Chapter Text
“Midoriya-san, your new patient is waiting outside.”
And Izuku, who spent the last forty-five minutes in a trance-like state of mindlessly chewing a pen cap while looking at his patient spreadsheet, blinked in confusion, raising his eyes from the computer screen to the small beta in front of him.
“What?” Izuku looked around the room, untrusting his ears. “Are you… talking to me?”
The girl chuckled. “You’re the only Midoriya around here.”
“But I’m not taking new patients,” Izuku said, and when the beta simply looked at him, he frowned. “I told Aizawa-sensei about it this week. Are you sure it’s for me?”
The nursing assistant stopped to check the thick fold of papers on her arms — she was barely eighteen, this was her first job, and she’d been with them for less than a month; it could just be a mistake — but ended up nodding with her head, raising a filled-out form for Izuku to see.
“Yep, I’m sure.” She said, popping the ‘p’. “It’s right here, see? Nurse Midoriya’s three o’clock appointment, the Bakugou family. There’s even a little note in the margins! It says: ‘please don’t tell Izuku about this appointment without me being present, I need to talk to him first and—’”
The assistant's face became as red as a ripe tomato when she realized her slip, and if it had been any other day Izuku would've probably laughed, trying to brighten the mood. Unfortunately, the omega could already feel the telltale signs of a migraine coming just by thinking about this new situation. He exhaled.
“It’s written in pink Sharpie, right?” When the girl agreed, Izuku got up from his chair. “Thanks Saori, I’ll take it from here.”
“S-Sorry, Midoriya-san.”
Izuku took pity on the youngling, smiling sweetly at her, lightly patting her shoulder.
“Don’t worry about it, you did nothing wrong.” He said. “Can you make sure the Bakugous are comfortable? I’ll be with them in a moment to clear this mess.”
The young beta smiled, a little unsure, but went along with renewed purpose, leaving the break room probably to go back to the clinic’s reception. Izuku smiled despite himself.
Saori was a little clumsy, sure, and empty-headed more often than not; but she worked harder than most freshly certified nursing assistants Izuku knew, and she seemed open to learning. She just needed a little guidance, that’s all. Izuku would try his best to do that for her.
His friends called it his maternal instincts, but Izuku was always quick to roll his eyes when they said these types of things. His omega had nothing to do with Izuku’s nonstop impulse to help anyone he thought would need it. Hell, call it his nurse instincts — Izuku’s pretty sure his four years of nursing school had contributed more to it than his empty womb.
For instance, right now there’s nothing maternal inside Izuku’s heart as he went down the clinic's hall and knocked on Ochako’s office, glaring a hole into the brunette’s head as he entered the room. Oh no. No maternal drive for his backstabbing, writes-with-a-pink-Sharpie-only friend.
The female omega was none the wiser of the imminent danger stepping inside her office, too busy typing away in the clinic’s old beige box computer to pay attention.
“Izu, hi! I’m so glad you’re here.” The brunette said when she noticed his presence, still typing. “I was actually hoping to catch you before lunch, but Aizawa called asking me to digitize some charts, and I just lost track of time. Is it lunchtime already? Maybe we can go grab some—”
“It’s three o’clock in the afternoon,” Izuku started. “and there’s a family I’ve never heard of waiting outside for an appointment with me.”
Ochako froze in her chair, and Izuku instantly picked up the smell of rotting strawberries, strong and sharp even through her scent patches. Busted.
“Shit.” The omega looked at her wristwatch, swearing again. “Shit. Is it the 8th already? I thought that was next week…”
Even with all his frustration right now, Izuku still had to suppress a fond smile. “Your mate gave you a calendar for this exact reason. You’re terrible with time management.”
“Goddammit, I was supposed to talk to you about this days ago.”
“After you’ve already booked them without my consent?”
The female omega sighed defeatedly, raising her hands in surrender.
