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Explaining John Watson's Medical Discharge

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(art credit: punkypeggy)



I explore the reasons why John Watson was discharge from the army. I also explain the discharge process and calculate John Watson’s army pension from his CV.


I have written before that doctors are very valuable to the armed forces – they would not be discharged for a shoulder injury or a psychosomatic limp. Both of these things do not prevent John from being an army GP.


Something more must have happened for an experience doctor like John to be discharged.




A Canon Tie-In


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Thecutteralicia has recently pointed out in ACD!Holmes John Watson states that enteric fever emaciated him and forced him to leave the army.








I was struck down by enteric fever, that curse of our Indian possessions…For months my life was despaired of, and when at last I came to myself and became convalescent, I was so weak and emaciated that a medical board determined that not a day should be lost in sending me back to England







She puts forward the theory that in the modern adaption John Watson was not discharged on account of his shoulder injury but rather a tropical infection that followed.


Whilst this theory agrees with the original ACD canon - it does not seem a likely scenario in the modern era:


As thecutteralicia writes:








However there are still plenty of other infections and diseases our modern soldiers have been suffering from in Afghanistan: MRSA, gastroenteritis, malaria, Q fever, leishmaniasis,


John expected to recover totally without any permanent disability and to return to his duties with nothing more than a nasty scar. However, in the middle of his recovery he contracted an infection. Perhaps it was complicated by another concurrent infection, like malaria or dysentery, but either way John became critically ill and almost died.








I do like this infection theory, its very intriguing. However the main problem I have with this theory is that we are now talking about 2010 and not the 19th century.


Disease can spread like wildfire through military bases - we have many accounts of British troops being decimated in the 19th century due to cholera, plague, dysentery etc. However healthcare and sanitation has vastly improved, so has our understanding of what causes disease.


Food poisoning (gastroenteritis) still happens on a frequent basis everywhere but it is no longer life threatening - antibiotics and fluid replacement are sufficient for severe cases. Besides, food hygiene standards in the military should ensure that outbreaks are isolated, and very uncommon.


There are vaccines, treatment and/or prophylaxis for malaria, leishmaniasis, tetanus, typhoid, hepatitis, cholera etc.


British troops are provided with a very high standard of healthcare that is incomparable to what ACD!Watson would have received. The NHS also contributes some of its best civilian doctors to fill expertise gaps if needs be. There is a huge thriving specialty for Infectious Disease and Tropical Medicine in the UK and plenty of well qualified experts to deal with disease like malaria.


Generally as a population we are in much better health compared to even the comfortably well off Victorian doctor. Therefore John Watson is also much less likely to suffer long last ill effects from the diseases mentioned compared to his Victorian counterpart.



More importantly John would have lived almost exclusively inside military bases. The vast majority of British RAMC doctors are based in Camp Bastion - their patients mostly come to them and not the other way around. For battlefield emergencies there are paramedics.


Although military life may sound harsh - John is not an ordinary soldier - he's an officer. He also spends most of his time in highly sophisticated, well equipped large military bases. He would be able to enjoy creature comforts that are available, including TV, internet, better-than-hospital-canteen food, particularly in Camp Bastion (actual combat officers in more remote military camps would endure a much more basic existence). Even if he wasn't an officer - all military bases have a good standard of sanitation and healthcare. Much, much better than the general population in Afghanistan.


John as any army doctor would not be out mingling with the local populations on a frequent basis. Incidences of tropical disease among British troops in Afghanistan are small and isolated. Tropical disease when faced with good sanitation and correct precautions do not spread. The isolated incidents inevitably come from contact with locals or expeditions to remote regions outside of the main base. John would be doing neither.



Side Note - Meet MRSA


MRSA stands for Methicillin resistant Staph. aureus. Staph. aureus is a bacteria that lives harmoniously on our skin, in our noses, on our eyelids. It will also cause disease - it just depends on the situation.


