carpe diem

25

JAMES

Drumming his fingers rhythmically on the steering wheel, James stares out at the expanse of Hyde Park in front of him. The radio plays softly, the sun is shining through the windscreen and warming his uniform clad body.

Today is his last shift of four, and despite this being his first week back at work and doing 12 hour shifts, he’s not feeling the least bit tired. He's still as wired with energy and excitement as he was at the beginning of the week on his first day.

James has loved every minute of this week. Now that he's back, he can't believe he allowed himself to have so much time off. He didn't realise how much he missed working as a paramedic until he stepped back foot on the ambulance.

Getting a job with the London service wasn't as hard as James expected. More so, he wasn't expecting for it to be so quickly tracked to the point that after just a month since he got back from his holiday with Regulus, he's already back at work. Before he could blink, he was being called in for uniform fittings, refresher classes with equipment, and security and fitness checks. Then, barely a few weeks passed and he was getting ready for his first shift back in months.

James was anxious that he wasn't going to be able to get back into it. He was worried he'd been out too long, that he'd lost the spark he once had to be able to do the job, the knowledge and the initiative. His first day was rocky, flustering when he couldn't remember after a minuscule tour where things were in the ambulance trucks. But, by the end of the shift and the start of the second, he felt like he'd never left.

"Okay, I’ve got a good one," Fabian, his new crewmate, says in the seat beside him. "Would you rather say your ex’s name in bed, or your best friends name in bed?"

James can’t help but chuckle. "The second would be incredibly awkward considering my best friend is my boyfriend’s brother, a brother whom they’ve got nine years of pretty shit stuff they’re still trying to sort out."

Fabian’s jaw drops open. "Fuck! Best friends brother? My, Potter. You didn’t strike me as the type!"

"In my defence, I didn’t know he was my best friends younger brother when I met him."

"You..." Fabian frowns, clearly confused. "You didn’t know? You didn’t know this guy was your best friends brother?"

"Nope," James shakes his head, shrugging. "Been best friends since we were 11, and he’d lived with me since we were 16, and I had no idea until they bumped into each other on New Years."

Fabian whistles, shaking his head in sympathy. "Fuck me sideways."

"I feel like it would honestly be more forgiving if I said my exe’s name in bed," James answers truthfully, chuckling at the thought of what Regulus' reaction would be if James called him 'Sirius' while he was buried to the hilt in the smaller man's ass.

Yeah, that would not end well.

Fabian laughs beside him, shaking his head in amusement.

When James met Fabian Pruitt on his first shift, the two of them clicked instantly. Like James did with the Marauders, him and Fabian get along like a house on fire. Two peas crafted from the same pod, James feels like he's met his long lost twin.

The sound of the alarm fills the cab as a job comes through, lighting up the screen between the two of them.

"What’ve we got?" James asks as he turns the key to start the truck up.

"Lad called Kevin, 46 years old, head injury," Fabian reads off. "Story says he fell down the stairs at home and cracked his head. Was unconscious, now awake, but bleeding like a bitch. Oh, Kevin, you absolute twat."

James grins at Fabian’s cringing sympathy, shoving the ambulance into drive and pulling away from the park.

Two hours later, and James is walking through the door of his flat. Sirius is at Remus’, so the darkness of the empty flat greets him. Turning the lights on and unlacing his boots, James tosses his bag onto the rack and collapses on the sofa.

He did it.

His first week done.

A smile splits his face, and he’s grinning like an idiot.

There’s an ache in his back, his legs and arms are tired, and his brain feels like it’s been overworked into mush, but it’s all worth it. He’s exhausted down to his bones, every thought feeling like it’s trudging its way through thick mud, and he loves it.

His first week as a member of the London ambulance service has been one of the best weeks since his first week after graduating in Scotland. Days of laughter, of work, of helping people. His colleagues are awesome and fun, Fabian taking the title by making every possible moment of the shift uplifting and easy.

The gratifying feeling of helping people in their time of need, of bringing people that glimmer of hope and help whenever they walk through their front door, fills James with something he didn’t realise he’d been craving and missing until now.

His phone buzzing in his pocket draws him out of his head. Fishing his phone out, he see’s a new text from his mum.

Mama (19:03) you home darling? Xxx

James (19:03) i am! you free for a call?

Unsurprisingly, his mum and dad have been ecstatic for James this week. James is sure that his mum has been itching to quiz him on his shifts ever since the first one, but she told him she’d hold back until he finished his first week so he didn’t have to phone her every night. James is sure half of her unmatchable interest comes from her own career in emergency health care, and the excitement she had when James told her he wanted to be a paramedic has been reborn since he’s started working again.

When his phone rings a moment later, James picks up immediately.

"Sweetheart!" His mothers bright and excited voice answers.

"Hey, mum."

"Hold on. Your dad is here, let me put you on speaker phone," she says, and a moment later, his dad’s voice comes through too, "Hey, son!"

"Hey, dad," James grins. "How are you both?"

"We’re both fine," his dad replies, and his mother quickly cuts in.

"Enough about us, baby," she says. "Tell us! Tell us about your first week!"

"We want to know everything!" His dad adds.

"It was amazing," James starts, because nothing really sums it up as lame as that.

He tells him the type of calls they attended, the nice and the snarky patients, the laughs he had with Fabian, the difficult and frustrating moments they had to get patients out of inconvenient flats or apartments in the carry-chair. Abiding to the confidentiality laws, of course, he tells them everything about his first week, even the McDonald’s lunch he had today when they got put on stand-by just before their lunch break and made a cheeky detour to gets some greasy fast food.

His parents are in awe, his mother asking as many questions as she possibly can, and his father howling when James tells them about how he accidentally ran over a doctors foot with the stretcher in emergency.

By the end of the conversation, he’s buzzing again. All the exhaustion and the fatigue he felt when he got home has disappeared, replaced with the excitement of re-living his first week.

When he gets off the phone with them, he realises that an hour has passed and he’s only got about 30 minutes until Regulus is due to come over. Leaping off the sofa, James darts into the bathroom to shower and wash off the days sweat and grime.

