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double-0h-no · 2 months

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Doctor's Note

Prompt fill for both 3000 words and medical staff. This is a… very different kind of thing. Not my usual perspective, not my usual style of writing, but hey, this here is to try new things, and I had fun writing this. I hope you enjoy :)

on ao3

What's it like being a Doctor for Medical at MI6? Well, it goes a bit like this…

Hi. You must be the new Doctor working here, right?

I'm Hermine Dalton, pleasure to meet you. I've been with Six for longer than I'd like to admit to, and I'll be showing you the ropes the next few days and weeks. So, if you've got any questions, fire away. Should I at any point not be around, the nurses know more about the way of things than I do. All right, let's not dawdle. And welcome to the team.

***

Right, so we have a couple of divisions that you're not really used to from a normal hospital, and obviously, we're completely lacking others. No paediatrics, no oncology, stuff like that. A lot more forensic medicine and maybe in ways you're not entirely used to. And we have an intersection with Q-branch, if you're interested in that, namely with R&D where we have some guys who work on toxins and antitoxins and some creative biological weapons. That sounds a lot more malicious than it is, the creative part is mostly about how to target it and prevent the agents from accidentally injecting themselves with it or something similar. Should you wind up there at some point I have one advice for you: Trust the Q-branchers there. If they say "we can't do it like that, the agents will totally do this and that with it", no matter how outlandish it sounds, trust them. They know what they're talking about. All safety regulations are written in blood, and all that.

***

So this is where you'll start out. I know it's not the most exciting, but it'll give you a bit of time and peace to ease into things. So, most of this is from some sort of ongoing investigation. We have a colour coding system for prioritising those things, there's a list on the server. Take your time familiarising yourself with everything, I'm sure you'll get the hang of it fast enough. Tomorrow you can join me for my round with the current patients.

***

Good morning, so glad you'll join me. So, we don't have a whole lot of patients at any time, usually not more than five who are supposed to stay here. When I left last night, we had six patients, let's see how it looks this morning.

Why? Oh, let's just say there is a certain type of patient who is less than inclined to stay put.

Stop them? Oh, no, love. We... it's a recent thing, admittedly, one I've managed to painstakingly build up. It's... Let me explain this to you over a cup of tea after. Let's see the patients first, yeah?

***

So, that's them. Only four patients left, admittedly, but I would have made that bet. Let me show you what we do now.

Of course we'll have a coffee over it. What else is there to do? And we'll take a look at this nice little document there. Okay, so the people who were here last night and aren't anymore, that's Agent Booth, and 004. So, Booth wasn't hurt too badly, he was supposed to stay because we suspected he might have a concussion. He has a wife here in Six, she works in accounting, and they have two kids. So him not being here just means that he wants home to go and see them, and I sent his wife an email when he was admitted. She knows about his medical status, I'm not worried about him, so we'll let it go. Prep the paperwork for him to sign as soon as he's back at work, backdating it all, so that the bureaucracy monster working on the fourth floor is fed and satisfied.

Now, 004, that's a different thing. She had a... Sorry. Sometimes the job still gets to me, too. But she had a... fucked up mission. I don't want her to be alone for even a second, and she's in no good condition healthwise, either. What I do now is, I pull up the Double Oh roster, and check where 003 and 007 are. Three is out in the field, so that road's blocked. Seven is in London. Great. Let me just text him real quick.

Okay. That's done. And now we can only hope and pray.

How I know what? Oh, the mission. Yeah, no, we're not supposed to - hm. Hm. See, that's... It's easier to do than you might think. And not all agents take it too seriously. I know you've only been here for two days, and you already picked up on the reputation of Double Ohs, but...

Yes, they are the worst patients you could wish for. Horrible. Rude. Don't keep to any of your orders. But... They're our patients. I care for them. And with most of them, I've managed to build a rapport. They trust me with details of their missions, so I happen to know more than I'm supposed to. Sometimes, you find out things because you treat them. You'll get practised at it eventually, recognise certain types of injuries, all that. And other times, you have to ask, because maybe they've ingested something, or you need to know what happened to be able to judge how deep the injuries might be, how likely a concussion is, questions are important.

