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drlahlahroo · 4 years

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A Rare Case

( SNK / Rivetra / Veterinarian AU )

Chapter 2

(read Chapter 1 here)

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He knew she looked familiar.

She was that same ginger-haired girl he saw in a class in the university auditorium more than a year ago. Back then her hair was longer, neatly tied in a low ponytail, the color a stark contrast against the mandated forest green scrub-uniform that all the senior veterinary students wore. It had caught his eye from his place at the far back of the room, where he sat low in the corner most seat to avoid the attention of anyone, especially from the students below.

The large auditorium was one of the few places Levi would normally hideaway when he wanted to take a break from a busy hospital setting (much to the dismay of the dean) as it was mostly unused and empty, only ever reserved for large gatherings and conferences, so it was a surprise to him that a class was held in it when he arrived. It wasn’t even a large class; they had only occupied the first 5 rows. Because they were so few and too far for them to have noticed his presence, he had decided to stay and eavesdrop on their lesson. It was a clinical pathology class, he recalled. They were doing a case analysis.

She had stood in response to her name being called. Levi hadn’t been able to pick it up, not like he would remember it anyway.

“Based on the clinical signs and laboratory findings, what do you think is the probable cause of the canine patient’s sudden hindlimb paralysis?” He had heard their professor ask. Doctor Mike Zacharias voice was too deep and monotonous that Levi had to strain his ears just to listen from his distance.

The ginger student did not respond immediately, but Levi could see from his spot how her brows furrowed in deep thought. Aortic thromboembolism had been his answer, and that had just been from reading the notes in the PowerPoint presentation. The girl was taking her time, and he had started to think that she was probably a slow one.

Then a hand had landed heavily on his shoulder, and in his shock, he turned to find a grinning face. “Found you, Levi.”

“Fuck off, shitty glasses.” He had to say it in a hushed grumble to avoid the class from overhearing. “How long have you been sneaking behind my back?”

“Maybe a few minutes,” Doctor Hanji Zoe’s grin had only widened, which he always found annoying. The veterinary pathologist always did seem unaffected by his crudeness. “Erwin sent me to fetch you. Said he needs you back in the hospital pronto.”

He was about to go into a tirade, something about how Erwin would just have to suck it up and find some another doctor to deal with whatever boring routine procedure he had in mind, when a feminine voice had echoed through the auditorium walls from the rows below.

“I believe it’s due to an aortic thromboembolism, doctor.” The ginger-haired girl had finally responded.

“And can you explain what made you come up with that?”

“There are irregularities in the dog’s electrocardiogram, and its femoral pulse rate is not equal to the heart rate. It’s fifty percent weaker. Meaning blood flow to the posterior-most part of the body is weak. Something is disrupting blood flow to the hind legs, so it’s most likely a clot since the patient is negative for heartworm.”

Levi had turned his attention back to the girl and ignored his colleague, although he did notice that she also seemed to be drawn to the ginger’s explanation.

“Plasma D-dimer test is also highly elevated, which means the body is trying to break down a large clot somewhere. And to add to that, the patient’s history also states that he has Cushing’s disease or hyperadrenocorticism, which is known to increase clotting factors in the blood, as well as the likelihood of forming thromboembuli.”

Levi had raised an eyebrow at that. It was a particularly difficult case to analyze even for a student, but she was able to catch the necessary markers to pinpoint the disease condition.

Her thorough explanation had rendered everyone in her class to silence. All eyes were on her.

“Excellent, Miss Ral. You may please take your seat.” He heard the proud undertones in Mike’s voice. There was a short burst of clapping and praises from the other students as she sat back down, rubbing the back of her neck, embarrassed from all the attention.

From behind him, Hanji had whistled, impressed. “Oh, it’s her. The interns back in the lab said she’s the top of her class. They weren’t kidding. Damn, that was a great response! She’s a smart kid.”

Ral. Levi repeated the surname in his head as he watched her from his corner. The lecture had continued and her attention was back to the topic, but he had noticed that, despite her previous display of bashfulness, she still wore a wide, proud smile on her face.

And that same wide, proud smile was displayed before him right now as she stood at the entryway of his office.

“ALT is elevated.” Petra declared, waving the lab results before him.

The leather of his chair creaked as he straightened from his previously lax position, then he reached for the paper presented before him.

“All other values are within normal range, except for the liver function test, so it’s a hepatic issue.” She continued, watching as he scanned the lab results with a rather bored expression.

“Platelet count is high.” He said, dropping the paper on his desk before turning to her.

Petra shrugged a shoulder. “Platelet count that's higher than normal isn't exactly significant.”

“Anything that’s not normal is abnormal, Ral.” He stood from his chair and turned towards a whiteboard that hung from the wall across the desk.

Petra watched as he retrieved a black marker and started writing “High ALT” and “Thrombocytosis” on the whiteboard. Above the 2 new additions, he had already written down “Right-side abdominal enlargement” and “Weight loss with appetite”.

“You didn’t include hepatomegaly,” Petra said as she approached the board.

