#should i pull a karen and contact the chain business office?

[fific7]

That Swept-Back Hair

Billy Russo x Reader

@omgrachwrites 500 Follower Celebration

AU Prompt: Friends with Benefits

Summary: How will Billy Russo react when his FWB finds another lover? Bearing in mind that he’s a complete hypocrite.

Warnings: Swearing, jealousy, fluff with mentions of sex.

A/N: Loosely based on S1 Billy, it’s non-canon & set in my imaginary Punisher universe.

(My GIF)

»»———————————————　⚜　———————-————————-««

Your phone was jumping like a jack-in-the-box on your bedside table, the blue light of the screen illuminating the wall behind it every few seconds.

You rolled over with a groan, taking a moment before picking it up and looking at it. Of course it was Billy Russo, who else would it be at 1 AM on a Saturday morning?

The guy next to you in the bed also rolled over, covering his mouth as he yawned, eyes half-open.

“Everything OK, Y/N?” he asked.

“Yeah, Raf, just a needy friend.... gonna call them back, so do you mind staying hush-hush for the next few minutes?”

He yawned massively again, speaking through it, “Ahhhhrrrrr...yeah... no problem...”

You hit the ‘Favourites’ star next to Billy’s name in your contacts, hearing it start ringing.

It went to voicemail so you hung up, slid the phone onto the table and threw your head back down onto your pillow. Fucking Russo. Blows up your phone with missed calls & “Pick up!!” texts then doesn’t answer when you call back.

It rang two seconds later, just as Raf had turned towards you, opening his mouth to no doubt ask you about your ‘needy friend’. You rolled your eyes and grabbed it, but the screen went dark just as you did so.

You hit redial, it rang out, went to voicemail. “Fuck!” you ground out between your teeth.

Your head had touched your pillow again for about 5 minutes, when there was a staccato series of knocks on your apartment door.

You shot up in bed, quivering - ah hell, it couldn’t be, could it? Really?

Raf had dozed back off in the meantime & didn’t even stir when the knocks rang out sharply in the quiet apartment. Not much of a guard dog, you thought, quickly throwing on your discarded PJs.

You padded barefoot over to the front door, confirming via the peephole that Billy Russo was indeed outside in the hallway, leaning on your doorframe so he could place one eye right to it. You spotted an eyebrow wiggle as you made eye contact. Oh holy hell!

You straightened your shoulders, took the chain off and unlocked the door, swinging it open.

“Billy!” you said quietly, with a small smile, “What brings you here?” You hadn’t seen hide nor hair of him for about three weeks. Not that that was anything new.

He moved gracefully past you like the panther he was, even though you’d been trying to subtly block him from coming in. He was dressed in one of his sharp suits, so you guessed he’d been at one of the never-ending stream of events he attended.

Your mouth drew into a line. Whoever he’d gone there with must have bucked the trend and bailed on him. Otherwise he wouldn’t have turned up at your place when, in his mind, the night was still young.

He turned towards you, placing both hands on your hips as he did so, pulling you up against his muscled chest.

“Now, Y/N, why do you think I’m here, holding my best girl in my arms?” the New York accented voice purred in your ear.

He leant in and kissed you hungrily, deepening the kiss immediately to a passionate one.

You pulled away, escaping his grasp. His eyes widened in surprise, a small frown making its way onto his brow. A few locks of his dark hair had fallen forward onto his brow and he swept them back up with his fingers, a reflexive gesture for him.

“I tried to call you back,” you mumbled, “I’ve... uh... got a friend staying with me at the moment.”

He shot his trademark smirk at you. “Hey, that’s OK. We can be quiet for once, yeah?” Grinning now.

In true romcom fashion, Raf picked that moment to come wandering into the lounge, clad only in his boxers, both hands ruffling through his short hair.

Billy’s mouth dropped open. He made a quick recovery, though. Gestured with a thumb.

“So... this your ‘friend’?”

He looked Raf up and down. He was a 6 feet 3 firefighter with the FDNY, and to put it mildly, he was ripped.

He topped Billy by a couple of inches, and by a few pounds. Billy scowled at him.

Raf eyed up Billy too, turning to you and asking, “This your ‘needy friend’ you were talkin’ ‘bout, Y/N?”

Oh crap.

Billy’s scowl turned to a furious glare, aimed right at you. “Needy?!! Ah, fuck this, Y/N! I think we all know who’s needy around here.”

Your mouth rounded into an offended O, but before you could reply, Billy was out the door and it slammed loudly behind him.

Great - now all your neighbours were gonna be mad at you too.

