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Matters of the Heart

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“A merry heart doeth good like a medicine: but a broken spirit drieth the bones.”
— King Solomon, Proverbs 17:21-23

 

Yusuf al-Kaysani, M.D., Ph.D., F.A.C.S., attending physician and head cardiothoracic surgeon of New York City’s Vanguard Medical Center, also known as Doctor Joe, was a man of precision, dedication, and careful intent. Which makes the entire incident of his discovering Doctor DiGenova’s heart condition by accident all the more baffling.

Of course, he would have discovered absolutely nothing if he’d listened to his boss when she barged into his office with a scowl that morning. “No more, Joe!”

“No more… what?” he glances down at his desktop. There is only his schedule and his on-the-go breakfast. “No more coronary bypass grafts? Because I have two booked… Or do you mean no more bagels?

“Neither. But actually, wait, I will be confiscating that bagel.”

“I suppose you can have half—” he begins before she leans over his desk and the entire napkin wrapped bagel is snatched away. “Or you can eat the whole thing, by all means. We wouldn’t want you to be too famished for your board meetings, Doctor Scythian.”

Andy hits him with some sort of retort, but it’s hard to make out before she chews and swallows. 

“I do have six consults today and plethora of interns on my rotation, plus a new breakfast to scrounge up. So if you could finish whatever it was your were berating me about?”

“You are going to stop harassing the other departments,” she tells him between oversized bites. “If I get one more, just one more, complaint from Urology, I will fire you.”

Joe frowns, half at Andy’s obvious relish as she devours his breakfast, and half at the implication. “Firstly, when have I ever pestered the bores down in Urology? And second, do you even have that kind of power? Wouldn’t you at the very least have to phone Copley before firing the single most talented and handsome doctor on staff?”

Joe has plenty of evidence for the former assertion. His hours of surgeries clocked, his decorated outcomes, his record rate of publishing, and being named the youngest ever head of his any CT department in the country. The second assertion, however, he left up to good taste. 

Andy, unamused, gives him a look; an ‘I’ve known you since medical school and it still astounds me how ridiculous you can be’ look.’ “New rule; none of your vanity before eleven AM. And to answer your question, you’d be surprised what my powers as Chief of Surgery can muster up, especially when Doctor Lykon says you’ve roped several of his senior attendings into running a time-wasting demo with the new batch of interns.”

“Yes,” Joe nods; that did seem familiar, save for the time wasting part. “And what of it? This is still a teaching hospital, isn’t it?”

“Don’t remind me.” Andy rolls her eyes with contempt and plops down in the desk chair opposite his. She looks ready to mug him for his morning coffee. 

“See, that is the difference between you and I. I enjoy my time roaming the halls of The Old Guard because I actually enjoy teaching.”

“And here I thought the reason you were so damn happy was because you had the foresight to stay a freewheeling bachelor while I married out of my league.”

“To be fair,” Joe winces, “was anyone in Quỳnh’s league?”

Not missing a beat and capitalizing on his sympathies, Andy makes a swipe for his carton coffee cup. He barely manages to evade her.

“Look, Joe. I have a surgical floor to run. I can’t be fielding complaints about your overenthusiam. And while technically — and probably legally — I can’t tell you to stop teaching, maybe you could try to enjoy teaching a little less? Or even a lot less. For my sake if nothing else.”

Hand over heart, he pleads his case. “But Andromache, if I did that who would craft the great medical minds of tomorrow?”

“How you say that shit to me with a straight face, I will never know.” Andy grumbles as she rises. She’s taking a heady sip from a coffee cup — his coffee cup, dammit when did he lose sight of it? — as she heads to the door. “Just remember, anyone with a badge reading “CARDIO” is yours to torture with your optimism. But all other departments are officially off limits. Understood?”

Joe gives a fingers-crossed salute. “Understood.”

* * *

Joe had every intention of heeding Doctor Scythian’s warnings. The Vanguard Medical Center was far too busy a place to go looking for trouble. Like any other shift, patients were rushed in, discharges were rolled out, the OR’s were overbooked, and the medical interns cowered at his feet in both fear and awe. Some of them  — ahem, Doctor Freeman — showed promise. However, as far as the others were concerned he had genuine curiosity as to how they had even earned their medical degrees. The amount of hands-on demonstrations needed for simple cardiac monitoring was astounding. 

And Joe was running out of willing test dummies.

It was something of an unusual occurrence. More often than not patients volunteered their time and cases. But in the rarer, slower gaps they ran dry on the willing and able.

“Keep watch, Doctor Freeman,” Joe says, leaning on the nurses station in the surgical floor lobby. “Barring an actual, interesting medical emergency, someone’s bound to stumble in here sooner or later.”

The young intern shuffles a step in place. “Doctor Sycthian says I’m not allowed to help you annoy the other departments anymore.”

Joe sets down the patient chart he was glancing over. “It wasn’t Doctor Scythian who let you scrub in a quadruple bypass, if memory serves.”

“I was actually thinking about the open slot on your upcoming bypass graft…”

“Ambitious and cheeky. I knew I liked you Doctor Freeman. How about this; find me a warm body to use to teach your idiot cohorts and we’ll see.”

“In that case…” Intern Freeman turns on her heel and points. “There’s someone from Neuro trying really hard to avoid us.”

She’s right. There’s a white coated man crowding close to the wall, budging through a couple of janitors and rolling mop buckets as he slinks towards the elevators.

“So there is. And of course, you wouldn’t have spotted him before twisting my arm for more surgeries?”

She gives a telling smile.

Joe dismisses her with a wave. “Tell the other interns to gather in Exam Room 303. I’ll go fetch our wayward offering from Neurology.” 

“Gotcha, boss!”

It takes closer inspection to realize that it isn’t just any neurologist on the Vanguard staff currently hiding behind the tacky hospital decor. It’s the new hire and interim head of the department. Doctor Nicolò DiGenova.

“We can all see you, Doctor,” Joe greets, aiming straight at him with his clipboard. By reputation alone, the man is a medically minded marvel, but he is none too stealthy. “You’re not fooling anyone hiding behind the orderlies.”

“I don’t know what you’re talking about—” comes the telltale Italian accent, though poorly concealed with what Joe thinks might be an attempt at sounding American. “I’ve never heard of a DiGenova. You should try paging him—” This man, who may or may not be Doctor Nicolò DiGenova, is repeatedly tapping the elevator call button, the upward pointing arrow shape blinks and blinks but the doors do not open.

Joe cannot help but wonder how much of his reputation proceeds him. Someone has clearly warned DiGenova of his ruthlessly unconventional methods. The poor man looks ready to sweat. 

“You’re a long way from Neurology. Did you get lost again?”

“No,” he offers nervously. “I am only finishing up a consult for Doctor Hanh. And now my shift is…” The other man pauses, looking caught. He’s said too much.

“If your shift is over, might I interest you in a tour of the Cardiac Unit? Afterall, I know you’re new here, still getting acquainted and learning your way around. Let me introduce you to some of my interns. In fact, if you’d be so willing to donate some of your time to a little demonstration of ours…”

The man goes a shocking shade of red. “I do not believe I would be much help.”

Joe shakes his head with a smile. They always have so many excuses once they know they’re trapped. “As you certainly know, this is a teaching hospital. Meaning, we all chip in for the future of medicine and shaping the minds of…” 

“Yes, yes, I am aware,” the neurosurgeon retorts, his hands jammed in his coat pockets.

Unable to fathom what’s flustering the man so, Joe tries a new tactic.

“So, Nicolò, can I call you Nicolò? Or are you still pretending to be some other Italian neurosurgeon we have on staff?” Joe smiles, arm blocking the now cleared path into the elevator. Nicolò does not turn to face him, only staring ahead into the empty space. He sighs at the doors slide shut and the digital numbers on the monitor above the doors  climbs higher and higher.

“Nicolò is fine. But, again, Doctor Kaysani, I—”

“Al-Kaysani,” he corrects. “But as we’re going to be friends, you should call me Joe.”

Seconds pass before grants a moment of eye contact allowing Joe to take in his light eyes and straw dark hair. He lets out a subdued little laugh. “Very well. Joe it is, then.”  

“Excellent. Now, I understand you’re a busy man and Doctor Scythian has most likely shared some outlandish falsehoods about me with you. But I promise you our interns will not take too much of your time. Unless… well, others of your stature might think themselves far too accomplished and well-thought of to toil away with inters.”

“Pride is a sin,” Nicolò points, despite knowing very well that he is being goaded. “A sin I do my best to avoid.”

It’s a peculiar answer, and Joe imagines it still would be even in the man’s native Italian. Joe’s never met a first chair surgeon in any department that wasn’t a blowhard and otherwise commanding presence. But there was something about Nicolò that felt resigned. Meek, almost.

Not that Joe wasn’t predisposed to arrogance. He didn’t spend his entire career getting this good only to pretend to be unaware of it. But for all his vanity — again, a word Doctor Scythian used, never him — it did leave him with one vital tool in his belt. His ineffable charms.

“So we’re in agreement! So, you can just follow me, easy does it now…” He smiles is prize-winning grin as he tucks  his elbow around the other man’s arm.  A waiting trail of duckling doctors follows them into a closed examination room. “Alright class, now that we’ve procured yet another live specimen, shall we try to get it right this time? Oh, and Doctor DiGenova, please take off your shirt? Thank you.”

*

It’s basic work. Shockingly basic, and as such no intern with a proclaimed interest in all things cardio-thoracic should have such gaps in their knowledge about setting up an ECG. The arrangement of electrodes really is not that complicated. The first, VI, is applied at the fourth intercostal space at the patient’s right side from the sternum. The V2 electrode mirroring that on the left of the sternum. The V3 electrode is placed halfway from V2 and V4, with the V4 settled on the fifth intercostal space over the midclavicular line. And so on and so forth. Except the twenty-something, slick haired and monied young physician who bragged about his family donations to the Vanguard can’t seem to find the midaxillary line for V6 node and Joe can feel the frustration suffocating the room.

At this rate he is rethinking his policy of not telling Doctor Freeman to correct her cohorts’ every mistake. At least she was getting the work done.

Doctor DiGenova, or Nicolò, as Joe keeps reminding himself, is ramrod straight on the bed as he allows the adhesive markers to be placed on his skin. He’s a good sport about it otherwise. Modest perhaps, or his stiffness a subsequent result of shyness, Joe thinks. He finds it easier to engage with the interns than with Joe and for the most part, he’s patient with them. 

They certainly need it, with the lot of them running the gamut from youthful and bright-eyed, resolved and ambitious, to frankly bored and a touch too haughty for his liking.

The latter rears its ugly head when Doctor Kipling finally gives up.

“I’m sorry, Doctor Kaysani, but this—”

“There’s nothing to be sorry over. You’ve almost got it, and there’s still time to learn—”

“No,” the young man insists, eyes flaring, “I mean to say, I’m sorry, but I’m not some nurse’s aide and I didn’t come here to be trained in grunt work.”

Several fellow interns avert their eyes in shock and embarrassment.