He showers in quick time, excited to see Regulus and doesn’t want to waste any time by still getting ready when he gets to the flat. By the time James is drying off, his stomach is growling with hunger and his heart is pounding in anticipation. He hasn’t seen Regulus since Monday evening when the younger man left for his night shift. Since then, James has been on day shifts and has come home to shower, eat and go to sleep for the next one. He’s out of the rhythm of working, and no ounce of discipline to keeping a routine has helped with the whiplash his body got from working four 12 hour shifts in a row. Regulus didn’t seem to mind, and he actually sounded pretty sympathetic and understanding when James said it’s probably best he goes home after his shifts.

Now, though, James is done until next Tuesday. Regulus has shifts, but James has four days off and the fourth, Regulus is off too. Hence, why Regulus is coming over tonight. The younger man seems to be able to handle the work and play mix a lot better than James at the moment.

James has only finished getting dressed when he hears the front door open and close.

"James?" A voice calls out.

Regulus.

"Coming!" James replies, kicking his wardrobe door shut and practically running out of his bedroom. He skids to a stop when he see’s Regulus, toeing his shoes off by the front door.

Regulus looks up when James comes racing out of his room, flashing him a smile that has James’ heart skipping.

"Hello, you," James grins, slandering up to the smaller man and winding his arms around the familiar, narrow waist. He tilts Regulus’ head up, kissing him like a starving man which, he feels like he is after not seeing Regulus since last night.

"Evening," Regulus purrs, kissing him with a hum. When he pulls back, he holds up the bag in his hand. "I brought dinner. It’s from Tangs, your favourite."

"Yes!" James moans. "Fucking hell, I’ve been craving sweet and sour chicken balls all week."

"I know. You’ve mentioned them almost every day."

James pouts, "They’re worth mentioning."

"Of course, sweetheart," Regulus rolls his eyes, patting James’ chest. "Grab some plates. I want to hear about your week while we eat."

REGULUS

Regulus is having a pretty shit day.

He started it off this morning with a flat tyre, and he had to begrudgingly wake James up on his first day off at the crack of dawn to ask for a lift to work as he was already running too late to get the trains and every taxi company he phoned were all inconveniently busy. James, of course, is not annoyed in the slightest at being woken up and requested to be Regulus' chauffeur, but it puts Regulus in a bad mood before he's even made it to the hospital.

Then, when he gets to the hospital, he realises that in the chaos of his flat tyre, he left his coffee cup on the kitchen side. To make matters worse, he discovers that the cafe at the hospital is closed due to low staff.

Handover from Effie gives him a headache with the utter shambles that happened overnight and the Class A group of idiots he's being left with in disguise of patients. Apparently all the twats of London have decided to put themselves in the beds of the neurology ward overnight just so Regulus can spend his entire day shift dealing with them.

Excellent.

Following his deflating handover with Effie, he discovers a small mercy that they’re fully staffed with nurses and HCA’s for Regulus’ shift, and that Slughorn is in theatres, so at least while Regulus is alone in running the ship, he isn’t expected to run the whole thing.

The small mercy does not last. They may be fully staffed, but every patient on the ward seems to require a doctor or prescriptions or scans. Regulus spends his entire first hour on the ward running around like a headless chicken.

It’s barely two hours into his shift when he’s sitting at the reception desk, scrolling through the charts of a patient they have on the ward who is scheduled for a delicious sounding spinal reconstruction surgery at the end of the week, when the phone rings.

"Neurology ward, this is Doctor Black speaking," Regulus answers robotically.

A thick French accent comes through the phone. "Hi, it’s Delacour."

"Hello, my darling," Regulus says, though he likes Fleur a lot, having a phone call from emergency does not fill him with ease. "What can I do for you?"

"We’ve got a patient down here we were hoping to move up to neurology," Fleur explains, and Regulus hums in confirmation for her to recite a handover. "Male, 25 years old, frequent visitor and known epileptic. Came in today via ambulance in status epilepticus for a total of 48 minutes. We’ve managed to stabilise him with Midaz, Diaz and Phenytoin regimes but he’s going to need monitoring overnight. He’s yet to come around properly, still presenting very confused and fatigued. We’ve started oxygen therapy to reduce the effects of hypoxia. He sustained a lesion to his forehead and another lesion on his right forearm from the fall at the beginning of the seizure, but both have been cleaned and sutured down here. We haven't been able to assess his pain management properly as he hasn't been completely coherent with us yet, but he's had IV paracetamol and a low dose of morphine."

Regulus nods to himself as she speaks. This all sounds very normal for status patients, so he’s not concerned. It’s likely they need the bed in emergency so they’ll be sent up to neuro to stay for overnight observations and will be discharged tomorrow after some scans, tests and a medications review.

"The biggest concern we have is that this is the third time he’s been here this week with in-status, and his seizures have developed into this stage 12 times in the last month."

Regulus’ spine snaps straight when she says that.

Instantly, his brain connects the unfortunate dots, and Regulus’ stomach drops to his feet.

"Fleur, what is this patients name?"

Don’t say Remus.

Don’t say Remus.

Don’t say—

"It’s Remus Lupin."

Regulus drops his head.

Remus was here at the beginning of the week when Regulus was on a night shift. He’d come in via ambulance in a daunting state of status epilepticus were the only way that stopped the seizures was administering anaesthesia that put him unconscious and on a ventilator. This wasn’t the first time in the last month that Regulus has seen Remus either; the older mans seizures seem to have gone on a rampage since Regulus got back from his holiday and he’s seen Remus at least once a week while he’s been on shift. 

A few weeks ago, during a night shift where Remus had spent after being in status epilepticus for over 50 minutes, Regulus had consulted with Slughorn and Remus’ GP doctor about the next steps they need to take as Remus’ medications were proving to be incapable and the seizures were no longer responding accordingly.

They’d briefly spoken to Remus about further treatments and options he has available to him as the prescribed medications aren’t being as effective anymore and the continuous hospitalisations from uncontrolled seizures is detrimental to his health. If Remus’ seizures have become this uncontrolled to the point that he’s being hospitalised biweekly, then they’re entering the dangerous waters where it won’t be a new medication that is being considered.

If Remus is back already, not even three days after he’d been discharged, then he won’t be going home with good news.

"We have a bed," Regulus answers, finally, once he’s got his thoughts in order. "Do you have the staff to bring him up, or shall I send down some HCA’s?"