What that third column is? It's their handlers. Let's go through the list real quick. You will not be needing it for a good long while. Treating Double Ohs takes a bit of time until you're at a point where you can make decisions for them without them raising hell on you. But I hope the insight will help you a bit. So the first two columns are the agents and their designations. The next two are their usual handlers. They might change in between missions, but those are the two they trust the most.

If an agent comes in and they are in a really bad shape, you contact their handler as soon as they're stable and look human again. Q-branch needs to know that their charge is home safe and sound. If an agent acts up while they have a bed here, just being a little bitch, pardon my French here, you can also call their handler, and they usually get the agents in line. Do it surreptitiously, though. The agents have not yet caught on to me strategically ordering Q up when I need to get them in line, and I'd rather keep it like that for as long as possible.

Next column is significant others or people that the agents themselves have cleared for me divulging medical information and all. It's empty for a lot of them, but that's usually not as much of an issue as it sounds.

Next columns are people to send after them if they pull a runner. That one I know by heart. The trick is finding out who's available. Scarlett's first contact is, and always will be, Tanner from admin upstairs. Don't know why, I don't ask, don't care. But Tanner's busy, and I have the feeling that she would appreciate someone who knows what it's like to come back from... that. So one of the other Double Oh, then you pull up the roster, check whether they're in, and Bob's your uncle.

Okay, I know that was a lot, but you're a quick study. I know you've heard all the horror stories about our most notorious patients but... Well, I'm sure you'll figure them out. Just don't -- Don't listen too much to others.

***

Oi, come over here, I need another pair of hands! Don't just stand there, it's only blood and there will be more if you don't put your hands right here!

Thank you! Fuck! Fuck!

007, get out of the way now, you did your part, we'll take over from here. We've got her, she's safe.

***

Fuck, I need more coffee. Thanks for that. Sorry for just jumping that on you and barking orders but -- Oh. Yeah, thanks. That doesn't usually happen, mind. By the time we take care of the patients, they're usually not in any immediate danger anymore. We do surgeries, but they're stable, not bleeding out anymore. At least when they get a medevac. 007 has a horrible track record of dragging his sorry arse all the way to London by himself, no matter his physical state. But still... This is not a regular occurrence. Hold on --

Bill? Yeah, she's in room two. She's not awake yet but I don't think she should be alone. Yeah, I sent James after -- Oh hush, you know better than that. She badly pulled those stitches of hers and -- Yeah, I think so. I mean she had wet hair and was scarcely dressed, so... Go see her. Can she stay with you, if she doesn't want to hang around? I'll make sure no one's watching. Thanks.

***

Now, how was your first week? Eventful enough? Exactly what you expected from working at Six?

Yeah I bet. Hope we haven't scared you off. Have a nice weekend, and see you on Monday.

***

Oh, hello. Had a nice weekend? What can I help you with?

What was that? Oh, yes, that's... Yes. I see. Of course. Let's... I'll be right with you. What did you say that they did in Q-branch that caused this?

Right. Of course. Just a regular Monday morning, right?

***

I'd like you to assist me this afternoon, if you don't mind. We've got 007 coming in from his latest mission and he's being transported back in with a medevac. It's not too bad, nothing you haven't seen before in clinic.

***

So, how was that for your first foray into Double Oh field medicine?

Oh no, I dare say he was perfectly pleasant, actually. Oh you sweet summer child. No. That was him being kind.

All right, now, what do you know about the mission?

No no, not the things that Bond told us, however begrudgingly. The rest.

Like what? The wound on his shoulder, for example.

Oh no, that's... older. That shoulder is just banged up. If you want a case study in "how is that human body still moving?", I recommend the files of 004, 007, and the previous 006. He retired, so he, too, is still moving around, just not in active service anymore. No, what I mean is the cuts that we tended to. What happened there?

It's all right, there's no shame in not knowing. I've spent years here learning to read between the lines, and you can do your job without ever questioning the pattern of injuries. Now, what I gather from those wounds is an explosion. The way those scratches were scattered, the kind of shrapnel we got out of the wounds, it all looks like an explosion inside of a building.

