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the-hilda-librarians-wife · 1 year ago

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Sketchbook Week Day 7 - Cellularity

Summary: Trolberg General Hospital is a lovely place to work in. Unless you piss the pathologist off, of course, in which case it's hell. But she is hardly ever even seen in those white corridors, anyway, and apparently her mood has gotten better in the past few months since the new paediatrician had been hired.

That day was an unfortunate exception to Dr. Underhill's new wave of goodwill, though.

Notes: Written for @sketchbookweek Day 7 - Alternate Universe

‘Oh if we give people a free/AU day, they’ll surely make good use of it!’. WRONG. HOSPITAL AU 🧠🫀🫁🦴🧑‍🔬🔬🏥🏥🏥 🏥🏥🏥🚑🚑🚑🚑🚑🚑🌡️🌡️🌡️🌡️🌡️🥼🥼🥼🥼🥼🥼📋📋📋🧪🧪🧪🧫🧫🧫🧬🧬🔬🔬🔬🔬🔬🔬💊💊💊💊💊🩹🩹🩹🩼🩼🩺🩺🩺🩻🩻🩻🩻🧠🫀🫁🦴

That being said, content warning for discussion of health conditions, cancer, hospitalisation… all that stuff. Nobody actually suffers, this is silly fanfic, but keep that in mind if those are sensitive topics for you <3

-> The reference numbers scattered throughout the chapter are all things that I thought might be nice to explain. You can find the notes at the bottom of the fic, though they will be easier to read if you do so in ao3 (I put return to text options there)

Read it on ao3

When anyone asked Kaisa the reason why she’d picked this job, there were many different answers she was used to giving. She wanted to help people. It was all terribly interesting. It was the area that felt the least overwhelming. She just had a natural affinity for it. None of them were lies, and she’d gotten good at choosing which sides of the truth to reveal to each person who asked her, depending on how close they were. But the embarrassing truth that she was never going to admit anyone, was that she’d chosen pathology, simply put, because cells were pretty. She’d chosen it way before she could rationalise any of those other explanations. Way before she’d even realised her path had been traced, back when she was still so certain she’d follow in her tutor’s footsteps during histology class.

It couldn’t be helped. One look into a microscope and she’d been a goner. Those blasted hepatocytes would always be remembered as the thing she fell in love with the most quickly in her entire life. Though not by much.

So here she was, at this crossroads. Because she’d chosen this specialty - before she’d seen its other merits - for its beauty. Because for all that this might sound silly, the fact that she was in on this hidden, miniscule world and therefore was the only one who could find answers to truly essential questions sent her reeling every time.

But how the fuck was she expected to explain what was going on with the cells if there were none of them?

Kaisa huffed, giving up on the endeavour of finding a single useful cluster after she’d already run through the entire slide with no luck. Only useless blobs of stringy colloid [1] - which, okay, did look pretty but was not at all helpful - and the odd cell here and there. It was not, in any way, shape, or form (and it’s worth mentioning that a pathologist knows a lot about shapes and forms) enough for a diagnosis. And that’s because she knew what she was looking for, because truly, a child with a single thyroid nodule, irregular outlines and microcalcifications? She knew what that reeked of. And so did the paediatrician, who had immediately ringed Kaisa about it. She’d picked up the very second it had rang, of course. Kaisa didn’t much like using her cellphone to actually talk, but for her she always did.

And it had been a good thing, too. Always helped to know what to expect of the new slides that came in. Most doctors in the hospital liked to think of pathology as a magic lab you could send your problem to and just have it miraculously disappear, but contrary to popular belief Kaisa was not some sort of magician. She was not going to guess which card you picked. Nor was she going to throw around diagnosis without knowing the first thing about a patient’s case.

She shouldn’t have to, at least. But anyone would be hard pressed to remember a single time she’d gotten her verdict wrong, even when the information she’d been provided with was nowhere near sufficient.

Perks of having chosen the superior area of medicine.

That, and talking to nobody.

Which was clearly not working for her at the moment since she had to hastily turn off her microscope’s light to strut down Trolberg General Hospital’s not-so-busy corridors (admissions were on the lowermost floor), people in scrubs and white coats moving out of the way at the inpatient look on her face. She wouldn’t ever knock over anyone, of course. But they didn’t all necessarily know that, and would probably rather not try their luck.