"We are able to bring him up," Fleur replies. "I’ll come myself too so that I can give you a more detailed handover."

"Perfect. Does he have any visitors with him at the moment?"

"He’s got his mother with him."

Regulus breathes a selfish sigh of relief: at least it’s not Sirius. While in the last month since him and James have been back from their holiday, Regulus has been able to maintain a civil relationship with Sirius for the sake of James and Remus, he is not in the mood to deal with Sirius yet.

Plus, the conversations Regulus might have to have is going to need to be with Remus and his next of kin.

When he gets off the phone with Fleur, he grabs the nurses and HCA’s to give them the debrief that Fleur gave him. He knows he’s got some time before Remus comes up, so he gets on with discharging and signing the prescriptions for the patients the nurses are ready to get packed up and gone. He goes to the theatres ward to make sure that Slughorn will be available to review Remus’ file and have a consultation regarding the treatment plans they’re going to have to revisit with Remus and his next of kin. While he’s doing all of this, Alex, the angel, runs down to the paediatric section of the hospital and grabs him a coffee that’s sitting and waiting for him at the reception desk when he gets back. He honestly almost kisses the girl, because she read his mind and he hasn’t had the time to take such a leave from the ward all morning to make the journey to the paeds ward and cafe.

When the ward doors open and Remus comes in, Regulus quickly directs them to take him straight into room 404. He follows them in while Fleur settles at the reception desk with a hefty file in her hands.

The HCA’s that wheeled Remus’ bed in are assisting the neuro nurses in plugging all of Remus’ wires into the wall. Remus truly looks awful; sallow and pale, skin so colourless it’s almost translucent. He’s thinner than when Regulus saw him the first time after their holiday, as if this month has taken such a toll of his body that the muscle and minimal amount of fat he barely had has melted off of him. Even unconscious, he doesn’t look relaxed or restful.

Turning his gaze away from the sick man in the hospital bed, covered from head to toe with wires and cannulas and machines, he looks at the small woman who seems to be staring at the bed with a gaze of fear. Regulus’ heart aches a bit for Remus’ mother, because the woman is looking at her son as if he’s about to flatline. She looks chronically tired, sagging, so broken down that it’s almost kid-like.

"Hi, Mrs Lupin," Regulus smiles. "I’m Doctor Black, I believe we met a few weeks ago."

"We did," the woman smiles back, though it’s wobbly and worn.

"I’m just going to have a chat with Doctor Delacour and read Remus’ file so I’m up to date with what’s happened today, and then I’ll come in and we can have a bit of a chat ourselves, okay?" He says gently, and when the woman nods, he adds, "One of our nurses will be in to take his observations, as I’m sure you know, we’re keeping him closely monitored at the moment so don’t be concerned if they’re frequently coming in."

"Of course," she says quietly.

"Make yourself comfortable, and if you need anything, please don’t hesitate to ask or ring the assistance bell."

When she nods and Regulus see’s her take a seat in the chair beside Remus’ bed, he quietly exits the room and joins Fleur at the reception desk.

Fleur explains in a bit more detail of what Remus’ treatment entailed while he was in hospital, the handover from the paramedics pre-hospital, and what tests they’ve done downstairs. After Fleur has gone, Regulus reads over Remus’ file again before he pages for Slughorn. When the older man comes onto the ward, Regulus sits with him and goes over Remus’ history again.

A few weeks ago, when Remus came in three times in one week, Slughorn and Regulus had a consultation with the surgery team about the options of epilepsy surgery for Remus. They’d got Remus’ records from his GP, reading as far back to when he was diagnosed with epilepsy as a child to determine in surgery was the right suggestion for treatment.

Typically, epilepsy surgery is only recommended to those who have tried numerous medications to no effect. In the last year, Remus has spent more time in hospital with uncontrollable seizures than he ever has, and no medication reviews or changes seemed to have had a positive impact.

Regulus spoke to Remus and his mother about surgery options, risks, benefits, and procedures a few weeks ago. Of course, brain surgery isn’t something people are easily swayed towards, and it was left that Remus could go away and think about what he wanted to do.

Regulus doesn’t like pressuring patients into agreeing to treatments, but after this month of continuous hospitalisations, Regulus and Slughorn are more worried about the consequences of these seizures on Remus’ health and body than they are from the risks of brain surgery.

"Have you spoken to him or his mother today?" Slughorn asks as he browses through Remus’ charts.

"No," Regulus shakes his head. "Remus is still asleep, and his mother looked about two minutes from a breakdown, so I want to give them some time. I don’t want to go in there and start rambling about surgeries and operations when Remus isn’t awake and coherent to listen."

Slughorn nods. "Good plan. Right, I’m going to and review this a bit more. Has he had an MRI today?"

"He had one down in emergency after they got hims stabilised. I was planning on doing another one when he comes around, along with an EEG and a MEG scan."

"Perfect. Let me know when those are done and we can go in and have a chat with the two of them," Slughorn says before he's climbing to his feet, taking Remus' file, minus his current charts, with him.

It's another hour before one of the nurses comes over to let him know that Remus is awake, updating his observation chart. Regulus takes a quick glance, reassured to see that his numbers are all in order. Regulus has to hand it to the older man; he's in a pretty poor state after his ordeal this morning, but he's recovering like a champ.

Regulus walks up to the door of Remus' private room, giving the door a gentle knock. Because Remus is stable and his mother is in there, Regulus has decided to give the two of them some privacy and quiet by keeping the door shut from the noisy main body of the ward.

"Come in," calls from inside.

When he enters the room, he's pleased to see that Remus is awake. Though he's slouched and looking exhausted, he's sat up and coherent.

"Good afternoon," Regulus greets, closing the door gently behind him and coming to stand at the end of the bed. "How are you feeling, Remus?"

"Pretty shit," Remus grunts, sounding groggy and as tired as he looks.

Regulus flashes him a sympathetic smile. "I’m not surprised about that. You’ve had a rough morning, but hopefully you’re in for a much more comfortable afternoon."

"Fingers crossed," Remus grunts, but his lips tilt up in a small smile, so Regulus takes that as a positive.