»»———————————————-　⚜　-———-———————————-««

You had then spent an uncomfortable half hour over a coffee with Raf, explaining the dynamics of your non-relationship with Billy.

“Now,” he’d said, brow furrowed, “let me get this straight. He’s part of your friend group, you see him every so often at a bar or at one of their places - but never his. He sees tons of other women but turns up here for booty calls whenever his busy schedule allows?”

He shook his head. “He’s using you, Y/N. What a selfish prick.”

You bristled, “Look, we go back quite a ways. Since he was in the Marines. I knew Frank first as we were neighbours when we were kids, and I eventually met Billy through him. He’s Frankie’s best friend, they’re Marine brothers.”

“And how long have you been ‘friends with benefits’?”

You muttered your response. “Sorry, what was that you said?” he asked.

“Three years,” you repeated reluctantly.

“Damn.” he said. “And what am I, exactly? Filler for whenever fuckboy isn’t calling?”

“No! Raf, you’re a really nice guy, and I love spending time with you.”

He stood up, heading to the bedroom. “Look, I’m gonna go. I need a few days to try and get my head round your fucked-up relationship with the suit-wearing Marine.”

He’d left shortly afterwards, saying he’d call. You weren’t sure that he would.

You met up with Karen for lunch later that day. You’d been co-workers first off, then had become good friends. She was currently dating Frank, your childhood friend.

You were so glad that he was back out socialising, in a small way, after losing his wife and kids in a brutal gang clash just over a year before. They and several others had been what the papers described, rather callously, as “collateral damage” while minding their own business in the public park the gun fight took place in.

Frank had understandably closed himself off to a large extent as he grieved and after a decent interval, you’d tried your best to draw him back out in a gentle way. You’d decided to indulge in a bit of Matchmaking Lite, and had invited Karen along to a night out with the rest of your friends. You knew Frank would be there and as you’d hoped, they hit it off right away.

You spilled what had happened the night before to her, grateful for a shoulder to cry on. She looked and sounded sympathetic, but you knew she wasn’t a big fan of your arrangement with Billy. She again voiced her astonishment that you still had it going on with him.

“Karen, without making you vomit by sharing too many details, Billy is just the absolute best in bed. He’s got the stamina of an ox. Several oxes, in fact.” You just knew your eyes had a faraway look in them.

Her mouth pursed in a ‘moux’ of distaste. “But still, Y/N, he’s just so damn selfish about it! It’s all on his terms.”

“You know he’s got commitment issues.”

She choked on her espresso martini. “Ya don’t say!!”

“It’s complicated.”

“Look, honey, I’m gonna be straight with you. It is anything but complicated. He spends 90% of his time at Anvil, 9.9% with other gals, and guess who gets the remaining measly 0.1%, the crumbs from his table?” She pointed her finger straight at you. “Coconut for the lady over there!”

You sat in silence for several minutes, turning over in your mind what Raf, and now Karen, had said to you. Eventually you nodded slowly. “You know what, Kar, you’re totally right. I just let the great sex blind me to all the rest of his fucking bullshit.”

Time to cut Billy loose.

Not that you ever had him tied down in the first place. If you were being brutally honest.

And you weren’t sure whether he’d even bother showing up at your place ever again.

»»————————————-———-　⚜　———————————-————-««

The next day being Sunday meant that some serious ‘Me Time’ was in order.

Sitting on the sofa, you stared off into space, thinking about the two men in your life. You huffed to yourself; you hadn’t heard from either of them so far, and that was probably for the best. You could do without being stuck in the middle of some kind of testosterone-fuelled conflict between the two of them.

Then you laughed out loud at yourself. Who were you kidding? You’d probably never see either of them again! You stood up, stretching out your shoulder and neck muscles. Time for a bit of self-pampering.

You had a long relaxing bath, gave yourself a leisurely mani-pedi, ordered in some pizza, and began to go through some layouts for work the next day.

You were a digital content editor at the newspaper both you & Karen worked for. It was okay as jobs went, but it didn’t set your world on fire. However, what did excite you was that the newspaper’s parent publishing house was about to launch a travel magazine, and you’d applied for a transfer.

What really made butterflies pop up into your stomach, though, was the fact that the magazine’s content editors would also be contributing instead of just collating. You’d already had an interview with the Editor in Chief, and should be hearing back within the next few days.

If someone else got that position you’d applied for, you’d just have to shove them out of your third floor office window at the very first opportunity.

While you were thinking of potentially becoming a murderer, there was a familiar pattern of raps at your door. Your heart sank straight through your boots.