With the slight cock of his, Joe speaks slowly. He’s a forgiving man. He can provide ample opportunity for this brash young man to walk back his own errors. “Is that so, Doctor Kipling?”

“Yes,” he doubles down. “All these exercises, none of it is surgery . I mean it’s barely even medicine.”

Joe laughs. It’s a sharp and serious sound to anyone who has the ears to know it for what it is. But he’s surrounded by student doctors and a bare chested coworker who still won’t meet his eyes. Shame there will be so many witnesses to him ending this sneering fool’s entire career.Joe’s barely cracked his teeth open to rip him a new one when the calm, clear voice of Doctor Nicolò DiGenova cuts through the tension. 

“The midaxillary line.”

“Pardon?”

“Your placement of the sixth electrode,” retorts Nicolò, both rankled and displeased from where he lay abed. “It’s posterior to the midaxillary line, too far back. Something any accomplished nurse could inform you of, or even, it seems, even a doctor in an entirely unrelated field.”

Not so meek after all, his stare is icy and hard and leaves Kipling is left stammering. “I— I apologize, Doctor—”

“Do not apologize to me. Apologize to Doctor al-Kaysani for wasting his time. Moreover, apologize to your future patients and what it might cost them that you thought simple diagnostic tools were too menial to learn.”

Admittedly, Joe has never spared any real thought to the new head of the neuro department. Sure, he knew of him, got the emailed memo of the new hire several months ago and filed it away with all the other extraneous details of the hospital. Because otherwise, the purview of Nicolò DiGenova’s work was literally head and shoulders above Joe’s and Joe was perfectly content never having to page his department. Keeping hearts and lungs healthy enough to avoid cerebrovascular accidents was something he prided himself on.

And yet Joe finds himself struck with a nagging feeling. A similar sensation that plagued him when faced with a peculiar diagnosis. You’ve been missing something here, Doctor. Pay attention.

“These trivialities are anything but,” continues the cool-faced DiGenova. “They are fundamentals that each of you signed up for when you applied to work here at the Vanguard. You want to be surgeons with even a tenth of the calibre of Doctor al-Kaysani? Then you need to reevaluate how hard you are actually willing to work, and better yet, why you are even here.”

There’s a grumble of agreement and acquiescence from the interns. Kipling even manages to look embarrassed.

“Alright, the lot of you,” Joe cuts in. “Thank Doctor DiGenova for being the one to yell at you so I didn’t have to.” Doing as their told, a murmur of thank-yous follow. “Good. Now go to lunch. Out. Now.” As the dubious future minds of medicine clear out, they leave Joe with his still frowning colleague. It dawns on him that this is a terrible first impression.

“We haven’t formally met, other than me wrangling you in here, have we?” Joe extends his hand. “Doctor Yusuf al-Kaysani, head of Cardio. All the Americans call me Joe.”

“I am not an American,” Nicolò points out, swinging his legs over the edge of the exam bed. His feet touch the floor easily. He seems taller than Joe first estimated. Lithe as he is long, with a rawbone structure that Joe also can’t help but notice because the esteemed neurosurgeon is in fact still shirtless.

“But it is… pleasant to meet you, too,” the other man adds with an air of carefully practicing a language that was not his native tongue. “And I mean no offense when I say this, but some people are beyond even your skills to teach. You should inform Doctor Copley of some needed cuts to your program.”

“You’re telling me. I swear they get younger every year… Oh, here, while we’re here let me just hook it up properly.” On autopilot, Joe is attaching the last electrode to the side of Nicolò’s chest, over the ribcage, and oh, his hands must be cold because Nicolò shivers at his touch. Joe rubs his hands together to warm them before flicking on the electrocardiogram.

The machine starts chirping through its waveform display and it’s right there in front of them, plain for all to see. In an instant, Joe takes a back seat and Doctor al-Kaysani steps up to the monitor. And he does not at all like what he finds. “Don’t get up, Doctor DiGenova.”

“Actually, it would be best if I got going…”

“I’m afraid I can’t let you do that,” Joe tells him. “With these readings, and your heart rate—”

Then the screen goes startlingly blank.

Doctor DiGenova is hastily stripping off his electrodes and climbing off the exam bed. A moment later he has his shirt and coat back on and he’s headed towards the door. “Thank you for the checkup, Doctor, but I’m perfectly fine.”

“No, wait,” Joe urges. “This is a serious matter. I need a better idea of your—” Nicolò pays him no heed. He’s already out in the busy hallway. “DiGenova! Nicolò! Stop! we need to discuss this!”

Giving chase out of the exam room and into the hall, Joe realizes he was more or less lucky that he was able to corner the other man at the elevators earlier. He’s a wiley maneuverer when he truly has his mind set on escape. Pushing out into the corridor, Joe can’t keep as he tries to follow after him through the ward. Cutting through the unit desks, nurses are glancing up at the commotion between them before deciding it isn’t worth their time.

“PAGING DOCTOR AL-KAYSANI,” blares the PA system. “DOCTOR AL-KAYSANI, CALL EXTENSION 198.”

Joe stops in his tracks.

“This isn’t over, DiGenova!” he calls after the stubborn man. Nicolò spares him little more than a panicked look over his shoulder before disappearing into a stairwell.

Joe can only sigh, his mind is still rolling over possible diagnoses as he’s marching over to the nearest corded phone to dial the ICU. Joe would have to get to the bottom of the mystery of Nicolò DiGenova’s heart another day. 

* * *

Joe is in the midst of his good deed of the century, once again forcibly stocking the kitchen of one particularly grouchy ex-physician at his mother’s behest when it dawns on Joe that the man could be of some help. Which would be a nice change of pace, considering how badly Sébastien refuses to be of use to anyone these days.

“Say, Booker?” he asks as conversationally as possible, “what do you do when your patient is a surgeon?”

“Hm?” the man grumbles, head sticking out from the now pantry. “What did Andy do now?”

“It’s not Andy.”

Booker nods disbelievingly, scratching at his beard. “Right. Of course, it’s ‘not’ Andy.”

“It isn’t. It’s really not about her!”

“She got into another fist fight, then?”

“No! She— she hasn’t done that since her wedding, I think.” Joe couldn’t remember. For all her professionalism turned up to eleven while wearing her white lab coat, she was still a hellion with a drink in her hand and a grudge to settle. The woman wore so many faces.

“Look, I’m only asking your advice—” Booker snorts derisively, “because once upon a time, you ran that ED like you had a bullwhip to keep attendings in line.”

Booker almost nods fondly at the memory, before shaking it off to settle into his usual dourness. “That was a long time ago.”

“So out of everyone, you have to know what’s the best course of action when treating difficult patients.” Especially patients who dodge his calls and emails and none-too-subtle visits of his office.

“First, you pray,” Booker says . “Then when that doesn’t work, and it won’t, you contact the vultures down in legal.”

“What would I need the hospital lawyers for?”

“You need them because when your so-called patient ignores your advice and it backfires, you don’t want to be held liable.”

“So-called patient?”

“Any surgeon who comes to you for treatment is going to think of themselves as co-consulting on the case. Some do it out of arrogance, and some just don’t know how to be patients . They’ve simply spent too long on the other side of the Rx line. Nothing you say or do or any amount of pain is ever going to convince them otherwise. Hell, I once had a podiatrist shatter both arms and his sternum in some gold-carting accident. He came into the ED somehow still lucid enough to tell me how to do my job—”

“The audacity…” Joe exaggerates, watching Booker find his stride.

“The moron delayed his own treatment enough to throw an embolism from all the marrow leaking into his circulation. A fat embolism that landed in the brachial artery. The left brachial artery, mind you, so now the genius deduces that he’s having a heart attack instead of—”

Joe’s pager beeps. 

Booker stops, suddenly aware of himself. “You’re on call?” 

“No, just waiting on lab results I wanted to hear about first thing. But you were saying? About the podiatrist?”

“Oh, it’s a nothing story. We argued. He was wrong, I was right. We placed a stent. Sent him to one of your vascular specialists. The end.”

Joe sighs. Damned interruptions. “You know, you can act as if you don’t miss medicine—”

“And I don’t—”

“But one of these days you’re gonna come crawling back to T’he Old Guard begging to operate on some swollen appendix.”

“One day, you’re going to realize there is more to life than medicine,” Booker warns. “Anyway, which lout at the hospital has hypertension?”

“I can’t break medical confidence, you know that.” Joe yawns. “But its not hypertension. It’s… I honestly don’t know what it is.”

“Still diagnosing him?”

“If only he would let me.”

Booker frowns. “What are you talking about?”

“So I might have accidentally found out one of our new hires in the Neurological Department has a heart condition. And he won’t let me evaluate his arrhythmia any further.”

“I’m sorry, what?” Booker twists the top off a pair of bottles of beer. He comes short of attempting to hand one over to Joe — who will of course politely decline because he cannot drink with Booker, he can’t — because he’s laughing. “Did you say you accidentally ?”

“It happens! Remember the patient, you were resecting their bowel and you found enlarged nodes on the pancreas?”

“Yes, an abdominal surgery revealed cancer in an abdominal organ. But what you’re talking about, I mean, how do you happen to chance upon an arrhythmia? Did he just fall into your EKG machine?”

“Kind of? Look, the moment I found the arrhythmia, he bolted. Ran right out of my exam room… and I will strangle you if you don’t stop laughing!”

Booker muffles his chuckling into his sleeve from where he’s doubled over. “But Zainab will be very upset with you if you do.”

“Will you stop being on a first name basis with my mother! It’s just wrong!”

“But you know how she loves to ask me if you’re seeing any nice young men.”

There is a high possibility that Sébastien isn’t joking. He should have noticed that his mother’s pesting about his love life died off far too abruptly.

“That’s it. I’m done. You can starve or live off booze and take out. But I am done bringing you baked goods and shorba—”

“Actually, I think this weeks’ dish is chicken tagine. Plus, if you did stop delivering it, she’d just come over for tea herself. Then we could really get to the bottom of why she doesn’t have any grandchildren yet.”

Groaning into his hands, Joe gives into the inevitable. “If you would have told years ago that the great Doctor Lelivre, trauma surgeon extraordinaire, would be taking an early retirement to gossip with old ladies…”

“Hey, I do more than gossip.”

“Yes, I forgot about the day drinking.”

Booker, without an ounce of apology for conspiring against his friend with his own mother, plates some herbed couscous and curried meats knowing damn well it’s Joe’s favorite.

“If you’re done being a bastard—”

“I’m not.”

“— you can actually help find a way to convince this man he needs to let me look at his heart.”

“You said he was from Neuro, right? Because if that’s true, than it’s a moot point no matter what you do. Every brain surgeon is convinced they’re a genius. And worse, some of them actually are. You’ll never convince them you know better than they do.”

“That doesn’t help me at all.”

“It’s not supposed to,” he shrugs. “But here’s hoping the fool doesn’t keel over on the job,” Booker raises his bottle in a mocking toast to Nicolò’s health.