Then there's the bruising. It's on the opposite side, so that suggests - exactly, the blast probably flung him into a wall. There were marks on his thighs and arms that suggest close combat. The marks on his neck were the thing prompting me to ask whether wants to get tested.

Why I offer? Most agents are really conscientious about that part. Not 001, but then, I never have to treat him, either. He's sexist like that.

Thanks for your help, by the way. Don't count on Bond hanging around for the night, though. He's mobile enough, he might make a run for it.

***

Oh, hi. Sure I have a moment, what's up?

Whether what--? Oh. Oh!

Right. Sometimes I forget you've not been here for ages with how well you've managed to settle in. No, no, take the compliment.

So Q snuck up here with dinner for Bond yesterday evening? That's kind of him.

Did he? Well, usually I'd say, do with that what you will, but remember one thing, in this very specific case: There is such a thing as plausible deniability. Should two people who work together as closely as an agent and their handler be in a relationship, that might end their working relationship here. There are precautions to be met and everything. Unless that's inconvenient, because they clearly work well together and who would disrupt that. So sometimes, there's nothing where there's something, and everybody knows unless someone comes asking, you see?

Yes, they are. It was the most exciting thing I've seen happen here. They're actually good for each other, if you can believe it. A lid for every pot, as my gran used to say.

004 and Tanner? Oh Lord, no. She's the godmother to his daughters, though. I think they served together. Oh, yes, Tanner's a military man. Doesn't look like it, does he? No, from what I know, they were in some deep shit together and have been inseparable ever since.

Other gossip? I mean, someone probably warned you about the Double Ohs being prone to sexual advances, especially if they think they can wheedle some special treatment out of you. Everything else, I won't tell. I'm sure you've caught plenty on your own.

Now tell me, how's your first month been? Ready to take on your own patients?

***

Hey, could you fetch me a rape kit real quick? I don't want to leave her alone.

She's an agent, she says she's fine, all part of the job, but... She's only human, too, you know?

Thank you.

***

My goodness, I've got to tell you what just happened. So, you know how Nomi's currently here? Well, she just woke up, incredibly high on pain meds, and I went through the usual questions, who are you, do you know where you are, what day is it, and she answered it in absolute Double Oh fashion, and then we got to the current events question and i asked her who the current prime minister is, and she just groaned and mumbled "Don't make me say it'' and I think that counts, too, doesn't it?

Anyway, Miss Moneypenny showed up shortly after, awfully chipper for a Friday afternoon, and spent over an hour in there for the debrief. A bit long for a person who can't string two coherent thoughts together, don't you think?

***

Hey, can you take over Trevelyan's check up for me? My sister's in town and I'd love to meet up with her if you -- Oh thank you so much, you're a lifesaver.

Have you ever had the pleasure? No? Oh, well, it's rather easy, though he might try to get under your skin. Don't let him, he's all bark and no bite. Terry will be here, too -- yeah, PT, that's him, and Camilla from Q-branch -- I know, I know it sounds like a big thing, but it really isn't. Just routine check up, we just all pool together because it's more convenient. Trevelyan is Q-branch's test bunny for their new prosthesis that they're trying to link to his neural pathways and muscle impulses to use a robotic prosthetic that can react to those impulses. Mostly it's Camilla and Trevelyan talking and you and Terry looking pretty until your expertise is called upon.

Yeah, they're actually on to something there. Last time Alec started asking whether they could weaponise the thing, and I'm living in fear ever since.

Oh, right, that was before you. Trevelyan was 006, not too long ago, and he has a propensity for arson and explosions.

Still has, I meant what I said. He occasionally helps out in Q-branch. Those are usually the days when the fire alert goes off somewhere in the building.

I have a note with my standard questions and procedures for this meeting so I don't forget anything, I'll forward that to you. Alec will answer the questions before you can ask them, he knows them by heart.

Thank you so much, I owe you one. No, really. If I can jump in for you at some point, please let me know. All right. Thanks. See you!

***

Yeah, I heard. How... Well, stupid question, but how bad is it?