The silent halls began gradually filling with sound as she moved out of the labs area. One floor down, to the surgical wards; now there were companions, friends and family of those admitted spread across some of the chairs lining up the walls, hushed conversation over the phone as someone delivered whatever news they had to the family members that weren't able to be present. Another flight of stairs and she was at the clinical wards, this one with corridors much more busy not because of companions, since patients there usually didn’t stay for long - for good reasons, get your mind out of the graveyard, Christ’s sake - but rather because of the rustle of nurses and technicians going from ward to ward. Kaisa rather thought that one blond woman she saw walking around was a nutritionist. Must be lunch time for them.

She really wouldn’t know. She’d been so caught up in going through every millimetre in all the slides from that damned fine needle aspiration (fancy way of saying you reverse-injected someone’s throat, that was) that she’d completely lost track of time and internal cues of hunger.

Come think of it, that may just play a part in why she was so damn pissed. Maybe she should take a break. The case wasn’t filed as urgent. She could easily go to the cafeteria, get her blood sugar levels back to normal, and deal with that issue later like a cool, controlled person.

She didn’t do that, of course. Kaisa knew very well what her hurry was about, and it wasn’t lunch time. Instead, she went down the last flight of stairs, where the clinics were, and marched straight up to radiology, uncaring if the patients all waiting to be called for their consultations, sitting or standing calmly near the walls, thought she was mad as she walked around with her white coat flowing behind her like a cape.

Oh, hell, she’d forgotten to close it all the way through again, hadn’t she?

The point was, when she’d arrived at the imaging centre, she’d worked herself up to such an unpleasant-looking state that no one so much as tried to stop her from strutting right in. ‘White coat effect’ means more than just blood pressure rising when you’re around. It was why she still wore it to work even though there was nothing to get dirty with at the lab.

Well, to avoid contamination too, she supposed. But it was mostly to Look Cool and to Open Doors, and everybody knew that.

The secretary let her know right away where the doctor was. All the aspiration’s slides had come with Lloyd’s stamp under the analysis request, so there was luckily no doubt about who she had to go to for this.

He had locked himself away in one of the report rooms, and was understandably startled once Kaisa opened the door up without as much as a knock to warn him. Light from the corridor immediately flooded the dark room, making him shield his eyes since he’d looked back at the sound of someone entering. He didn’t even have the time to ask her what was going on before Kaisa reached beside the door frame and turned on the ceiling lights.

“Come on, man!” It was the most emotion she’d ever heard him put in a sentence. Perhaps she should attempt to blind him more often.

Unwilling to remain there any longer than strictly necessary, Kaisa picked the folded request from her pocket and extended it towards him. “Did you do this FNA [2]?” The question was redundant given his stamp and signature were both present, but an accusation being the first thing out of her mouth sounded like it was a step over ‘rude’ and already inside ‘might get you kicked out of the imaging clinic’ territory. The younger man reached out to grab it and attempted to read even though he was still blinking from having to adjust his eyes so suddenly to the brightness. Even so, it took a couple moments longer than Kaisa would have deemed reasonable for him to give an answer.

“Hmmm, yeah?”

“Yeah?” She repeated a bit mockingly. “There isn’t a period at the end of your sentence. I’m only asking to be polite, what is yeah? supposed to mean?”

He rubbed the back of his head, with its ridiculous monk-like haircut. The man didn’t look shameful, only tired and more than a little annoyed at Kaisa’s presence.

“I mean, I asked for the cytology. But I didn’t do it.”

There was an answer already ready at Kaisa’s tongue. It went something among the lines of ‘what the fuck do you even think cyto means [3] if you don’t give me any damn cells to bloody look at?’ The plan was, however, foiled by the last part of his sentence. Her mind screeched to a halt

“What?”

Aware of what that must have sounded like, Lloyd raised his hands before Kaisa could start screaming at him. The sooner he got rid of her, the better. It was way too bright in there for his tastes.