There is no such thing as good and bad bacteria. It's not like MRSA is sentient, though if it was, it should be suing the British Press for libel.


The media have conducted what amounts to a witch hunt against MRSA. It's nothing more extraordinary than a strain of Staph. aureus that is resistant to one particularly antibiotic, Methicillin - a type of penicillin. It's not going to cause a pandemic, it does kill people but far less people than Influenza. It's just slightly harder to deal with when it causes disease than non-resistant strains.




A Cesspool of Possibilities


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(art credit: sheWolf294)



However, as I said: I still like the theory that John did become critically ill because of how it reflect the canon ACD!Watson’s discharge.


If John were to fall critically ill - I would say it would be due to his bullet wound rather than a mixture of tropical infections.


The shrapnel would have produced an entry wound that would allow all the normally docile bacteria on his skin to enter the bloodstream in huge quantities (and the bullet probably added a few new bacteria of its own).


Several things can happen:



1. Osteomyelitis - infection of the bone. This doesn't have to occur in the shoulder. The surgeons will have a done a thorough washout and paid special attention to making sure the procedure is as a sterile as possible. What they can't control is where the bloodstream seeds the bacteria. He could have osteomyelitis in any bone but it is more common in the long bones of the leg.


Osteomyelitis is treated with months of very potent, very poisonous antibiotics given through a line that goes straight into the heart (which gives you an idea of how serious this is).  John would be unfit for duty for a much longer period if he had side effects from the antibiotics which could easily have given him acute renal failure, temporary deafness to name but a few common effects.


I think John really did have a very painful leg for a very long time. This most likely contributed to his psychosomatic limp in one particularly leg as in times of stress the brain can fall back into a pattern of reliving old wounds. For example: the myriads of patients who state that their leg has hurt on and off for decades after a fall even though physically the leg is fine.


However despite frail health during treatment - most people recover from osteomyelitis or have permanent joint/bone damage. John appears to have recovered fully and as he's not hooked to a dialysis machine, or hard of hearing, I don't think he suffered long term sequelae from the treatment. In fact he does appear to be in robust health.


There is no reason to discharge John from the army during his treatment period. There is every chance and indeed expectation that he should be able to recover as a fit young man with the correct treatment.


ACD!Watson was discharged because enteric fever had bought him to the verge of death and given the state of Victorian medicine it was quite possible he would never recover his health. On this basis the army was right to discharge him.



2. Infective endocarditis: bacteria might also seed to the heart valves.


Staph. aureus (of MRSA fame) is particularly good at completely destroying perfectly healthy heart valves in under a week. John would need major valve replacement surgery and potentially be on warfarin (if he has metallic valves) for life. This alone is good enough reason for him to be referred for assessment to see whether he is fit to carry on active duty in a combat zone in the modern era.



3. Brain Abscess  – a collection of pus inside the brain from infection



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This is thankfully rare but cannot be ruled out. Although the brain has a “filter” in its blood vessels to keep out bacteria – brain infections nevertheless occur from blood-borne bacteria.  Again, our old friend Staph. aureus is often a prime culprit. Brain abscesses can cause functional brain damage but more often they cause seizures. Even after the abscess has been drained and resolved – the damaged brain tissue may still be a focus for seizures and a significant number of patients do go onto the develop epilepsy.


The fact is once John had one seizure from his brain abscess it would be impossible to say whether it would be the last, if or when he will have another one, or if he would eventually go onto develop epilepsy.


Patients with epilepsy (and all other seizure conditions) who have had one or more seizures in the past 10 years are not able to join the army. In terms of medical discharge – a seizure disorder like this may very well have caused John to be discharged due to the implications of having a fit whilst on active duty (even in the relative safety of a military base).


The other thing I want to mention is that we never see John Watson driving (this is because Martin Freeman does not have a license) but being banned from driving by the DVLA due to his seizure(s) could be a fitting in universe explanation.