* * *

This should have been the first place he looked, Joe realizes. He’d been caught snooping around the neuro unit looking for the head chair’s office. Instead he’d been redirected by an exuberantly helpful nurse to check the OR schedule. The board is crammed with blocky lettering and back to back rotation of chalked-in surgeons. Theatres 1, 2, 4, 5 and 6 are all a grab bag of exlaps and hernias and biopsies over the next few hours. But OR 3 is blocked off entirely for PATIENT: L, WYATT of RM 555. The operation is listed as TUMOR, with general anesthesia and a good team of nurses between the assigned scrub nurse and float staff.

Joe could wait a few hours to try and catch the medical team on their way out. Hell, he could leave yet another invoice at the department line for it to be ignored. Or, he could pay a visit to the operating room gallery. 

He can’t remember the last time he observed someone else’s surgery. Though it seems to be routine for half the staff squished into the seats behind the overlooking glass. He sees a few of his own residents down in the front row, and even Intern Freeman who spies him back.

“Doctor al-Kaysani? Guys, move over, make room.” She shoos Doctor Ali over. Joe appreciates the gesture and the decent view, no matter the grumbling from the back. 

Joe leans over to whisper, “I can see why you were all so quick with your rounds today.”

Freeman doesn’t try to deny it. “It’s not everyday you get to see an intradural spinal cord tumor removal.”

“And here I thought you had your heart set on cardio.”

“I’m keeping my options open.”

“Smart woman,” Joe adds just as the crowd ooh’s and ahh’s. Below them is an array of gowned figures surrounding a patient lying prone on the operating table. Center stage is Nicolò wearing an adorable scrub cap with little red, green and white flags. The surgical field is contained to his back. There’s little blood and a few explorary tools that cast a blown up image of the internal structures, the tumor included. It looks expansive between the sutured back lining of the delicate white dura.

“Is he planning on excavating that whole thing?” Joe wonders half to himself.

“Nobody knows,” says Freeman. “Doctor DiGenova is always pretty tight-lipped.”

Joe thinks back to the reserved exam subject during that first disaster of a demonstration. Here, he’s a pinnacle of certainty. He moves with deftness in his hands, as an adroit as he is coordinated. Joe finds it hard to blink. It’s a far cry from thoracic surgery, but it’s riveting to watch in real time. Without meaning to, he's come to the edge of his seat, leaning closer to estimate what Nicolò’s next move, next cut, next decision might be.

“Sgombrare il campo,” announces Doctor DiGenova to his team of puzzled monolingual assistants. “Or, pardon, I mean, clear the field, if you will.”

A nurse applies some suction.

“Does he really think he’s ready for dissection?” asks one of the neuro attendings leaning against the back wall.

“Not unless he wants to paralyze the guy,” says another. “Then the egg would be on Copley’s face for flying halfway around the world to hire the guy.”

“Well, he couldn’t give the job to you, Maurice,” Joe adds, not bothering to turn around. “It would have cut into your preening time for all those fundraising luncheons.”

Doctor Maurice flips Joe the bird and Joe would blow him a kiss if he wasn’t currently watching a medical marvel in the works. Because Nicolò isn’t dissecting the tumor. It is clear now that he never was planning to. Instead it becomes impossibly clear just what he has spent all this time methodically preparing for as he disentangles the growth and gently, swiftly, eases the mass out whole, all in one single piece.

Oh shit, Joe realizes. He really is brilliant.

Every other present medical mind is losing their shit, whooping and cheering and clapping each other on the backs like they’ve won the war. Hell, even Maurice and company are smiling. The noise is definitely audible from the surgical floor below but Doctor DiGenova only looks up after it’s died down. The other residents and attendings are filing out, save for Joe. He’s still fixed to his spot, even before he knows Nicolò is staring up at him.

Nicolò sways a half step. He strips off one glove and rubs the back of his wrist against his chest in tight circles, then departs to the steel wash basins to scrub out.

* * *

“Doctor DiGenova!” Joe cheers later that day bustling through the door, “funny running into you here.”

DiGenova’s head pops out from behind his computer monitor. “This is my office.”

“Like I said,” Joe shrugs, setting down two coffee cups and helping himself into a chair, “quite funny.”

The other doctor pinches the bridge of his nose, much the way Doctor Lelivre did in the early days when Joe swiped surgeries from the emergency department. Of course, Joe had won over Booker. He’ll win over Nicolò DiGenova too.

“I see you’ve settled in nicely,” Joe remarks, glancing over the two framed photographs on the walls. “And Copley set you up in a decent office. I must, I’m slightly envious of the sunlight you get this time of day. I myself himself have resorted to Vitamin D tablets as of late.”

“I… Doctor al-Kaysani—”

“Joe.”

“Joe, forgive me, but I am not very adept at small talk.”

“Yes, I’ve noticed. However, you don’t seem to appreciate my efforts to cut straight to the chase, so I thought a new tactic was in order.”

“That is not… I know what you may believe about my health but—”

As fun as it is to watch the man flustered, Joe cuts him off. He’s got a plan. He knows how to get DiGenova right where he wants him “Tell me, have you been in the states long?”

“Oh? No. Only a couple months. But I feel I’ve finally managed to get my foot in the door.”

“And may I ask, is it small talk in English that’s the struggle?”

“Who said it was a struggle? Was it Maurice again?”

“I overheard you speaking Italian in your surgery earlier today.”

“Oh, yes, that was a mistake, and I—” Nicolò stops shortly, looking once again embarrassed. “It’s odd. I never had this trouble when I practiced in France or Spain. But now that I’m here, I find myself crossing over languages in my head all the time. Like part of my brain is rebelling against all the English it hears.”

“That’s understandable. It is an abhorrent language.”

Reaching for his coffee cup, DiGenova hides his smile. “You’re good at this.”

“At what?”

“Putting people at ease. But this, the talk, the visit, it really is not necessary.”

“Except it is. You’ve been dodging calls from my office. And the nurses on staff in this unit are sick to death of hearing from me.”

Nicolò fixes with an impassive stare. “I think we both know that isn’t true.”

“I don’t follow.”

“Nurses love you,” he accuses. “They drop everything to answer calls from your department. You and I both know this, so don’t play coy.”

He can’t help but chuckle. He eases back into the very stiff padded seating but he does not feel the slightest bit uncomfortable. Behind all of DiGenova’s politeness and quiet temperament is a slyness Joe would be more than willing to indulge in.

“If I didn’t know better, I’d think you have been holding out on us. All those staff meetings you spent sitting in the back row, hiding that cutthroat sense of humor.”

“If that were true, please keep the revelation to yourself. ‘ Cutthroat ’ is a terrible thing to come attached to any surgeon’s resume.”

In that moment, Joe does find himself more thankful for the lighting. He had not known his eyes were quite that blue, or that they could smile even when he was willing his mouth not to.

“Alright, Nicky, what do you say? Shall we do away with the foreplay and get down to it?”

Nicolò half coughs as he swallows more coffee.

“Easy now. Choking is one way to get you into an exam gown, but not quite what I had in mind.”

“I do not need to be examined! And you will need much better coffee than this,” he slides the cup back to Joe, “to make that happen any time soon.”

Joe shrugs. “With an arrhythmia like yours, I had to bring you decaf.”

Nicolò recoils almost comically, his nose turned up like he’s imbibed poison. “I do not need your decaffeinated coffees because I do not have an arrhythmia.”

“I literally saw it with my own eyes. It’s impossible for you not to feel it.”

“It was a fluke. I am feeling fine.”

“Then prove it, come to my office, let’s arrange an examination.”

“We are doctors. We don’t prove negatives, Joe.”

“So no fluttering chest sensations?” he inquires, hand over his own heart. “Nothing feels tight or constrained? NO acute pains? No dizziness or shortness of breath?”

“No,” he answers a touch too late. “I have experienced zero symptoms.”

“Maybe it only occurs in stressful situations,” Joe offers. “It would be more noticeable then.”

“Don’t most people experience a more rapid heartbeat during stress?”

“Cheeky, aren’t you?” Joe leans back in his chair. “But I know what you’re doing. You’re being willfully obtuse in the hopes I will give up and move on.” 

“Is it working?”

“Not even remotely. I faced off with far more stubborn patients.”

“As I keep reminding you, I am not your patient, Joe.”

“But you should be. Especially after what happened earlier today.” 

“Nothing happened early today.”

“I mean, during your post-op. I saw you grasping at your chest.”

“I did not!”

“Yes, you did. Before you exited the operating room or even scrubbed out. We’re both surgeons, we both know the procedure. A doctor as good as you would never risk contamination unless distracted by real pain, real disorientation.”

“You’ve certainly thought this all through, haven’t you?” Nicolò asks slowly.

“Yes, because I am also a good doctor. Something you’ll find out for yourself if you would just trust me.”

Nicolò shifts in his seat. “Trust you?”

“Yes. Trust me,” Joe all but begs, “trust me because I’m renowned in my field, trained under excellent diagnosticians, not to mention my pulmonary subspecialty. Trust me because people fly in from around the world and come to this hospital for my department, for my expertise. And to top it all off, I’m told I have a winning smile.” Joe beams just for the hell of it, because what else does he have to lose at this point. “So, Nicolò, what will it be?”

Nicolò’s trademark reserve is firmly settled on his features once more. He seems but a breath away from giving in. “Joe… I think you should know—”

A knock comes to the door. 

“Doctor DiGenova, can we move up that—” Andy’s brow furrows. “Joe, what are you doing here?”

“Practicing medicine, and you?”

“I am moving up the tour of the neurology suites,” Andy points out. “And you need to get back to cardio. He hasn’t been harassing you, has he?” she asks Nicolò.

“No, of course,” he says. “We have only reached a… stalemate with a patient’s treatment.”

“Oh?” she turns between them. “What’s the diagnosis?”

“There isn’t one,” Joe admits, leaning over the desk to look Nicolò square in the eyes. “The patient is refusing both an evaluation and treatment, despite it being in his best interest.”

There’s a flash of uncertainty before Nicolò steadies himself. So goddamn stubborn.

Andy misses the exchange entirely. “If that’s the case, cut him loose and send him to billing on his way out,” she scoffs. “Honestly, it’s like you learned nothing from Booker. You can’t help anyone who doesn’t want to help themselves.”

“It’s more complicated than that—” Joe protests as Andy, ever the thief, swipes one of the coffees off the table. She barely manages one swallow.

“Jesus christ, is this decaf? You drink this shit, DiGenova?”

He shakes his head, trying not to look guilty in front of Joe. “Not at all. It’s actually Doctor al-Kaysani’s. But we can stop by the coffee cart and find something properly caffeinating before we get to work.” 

“Right, right,” Andy agrees, steering Joe out of the office by his shoulder. “Now you, back to Cardio,” she commands. “And as for you DiGenova, we’re off to schmooze some donors…”

* * *

Joe is trapped in his office for the foreseeable future, catching up on paperwork and fielding calls from concerned patients. He’s this close to praying for some natural disaster or even a run of the mill myocardial infarction that his six year residents are just too swamped to handle. However, his pager refuses to beep and the intercom hasn’t bellowed his name in hours.