“I let one of the students do it.” He said it as if it were a good thing, but Kaisa actually thought she was about to faint. “There’s this quiet little guy that shadows me often. I thought he was ready to give it a try. He’s already in his third year, you know. Was scared shitless, but it worked out in the end.”

Many thoughts swarmed Kaisa’s mind all at once, all fighting for a chance to reach her mouth and to maybe influence her to hit the radiologist’s extremely punchable face. Third year is far from old enough and are you fucking talking about David?!, but the one that came out instead was:

“You thought it’d be a good idea to let him practise it for the first time on a ten year old?”

Lloyd blinked, but it was the only show of emotion in his face. His brows, eyes and mouth remained as inexpressive as ever.

“Oh, the kid was ten? I didn’t really read the examination request all the way through.”

TIldy was going to be so very upset if she got expelled from the hospital for attacking a fellow doctor. Her left eye twitched. She bit her own tongue to try to keep it from spilling something that she’d come to regret. Her hands balled into fists. Yes. Tildy would be very upset indeed.

“Yes.” Kaisa said through clenched teeth. “The patient is ten.”

Lloyd seemed to take a moment to consider the information, though Kaisa doubted he was using more than two neurons to do so. It took him no longer than five seconds to lose whatever train of thought he'd been running after (if there had ever been one at all) and raise both eyebrows at her. Only slightly, of course. No one would ever be able to accuse him of emoting any more than was strictly necessary.

"So?"

"I mean, it went well. He told me he'd gotten the patient to cooperate and had done what had been requested. By the looks of it, you got the material, didn't you?"

She had gotten the material, which was something he should give more thought to. It meant she had several useless pieces of glass to spare, and she really wouldn't mind using them to play target practice with him.

"Did you-" Kaisa spoke slowly in hopes that a little bit of breathing would ground her. "Instruct him on how to do it properly, and on what to ask the patient for? Because the cellularity in the slides you sent me is shit. I can't see anything. At all."

The man shrugged. "Well, I didn't just send him to test his luck. I let him watch me do it several times."

"But was he present when you talked to the patient? Does he know you need to ask the patient to, I don't know, stay silent? Or to not swallow? Or to not breathe too deeply when the exam is being done?"

"Well, no. I tell them that before they go to the ultrassonography, and the boy usually stays there. But, you know."

The sentence was left there. Right there. Kaisa began popping her fingers joints. Raven would be beyond annoyed.

"I do not know." She growled, and Lloyd just sent her a level look.

"It's very instinctive to ask for these things." He completed, to which she took what she hoped looked like an intimidating step closer. It was hard to feel in charge near most of her coworkers, but Lloyd's energy was so perfectly described by 'wet and pathetic' that it helped matters along for her.

"Well, clearly it's not instinctive!" She poked pointedly at the exam request with his stamp, his signature, and what she now understood to be David's calligraphy. "You know what's instinctive, though?" He shook his head, letting the tiniest bit of apprehension show by the bob of his cricoid cartilage. "To speak, breathe deeply and swallow when you are ten and someone's sticking a needle in your throat!"

The message finally seemed to have come through his thick skull, and he moved to his monitors to close the thorax radiographies he'd been looking at (someone had a pretty nasty pneumonia, apparently) to look for images and notes on that exam in the system. Kaisa wondered if he'd ever done a tomography on himself. She doubted the rays would have managed to have made it inside his head.

Maybe that was exactly the problem, though. Maybe he had been smart once and all that radiation had just melted his brain into something gooey and bright green. Heavens knew it was entirely likely.

"See the nodule?" He asked once he had found the young boy's file, and all the exams that had been performed on him in it. "It's not markedly hypoechoic, which is good. But the contours aren't precise and there are some calcification foci. What do you think?"

She thought it looked black and white and blurry. People who understood ultrasonography were either able to see stuff that other people weren't, like they were medicine's shrimps, or were just straight up making that shit up to make everybody else feel dumb. Kaisa saw a black ball in the middle of a light grey streak, thank you very much.

"I think the nodule's image matters very little to me right now. I need the material."

"Well..." Lloyd rubbed at his chin, looking entirely disinterested. "That's gonna be a problem. I already told him to send you all the slides that could be used."