The Mental Options - PTSD and Depression


I have already dedicated a meta to John's PTSD (or lack of PTSD). From a medical point of view - it is very unlikely that John actually has PTSD.


John, himself and his Post Traumatic Stress Disorder.


As a doctor John would not be fighting on the front lines or out on patrol. He would be working in the hospital back at the military base. They are technically in an active combat zone but would not be in combat. Therefore combat situations are not a routine part of his job. The firefight in which he got shot was most likely the first and the last combat he ever experienced. The most plausible way for John to be injured Taliban insurgents attacked the army base (which they did in 2012 to Camp Bastion) and John was injured in the ensuing fight.


The other reason why I now err more towards a physical explanation for his discharge is that PTSD is very common particularly in combat soldiers on the front line. If everyone with PTSD was discharged the army would have a troop shortage.


The conditions is treatable and most people do make a good recovery given time and appropriate therapy. As I said before discharge is done an individual basis - the severity of the symptoms, coupled by response to therapy, functional status etc are influential in the decision.


A diagnosis of PTSD is not sufficient for automatic medical discharge, even if John had PTSD


Military psychiatrists are probably the best people to deal with PTSD, and therefore it is in the  military's interest's retain these soldiers for treatment rather than hand them over to the civilian NHS as soon as they are diagnosed.


As for depression - again John does not display symptoms consistent with clinical depression at the beginning of the series. His general low mood is much more likely to be due to having to adjust to civilian life.


Depression is common in soldiers (if only because depression is terribly common in the general population). As a GP, a significant proportion of John's job may have been to manage depression in soldiers.


Again, discharge depends on the severity of depression. Mild depression, appropriately treated and controlled does not necessitate a discharge. If John really did have severe clinical depression when he was discharged, the army has a duty to provide him with appropriate rehabilitation and mental health services.


The therapy sessions we have seen are not how the NHS would treat severe depression, nor is it how the army would treat PTSD.


The therapy session looks every much like a civilian counselling session, that John himself has a organised on his own initiative.



The intermittent tremor in his hand is not enough for John to go before the medical board.



Firstly, John is an army GP, he has to be a qualified GP in order to take a locum GP position when he is in civilian world. As a GP an intermittent tremor does not affect John's ability to do his job, practical procedures can be and often are delegated to nurses. John's main job is to interview, diagnose and prescribe medication (which is now done on computers). My GP worked through two broken arms (at the same time) and had no problems - she just got another doctor to sign the prescriptions.



Secondly, Mycroft has proved that John's tremor only occurs when he is relaxed. It goes away when he is stressed. Therefore it would not affect John's work even if he was a surgeon (which he is not). Not matter how many times a doctor has done a procedure there is always an element of underlying stress. Trust me, I know as I have the opposite to problem to John but even so I've yet to be labelled unfit to work as a doctor.



Procedure for Medical Discharge


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Veterans UK has a very good webpage on the process of a military medical discharge.


http://www.veterans-uk.info/medical_discharge_pathway/index.html


Soldiers who have sustained injuries that affect their function and ability to remain on active duty will be referred to a regional occupational health team. Occupational health specialists aim to help patients adapt to their injuries and adapt their jobs to suit their current functional status. For example: during John’s recovery from his soldier wound – he would may be taught how to perform daily tasks one handed such as making tea and dressing (it’s not as easy as it sounds).


For many soldiers, after a period of recovery and amended duties they can return to their normal jobs. Occupational health thought John evidently couldn’t.


The next step is going before a Two Member Medical Board (TMMB). It’s akin to an interview/health check up. The two members are usually military doctors who scrutinize the occupational health reports, medical reports and take into the account the views of the soldier in question. The board issues Joint Medical Employment Standard grade. These grades may qualify the soldier for full active duty or a certain set of amended duties or restrict soldiers to duties outside of active combat zones.