You knew it was Billy before you opened the door. It sounded ridiculous but he had a certain way of knocking. Peremptory, demanding, with military precision.

He stood outside your door, tensed up and rigid, with a carefully blank look on his face.

“You alone?” he barked, by way of greeting.

You crossed your arms over your chest, glaring at him. “Why, hello Billy. How are you? I’m fine, Y/N, how are you? Yeah, I’m great.”

He glared right back. “I asked if you were alone.”

“That’s highly unlikely, Billy, seeing as how I’m so needy!”

He huffed and marched inside straight to the sofa, sitting down and leaning his arms on his spread-apart thighs. He clasped his hands together, letting them dangle loosely between his knees.

“You said I was needy first.” Sulky face.

“Hey, are we back in school or something?”

He looked up at you, dark eyes staring into yours intensely. “Why d’you get with another guy, Y/N?”

Straight to the point, then. OK, you were going to return the favour.

“What, I’m not allowed to have a life? D’you think I’m going to just sit around, waiting to gratefully receive 5 minutes of your attention every few weeks? Like some kind of fucktoy, to be picked up and dropped at will? Seriously?”

He clenched his fingers until the joints went white. “I thought you were happy with the way things are between us!!?... our... our arrangement. You’re important to me. And you know I care about you!” Not meeting your eyes at this last comment.

“Huh!!!” You leant against your kitchen island, you weren’t going to get into Billy’s orbit. Too risky.

“So important that you spend all your time at work, while bedding half of Manhattan? Leaving me with the crumbs from your table, as someone put it recently.”

He shot up from the sofa, fury in his eyes. “Who fuckin’ said that?!”

You shrugged, “It’s not important. What is important is that our arrangement, as you call it, is over. Since you put it in such business-like terms, think of it as a contract which has been terminated.”

Billy stalked across the room until he was an inch away from you, eyes boring into yours. “No.”

You laughed in disbelief, eyebrows arching. “You think that just cos you say ‘No’ it’s not gonna happen? Because no-one ever says no to Billy Russo, is that it?”

He grabbed you, lips finding yours in a ferocious kiss. One hand crept up the nape of your neck, his fingers running through your hair, while the other hand pulled your hips to his. He had an impressive erection. You gasped as you felt the pressure of it against you, but pushed him away, escaping to the other side of the kitchen island.

“Just go, Billy. Please.”

He stared at you, wide-eyed, those dark pools of his looking suspiciously glossy. Was he...? No way.

Billy turned on his heel and slammed out of your apartment. Again.

»»————————————-———-　⚜　———————————-————-««

Billy knocked his beer bottle off the table with his elbow, as he leant forward to drunkenly wave a finger in his friend’s face. Luckily, it fell onto the grassy verge below, rather than the decked patio they were sitting on in Frank’s back garden.

Frank grabbed his finger. “Russo!!! Chill out, man.”

“She tol’ me... t’go, Frankie, I was kissin’ her an’ she jus’ said Go!” slurred Billy. Frank squeezed his eyes shut at the whiny tone then looked back at him.

“Bill! We all warned you she wouldn’t put up with your bullshit forever. You should’ve known this was comin’ bud.”

“Bu’ I... I... love her,” he blurted, then stared at Frank, eyes wide, part horrified, part terrified.

“Got a strange way of showin’ it, Bill. Picking other women over her, until you decide it’s time to hook up. Surprised she’s stood for it so long!”

Billy swayed slightly in his garden chair, just staring back at him, nodding repetitively like a bobble head every so often.

“I gotta get her back, Frankie.”

“Whooo,” Frank huffed out a big breath, “well, ya always did like to choose the impossible missions, Russo.”

»»————————————-———-　⚜　———————————-————-««

You were beginning to understand what having a stalker was like.

When you left work the following day, the first person you spotted on the sidewalk outside your office building was Billy Russo.

You hesitated, shocked, then nodded and said quietly, “Hi Billy,” before continuing your short walk to the subway.

He fell into step alongside you. “M’gonna show you just how much I care about you,” you heard, then he was gone. Just gone, into the crowd of commuters around you.

That was just the beginning. Every morning, one single rose of the palest pearly pink would be delivered to your office, laying in a swirl of black chiffon within a silver gift box.

Texts would drop into your phone at unexpected hours. “Please forgive me. Let me back into your life. I love you, Y/N.”

The first time you saw those words, you nearly dropped your phone. What the....?