"I only got four!"

"Yeah, the other ones were hemorrhagic [4]. You wouldn't have seen anything either."

Kaisa took a deep breath, and was proud of herself when the exhale didn't come out a scream. She also put a fingertip to Lloyd's chest and told him in no uncertain terms what he had to do, and what she'd do to him if he didn't go through it.

She was also proud of herself for that.

.........

It was a common misconception that hospital food only sucked for patients. Kaisa had no idea where it had come from, since it seemed very cruel from the people who had actually promised to only ever help them to have good food and only give them access to the soggy, saltless one. No. Hospital food was just all around trash. They all blamed the nutrition department for it; they were right to do so, too.

It wasn't like they didn't have other places to eat (the hospital staff, that was; the patients truly had no choice). They were in the middle of a bustling city, there was no lack of dining options in the blocks surrounding the hospital.

Did they ever go to any if it wasn't a special occasion? No. Because the laziness to even leave the building during their working hours united them all and made them hostage to hospital food.

"Hemorrhagic." Kaisa mumbled under her breath as she toyed with a roasted baby potato on her plate. "Fucking erythrocytes. They shouldn't even be real cells."

"What are ye whining about this time?”

There was a clatter as Edmund not so gently placed his tray on the table, sitting down on the spot right in front of her. He looked tired, and Kaisa would have worried that his morning had been too harsh except that tired was just how he usually looked. She threw her hands up in the air, not really caring that she probably sounded like a toddler.

“Red blood cells! They’re a pain, they don’t-”

“They don’t even have nuclei, yeah, I know, we’ve had this conversation a couple of times before. It’s never about them, though. Which slide is kicking your ass this time?”

Kaisa crossed her arms and slid a few inches down the back of her chair. The cafeteria was mostly empty, way past its rush hour. That meant the food was no longer as fresh, but Kaisa preferred that over the insufferable noise of every physician in the place talking all at once. It was mostly the technicians who ate at that hour of the day; they were eons more bearable. Especially because they didn’t try to engage her in small talk.

Edmund being there didn’t bother her, though. She hadn’t gotten truly close to many people regardless of how long she’d been working at that same hospital, but the infectologist was someone she was reasonably sure she could call her friend. Him, and the psychiatrist as well, she had to admit, even if she’d known her for a long time before; madwoman had grown on her like an MRSA colony [5]. Which unfortunately didn’t mean she wasn’t stressed enough to prefer not to speak to anyone.

“None.” She lied. “It’s nothing. You’re looking far worse for wear than me, though. What is it?”

Though she was under no illusion that he was convinced, Edmund took the bait. That meant, of course, that he must be bursting to talk about it. Which he did, rubbing his eyes with the heels of his hands, his food remaining untouched while Kaisa took the opportunity to continue eating hers.

“I think I’ve got a case of spotted fever.”

She raised an eyebrow, barely finishing her chewing before speaking. “Why the suffering over it? You like these weird diagnostics. If you already narrowed it down to spotted fever you can begin treating it, right?”

“Yes!” He laid both hands flat on the table surface. “That’s not the problem! The problem is that he could have been diagnosed and treated long ago if his GP had been moderately inquisitive. Wanna know how I found out?”

Kaisa nodded, though she knew she’d end up hearing it no matter her answer.

“I asked about any recent travels and the patient, unprompted, showed me a picture. Of himself in a forest.” Edmund leaned forward towards her, lowering his tone of voice to a conspiratorial whisper. “Holding an Amblyomma sculptum.”

Nodding slowly, Kaisa leaned towards him across the table as well, keeping his gaze and a deadpan face. When she was close enough that she could feel the man’s breath across her chin, she whispered with the same solemnity as he had.

“Your little bug names mean nothing to me. [6]”

“Wow!” He leaned back in a swift motion and crossed his arms. “See if I ever let you show me a ‘pretty eosinophile’ again!”

Kaisa also returned to her previous position, except this time her right elbow was on the table and she was pinching the space between her brows. “Ugh, sorry, Ed. I didn’t mean it in a rude way, I’m just not in a good mood today. And I really do have no idea what that name means.”

