I.
Paramedics are still unloading the injured from ambulances when Ishida Ryuuken reaches the emergency room, summoned by his pager and word of a four-car accident on one of Karakura's busiest roads. Once again, he's told, a rainy night, slick streets, and a drunk driver have added up the usual disaster: three killed outright, two already in surgery, and a handful more injured on the way. It's another tragedy, but only notable for being wholly banal. Everyone at the hospital has seen this story before.
Except this particular story never actually happened, not as it's being told. Even before he hears the victims' oddly garbled accounts, Ryuuken is certain that he'll only hear lies. He felt the confrontation between the shinigami and the hollows like a normal person might feel an earthquake; he guessed that there would be collateral damage, and he knows how Soul Society deals with inconvenient witnesses. Now the rotten reiatsu seeping from his patients' wounds is making his head ache. His only consolation is that it's probably not enough to interfere with their healing, only enough to inconvenience their Quincy doctor.
He's hurrying between examining rooms when his spiritual powers flare into awareness. He's being watched. His feet stop and turn of their own accord; his fingers itch to shape a bow. At first all Ryuuken finds behind him is the expected chaos of an emergency room during a crisis; then he narrows his gaze, and waving white spirit ribbons overlay his vision. He's only slightly surprised when he spies a tell-tale flicker of red.
The next day, when he completes his rounds, he's not surprised to discover that every trace of Hollow reiatsu in his patients' wounds has disappeared.
II.
As the days pass, Ryuuken becomes aware that strange things are afoot in Karakura. Hollows are appearing more frequently, and so are shinigami; the air fairly crackles with reiatsu. Ryuuken's thoughts return again and again to that red ribbon and what it might mean. He eventually concludes that the shinigami presence in his hospital that night had nothing to do with him or his secrets.
He comforts himself with this lie until the department chief interrupts him during his rounds to introduce his newest colleague.
"This is Kurosaki Isshin, Ishida-san. He'll be joining the department, starting today."
Ryuuken's too used to deception to show his surprise, so he nods his head coolly at the newcomer, pretending he can't see the red spirit ribbon waving like a battle flag. "It's a pleasure to meet you, Kurosaki-san."
"Likewise, Ishida-san."
The shinigami's neutral expression gives nothing away during the small talk that follows, and Ryuuken wonders if the shinigami's presence in Karakura is, after all, just a coincidence. But that hopeful fancy is shattered a few minutes later, when one of the nurses briefly claims the chief's attention. The shinigami immediately takes the opportunity to offer Ryuuken a manic grin and thumbs up behind the chief's back.
Ryuuken decides that he hates his life.
III.
"This is the only time we're going to have this conversation, shinigami," Ryuuken says. He's tracked down the other doctor in his office and locked the door to prevent any interruptions. "Stay out of my business. In fact, just stay out of my way, period."
"Oh, is that all?" The shinigami laughs as he shucks off his white doctor's coat; he hangs it in the closet, exchanging it for a leather jacket. "What makes you think my presence here is about you, Ishida?"
"You're telling me it's a coincidence that a shinigami showed up in the hospital where the last heir of the Quincy works? And stop addressing me so familiarly!"
"Last heir of the Quincy? And here I thought I'd left dramatic statements like that behind in Soul Society." He pauses, then adds, a bit forlorn, "You could call me by my name once in a while, you know. 'You', 'idiot', and 'shinigami' are getting old."
"I refuse to use a name that's so obviously fake."
"Have it your way then, Ishida." The shinigami pats his pockets and finds them empty. "Hey, can I bum some cigarettes off you? My girlfriend says I look cool when I smoke."
"Cigarettes? Girlfriend? Oh, please don't tell me anymore." Ryuuken buries his face in his hands. "Sometimes I think I'd rather be dead."
"Trust me, you don't. It's really quite dull. Same old, same old, century after century. The living world's a blast in comparison." The shinigami checks his appearance in a mirror on the wall before stepping around Ryuuken to reach the door. "See you in the morning, Ishida! Wish me luck on my hot date."
When the shinigami's gigai has disappeared into the elevator, Ryuuken goes off in search of drugs to ward off his budding migraine.
IV.
"You're still here," Ryuuken says to the shinigami one night many months later. "Why?"
The shinigami nearly chokes on his mouthful of canned coffee. "Eh? Where did that come from?"
The two doctors are standing in the driveway leading up to the emergency room, indulging in their usual vices, nicotine and caffeine. The graveyard shift's been quiet for once, and both are hoping that the crisp autumn air will do something to keep them awake in the absence of the usual adrenalin.
"I keep expecting you to disappear back to your other life. Er, existence." Ryuuken leans against the nearest wall and looks up at the starry sky. "But you're still here. So why?"
The shinigami shrugs. "The obvious answer would be that I haven't completed my mission."
"Oh, a semi-serious response? That's strange. Where happened to the idiot jokes?"
"Don't know. What happened to your usual hostility? You even started a conversation with me of your own free will."
"I don't have the energy to be hostile at this hour." Ryuuken yawns. "You'll have to settle for mild sarcasm. I'll be hostile tomorrow."
"Fair enough. I--Oh, here they come."
Ryuuken's noticed that the shinigami always hears the sirens first; it's almost as if something else warns him of their approach. Ryuuken watches the ambulances speed along the road and sighs. "Three of them. So much for a quiet night." He steps back, until he's no longer in danger of being run over when the ambulances pull up. "Get out of the driveway, fool. And don't think I haven't noticed that you've avoided my question."
The shinigami tosses his empty can into the nearest receptacle, then cracks a smile. For once, it looks forced. "With regards to that, there are two possibilities you're overlooking, Ishida."
"And those are?"
"First, that I don't want to go back."
"So you're a runaway from Soul Society? Try that on someone more naive. What's the other?"
"That I simply can't."
"What would stop you?"
The shinigami's not one for straight answers; even in his odd mood, it's unlikely he would have offered one. But Ryuuken never finds out what the shinigami's answer would have been. The question's been drowned out by the howling sirens, and when the ambulances screech to a halt in front of them, both doctors have more urgent things to think about.
V.
"You're opening a clinic?" Ryuuken reaches for his cigarettes, defying the "No Smoking" signs posted throughout the hospital. "Do what you want. It's not my affair."
The shinigami dances in merry circles on the other side of Ryuuken's desk. "We've just found the perfect location! The house attached has lots of room for our blooming family!"
Ryuuken's hands freeze in the middle of their search for his lighter. "Family?"
"Masaki is due in July!" The shinigami grins, and Ryuuken cringes. It's been a while since he's been face to face with that mad glee. "If it's a boy, we're going to name him Ichigo!"
"You're naming your kid after a fruit? Do you want him to get beat up in school? What an awful father." Then Ryuuken's brain catches up with his mouth, as everything he knows about reproductive biology and gigai suddenly registers. "Wait, how is that even possible? You're not even human! Or alive!"
The shinigami cackles insanely. "Ishida, never underestimate the power of science!"
Ryuuken remembers meeting a certain person wearing a bucket hat and geta and decides he is happier not knowing any more details. He settles for saying, "The very idea of you breeding makes me feel vaguely ill."
The shinigami pats him on the shoulder. "You and your wife better hurry up, Ishida. Our kids will be in different years at school if you don't!"
Ryuuken can only put his head down on his desk and laugh. His wife's lab tests only came back yesterday. "Actually," he mumbles more to himself than his tormentor, "you don't have to worry about that."
"What do you mean?"
"You'll find out." He counts the months in his head. "Ask me again in November. Now get out."
Author's note: According to the datasheets in the manga, Ichigo's birthday is July 15, and Uryuu's is November 6.