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To say the changing room situation for the emergency department was less than ideal was a bit of an understatement.
They had a changing room, of course, right next to their shower room, but both were inconveniently located halfway around the building from the lockers. A design flaw, maybe, an oversight, a disregard for the natural flow of employees as they started and ended their work day. It was worth the trip, for a shower, but when it came to just changing in and out of street clothes, more often than not they found themselves ducking into one of the co-ed bathrooms right by the lockers. It was just easier.
And that was how Mel found herself, backpack still on her shoulder, a fresh set of scrubs in hands, opening one of the unlocked bathroom stalls.
She stopped short.
The stall was already occupied, and she found herself a foot away from an expanse of unfamiliar skin, though the shape of him registered immediately. Broad shoulders tapering down into a trim waist and-what was that?
“Oh, shit, sorry!”
She moved before her mind could catch up, closed the door again quickly, just as Langdon began to turn around.
“Shit, sorry, should have checked the lock!” He called back, sounding about as startled as she felt.
“No, no worries.” She assured him quickly, ducking into the next empty stall to change there instead, making sure to lock the door. He exhaled audibly, a chagrinned edge to it.
It was only then that her mind actually started to process what she had seen, what had given her pause.
There was something on his back, a pattern that flowed from his lower ribs all the way down to the seam of his underwear.
Tissue marbled in browns and reds, not bruised, but tender looking. It took her a moment to place the visual, but once she did it was unmistakable. She had seen it before, many times, usually on women, often in the abdominal area. An attempt to ease period or digestion-related cramps with heat, usually a water bottle or heating pad, applied at too high a temperature and for too long.
Erythema ab igne, redness from fire, EAI - hot water bottle rash, sometimes toasted skin syndrome – spread all over Langdon’s back, painting a picture of distress.
The sight told a story of pain, barely contained, managed drastically with what was probably one of the few things that felt like it actually helped - excessive heat.
Mel changed quickly, packing her outside clothes into her backpack and stepping out of her stall at the same time he did.
“Sorry, didn’t mean to traumatise you first thing in the morning.” He laughed as they both washed their hands in the sink, cleansing away the traces of the outside world.
That wasn’t the word she would have used.
“It’s really fine… just–“ She paused for a moment. “I might be overstepping here. Do you mind if I ask you a personal question?”
He met her eyes in the mirror above the sinks. “Shoot.”
“Is your back giving you trouble?”
His facial expression fell into something more somber. “Uhm, not too terribly, why?”
“It’s just, on your back–“
He frowned, not quite suspicious, but uneasy. Mel felt bad immediately, she didn’t make a habit of commenting on people’s body, didn’t like it when others did, but this wasn’t something to be ignored.
“It’s–you have a bit of a heat rash, I think?”
The frown deepened. “I do?” He lifted the bottom of his scrub shirt.
Instead of skin, what peaked out underneath was thick black polyester material, held in place with hooks that ran up the centre of his belly and velcro straps that pulled his waist into tight alignment. A back brace, she realised.
He undid the hooks, keeping a hold of the brace as it fell open. When he turned around to try and see it for himself, Mel helped him lift up the back of his shirt, giving him a clear view in the mirror.
“Holy shit…” He whispered. “Damn, okay, wow. I didn’t realise.” Tentatively, his fingers explored the area, feeling the skin. Mel couldn’t help but watch, both as a doctor and because… well, because it was Langdon.
“Would you let me take a proper look at it?” She asked.
He let go of the fabric of his shirt, and she did too, allowing him to cover up.
“It’s fine, Mel. I’m not your patient.” He looked down at the back brace in his hand, but he wasn’t putting it back on, not yet, his movements faltering as he hesitated.
He was thinking about it.
“Whose patient are you?” She asked.
“What?”
Mel gestured to his middle with a vague hand movement. “Whatever made you boil yourself, it’s got to have a cause, and I’d hope some other doctor knows about it and is treating you?”
“Uhm…” He fumbled with one of the hooks of his back brace that had gotten caught in one of the seams when he had taken it off. “I’m not really seeing anyone about it right now.”
There was a pang in her chest, something that was ever-tender for him.