For all his talk, Edmund was a patient man. Not that he’d ever admit it, but he was. He opened (though ‘open’ might be too strong of a term for the subtle expression on his face) a compassionate smile for her

“It’s one of the tick species that transmits the Rickettsia rickettsii.” He answered, and Kaisa patted herself in the back for not calling him a nerd for throwing another scientific name at her. “Now will you tell me why you’re grumpier than normal?”

“I- yes, well, I suppose I should.” She sighed, not even bothering to protest the accusation. It was hard even for her to bear herself at the moment. “I’m just frustrated because the cytology samples for a patient I wanted to diagnose as soon as possible came with very low cellularity. Couldn’t see shit. And when I went to Lloyd to talk about it, it became clear that it was his fault. He let a student do the aspiration for the first time without any supervision whatsoever. So now we’ll have to wait two more weeks [7] to redo it and see if I can get some decent slides.”

“Hm.” Edmund played with his food more than he ate it. Kaisa had a good inkling that he was probably wishing it was a sandwich instead of an actual meal, but didn’t want to eat one in front of his coworkers. Had to set an example, and all that. “Well, not Lloyd’s smartest idea - not that Lloyd ever has many of them - but I guess the student had to begin somewhere.”

“Somewhere didn’t have to be a ten year old.”

The infectologist lifted his gaze to her, suddenly looking a lot more excited. Which never bore well, of course.

“Oh, so this isn’t about the slide, is it?” He asked with a mischievous twinkle to his eyes. Kaisa squirmed in her seat in front of him.

“What else would it be about?”

Humming in fake contemplation, he rubbed his chin before answering. “Maybe, just possibly, it could be about the new paediatrician who someone has oh so kindly been trying to befriend?”

Kaisa almost choked on her food. Almost, because her mouth hadn’t actually been full, so it would have actually been an achievement if she’d done so. She was certain her cheeks were getting red, no doubt giving her away.

Fuck, this was the major downside of having friends. She’d thought she was being subtle.

“Edmund, I’m a professional!”

“Of course you are.” He said, a little more seriously. “And honestly, you need to get rid of this idea that being a professional means not talking to anyone. It’s healthy to have people you rely on. Nothing more natural than getting close to the people you work with, too.”

Kaisa tried to look away, but he petulantly flinged a crouton at her to get her to pay attention to him.

“Listen, it’s been cute seeing you try to hide this crush-” At that point she opened her mouth to argue against the accusation that she had something as embarrassing as a crush, but he lifted his hand to ask for her silence. For some reason, she acquiesced. Probably because she knew she had no good arguments against him. “But I just want you to know you can be straightforward about it to me. I can be your wingman!”

Impaling a potato with her fork, Kaisa grumbled. “I don’t need a wingman. I need sufficiently cellular slides.”

“Which brings me to my next point.” He continued as if he had never been interrupted, completely unfazed. “You should be there for the kid’s next FNA.”

“What?” It was bold of him to suggest she leave the comfort of her lab. Very bold. “Why would I do that? I don’t know shit about ultrasonography.”

“‘Course not. But I bet it would be easier for the patient.”

“How the fuck does having another nitwit in a white coat in the room help the patient?”

Edmund rolled his eyes. He was a good decade older than her, and even though most days it didn’t feel like it, every now and then he’d act just condescending enough that she’d remember it. It made her want to deck him each time.

“Do you have kids, Kaisa? Nephews?” He asked even though he knew damn well the answer. She shook her head anyway, glaring at him. “Well, I do. And let me tell you, a ten year old patient will not be happy about going through all that again. It’s a wonder they even managed to do it the first time.”

“And you want me to do what, distract him?”

“Comfort him. You can’t do a lot but you can make sure the kid and his parents know that there is at least one doctor who truly cares about the case.”

Bastard. He had a point. And he probably knew she’d recognize it too, judging by his smug smile.

“Besides, that’s the way to know the procedure will be done correctly, isn’t it? Get your slides as soon as possible and run to your lab. Wouldn’t want to leave the patient’s doctor waiting.”

She didn’t even acknowledge the jab, but Edmund’s smirk made Kaisa hyper aware that this wouldn’t be the last time they talked about the subject.