He’s truly a man who suffers for his craft.

When his door swings open, he quickly realizes his prayers haven’t been answered. It’s only Andy for the second time that day, but now she wears a trepidatious look.

“Whatever it is, I didn’t do it,” Joe states, reaching for his croissant sandwich. It’s all the provisions he’s stocked up on and he cannot afford it to be sacrificed to the bottomless pit that was Andy’s love of coffee and baked goods.

“What makes you think I came here to accuse you of something?”

“That face your making either means someone’s fucked up or someone’s died. That or the third option would be Quỳnh cancelled on her home visit again.”

Andy’s eyes narrow. 

“Oh. And that look is telling me that she did cancel, but that’s not what you’re here to talk about. I’m just going to shut up now. Unless, you did want to talk about it because I am your friend and support you and will completely take your side in any martial argument you and Quỳnh might be having.”

“Quit sucking up,” Andy snaps. “That’s the worst part of her leaving on her whole Doctors Without Borders adventure. Everyone just fucking assumes my moods are about her and her being gone and her missing her flights back home. It’s bullshit. I can be pissed just because I’m pissed. Maybe I’m just an asshole. It doesn’t have to be because I miss my fucking wife.”

Joe maintains his silence for as long as humanly possible. “… but you do miss your wife.”

“Shut up, Joe.” Andy crosses and uncrosses her arms, uncomfortable in her skin in a way Joe rarely sees from her. “And fine, yeah, I miss my wife. This shit was only supposed to last six months. It’s been almost a year and now she’s telling me she’s being scouted by new foundations. One of them is actually called Second Chances for the Third World! Can you believe that?”

Joe winces. “Why is it the more money these foundations make, the more condescending the letterhead gets? Why don’t they just name the next one The White Man’s Burden?”

“Agreed. But it doesn’t matter,” Andy steams, “because she’s out here fundraising and trailblazing— don’t you look at me like that, The New York Times said it in their puff piece, not me. The point is, she’s a success on the other side of the planet and I’m stuck here and can’t even get doctors on the other side of the city to do their fucking jobs—”

“Don’t,” Joe pleads as gentle as he can. “Don’t drag him into this. Booker can’t come back to work. Not after what he lost here. You know that.”

“Right. He just gets to drink his life away while the rest of us pick up the pieces. If he’s so hellbent on killing himself, he needs to just get on with it.” Andy’s seething bitterness evaporates the instant the words leave her mouth. She buries her face in her hands. “I shouldn’t have said that.”

“I know, Andy.” Her eyes aren’t wet, but he knows that furious gleam by heart when he hands her a tissue from the box anyway. She’s an angry crier and once she’s well and truly alone Joe wants her to be prepared.

“I didn’t mean that. You know I didn’t mean that.”

Joe squeezes her shoulder. He’s glad to say his excellent bedside manner comes to the rescue in moments like this. “We’re in a hospital, Andy. The first thing we learn here is that people say and do careless and awful things when they’re hurting.”

Andy shakes her head. “I’m not hurt.”

Joe sighs. “You know, Boss, you can admit that you miss them. I won’t tell a soul”

“Fine. I miss them. And I hate it because I just need people to stay, alright? I need everyone to stay long enough to do their goddamn jobs. Be doctors, save lives, and occasionally be married to me.”

“I’m sure Book has an opening in his schedule for that last one.”

Andy swats his arm. Then she is suddenly serious, fixing him with her no-nonsense state. “Why have you been hanging around DiGenova’s office?”

Joe reels back, feeling oddly interrogated “What?”

“People talk. They’re saying you’re calling his office and badgering him about appointments.”

“I can’t really discuss that with you—”

Andy curses. “Do you have a tumor? I swear to fucking hell if you have a brain tumor I will set this hospital on fire.”

Jaw hanging open like a fish, Joe tries to comprehend just what in the world Andy is implying. “You think … you think I’m the one going to DiGenova for treatment?”

“It would make the most sense. Booker’s gone. Quỳnh’s gone. Why not you next?”

Joe tries and tries to make sense out of that morbid logic. The only result that makes any sense is that Andy is scared. Scared because under that gruff exterior of scathing insults and lunch thievery is a woman who cares. “Hold on,  hold on. That’s why you came in here? You’re worried about me? Because you’d miss me so much if I were gone? Andromache… this might be the sweetest thing you’ve ever said or done.” Joe spreads his arms wide. “Get in here. This calls for a bear hug.”

Andy’s reflexes are quick; she snatches a stapler off his desk to defend herself as she backs out his office door. “Come near me and I will call HR!”

* * *

Between a barrage of Code Blues issued from in the ED over the weekend, Joe thinks a lot about his friends. Thinks on when and how they stopped being just coworkers. He saw more of them than he did his own family. And they were family; a pack of stubborn idiots with medical degrees who swore that long hours and impossible workloads would never divide them. He thinks about how Booker taught Joe everything he knows about emergency medicine. How Quỳnh convinced him to come out to his mother in their second year of residency. How it took three separate awkward lunches with Andy before she asked him to be the Man of Honor at her wedding. He thinks about the taped over drawer that still reads LELIVRE in the attendings lounge he kept meaning to clean out. How radiant Quỳnh looks in glossy magazine photos. How exhaustion radiates off Andy before a shift even starts.

He thinks of Nicolò, too. Thinks of the way the very quiet in the air seems to illuminate around him. How he never flinches at the blaring alarms of a patient coding. How he manages to be so courteous and polite, thanking anyone who so much as hands him something. The way he speaks in Italian under his breath when he thinks no one can hear him. How he never makes a single movement that doesn’t feel decidedly precise. How sometimes he glances at Joe with that same purposefulness. An intent that Joe wants so badly to discover.

Joe is about ready to crack a patient’s chest to access their faulty heart valve when it dawns on him that he hasn’t know Nicolò DiGenova anywhere near long enough to include him in such company as Andy, Booker, or Quỳnh.

You’re missing something , his instincts tell him. Pay attention, Doctor .

And then Joe remembers he is about to saw a twelve-inch incision into a patient’s sternum and snaps out of it. He can dwell on his longings on his own damn time.

* * *

Doctors tread the well worn paradox of schedules that are highly regimented and highly erratic all at the same time. It is a number of days before Joe runs into Nicolò again. To his own surprise, he still feels simmering annoyance at the sight of the man. He’s wayed too heavily on his mind lately. It reminds him of how he felt days after Booker’s first intervention. A familiar exhaustion. A bone deep disappointment in himself. It’s why he tries to carry on past the man with only a curt nod. “Doctor DiGenova.”

“Good evening, Doctor al-Kaysani, please wait.” It’s a change of pace to have Nicolò traipsing after him. But unless he is about to submit to a round of thorough cardiac monitoring, Joe would rather he didn’t.

“I’m on my way to a transmyocardial revascularization. ”

“It will only be a moment. I meant to say thank you for the other day. For not sharing your concerns with Doctor Scythian.”

“I damn well should,” Joe fumes, starting to feel irritated. Out of everything, this isn’t what Joe should be thanked for. He should be thanked for his patience, his vigilance, the fact that he cares so damn much when Nicolò clearly does not. He almost shouts as much but a herd of blue-scrubbed nurses are moving together behind them, near enough to overhear them. Joe moves in step closer to Nicolò so that only he is within earshot. 

“I really need you to stop and think. Think for one minute about what you are doing here. Not a week ago you tore into my interns for ignoring my expertise and all I had to teach them. Ask yourself why you’re so determined on doing the same thing?”

“It is not the same thing at all,” Nicolò persists, still without explaining why. His accent is thicker when he’s upset. His eyes are bluer, too. He tugs at his collar and keeps his own voice hushed. “And I thank you for all your concern, but you are mistaken. There is nothing wrong with my heart.”

“That is verifiably false and scientifically untrue. I know what I saw on that EKG. And you have to have some ridiculous reason as to why you refuse to listen to me—”

They both fall mum when one of the float nurses, Bradley, makes headway towards them. As far as Joe can remember, he’s assigned to his next surgery. Which is a good thing; he’s a capable nurse and always calm and dependable. His only fault is his love of innuendo and proneness to flirting with Joe while on shift in the cardiac unit. It’s why Joe barely notices when Bradley makes yet another pass; “In for a long night, Doctor Joe?”

“Don’t you worry, Brad,” Joe tells him, his eyes leaving Nicolò for half a second, “we’ll be done here before last call.”

“Good,” Bradley winks, “that means the fun doesn’t have to stop.”

Joe waves him off enough to humor him. He’s far too established in his practice to entertain such a compromising invitation, but not enough of a prude to make a fuss of it. Except when his attentions return to Doctor DiGenova, he sees it. The opposite of a tolerant inclination. An unmistakable look of distaste twisting his mouth and averting eyes.

And Joe realizes just what an idiot he’s been this whole time. But he had said it himself. Nicolò would have needed a ridiculous reason to ignore him. That, or a hateful one.

“I believe we’re done here, Doctor DiGenova?”

“Yes. Yes we are.”

If Joe shoulder checks him on his down to scrub in to his next surgery, its entirely innocently and wholly by accident. And certainly not because Joe wishes and prays that when it does come time for someone to operate on that heart, it doesn’t have to be him.

* * *

Joe decides it’s healthier to ignore Nicolò DiGenova forever than it is to hate him forever. Less of an expenditure of energy. Unfortunately, the former is easier said than done. The man who used to be completely nonexistent in Joe’s world is now perpetually in view, always somewhere on the edge of his periphery. Joe sees him at patient handoffs and walking around with Copley and sitting in the back of the cafeteria and he’s done a handful of double takes during operations squinting at the surgical gallery wondering if he sees him watching among the crowd.

But that’s pretty damn unlikely. 

Joe tries to throw himself back into teaching. It’s what he’s good at, and he’s actually making headway with interns who aren’t just Doctor Freeman. Though she does her best to stay leagues ahead of the rest. Exiting a pediatric consult, they go over their findings: “The child’s blood pressure is lower in the legs than in the arms. Meaning the most likely diagnosis is?”

“Coarctation of the aorta?”

“Point for Freeman. The rest of you, wake-up. Double shifts are a part of the game and until one of you overthrows capitalism, that’s just the way its going to stay.” Milling around the next corner in the hall, he runs directly into Doctor DiGenova. He’s holding a file of printouts and looking expectant. Joe sighs. “All of you, scram.”

To their credit, they've been learning fast; they depart without being told twice. Nicolò smiles softly the second they are alone; “Good day, Joe.” 

Joe tries not to scowl. “ Doctor DiGenova.”

“I…” Nicolò blinks, then swallows. “I hoped I would run into you—”

“This floor is cardio,” he points out.

“I— what?”

“I’m a cardiothoracic surgeon. You’re standing in Cardiology. Means you didn’t have to hope for much.”