"We’re going to run a few more tests this afternoon. We want to do another MRI scan now you’re awake, and an EEG and a MEG scan. We did this a few weeks ago, so we’re going to do them again," Regulus explains, and when both of them nod and aren’t wearing expressions of bafflement and confusion, he continues, "After that, myself and surgeon Slughorn are going to come in and have another chat with you about surgery options."

Mrs Lupin’s face falls instantly.

"Surgery?" She whispers in horror.

"They spoke about it a few weeks ago, mum," Remus says, thankfully confirming what Regulus hoped he’d remembered.

Mrs Lupin shakes her head, "But... b-but I didn’t..."

"Nothing is set in stone, Mrs Lupin," Regulus assures her. "We are not discussing surgery options with you because we believe it is the only option or that we have anything scheduled. As we mentioned last time, myself, Remus’ epilepsy team at his GP and the surgeons here have all discussed treatment plans and options for Remus’ developing epilepsy. Surgery is generally a last resort in epilepsy treatment, and I am not trying to scare you into thinking that we've got to the point that it's surgery or nothing. We just want to make you aware of the options as Remus has now fallen into the bracket of being eligible for this treatment."

He see’s Mrs Lupin's face become more and more distraught as he talks. He remembers her reaction when they mentioned brain surgery the first time, and she was more scared of the idea than Remus was.

Remus, surprisingly, doesn’t look shocked. Maybe he’s too tired and fed up to sustain such emotion, or maybe he knew this was coming after going from being in his house this morning to waking up on neurology ward attached to a hundred wires and machines.

Regulus flashed Remus a sympathetic smile. "We’re not doing this to pressure you, so please don’t feel that way. We just want to give you as much detail about your options and what treatments we have that can help you. I’m sure you don’t need me to tell you that the seizures you’ve been having this month is unsustainable, and that we need to come up with a plan as to what we can do to make your epilepsy more manageable."

"I know," Remus nods. He looks at his mum, "I can't keep doing this, mum."

Mrs Lupin's face crumbles. "I know, baby."

"Nothing is being decided now," Regulus reminds them. "I'm only warning you that myself and our surgeon are hoping to be able to have another chat with you about it."

"Yeah, I know," Remus replies. "It's all good, Reg."

The corner of Regulus' mouth tugs up in a smile. "A nurse will be in shortly to take you down for an MRI and a MEG scan. In the mean time, can I get you anything? How's your pain?"

"I'm fine," Remus croaks, blinking tiredly. "No pain."

"Wonderful," Regulus nods. "If you need anything, don't hesitate to ring the bell. Hope, that's for you too. Anything at all, please let us know."

"Thanks, Reg," Remus nods.

"Thank you, Doctor Black," Mrs Lupin adds, eyes glistening with tears. Regulus see's her hand is white where she's holding Remus' in a tight grip on the bed.

While the nurses take Remus down for his MRI and MEG scan, Regulus hurries to get his backlog of jobs and tasks done for other patients. With all his focus being on Remus since he was brought up to the ward, he needs to catch up with the other new patients who have arrived, also needing assessing and treatments.

After the MRI and MEG scan are complete, Regulus completes the EEG. With all three results in his hand, he takes a look with a clenched stomach. He can't tell if what they see is good news or bad news. He runs them down to Slughorn for the older man to take a look too.

Hours bleed past. Regulus wishes he had more time to check on Remus personally, but he's run ragged with assessments, prescribing and new patients that he has to rely on the nurses and HCA's feeding back that Remus and his mother are fine.

It’s early afternoon when Slughorn finally reappears.

"Afternoon, Doctor Black."

Looking over his shoulder, Regulus eyes the chief head of neuro surgery.

"Hi, Horace," Regulus replies. "Are you free?"

"As a bird," the odd man smiles. "So, I think we need to have a chat about young Mr Lupin."

Regulus nods. "Have you had a chance to have a look at his file and scan results?"

"Yes, but I haven't had a chance to look at his EEG."

Regulus wants to roll his eyes, but he's also not surprised.

"It’s generally originating from his temporal lobe," Regulus explains. "It’s the right side, so his non-dominant region, but still not fabulous."

"Well, that narrows it down to two surgery options," Slughorn nods. "If it’s in the temporal lobe, we can suggest either Resective or RNS. Is he fit and well?"

Apart from the deliberating seizures that have his brain and heart under immense stress and duress? Regulus thinks grimly, but he knows what Slughorn is asking.

"Other than the epilepsy, he’s a perfectly healthy 25 year old."

"Wonderful. How do you want to do this?" Slughorn asks, and when Regulus flashes in a questioning look, he elaborates; "Well, Remus is vastly more familiar with you than he is me, and what we’re going to discuss with him is going to be extremely daunting and worrisome."

"I don’t think I should be the only one delivering this information, if that is what you’re getting at," Regulus interjects, already knowing where Slughorn is going. "I appreciate we want Remus and his mother to not feel bombarded, but you are the qualified neurology surgeon. I can explain everything, but they may feel more reassured having a qualified surgeon in there to answer any of their questions or put them at ease. We’re presenting them with the idea of brain surgery. They’re going to be shit scared, and I think they’re going to feel less intimidated and more terrified if they don’t have an actual surgeon answering their questions for them."

Regulus understands where Slughorn is coming from, but he truly does think that Remus and Mrs Lupin are going to feel more reassured having a qualified surgeon in the room than just a doctor. Plus, while Regulus doesn’t feel an inch of swaying professionalism due to it being Remus; James’ best friend and Sirius’ boyfriend, he doesn’t want the older man to feel like the line is blurred.

Regulus was Remus’ doctor first, and while they’re in the hospital, Regulus isn’t going to allow for anything less than the upmost professionalism and no allowance for a conflict of interest, he doesn’t want Remus to worry that there is.

"Do not discount your impressive intelligence and competence, Doctor Black," Slughorn smiles. "I know you are still a student when it comes to surgery and operations, but you know just as much as I do about these surgical treatments. Any questions they have, you will be able to answer them."

Regulus barely resists the smirk and nod. He knows he’s impressively capable, he’s seem Slughorn perform plenty of these surgeries before, but he still wants back-up.

"We’re going to be discussing RNS and resective brain surgery," Regulus reminds him. "You’re the expert. They deserve to have the best in the room."