Alternatively, the board may recommend a medical discharge. This is influenced mostly by the nature of the medical condition and occupational health reports.


The medical discharge request then goes through the Army personnel center – and if the recommendation is accepted a date for discharge is set.  It is only after this that the soldier in questions gets to hear about the decision. I imagine that John might have mistakenly thought he would not be discharged and was then faced with the horrifying reality that he would be out of the army in X amount of days.


Once discharge is approved – rehabilitation and support services will engage with the soldier. I have heard mixed views about the effectiveness of these services and I think it depends on the soldier’s personality whether he/she finds them helpful.


John would have access to therapists after his medical discharge but his therapist might not be a military therapist. She certainly doesn’t look or act like any military psychologist I’ve ever met.


As a civilian, John is a supposed to be cared for by the NHS, but unfortunately mental health provision for veterans is not as good as it should be. There are few psychologists who can specialize in therapy for ex-servicemen because as a proportion of the population ex-servicemen are a very small percentage. If John doesn’t want to travel far for expert help, he’s only available option may be the local civilian therapist.




Army Pension



Through the Army pension calculator online: https://www.gov.uk/armed-forces-pension-calculator


With a few estimated dates:


John’s CV faithfully reproduced from screenshot in TBB by Trishkafibble (http://archiveofourown.org/works/503732) it says that John graduated medical school in 2004. This means he would have served in the army for a maximum of 6 years.


According to the calculator his pension would have been:  £11436 lump sum plus £3812/year.



It is quite true that he cannot survive in London on an Army pension though the lump sum would have tide him over until he managed to get the locum’s position.



List of Other Metas

Comments

( 25 comments — Leave a comment )
frodosweetstuff
Jul. 16th, 2013 07:15 pm (UTC)
Thank you!! This was so very interesting (like all your metas!). I was wondering about how much his Army pension would be, especially, so thank you for the info.
kizzia
Jul. 16th, 2013 08:08 pm (UTC)
This is really interesting - especially the Veteran UK info and the Army pension calculation (even if i don't believe a word of that CV other than the names of the educational establishments John went to).

I'd also wondered if, in this day and age, severe infection could have meant a discharge for John had he been in the RAMC so thank you for looking at it and sharing what is possible - once again you've been a marvel.

And I know I'm a complete pain and drive you made with the military stuff but at the top you state (and i'm paraphrasing a little) that since John was an officer he'd have all the creature comforts whilst on deployment.

Whilst that might be true of RAMC officers (because they aren't on the front line ordinarily) that isn't true of all officers - certainly not those in command in the Infantry! Up to the rank of Captain at the very least (and for some, although certainly not all, Majors), Infantry officers are right out in the Forward Operating Bases living exactly the same as the "ordinary" soldiers.

Would you mind making that a bit clearer in the meta? I know a couple of Infantry officers who have served on the front line in Afghanistan and I know they'd be a bit upset that people might think they'd been living it up when actually they'd been to hell and back with their men.

Edited at 2013-07-16 08:09 pm (UTC)
wellingtongoose
Jul. 16th, 2013 08:37 pm (UTC)
That is a fair request. Should have phrased it better. Thank you for pointing it out to me.
kizzia
Jul. 17th, 2013 09:13 am (UTC)
Thank you for not minding :)
rifleman_s
Jul. 16th, 2013 09:13 pm (UTC)
Fascinating and informative, as always - thank you so much.

It's also interesting to note from John's CV that he's specialised in "Post operative oliguria hypotension [whatever that might be!!] and post op infections which could be as a result of his own . . .

(And may I ask you a question from his CV - what does it mean by "Crusader of clinical governance"? If it's easy to explain, that is!)
wellingtongoose
Jul. 16th, 2013 10:26 pm (UTC)
I've been in the process of writing a meta about John's CV for the last three months. It's turning into a terribly long essay.