“Yes, Is… Is this a bad time?” Nicolò asks, and there’s that dip in his syllables, the swirl of the Romance in his first tongue. “Or, I would hope that my disagreeing with your,” he pauses, choosing his words carefully, “assessment… wouldn’t mean that we can’t be civil as colleagues.”

“Of course not. This is my civil face.” But the smile on his face is just this side of a sneer. Joe had forgotten just how angry he could be. He had overinvested in all of this, in this man, in his health. That was what was expected of him as a physician, as a healer. It was what he demanded of himself and more.

And of course, Joe’s fatal flaw. He let himself wish for more.

“Unless you have an urgent matter or something pertaining to patient care, maybe you should get back up to Neuro. You know how Doctor Scythian likes things, with each of us staying out of each other’s way.”

Without meaning to Joe is moving off in a huff and finds himself striding into a stairwell. Pacing down the stairs, he figures he might as well head down to the surgical floor, sweettalk his way into the prime schedule blocks for his patients still waiting for a slot. Barring that, he might even juggle a few scalpels. Literally anything would be better than looking back at Nicolò goddamn DiGenova who couldn’t afford him the dinigity of not chasing after him.

“Doctor al-Kaysani! Joe! Wait!” His voice bounces off the concrete walls and Joe spins on lower stair, now freely glaring.

“Unless your stopping me to tell me I have a brain tumor, which if you did, I might decide against deferring to your expertise. Turnabout is fair play and all that.”

Nicolò clearly finds none of this funny. He edges closer to Joe but keeps several steps between them. “What did you expect me to do, Doctor al-Kaysani? You were determined to find an illness where there wasn’t one, refusing to listen to me no matter what I said—”

“Excuse you?” Joe rocks up a step, anger mounting. He realizes too late that Nicolò was smart to leave a gap between them. Standing this close to him on the verge of shouting makes him feel lightheaded, reckless. “Do you even hear yourself? Because other than the insulting implication that I can’t do my job, all I hear are excuses.”

“That was never my intention!”

What it is that seizes Joe to the spot, he might never know. He cannot simply walk away from this fight as he would any other. He’s dealt with stubborn patients and haughty interns and ignorant colleagues but Nicolò DiGenova is set apart from the lot. He’d managed to crawl under Joe’s skin somewhere along the line and he fears they might both end up paying for it.

“What is it with you?” Joe demands. “You and all the others like you?”

“What other people like me?”

“Neurosurgeons. Bigots. Take your pick. I suppose it comes down to your superiority complexes. How it’s just beyond you to comprehend that there are other disciples, other schools of thought, other ways of living that are just as valid and meaningful as your own.”

“You don’t know what you’re talking about!” is Nicolò’s best defense. Pathetic, really.

Joe laughs, bitter and resentful. He sounds nothing like himself.

“In case no one’s bothered informing you, there are other organ systems in the body that require attention besides. The heart is actually a big one, in case you missed that in medical school. But hey, maybe you could pay attention to the damn thing in your chest if I reminded you that the vagus nerve has some role in your atrial fibrillation? No? Or maybe you’d sit still for a rehash of the parasympathetic innervation—”

“Now you are just patronizing me.”

“It’s my way of ending this conversation sooner.”

“Did I miss something?” he asks at last. “All I have done is refuse to indulge you and your snap judgement about what you think you saw on an EKG. Is that really so offensive? Is that all it took for you to behave this way?”

“No, you didn’t miss a thing. But you did give yourself away.”

He swears in Italian. “I do not understand what you mean by that!”

“You have a tell, Nicolò. And a revealing one at that. One that made it all clear you don’t want to be helped by the likes of me. But if you ever do wise up and decide you care about your own health, give Doctor Hanh a call. She’s second chair in our department, but I’m sure you’ll find her far more tolerable.”

Joe does his able best to leave him like that; with Nicolò looking stunned and aggrieved. It should feel more satisfying. But instead he’s just winded and exhausted. His medical instincts once again warning him, you’ve missed it. The nagging sensation trips him up. For a second, and only one second, he glances back. Nicolò hasn’t moved, but something behind his eyes has.

“I will set the appointment with Doctor Hanh.”

“Excellent,” Joe nods, his voice scathing. And he is finally able to walk away.

* * * 

None of it feels like a victory. It feels like a concession. And if there was one thing his father always said, half measures have never won any war. Though his mother would throttle him for thinking like that. It was still the great achievement of her life that she won in convincing Joe to attend medical school. His father never got to make a soldier out of him. But at the rate of Nicolò DiGenova rescheduling his appointments with Doctor Hanh again and again, he wonders if he didn’t miss out. Perhaps the art of killing would have been more useful in times like these. 

Finding himself once again crowding in around Hanh’s office, she doesn’t bother looking up from her patient charts. She informs him they’ve left the matter on an indefinite hold. The Neuro department is very busy, etcetera etcetera, so on and so forth.

Joe figures it’s time to stop calling Hanh. The woman has an impressively dour outlook that only clashes with his usual sense of optimism. Eventually she’s going to complain to Andromache, or worse, to Nicolò. And the last thing Joe wants is that man knowing Joe still gives a damn.

That and perhaps in Joe’s weakest moments, part of him is still clinging to his foolish first assessment of the man. That there was something temptingly radiant beneath that shy demeanour. Something foolishly decieving that once again proved that all the prestige and medical advacement in his career could never fix his stupid, hopeful heart.

* * *

They’re wrapping up their shift and Joe notices his interns are antsy. Even Doctor Freeman looks to be watching the clock. Realzing his is the only obstacle to whatever prize they are so ready to dash after, Joe tosses his pen down to the nursing station he’s commandeered. “Is there somewhere you all need to be?”

Doctor Freeman shakes her head. “Need to? No.”

“Alright. Let me rephrase that. Is there somewhere you all would rather be right now? Doctor Ali? You look like you’ll be the one who breaks first.”

Doctor Freeman gives her fellow intern a look that immediately says ‘do not blow this for us.’ But Joe’s correct in his estimation. Doctor Ali can’t hold up to his instances.

“It’s a hemangioblastoma,” she blurts out and a chorus of groans follows. “Its a totally inoperable hemangioblastoma and DiGenova is operating on it anyway and its going to be like, a seven hour surgery and we’ve already missed the first six!”

“And you want to go gawk in the gallery with the rest of the hospital?” He must sound bitter because each of them squirm on their feet. Freeman finally bits the bullet on everyone’s behalf. 

“If it’s alright with you… Yes, we really, really do.”

If even his prodigy is betraying him, he may as well let them go. “Fine. Begone, all of you.”

In the following scramble, elbows are thrown and insults lobbed as the small army of interns try to force their way onto the elevator. The only one left is Doctor Freeman, who for some reason is hanging back.

“I commend you for taking the stairs, Doctor Freeman. You’re less likely to get a black eye.”

“Nile.”

“Excuse me?”

“Nile. It’s my name.”

Joe blinks. He’s certain he was aware of that fact on some level. He shakes her hand anyway. “Well, Nile, how else can I help you?”

“I was wondering if you wanted to tag along? If you believe the hype, this is supposedly the surgery of the century.”

“And if you don’t believe the hype?”

“Then he’ll probably publish his results and get some pretty cool press for the hospital.”

“Glad to see you haven’t been completely bought over by the neurology department.” Joe really only means to malign one man, but he has no problem throwing neurosurgeons as a whole under the bus. But he still follows Nile into the elevator and presses the button that will lead them to the surgical floor.

“Can I ask a personal question sir?”

“Sure. Shoot.”

“Why do you dislike Doctor DiGenova?”

Joe scrubs at the back of his neck. He hadn’t expected that or the cool unbothered way Nile manages to ask without feeling the slightest bit overstepping. “Is it that obvious?”

“Not at first. At first I thought you two… well, now pretty much everyone knows you can’t stand each other. So I was wondering if there was a reason?”

“As juvenile as it might sound, he disliked me first.”

Petty grievances aside, Joe does feel a twinge of surprise at the audience turnout. The whole hospital is packed into the gallery. It does beg the question of who is actually left running the Vanguard; every physician he’s ever met at his tenure here has their face pressed to the glass. There must be an entire ghost shift he’s never heard. That or they have all really left patients to fend for themselves in the name of Nicolò DiGenova’s ego.

The most familiar of faces singles him out and flags him down to a nearby seat. 

“Et tu, Andromache? And here I thought I was your favorite.”

“I have to pay attention to the other doctors who work here, not just you.”

“Oh? So when was the last time you watched one of my surgeries?”

She rolls her eyes. “That would be the stentless valve replacement for your patient with the infectious endocarditis last Wednesday. Excellent work, but don’t let it go to your head.”

“Ah, sorry, too late. Now what have I missed?”

“More or less all the best parts. I think DiGenova’s got some moves down there that aren’t exactly legal stateside, but the procedures worked.”

There’s a chittering of agreement from Neuro, Plastics and Ortho. The trifecta of vanity. “Urgh. The next time I want to launch a highly experimental technique without filing the proper paperwork, I’ll remind you of this.”

“Don’t be bitter, Joe. We’re all on the same team.” 

Then a  coiffed haired Plastics attending who’s name Joe never bothered learning turns to them and asks, “Where’s he going?”

Tilting forward, they can see Nicolò in his signature Italian flag scrub cap backing off from the table. The assisting surgeon, a fellow attending, moves in to close the gap and begin closing up the patient.

“Weird,” says Doctor Maurice, “DiGenova never hands off his surgeries. Not even the close.”

“Does it matter?” asks another. “The procedure’s all done. All glory and none of the clean-up, I say.”

Joe is still watching Nicolò’s retreat. He’s stepping out of the sterile zone and back through to the scrub sink. He’s not sure why he says it nor why he is so deadly certain, but he knows.

“Something is wrong.”

Andy turns to him. “What are you talking about?”

“You need to get down there, Andy.” Joe rises out of his seat. “ We need to get down there. Page Hanh now.”

“You are not making any sense. You know Hanh is out for a week.”

“Shit,” Joe mutters through clenched teeth. Nicolò has already crossed the threshold and there is no clear vantage of the stainless steel wall where the row of sinks stand. He does see the outline of a shadow sway. Joe is about to break for the door when Andy grabs his arm. “Fine. It’ll be me. Let’s go.”

“What are you on about?”

“Andromache—”

The intercom buzzer goes off and breathless voice filters through, “Doctor Scythian? Are you… still in the gallery?”

Andy stalks over to the panel and mashes her finger into the call button. “What’s going on down there, DiGenova?”

“If you could… page cardio… I would very much… very much…” a shuddering breath cuts through, and it almost sounds like Nicolò whispers a name; “Joe?” Then a loud banging ruckus follows and the feed cuts out.

Below, a scrub nurse starts screaming.

*

“Explain it again!” Andy demands, bulldozing her way through the ED. She’s pulling her weight at the other end of the gurney while Joe keeps up at the rear. Doctor DiGenova rides atop it, lying supine and motionless. He’s got a precautionary neck brace holding his head and a controlled bleed at his browline. Intern Freeman had pitched in and packed with gauze and tape with neat steady hands while Joe relayed the other symptoms; dilated pupillary response in the eyes, scant heart beat, blue tinged lips under his surgical mask.