Clearly, flattery was the best route, because Slughorn practically puffs out his chest like a fucking gorilla and nods, "Very well. Shall we get this over and done with? I want to give them plenty of time to think about their options, and you need to formulate a plan-b if they decide that surgery is not what they want."

Regulus nods. His brain feels like it’s been running a mile a minute since Remus was sent up here. They’re going to re-present the idea of surgery to him, but if Remus refuses, Regulus has to figure out what their next step is going to be in terms of prescribed medications and treatments. Remus can’t go home as he is, not when he’s been in numerous times in status on his last few medications.

His current treatment plan cannot continue, and if he declines surgery, it’s up to Regulus to figure out what to do next.

"Are you ready to go and have a chat now?" Regulus asks.

"Of course."

Like he’s done before today, Regulus knocks on the door before entering.

Remus still looks like wrung out shit, but he’s awake and flashes Regulus a smile when he walks in, so Regulus takes that as a positive.

"Afternoon, how are we?" Regulus asks.

Remus hums. "Good. I guess."

"You don’t have to lie to save my feelings, Remus," Regulus quips. "If you’re feeling like crock-shit, feel free to say so. I do believe you’ve had an exciting enough morning to constitute feeling like a pin cushion down in A&E."

Remus chuckles, face splitting with a tired but amused grin.

"Alright," he concedes. "I’m knackered, fed up, and I’m sick to shit of being here. Happy?"

"Ecstatic. Any pain?"

Remus shakes his head.

"Excellent," Regulus nods. He glances at Mrs Lupin, "And you, Mam? Have my nurses been treating you nicely?"

"They have," Mrs Lupin smiles. "Alex brought me a cup of tea earlier."

Regulus doesn’t expect any less. He knows all of his team have a soft spot for emotional relatives, and one as tired looking and shattered as Mrs Lupin was guaranteed to tug at their heartstrings.

"So," Regulus starts. "I’m not sure if you’ve been introduced, but this is Horace Slughorn, our Chief Neurology Surgeon here. We’re wondering if it’s alright with the two of you if we come in and have a little chat about what we found in our scans and those treatments we wanted to discuss with you."

Regulus knows, as Remus is over the age of 18, that Regulus doesn’t have to keep including language like 'the two of you'. But, Remus is unwell, vulnerable, and his mother looks equally as emotionally fragile right now. While the decision is Remus', he wants his mother to feel included and heard.

After all, they’re about to talk about some pretty intimidating brain surgery.

Regulus wants them both to feel as comfortable as possible.

"Please," Slughorn smiles. "Call me Horace."

"What did you find in the scans?" Remus asks, frowning.

"One of the main things we needed to assess before discussing surgery with you is if and where in the brain the majority of your seizures originate from," Regulus explains. "We have been able to locate that the majority of your seizures begin at your right temporal lobe, which thankfully is your non-dominant lobe. This means that your language, vision, and emotional control and processes won’t be affected. The non-dominant side of the temporal lobe is involved in learning and remembering non-verbal information, like music."

"Makes sense," Remus huffs with a smile. "Always been shocking at remembering lyrics."

Regulus returns the smile, pleased he hasn't had to whip out the sympathy party just yet. "Because we have been able to localise the seizures to a single part of the brain, it has further opened up the eligibility towards surgical treatments."

"What makes me eligible for surgery?" Remus asks. "I know you told me when you first mentioned it, but I..."

"Typically, surgery is considered when two or more epilepsy medications have no effect," Regulus explains. "Of course, previous epilepsy medications have worked for you for specific periods of time, however overtime your body seems to become almost immune to them. Because this has happened numerous times and the last two medications we have provided haven't done anything at all, we considered the idea of surgery and presented it to you a few weeks ago. Since then, your seizures have progressed and you've been hospitalised biweekly due to the signicance of these seizures.

"I'm sure as you know, this strain on your body and brain can not be left and maintained, which is why we have decided to have further discussions with you about the option of surgery to try and treat your epilepsy."

"Right," Remus croaks. "The brain surgery?"

"Yes. We have two surgeries to present to you," Regulus begins. "I’m going to start with the one that is perceived as less graphic, and that is a surgery to inplant a neurostimulation device called 'Responsive Neurostimulation', or shortened to RNS. It's a simple and small device that records seizure activity directly from your brain and delivers stimulation to stop the seizures. This device will be implanted on your skull, and electrodes are then place inside your brain in your temporal lobe, which is directly where your seizures begin. The easiest way to try and compare it is to do so to a pacemaker for the heart. You will not be able to feel it, nor will you know when it's sending signals to diminish developing seizure activity."

Slughorn chimes in to go on about the length of the procedure and what it will entail, and Regulus watches as Remus' and his mothers faces become more and more pale.

When Slughorn is done, they both give the other two a minute to chew on his words. Then, Remus appears to steel himself, and he looks to Regulus with a solid nod.

"What's the second surgery?" He asks, and he surprisingly doesn't sound wobbly or shaky. His voice is calm.

"The second surgery we want to present to you, is one called 'Resective Surgery', and it will involve removing a portion of the brain tissue in your temporal lobe that our scans are showing the highest seizure activity," Regulus explains.

"That sounds worse," Mrs Lupin shakes her head.

Regulus flashes her a reassuring smile. "Some people misinterpret it to be a more major brain surgery as brain tissue is being removed, but the two are very different and both have the same caliber of risks and benefits. The Resective Surgery will involve us making an incision in your scalp and removing a small part of your skull to expose your brain. We will then make an incision through the thin membrane called the dura that sits over your brain. From there, we will remove the part of the temporal lobe that is causing your seizures. After it’s all done, we replace the part of the skull we removed and close the incision."

"Oh god," Mrs Lupin moans, clenching her eyes shut.

Remus instantly grabs her hand, and the woman practically folds herself around his arm.

"I appreciate this all sounds incredibly scary," Regulus says slowly. "You have a choice in this, and it’s a lot of information to take in. We’re only recommending surgery due to the influx of seizures you are having and that they are no longer responding to medications. You don’t have to make any decisions yet."

"Of course not," Slughorn chimes in. "We want to provide you with the best care, which is why we’re suggesting something that must come across as incredibly invasive and… dramatic."