…......

A lot of time had been lost with her whole mad dash for proper cytology samples, so after she came back to the lab Kaisa found out she was behind schedule. That sure did put a damper on her plans to sneak down to the paediatrics clinic, but unfortunately she had to admit it wasn’t actually necessary to go there.

“Hey, Johanna. Kaisa here.” She said and immediately cringed, turning her face away from the microscope’s lens and to her phone, deleting the audio she’d begun recording right away. It was an audio message in a chat they’d already begun. She didn’t need to introduce herself, for heaven’s sake.

Pressing the recording button again, she went back to the prostate biopsy on her microscope, even if only to pretend - to herself, seeing as there was nobody else nearby - that she wasn’t completely focused on Johanna.

“Hey, Johanna. Sorry for the audio message, I didn’t want to call you so I wouldn’t bother your consultations. I looked at the slides from that patient you were worried about. The ten year old with a papillary carcinoma suspicion. I’ll have to get back to you about it, though. The cellularity was awful, Lloyd will have to call him back to repeat the FNA. I’m so sorry about that. You, uh, you might want to contact the family to tell them that yourself. Both because they know you better and because Lloyd has the sensibilities of a rock. Um. Yeah. That’s all. Good afternoon.”

Kaisa sighed and dropped her head to her hands as soon as she’d pressed send. Her brain hadn’t actually registered a single thing she’d seen on that slide.

Her answer came around half an hour later - meaning she’d been right not to call - when Kaisa had actually already managed to diagnose a benign hyperplasia, write her report on it (easily the worst part of her job), and move onto the next slide. It was a couple of short messages in a row, which initially disappointed her, silly as that was. She’d sort of been hoping she’d also get an audio message back so she could at least hear Johanna’s voice. However, when she read it, she immediately decided it was better than a few seconds long recording.

Johanna (ped)

Hi, Kaisa!

Ugh, that’s frustrating to hear, but I’m sure they will understand. Thank you for letting me know, I do prefer to tell them that myself

Also thank you sooo much for checking that out and getting back to me so quickly. I truly appreciate it <3

Are you free this evening? Heard there was an italian place two blocks away and I thought we might try

Well, I might try with you, at least. I’m sure you’ve been around long enough to already have eaten there 😅

Kaisa bit back an embarrassing giggle - even if her microscope would have been her only witness - and down on her bottom lip. She’d finish looking at this slide and then she’d answer, she promised herself. It would be her first time visiting whatever place that was, and she couldn’t be more excited even if she didn’t care about the food. Though she’d never admit to Johanna that the promise of her company was the only thing strong enough to ever get her to leave her hospital-home routine.

…......

The procedure was uneventful the second time around. Not that it didn’t involve a fair bit of whining from the patient’s part, but Kaisa rather thought he was more than justified in it. Like hell she’d have allowed someone who looked like Lloyd to pierce her throat. He was a lot more cooperative than he could have been, and all in all, Edmund had been right (not that she’d ever tell him that). It seemed like Kaisa’s presence really did mean a lot to both him and his father.

Not to blow her own horn, but she kind of could see why. She definitely thought - hoped - she inspired more confidence than bloody Lloyd.

As soon as it was done, Kaisa took the slides to her lab technicians right away. They seemed to take her pleas for speed seriously, given that in almost no time at all she had the samples on top of her microscope’s stage.

No unusual architecture; the cells weren’t arranged in papillae or swirls. No enlarged nuclei, nor were they irregular, pale, or had grooves or pseudoinclusions. She searched every inch of the six slides she’d gotten and there wasn’t a single atypia, psammoma body, giant cell, hobnail cell, or anything else that might give away a papillary carcinoma. There wasn’t anything that might indicate any malignancy, truth be told. All Kaisa saw were clusters - six in her least cellular slide and fifteen in her most cellular one, thank the heavens - of perfectly normal looking cells. That, and a lot of colloid.

She breathed a sigh of relief. It wasn’t usual for her to get attached to cases. But she’d actually seen this patient and it was a child. She’d have been lying if she said she wasn’t hoping to find nothing. That, and she bet Johanna would also be pleased.