“We’ve been over this, Andy—” Joe turns to the new head of Emergency Medicine, “Keane, we’re taking Med Bay six.” He and Andy and two spare nurses heave and lift Nicolò onto an exam bed.

Andy pulls over a cart with so much force that it nearly pinwheels. “I believe I told you to explain this, again, Joe. And you will explain it as many times as I damn well ask for because I’m your Boss and you—”

“Jesus, Andy, can’t it wait? Get me the oxygen bag, and Doctor Freeman, pass the garment scissors.”

“No. It can’t wait. Because before it even happened, you somehow magically knew DiGenova was going to collapse. And you know what I don’t believe in?”

“I’m gonna say magic.”

“And you would be right,” she snaps as she’s holding Nicolò’s scrubs taut for Joe to shear open. “So I’m not gonna buy that you just had a bad feeling or some bullshit sixth sense. You were damn sure we didn’t need to follow emergency protocols back there.”

“Because there wasn’t an oxygen leak or a bacterial containment. Not that there’s a bacterial agent in the world that could act that fast. Look, if you want to help, we’re going to need to raise his oxygen count.” 

“How do you know that?” she insists, looking this close to throttling him. “You run in there and insist that there’s nothing wrong with his head—”

“It’s a secondary injury, it’s not what caused the fall—”

“And you’ve offered nothing to back up that diagnosis!”

“Just let me work, Andromache!” Joe is moving swift as he can in well, worn practiced motions. He places the electrical nodes as he’s done this a million times before, knowing there’s a chance he could still be wrong. A fat chance, but a chance.

He kicks on the EKG.

“Yusuf, if you think that I won’t fire you because of favoritism—”

“I could use the vacation time,” he chuckles, vindication racing up his spine. “Doctor Freeman, what do you see on the screen?”

“Oh? Me?”

“Yes, Nile, you. What’s your diagnosis?”

“That looks like… a delta wave. It’s missing all of the PR interval. There’s something wrong, a atrial fibrillation.”

Joe grins wide, “in layman’s terms that means he has a…?”

Despite knowing the answer, Nile feels certain she’s been asked a trick question. “It’s a… it’s… an… arrhythmia?”

“You’re damn right it’s a fucking arrhythmia!” Joe might have shouted that last part a little too loudly while Nile tries to chuckle along nervously, eyes dancing back and forth between the senior physicians. 

“Uh, yay?

“No. Not yay,” Andy butts in, sour and increasingly murderous.

“Yes, yay, Andromache! Yes yay! This has been a long time coming! Plus, look at his numbers; ox sat is already improving. He’ll make it through with no impact to his faculties so a little gloating can’t hurt him. At least not as much as him being an idiot could have. And I deserve to gloat! Because I’ve claimed to be many things in this life; a healer, a genius, God’s gift to men who love men, an expert in the whereabouts of all the best halal food trucks in New York. But never once did I claim to be a gracious winner—”

Andy reaches over Nicolò to snatch Joe by the collar of his white coat.

“Explain this now, or I roll you into an OR after I stab you.”

Joe raises his arms placatingly. “Well there’s no need for violence, Doctor Scythian. Just sit down, though. The whole story might to piss you off… In fact, I know it will.”

* * *

Nicolò wakes up in a recuperation room an hour later. His breathing picks ups and he shifts awake, eyes easing open. He blinks, confused. Then realizes where he is and that something has gone wrong. 

“Why am I in bed? Doctor Scythian?”

Andy scoots closer int he swivel chair she’s perched upon. “Doctor DiGenova. Glad to see you’re alive.”

“I— um, thank you.”

“I’d be more glad to see you doing you rounds.”

“Of course,” Nicolò nods, turning to climb out of the bed. “Just let me find my—”

“Fucking hell, DiGenova!” Andy snaps. “I am not expecting you to get out of this bed. I am expecting answers for your neglectant choices while on duty in my goddamn hospital!”

“Andy, he has a concussion,” Joe intervenes, leaning in to check Nicolò’s vitals. “He can’t exactly parse out humor right now. He probably doesn’t even remember the fall.”

“I fell? No. I have surgery to get to. Missus Richards is waiting—”

“It’s already done, DiGenova. You operated on her hours ago. You were scrubbing out when the nurses said you got dizzy and incoherent and slammed your head into a sink.”

“That feels familiar,” Nicolò offers, rubbing the bandage on his head. “I maybe have not had enough sleep.”

“Or you’ve known about a heart complication for weeks. And have taken great pains to ignore it until you collapse outside one of my ORs.”

“I—”

“Joe has already told me everything, don’t try to deny it.”

“No, Doctor Kaysani is, he isn’t… my heart is fine…” Nicolò pleads, rattling off into something in Italian.

“This is what I’m talking about, Andy. He doesn’t want to hear it.”

“It doesn’t matter. We all saw your heart rate and it’s in your charts. Joe even recorded an electronic sample that we can play back for you. He’s also got an expert diagnosis if you care to hear it.”

Gingerly, Nicolò rubs his chest over his hospital gown. “Then I really… oh no.”

“Yes, really. Tell me why Doctor al-Kaysani here has been warning you of this for weeks—”

“We can get to that later, Andy.” Joe waits until she has adequately backed off, still fuming from the corner. “Alright, DiGenova. You have WPW. It is a working diagnosis, but Wolff-Parkinson-White syndrome is the most likely culprit. A congenital defect causing an accessory pathway in your heart. Symptoms tend to flare up in adulthood. It’s practically impossible for me to think you’ve never noticed tachycardia this bad.

“I… It is something I’ve grown used to, I suppose.”

“It needs surgery. A standard ablation. And with good post ops you could get by with medication.”

“I understand.” Nicolò‘s head rocks back onto the thin hospital issue pillow cushion.

“Do you, DiGenova? Because this looks bad from where I am standing. The Dean of Medicine is going to hear about this, and he’s going to want to know how why the Vanguard employs a surgeon who so reckless he ignores his own health. you look like a liability to the hospital—”

“I dont think youre supposed to say that part out loud, Andromache,” Joe points out.

“If I am the only one in the room being honest, so be it.”

“When have I lied?” Joe protests.

“You didn’t say anything when this all first started! You’re as guilty as he is.”

“Doctor Scythian, I swear, Doctor al-Kaysani did everything in his power to persuade me to seek help. I… I ignored. I felt there were other reasonsfor my symptoms. I see that was foolish now. But I can promise this wont happen again. I just— please, I’ll have the surgery and then—”

“The surgery was never optional.”

“Andy, seriously?” Joe edges in closer to Nicolò to stand between them. “The hardass routine is appreciated, but DiGenova’s agreed already—”

“I am not having another Booker on my staff,” Andy spits, deadly serious. “If you aren’t willing to help yourself, if you are not willing to let other people help you, then you can get the hell out of my hospital.”

“That is not necessary,” Nicolò swears.

“Good. Joe will perform the surgery. You can take a few days to recuperate.”

“We can arrange it so that Doctor Hanh will perform the procedure,” Joe corrects, still well aware of what started all this. Saving the man’s life or no, Joe knows he still bears him a deep aversion.

“Why the hell would Hanh do it? She’s second chair in your department.”

Sighing, Joe does his best to explain without explaining. “If it would make the patient more comfortable, we are obliged to—”

“Do I look like I give a shit right now about—”

“I am fine with Doctor al-Kaysani holding the knife,” Nicolò says. He needs to say it twice to be heard over the volume of his bickering doctors. “In fact, I would prefer it were him.”

“Good. Then that’s settled.” Andy glares at them like she might fire them on the spot. “Whatever the hell it is going on between the two of you, I don’t need to know and I don’t want to know. But you’d both better bury the scalpel and soon. This is your first and final warning.”

* * *

The pre op work is unbearable. The sterile hospital air is swelling over with unspoken accusations. Joe wonders if competence in every field of care wasn’t a miscalculation on his part. If he left more work to the nurses, he wouldn’t be here sharing in Nicolò’s palpable sense of dread.

Rolling down to the surgical floor, Joe’s chosen an operating theatre with no gallery views. The gossips and the shit-stirrers of the Vanguard have had enough salacious fodder for one shift. It leaves the pair of them waiting on the auxiliary staff in an empty room. A few reliable, seasoned nurses and an anesthetist whom Joe has heard speak all of twice. Quiet types who never share what they overhear.

Joe fastens on his surgical mask and scrubs and rescrubs his hands to avoid looking at Nicolò or talking to Nicolò or even thinking about Nicolò. So far he’s failing spectacularly at aloof the above. Again and again he reminds himself that this whole ordeal is not his fault. It’s not. And yet it feels like— 

“I won’t hold it against you if you say it,” comes Nicolò’s voice over the rush of the faucet. 

Grudgingly, he twists off the sink with several fresh paper towels in hand. “And what am I saying, exactly?”

Nicolò turns, now laying on his cheek to watch Joe come closer. “I told you so.”

“‘I told you so’ doesn’t even begin to cover this. I warned you, Nicolò.”

“You did.”

“I chased you. I hounded you.”

“Yes.”

“I begged and I pleaded with you! Do I look like a man who begs or pleads? The answer is no. Because I, as an extraordinary cardio thoracic surgeon, who you are lucky to have watching over your case, am generally accepted to know what the hell I am talking about when it comes to the little organ beating away in your chest!”

Nicolò squeezes his eyes shut.

“And you, you, in all of your arrogance, you let your dislike of me cloud your judgement and you fucking collasped on the job! You hate me so much, it literally could have killed you!”

“I do not—” Nicolò bolts up in bed, angling to catch Joe by the eyes. “I do not hate you.”

“Lay back down. You’ve all but admitted it—”

“No, that is not true. I never said that!” The pre-monitoring set up alerts to an elevated heart rate. Joe leans over to flick the damn thing off.

“Have you not been listening? As I keep telling you, I’m a smart man. I can read between the lines. It was pretty obvious that you didn’t want a gay physcian telling you about your health and now look where you are!”

“What? No!” 

“Then what was it then? Because I’m a brown man?”

“Of course not!”

“Muslim?

“Why would you even think that?” Nicolò appears half ready to climb off the surgical bed. Joe angles him back down with his hand to his chest and Nicolò catches him by the wrist with pleading eyes.

“I think that because it has to be something ,” Joe seethes. “And in my experience those three tend to be the big reasons people decide to pass on my expertise. But hey, if you have a new one, do let me know. I’d love to hear it. What imagined and unchangeable fault do I have now? I’m certain it isn’t that I’m so devilishly handsome and unbearably charming—”

“Yes, actually!” Nicolò interrupts. His fingers tighten on Joe’s skin and he swears he can feel one of their pulses jump. “That’s exactly it.”

Joe laughs hollowly. “Good one.”

Nicolò’s face glows impossibly red. He says nothing more and releases Joe’s hand.

“Wait… You?”

“Please call the anaesthetist,” Nicolò mutters through pursed lips. “I would like to be unconscious now.”