"If…" Remus pauses to clear his throat. "If it’s brain surgery… will I be awake?"

"No," Regulus shakes his head instantly. "Because the location of your seizures is not on the side of your brain that controls your language, there is no need to wake you up during the surgery. You will be completely under anaesthesia during the whole process. Neither of the surgeries will require you to be awake."

"What are the odds?"

"The odds?" Slughorn echoes.

"The success rate," Remus says, and then his jaw ticks. "Mortality rate."

"Remus…" his mother whispers, eyes bright with tears as she looks at her son with a pained expression. Regulus can’t imagine this is easy for her to listen to, especially since they just spoke out cutting her son’s skull open and removing brain tissue.

At the mention of mortality rates, the woman looks a beat away from completely breaking down.

"Between 70-80% of the time, there is significant reduction or complete seizure control," Slughorn explains, "and the mortality rate is 1-2%."

Mrs Lupin visibly relaxes at the tiny percentage, and Remus seems marginally reassured when he nods.

"What one do you recommend?"

"Remus…" Regulus starts, but the older man cuts him off.

"I know you can’t tell me what to do, but a recommendation doesn’t have to be an opinion," Remus snaps. "What one do you, as doctors and surgeons, recommend?"

Regulus releases a tight breath. He looks to Slughorn, silently commanding the older man to take this one. He’s the surgeon, after all, if anyone is going to give Remus advice on which surgery he wants to take a knife to his brain, it should come from the person who’s actually qualified.

"Both surgeries come with risks," Slughorn starts, "Any brain surgery is a risk in itself, as we’re exposing your brain to infection, bleeding and injury. The RNS procedure is less invasive in the sense that none of your brain is actually removed, posing less risk than other surgical treatments. The device we implant during RNS is also a reversible surgery as we can remove the device later down the line. However, RNS is less effective and is not known yet to reduce seizure activity like Resective Surgery.

"Resective Surgery is more invasive, and does bode more risks. However, this surgery is more well practiced, and is recorded to have better results in managing seizures. We do not want to sway your decision, as this is your care…"

"But?" Remus prompts.

Slughorn sighs. "While the procedure sounds more complicated and daunting, the Resective Surgery is the one I would recommend."

Remus’ eyes seem to unfocus for a moment, before he looks mournfully down at the blanket on his lap. He fiddles with the edges for a while,

"If I went with the one where you took the stuff out, what will happen to the rest of the lobe that is left?" Remus asks.

"There shouldn’t be any lasting damage to your right temporal lobe, but unfortunately with any surgeries, we can not promise anything."

Remus swallows thickly as he mutters out, "Of course."

A heavy silence settles over the room. This isn’t the first hard conversation Regulus has had with a patient and their family, and it certainly isn’t the hardest. But there’s something pinching about looking at his boyfriend’s friend, a person who Regulus knew as a pleasant patient before, and having to watch as the words Regulus has said sink in.

"I… I don’t know what I want to do," Remus starts, licking his cracked lips. "But I… I’ll probably go with the res-resective one."

Regulus smiles sympathetically at Remus, who seems to have aged 10 years since him and Slughorn came into the room. "We’ve given you a lot of information today, Remus, and on top of the emotionally and physically taxing status episode you had this morning. Take some time, have a think. Nothing has to be decided today."

"You can take as much time as you need," Slughorn adds. "This is a important decision."

"But you want an answer soon, don’t you?"

"We do, but only because we want to be able to provide you with a treatment that is going to improve your quality of life. Whether that be via surgery or prescriptions, we want to do what we can," Slughorn replies.

Remus nods wearily. "Okay."

"You want to take out some of his brain," Mrs Lupin whispers, voice tight in horror.

"The bad bit, mum," Remus replies, reaching for her hand. "They want to take out the bit that is causing all of this."

"Still!" She shakes her head.

"Don’t be scared, mum," he smiles.

"You’re my boy. My baby!" She cries, tears finally spilling over and rolling down her flushed cheeks. "They want to cut into your brain, Remus! Of course I’m going to be scared!"

"It could be better," Remus replies tiredly. "If they do this, it'll be better. Anything must be better than this."

Remus’ words seem to be a punch in the gut for his mother, as she quickly breaks down. Remus pulls her in for as much of a side hug as he can, his mother pressing her face into his side and sobbing in earnest.

Regulus barely refrains from squirming in discomfort at the pained cries Mrs Lupin is making, but he can see Slughorn shifting out of the corner of his eye. The older man rarely deals with patients unless to have a consultation about surgeries, so to see a woman weeping about her son having brain surgery, is highly out of Slughorn’s comfort zone.

"Mrs Lupin," Regulus begins softly. When the older woman pulls away from her son to look at Regulus with blood-shot and puffy eyes, he continues, "I appreciate this is all dreadfully scary, and I can’t fathom the fear and shock you are probably feeling right now, but I promise you we only want the best outcome for Remus. This is just a suggestion, unfortunately it is a recommendation, but ultimately it is Remus’ choice. If he chooses that surgery is not what he wants, we will find an alternative treatment to give your son the best quality of life we can against his epilepsy. I can’t promise much, but I can promise you that regardless of what treatment is chosen, myself and the rest of the team here will do everything in our power to do our best for your son."

Silence settles after Regulus’ speech, his voice and tone having got more and more sure and strong as he spoke.

Regulus doesn’t make a lot of promises in his job, but the assurance that he will do his best, is something he can always give to patients and their families.

"Thank you," she murmurs, voice thick with emotion and smile wobbly. "Thank you."

Regulus nods, and when his eyes flick up to Remus, the older boy flashes him a grateful smile.

"Do you have any questions?" Slughorn asks.

Remus and his mother both shake their heads.

"I’ll leave you in the capable hands of Doctor Black then," Slughorn beams, pushing himself off the wall. "Please, do not stress yourself with this decision, Remus."

Regulus wants to scoff, and he almost smirks when Remus does. Slughorn is an amazing surgeon, but there is a good reason why the patients he deals with are almost always under general anaesthesia - because his people and social skills are awful.

When Slughorn leaves, Remus seems to marginally relax.

"There really is no rush, Remus," Regulus adds. "We’re not going to be pressuring you in the next few days for an answer."