It's crazy, isn't it? When it's agents, that's no big deal, but Q? I ran into James -- Yeah, probably why he didn't kick up a fuss. You're welcome, but it really only was a coincidence. That man looked murderous, and I would know.

Yeah, he's in there with Q now. And I don't think he'll leave his side. I think M officially assigned him as Q's security detail now. We'll have to take care of the visitors. Not too many and all that. Not a problem we usually seem to have, but there's a first time for everything, huh?

Anything broken?

Cracked ribs are a bitch. I bet he's glad it's not his fingers. God, that's morbid. Okay, I gotta get going. I've got a meeting with the Head of Department.

Don't call him that! You're insulting those old and cranky dragons with that comparison.

Yeah, I also shudder to think what this is about. I'll let you know as soon as I'm done. Take care of the head boffin for me, will you?

***

I know, I can't believe it either! Head of Medical! Look at me, having even less time for my patients from here on out.

No, it's... Wow. Still can't believe it. Then you've got a new old and cranky dragon to complain about.

Thank you so much.

Hey, what would you say to a promotion?

***

I can't anymore. Just shoot me, please. Or let me take a good, deep breath from one of the funny gases we have around. Chloroform, nitrous oxide, I'm not picky.

I mean, I knew that the budget meeting had the potential to be my Waterloo, but this... It's so disgusting to argue for a budget that's supposed to keep people alive. No, we can't cut back on our expenses for the blood bank, we actually need that considering the state of our agents. Goodness.

***

Come on, hon. Go home. You did what you could, and nobody will feel better if you run yourself ragged. You did well. Good night.

#007 fest 2024 #station atlantic #double oh no fic

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the-girl-wh0-cries-w0lf · 1 year

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Hiii!

I love your Wilson x peds story! I love how he's so in love with her... Would you be able to write how they met? I'd love to see his reaction to her ehehe

Sorry for any mistakes, English isn't my first language.

-x-x-x-x-x-x-x-x-x-x-

Let's establish first of all that James fell for peds first. Her first day on the job of Head of Paediatrics and it was lunch time and she was desperate for a sandwich. However, Cuddy hadn't gotten that far into the tour because of a 'House' emergency. So she plucked up the courage and tapped a doctor on the shoulder. He turned around and managed to lower his gaze to meet her bright eyes.

He was so overcome by her smile that he'd barely registered what she'd said.

"Pardon?" "Where's the cafeteria? I'm new see, Dr y/l/n head of peds." "James Wilson, head of oncology." They shook hands and he didn't want to ever let her go. But he eventually did when she'd registered the awkward length of the handshake.

This is when they met but they didn't actually have the joy of working together until 2 weeks into her stay.

Unfortunately, it was anything but joyful.

She had a patient, 6 year old girl, who was in for persistent headaches.

She'd done a CT scan and there had been something weird on the scan that she didn't understand, but as it was a mass she felt it safer to take it to Wilson.

He'd been so happy when she'd entered his office and suddenly became as nervous as a teenage boy. Going as far to try but fail to tidy up his desk for her. But this was all ruined when he saw the scan.

"Y/n, it's a brain tumour. It's malignant. I know that is the answer you feared. But that is what this is."

Y/n began to giggle uncomfortably as tears streamed down her cheeks. James is used to this sight now, knowing it is her way of coping. But the first time he saw it, his heart broke a little. Someone so strong and positive reduced to fragility.

In that moment he wanted nothing more than to gather her up in his arms but professionalism refrained him.

She went to leave his office, having to give the new diagnosis. But she faltered and turned back to him and her meek voice just managed to offer...

"Coul--could you c-come with me." "Of course."

And James stood right next to y/n as she delivered the news to the child's parents. Only offering a gentle touch on the shoulder when he saw her professionalism begin to crack upon hearing the wails of the mother.

After the worst was over and when she came off her shift after going through all the possible options with the girl and her parents, she once more ran into James who had sat waiting outside her office for 30 minutes.

He jumped up when he saw her. Seeing the glassy look in her eyes, he chose not to bother burdening her with the "Are you okay?" question.

Instead he chose to merely randomly shout "Pizza?".

She turned around laughing and waited for him to elaborate.