“Five minutes?” She offered, knowing full well that they had more to talk about here than would fit into a five minute time frame. Mel checked her watch. They were still early for their shift. “Please?” She added quietly.
His shoulders sagged and he looked at her like she had pulled a very dirty trick on him. Holding her gaze for a long moment, he took a deep breath, and then visibly gave in. “Fine, five minutes.”
Mel couldn’t help but smile, not too much, he was in pain, that was bad, but it felt like a bit of a victory that he chose to trust her in this moment.
They dropped their belongings into their respective lockers, and took a look around the ED to get a bit of an overview.
“South 21 is free.” A quick scan of the area told her that there were a couple more free areas. If she pulled the curtain they might get a few minutes undisturbed in there before someone came to check why the room was looking occupied.
Ducking into the room, she closed the door behind them and pulled the curtain quickly. A vague, far-away part of her brain wondered if this could look conspicuous, but it didn’t matter if it did. She was here to help, nothing more.
The room had been freshly cleaned, Mel could still smell the cleaning agents and traces of alcohol from the wipe-down.
Langdon pulled a fresh paper sheet over the bed.
“How do you want me, Dr. King?” He asked, scooting himself up onto the bed.
“You can lift your shirt up, or take it off, whatever is more comfortable.”
Langdon gave her a warmer smile than the situation maybe called for, setting his back brace down on the foot end of the bed and tugging the material of his scrub shirt up, bunching it under his arm pits to make it stay up for her.
Mel walked around the bed, pulling up a rolling chair. “Scoot back for me, please.” She pulled a pair of gloves out of one of the wall-mounted dispensers while he did so, turning on one of the lamps and moving its head so she could get a good look at his skin.
“I’ll examine the areas with my fingers.” She warned him before touching him.
He exhaled audibly, a soft huff to it, but he didn’t say anything.
Gently palpitating with her fingertips, she made her way around the affected area. She had observed correctly earlier. The pattern started right at the very bottom of his thoracic spine, and affected the entire lumbar region with the deepest hyperpigmentation around his L3 and L4. The marbled appearance spanned all the way to his sides, but didn't wrap around any further. His skin was tender, and he hissed through his teeth when her fingers probed closer to his spine.
She must have been quiet for too long, because Langdon started squirming where he sat. “What’s the verdict?” He asked, glancing at her over his shoulder.
Mel gently untucked the fabric of his shirt from under his arms and pulled it back down to cover him up again before coming around and sitting down on a chair in front of him instead.
“The good news is that your skin isn’t atrophic yet. But in some areas the pigmentation is starting to settle quite deeply. A lot of it will resolve again over the next few months if you stop now, I'm not feeling any lumps or seeing anything that looks concerning... yet.” She looked at him intensely, could see the implications take shape in his eyes. He knew as well as she did that continued exposure to this much heat could have serious consequences.
Langdon swallowed, working his jaw. Mel gave him a moment to find his words.
“I can’t stop.” He told her, the light tone and amusement from a minute ago fallen off completely. “I don’t–I just can’t.”
“Does it feel like heat is the only thing that helps?”
He nodded. “Yeah, I mean, I take the ibuprofen and the Tylenol, I do the stretches, but it’s not getting better. It feels like I’m just shifting the tension around.”
“And what was the initial injury?”
“I didn’t really get it checked out properly. I mean, it felt like a strain, just… it wasn’t workplace-related, I didn’t have time and then… time passed.”
“When was the last time you saw someone and brought this up?”
He shook his head, looking grim.
When she didn’t catch his drift he spelled it out for her. “I haven’t seen someone about my back since I got my first lorazepam prescription.”
“Oh.”
“Yeah.”
“That’s good!” Mel told him.
He frowned. “It is?”
“Yes! Yes, it is. It means you haven’t had a chance to try everything yet. I hear the pain management team on the fifth floor is excellent, and I’m sure they’ll make time to see you without the whole wait list situation if we ask nicely.”
“I really don’t know, Mel. I don’t want to slip from one thing into another.”
She shook her head, rolling her chair closer to him. “I’m not talking opioids. But massages could help, deep tissue, fascia release. There's steroid injections, or even a nerve block. They’ll know better than me what would suit you best after they check you out properly, but the point is there’s plenty to try.”