“Not until I see the x-ray.” Levi lowered the marker and turned to her, eyes narrowing slightly. “Don’t assume something without completing the evidences first. A right-sided abdominal enlargement can easily be any abdominal organ other than the liver and a high ALT can be caused by other stressors to the liver.”

She crossed her arms and once again rolled her eyes at him. She’s stubborn, he can tell. She oddly reminds him of himself.

A sigh escaped his lips. Levi leaned back on the edge of his desk and crossed his arms. He stared up at those amber eyes, deciding to humor her with her suspected diagnosis.

"All right then. Assuming there is hepatomegaly, then what would you do next? An enlarged liver isn’t exactly a definitive diagnosis. Nothing in the dog’s signs and lab results would explain how the liver got big.”

This caught Petra off guard, and she uncrossed her arms and furrowed her eyebrows in deep thought. It was the same look she had on as she contemplated the answer to that case question back in the auditorium.

Just like before, she took quite a while to respond.

“We’ll check for possible causes of hepatic inflammation.” She began.

“Inflammation means infection. There’s no elevation in white blood count.” He stated matter-of-factly.

“It doesn’t have to be an infection. Certain toxins could also cause the liver to be inflamed.”

“With that much toxin to swell up a liver then his kidneys should be failing. Creatinine is within normal range. Besides that, there’s no indication of pain. It’s not inflammation," He raised his chin at her. "If all you’re going to do is list down the differentials then you’re wasting your time.”

Petra’s lips tightened and the crease between her eyebrows deepened. She turned away from his scrutinizing gaze and focused her eyes on the words written on his whiteboard.

All the while, Levi continued to watch her mental struggle. Of course, he already had an answer to his question. Even if he didn’t think this was truly a case of hepatomegaly, there was still something that would at least support her diagnosis. If she was as smart as Hanji and Erwin had claimed, she would have seen it as well. Maybe not as quick as he did, but she should be able to see it.

And when she did saw it, Levi saw that unmistakable determined fire that seemed to lightened her amber orbs.

“It’s a tumor,” she finally responded, “Elevated platelet count is a strong indicator of cancer.”

A sudden silence fell between them. Petra waited for a response from him, one that would try to rebuff her findings, but as none came, the corner of her lips tugged up slightly in a small smile.

Eventually, Levi stood straighter, slipping his hands in his coat pockets. He didn’t keep his eyes off her. “Tell the brats to hurry up with the patient’s x-ray. If it’s the liver, do a biopsy.”

Petra turned away and started walking out of his office, still wearing that proud smile on her lips. Levi trailed slowly behind her, stopping just by the door frame to watch her walk towards the lobby.

He stood there for a minute, playing back the previous debate in his head. He’d have to admit, Petra truly was a smart one, but not quick enough to gather her thoughts. That would be rather disadvantageous in emergencies, but he supposed he could let it slide for now. She’s young. She’s new. She’ll get better.

His musings were disrupted by the sound of loud barking. Normally, he was used to the various animal noises that were normal in a veterinary hospital, but for some reason, his attention had peaked at the particular sound. The barking was deep, as if coming from a large dog, but it was rough and aggressive. He turned to the noise, suddenly realizing that it was coming from the same direction Petra had walked into.

He pulled himself away from the doorframe and walked to the source of the barking, and as he got closer to the lobby, he could hear a few voices in between growls. Curiosity and uneasiness settled in the pit of his stomach.

When he reached the lobby, he saw the familiar pet owner from Exam Room 8 trying to pull back on the leather leash of the same Golden Retriever Petra had attended a few hours ago. However, the previously affectionate dog was now baring his teeth at another client, who held on to a small poodle in her arms, trying to back away at the larger canine. Petra stood in between the confrontation, while Eren and the few other interns tried to move the other owner away to a safer distance.

“I-I’m so sorry! I don’t know what’s wrong with him!” The retriever’s owner cried out, struggling to keep hold of the leash.

“Spark, calm down, boy,” Petra said in a soothing tone, getting down on one knee and lowering her arms in a way as if she was inviting the dog into her arms. But her attempt at calming down the animal was overpowered by its hostile snarls. “Is he normally this aggressive when seeing other dogs?” she addressed towards the owner a little louder.

“N-no! He has never harmed anyone or another –”

At that moment, the dog had pulled hard enough that the leash slipped from the older woman’s grasps, and it began to charge. But instead of rushing to leap up at the smaller dog that was pulled away to the far corner, it turned its eyes to the female vet crouching on the floor.

She tried to pull back quickly, but the dog was quicker. It gave one more snarl before rushing to her with jaws wide. Petra braced herself, closing her eyes and raising her right arm to protect her face, just in time to feel a pull on her sleeve.

Then she heard a tumble, a yelp followed by suppressed growls. Petra opened one eye nervously.

Doctor Levi was crouching on the floor. One of his arms was around the Retriever’s neck in almost a chokehold, while the other arm held down its torso in a manner that pinned its hind legs on the floor. It was the classic method of restraint used to steady a large dog, though Levi seemed to be adding more strength than usual. Petra noticed that despite that rather forceful embrace he had on the animal, he still avoided adding pressure to the right side of the body, where the bloating was defined.