"Would you like to come round my flat for pizza and beer? Only if you want to of course, it's just that's what I like after days like today."

"I'd love that." She giggled. She grabbed her stuff from her office and joined him to walk out of the hospital.

"So does your wife take care of you with pizza and beer after rough days?"

"No, no wife. I don't usually have anyone on those nights."

"ah i see. Maybe I can return the favour next time." She winked up at him.

"I'd like that." They both found their fingers dancing towards the other and they felt the electricity bubbling in between their palms.

-x-x-x-x-x-x-x-x-

a/n - sorry it's a little sad but unfortunately a peds doctor and an oncology doctor working together only means one type of case

Masterlist

Requests open - here

#dr james wilson #dr james wilson x reader #house md #james wilson #dr james wilson x peds!reader #house x wilson #dr house #dr house x reader #house x reader #james wilson x peds!reader #house x cameron #house x cuddy #house x stacy #dr gregory house #dr greg house #dr chase #dr cameron #dr foreman #dr wilson

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silicacid · 11 months

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Gaza Medic Voices (a group of senior clinicians with experience working in Palestine) is trying to coordinate a remote telemedicine service to support medical colleagues in Gaza. This service will offer pro bono, remote support in the management of complex clinical cases.

We are looking for:

UK and overseas consultants (or Associate Specialists, post-CCT Fellows)

The following specialities:

Vascular Surgery

Trauma and Orthopaedics

Plastics and Burns

Paediatrics

Obstetrics

Oncology

Radiologists - brain and body

Neurosurgery

link

If you have queries please email Gazaremotemedic(at)gmail(dot)com

#palestine #gaza

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raghunathnetralaya · 1 month

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Eye Care Solutions for Kids in Mumbai

Children's eyes are precious, and it is essential to their development and health that their vision grow normally. We provide comprehensive paediatric ophthalmology services at Raghunath Netralaya in Mumbai because we understand how crucial it is to give children's eyes extra attention as they develop.

#Paediatric Opthalmology Specialist Mumbai #Eye Care for Kids #Glaucoma Treatment Mumbai #For Diabetic Patient #Squint Specialist Mumbai #Squint Eye Surgery Mumbai #Ocular Oncology Specialist Mumbai #Ocular Oncology Treatment #Oculoplasty Treatment

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bearsinpotatosacks · 3 months

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#top gun #carole bradshaw #nick goose bradshaw #nick bradshaw #tumblr polls #my polls #goosecarole #goose x carole #bradley bradshaw #bradley rooster bradshaw #goose top gun #rooster top gun

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mrsterlingeverything · 9 months

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How many of your followers are cancer survivors? Because I also spent some time in the paediatric oncology wards of hospitals…

#glad youre here #got 2 asks about it today and its just been todays topic

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lonelynpc · 2 months

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dear dr. on mandated leave,

have you ever been in the room for an alcohol detox? is anaesthesia used to smooth out hardcore withdrawal symptoms, or just sedatives, or am i confusing which is which? basically, any thoughts alcohol use, alcohol withdrawal, AUD, & anaesthesia

hi! this will be a long one but thank you for the interesting question! i'm not an addiction specialist nor critical care specialist but this is what i know.

so, first of all, you are right in saying that sedatives are part of anaesthesia. there are several different types of anaesthesia that can be used combined or as individual treatments. in no particular order, there's general, local, regional, neuraxial, and sedation, each with different indications and goals.

AWS is part of critical care medicine (or intensive care) which is a sort of sub-specialty that requires prior training in anaesthesia, emergency, paediatrics or primary medicine, and there are further subcategories to critical care. some countries also have addiction specialists as a separate subcategory.

now, general anaesthesia (GA) masks the onset of AWS. approximately 1 in 5 patients in for surgery have an alcohol use disorder (AUD), for emergency surgery or aerodigestive oncology surgery this is about 50% if i'm remembering correctly. a side effect of general anaesthesia is emergence delirium (ED*), there are different forms of ED but a risk factor for ED is AUD. patients with AUD are also at higher risk of other surgical complications. this is just a bit of a side note.

