an attempt to obfuscate. She clearly had no intention of letting him. If anything, now she looked more expectant.

He was still confident that she knew more than she was letting on, but this was her way of being polite. Privacy concerns were always foremost in their minds as medical professionals, but things got gray when you were handling hospital staff. They were like family, in the end. Will had some hope that not everyone knew he had been diagnosed with severe heart disease -- not until he could prove that it wasn’t that bad -- but he was pretty sure that Ms. Goodwin had to know by now.

Which made lying to her pointless.

Although, lying to her was always pointless.

Will had learned that lesson the hard way time and again.

With a sigh, he gave a small shrug. “Everything is pointing to some kind of cardiac event,” he said. “And the echo suggests that there is evidence of heart disease, likely from genetic factors.”

There wasn’t much surprise in her expression, but her lips drew together sympathetically. “I’m very sorry to hear that, Dr. Halstead.”

He shook his head to dismiss her concern. “Dr. Latham has his concerns, but I think he might be approaching this as more severe than it is,” Will said. “Given my overall age and health, I’m hesitant to agree that the surgical option is necessary at this point. Bypass is invasive, with a long recovery time, and I think it’s worth seeing if my heart function improves with rest and medication.”

She looked grave, but she didn’t back down. “Again, it’s none of my business--”

He wasn’t going to dicker about protocol or policy, not with her. Instead, he stuck to the only thing he’d ever been any good at: diagnostics. “I know Dr. Latham thinks I’m being unreasonable, but I’m not convinced it’s my heart -- or, not solely my heart,” he said. “There are other contributing factors that can exacerbate a genetic predisposition, and if those factors can get under control, then the heart function may not be as much of a problem. I’ve been working a lot lately, lots of stress--”

“I understand that those factors can make heart disease appear more advanced,” she said. “But those factors can also be caused by the heart function in the first place.”

“Sure,” Will said. “But we still have to look at the condition holistically in order to find the best course of treatment. Because the simple fact is that a lot of other conditions produce the same symptoms I’ve been experiencing, including a number of stress-related options.”

Ms. Goodwin nodded with thoughtful caution. “Have you consulted with Dr. Charles, then?”

Will flushed, because bringing another colleague on board was really the last thing he was going for here. “No -- I mean. Look, I’m fine, Ms. Goodwin. I’m handling this. I promise you, you don’t need to worry about me.”

He’d thought his pitch here was well reasoned and amendable, but Ms. Goodwin gave him a look of surprise. “You are a member of my staff. Of course I’m going to worry about you.”

There was renewed pressure in Will’s chest, as the familiar anxiety spiked once more. This was the kind of stress he’d been talking about. The kind where everyday he felt like he had to prove himself on the job. The kind where he always felt pressure to be good enough. “Ms. Goodwin, I assure you, I’m well aware of your oversight, and I’ve worked hard to live up to the standards put in place,” he said. “I know how many second chances you’ve extended me--”

She leaned back, face contorting with apparent confusion. “Dr. Halstead, I hope you understand that your professional ups and downs have no bearing on my questioning here. I’m not here in a professional capacity. This isn’t an interrogation. I’m concerned about your well being, that’s all.”

He geared himself to explain himself better. “Ms. Goodwin--”

“No, I want to really be sure you understand,” she said, speaking firmly now. “Because don’t think I haven’t seen the change in your work since your probation ended. You have been nothing short of an exemplary employee. You’re the first one in each morning, the last one to leave each night. You volunteer for every extra shift. Your paperwork is impeccable, and everyone reports the same thing: that you are the heart and soul of this ED.”

Will was dumbstruck at that. Here he was, trying to head off criticism, and Ms. Goodwin was loading on the compliments.

He must have looked a lot worse than he appreciated.

“Dr. Halstead, as impressive as all of this is, I am concerned about the toll it is taking on you,” she continued carefully, keeping her gaze steady on him.

The plainness of it made him uneasy.

The honesty to it made him straight up uncomfortable.

“There’s no toll--” he started to say.

She sighed, the professional guise slipping for the first time since she entered his room. ‘Will, please,” she said, saying his name with unusual care. “Just this once. Focus on you -- not the job. Not your commitments. Right now, you really need to focus on yourself.”

For the past six months, every interaction he’d had with Ms. Goodwin had been stressful and punitive in nature. Even when he’d been allowed off probation, he’d felt her wary eye on him at all times. Therefore, this flurry of personal concern came at him as jarring.

He stared at her, not sure what to say.

She smiled tautly, and nodded at him one more time. “Anyway, feel better, Dr. Halstead,” she said. “I hope to see you back on the job soon.”

With that, she made her exit, and Will was left even more befuddled. Was she warning him that his job was at stake if he didn’t come back soon? Or was she telling him that he needed to get healthy before he would be allowed back?

Or was she being sincere? Did she actually care about his physical well being?

Will quickly talked himself out of that one. Ms. Goodwin was a professional; she knew what she had to say. With an employee in the hospital, there was a fine line to walk. For all he knew, there was actually protocol for such things. The lawyers were probably breathing down her neck to make sure she didn’t create a liability situation. Because that could be a thing, right? For Will to sue the hospital? Stresswork working conditions? It might have the makings of a workers compensation case.

This was just Goodwin being Goodwin, assessing Will for the risk he posed to the hospital. He’d found a whole new way of being the worst employee ever.

Surely, she could see that he wouldn’t want that. He would never be stupid enough to sue the hospital. These were his mistakes -- his. He knew his position here. He knew how tenuous it was. He wasn’t sure if it was pity or desperation that had gotten Goodwin to offer him his job back, but he’d been without other options. He’d accepted it, dedicated himself to rebuilding -- well, everything. He’d sat through every probation check in. He hadn’t chafed once. He’d followed every order.

And he’d done it to show he could. To show that he belonged here. He wasn’t a deficient player. He was all-in. He didn’t need special favors anymore. He would earn his spot, each and every day. This was a desperation play. It wasn’t a pity move.

He couldn’t let it be that.

This whole stupid incident was threatening to undermind everything, all of it.

So, for the record, Will had to worry about minimizing his brother’s anxiety, keeping his relationships with his colleagues in professional bounds and the integrity of his employment.

While everyone thought he’d had a heart attack.

Honestly, when Will was honest with himself, that seemed just about right.