“No you dont… you… you can’t just…”

The rest of the surgical team arrives and Nicolò pretends he can’t hear them. Dumbstruck and finding no reason for further delay he gives the go ahead to begin the procedure. Nicolò counts back from one hundred in Italian until finally he feels nothing and lays slack on the table.

Shit, Joe thinks. Then he asks a nurse for a scalpel and decides he might have to strike genius off his long winded list of accomplishments. 

* * *

The procedure is a success but Joe spends every moment after on pins and needles. Its  waiting game as to when he’ll wake but Joe stays posted at his side. He feels there’s something he needs to be able to do to make up for this. He’s not sure what to say to someone who’s character he’d spent the past week defaming. For fuck’s sake, he’d accused the man of being a bigot when instead he—

Joe isn’t sure how to end that sentence.

From an array of propped pillows, the blues eyes finally open.

“You don’t have an emergency contact,” Joe points out. It’s not his best opening line, but it’s all he’s got. You only learn so much reading and rereading someone’s medical history. “Do you have someone we can discharge you to?”

“No. I am afraid not.”

“That’s unfortunate. I was hoping to get you released before Andy finds out you’re awake. She’s still on the warpath.”

Wiping the sleep from his eyes, Nicolò looks around the room worriedly. “Would it be alright if I called a taxi?”

“That’s against policy. So no. But I can offer you a ride home?”

“I… I could not impose, especially after…”

“Shut up and take the olive branch, Nicolò.”

“Alright. Yes. Let’s go.”

* * *

Once the ball’s rolling no amount of procedural red tape can stop Doctor al-Kaysani. Nicolò looks at him skeptically when Joe says he’ll be home in an hour’s time. Joe takes that as a challenge.

Sure enough, Forty minutes later he’s strapping a freshly dressed Nicolò DiGenova into the back seat of a taxi. He’s a little indigent about the whole affair. “You said we couldn’t take a taxi!”

“I said you couldn’t take one alone. If I’m here, it’s fine. Unless you want to head back into the hospital. Andy is still probably looking for you.”

With Nicolò dejectedly shaking his head, the cabbie gets the picture and rolls out of the patient pick up bay. It’s a short enough drive. Close enough for Nicolò to jog to work as Joe has seen him do in the past. Not that Joe had been paying attention. He was a professional. He simply noticed things.

Helping Nicolò into a cramped standards-violating elevator and to his front door, he ends up leaning on Joe as he fusses with his keys. “I’m sorry,” he apologizes effusively. “I just… I’m a little winded.”

“That’s why I’m here. That and saving you from Andy’s wrath.”

“Doctor Scythian… she seemed to take my lapse in judgement a little personally. Something about someone named Booker?”

“He’s a friend. Another surgeon, one of the best. But we had to let him go for his own good… But that’s a long story we can save for another time. And really, all of the things eating Andy these days wouldn’t fit into a book.”

“I am sorry for her troubles,” Nicolò offers, sounding a tad bit woozy. “And for the trouble I have caused you.”

With the door open, Joe nods and leads them inside. They are greeted instantly by a jet of orange fury darting between their legs. “Her name is Carbonara,” Nicolò explains with a straight face as if that name is not the most adorable thing Joe has ever heard. “She is a terror and an instrument of the devil. Please, take known of her yowling to heart.”

Joe heaps Nicolò onto his fresh-out-of-the-cardboard box couch and bends down to scratch the feline behind the ears. “I think she likes me.”

“I can assure you that you’re wrong,” he cautions. “She hates everyone.”

“Well, I have been wrong about a lot of things lately…” Joe trails off. After, they both say nothing for a significant silence while the cat purrs between them. “ … except about the arrhythmia. I was right about that.”

Nicolo sigh. “Yes. I know that now.”

“For the record. I was very, very right.”

A flash of anger shines in Nicolò’s eyes. “Will you allow me to live this down in peace?”

“Yes, once I understand exactly how the hell we got here in the first place!”

“We took a taxi,” Nicolò shifts uncomfortably on the couch. If he had strength enough, he might make a break for it, despite this being his home.

“You’re being obstinate again. If you think you’re going to run me off, let me again offer you a lesson in how persistent I can be.”

“What more do you need to know, Joe?” Nicolò clambers to his feet. Joe tries to steady him but he pushes him off. In spite of all his obvious discomfort, Nicolò paces to and fro. “Yes, I’m a fool. And yes, I was wrong. And yes, I got used to feeling light-headed around you! I got used to my chest tightening  and my heart beating faster whenever you’re near me and…” Nicolò bends double to massage his aching chest. Joe is right beside him in an instant to lead him back to sitting.

“I should have asked you for a coffee all those months ago. Instead of this. Letting it go on and on until now. Because at least then it would have been over quicker, instead of this slow mortification—”

“Don’t be so hard on yourself. It happens to the best of us. And I am incredibly handsome, after all.”

Nicolò shoots him a look, utterly appalled.

“And charming. I am so very charming, aren’t I?”

“At this very moment, no. You are the worst person I have ever met.”

“Hey, I saved your life! Against your best efforts, I might add. And on a slide scale of embarrassment, I feel like crushing so hard on me that it nearly kills you only narrowly beats out thinking another gay man was a homophobe.”

Nicolò’s nose wrinkles with indignation. “Why on earth did you think that anyway!”

“You were shooting daggers with your eyes at the nurse flirting with me!”

“Because I was jealous! Not all of us can flirt so easily! For some of us… this is harder. Telling you that I had feelings…” Nicolò buries his face in his hands. 

“If it helps, this will be the most inventive way anyone’s ever gotten into my pants.”

“No,” Nicolo admits miserably. “That doesn’t not help! Because I don’t just want into your pants! I want…”

He falls quiet again and Joe’s certain he has the final piece. The nagging voice in his head is finally calmed. This is it, Doctor. Case closed, diagnosis settled. In front of him is a gentle, careful man. One who is measured and precise in all things he did, from surgery to speech. A brilliant delight of a man wrapped up in all of his own delicate nuances and distractions, who could barely get out of his own way. 

“I’m sorry to say this Nicky, but when we finally go for that coffee, you’ll have to order decaf.”

Nicolò bites his lip. “Is that… are you… sure?”

“Yes. Minor surgery or no, you still need to watch you caffeine intake.”

It’s a beautiful thing when Nicolò smiles next and asks, “Doctors orders?”

“Doctors orders.”

They share a smile and for the first time, they both know exactly what they other intends. However the moment is ruined at once by a wretched and unearthly screech emanating from below them. Carbonara is getting restless.

“By chance, is there anyone who would have fed your cat while you were laid up in the hospital?”

Nicolò shakes his head guiltily.

“Then by all means, allow me and her to get better acquainted.”

“You are going to regret it if you do.”

“Nonsense. Just lay down and let me take care of it. Her food is in the kitchen, right?”

*

All good will and gestures aside, Joe quickly realizes there is a hitch in his plan. The bag of cat food in the corder is filled only with crumbs and has been scratched to pieces by angry tiny paws. It feels a little ridiculous to Joe to let an empty bag of cat food ruin what was already a ludicrous admission of affections. So he ends up convincing Nicolò to hand over his keys and let Joe run to the market. That comes with the caveat that Carbonara, the eight-pound hellbeast extraordinaire, only eats specialty cat food from across the borough. So of course Joe volunteers to go get it anyway and nothing Nicolò says can stop him.

He’s in grand gesture mode. Sue him.

But while he’s out he remembers Nicolò’s slow, pained movements and stops at a pharmacy to scribble a prescription on the pad in his pocket. He picks up a few things for Nicolò’s fridge which he saw in passing and couldn’t help but not was quite empty.

Returning hours later, out of breath, lugging grocery bags and cat food, he finds Nicolò lying asleep. Still on the couch, never having made it to the bedroom. His hair falls softly in his face and his cat curls close to his chest, no matter how starved the poor creature is. He thinks he might just instinctively understand that urge. The need to seek comfort.

And Nicolò might just be more than that. Joe’s seen it before. The way the taste of some medicines are dangerous. Meant to be controlled and regimented for the good of those being dosed. Because otherwise, they grow addicted. Otherwise they barely scrape by with their lives.

When Joe stocks the fridge and leaves the cat food by the kitchen door, all he can think of is Andy and her perpetual bad moods. The way she misses and misses her wife and never says a thing because of that godawful thought plaguing her; that Quỳnh might be happier and more successful without her.

When Joe leaves the keys on Nicolò’s coffee table without waking him, he thinks of Booker. Thinks of the man Sébastien was before when he had everything imaginable. Thinks about the way he doted on his wife, cherished her, before she was the last thing that left him.

Shit.

Grand gestures or insanity or a fool rushing in love, Joe can’t be sure. So he leaves a barely legible note by the door and hops into the first taxi he manages to hail.

* * *

“Pour me something,” Joe demands before Booker’s managed to fully open the door.

“What? It’s eleven in the morning—”

“Don’t start with that shit, Book.” He pushes his way inside, shoulder checking him on the way. “I know you’re fully stocked and drinking at all hours of the day in here. Now pour me something and make it strong.”

“Yeah… no,” Booker says, oddly resolute. He’s looking at Joe as if he’s been transplanted with an extra limb, as if he’s something unrecognizable. And he might be. Joe can’t remember the last time he felt like this. Unable to sit still or breathe in his own skin. He thinks and thinks about Nicolò’s face and how he might have looked waking up on that couch. It would be different than watching him wake up in a hospital. More intimate, softer, sweeter. The image makes him laugh incredulously at himself because wow, he’s done for and there’s nothing left to do but self medicate. Ripping through Booker’s cupboards and the shelves and fridge and pantry, he comes up empty with nary a bottle of beer in hand.

“What the fuck, Booker? Where’s the alcohol?”

“I drank it all,” he admits, sheepish. 

“Yes, I realize that now!” Joe is wearing a circle into the tread of the carpet. “What, do you buy more liquor everyday?”

“I don’t exactly ration it. Its a big part of the problem when you think about it. Do you want to sit down, Joe?”

“No! I want to be drunk out of my skull and I need you to help me do it!”

“Didn’t you promise Zainab that you would stop—”

“Do not use my mother or my religion against me right now! If you had any idea of the day I’m having you’d shut up and take me somewhere they serve stiff drinks and fast.”

Something about Booker shifts just then. Under the five-o’clock shadow and browbeaten appearance is a figure Joe knows well. Doctor Lelivre. Ex-trauma specialist who always knew the cleanest cut to the root of anything.

“Alright then. Tell me everything and I’ll drive you where we need to go.”

Joe lets out the longest breath of his life. “Fine. So you remember that neurosurgeon that wouldn’t let me treat him?”

“That idiot? What about him?”

“He’s not an idiot! Or I thought he was for a while, back when he as most likely a homophobe—”

“Really?” Booker’s face twists in revulsion. “Fuck him then. Let him die.”