“Okay, fair enough. I screwed up.” Ochako groaned, already aware of her upcoming misery. “C’mon, unleash it on me.”
And unleash it Izuku did.
“What the hell, ‘Chako?! You know how swamped I am! You complain about it every day!”
“I know that, but—”
“Just this week, one of my patients went into respiratory distress, and another developed DRESS because of their new medication. This is the first time in days they’ve been stable enough for me to get out of the hospital.”
“Izu—”
“And don’t even get me started on my oncologic patients who, although stable, are still oncologic patients.” Izuku said. “I’m not joking! Last month the night janitor gave me the keys so I can lock up the clinic, because I kept leaving after him. And that was before two of my patients became hospitalized!”
It was a little strange to be the one lecturing Ochako about how much work Izuku has on his shoulders, considering she was usually the one consistently reminding him about it — the reminder normally being followed by a long speech about how Izuku’s work schedule was too much at best, and a step-by-step recipe for burnout at most.
Most of his other CHPN colleagues took two, maybe three private patients at the same time. Izuku was the only professional he knew of who juggled four. It was doable, of course, and completely comfortable for his patients. None of his patients are in need of an end-of-life type of care, not currently, so Izuku could divide his hours equally between them, not leaving anyone wanting for anything. Like he said, it was doable. No loss for anyone.
(A whole lot of loss for Izuku, considering it had been at least five days since he last saw the interior of his apartment, but he could manage it. After so many years as a certified nurse specialist, he was used to it. Work always came first.)
But five patients at the same time? Not even Izuku was that ambitious. Too much work quickly turned into bad work, and that the omega could not accept.
So, yes, he was a little shocked that someone would try to pile more work onto him, knowing his workaholic and self-destructive tendencies. He was even more shocked that that someone was Ochako.
“I know all about your maniac work schedule, Izuku. Believe me, I’ve been intimately familiar with it since college.” Ochako said, shoving an empty chair closer at him with her feet.
“Then why are you actively trying to kill me right now?” Izuku sat down only to shove his head between his knees.
Ochako was kind enough to give him ten seconds of blissful silence, and although Izuku was still pissed at his coworker slash best friend, he could still be grateful for small mercies. He also knew for a fact that Ochako wouldn’t book him a new case without good reason – he trusted the omega blindly, had since they met — but he was exhausted beyond imagination after the decline of two of his patients, so his brain didn't really want to be rational right now.
What his brain wanted right now was a hot bath, one long enough to make him regret it once the bill came, to change into his old PJs, and sleep for the next forty-eight hours uninterruptedly. It also wanted for all of his patients to miraculously get better in the blink of an eye, no pain and tears ever again. Maybe world peace too, since we’re at it. And a steamy bowl of katsudon.
But it would get none of these things, and Izuku’s headache has now fully set in, so the omega felt a little too entitled to continue being difficult.
“Here.” Ochako walked over to give him a warm cup (when did she leave the office?), and Izuku moaned shamelessly at the first gulp. Nothing like cheap coffee to brighten his mood. “Better?”
“Much.” He admitted. “The textbooks are all wrong, you know: caffeine doesn't give you headaches, it cures them.”
“When your headaches happen because you go four hours without a cup and forget about your raging caffeine addiction, then yes, it does.” Ochako said, sitting in front of her friend again, now holding a warm cup of her own. “Can I explain myself now, or do you need to yell at someone for a little longer?”
Feeling much calmer after dunking half a cup of coffee down his throat — maybe Izuku does have a caffeine addiction — the omega simply nodded, watching his friend type something on the computer, quickly followed by the high-pitched sound of an old printer fighting for its life.
“The patient is an elderly omega, and he was referred to our clinic by his neurologist at the end of last month. He was first assigned to me when he entered our system, but after reading his neurologist’s letter, I thought he should go to you. So I put his appointment under your name.”
Izuku groaned painfully.
“Because you hate me.”
