Amelia gets her PEG Feeding Tube Removed (Part 1)
In this one shot (which will be uploaded in two parts), Amelia decides to have her PEG removed and approaches Carlisle about it. He reflects briefly on meeting Amelia and making the decision the make her a part of the family, with some help from the most unlikely member of the Cullen clan. Special thanks to my very own (soon to be) Dr Samodien for generously allowing me to borrow her name.
POV - Carlisle.
From where I was sitting in my study, I could hear Amelia pacing up and down her bedroom. I grinned to myself. My youngest daughter was going to wear a hole in the wooden flooring if she didn't stop soon. I had left my door propped open, waiting for her to come to me. The rest of my family was out and about. Esme had gone to Port Angeles to fetch Amelia's medication. There was a delay at the hospital's pharmacy, where we usually got her medication from. It was sent from Seattle, but due to some or other mix-up, it had been sent to the wrong hospital. For reasons known only to themselves, the hospital wanted to send it back to Seattle so that it could be resent to Forks. It was a ridiculous notion, but we had one of two options, either wait for it to arrive in Forks, or fetch it ourselves. Esme preferred to keep a well-stocked drug supply for our daughter, and decided rather than wait three additional days for the medication to arrive, she'd fetch it herself.
Edward, Bella and Renesmee were out on the reservation again, it was one of the pack members' birthday, Jared I think they said. The rest of my children had gone to Seattle, Blythe included. One of my colleagues was now one of my children. It was a strange concept, her medical knowledge and capabilities far surpassed mine, even although she was nearly two centuries younger than me. Blythe had been living with us officially for a few weeks, her brief absence while she returned to Germany leaving a void within the family. Amelia took their separation the hardest, Esme was a close second. Alice had been resolute that Blythe would return within a week of leaving, and she was, as per usual, correct.
Alice had told us a few weeks previously that Amelia wanted to remove her PEG feeding tube. It was providing her with enteral nutrition, as she needed the extra supplements to keep her weight up. Her appetite had all but diminished and her weight was plummeting. 50kg, or 110 pounds was our goal. She weighed substantially less. It worried me, but any intervention was merely palliative at this stage. She'd given up the fight, and was about to ask me to remove the one thing that kept her going. I could understand it from her perspective – its mere presence was prolonging her human life and forcing her to endure more unnecessary suffering in the process by providing us with a means of enteral nutrition. But to remove it completely?
I recalled the first time I laid eyes on her, so sickly and frail, but with an internal resolve that would not be silenced. Esme had suggested making her a part of our family within a day, but I was hesitant. I'd read Amelia's file, I'd heard Dr Anderson telling Dr Sanders that her young patient was refusing a transplant. She had respect for the seemingly fearless teenager whose grip on reality was unfailing. Like Joanne Anderson, I knew that the likelihood of Amelia being stable enough to undergo the minimum-eight hour surgery was statistically unfavourable. Lung transplants had the highest rejection rate out of any donated organ of the human body. Reality was that even if she survived the surgery and the extremely critical post-operative period, she would have invariably fallen into the category of patients who go into chronic rejection within the five year mark.
As much as I wanted to make Esme happy and make this dying fifteen year old a part of our family, her happiness would have been short lived, and I would have a wife who grappled with the loss of another of her children for eternity. She mourned for her human son, who had passed after only two days, and while she had moved on from it, he was never far from her thoughts. Only time would have told how long Amelia would have survived for. I was not sure that I could do that to the love of my life, to subject her to that kind of pain. Bringing Bella into the family was different, as she was Edward's mate. Chalk and cheese, I had tried to rationalise with Esme.
It wasn't until Esme had gone to visit Amelia during visiting hours that I finally understood the level of Esme's feelings for the young girl. Edward and Alice helped of course. As my first companion, Edward was my sounding board for a lot of major decisions. We had an understanding that I did not have with any of my other children. I quickly learned that my children had been fooling both Esme and myself with their plans to decorate the empty spare bedroom next to my study.