“Appreciate it, buddy, but no, actually… He’s beautiful and confusing and shy and soft spoken and brilliant and he names his pets after pasta and I the things I’ve seen him do with the most delicate instruments, it’s like he can resect a tumor with a blindfold on and what the hell am I supposed to do with that? Not fall in love with him?”

Booker grasps him by the shoulder. “Breathe, Yusuf, breathe.”

Joe does his best but it isn’t helping. “I think I fucked up. I asked him for coffee.”

“You just said you liked him?”

“Yes. But I more than like him. And maybe that’s okay because apparently he had such a crush on me that he thought his heart condition was just butterflies in his chest or stomach or whatever the hell that awful metaphor is!”

Booker barely contains his laughter. “And that’s a bad thing?”

“Yes!” Joe isn’t sure why he’s shouting. He might be panicking. This feels like panicking. 

“Why?”

“Because I had no idea about him! That he felt anything about me at all! I was walking around blind and living my life and now he’s just right there, in the way and we barely know each other! What if he changes his mind and I don’t? What if… what if…”

The sympathetic look on Booker’s face is too much.

“Dammit. I need to quit my job. Sell my apartment. Change my name. Maybe go work for Merrick Medical.”

“Absolutely not.”

“Then can we just go get drunk now? Please, Book, I’m begging you.”

Booker sizes him up one final time. Joe isn’t sure what he sees, watching one of his oldest friends, one of his last friends, pace up and down the sparse empty remnant of his home like a madman. He comes to some conclusion or another because he picks his keys and motions towards the door saying, “I know where we should go.”

* * *

It’s not a bar or a liquor store they end up parked at. It’s some nondescript office building on a dirty street lined with “for sale” posters and busy commuters. When pressed Booker swears it’s some sort of quick errand on the way. That he only needs Joe to step inside with him for a minute.

“Glad my crisis can afford to have pit stops,” Joe murmurs darkly. He’s follow Booker down a straight cement staircase under poorly lit buzzing lights. It reminds him of the morgue in the hospital levels. It feels about as cold. “Where the hell are we going?”

“Through here, not much farther.”

Joe tries to worry more about the murder basement his substance dependent friend of questionable judgement is leading him into. But all he manages to dwell on is how Nicolò might be doing, if he’s awake now, if he’d taken the correct dosage of painkillers, or if Carbonara is being mindful of the injection site on his chest where Joe inserted the ablation catheter.

He’s lost in thought when Booker shoves a folded chair of all things into his hands.

“What? Why in the hell—”

“We’re early,” Booker says cryptically. “That means we have to help set up. But look, free donuts.”

Joe takes stock of just where the hell Booker’s led them. A basement filled with metal chairs and folding tables and burnt coffee and boxed pastries and long faces of old men and the young alike. There’s a pamphlet handed to him with an embossed triangle surrounded by the words unity and service and recovery .

Joe leans in close to growl lowly at his traitorous friend.

“Sébastien.”

“Yes, Yusuf?”

“Why the hell are we at an AA meeting?”

There’s a brief glint of a smile that Joe learned all too well even as an intern. “I didn’t feel like getting drunk today. So here I am. You’re my plus one by the way.”

“How long have you even been sober?”

“All of this morning and counting.”

“Fuck you, Book,” he says with a smile while a sweet girl, no older than a college graduate passes him another chair to set up in the circle.

“No, Joe, fuck you,” Booker returns with just as bright of a smile. “You think you can show up at my house in the middle of the day to get wasted — something you never do, something that you hate that I do— and I’d just let you?”

“I didn’t figure you’d care so damn much!” he whispers back fiercely.

“Right. Because I’m too much of a drunk to care about anyone else or stop you from ruining something good in your life.”

“Who said I was ruining anything?” Joe hisses back, features flushed and irate.

“You think I don’t know that look on your face? You were talking about quitting your job—”

“As a hypothetical!”

Booker snatches Joe by the arm and hauls him off through a door marked EXIT into a more secluded corner. Joe had forgotten what an imposing figure he could be, stone sober and dead set on a course of action. He tells himself he is not letting himself be dragged if his footsteps pound after the other man.

“You came to me to drink.”

“Yeah, and I—”

You came to me to drink.” Joe swallows the rest of his objections. Because fuck. He had. If his mother knew. If Andy knew? He would be a dead man. “Ever since I left The Old Guard, since I stopped being a surgeon, you haven’t so much as had a beer in my house because of how much you hate my drinking… Do you even remember what you said to me at my intervention?” When Booker asks him, neither can look at the other. “I hope you do, because I haven’t forgotten. I can’t ever forget. It’s all I think about when I remember the job, when I miss treating patients, when I come here and think that maybe this time I’ll let myself stop.”

It is a shameful thing to realize that Joe hadn’t thought Booker capable of ever setting foot in a meeting. In his mind, his friend had stopped trying long ago.

“Sébastien, I’m sorry. I don’t know what…” He remembers the looks on the people in the other room and feels a strange sense of pride for every one of them. It’s the physician in him. He wants them to be well. “I don’t know what I was thinking. Temporary insanity.”

“Yeah… is that going to be a regular routine for you and your neurosurgeon?”

“He’s not the problem here! I am!”

“Already defensive over him. Zainab is going to love that.”

“I know I don’t deserve it but cut me some slack here—”

“You get zero slack, Joe. Zero.” Booker leans against a wall, staring him down hard. “So you’re maybe in love with a guy and it’s all terrible and sudden and new. Tough shit. It’s like that for everyone. I don’t know where you got the idea that life wasn’t supposed to be fucking scary.”

“Usually it’s someone else’s life I’m calling the shots on.”

“Life isn’t an OR, Joe! I keep telling you there’s more to life than medicine.”

“So I should have been a soldier like my father said?”

Booker groans. “You would have been terrible at killing people. Or really good at it. One or the other, I’m not sure. But my the fucking point is this; stop panicking. Go have great sex or get your heart broken or go introduce him to your mother and scare him off. Hell, do all of the above. But leave the self destruction for the people with nothing left to lose. Now get the hell out of here. I have a meeting to go to.”

It takes Joe a second to realize he’s being unceremoniously given the boot. “You sure you don’t want me to stay?”

“Hell no. Also, don’t tell your mother I came to this meeting. If I’m drinking again in two weeks, it’ll just break her heart.”

* * *

Andy barges into his office again, just like always. “So what’s the verdict on your and DiGenova?”

Blank faced and unphased, Joe folds his hands over his desk. “He’s dreamy and I want to run my fingers through his hair. We’re getting coffee later.”

Andy makes a gagging sound. “That’s disgusting… wait, you’re not serious? Tell me you’re not serious.”

“Andromache, will you be the Best Man at my wedding?”

“Jesus Christ. I’m telling HR so we can get ready for this shitstorm.”

Joe nods safely. “On your way there, tell the scheduling office you’re taking a few weeks off. You’ve got a flight to catch.”

“Am I going somewhere?” Andy peers at him suspiciously. “Do you know something I don’t?”

“Only that your wife misses you and thinks you’ve moved on without her.” Joe slides his phone over the table. His hours long text message session with Quỳnh scrolls up from her first tentative responses to her more truthful admissions. What if Andy doesn’t want to see me?

“She does not… she doesn’t think that.” With a shaking hand, Andy rereads every message. “She’s not that stupid. I’m not that stupid. We—”

“There there, Andy. I know it’s hard to be so tragically in love with your wife, but maybe just get on the plane and meet her in Paris. Order room service, fuck her brains out, have a great time.”

“I hate Paris.”

“She loves it. You love her. Get over it.”

Andy looks close to actually hugging him and Joe knows she’ll never forgive herself for showing that much affection in a public space. “Who’s going to keep this surgical program running while I’m gone? If… if I’m gone…”

“Cleared it with Copley. Apparently any senior department head is up for the job on an interim basis. And I’m on the only fool willing enough to do it on short notice.”

Andy blinks hard. She might be tearing up. “Why?”

“I… don’t know,” Joe admits. “Everything’s so damn weird and new… and we work too damn much and too hard to forget to try and live, y’know?”

In the span of time it took him to explain himself, Andy stole his mug of premium roast. “Jesus, Joe. You sound like Booker back when he was sober. I don’t know if that’s a complement or not… but either way, when I get back I expect three sugars in my coffee.”

Joe rolls his eyes. “Sure thing, Boss.”

* * *

Nicolò comes back to work to a great deal of fanfare. There is ice cream and cake in the lounge and even some balloons. With his heroes welcome one might think he’d been off to war. He certainly looks shell-shocked at the party’s turnout. When the masses disperse and they’re left alone, Joe ditches his wallflower routine and makes his move.

“Looks like I’m not the only one the nurses love after all.”

“Doctor al-Kaysani,” Nicolò greets him, looking nervous and hesitant. “I’m glad to see you—”

“Acting chief al-Kaysani, actually.”

“Oh? When did that happen?”

Joe shrugs, the picture of humble bragging. “You know how I am. Saving lives, making moves, booking five star lesbian vacations.”

Nicolò’s eyes squints and his mouth gaps. He shakes his head, both bewildered and affectionate. “You are very frustrating. I almost cannot stand it.”

“If your taste in cats is anything like your taste in me, that’s a point in my favor. How is the mongrel?”

“She steps on my stitches. But I do not think you want to talk about Carbonara.”

“Well not only her. You see, I have a whole speech prepared. It’s actually kind of embarrassing.”

“Again, I gave myself a low grade concussion because of what was essentially self inflicted hypoxia. Nothing you say will be worse.”

“Oh, Nicky. Don’t you know I’ll take that as a challenge?”

Nicolo‘s eyes shine. “No one’s called me that since I left home.”

“Do you want me to stop?”

“No.”

“Good. So just… sit here.” Joe helps Nicolò onto a changing bench in front of a row of lockers. “Okay. So. When I left your place, I might have spiraled. Because it’s one thing to know I’m handsome and charming, but that wears thin real fast and we… it felt like we were agreeing to more than just coffee. More than just a roll in an on-call room.”

“On-call rooms?” Nicolò — Nicky — asks with a raised eyebrow.

“Look, work with me here. I’m trying to tell you that the guy you see in the hospital, who knows what he’s doing and what he wants? That guy knows what other people need in their lives. Not his own. When its someone else, nothing scares Doctor al-Kaysani. But when it’s just Joe, just Yusuf… ”

“I want to know him.” Nicolò rises, stepping closer. “I want to know all the things he needs.”

“Yeah? You sure? Could be a hell of a slow learning curve.”

“I’ve been certain from the first moment I saw you.” Ducks away, still blushing. “Do you still think you are more embarrassing than me?”

“For your sake, Nicky, I can try harder. Do you like poetry? I always saw myself as something of an artist. Would you like to be serenaded?”

Nicky chuckles. “What if we go get that coffee first? My treat.”

Joe cups Nicky’s beautiful face in his hands. “It’s so sweet of you to try and pull one over on me, love, but I’m not letting you order caffeine. I’m a little too invested in this heart of yours.”

Nicky leans into Joe’s touch, happily defeated, and lets himself be led along the hallways of the Vanguard.

 

fin.