Gourmet meals and bottles of rosé prosecco would be delivered to your door, precisely 30 minutes after you’d get home. Was he watching you or something? A little shiver ran up your spine. He was still a sniper, after all.

You would catch glimpses of Billy when you left the office, and outside your apartment. Without a shadow of a doubt, he meant you to see him, he would never be so visible on a real surveillance job. But he didn’t ever approach you.

Then you got your dream job. You, Karen and a bunch of your colleagues went to your regular bar after work for a quick celebration. There was a toast proposed to your new job at one point, and one of your male colleagues grabbed you in a friendly bear hug after they’d all shouted “Cheers!”

You were looking past his arm as he hugged you, and found yourself staring into Billy Russo’s dark eyes. Casually dressed, he was leaning on a high table near the door, a beer in front of him.

Billy lazily pushed back from his table, strode over to you, swiped you out of the guy’s arms, wrapped his own arms round you and planted a kiss on your temple, with a nonchalant, “Hi, sweetheart.”

Karen, who had heard all about your last encounter with Billy, looked thunderstruck. You’d be getting interrogated later, that was for sure.

He, meanwhile, landed another kiss right next to your lips and said, “See you later at home,” giving you a quick squeeze before walking off.

Your female colleagues meanwhile were swooning over Billy, one of them commenting that she wasn’t surprised you’d kept so damn quiet about your hot boyfriend. You gave Karen a meaningful look and just smiled back at them all, neither confirming nor denying anything.

However the feeling of Billy’s body against yours, the delicious smell of him, his lips on your skin, had set your heart racing at a dangerous speed. You really did try to push those thoughts aside.

»»————————————-———-　⚜　———————————-————-««

Flopping down onto your sofa when you got home, you laid your head back on it and thought about that evening. As expected, Karen had questioned you ruthlessly as you left the bar together, like the perceptive investigative reporter she was.

Talking as you walked to the subway, you’d given her every detail of all the deliveries, glimpses of him and texts you’d received in the last few days. Karen had stopped walking, looking at you in surprise. “Y/N, why didn’t you tell me about all of this before now? Hell, Frank told me he had some crazy plan to win you back, but I never really thought...” her voice trailed off.

“Is it working?” she asked next. “Mmmm, yes and no, to be honest,” you said. “Don’t let it!” she said firmly, “This is what he should have been doing all along, instead of treating you like a total afterthought.”

You nodded, “Can’t argue with ya on that,” you agreed. “Is he going to turn up at your place, d’you think?” she asked. “Wouldn’t be surprised,” you laughed, “I think that was Billy giving me a heads-up.”

So as you’d been 90% expecting, the familiar knock at the door came about 15 minutes after you’d got back. You got up and after checking the peephole, sighed and opened it. “Hi, Billy.”

This was like déjà vu. Billy brushed past you and sat himself down on the sofa, in the same pose as the last time. Head down, hair falling forward and hiding his eyes from you. This time, you bit the bullet and sat at the opposite end, leaning against the armrest so you were facing him.

“Well, Billy.... leaving aside the stalkerish overtones, I guess I should thank you for the roses, gourmet meals and prosecco.”

He swung his head towards you, eyes wide. “They were just to get your attention. Frankie told me it’s what I shoulda been doin’ anyway, all along.”

You nodded, “Yeah, he’s not wrong.”

Billy heaved out a big sigh, head dropping. “I know I’ve been a complete shit to you, Y/N. Took you for granted.” He met your eyes again, “Truth is, I was fallin’ in love with you, and I really didn’t know how to handle it. I thought it was... just sex to you, so I... I was a coward and tried to ignore it, and acted like I didn’t give a shit about you. I just couldn’t have you kick me to the curb if I told you how I felt.”

You were genuinely shocked - Billy had never talked about his feelings before. You’d accepted this in the past, telling yourself it was due to his upbringing in the system.

“So you meant what you said in your daily texts, then?”

He nodded, still looking straight at you, “Yeah...I meant it, I do love you, Y/N.” Then he quickly looked down again.

Before you could stop yourself, you’d leant along the sofa and your fingers were pushing that silky hair off his forehead. He looked up at you, taking hold of your wrist and kissing your pulse point softly. You stood up, saying “C’mere, you,” and took hold of his hand, pulling him up along with you.

He put his arms round you, burying his face into your hair and just holding you. “I’ve missed you,” he mumbled. You laughed, “What?! Even though you hadn’t seen me for weeks before the night you landed on my doorstep?!”

“I know, I know, you don’t need to remind me I’ve been a complete prick. I’ll be honest, I think it took me seein’ you with that guy, and him actin’ like you were his, to give me that kick up the ass I needed.” The dark eyes looked down at you, and he sniffed, “He still around?” You shook your head.