“Because I know you.” She said, picking up the printed paper behind her. “And I know you would want to be involved in this case.”
Izuku’s face twisted in confusion. “Why would I want—”
“It’s CJD.”
Izuku felt as if time had tripped over itself, stopping too fast.
He blinked. Izuku could decode that acronym anywhere in the world, and the realization burns like a slap across the face. His heart raced as if he were in danger, and Izuku needed a couple of milliseconds to remind himself that he was not. He also needed a couple of milliseconds to remind himself that, this time, it had nothing to do with him.
Izuku’s hands were reaching for the paper Ochako offered before he could even think about it. His fingers were shaking.
“Are you sure?” Izuku asked, even though he knew no one would give such a diagnosis without being sure. “CJD? Are you absolutely sure?”
“It’s what his neurologist said.” Ochako pointed at the paper. “Apparently his spinal tap came back positive for 14-3-3 protein elevation, and they’ve already ruled out every other diagnosis. The doctor sent an email to the clinic when she referred him, explaining what she could.”
Since neither Izuku nor Ochako nor the clinic are involved in this case directly — not yet, not until they’ve accepted the patient and the patient has accepted them —, they weren’t allowed to read the man’s medical record. So his doctor wrote a short memo explaining everything she could without breaking confidentiality laws beyond the necessary.
The email was short, but also undeniable.
Sixty-four-year-old man presents with random periods of fluctuating mood and irritability, quickly followed by episodes of short memory loss, confusion, and tremors, associated with the sensation of “weakened legs” and trouble walking. The symptoms started a month ago. The man does not use any medications and has no prior medical conditions. No signs of meningeal irritation. The imaging showed nothing out of the ordinary. Spinal tap negative for GBS and encephalitis, but suggestive of prion disorder.
Most probable diagnosis: Creutzfeldt-Jakob disease.
“Fuck.” Izuku exhaled, reading the letter a second, third, fourth time. His chest ached. “Fuck.”
Ochako looked at him sympathetically.
“Yeah.” She breathed. “I scheduled the patient for a consultation at the beginning of the next month, which I thought would be next week. I was going to talk to you about it—”
“It’s fine, Ochako.” Izuku assured, eyes still glued to the letter. “I get why you did this.”
His friend simply looked at him some more, letting him roam his eyes wildly through the printed words again and again. It did not help, but Izuku couldn't help himself.
“Did I overstep?” Ochako said, sounding a little unsure now. “I know it’s a sensitive subject for you, and I was planning for us to talk first, I swear. I never meant to surprise you or—”
“I know.” Izuku raised his eyes to his friend, trying to give her a convincing smile. “I’m not mad. I mean, sure, you should’ve talked to me first—”
“God, Tenya will be so sad I didn't use his stupid calendar.”
“—but you were not wrong.” He said. “I… I do want to be involved in this.”
Izuku looked at the paper on his hands once again, remembering the name Saori told him a couple of minutes ago. Bakugou. The Bakugou family was outside, waiting to talk to Izuku. Waiting to be guided on what to do, what were the next steps in a moment such as this, and Izuku…
Izuku was a little stunned, truth be told. Petrified, too. Very, very close to crying, if he was going to be honest.
“I just can’t believe it’s CJD.” Izuku whispered, running his hand through his mashed curls. “I mean, Christ. Do you have any idea how rare this disease is? It's something along the lines of—”
“One in every two million people, right?” Ochako asked, looking at him. “I did some research after… You know.”
Izuku swallowed down the saliva pooling in his mouth, and the taste was bitter. There was also this horrible smell burning against his nostrils, and it took him a while to realize it was his own scent stinking up Ochako’s office. Even with the suppressants and scent patches on his glands, his distress was too big to be contained right now.
“I’m sorry, Izuku.” Ochako said. “I really am.”
Izuku knew she was apologizing for something completely different now. He wished she wouldn’t.