AWS can range from mild to severe, sometimes it can be fatal. it is seen after a reduction in alcohol intake after a period of excessive use as chronic use of alcohol changes the brain chemistry, especially changes to the GABAergic system. the GABAergic system is the primary inhibitory neurotransmitter for the central nervous system (CNS); alcohol is a CNS depressant.

a short explanation of this is that episodic intoxication causes excessive production of GABA which has a sedative effect. chronic alcohol use changes the balance of the inhibitory signals and excitatory (glutamate) signals of the CNS, basically the body adjusts to the influx of GABA by over-producing glutamate. once a patient who chronically drinks alcohol stops or reduces the amount, the GABA signals are diminished and the excess glutamate causes AWS.

a lot of the drugs used in anaesthesia are GABA receptor agonists, the treatment of an overdose is a GABA receptor antagonist, which have a stimulant or convulsant effect. for example, propofol is a really common GABA receptor agonist in general anaesthesia.

so, you can imagine that in the acute phase of AWS, management of a patient's neurochemistry is crucial and this is managed with medication.

management of the signs and symptoms of AWS are generally:

a quiet room with minimal stimulation and low lighting.

fluid and electrolyte balance.

early sedation to manage acute symptoms and prevent injury.

nutrition management.

airway management in heavily sedated patients.

psychiatric treatment.

medication, especially benzodiazipines and anticonvulsants.

basically, a person experiencing AWS will likely be sedated early on and will require monitoring to prevent aspiration (entry of foreign materials into the airway and lungs). we have to be very careful what drugs we give and how much we give so that we don't mask the symptoms or over-sedate, propofol has been given in some cases but as mentioned above, GA masks the onset and patients have been observed coming out of GA with the same withdrawal symptoms they went under with.

there are different levels of sedation and as i don't manage this, i'm not too sure what level they would use as a standard but i would imagine that it would depend on the patient as i know some are deeply sedated.

typical monitoring devices** you will see under sedation:

3-lead ECG or 5-lead depending on cardiac history and concern. a 12-lead ECG is purely diagnostic so unless a cardiac event has taken place or is suspected to have taken place, it will not be used.

pulse oximetry.

IV access for fluid and electrolyte balance.

blood pressure, either non-invasively (cuff) or invasively (arterial line). typically it depends on the severity but generally we aim for non-invasive, cycling every 5 minutes if possible. an arterial line would more than likely not be used.

capnography which monitors the ETCO2 of a patient, this is end-tidal carbon dioxide so it's telling us how much is being exhaled. i could make a whole post on capnography alone, it's extremely valuable. capnography is measured with a gas analyser attached to the monitor and to the respiratory filter, it looks like a clear, thin tube.

my closing thoughts and footnotes are below the cut.

AUD and AWS need to be treated with compassion and sympathy as much as being treated medically. i have profound sympathy for people struggling with addiction, it's an incredibly difficult thing to manage alone and it is so important to be somebody that the patient can trust and find comfort in.

we see a lot of shame in people struggling with addiction and it is incredibly difficult to seek help, people are often deterred because they think their healthcare provider will judge them which, unfortunately in some cases, is true. i think a really important part of this branch of medicine is breaking the stigma that surrounds addiction.

i have had patients confide in me because i go out of my way to make sure they can feel comfortable talking to me, from there i ask if they would like me to put them in contact with support services. i offer to call a psychiatrist in, and i listen. i listen to them talk about the heavy stuff, i listen to them talk about the light stuff, i listen to everything.

as one of my old teachers said:

"listening is a valuable tool in medicine. let your patients talk to you, let them rant, let them cry, let them shed some of that burden. you might be the first person that's listened to them in a long time."

*this is why it is so important to be aware of what medical terminology we are using and who we are using it with. ED to me is emergence delirium but to most others it's probably erectile dysfunction. PND generally is post-natal depression, to me it is perioperative neurocognitive disorders.

**i tried to find some good pictures of anaesthetic monitors so that i could label the different values and waveforms but they all looked ugly or had watermarks and it would also make this page way too long.

#anaesthetist #anaesthesia #healthcare #surgery #medicine #medical #anon ask #ask #ask me anything

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