"When do you want to know by?"

"We’re going to keep you here for a week of observations. We want to run some more tests and if you don’t choose to go with surgery as a treatment option, then we need to come up with a medication plan so that you can be more comfortable at home."

"A week?" Remus breathes in horror.

"Give or take a few days, depending on how you’re doing," Regulus shrugs. "We’re reluctant to send you home so early incase you have another status epilepticus episode and land yourself back in A&E in a worse state than today."

Remus shudders as he nods, "That makes sense, I guess."

"You won’t be on your own," his mother says fiercely. "I’ll be here, or Sirius, and we’ll bring your books."

"It feels like a prison sentence, but I promise it’ll go pretty quick," Regulus says. "I couldn’t say the same if you were in a shared room or on the curtain ward, but you’re pretty popular around here, so you landed yourself an ideal private room."

"A regular, more like," Remus argues with a chuckle.

"No one around here becomes popular if they’re not in here numerous times," Regulus counters.

Remus rolls his eyes. "Thanks, Reg."

Regulus leaves them after that. He grabs Alex and asks her if she wouldn’t mind grabbing the Lupin’s both a cup of tea while he writes up the report of their consultation.

If Regulus thought his day couldn’t get any worse, from the rough start in the morning to having to treat Remus for a life-threatening status epilepticus episode, then he was incorrect.

His day can get worse.

And it happens an hour before his shift is due to end.

Regulus is busy analysing some blood samples that have come back when someone comes racing up to the reception desk. Looking up through his fringe, Regulus’ shoulders slump at the sight of his older brother standing on the other side, practically vibrating with energy.

"Oh goody," Regulus sighs heavily. "You’re here."

"Not today, Reg," Sirius snaps angrily. "Please, be a cunt to me any other day of the week, but not today. Not when my boyfriend is in a fucking hospital bed again!"

Regulus’ eyes widen when Sirius’ voice raises to a shout.

Well then, he thinks. Clearly not in the mood for the usual estranged hatred.

Shouldn’t be surprised, Regulus supposes. Sirius isn’t likely to be in the mood for Regulus’ bitterness towards him when he’s probably had the shock of his life to hear Remus is in hospital again.

Regulus can’t wait to hear Sirius’ reaction to what him and Slughorn have proposed to Remus. Sirius is far more dramatic than the next person, and he’s likely to take the idea of brain surgery as well as someone reacts to their home burning down.

"Doctor Black…" a voice sounds behind him, and Regulus rounds to see Alex standing by the desk, jaw hard and eyes flicking between him and Sirius. "Do you want me to page security?"

"It’s alright, Alex," Regulus smiles at her. She continues to him and Sirius cautiously, but finally nods and leaves after she’s got what she came for off the cannulation trolley.

"Please," Sirius whispers when she’s gone, and his voice cracks as his entire body sags. He looks wrecked; hair in disarray and eyes bloodshot. "What room is he in?"

"404," Regulus answers. "His mum is still in there with him. He’s awake, he’s doing alright. We’ve already been in to discuss his treatment plan and options, and he’s going to be staying here for the week under observations."

"Right," Sirius croaks, nodding. "What..."

"I’m sure they’ll explain to you, if not, I’ll explain when I come in later," Regulus gently interrupts. He nods at the door of Remus’ private room. "Go. He’ll want to see you."

"Okay," Sirius breathes, shoulders slumped. He scurries off to Remus’ room, and Regulus watches him go with expensed energy and patience.

It’s not even 10 minutes later that Regulus’ attention is snatched once more. To help out the nurses and avoid the neuro assessment he’s due to do, Regulus is helping Alex with drawing bloods and taking observations from various patients. He’s just finishing up with a set of bloods, striping off his gloves when Remus’ door flies open with a loud bang.

Regulus looks up in time to see Sirius come storming out, eyes red and hand over his chest. Regulus can hear his uneven gasps when Sirius practically runs past him.

"Sirius!" Mrs Lupin calls, stepping out of the room after him. "Sirius, please wait!"

Sirius doesn’t wait. He doesn’t stop, or slow, or even seem to register Remus’ mother shouting for him. He continues his speedy walk all the way to the door leading to the stairs.

Mrs Lupin looks distraught, taking uneasy steps and jolting to a stop after each one, as if she wants to run after Sirius but an invisible rope is keeping her tied to Remus’ room.

Inwardly sighing, Regulus realises he needs to do something. Mrs Lupin clearly doesn’t want to leave Remus, but chasing after Sirius and checking on him has her almost in tears.

"I’ve got him, Mrs Lupin," Regulus offers.

The older woman nods warily. "Okay. T-thank you, love. He’s quite upset, but I—"

"I know. Stay with Remus, I’ll speak to Sirius," Regulus answers, already turning away. He finds Alex, his official declared life saver of the day, and asks her if she doesn’t mind running the blood samples down to the lab so Regulus can chase after his run-away brother again.

With the samples taken care of, Regulus takes a small detour on his quest to find Sirius by dipping into the mess room and grabbing his cigarettes from his locker. He imagines Sirius is going to need one if his dramatic exit was anything to go by, and if Regulus is going to have to spend this quality time with his stupid older brother, then Regulus is going to need one too.

When he leaves the ward through the same door that Sirius did, Regulus realises it’s quite a long shot he’s going to find Sirius. There are plenty of places to hide in a hospital, but Regulus figures that Sirius has headed for somewhere outside. The simplest place to check is the designated smoking spot, because that’s the first door all the way down to the ground floor that leads outside.

If there is one place that Regulus always runs to when he needs space, it’s the tiny area outside the fire escape that the doctors and nurses have proposed a secret smoking place.

Regulus checks there first, and he isn’t marginally surprised when he opens the door to find a hunched figure over the fence.

Sniffs and squeaky sobs fill the air, ragged gasps between soft cries. Regulus inwardly sighs, realising Sirius is actually quite upset instead of just throwing a tantrum.

Stepping out, Regulus walks quietly to stand next to Sirius, mirroring his stance and leaning on the barrier. Sirius doesn't say anything, even after he glances to the side to see that it's Regulus who's invaded his private breakdown.

After a minute, Regulus pulls out the cigarette box from his pocket, placing on inbetween his lips and holding out another to his brother.