According to Alice, Amelia was already a part of our family. Her decision to not have a lung transplant was all but cemented, but as no one had broached the topic of immortality with her yet, Alice could not determine her presence as an immortal member of the Cullen family. Jacob had wrestled the phone away from Alice and informed me that he could accept Amelia being changed when the time was right. Rosalie had then screeched and lunged for the phone, only to inform me that I had better be bringing her baby sister home, and that if it came to it, she'd change Amelia herself. There was a loud squabble until someone had the sense of mind to put the phone onto loudspeaker and I could speak to all of my children at once. I was pleasantly surprised to hear a unanimous decision for once. There was always someone disagreeing with someone else about something. The vote to change Bella was nearly a full out war. Rosalie and Edward had been outvoted, but both were equally determined to make their opinions understood to the human in question.
Rosalie's decisiveness was surprising, as she had been the daughter who had been the most difficult and the most bitter about her change. She begged me to change Emmett, if only for selfish reasons, but she refused to condemn someone else to this life, someone who might otherwise have had a choice. Were they aware of their potential sister's failing health? It seemed that for once, I would be the one outnumbered. I hated to damn someone as well, but Amelia's change would have been because there was no alternative, other than death.
"Rosalie, why are you so supportive of this decision?" I had asked, mystified. My eldest daughter was stubborn and set in her ways, why change her mind now?
"Because I can't stand the thought of losing my baby sister," she had replied quietly.
"Your baby sister?"
"Yes. She is one of us. Carlisle, I can't help but feel attached to her already. She needs us." And I need a sister, not a friend. The unspoken words were there. Rosalie would forever be rebuked for her less than friendly attitude towards Bella, perceiving her to be a threat. She knew that an incident involving Bella would be responsible for an untimely move from Forks, and she had not been wrong. She took no satisfaction in being right. Rosalie hated change, it reminded her too much of her immortality – her body remaining unchanged while the rest of the world aged.
"We'll have to move, you know that, kitty?" I reminded her, calling her by the familiar nickname born out of affection that never failed to bring a smile to her face. She was like a cat in some ways, lithe and graceful, but every inch the predator she was when aggravated.
"I know," I pictured her smile, her nose scrunching up as it always did when I called her that, "but it will be worth it."
"You really want this?"
"Yes."
"Alright."
Alice had started shrieking gleefully again. I suddenly had adoption papers arriving in my email inbox. Always prepared was Alice. That day, Esme and I gained another daughter, one who would be uniquely challenging in her own right. Round-the-clock care dictated the next few months, and would continue to do so until Amelia's heart stopped beating. It is said that one cannot miss what one does not know, like how someone born deaf cannot miss hearing, having never experienced it. The loss is always more acute to have had something, and then lost it.
I didn't know what I was missing until Amelia joined us, I didn't fully fathom how much she meant to us all until we almost lost her in Rochester, and again in Forks, barely a month later. Amelia completed our somewhat motley accumulation of vampires that we called family, something which Esme remarked on frequently. My wife adored her human child, her joy at being able to care for someone was almost tangible. Our children loved their sister fiercely, determined to go to the ends of the earth to ensure her safety. I loved my new daughter with every fibre of my being. There was always room in my heart for more love. As a family, we watched our beloved human gradually come out of her safe little cocoon that she had constructed to safeguard herself, and bore witness to her flourishing with each passing day. When we first saw her, she was burdened and unloved, carrying around the ghosts of her past to her detriment. Now she was free, her past no longer haunting her, and very much loved.
Now in April, three months since Esme and I had met her, we barely recognised her - she was a shadow of her former self, but in a good way. She had had a confidence about her and her fighting spirit had returned for a while. Since the concert, she had gradually lost that spirit again, lost that determination. She had little choice but to admit defeat, as her disease took its toll one final time, ravaging her body for the last time ever. She was exhausted from the fight. I didn't blame her one iota, how did she manage to continue the fight for so long, alone? With family by her side, she fought. She fought for Esme, for her siblings, and for me. She dragged herself through each hurdle that crossed her path, if only for Esme's sake. She had finally managed to cross off an item from her bucket list: to love someone, and be loved in return.
From her bedroom, Amelia sighed decisively and walked towards her bedroom door. Here it comes.
"Come in, sweetheart," I called, hearing her pause at the study. I glanced up and smiled wryly at her, her hand still raised in a fist to knock. She was ever the polite one, always knocking and waiting for permission to enter, knowing fully well that we could hear her.