“Get a muzzle!” the dark-haired vet cried out like an order, and suddenly the interns, who were previously dumbstruck at the situation, scrambled about, grabbing a muzzle from the nearest exam room. All the while, Levi stared down at the dog’s dilated pupils. His intimidating stare had somehow slowed down the dog’s manic state, and its growls slowly lowered in volume, until all it could muster were anxious yelps.

Eventually, one of the interns managed to fix the muzzle over its snout. When Levi deemed it safe and that the patient’s aggression had died down, he slowly slipped his arms off its body, but kept one hand over the dog’s nape, keeping its body low on the ground.

He then started shouting instructions to each intern, but it all sounded incoherent in Petra’s ears because the quick beating of her heart was too loud. The hand which was previously raised to protect her face lowered to her chest. She could feel the rapid thumping beneath her palm as she slowly stood up from the floor.

Then she felt a strong grip on her elbow. It took her a minute to realize that it was Levi’s hand, and before she could turn to him, he had pulled her away from the lobby and dragged her into the hallway. Then it took her another minute to realize that he had pinned her to the wall next to his office door.

Levi glared at her. The same glare he used that rendered that dog to silence, and Petra stilled.

“What the fuck was that?” He almost snarled. “You’re an idiot to go down face level with an aggressive animal.”

She swallowed thickly. “I… I was trying to calm it down…”

“By offering it a hug? You should know it doesn’t work like that. Just because an animal was friendly to you doesn’t eliminate the fact that it can still bite your face off if it wanted.”

Petra bit her lower lip and lowered her head. In embarrassing situations, she would normally clutch her wrist nervously, but the action caused a painful sting to run up her arm. Levi had noticed her sudden reaction, even when she tried to hide it. Reaching down, he took hold of her right arm, raising it to eye level, where the sleeve lowered down to reveal a bite mark just below her wrist.

He clicked his tongue, irritated. Petra was once again pulled away from the hall and back into his office.

“Sit.” He told her, or rather ordered her, as he shut his office door close.

Petra stood for a while, watching as he shuffled behind his desk, pulling something out from one of the drawers. Not wanting to get into his bad side again, Petra hesitantly sat on the adjacent seat in front of his desk. It was then that she noticed the box he had pulled out was a first aid kit.

He then sat across from her, sighing in exasperation. He took a moment to himself, massaging the space between his eyebrows, before offering a hand, indirectly telling her to show him her wounded wrist.

Petra did so after rolling back her sleeve. Levi’s fingers encircled her wrist in an oddly gentle manner, very different from when he grabbed her by the elbow a while ago, as he inspected the wound.

“It’s a shallow bite. Managed to nick you enough to bleed but it’s not a big deal.” He said, showing her the four indents on her skin, clearly from the dog’s canines. “Guess I managed to pull him back before he chomped down hard enough. Still, expect some bruising.” He said as he began to wipe her skin with an alcohol swab. Petra tried not to hiss.

A silence ensued as his nursing of her bite wound continued. Petra tried to hide the severe flushing of her face by turning to face the whiteboard instead. She was deeply ashamed of her naïve attempt in handling the previous situation, but was also embarrassed at her proximity with the dark-haired vet and his gentle ministrations with a wound that she could probably tend to on her own.

“I’m sorry.” She apologized with a sigh, “I shouldn’t have crouch down like that, it probably provoked him some more. No wonder he decided to come for me.”

Levi was in the middle of applying an antibiotic cream over her wound when he responded. “Yeah, you were an idiot. But your stupidity did reveal another symptom.”

Petra looked up at him suddenly, eyebrows furrowed. “What?”

“The dog’s vaccinated against Rabies, right?”

Levi heard her gasp and felt her hand stiffen and shake in his hold.

“You think the sudden aggression is due to Rabies? Are you trying to scare me? Because Rabies isn’t a joke!” She replied with a hint of fear in her tone.

“Stop fidgeting and just answer the damn question, woman.”

“The patient’s vaccinated! There’s no way its Rabies.”

“Then there you have it. You ruled out Rabies then.” Levi grumbled as he pulled her wrist back so he could start bandaging it up. “What else causes sudden aggressive behavior in dogs?”

“You think it’s a symptom?”

“Owner said the mutt was never aggressive towards other animals and humans before. Which means it’s a new symptom.”

Petra once again furrowed her brows in thought, looking up at the ceiling. “High testosterone levels.” She concluded. However, he heard the doubt in her tone, and he looked up at her with a raised brow, because she never sounded so doubtful from their previous exchange. He watched her rubbed her chin with a finger as she continued to think. “But… the patient’s neutered.”

Levi lets go of her now bandaged wrist. “When was he neutered?”

“The owner has no idea. She adopted Spark from the local shelter 3 years ago. Their previous vet noticed that the dog didn’t have testicles, so he was probably neutered before he ended up in the shelter.”

“And you confirmed he’s neutered?”

“Of course. I checked him.”

Levi hummed to himself as he leaned back on his chair. He stared up at the list of clinical signs written on the whiteboard, deep in thought. Petra watched him and could almost see the gears turning in his head. Meanwhile, she was too stumped at the new information to think of any more differential diagnoses to add on the list.