“Nah. I think he thought I was completely insane for still being with you.”

Billy laughed, “Maybe he’s right....” he looked at you, serious again. “You willin’ to give me another chance, Y/N? I promise you I’ll do it right this time. The whole dating thing, asking you to be my girlfriend after three dates, all that stuff... everything.”

“Everything? Like, what if I say no sex to start with? And no running off to other women to scratch that itch? You’ll swear to all that? Really?!”

“I swear to you, on my Ka-Bar.”

“Wow,” you said, knowing that the knife was never out of Billy’s possession. It was an integral part of him. Maybe he was serious after all.

»»————————————-———-　⚜　———————————-————-««

A small kiss on your cheek woke you the next morning. Those eyes, those dark liquid pools, stared into yours, while a thumb ran over your cheek. “Mornin’, sweetheart,” smiling down at you. Reaching up, you ran your fingers into his hair, moving it off his forehead. “Morning, sweetheart,” you echoed, smiling back.

You and Billy had shared a bed but nothing else, except hugs and hand-holding. You were in your PJ’s - well, camisole top with matching shorts - and all Billy had on were his boxer briefs. You couldn’t deny you’d had thoughts of just leaping on him during the night... let’s face it, he was one hot dude. And he knew how to ‘look after’ a woman in bed, as he himself put it.

But no, you were determined he was gonna have to work for it, just like he promised he would. So you’d had to show some self-discipline, well, a lot of it, actually. He’d passed the first test - he’d actually stayed all night. Usually he was gone before the morning light stole through the curtains.

Now, he kissed your bare shoulder and leapt out of bed, like he was back in the Marines. He stood still for a moment, sideways next to the bed, having a leisurely full body stretch. Billy knew full well you’d be totally enjoying the view. A little tease from him to remind you what you were missing.

The sunlight, which stole through a small gap between your curtains in the otherwise dim room, picked out the sculpted muscles on his back & torso. Then he turned slightly more, ensuring you wouldn’t miss seeing the hard-on he was currently sporting. You shook your head, with a slight smile on your lips. The cocky big bastard.

“Where you off to, Billy?” you asked, thinking to yourself, if he’s headed to Anvil, he can fucking shove his second cha......

“I’m gonna make my beautiful almost-girlfriend a cup of good Italian coffee.”

You smiled at his departing back as he disappeared out of the bedroom. “Oh, Billy?”

His voice drifted back through from the kitchen, “Yeah, darlin’?”

“Can I please get some toast with that, too?”

“Sure, sweetheart.”

You stretched luxuriously, nestling your head into your pillows.

Looked like you were going to find out what having a panther on a leash was like.

#ben barnes #billy russo #billy russo fanfic #billy russo imagine #billy russo x reader #billy russo fanfiction #that swept back hair

[lynesonline]

Munchausen Syndrome

A Surgeon’s Blade

William Lynes, MD

November 29, 2019

Night call was hectic, little sleep to be had.  A new day and as usual, Jackson Cooper, MD. anticipated another long busy one.  At task presently, consults from hospital services asking for urologic evaluation.  As junior resident on the University Medical Center urology service, he was responsible for timely completion of these hospital urology assessments.  

He stood that morning in the urology resident’s office, a cramped crowded room filled with three old wooden desks, a well-used pot of burnt tasting coffee, and a wall of incoming department mail niches.  Consults were recorded by the department secretary in a small tattered ring binder which was jammed into the lower corner slot.  Three new consults filled the book, a full morning of labor for the overworked urology resident.  

Jackson stood just under six feet tall, with a messy head of brown hair in need of a cut.  He had, some would say, friendly, smoky blue eyes covered with heavy brown rimmed aviator shaped glasses.  He was dressed in an alternative uniform to the common surgical scrubs, a button-down white shirt, blue and white stripped hastily tied tie, and brown corduroy cuffed pants covered with the usual white coat.  He stood with style however, in his signature scuffed carrot colored iguana cowboy boots.  

The resident sighed when he thought of the work before him.  He read from the binder of consults.  There was a 75-year-old male with a history of prostate cancer, a pediatric cancer patient with nighttime wetting or enuresis, and lastly a 45-year-old female with a persistent urinary tract infection (UTI) and fever.  Clinic would begin in just one hour, so he would have to get moving, each of these three patients waiting to be seen.  He decided to work from the end of the list, tackling first the UTI in a woman named Gloria Sands on the internal medicine service.