"Want one?"

Sirius' gaze flicks between the offered cigarette and Regulus' face a few times before he eventually nods, mumbling out a raspy and weak, "Yes please." After he's lit his cigarette, he asks, "How did you know I was here?"

"I didn’t," Regulus replies. "It was an educated guess looking for someone who likely was looking for fresh air and quiet."

"Good guess."

"Do you want to talk about your dramatic and flamboyant exit from the ward?"

"He’s having brain surgery," Sirius murmurs, voice shaking and eyes wide as he stares into the empty space in front of him. "He… his brain…"

"Yes, that is generally the organ they operate on during such surgeries," Regulus mutters, tone deadpan and completely unfazed.

"Can you not? Just for five minutes?" Sirius snarls. "If you’re just going to be a sarcastic cunt, then go away!"

"I can’t," Regulus shrugs as he exhales a cloud of smoke. "I told Mrs Lupin that she didn’t need to worry because I was going to find you."

His brother scoffs beside him, angrily wiping away the tears that continue to fall. "Well, you found me."

Unfortunately, Regulus thinks.

They stand in silence for a few minutes. The sniffles coming from Sirius begin to slow down until his eyes are dry and red-rimmed. The world around them is still alive and bustling, but it’s quiet enough that Sirius can calm himself down in peace and quiet.

"You know it’s not that scary," Regulus breaks the silence.

"What?"

"Brain surgery," Regulus says. "Seen hundreds of them. It’s really not all that."

"Of course you’d say that."

"The surgery we’re proposing to Remus is actually very mild compared to other things I’ve seen or Slughorn has done."

Sirius shakes his head, "I don’t—"

"He’s going to be okay," Regulus interrupts, and Sirius’ jaw shuts with a click. When Regulus glances at him, he see’s Sirius’ eyes swimming with tears again. "If he chooses to do surgery, it’s going to have an impact afterwards. He’s going to be tired, groggy on the pain medication, but in the long run, he’ll be fine."

"You can’t promise that."

"No, but I know the odds, and I’ve done this for long enough to know when I can tell people they’re going to be okay and when they’re not," Regulus replies. "Remus isn’t fragile, as much as you and his mother treat him so when he’s here. He’s strong, stronger than anyone expects him to be for someone who is gutted with seizures almost every day. We wouldn’t be suggesting surgery if we didn’t think he had a chance of making it off the table."

"People die every day from much less."

"They do, but you can’t think like that. For Remus, you can’t think like that. You can’t look at him and see someone weak, someone who isn’t strong enough for this. You’re meant to be the strong ones, the one who supports him. You can be as scared as you want when you’re away from him, but when you’re with him, this fear? It will kill him before any surgery does."

"I can’t lose him," Sirius whispers, his bottom lip wobbling.

"In all honesty, he’s more likely to die from another status fit than he is from surgery."

"Oh God," Sirius moans, face paling.

If Regulus was a kinder person, he might have given Sirius a comforting pat on the shoulder or some wise words of wisdom.

Only, Regulus isn’t a kind person, and he hates Sirius.

Watching him suffer right now is giving him a kind of euphoria.

"If he chooses surgery, whichever one we’ve proposed, then he’s going to need you, Sirius," Regulus says. "Any surgery requires recovery and support, time and rest and all that shit. He’s going to need you to not flap like a fucking distressed pigeon in his face."

Sirius’ face twists in confusion. "Distressed pigeon?"

Regulus rolls his eyes and stubs out his dead cigarette bud. "Nothing is going to happen to your boyfriend. If he does the surgery, he’s going to go to sleep and then wake up hours later with a raging headache. The side of his temporal lobe where the seizures originate from is the side that functions learning non-verbal functions."

"What is that?" Sirius asks. "Non-verbal functions."

"Things like remembering music."

"Oh."

"Every surgery has risks. Things happen, things go wrong, which is why we’re not allowed to make promises because sometimes shit just happens."

"Reg—"

"But," Regulus ploughs on, pulling out another cigarette. "We have no reason to be concerned about Remus’ mortality rate with either surgery. He’s young, he’s physically fit and healthy outside of his seizures. Brain surgery is delicate, but Remus has got one of our best surgeons on his team. He’s going to be fine."

"Moony said that Slug bloke was weird."

"Oh, he’s entirely off his rocker, but he’s a damn good surgeon."

Sirius chuckles, shaking his head as he takes another offered cigarette.

"I can’t believe I freaked out like that," Sirius sighs a minute later, exhaling a cloud of smoke.

"I can’t believe I’ve spent my break talking to you."

"Haven’t you been here all day?"

"Yep," Regulus sighs. "Welcome to working in health care. Look, consider this moment your only granted freak-out time. After this, you need to keep your emotions in check around Remus. No more storming out of his hospital room, because I wouldn’t be surprised if that idiot would try and follow your sorry ass."

"I know," Sirius nods. "I just… I was already freaked out when his mum told me he was in hospital again, and I wasn’t… I wasn’t there, Reg. I should have been with him, and by the time I finally got here, he looked so… he just looks so sick, and then he started talking about surgeries and you guys going into his brain with a knife and removing his skull and I just—"

Sirius breaks off with a crack in his voice, head slumping.

"It’s not a death sentence," Regulus says softly. "It… it sounds scary, but it’s not a death sentence. Have a bit more faith in him. He’ll be okay."

"Yeah," Sirius nods, smiling. "Yeah. He’s tough. He’ll be fine."

Checking his watch, Regulus realises he needs to go back in. He’s got less than half an hour left of his shift, and he needs get his ducks in order before Effie comes in for hand over.

"Well, now that your pathetic crisis is averted, I need to go back and do some actual work," Regulus says, tossing his second dead cigarette away. He’s almost at the door when Sirius calls him back.

"Reg?"

He looks over his shoulder and asks, "What?"

"Thank you," Sirius says, and when Regulus flashes him a quizzical eyebrow, he adds, "For being here for Moony today, and… and talking to me."

"Yeah, well, it’s kind of part of my job," Regulus shrugs, indifferent. "Especially talking to deranged and insufferable family members."

"Charming as always."

"Difficult as always."

"Fuck you."

— tbc.