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Competencies

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John let out a long, weary sigh at the sight of Private Bainbridge laying prone on the shower room floor, the young man’s head turned away amidst a spread of diluted blood and broken glass. In hindsight, John realized he should have asked permission from the Major before continuing to walk toward the body. Perhaps he was so used to Lestrade and the usual way of things, examining bodies without a second thought, that he didn’t stop his forward momentum, never considered that someone would have an issue with it. But he was swiftly and painfully reminded that this was not Lestrade, nor was this his former regiment. He was an outsider, an unknown, showing up in the breath before one of their own took his last. When he thought about it later, being held back as a potential suspect really wasn’t all that unreasonable, whether they believed he was a doctor or not.

While Sherlock and the Major went back and forth between accusations, refuted theories, and questions without answers, John kept his own commentary to a minimum, straining to see the dead man’s face around the strong grip of the Sergeant restraining him. As John had said, Bainbridge was off duty approximately five minutes before he was found, so he couldn’t have been dead long. Sherlock and the Major continued arguing about murder weapons, suspects, wet hair and shampoo, as the Sergeant mentioned having to break the shower door down. But John was getting small glimpses of Bainbridge’s face and his stomach began to churn with memories that still occasionally assaulted his dreams.

It was those memories - of pallor, sand, and more blood than a human should ever survive being lost - that fueled his final demand.

“Major, please. I’m John Watson, Fifth Northumberland Fusiliers. Three years in Afghanistan, a veteran of Kandahar, Helmand, and Bart’s bloody Hospital. Let me examine this body.”

John was outranked, in more ways than one. He was “retired”, as the Major had said earlier. This wasn’t his unit. And he had completed his service as a Captain, not equal to, or above, the Major in rank. But it worked. Whether it was the authority of experience in his voice, or respect for the places he’d named, John felt the Sergeant’s grip loosen a fraction before the Major nodded a reluctant, frustrated assent.

Without a hint of his previously raised voice and frustration, John replied with a calm “thank you”, removed his coat for more freedom of movement, and pulled on a pair of gloves from an inner pocket. His gut and chest tight with memory, he crouched at Bainbridge’s side. The first full look at the man’s face confirmed what he had caught glimpses of before: his color was still too good. Granted, not everyone immediately lost their color at death, but John had seen enough people die to see the leaching of color in the face in those last breaths, that gray/yellow skin tone as the body stopped circulating oxygen. Bainbridge’s color was still too close to normal. Of course, there were other things that could cause more of a flush, but….

While Sherlock was talking about blood and murder weapons, part of John did note that much of the blood was around the man’s abdomen, but he kept his eyes on the man’s face, slid two fingers into place to palpate the carotid artery, and watched the jawline and upper chest with an intensity equal to Sherlock’s own deductive focus.

There.

A tachy, barely palpable, irregular beat. And then, after over a minute, a tiny jaw movement.

“Sherlock,” John interrupted calmly. “He’s still breathing.”

“What?!” the Sergeant exclaimed. “No, sir, I checked. For over a minute, before coming to tell the Major. There was nothing.”

“Apnea,” John said, keeping one eye on the man’s face, the other on his watch. “He’s doing it again now,” John nodded down at the still face.

“What do we do?” Sherlock asked.

“What do you need?” the Major asked almost simultaneously.

“Sergeant, call an ambulance,” John said, looking up and pointing to the man. One of the primary rules of a crisis: be specific.

The Sergeant turned and took off down the hall.

“I’ll get the first aid kit,” the other soldier said, turning to leave the room.

“And the AED,” John added, knowing that the regiment must have one somewhere on site.

“Yes, sir,” the soldier acknowledged, hurrying off.

“Sherlock, take your scarf and press here, hard,” John instructed, resting the hand that wasn’t at Bainbridge’s carotid to a place on the man’s abdomen.

“All right to move him?” the Major asked.

“No obvious head or spinal trauma, but not much choice. No palpable radial pulses, nailbeds are cyanotic, agonal breathing,” John nodded at another long-awaited, faint, gasping jaw motion. “I’m going to lose this pulse any minute. We need him out of the water.”

The Major stepped forward and assisted John in moving Bainbridge to a drier area, keeping his spine as stable as possible, while Sherlock kept pressure on the wound. As soon as the young man was back on the ground, John knelt at his head, opened his airway, and checked the carotid: nothing. He immediately moved down to one side of Bainbridge’s torso and began chest compressions.

“Major, take over his airway and hold it,” John ordered. “Sherlock, maintain that pressure.”

“Want me to count, doctor?” the Major asked, emergency medical training kicking in.

“Please,” John grunted, maintaining a steady rate of compressions.

“Ambulance is less than five minutes away,” the Sergeant announced, rushing back in. “I’ve got someone waiting for them outside.”

“Excellent,” John exhaled, sweat beading on his forehead as he followed the Major’s compression count.

The other soldier ran in with the first aid kit and AED.