“I understand if you think you can't do it.” She continued. “Seriously. I know it's a lot, and I don't have any patients under my care right now, so I can take him. It will be no problem at all.”
Izuku looked at her. “And yet, you put my name on it.”
Ochako sighed. She fidgeted with her fingers for a second, but caught herself doing it, sighing once again. She was deciding whether he should say something or not. Izuku knew her too well; she was going to say it.
“Honestly? I think this could be good for you.”
Izuku knew what she was talking about, but he pretended not to.
“Why?”
Ochako didn’t let him get away with it. She never does.
“You know why.” She said, then looked at him a little more gently. “Closure.”
Izuku felt the air twist inside his lungs.
“I don't need—”
“You have to forgive yourself.”
“Ochako—”
“Izuku.” She said firmly. “You're older now. You’ve studied, you’ve been trained, you're a professional. Things are different than before. And I think helping this family can help heal some of the open wounds inside you.”
The last thing Izuku wanted to talk about was the open wounds inside of him. His week had been hell, there was a patient whose family is actively waiting in the waiting room right now, and the omega was already way too close to a crying fit as it was. Izuku had always been an emotive person, and he already knew: if he starts crying now, there’s no way he’ll stop. Not when the subject is this.
So Izuku took a deep breath, focusing on anything other than the nonstop stinging of his eyes, and thought about Bakugou, the sixty-year-old omega who’s just been given the worst diagnosis possible.
He thought about Bakugou’s family, his spouse or his children, hearing about the disease’s name and getting confused. Creutz what? How does one say it? How does one even spell it?
And once the name was put on Google, the results were scary.
… A rare, rapidly progressive, and fatal brain disorder…
… Life expectancy of six months to a year after diagnosis…
… The only treatments available for CJD patients focus on easing their symptoms and discomfort…
Thinking about Bakugou reading about his condition online made Izuku want to throw up. Izuku knew the feeling of despair all too well. He wished no one else would ever know it, too.
“I want to take this case.” Izuku admitted, looking at his friend. “Not because of closure or anything like that. I just… I know a lot about CJD. I could help them.”
He wasn't lying. The omega knew for a fact there was no nurse in this town who knew more about CJD than him. Izuku read everything he could about it back then; all the case reports, books, cohort studies, personal blogs — anything about the illness and living with it was avidly devoured by the little omega.
Izuku never got a patient with CJD, not since he got his certification as a nurse specialized in palliative care, but he knew what to do; what plan of care to follow. Ochako was right in passing Bakugou to Izuku’s care. The omega would be able to help more than others, both clinically and mentally. Of that he was sure.
Still.
He would be lying if he said he ever thought he would encounter another CJD case in his life. And he would be lying if he said he wanted to take this case, when in fact it felt more like he needed to.
Izuku didn't want closure. He accepted a long time ago that he didn't deserve such a thing.
But perhaps… Perhaps he wanted a second chance? Not for himself, but for others. A way to make right all of the wrongs he did the last time.
Things were not so easy, however. And when he suddenly remembered his patients, the ones actively under his care, his face heated with shame.
“But I can’t.” Izuku said, shutting his eyes tight. “I can't leave my current patients. And five patients at the same time is simply—”
“How about three?” Ochako asked. “I’ll take over your two oncologic patients.”
Izuku felt his eyes widen. “Really?”
“Why not? They’re both stable from what I know, and they’re both in early stages, right? Neither of them has metastasized, either. I can deal with that.”
Izuku thought about it for a second, but he could already feel his heart racing with the idea. He would have to talk to his patients first, of course. They needed to be on board with changing their personal nurse, Izuku couldn't just drop them like that, but he didn't think it would be a problem. His patients are good people, and they already knew Ochako from the clinic. They seemed to like her very much.
It was only half of his problems, though.
“What about my other two patients?” Izuku continued. “One of them is getting better, will probably leave the hospital in the next few days, but the other—”
Izuku exhaled, pinching the bridge of his nose.