The room fell silent for a moment, and Mel held her breath for his reaction.
“Wow…” It came out quietly.
“Wow?”
His smile was fond, confusingly so. “I’ve seen you do this a hundred times now, but I wasn’t ready for it.”
“For what?”
“The way you make a patient feel. I don’t remember the last time I’ve had the feeling that someone who was looking after me was this on-it. It’s like I can see you see how this is going to play out, it’s kind of amazing.”
Mel couldn’t help but smile, a rush of pride sweeping through her chest. Langdon said the nicest things to her sometimes, and he wasn’t even taking the weight out of it by adding a teasing tone to it. He just said it and let it hang in the air between them for her to absorb into her bones.
“I might not know what will help you best yet, but I know we'll fid something. Either way, we’ll get you seen and treated, and soon.” She promised him, already planning the phone call upstairs in her head.
“If only so I don’t boil myself to death.” Langdon chuckled.
Mel smiled. He was joking. “I wouldn’t imagine that’s a good way to go.” She agreed. “If you can stand to stop, please do. Or maybe reduce the duration or temperature, if you can. What do you feel helps you better, Tylenol or ibuprofen?”
“The ibuprofen, probably.”
She nodded, standing up and walking over to the computer. “I’m going to prescribe you some ketoprofen, same class but packs more of a punch. I hope it has a better chance of tiding you over until your appointment.”
For the couple of minutes it took her to capture her findings in his file, and put the prescription in, he was quiet, too quiet. She locked the screen, turning back to him.
Langdon’s head was hung low, like he was deep in thought, hands braced on the edges of the bed.
“Are you okay?” Mel stepped into what would be his field of vision if only he looked up at her. A moment later, he did, holding out his left hand to her. She took it with her right, and he closed his fingers around hers, setting their linked hands down on his lower thigh.
“I’m really trying.” He said quietly.
“I know you are.” There wasn’t a sliver of doubt about it in her mind.
“I just miss not being in pain.” His eyes were pained when he looked at her, like he felt guilty for the memory of relief.
“No one wants to be in pain. And you deserve not to be. We’ll work on that together, okay? I’ll come to the appointments with you, if you’re okay with that. I know it sucks, with work and with everything else - one more thing to worry about. But it’ll be good for you in the long run.”
He nodded, closing his eyes and leaning forward a bit.
She stepped in closer, her other hand trailing up his forearm, half because he looked so defeated, and half because she worried he might lose his balance and she wanted to be able to get a hold of him fast if he did.
“Would that be alright? If I came with you?”
“Please. Yes. Yes, that–I can’t… please, yes.”
Mel nodded, squeezing his hand. “Of course.”
Langdon exhaled deeply, shaking his head, letting it hang for a moment, then looking up at her. “I know you’re my doctor right now, and this would be highly inappropriate for a patient, but I would really like to hug you right now if that’s okay. Totally fine if not.”
Her head was nodding on its own accord before she could even think. “That’s–yes, I think we can make an exception.”
His tight expression relaxed. The tug on her hand was gentle, and before she knew it she was standing between his knees with his head heavy on her shoulder and his arms around her middle.
“God, Mel, never leave this department, we’d be fucked without you.” He sighed, relaxing into her a little.
“I’m not going anywhere.” She promised him, hands settling over his upper back where she knew his skin was unmarked by the evidence of his continued pain.
“Good.” He said softly, pulling back when she did, but looking a little dazed.
She handed him his back brace to put back on.
“Pick up your prescription, okay, and text me how the day went if we don't end up working together.”
“I will.” He promised, slowly scooting off the bed and wrapping his brace around himself to re-fasten it. Mel made herself look away when he pulled his shirt back up to get the brace into its proper place, her chest and cheeks warm. Instead, she glanced behind the curtain, out into the ED where the dayshift was slowly gathering around the charge desk to begin their round, the night shift crew joining gradually, looking tired.
“Looks like we're just on time." She told Langdon, glancing over her shoulder where he was looking more like himself again, dressed, ready, smiling at her.
"I’ll see you at the handover?”
“I’ll see you there, Dr. King.”