Clinical governance are the methods healthcare works and their managers use to ensure that the standard of medical care is up to scratch. GP are given a great deal of leeway in managing themselves but they are encouraged (with money) to meet government set targets for healthcare. Clinical governance is often quite a tedious job involving a lot of audits and form filling. John is putting himself forwards as a guy who is willing to do this as well as his normal work. Basically a subtle way of saying: hire me - I'm more than a one trick pony.
kizzia
Jul. 17th, 2013 09:15 am (UTC)
Now I'm really looking forward to that meta! Can't wait to see what gems of information you'll provide in there.
rifleman_s
Jul. 17th, 2013 09:37 am (UTC)
Oh thank you very much for explaining that - it's always useful to know how these processes work.

I can see that with John being so steady, it would be a good (if boring) job for him to undertake.
mirabile_dictu
Jul. 16th, 2013 09:28 pm (UTC)
Thank you! This is wonderful information.
blackcat348
Jul. 16th, 2013 09:31 pm (UTC)
I really like your metas, but MRSA is more serious than you make it sound. I've spent a year and a half working with it in the lab. While MRSA does stand for Methicillin Resistant Staphylococcus aureus, research has found that usually MRSA is resistant to multiple antibiotics, not just Methicillin. MRSA has also killed more people than AIDS in the US in the last couple years. I agree that it is a bacterial infection, and that S.aureus is found normally on the skin, and in the nose, but it is a serious one.

Other than my issue with how you represented MRSA, I love that you explain all of these things that we wouldn't normally know.
wellingtongoose
Jul. 16th, 2013 10:06 pm (UTC)
I agree that MRSA can be a serious infection but so can non-resistant strains of staph aureus. Staph aureus infections tend to run aggressive causes due to the nature of the bacteria and its victims.

My point is that MRSA is not particularly special in that most common bacteria are resistant to multiple antibiotics. Strep pneumoniae resistance is now significant for beta-lactams, macrolides,tetracyclines and fluoroquinolones. Each region in the UK now has to have its own tailored antibiotics policy for pneumonia because strep pneumoniae has such a wide spectrum of resistance profiles. Whereas MRSA in the UK is still very much susceptible to glycopeptide antibiotics.

Strep penumoniae is the major cause of pneumonia and kills far more people than MRSA simply because it is a much more common infection.
MRSA is not nice, but it is also not the end of the world.

rabidsamfan
Jul. 16th, 2013 10:19 pm (UTC)
That's fascinating.
librasmile
Jul. 17th, 2013 02:46 am (UTC)
Yay another installment! And lovely that you mention thecutteralicia whom I've only just discovered.

Thanks for reproducing the CV link. I've always wanted to get a closer look at it.

Don't have much else to add. Have neither medical nor military expertise. Just enjoying your work as usual =^)
corbyinoz
Jul. 17th, 2013 07:17 am (UTC)
I do enjoy your metas, so thank you again. I would diagree with a couple of your points above, most particularly with your comments regarding food poisoning. Salmonella *does* kill people every year in Australia - and that's with modern hygiene, medicine etc. Some people are susceptible to it. Salmonellosis is a constant concern no matter where food is handled; an army grunt who chops raw chicken on the same board on which he later chops vegetables, or who doesn't refrigerate cooked rice soon enough, or who mishandles food in any of a dozen ways could occasion a salmonella outbreak, and it is a vicious affliction that, even if survived, can have severe long term consequences. Salmonella is particularly difficult to guard against as some people can be carriers without being aware of it.
wellingtongoose
Jul. 17th, 2013 11:41 am (UTC)
Oh yes salmonella, shigella, campylobacter, e. coli all claim lives all over the world. I am not implying that food poisoning is never fatal.

However in the UK fatalities are overwhelmingly at the extremes of age: young children, the elderly and with people who have co-morbities: lung, kidney, liver, heart problems.