“I don’t think his condition is going to improve. Maybe we’ll have to start end-of-life care. And if that’s so, I need to be there for him. I want to be there for him. I can’t just accept a new person in a moment like this, Ochako.”
His friend hummed. That’s all Ochako did for a moment, seemingly assessing the situation, and Izuku drank the rest of his crappy coffee, trying to drown all his worries away. He had no business being anxious about this, feeling guilty, being sorry. This wasn’t about him. It might be the same disease, but this had nothing to do with him.
This was about Bakugou and his family, and if Izuku was going to find a way to accept them as his patients — palliative care includes both the patient and their family, it's impossible not to — then he needed to make sure his feelings would be kept in lock and key.
This wasn't about him.
“Well, they’re already here, right?” Ochako asked. “I say talk to them. Understand their situation, who they are, what are their fears and expectations following this diagnosis… A full-on first consultation, really. Then tell them you might be unavailable for a while at first; that you do wish to be involved in this, but you have patients to assess the risks before thinking about rearranging them. Just be honest, and see what they’ll say about it. They can always look for another nurse to care for them if they don’t want to wait.”
It was the best course of action they had, but Izuku couldn't help but feel as if his mouth was full of ashes. His scent was soaking through his patch, and calling it unpleasant would be a euphemism.
“It’s not fair to make them wait.” Izuku said. “Not when CJD is all about time.”
Not when CJD is all about making do with the rest of time they have.
“No, it isn’t. But it’s the situation we’re in right now.” Ochako agreed. “They’ve just received this diagnosis, and accepting care from a palliative professional can be tough at first. Maybe the time you’ll use helping your other patient will be the time they need to get on board with things.”
The male omega fidgeted with the hem of his mauve scrubs, trying to think of a better solution to this mess, and thinking of none better than Ochako’s. He already knew his friend was right. Even if Izuku couldn't accept Bakugou as his patient right now, the man was already here, and Izuku wanted to talk to him. More than anything, he wanted to see him. Assess the extent of the damage, perhaps.
The last time Izuku dealt with Creutzfeldt-Jakob, everything happened so fast. The disease was already known for being an incredibly fast-paced dementia, but last time the diagnosis was made too late, so everything felt even quicker. The symptoms’ progression, the flare-ups, the pain… It was—It was ugly. It was brutal. Izuku had never seen anything like that before.
The omega wondered if it would be as bad as the last time. Then he wondered if he was prepared for it now.
This isn’t about you.
“Maybe.” Izuku sighed, head aching for a reason different from his caffeine addiction. “I dunno.”
When Izuku led his hand to his mouth, his terrible habit of biting his nails raw until they were throbbing and bleeding kicking in, Ochako gently took his hand away, intertwining their fingers. She always had a way of knowing exactly how to deal with an Izuku getting inside his own mind.
“Talk to them, Izuku.” Ochako said. “Do the thing you’re good at.”
Izuku chuckled awkwardly. “Freaking out over nuances?”
“Breaking people’s walls. Caring about them.”
The omega nodded along, even if not completely sure about it. He then nodded again, trying to put on his happy and helpful nurse mask. He was here to do a job, to do his job — and Izuku would be damned if he wasn't good at it.
“I’ll go see them right now.” Izuku said, only to be quickly stopped by Ochako.
“Maybe change your patches before going to see them.” She suggested with a small, fond smile on the corner of her mouth. “Getting in there smelling of sad, anxious omega is probably not the best first impression, hm?”
Izuku could feel his own face heat up, alongside his neck and probably the rest of his body too, and he left his friend's office stuttering about it, leaving the gentle laugh of Ochako behind when he closed the door. He headed toward the clinic’s bathroom praying it would have some extra scent patches on the dispenser today.
Talking to them. Talking to the Bakugous. Just talking. Izuku could do this.
And if he couldn't do it…
Well. He would sure do his best to not let it show, then.