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Robby finds Langdon in the bathroom, knees on the hard tile, head cushioned in his arm over the toilet bowl. Robby had been there at central when Langdon, who'd been talking to Mel, suddenly went from flushed, to pale, to a particular shade of green that everybody in healthcare understood, and took off for the men's room. Mel, eyes wide, had looked to Robby. Robby had sighed.
Langdon came back from rehab with feverish eyes and a near-constant grimace. He was still fidgety, even at the end of his shift, still snarky, still competent, but he didn't look Robby in the eyes. Robby returned the favor. The trust between them had disintegrated the second he'd shoved Langdon towards the door. The second Langdon decided not to tell him what was going on. They still speak to each other, still work side by side when the situation required it, but their friendship had faded into practically nothing.
Langdon hadn't even closed the stall door. Robby leans against the side of it, looking down at his former best-resident, and breathes out through his nose. Langdon knows he's there, of course. He shifts slightly, swallows hard, and speaks without turning.
"Robby," he basically croaks, acid surely eating at his throat. "Do you need something?"
Robby leans forward, glancing into the bowl that Langdon hasn't flushed yet. There's not much there; mostly bile and saliva. Langdon half-retches again, and winces when the movement pulls his head forward even further.
"What is this?" Robby asks, instead of answering the question. "Are you sick? Did you relapse? Is this withdrawal?" Langdon is sweaty enough, pale enough, though he's not shaking or scratching. Not yet.
"Jesus," Langdon groans. "No. I'm clean. You can test my blood if you feel the need, but you won't find anything." He spits into the bowl, but only ends up gagging again and swallowing reflexively.
"Give me a better explanation then," Robby replies. Part of him feels the urge to help, to grab Langdon a water bottle or a tissue, but he stays where he is, watching instead.
Langdon groans again, though this time it's more frustrated than anything. "It's...," he gestures slightly, twisting his arm behind him and finally turning his head towards Robby. His eyes are bloodshot. "It's my back. Sometimes when it gets bad enough, you know. Wires get crossed in my brain. Give me a minute, I'll get over it."
Robby isn't entirely sure how to respond to that. He'd known about Langdon's original back injury, the one he'd sustained in a car accident years ago, though he'd never realized it was as bad as it apparently was now. Probably the secondary injury from helping his parents move made things worse. Or, Robby reminded himself, Langdon's drug theft was masking the symptoms.
The thought has him pushing off the wall, wiping his hands on his scrubs. Langdon has turned back to the bowl, eyes squeezed shut, trying to breathe through another apparent wave of nausea.
"I'll come find you if you aren't out in five minutes. Collins is coming in late this morning, remember, so we'll need you out there. Grab some ondansetron if you need it. Actually, get it from Dana." Langdon still isn't allowed to prescribe or dispense meds, and he wouldn't be trusted to get his own. Langdon half-nods, until the movement triggers another bout of retching. Robby leaves him there, bringing up bile, and heads back into the fray.
He's almost surprised to find Mel waiting outside, though he shouldn't be. She and Langdon became fast friends, and Langdon seems to be at his best when he's working with her. She'd been one of his best supporters since he returned.
"Is everything okay?" She asked, wringing her hands together.
"Fine," Robby replies. "He should be out in a minute. How about you help Whitaker with the trauma in North 7?"
She goes off with a short nod and a downturned mouth, but Robby doesn't expect there to be any problems with her. She's one of their best already, and he's hoping she stays on when she's done with her residency. He sets off in the opposite direction, back towards central.
Dana looks up at him when he arrives, one eyebrow raised. "Langdon blowing chunks in the men's room?"
Robby sighs, probably for the fifth time in the last three minutes. Of course Dana caught that, she catches everything.
"Not drug related. He'll be fine."
Dana's expression twists a little bit, but she looks back down at her computer and starts typing. "I saw him down like, six Ibuprofen at once the other day. Pretty sure he's running on Red Bull and willpower at this point."