Foregoing her usual etiquette of not leaving her lab unless something urgent was going on, Kaisa turned off her microscope and began the path down to the paediatrics clinic. The fact that it was a cyst didn’t erase that it had been big enough to bother the patient, and that there had been small calcifications on the ultrasound. She supposed that could be a remnant of past inflammation on that area; she definitely wouldn’t know, since nobody had given her the patient’s history as per usual (though this time she wouldn’t admit it was Johanna’s fault as preferred to blame the universe for it).

Johanna would probably have to sit down with an endocrinologist to decide which would be the best course of action. Kaisa had heard that ethanol ablation [8] worked well for some of these cases, it would likely be a better option than having the kid undergo surgery. Even if that would mean having to work with Lloyd again for the procedures. Either way, whatever it was, and whatever would need to be done, it wasn’t cancer. And that was reason enough to brave the packed full corridors of the lowermost floor of the hospital to deliver the news herself.

The paediatrics clinic was by far the loudest one in the hospital. Not because of the poor children (though there was a fair bit of crying and screaming going around), but because of parents. Kaisa still remembered with terror her paediatrics rotations from her time in med school. One of them had almost made her cry.

At least the structure was uplifting, seeing as the walls were covered in drawings and all the nurses in that area had white coats embroidered with fun patterns and the doctors had decorations on their stethoscopes. They all looked genuinely alive, which was more than could be said about the workers in any other area of the hospital, really. They had the kindness of palliative care workers and the energy of emergency room physicians; Kaisa couldn’t feel more out of place if she tried.

Luckily, it didn’t take her long until she found the room in which Johanna was consulting. The door was open, so Kaisa could see her give the young girl sitting on stretcher a lollipop, meaning she was probably done there. After five minutes and a couple of words exchanged with the parent (keeping the aspirin bottle where the kid couldn’t reach was of the highest importance, apparently. Kaisa really wanted to know what the story there was), the patient and the adult walked out hand in hand, and Kaisa nodded in acknowledgement to them before walking in.

“Hey, are you free right now?” She asked with just her head stuck inside the office, immediately startling Johanna, who had been rubbing a wet wipe on her stethoscope. Kaisa laughed while the other glared at her half heartedly, and she let herself in.

“Sorry for interrupting you in the middle of your work day, I just thought I should come talk to you personally.”

Johanna hummed, putting away a box filled with flavoured tongue depressors of every colour there was. “You do that a lot.” She remarked.

By then, Kaisa had been leaning her hip against the stretcher, but her balance hadn’t ever been all that so she nearly lost it (along with all her rational thought) when she heard that.

“I- what? I thought I didn’t interrupt all that much. I’m sorry, I’ll avoid-”

Halted by a whip of Johanna’s head in her direction, she blinked when she saw Johanna frowning at her with worry.

“No, dear, you never interrupt me.” She said softly. The endearment did something weird to Kaisa’s insides which she couldn’t really explain. What was an itch in the hypogastric region [9] a symptom of? “I mean you say sorry a lot. And it’s never warranted.”

Kaisa opened her mouth, to say sorry, obviously, but caught herself before she could. Which resulted in the likely pathetic image of her standing there with wide eyes and a hanging mouth. Noticing exactly what had happened, Johanna laughed, stepping closer to her.

“It’s always good to hear from you, Kaisa. Now, what did you want to tell me about?”

Shaking her head (maybe a good waggle of her synovial fluid would do her well. Yes. That made sense), Kaisa tried to remember why she’d come down to the clinics in the first place. Oh yeah. Thyroid cyst.

“You will be pleased to hear that you guys were wrong in your papillary suspicion.” She said and watched a grin spread on Johanna’s face. “No malignant cells in sight, lots of liquid. No clue what you’ll do about the symptoms, but lo and behold-” Kaisa made her silliest dramatic voice. The atmosphere of paediatrics was contagious, apparently. “It’s not cancer.”

“Oh, Kaisa!” Taking her completely by surprise, Johanna threw herself in her arms. She was pretty sure she actually yelped, but at least her reflexes didn’t let her down and she hugged her back instead of just standing there uselessly. Her heart took to beating embarrassingly quickly, and she really hoped Johanna wouldn’t feel it.