He was soon to be off to complete his task, a ritual however, needed to begin the day.  Jackson looked over his shoulder, confirming that he was alone.  On the floor by the corner desk sat a brown leather attaché case with a candy red stripe.  He lifted the case, a Christmas gift from his sister, and opened the briefcase with a pop.  Retrieving a large prescription bottle, he opened the vial, shook out and downed two oval white tablets.  Here in lay the ritual, he turned the bottle in his hand and read silently the pharmacy label.  Dated one year before in the summer of 1982, the bottle was marked as containing the opioid Percocet.

Gloria Sands was a plump round woman with an asymmetrical short bob of dirty blonde hair.  She possessed close-set hazel colored eyes which seemed too small for her face.  She covered them with a pair of green and black leopard pattern cat shaped glasses secured with a pearl beaded eyeglass chain.   When Jackson entered the room, she was very involved, laughing and occasionally applauding, the wall-mounted television broadcast of Jeopardy.

“Ms. Sands.  I am Dr. Cooper from the urology department.  Your doctor, Dr. Fitzgerald, asked me to review your case.”  Jackson reached and shook the preoccupied woman’s hand, pulled up a chair and sat at the bedside.  “Now I understand that you have been having fevers for a couple of weeks, is that right?”  The patient continued to be distracted, continually glancing at the broadcast and seeming to not listen.  Jackson reached for the off switch on the set.  “Can I shut this off?”

Gloria eventually looked at the resident, first at his nametag and then his face.  Grudgingly she said: “yeah . . . yes . . . sure . . .I don’t care.  What was your name?”

“Dr. Cooper.  From urology.  Now, I understand that you have been having fevers for a couple of weeks.”

Gloria slipped her glasses off, letting them hang on her chest.  “Yes . . . my Mr. Whiskers . . .I found Mr. Whiskers on the kitchen floor.  Fevers, I’ve had a fever ever since then.”

“Mr. Whiskers?  Who’s Mr. Whiskers?”

“My cat, Mr. Whiskers is my cat.”

“Your cat?  Was your cat dead?”

“Absent . . . I prefer the term absent, Jackson.”

Jackson let the use of his first name ride for the time being.  At least she didn’t call him Jack, his dreaded nickname.  “I’m confused, what did the cat have to do with the fever?  Do you know, Ms. Sands?”

“I don’t really know.  Isn’t that what you are supposed to tell me?”

“So, you’ve been having fevers, every day since the . . . since the absent cat was noted?”

Gloria nodded a bored yes.  She was still distracted, making little eye contact.  “You know fevers, I get them all the time Jackson.”

“Cooper . . . it’s Dr. Cooper.”  The interview continued.  She had been having some burning with urination as well.  She indicated the past history of many urinary infections, somehow always related to her cat’s health it seemed.  Jackson finished up a few questions for the patient, excused himself and made his way to the nursing station.

Jackson looked for the patient’s old chart which would indicate any prior medical visits or hospitalizations.  Filed in an old gray file cabinet in the S’s was an empty folder labeled with the patient’s name.  Ms. Sands had never been seen before.  He looked at the ongoing in-patient hospital chart.  Her urine had an E. coli bacterium in it.  The bacteria was sensitive to the IV antibiotics that the patient had been on for one week.  He looked at her vital sign record.  For the last two weeks a daily temperature fever spike of 102 to 103-degrees Fahrenheit was recorded.  If in fact she had a urinary tract infection, any associated fever would typically be resolved with adequate antibiotics in less than three days.  Given her urine culture and IV antibiotics, she should have been without a fever at this time.  Complicated UTIs with either a kidney abscess, or obstruction of the ureter, the tube connecting the kidney and bladder, could explain the persistence of fever.  He would check her x-rays and present the patient to his attending physician.

#

           They met each early AM five days a week in one of the classrooms at the university, complete with rows of metal folding chairs, an old wooden podium, and a huge urn of brewing bitter tasting coffee.  Lee W. Hickok, MD. poured himself some in a Styrofoam cup with LWH carved into the side and walked to the front of the room.  “Hello, I’m Lee W., and I am an alcoholic.”  The man was in his forties, with dark brown hair highlighted on the temples with gray and wearing round glasses. He was dressed in a brown plaid sportscoat topping another pair of distinctive cowboy boots, shiny black and snakeskin in construction. He went on to introduce the meeting, speaking with a suggestion of a southern accent.  

           “We have business this morning.  Teddy is going to make the report.”