She'd adjusted to Langdon's disappearance, and subsequent reappearance, better than anybody. She'd been a nurse for decades, however. She had probably seen it a hundred times at this point. Robby had too. This time though, things should have been different. It shouldn't have been Langdon.
"I told him to grab some ondansetron from you," he says, and then takes an iPad and sets off for South 11 before she can respond. He doesn't want to think about Langdon any longer, and there's no better distraction than the job.
He doesn't see Langdon reappear, but hears his voice half an hour later when an eight-car pileup makes its way into their ED. He sounds just as confident and energetic as ever, so Robby keeps his eyes on his trauma patient and tries to stem the blood flowing from her neck.
The day goes on.
Six hours later, Robby is shoving a granola bar into his mouth at central again when Langdon stumbles. He's standing at the computer, typing slowly, but Robby has noticed him stop to rub his eyes at least twice already. He's not trying to pay attention, he's really not, but there's something about Langdon that he can't ignore. He's grateful for it when, two seconds later, his resident tips backwards, hand's scrambling for purchase on the desk in front of him.
Robby is on his feet in an instant, but Dana is already there, and she puts a hand on his upper back to steady him. "Shit, kid, you okay?" Langdon has caught himself, eyes a little wide, but he nods quickly.
"Fine, I'm fine. Just stood still for too long." It's not an explanation that makes sense, but Robby is willing to take it when Langdon's chest hitches and suddenly he does go down, knees hitting the ground just before the rest of him.
"Fuck," Dana curses, getting a hand under Langdon's head just before he smacks it on the linoleum. Robby rounds the desk in seconds, and in that time Langdon's dropped fully out of consciousness, his eyelids just barely fluttering.
"I need a gurney, please," Robby calls out, dropping to his knees next to Dana. She has a hand on Langdon's neck, taking his pulse, and nods when Robby meets her eyes.
"Pulse is a little too quick, but it's strong. Let's get him up."
Mateo has already brought over a gurney, and he and Perlah help them lift Langdon onto it. Most of the other doctors and nurses in the room are looking in their direction, whispers shooting between them, but Langdon is oblivious to it all. Robby rubs his knuckles over his sternum, but the reaction is minimal. Langdon's head moves a bit, but he doesn't make as much as a sound.
"North 2," Dana says, already pulling the gurney in that direction. Robby goes with her, grateful to get out from under the eyes of the rest of the ED. Perlah and Mateo follow.
"Probably low blood sugar," Robby says as they lock transfer Langdon to the bed. "I caught him vomiting this morning, and I doubt he's eaten anything since then. Didn't look like he'd eaten much even before that.
"Pain could be messing with his appetite," Dana replies. They start with his vitals, wrapping a blood pressure cuff around his arm and sticking the oximeter on his finger.
"Tachy at 122," Perlah calls. Not unexpected with low blood sugar, but the longer Langdon stays under, the more worried Robby grows.
"Blood pressure 80/60," Dana responds. Robby frowns. With low blood sugar he would expect a slight rise in blood pressure, but maybe Langdon's has been down for a while.
"Check his glucose," Robby demands. "Perlah, take over for Dana outside, thank you." He knows Dana won't want to leave, not while one of their own is down, but they don't need all hands on deck here. While he says it, Mateo gets an IV going and draws the labs.
"Quickly," Dana says as he leaves.
"Do you think it's-" Robby starts, and cuts himself off before he can finish. He doesn't want to think about it, doesn't want to consider that Langdon did relapse and he missed it this morning.
"Stop," Dana says. "We'll run the tests, but you can't spiral over this. Not yet, at least." She pauses. "If it turns out he did...we'll deal with it."
Their conversation is interrupted, though, when Langdon gasps and sits up straight on the bed, hands already pulling at the wires on his skin. He looks panicked, pale and breathing heavy, and Dana grabs his hand immediately.
"You're okay," she says, calm but stern. "Just breathe for a second."