In the context of the army - young fit men (much fitter than the general population) deaths from food poisoning are exceedingly rare, and even in the civilian world when a healthy young person dies from food poisoning there is at least some semblance of investigation done into the medical care given, and the specifics of the case. More often than not something has gone wrong with the system and the death could have been preventable.

Secondly compared to other common diseases such as pneumonia or COPD - gastroenteritis in general produced far less sequelae and the morbidity for survivors especially in the previous young, fit and healthy. Therefore food poisoning itself, even a near life threatening bout is not enough in itself for an automatic medical discharge.



Edited at 2013-07-17 11:42 am (UTC)
frozen_delight
Jul. 17th, 2013 04:56 pm (UTC)
I really love your meta writings, and this one is great, too, especially since I know next to nothing about army life and medical matters. Thank you!
rranne
Jul. 19th, 2013 06:06 pm (UTC)
Personally, I think the 'tremor' was more the cause of John's discharge (and any accompanying PTSD/psychological issues) more than the shoulder or the limp.
aeron_lanart
Jul. 19th, 2013 06:28 pm (UTC)
A tremor which could potentially have been caused by a brain abscess, which fits in with the meta.

I like the idea of a severe infection causing that kind of problem being the reason for John's discharge and also that it does tie into ACD canon.
wellingtongoose
Jul. 19th, 2013 07:51 pm (UTC)
The intermittent tremor in his hand is not enough for John to go before the medical board.

Firstly, John is an army GP, he has to be a qualified GP in order to take a locum GP position when he is in civilian world. As a GP an intermittent tremor does not affect John's ability to do his job, practical procedures can be and often are delegated to nurses. John's main job is to interview, diagnose and prescribe medication (which is now done on computers). My GP worked through two broken arms (at the same time) and had no problems - she just got another doctor to sign the prescriptions.

Secondly, Mycroft has proved that John's tremor only occurs when he is relaxed. It goes away when he is stressed. Therefore it would not affect John's work even if he was a surgeon (which he is not). Not matter how many times a doctor has done a procedure there is always an element of underlying stress. Trust me, I know as I have the opposite to problem to John but even so I've yet to be labelled unfit to work as a doctor.

Thirdly, I have written an entire meta on why John does not have PTSD - no military psychiatrist would have diagnosed him with such.

here

ariadnechan
Jul. 20th, 2013 07:06 am (UTC)
I really love your meta specially because of the procedures for discharge and the army pension. About the cv. because of John age it is a bit crazy that he had left med school in 2004!
That cv is so wrong!

Also i would love to see a meta about his injures and a discharge for him if he was not RAMC and he was an army captain, do you remember the theory two?

I always had thought because of the discharge, been in a regiment and "the bad days" that he was an army captain who was a civilian doctor. so he fought in the front lines and the RAMC mug was a gift, from friends or colleagues from uni who were in the RAMC.

in this case scenario with the wound in the shoulder, the infection, and the limp, would be enough for discharge for medical reasons? because he was on the front and apparently even scouting if the dream is to be believed.
wellingtongoose
Jul. 20th, 2013 05:14 pm (UTC)
The limp would limit his ability to go out on patrol and automatically fail him on fitness. If there was a definite organic cause perhaps he might not have gone before the medical board but it is most likely that the limp simply didn't respond to any psychological treatment. The tremor, even if it doesn't occur when he is stressed, is enough to put him out of work as any kind of marksman. The shoulder wound is recoverable but at the time no one knew whether he would recover complete mobility. It might have looked far too bad for that to happen.

However I thought just for you ariadnechan - I will write a special new theory:

John Watson gave up his medical career to pursue a combat position in the army. He was then posted to one of the more remote bases (that didn't amount to more than a mud wall compound) with very basic health care facilities: no flushing toilets - water that has to be hand pumped out of the ground. All soldiers have special packs with which to "purify" drinking water and malaria prophylaxis. However this does not always guarantee an infection-free life. Perhaps whilst in the remote army base - the men may have tried to supplement their bland rations with locally sourced meat from a friendly farmer (this is advised against but does happen).