           A large male nurse dressed in a white tunic stood and approached the podium.  “Hello group.  I am Teddy and I am an alcoholic and a drug addict.”

           “Hello, Teddy,” the audience recited in unison.  

           The man began a presentation of local fund-raising activities for that month.  He reported as a treasurer, mentioning monies coming in and going out.  Karen was next, a neatly dressed woman of fifty or so, in a conservative skirt and high-heel shoes.  “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”  An Alcoholic Anonymous meeting then proceeded with mention of the twelve steps, and a short testimony about his life of alcoholism from a tall black cafeteria employee.

           After a short break, Lee W. Hickok returned to the podium.  “Well, ya’ll, you have the unfortunate distinction of having myself to give the long testimonial.  I am Lee W. and I am an alcoholic.”

           “Hello Lee W.”

“I stole my step-father’s Dr. Crow’s bourbon whiskey and drank each day under the porch when I was twelve.”   Lee W. took a handwritten notepaper out of his pocket, balled it up and threw his prepared talk across the room for effect.  

“He beat me, quite a bit for that and anything else he could think of.  Drinking, I can honestly say, was the only thing that brute handed down to me.  Soon, I couldn’t live without it.  I drank daily and frequently, heck I drank all the time, really since that day.  She was killed in front of me, my Mother.  She had taken me away from him in the dead of night.  They were fighting again; he was a rough one.  He broadsided us at the intersection.  I still see her dead eyes and blood soaked face in my dreams.”

Lee W. described a life of alcoholism, carousing and drugs.  At one point he withdrew himself from the alcohol, treating the resulting DT’s or delirium tremens with an IV and valium.  His sobriety did not last.  

“I was sober on and off for just a year after that.  Drinking again, it became my tool.  I am a surgeon, and not proud to say I was drunk during my medical practice and most of my surgeries.  I dabbled with cocaine and tried to kill myself after my wife Amber left me last summer.”  Lee W. held up his healed forearm laceration for all to see.

“I am sober now for fourteen months.  It has been 421 days now.  But for God, I would not be here today.  My life is truly one day at a time.”

#

He was just leaving the meeting when his pager went off.  “This is Dr. Hickok, I was paged.”

“Lee W., it’s Jackson.  Are you the unlucky attending on call today?”

“Hell yeah.  Y’all got something for me?”  Lee W.’s life was so refreshed now that he was sober. He looked happy for the phone call, like he was anxious for a medical problem to solve.

“Just three consults.  I need to present them to you, though.”

“Can y’all meet me in my office?”

Lee W. Hickok was a newly appointed associate professor of urology at the University Medical Center in northern California.  The university was a private institution, well respected as a leader in modern American medicine.  His office, however, did little to reinforce the importance of his position.  It was a cramped, crowded eight by ten-foot room, the door opening into the department’s small kitchen.  An IBM XT personal computer and a large dot-matrix printer filled an old oak desk which dominated the room.  

Jackson arrived as the attending urologist was just opening the office door.  “Grab us a couple of coffee’s my fellow tee-totaler.  And remember fondly as you pour it of adding just a drop of the good stuff, for me.”

Jackson turned and moved to the coffee urn in the resident’s office.  He wasn’t quite sure about the Texan’s last remark.  Yes, Jackson was a tee-totaler, a recovering narcotic addict.  Lee W. was supposedly a sober alcoholic.  Last year, during Jackson’s surgery internship he had drank with Lee W. in that same office and yes, he had added a shot or two to the man’s coffee on more than one occasion.  Guess he is just reminiscing, he thought.  Before he left with the coffee, Jackson quickly opened his attaché case.  He grabbed the prescription bottle and shoved it into his white coat pocket.

Lee W. was sitting back in his office chair, his black booted feet up on the edge of his cramped desk.  A smiley logo screen-saver circled harmlessly on the computer screen.  Jackson handed the porcelain cup to the man, and pulled a cardboard box full of books over, sat and drank his coffee.

“Did you freshen this up for me?”  Lee W. sipped the hot brew loudly, a sly smile on his face.

“Yeah, Lee W., sweet amber just as you like it.”  Jackson put his cup on the edge of the desk.  He reached into his pocket and pulled out the prescription bottle.  He shook out two oval white tablets and threw them into his mouth.  “You want a couple?”

Lee W. placed his feet on the ground.  He had a curious look on his face.

“Here, they’re just Tic-Tacs!”  Jackson shook a couple of the breath mints into the Texan’s hand.  “I keep this bottle.  It helps.”  He went on to read the prescription on the bottle.  “Percocet . . .dispense one-hundred.  One or two orally every three to four hours as needed for pain.  It’s dated June 23, 1982.”