"What happened? Why are you here?" Langdon's eyes skip over the monitor reading his heart rate, which has yet to go down, and then over Dana to Robby. "What's wrong?"
"You passed out at central," Robby replies, hands on his hips. "Have you eaten anything today?"
"What?" Langdon questions, eyebrows drawing down. "Uh, I had a red bull earlier. Didn't have time for lunch."
"Frank," Dana looks disappointed. "How are you supposed to take care of patients if you can't take care of yourself?"
Langdon shrugs. "I wasn't really hungry. I didn't think...," he trails off.
"You didn't think you would end up here," Robby finishes. He scrubs a hand over his face, pinching the bridge of his nose. "You can't do that, Langdon. You can't be that stupid. If you go down, you take us down with you. We could be out there right now, instead of in here, making sure you haven't killed yourself."
Dana looks at him disapprovingly, but Langdon only nods, his cheeks flushing. "I- yeah, no, I'm sorry. I didn't...I'm sorry." For a second, he looks like he's going to say something more, but then his breath hitches again and his expression drops. On the monitor, his heartrate ticks up.
"Langdon-" Dana starts, but she doesn't get to finish. Langdon leans over the side of the rail and heaves. His blood splatters against the floor, onto Dana's shoes.
Blood.
Robby is moving, again, before he even realizes it.
"We need help in here!" He calls out the door, as Dana pushes Langdon back onto the bed. He's got blood running down his chin, blood on his teeth, and he gasps for breath with a hand scrambling at his chest.
"Upper GI bleed," Robby says as Mel, Mateo, and Santos run into the room. Dana is already reaching for the endoscope, wiping Langdon's blood off his chin even though she shouldn't be taking the time.
"Knock him out," Robby says, then quickly adds, "no benzos."
Langdon looks to Mel, not to Robby, breaths coming too quickly. She looks just as startled, hands twisting for lack of something to do as Mateo pushes the drugs.
"I don't know-," he tries to say, his voice hoarse, and then he coughs, blood dripping down his chin.
"Suction," Dana demands, and Mel bursts into movement. Langdon chokes, panics even more, and then he's out.
"You're going to be okay," Mel says as she begins to vacuum the blood from his mouth, even though he can't hear her.
"Get him down," Robby demands, taking the endoscope from Dana. She lets him have it easily, backing off so that she can put a hand on Langdon's forehead. Her eyes stick on the monitor. Santos lowers the bed, wisely not saying anything, and lets the others take charge.
Robby's done this a thousand times before, his hands practiced and steady, but not on a resident. Not on his resident. He guides the camera though the esophagus, threads the endoscope down, down, down into the stomach, and finds the problem almost immediately.
"Bleeding ulcer," he says, his voice strained. It's on Langdon's left side, bleeding only mildly, but he cauterizes it quickly and moves on. Only a second later, he finds another one. Was there blood in Langdon's vomit this morning? Did he miss it somehow? How did things get this bad so quickly?
"Christ," Dana whispers.
"Heavy bleeding," Mel adds, somewhere next to Langdon's right arm. "Likely where most of the blood is coming from."
"Or maybe not," Robby says as he cauterizes, then moves on to another ulcer. Langdon's stomach is practically empty, filled with acid and blood. He'd probably been right about the low blood sugar, even if that wasn't the main reason for Langdon's collapse.
Overall, they find four ulcers. Only one is bleeding severely, but it's enough. Dana wipes the blood off Langdon's chin again as they get him set up as a boarder, his eyes still closed. Mel is the one who stays with him, even though he doesn't need a babysitter. His vitals have been stable for half an hour, especially now that they've added dextrose to his IV.
Robby and Dana don't have the luxury of waiting, and Robby's not sure he'd want to. He instructs Mel to get him when Langdon wakes up, and leaves the room. A few steps outside the door and he has to stop and take a breath, push away the memory of another coworker he'd once treated, with a different tube down his throat.
"He's going to be fine," Dana tells him, rubbing at her eye with one fist. "You did a good job."