“That is such good news! I’ll phone the parents immediately, thank you so much!”

The noise Kaisa made was hopefully a hum of ascent. Heavens knew she couldn’t manage to actually say something as complex as ‘no problem’ at the moment, busy as her brain was just trying to process the scent of apple pie and the warm softness that came with having Johanna so close. So very close. Touching her.

When the woman drew back, it was so that she could look at Kaisa’s face (blushing, no doubt) and she still held her by the elbows. To say that Kaisa felt out of her element was un understatement. She let herself wonder, briefly, if the woman reacted like this to anyone who brought her good news about her patients. She quickly decided she didn’t want to know.

“I really have no words for how grateful I am for your commitment to this case, dear. You did a lot more than you had to.”

Kaisa emitted a sound she wasn’t aware she was capable of, like her airways were constricting around something that wasn’t there. Maybe she was asthmatic and just didn’t know.

“It’s nothing.” And the way Johanna’s face was so close she could see herself in her eyes was making her forget everything else so effectively that it might as well really be nothing. She had to make a herculean effort to focus on what they were talking about. “I’ll write you the report in a couple of minutes. Just thought I should let you know already.”

Humming in delight, Johanna proved her intentions of murdering Kaisa by leaning forward and placing a kiss on her cheek. “It was much appreciated. How can I repay you?”

It was a wonder that Johanna didn’t immediately admit her, because Kaisa was certain she must look like she was going into cardiac arrest. The place where her lips had met her skin tingled, to the point where she was immensely glad that Johanna was still close enough for them to be holding each other’s arms so that Kaisa couldn’t immediately take a hand to her face in disbelief.

There was no chance she was going to be able to answer that question like a normal human being. Her brain had just given her a minus two seconds notice and fucked right off. But Johanna was nothing if not merciful, apparently, and didn’t even let the silence stretch into awkwardness before suggesting something herself.

“I’ll tell you what, Hilda has exams next week so she’ll probably be studying the whole weekend. Since that means I’ll be free, why don’t we go to that park you mentioned the other day? We could both use some fresh air, I bet.”

Kaisa nodded dumbly; that was the extent of her reaction capabilities in that moment. The other doctor just smiled, and they managed to decide they’d settle the details later over the phone. It was all Kaisa could do to put some distance between herself and the paediatrics clinic before allowing herself to fully process what had happened and grin like a lunatic.

Well. It sure would be hard to focus on cells for the rest of the day. As unlikely as that was, she’d found something even more beautiful to fall in love with.

NUMBERED NOTES:

1- Colloid is the stuff that’s inside your thyroid follicles! It’s where the hormones are produced & stored 2- FNA = Fine Needle Aspiration. Basically what Kaisa said earlier, you use a needle to collect some material from the nodule 3- It means ‘cell’, btw! Not sure how common this knowledge is, but someone who went through med school would know it, I promise. 4- When an aspiration slide is hemorrhagic, that means that there is waaay too much blood and not enough of the stuff you actually want the pathologist to see. Means it’s useless, basically :/ 5- MRSA stands for multiresistant Staphylococcus aureus! It is a. Very big problem. Hard to kill yk. 6- Meiri isn’t in this fic but if she were she’d remind Kaisa that ticks are NOT bugs. They’re arachnids :) 7- You can’t redo an FNA right away because the thyroid needs time to heal before you poke a needle through it again! 8- ok ok this is actually super interesting so hear me out. You can inject ethanol on benign thyroid cysts and that basically makes it dry out. You have to repeat the procedure maybe once or twice depending on its size, but the thing actually just. Shrinks. Just because you put alcohol in there. How cool is that?? 9- This is the best way I found to convey butterflies in your belly when you’re a nerd and avoiding your feelings

#you might think Kaisa’s characterization is leaning too heavily on her pre s2 fanfic self #but consider this:#med school is a literal villain origin story. Thank you for your attention.#sketchbookweek #fic: cellularity #my fic #verse: tgh #sketchbook ship #sketchbook ship hilda #sketchbook ship fanfic #kaisa hilda fanfic #johanna hilda fanfic

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