I think before John was shot out on patrol he may have already developed symptoms of typhoid (enteric fever has mentioned by ACD!Watson). Typhoid is caused by Salmonella - it is spread by the fecal oral route. If there are pools of standing sewage (no flushing toilets), contaminated drinking water, or contaminated meat - typhoid can spread like wild-fire.

However he might not have realised he had developed typhoid. Many people when they travel to developing countries get a relatively benign condition called traveller's diarrhoea mostly caused by E.coli. Generally you drink a bit more water and you will be fine. Likely John's had it before and might have thought the beginnings of typhoid were just that.

After he was shot - John may have lost a great deal of blood. In severe blood loss blood is diverted away from the gut to keep the brain and the other more vital organs alive. This coupled with the inflammation from the typhoid - may have caused John's intestines to perforate.

This is very, very bad - his entire abdomen would become infected and inflammed: acute peritonitis. Perforated bowel usually demands an emergency air lift to hospital (i.e. camp bastion). John would have to undergo an emergency operation to clean out his abdomen and chop out any dead bits of intestine. After the surgeons can't just join the two ends together because the bowel is just too inflammed it would not heal.

Therefore John would end up with a stoma - http://www.ostomylifestyle.org/content/what-stoma

Basically his poo now has to drain into a bag that he has to carry around with him. Of course - he's not going to be able to fight in that condition.

At the time it is quite possible that surgeons thought he might have to have a stoma permanently, even if they could reverse it, John might end up with chronic bowel problems. That in itself is enough to be recommend for a military discharge even without all the other problems John faces.

However John did make a full recovery in a civilian hospital - the initial prognosis did not take into account his general fitness and force of will. Any protracted illnesses, particularly one of this severity can lead to psychological sequelae such as depression, anxiety, insomnia - which may explain what we seen in ASiP


Edited at 2013-07-20 05:27 pm (UTC)
ariadnechan
Jul. 20th, 2013 08:09 pm (UTC)
Amazing! I love you!

This made a lot more sense than the pstd! And how a depression was cured so easily. He was almost out of his depression he needed purpose again to get the last of force to get completelly out. And maybe he still have some nightmares i don't think any soldier who lives free of that ones now and then.

And also the discharge. Poor John! And i making the watson woes challenge so i make him goes for troubles too, but i'm doing my head canon also. Look at my The sun's heir if you could is a drabble.

http://archiveofourown.org/works/885464

and this one i had bad days.
http://archiveofourown.org/works/886256

Edited at 2013-07-20 08:17 pm (UTC)
capt_facepalm
Jul. 20th, 2013 08:24 pm (UTC)
Thank you so much.
It is this level of detail that thrills my brain.
tulip_carrot
Jul. 23rd, 2013 04:48 am (UTC)
Thank you! I was just wondering about all this the other day, and you have given me plenty of food for additional thought.

I find the idea of John having had a brain abscess particularly believable. Presumably he is making a full recovery, but the army couldn't count on that -- and he would of course be prohibited from driving, at least for a certain period of time. Likewise, the bone infection is very believable, with a psychosomatic aftermath.

That pension works out to about $500 per month in American money -- it would be tough for a person to live anywhere (let alone London!) on that amount unless they shared living quarters with family or roommates.
jolie_black
Nov. 3rd, 2016 09:39 pm (UTC)
Osteomyelitis
Sorry, me again.
I'm fascinated by the idea of John having developed osteomyelitis after being shot, as a complication that would explain why he had to be discharged.
You mention the difficult treatment of that condition, especially the nasty side effects of the antibiotics. What exactly would these include? If you've got no time to type anything up, but you know of a good online resource that explains this to non-medical persons, please feel free to just point me there. I tried to research this but found nothing.
Thank you!
( 25 comments — Leave a comment )

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