“Maybe… the aggression isn’t significant at all. Maybe the dog was just stressed out.” Petra said softly but doubtfully, “Besides, it doesn’t add up with everything else. It doesn’t explain the abdominal enlargement, or the elevated ALT, or the platelet – ”

Both of them turned to the sound of knocking. Eren slowly opened the door, peeking into the office. At the sight of the ginger vet, the boy’s green eyes widened in concern. “Doctor Ral, are you alright? We saw the dog bit you.”

Petra beamed him a reassuring smile. “I’m fine, Eren. It was just a nip. Nothing to worry about.”

There was a look of relief in his face, which quickly morphed into fear when he finally noticed the other person in the room.

“What do you want, Yeager?” Levi chimed in with an annoyed scowl, standing up and walking towards the door.

The intern ducked his head a bit, as if trying to hide away from the intimidating glare. “I-I’m sorry for intruding, Doctor Ackerman. But radiology wanted me to hand this to Doctor Ral.” He raised a large manila envelope, which the dark-haired vet quickly snatched away.

“About fucking time,” Levi mumbled, stepping aside to check inside the folder, confirming that the x-ray films belonged to their patient.

“Thank you, Eren.” Petra once again smiled at the male intern before he left in a hurry, shutting the door close. She then turned to the other person in the room, scowling at him. “You should stop scaring him like that. He’s a sweet kid.”

He ignored her, opting to pull out the films from the envelope. He approached an X-ray view box installed next to the whiteboard, flipping a switch to light up the box. Petra squints her eyes at the sudden flash of white light in front of her.

One by one, Levi clipped the films over the white surface, so that it highlighted the more translucent areas of the radiograph. Once he was done, he stepped back to get a full view of the mystery of the case.

Petra’s gaped slightly at what she saw. Just below the ribs cage was a large opaque mass that extended to most of the right of the body. It was large enough to push aside the other organs. “Is that the entire liver?”

Levi hummed, walking closer to the view box. “No. The edges are too smooth.” He raised a finger, and used it to trace the outline of an almost triangular organ in the large middle portion of the mass. “See the angular edges? This part is the liver.”

Petra had stood and drew closer to the view box, standing by the right of the male vet as she followed the movement of his finger. “Why is it… smaller?”

“It’s not. It’s the normal size. Just very compressed.”

She watched as his finger moved away from the angular shaped part and to the smoother shaped right half of the mass. “This part over here is causing the right abdominal enlargement.” He traced what appeared to be two large ovoid masses right beside the liver.

“Is that…” she paused, gaping at the images before here. Levi watched the shocked expression on her face, and he wasn’t sure if the spark in her eyes was from the light reflecting from the view box, or the sudden realization as the puzzle pieces finally started to fit together.

“You were right about one thing,” He said softly, still observing the amber glow of her eyes. “It’s a tumor… Just not on the liver.”

End of Chapter 2

Medical Terminologies:

Aortic Thromboembolism: a disease process wherein a thrombus (a large clot) is formed in the heart and later breaks off to travel through the aorta, which is a large artery that supplies blood to the abdomen and the organs there, as well as the legs, until it reaches an artery with a diameter too small for it to pass through, causing a blockage in blood flow.

Electrocardiogram (ECG): a test which measures the electrical activity of the heart, indicated by a pattern of waves printed on paper or displayed on a screen.

Heartworm: a parasitic worm which inhabits the heart and the blood vessels of dogs. It is transmitted by mosquitos.

Plasma D-dimer test: a blood test which detects of the amount of a protein called D-dimer, which increases when a clot is being broken down.

Cushing’s Disease (Hyperadrenocorticism): a serious condition wherein the adrenal glands produce too much of the steroid hormone cortisol.

Thrombocytosis: a high platelet count.

Rabies: a highly fatal viral disease in that causes brain inflammation in humans and other mammals. Dogs with the virus show sudden neurological symptoms like disorientation, seizures, and aggression. The virus is passed through the saliva and causes death as quickly as 10 days. There is no cure, but is 100% preventable through vaccination.

A/N: Ok, so I thought I could fit this entire story within 2 chapters, but it appears to be much longer than I originally planned. Which is great, I suppose. Everyone’s always happy with an extra chapter hahaha! Chapter 3 would hopefully conclude this story, but you never know. Wink wink.

And as usual, no actual due date for the next update, but let’s see if I can get it up by next week. Until then, always vaccinate your pets!

#rivetra #levi ackerman #petra ral #veterinarian AU #veterinarian #veterinary au #fanfic #attack on titan #snk #aot

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drlahlahroo · 4 years

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A Rare Case

( SNK / Rivetra / Veterinarian AU )

Chapter 1

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She first saw him 2 years ago. Back then, she was on her 4th month as an intern in Trost Veterinary Teaching Hospital and had been assigned in the O.R., where she became one of the lucky few from her university to see him in action.

“They say he’s the best veterinary surgeon in Paradis.”

“But I heard he doesn’t do a lot of surgeries anymore, at least not as regular as most surgeons.”

“I heard it’s because he only takes up rare cases. None of those regular neutering and stuff. He’s just that great!”