"It's the Ibuprofen," he says in lieu of actually answering. "He's taking too much of it, and not eating enough just made it easier for it to destroy his stomach lining."
"I know," Dana replies. "We'll tell him when he wakes up. I'm sure he's figured that out already." Dana knows him though, and she knows there's not much else she can say to him. He needs to get over this by himself, and the easiest way to do it is to jump back into another case. He takes the drowning victim in South 6.
Half an hour later, Mel comes to find him.
"He's awake," she says, her mouth betraying her relief as she smiles. "A little groggy, as to be expected after anesthesia, but his vitals are stable and he says he's not in any pain. I told him I would come get you."
Robby is sure Langdon reacted well to that.
"Thanks, Mel," he says tiredly. "I'll go talk to him in a second." He wants to put it off a little longer, but there's no point. He's going to have to face Langdon sometime or other, and it wouldn't help to leave the kid waiting.
Langdon is alone when Robby enters the room, a heart monitor beeping steadily in the background. His eyes are closed, but they snap open the second he hears footsteps, and makes to sit up.
"Stay down," Robby says, putting a hand out. "I've already seen you go down once today, I'm not eager for it to happen again."
Langdon hesitates, a little awkward, but he settles. For a moment, they're both quiet.
Langdon breaks the silence first. He always will. He can't stand awkward moments, and he's never been able to keep still or quiet for very long.
"I'm sorry," he starts. "I didn't mean to cause all this...trouble."
Robby thinks back to what he said before Langdon started puking blood, the lecture he was prepared to give. He sits down heavily in Mel's abandoned chair, tipping his head back in exhaustion.
"Don't," he says. "Don't apologize. I didn't mean what I said earlier. I mean, I did. You need to be taking better care of yourself, and that means eating and drinking more than Red Bull, but clearly there are some other issues we need to address. How are you feeling?"
Langdon looks almost surprised that he's asked. "Well, my throat is a little sore." He grins a bit at the hoarseness in his voice. "I assume it's because I had a tube down my throat an hour ago. What, you didn't want to be a little bit more careful with my esophagus?"
"Don't even make those jokes," Robby responds. Langdon's smile fades, and now Robby feels guilty. It's the first time he's even attempted to talk to Robby with some kind of levity since his return from rehab, and Robby had ruined it. However weak the joke was.
"I just mean," he said tiredly, "that you worried all of us. I'm not sure I'm quite ready to laugh about it yet."
"Right," Langdon replies. "Mel filled me in. I scared the hell out of her." He looks guilty, more worried for his student than himself.
"It's the Ibuprofen," Robby says, instead of confronting that head-on. "It's destroying your stomach lining. You're taking way too much."
"I figured. There was a little bit of blood in my vomit a couple days ago, but I was hoping it would heal on its own."
"Okay, now that I'm allowed to be angry about. Are you serious, Frank? You're a doctor, you should know that any blood in your vomit is cause for concern. You should have come to us about it."
"Okay, well maybe I didn't want to cause any more concern," Langdon replies, suddenly frustrated. "I don't have another choice. I can't work if it hurts, and it always hurts. I have to do something to take the edge off." He looks desperate, his eyes wide and pleading for Robby to understand.
Robby does.
"Listen," he says, pressing his palms together. "Clearly Hagan was wrong to discontinue your pain meds. At least not without a proper plan. We're going to get something figured out for you, something that won't make you spew blood across my ED. We're just going to have to be careful. No benzos. I know you know that."
"I know that," Langdon replies, breath picking up a bit. "I promise I know that. I just need...I need help."
Ridiculously, Robby thinks to himself that he's just grateful Langdon asked this time.
"We'll get you help," he says. After a second, he puts a hand on Langdon's forearm. "And I'm sorry. That I wasn't there to help before, and I haven't been ever since."
Langdon looks surprised, but he nods. "I'm sorry too. That I didn't come to you."
"Well we're here now," Robby says. "We'll get it figured out."