“Sergeant, dry off Bainbridge’s chest, best you can around me,” John huffed, blinking back sweat. “Get ready to place the pads,” he nodded at the other soldier, who was opening the AED and starting to follow the prompts.

“Doc, it’s been two minutes, get ready to switch,” the Major interrupted his steady counting.

“Right,” John acknowledged, breathing hard.

Chest dried, pads in place, the Major counted out the last thirty compressions and shifted into John’s place to relieve him. A quick pause, no shock recommended, and the Major resumed compressions as John maintained the airway, accepting a face mask and adjusting the count to add rescue breaths.

The ambulance crew hurried in just as the AED was instructing the next rhythm analysis. With a succinct report from John, the paramedics took over and Bainbridge was soon on the stretcher, intubated and with an irregular, but present, rhythm. John put a brief hand on the private’s shoulder, bent down to his ear and said something too softly for even the paramedics to hear. Then he straightened, nodded crisply, and watched them rush Bainbridge to the ambulance.

As silence settled over the shower room, John stripped off his bloody gloves and looked each man in the eye. “Well done, everyone. Thank you.”

The three soldiers blew out a breath as the adrenaline began to recede. John crossed the room to wash his hands, leaning just slightly more than usual against the sink as the burn in his arms promised extra discomfort tomorrow and his brain worked to push the surging memories back where they belonged.

“Doc, I’m sorry….” the Sergeant began.

“You did nothing wrong, Sergeant. Apnea can be incredibly long and even the best can forget to check a pulse in these situations. You got the ambulance here quickly and that was the best thing for him,” John said, turning from the sink to look at the man as he dried his hands, ensuring his words sunk in.

“Yes, sir. Thank you, sir,” the Sergeant nodded. With their commander’s nodded dismissal, he and the other soldier left the room.

“Doctor Watson, I apologize for my earlier behavior. Thank you, for all you’ve done,” the Major shook his hand. “I’ll keep you updated, if you’d like.”

“Yes, please,” John shook the hand firmly.

The Major guided Sherlock and John back to his office, where they waited to give their official statements on the incident. Sherlock, oddly quiet up to that point, turned and looked closely at John once they were alone.

“Well, that’s comforting,” John sighed under Sherlock’s focused stare, rotating his shoulders and clenching and unclenching his fists as his sore arms protested the compressions.

“You knew.” Sherlock drew out the words, still searching for the answer. “Before checking Bainbridge’s pulse, you knew.”

“I suspected,” John corrected, taking a grateful sip of the tea left for them.

“I couldn’t see any of those….”

“Agonal,” John supplied.

“Agonal breaths,” Sherlock continued, “from where we were standing.”

“Neither could I,” John said. Sighing heavily as Sherlock continued to stare at him and try to work it out, John swallowed another sip of tea, rotated his aching left shoulder again, and stated, “His color.”

“His color,” Sherlock repeated slowly, mind rushing through various possible meanings.

John sighed again and moved toward the window for some semblance of air and space. “Sherlock…..” he swallowed and forced his left fist to uncurl. His next words were quiet, sad, but with an underlying strength and a sense of pride, of honor. His back straightened again, all thought of sore shoulders gone. “I’ve seen a lot of people die. Some quickly, some slowly, but they always, with very rare exceptions, have the same change of color as they take those final breaths. Their color goes sort of gray or yellow as they stop perfusing. Private Bainbridge certainly wasn’t perfusing well when we got there, but just enough that his color still looked relatively normal. So, I did what any prudent doctor would do and checked for basic signs of life.”

“Despite the Sergeant saying Bainbridge was dead,” Sherlock said.

“Never assume,” John shrugged, before adding, more seriously, the weight of memory in his eyes, “The human body can be both remarkably resilient and remarkably fragile. I’ve seen soldiers brought in looking like corpses, catastrophic injuries, and they’re alive today. Others nick themselves shaving, end up septic, and die. You never know. Always check circulation, airway, breathing. Then go from there.”

“I suppose the Sergeant will have to review those basics.”

“Leave the Sergeant alone, Sherlock,” John said firmly. “All soldiers have basic first aid and emergency medical training, but he doesn’t deal with this every day. I did. Still do.”

Sherlock nodded. “Lucky for Bainbridge you were there.”

“Lucky we were all there,” John corrected. “More hands, faster response.”

Sherlock’s face smoothed into one of his rare, honest smiles, eyes shining with a pride reserved only for his friend. “You were brilliant, John. Well done.”

John tilted his head, acknowledging the praise with a small nod of thanks.

Sherlock pulled another scarf from his coat pocket, wrapped it around his neck, and settled into a chair to begin researching what sort of weapon could have cause such a thin wound, one eye watching John for any emotional aftermath, any cause for concern.

But John just shook his head as the scarf resumed its place and turned his gaze back out the window with a barely perceptible smile, sipping his tea with steady hands, aching arms, and the exhausted gratitude of doing what he was meant to do.