“Well he did graduate top of his class back then. So he probably does more than just surgeries.”

“He’s pretty short though. I thought the Doctor Levi Ackerman would be some tall, beefy guy or something after I heard he performed a delicate cesarean on a Chianina cow by himself. Those things are massive, you know!”

“Petra, what do you think?”

Petra had hushed her fellow interns, opting to focus her attention on the ongoing surgery. She recalled looking down at the surgical theatre in wonder as he made one last clamp on a rather large vessel, before he raised a scalpel to make a long cut. Then he and the assistant across from him lifted the basketball-sized tumor from within the abdominal cavity of a Jack Russel Terrier.

No sooner after that, he was closing the dog up. He sutured very quickly – something her professor in surgery would surely argue against, as impatience would lead to ugly stitches and, therefore, ugly scars. But she had attended to that patient post-operation and found his stitches to be so precise and so perfect that it would heal as if nothing ever happened.

It was the fastest splenectomy Petra has ever witnessed in her entire life, especially on a high-risk patient. She never met another veterinarian who could beat his 2 hour and 32 minutes record.

She did come close though. 3 hours and 16 minutes on an almost similar case. Not that time should matter, as surgical success should not be solely based on speed, but it did catch the attention of her dean.

Less than a year after passing the board exam, she received an email from Doctor Erwin Smith, the dean of Veterinary Medicine from her alma mater, allowing her an opportunity to be part of the surgical department in Trost Veterinary Teaching Hospital, one of the top veterinary hospitals in the country. It was an offer she couldn’t refuse.

So here she is now in Doctor Smith’s office in her freshly pressed white-coat, with the name Petra Ral, DVM embroidered on the left breast pocket. They were going through some minor details about her employment when the door burst open and a rather short, dark-haired man stepped in with a scowl on his face.

“Erwin.” It was the first time she heard his voice. It was low and laced with irritation. “What’s with this new team your making that I have to lead and shit.”

“Impeccable timing, Levi. I’d like to introduce you to Doctor Petra Ral” Dr. Smith said with a smile, seemingly unaffected by the other male’s glare. “Doctor Ral, I’m sure you’ve heard about Doctor Levi Ackerman.”

Petra stood and turned fully to face Doctor Ackerman, smiling despite the intimidating stare he gave her. “Um…yes. I’ve heard many great things about you, doctor.” His scowl only seemed to deepen at that.

“Doctor Ral will be a new member of the surgical department. She graduated top of her class and is one of the best veterinary surgical interns I ever met. Quick, but precise.” At Doctor Smith’s praise, Petra dipped her head to hide a blush. She didn’t exactly think she was that great.

The blond veterinarian turned his attention back to the shorter male, who had crossed his arms over his chest. “Her skills almost remind me of yours, Doctor Ackerman. I was hoping that you’d handpick her to join your special team –”

“I don’t need a team.” Levi snapped back, cutting him off.

“A special team?” Petra asked, turning back to the dean.

“Yes. I wanted to form a special diagnostics and surgical team that would focus on high-risk and unusual cases. Something more in Doctor Ackerman line of interest.”

“And something I don’t need a team for. I’ll be fine by myself.”

Levi had walked closer to Doctor Smith’s table until he stood next to her, allowing Petra an up-close inspection of the well-renowned veterinary surgeon. She always thought he would be around her height based on when she first saw him, but it seemed that she was still a little shorter. He looked quite youthful for a man in his thirties, the only indicator of his age evident in the lines under his eyes. Either that or he just didn’t sleep a lot.

It was at this point that Erwin’s smile dropped. “You need a team, Levi. You can’t keep doing things by yourself.” He then reached for a folder on his desk and raised it for him to see. “I got you a case. It’s a referral from Doc Pixis. The patient and the owner are already waiting in Exam Room 8.” He then glanced at her. “I would like you and Doctor Ral to handle this one.”

Petra blinked in surprise. If this was a case meant for the Levi Ackerman, then surely it must be a difficult one. Something a fresh graduate like her would not be able to handle. “Doctor Smith, are you sure about this? I mean, I just started and I don’t think I have the experience to tackle such a case.”

“I trust in your capabilities, Doctor Ral,” he smiled at her, “I know you’ll do just fine. Hopefully, Doctor Ackerman will appreciate your skill sets as well, at least enough for him to be convinced that he needs a team.”

“There’s no need to tag her along, or anyone else for that matter. If I need someone, I’ll just call one of the brats.” Levi complained once again.

At that, Erwin stood, and he stood tall. Practically towering everyone else in the room. It rendered the other male into silence. Petra could tell that this was a topic the two have probably argued about for a long time now. However, she could understand why someone like Doctor Levi would be against the idea of putting up another team. It wasn’t exactly needed, and it was just going to be an extra expense in the hospital’s part. But it was always hard to say no to the orders of their dean. Besides, it was under his leadership that Trost VTH became the success that it is today.

The dean raised his arm, stretching out the folder in his hand towards the other male. “At least assess her competence, Levi. I’m sure you’ll see how she could be a great asset to this hospital.”