“One year ago, I see.  Jackson, these are the most delicious Tic Tacs.  You’re a strong man, my friend.”

The disposition of two of the consult patients were decided in Lee W.’s office.   Mr. Simpson was a 75-year-old black male with wide spread metastatic prostate cancer on the internal medicine service.  He was suffering with horrible pain from the boney spread of his cancer.  Dr. Charles Huggins won the 1966 Nobel prize for his revolutionary finding that removing the testicles and any source of testosterone in patient’s like this put the great majority into a temporary remission.  Jackson would arrange an OR time this week to perform a bilateral orchiectomy, a surgical removal of the man’s testicles.

Kenny Tobias was a six-year-old male boy with leukemia.  He was on the oncology service and receiving chemotherapy.  He had a problem with nighttime wetting, or enuresis, however.  

“Should we start him on Tofranil, Lee W.?”  Tofranil was an oral medication that relaxed the bladder.   Taken at bedtime, it was effective commonly in enuresis.

Lee W. reached to his desk drawer and withdrew a xeroxed medical article.  “Here’s what we’re going to do for that child, y’all.”  He tossed the article into Jackson’s lap.  Highlighted in yellow was the article’s title: Treatment of Persistent Enuresis with Desmopressin Nasal Spray.  “It’s new, Y’all.  It’s also called DDAVP or desmopressin.  It is a nasal spray that cuts down on the kidney’s production of urine at night.  It has much less side-effects than Tofranil.”

Lee W. wanted to go and see the UTI patient with persistent fever, Gloria Sands.  Her problem was that she continued to spike daily fevers after seven days of intravenous antibiotics.  

“She relates this fever to the death of her cat, Lee W!  The cat’s name was Mr. Whiskers.  She found him dead on the kitchen floor, and she has had a fever ever since.  There is something peculiar about her, however.  Sort of distracted.  Just a touch odd, I think.”

At the patient’s door Jackson handed the vital sign sheet to the Lee W.  “See,” Jackson said pointing to the graphic tracing of her temperature.  “She spikes a 102 to 103 fever each day at three PM.  You know, Lee W., now that I look at this again, that’s just after shift change!”  

Lee W. looked at his watch.  “That’s in thirty minutes Jackson.  Let’s go see her.”

The bedside curtain was drawn when the two made their way into the patient’s room.  The television was blasting a daytime soap of some sort.  The room was dark, all lights turned off.  Jackson pulled back the curtain slowly.  “Ms., Sands, it’s Dr. Cooper.”  

“Stay out, you troll!” the patient yelled.  

Jackson had already pulled the curtain.  Before the two was the patient, sitting with the head of the bed drawn up.  She was busy fumbling with her left arm and IV site.  Jackson grabbed her arm.  She was just in the process of injecting a syringe into the injection port of the intravenous line.  He removed the syringe and stood looking at the woman, incredulous.

“That’s mine, Jack!”  The patient was roused, she quickly stood at the bedside and wrestled Jackson for the syringe.  

Jackson grabbed both arms of the thrashing woman.  Lee W. stepped beyond the woman and reached into an open bedside drawer.  Within was a specimen cup of clear fluid.  In the bottom was debris, brown and green leafy material.

The woman started crying.  “That’s my stuff now leave!  Rape!  Rape!”  The woman stomped her feet jumping back into the bed.  She pulled the sheet over her face.  “Leave me alone you rapists.”

Two nurses hurried into the room.  “Dr. Hickok, what’s happening?”

Jackson and Lee W. left the crying woman with the nurses.  They moved to the hallway and eventually sat in the nursing station.  

“That’s stool,” Lee W. said.  He held the container up to the light shaking it gently, the debris in the bottom now dispersed through the liquid.  

Jackson took the container from Lee W.  He compared the syringe to the fluid in the specimen jar.  The two looked identical.  “What the heck?”

“She injects her own stool into her IV.  There is your source of fever, Jackson.”

“Munchausen, she’s a Munchausen, Lee W.!”

Baron von Munchausen was an 18th century German officer who was known for embellishing the stories of his life and experience.  Munchausen syndrome is the most severe type of factitious disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. Munchausen syndrome is considered a mental illness because it is associated with severe emotional difficulties.  

Gloria Sands left the hospital quickly.  She refused to sign her against medical advice (AMA) forms.  Knowing the course of Munchausen syndrome patients, her appearance in other medical institutions with identical claims was likely. 

William Lynes, MD

November 29,2019