"Can we chat?" she asked softly, staring at the floor as if it were the most fascinating thing on earth. I put my pen down and pushed myself away from my desk, walking over to the couch, a silent encouragement. Hesitantly, Amelia sat down too and stared at her hands.
"What's bothering you?" I queried, knowing that my dark-haired human daughter needed to speak to me on her own terms. I supposed that to an outsider, I could be misconstrued as having a favourite child. I had seven others, Bella and Blythe included, all of whom were vampires and therefore more capable of looking after themselves. Amelia was different. The others were frozen forever, but she was not. That in itself made her vulnerable. She was our number one priority. She had different needs, how could one treat their children the same when they were so vastly different that they were practically worlds apart?
"I want my PEG tube removed," Amelia stated in a rush, obviously wanting to get it out of the way before she lost her nerve.
"Why?"
"Because it needs to go. I'm stopping the feeds. It serves no purpose. How are we going to get it out when I am turned?"
"We can remove it just before, or at the beginning of the change," I stated confidently. I saw Amelia's resolute determination falter, before she gathered herself together and fought back, refusing to allow me to change her mind. Atta girl, I knew she had it in her.
"I want it gone. Knowing Alice, she had already foreseen this conversation and knows that I am quite determined to have it taken out."
"Of course she has," I smile.
"How do we proceed?" my daughter was all business-like now.
"We'll get you admitted the night before in a regular room. Private, of course. The next morning, you'll have it removed. Depending on how you fared, you will either be discharged the same day, or the next day."
"General anaesthesia or sedation? I read that you can have it removed via sedation," she commented.
"Sedation is an option, but you are a sedation risk because of your poor lungs. You're a GA risk as well but it may be the better option here."
"How is general anaesthesia a better option?"
"Sedation gives you a degree of control over your respiratory system with or without impairing your cardiac function. I'd be more inclined to send you to theatre under general so that we can have total control over your cardio-respiratory functions. Your cough reflex remains largely intact during sedation," I explained patiently. Comprehension dawned on her face.
"An intact cough reflex is not ideal, especially considering how much coughing I do on a daily basis," she remarked airily, "so when do we remove it?"
"We'll have a consult with Dr Westsmythe," my daughter's face remained impassive, "and consult with Dr Anderson, as well as an anaesthetist... or three."
"Team Amelia, huh?"
"Team Amelia."
"Are you ready for tomorrow, Amelia?" queried Dr Samodien. She was a kindly woman, and one of the best anaesthetists in the state of Washington. She was also as tough as nails, and it had been a hard sell to get her to consent to knocking Amelia out. In her opinion, and the general consensus of all of the medical personnel who were a part of 'Team Amelia', the risks far outweighed the benefits.
"Just Mia, and yes, I am actually. I think this is this first time I have ever voluntarily spent any degree of time in hospital," quipped Amelia. My daughter had just been admitted for her overnight stay, and was cheerfully sitting cross-legged on her bed with her right arm extended while I set up an IV line for her.
"Well, Just Mia, has everything been explained to you?"
"I've been to an operating theatre more times this year alone than I have gone to the movie theatre. I'm a pro."
"Amelia, you realise that this is a risk, right?"
"Yes. But it has to come out."
"Why is that? You can simply stop the enteral nutrition, rather than remove the PEG feeding tube completely," she commented, paging through Amelia's hefty patient file to find her anaesthesia records.
"She wants it out," I confirmed, pulling out the needle of the IV line and taping the casing down, "if it's what she wants, I'm inclined to get it over and done with."
"Alright then. Let's see, you coded twice in New York with a minor blood vessel rupture. So chilled, I've got my work cut out for me," she muttered sarcastically, "of all the cases to drag me out to the back of beyond for, Carlisle, you pick the most complex case for a relatively routine procedure, and the patient just so happens to be your daughter. Are you for real?"
"Yes," I replied nonchalantly, disposing of the sharp equipment in the sharps bin and removing my gloves with a satisfying snap. Amelia grinned cheekily at the anaesthetist, who poked her tongue out in return.
"I swear you are going to give me grey hairs tomorrow, Just Mia. You owe me a bottle of hair dye. I'm thinking of going platinum blonde," she stated. I blinked in confusion. Amelia dissolved into giggles, which ended in a coughing spasm. Dr Samodien raised an eyebrow, "One new grey hair already! No more laughing, young lady!"