From the corner of her eye, she thought she saw him inspect her from head to toe with a grimace. He eventually clicked his tongue before snatching the case file from the dean’s hand. Petra watched as he flipped it open, then skimmed through the contents of the first 2 pages, before shutting the folder again. Then he all but shoved the case file in her arms, much to her surprise, before he turned to the door and exited without a word.

Confused, Petra looked down at the folder in her hands before turning back to the dean, who let out a sigh of exasperation.

She bit the inside of her cheek, thinking her words thoroughly before speaking. “Uh…Is he always this…”

“Rude? Stubborn?” Erwin completed her sentence for her with an apologetic smile tugging his lips. “Don’t worry, you’ll get used to it quickly the more you work with him.”

Her smile dropped, “I don’t think he’s even interested in –”

“Oi.”

Petra quickly turned back to the door, where the dark-haired veterinarian was suddenly standing again. He nodded off to the direction of the hallway impatiently. “What the hell are you waiting for? Let’s go.”

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Levi halted in front of Exam Room 8, holding back a grumble in his throat. From the corner of his eye, he watched the ginger-haired vet halt a meter away from him, the case file held over her chest. He turned to look at her and he thought he saw her flinch a bit. She was short, shorter than him, and for once he was glad to find another doctor in this damn hospital that he didn’t have to crane his neck up just to look at. Still, he wasn’t impressed. She looked young and inexperienced – the kind of girl who would rather hug and comfort a horse than drain the abscess from its infected neck. She could be the smartest student in her class but may lack grit in the field. Levi has seen so many veterinarians like her.

Turning away from her for a bit, he called out down the other side of the hall where 3 interns in scrubs were busy mopping near the lobby. “Hey brat.”

A dark-haired male looked up. His green eyes widened at the sight of the doctor and he almost dropped the mop. Petra watched curiously as Levi called him over and the intern stiffly stood between the two of them, his visibly taller height apparent. On his left breast, the name Eren Yeager is embroidered in striking white against his forest green scrubs, which were slightly wrinkled at the edges. She could see the slight apprehension in his features as he waited for the older vet to speak.

“This is Doctor Ral. She’s new. Assist her.”

“Y-yes, Doc.”

Levi handed him the clipboard that hung from the side of the exam room door. “Get the initial signalment,” he said, eyes narrowing, “Don’t fuck it up, Yeager.”

The boy nodded, nervously taking the clipboard before opening the sliding door enough for him to step in.

“Do you always intimidate interns like that?”

Levi turned back to the ginger. She had her arms crossed and one eyebrow raised at him, with a look of annoyance. He clicked his tongue, shooting back a scowl. “His handwriting is shit and he always make a mess in the workroom.” He then crossed his arms over his chest, mirroring her pose. For a while, they exchanged glares.

Then he nodded his head to the direction of the door. “Well, get in.”

Petra blinked. “What?”

“I said get in. You don’t want to keep them waiting.”

She pursed her lips in annoyance before turning to open the sliding door. She steps in just enough to notice the young male intern lift a golden retriever off the weighing scale, when she realized that Levi did not follow her into the room. She turned back to the open door to find him still outside, leaning on the door frame with arms still crossed and eyes closed.

Petra stepped back out the door and faced him. Levi noticed her presence enough to bat one eye open.

“Are you not coming in?”

“No.”

“You’re letting me do this on my own?”

He shrugged. “You interned here, didn’t you? You already know where all tools and the important stuff is. Besides that, you got your license now. Surely you know what to say and do.”

“Doctor Smith said we have to handle this together.”

“Erwin wanted me to assess you,” He uncrossed his arms, opting to slip them into the side pockets of his white coat, “So I’m going to assess you from out here. Now get in.”

She stared up at him with an incredulous expression, mouth slightly ajar. She eventually resigned herself to do the examination on her own, turning back into the room, but not before shoving the folder back at him in almost the same manner he did back in Doctor Smith’s office. She then raised her chin and entered the room, hoping the dog’s owner wouldn’t see the stress behind her smile.

The intern handed her the clipboard, and she gave a glance at the patient’s name in the file before she offered a hand to the older woman in the room. “Good morning, ma’am! My name’s Doctor Petra Ral, and I’ll be Sparks attending veterinarian.”

From his spot outside, Levi watched as the ginger vet performed the basics of physical examination: taking the dog’s temperature, checking the skin, eyes, and ears, running her hands through the fine golden fur and palpating for lymph nodes. All the while, talking animated with the owner, asking the necessary questions while the green-eyed intern wrote as fast as he could.

She had giggled along with everyone else in the room when the Retriever licked her cheeks in affection while she held the bell of her stethoscope to its chest. Levi then saw her squeeze the dog’s face, squishing it. The odd and funny face made everyone laugh. The dog seemed to enjoy the attention (as most dogs do), scooting closer to the female vet and laying its large head on the crook of her arm. The air in the room was calm as she continued with her ministrations. Even the intern, who normally stood stiff and awkward when he was around, visibly relaxed in her presence.

Soon enough, she began asking the more serious questions, and he could see the exchange of worried faces as the owner began to point out her complaints. Levi drowned most of it out. It wasn’t anything different from what he saw in the file from the referring vet: Malaise, continued loss of weight despite normal appetite, and abdominal enlargement with no apparent pain that was first noticed 2 months ago. He was more interested in hearing the tests she’d want to be performed.

“All right,” He heard her say after all questions were asked. He watched her hang the stethoscope around her neck and turn to the male intern, “Eren, let’s draw some blood for CBC, creatinine, BUN, TP, and ALT. Then kindly get him to radiology for some abdominal x-rays in left and right laterals and dorsoventral views.”

The intern nodded and began to assist her in drawing the dog’s blood into a few tubes. It didn’t take her long to do the procedure. Levi has encountered many fresh graduates draw blood with shaky hands, but Petra was quick – not a twitch on her wrist.

Soon enough, Eren was leading the dog towards the door and he had to step out of the way as they exited the exam room and continue off towards the radiology department.

Petra made one last conversation with the owner, asking her to wait inside until the intern return with her dog, before she left the room with the tray of test tubes containing the dog’s blood samples.

Just as she slid the door close, she heard him speak, “Why ask for ALT?”

He was still leaning on the wall next to the door, scrutinizing her. She turned to him fully, one hand on her hip and that same exasperated expression on her face. “Well, if only you ‘personally’ examined the patient, then maybe you would have noticed the abdominal enlargement.”

“Then surely a simple radiograph would have sufficed, don’t you think?”

He saw her roll her eyes at him, which slightly pissed him off, because nobody rolls their eyes at him.

“Well, if only you ’personally’ examined the patient,” she repeated with more emphasis, “then maybe you would have noticed that the abdominal enlargement is more prominent on the right side.”

“And you’re suspecting it’s the liver.”

“The liver’s in the cranial right quadrant of the abdomen, is it not?” She stepped forward towards him and, as if trying to match his intimidating air, looked up to see him eye to eye. Petra noticed his irises were an icy blue-grey, almost like steel. “Or do you need help in reviewing your anatomy?”

If he was upset at that, he didn’t show it. Instead he tilted his head to one side, eyeing her back. Levi finally got a good look at her eyes, which were a vibrant but fiery amber.

“There’s no jaundice.” He stated.

She raised an eyebrow. “How would you know that?”

He raised the folder. “It’s stated here. This is a referral remember? Maybe you should opt to read the case files beforehand to avoid wasting time repeating the questions the owner already heard from the last vet.”

Petra glanced up at the folder in his hand, biting her lower lip in annoyance at being bested and for actually forgetting to take a look at the file in the first place. But she still had one counter to his argument.

“Hepatomegaly doesn’t always present with jaundice.”

Levi didn’t change his expression, nor move at all. He did make a low hum, as if in thought. Petra took this opportunity to lightly snatch the folder from his raised hand. She tucked it under her arm and then turned away to the other side of the hall.

“I’m taking the samples to the lab.”

Levi lowered his arm and watched her go. Then he slipped his hands back inside the pockets of his white coat while the corners of his lips tugged upward slightly.

End of Chapter 1

Medical terminologies:

Signalment: the complete description of a patient, like species, breed, age, date of birth, sex, etc.

CBC (Complete blood count): a test to check for the number of red blood cell and white blood cell and other important blood values

CREA (Creatinine): A test that measures the levels of creatinine in the blood, which is a waste product when muscles breakdown. The test determines if the kidneys are functional and has the capacity to excrete the creatinine.

BUN (Blood Urea Nitrogen): a test that measures the amount of nitrogen in the blood, which is another waste product. The test also determines if the kidney is functional enough to excrete the nitrogen.

TP (Total Protein): a test that measure the total amount of albumin and globulin (both are 2 types of proteins) present in blood. It is checked when a patient has unexpected weight loss.

ALT (Alanine aminotransferase): a test that checks for liver damage.

Cranial Right Quadrant: The upper right side of the abdomen.

Jaundice: a medical condition that causes yellowing of the skin, whites of the eyes, gums and tongue, due to excess of a pigment released by a diseased liver.

Hepatomegaly: a medical condition of having an enlarged liver, which often presents as an abdominal mass.

A/N: This was the result of a request by @mare-dogs. And since I am an actual veterinarian, it was something I couldn’t refuse to do. So, I incorporated my professional knowledge and experience into this Rivetra two-shot. I’m also a big fan of House, M.D., so If you’re a fan as well, then maybe the flow of the story might seem familiar to you.

But damn, a medical themed story is really hard to write! Took me a while plotting how this would go, and I had to draw out old files of interesting cases I actually handled to make this feel more realistic. I also needed to review my books to maintain accuracy, especially with medical facts. I might make a few slip-ups here and there, but I’ll try to make it work.

There is no definitive schedule when the next part of the story will be published, but I’m already on it. So let’s hope I managed to get this done soon. So stay tuned. Until then, spay and neuter your pets!

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drlahlahroo · 4 years

Text

A Rare Case

( SNK / Rivetra / Veterinarian AU )

Chapter 1

/////////////////

“They say he’s the best veterinary surgeon in Paradis.”

“But I heard he doesn’t do a lot of surgeries anymore, at least not as regular as most surgeons.”

“I heard it’s because he only takes up rare cases. None of those regular neutering and stuff. He’s just that great!”

“Well he did graduate top of his class back then. So he probably does more than just surgeries.”

“Petra, what do you think?”

It was the fastest splenectomy Petra has ever witnessed in her entire life, especially on a high-risk patient. She never met another veterinarian who could beat his 2 hour and 32 minutes record.

“Erwin.” It was the first time she heard his voice. It was low and laced with irritation. “What’s with this new team your making that I have to lead and shit.”

“I don’t need a team.” Levi snapped back, cutting him off.

“A special team?” Petra asked, turning back to the dean.

“Yes. I wanted to form a special diagnostics and surgical team that would focus on high-risk and unusual cases. Something more in Doctor Ackerman line of interest.”

“And something I don’t need a team for. I’ll be fine by myself.”

“There’s no need to tag her along, or anyone else for that matter. If I need someone, I’ll just call one of the brats.” Levi complained once again.

Confused, Petra looked down at the folder in her hands before turning back to the dean, who let out a sigh of exasperation.

She bit the inside of her cheek, thinking her words thoroughly before speaking. “Uh…Is he always this…”

“Rude? Stubborn?” Erwin completed her sentence for her with an apologetic smile tugging his lips. “Don’t worry, you’ll get used to it quickly the more you work with him.”

Her smile dropped, “I don’t think he’s even interested in –”

“Oi.”

/////////////////

Turning away from her for a bit, he called out down the other side of the hall where 3 interns in scrubs were busy mopping near the lobby. “Hey brat.”

“This is Doctor Ral. She’s new. Assist her.”

“Y-yes, Doc.”

Levi handed him the clipboard that hung from the side of the exam room door. “Get the initial signalment,” he said, eyes narrowing, “Don’t fuck it up, Yeager.”

The boy nodded, nervously taking the clipboard before opening the sliding door enough for him to step in.

“Do you always intimidate interns like that?”

Then he nodded his head to the direction of the door. “Well, get in.”

Petra blinked. “What?”

“I said get in. You don’t want to keep them waiting.”

Petra stepped back out the door and faced him. Levi noticed her presence enough to bat one eye open.

“Are you not coming in?”

“No.”

“You’re letting me do this on my own?”

He shrugged. “You interned here, didn’t you? You already know where all tools and the important stuff is. Besides that, you got your license now. Surely you know what to say and do.”

“Doctor Smith said we have to handle this together.”

“Erwin wanted me to assess you,” He uncrossed his arms, opting to slip them into the side pockets of his white coat, “So I’m going to assess you from out here. Now get in.”

“All right,” He heard her say after all questions were asked. He watched her hang the stethoscope around her neck and turn to the male intern, “Eren, let's draw some blood for CBC, creatinine, BUN, TP, and ALT. Then kindly get him to radiology for some abdominal x-rays in left and right laterals and dorsoventral views.”

Soon enough, Eren was leading the dog towards the door and he had to step out of the way as they exited the exam room and continue off towards the radiology department.

Just as she slid the door close, she heard him speak, “Why ask for ALT?”

He was still leaning on the wall next to the door, scrutinizing her. She turned to him fully, one hand on her hip and that same exasperated expression on her face. “Well, if only you 'personally' examined the patient, then maybe you would have noticed the abdominal enlargement.”

“Then surely a simple radiograph would have sufficed, don’t you think?”

He saw her roll her eyes at him, which slightly pissed him off, because nobody rolls their eyes at him.

“Well, if only you 'personally' examined the patient,” she repeated with more emphasis, “then maybe you would have noticed that the abdominal enlargement is more prominent on the right side.”

“And you’re suspecting it’s the liver.”

If he was upset at that, he didn’t show it. Instead he tilted his head to one side, eyeing her back. Levi finally got a good look at her eyes, which were a vibrant but fiery amber.

“There’s no jaundice.” He stated.

She raised an eyebrow. “How would you know that?”

“Hepatomegaly doesn’t always present with jaundice.”

“I’m taking the samples to the lab.”

Levi lowered his arm and watched her go. Then he slipped his hands back inside the pockets of his white coat while the corners of his lips tugged upward slightly.

End of Chapter 1

(read Chapter 2 here)

Medical terminologies:

Signalment: the complete description of a patient, like species, breed, age, date of birth, sex, etc.

CBC (Complete blood count): a test to check for the number of red blood cell and white blood cell and other important blood values

TP (Total Protein): a test that measure the total amount of albumin and globulin (both are 2 types of proteins) present in blood. It is checked when a patient has unexpected weight loss.

ALT (Alanine aminotransferase): a test that checks for liver damage.

Cranial Right Quadrant: The upper right side of the abdomen.

Jaundice: a medical condition that causes yellowing of the skin, whites of the eyes, gums and tongue, due to excess of a pigment released by a diseased liver.

Hepatomegaly: a medical condition of having an enlarged liver, which often presents as an abdominal mass.

#rivetra #levi ackerman #petra ral #veterinarian #fanfic #AU #attack on titan

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