A/N: Wow! Thanks so much for all the follows and reviews. I hadn't intended to write this until my first story was done, but the words and images to this one just kept coming up in my head. Glad people are enjoying it. If you like it, be sure to keep telling me! It gives me motivation to continue working on this.

Nothing had changed in the ICU room visibly. She still lay unmoving on the bed, seemingly unresponsive to anything done to her. He still clutched her hand, spoke to her at times, pleaded with her at others. The nursing staff had been wonderful, explaining the numbers on the monitor and what they were meant. Her heart rate was beginning to slow; it had been way too fast initially. Her heart had been trying to pump what little fluid remained in her vascular system as best it could, but it had been losing the battle due to the dehydration.

They had done an echocardiogram, apparently concerned about her heart due to the old gunshot wound. He didn't know the results of course, but nothing further had been mentioned regarding her heart's condition so he assumed it was ok. The nurses were drawing labs every two hours. They seemed satisfied with the results; the doctors occasionally ordering a change in the rate the fluid was dripping into her. Yet, again, he wasn't allowed to know. Just being there for now was all he wanted. He knew he would be told once they found Jim and got everything straightened out. For now it was enough to be the one holding her hand.

Martha and Lanie's plane landed three hours after he'd spoken to them. They came to the hospital after swinging by the hotel Alexis was at and picking her up. Agent Murray had gone home to her family long ago, asking to be called with updates. Castle was getting worried about Esposito. No word from him or Jim and he had said it would only take two hours. Rick was imagining Espo never finding Jim; without family to consent to it Rick would never be allowed any detailed information about Kate.

Rick looked up from his chair by her bed when his mother and Alexis walked in. He'd been told the normal policy for ICU visitation was two people per bedside but apparently the nursing staff was taking pity on them today.

His mother let out a horrified gasp when she saw Kate. She'd been told she looked bad, but nothing could have prepared her for the reality. Her son sat beside the bed, hunched over clutching her hand. She looked so small lying in the bed with all the monitors attached to her.

"Richard, oh Richard" she said as she walked slowly to his chair. She gave him a hug as he sat in the chair, his head pulled into her midsection. She could feel how tense he was; he was nearly shaking. When she pulled back, she grabbed his head on either side with her hands and looked deeply into his eyes. She mainly read fear there, though she thought she saw some traces of anger and frustration as well. She turned to the bed and placed her hand over his, the one that still clutched Kate's, then sat in the chair next to his.

"Any change?"

"No mother. Nothing has changed." He sounded defeated, exhausted.

Alexis had moved into the room as well, sitting on the opposite side of the bed from her father. She had tears in her eyes as she reached out and grabbed Kate's free hand.

"Where's Lanie?" He knew they had flown down together.

"Out trying to play the doctor card to get some information."

"That's not going to work. No one knows her here."

"Oh kiddo, I know that and you know that, but there was no getting her to listen. I'm not going to try and stop her. I'll let you handle that."

Rick tried to picture himself, or anyone, reigning in Lanie. Not. Possible.

"Have you heard from Jim yet?" Martha knew how much Jim's call would mean.

"No, and I'm getting worried. Javier thought it'd only take a few hours to get up there. It's been way longer."

Lanie entered the room as he was speaking. She visibly blanched a bit when she saw Kate, then walked over to the side next to Alexis and sat down.

"Castle, Javi only was at the cabin once. He was certain he could find it, but if not he was going to stop and ask people in the nearby town. You know there are all kinds of reasons why they haven't called yet. I'm sure it will be soon."

Rick knew she was right, but he just wanted the answers as to what was going on.

"Did they tell you anything?" he asked, knowing that they hadn't.

"No. They're right not to, but I was hoping some professional courtesy would help smooth things over. I did meet the attending physician, Dr. Baker. He seems very good. He told me he was hoping you'd find Jim soon as well; he hates not being able to tell you everything."

They sat in silence for a few minutes. Rick was already used to the sounds the monitors made, the sound of the ventilator pushing air into her. It felt like his entire life had been spent in this room, waiting for a sign from her. Her nurse came in to check things, speaking small words of reassurance to them.

"She's starting to make more urine and her heart rate is slowly coming down" she said; her tone made it seem like that these small details were the most important things in the world. She went through the process of drawing more blood off the central line to send to whatever labs they were monitoring. He longed to know more at this point, curious what it was they had to check every 2 hours. Had to wait for Jim to call. Waiting was all he could do.

Castle watched as she emptied the bag attached to the catheter into her bladder. The urine was dark as tea and while there was some there it certainly didn't look like enough to start a celebration. He knew the nurse was just pointing out the positives that she could so he kept his bitter thoughts to himself.

Suddenly, the sound of his cell phone broke the air. Finally, oh finally. He answered before even looking to see who it was; it had to be Espo and Jim, he was so focused on their calling that he couldn't fathom it being anyone else.

It wasn't them. He listened wordlessly as Paula's voice cut through the air. He couldn't hear what she was saying, couldn't process that the voice on the phone hadn't been Jim or Espo.

The three women in the room could hear enough of Paula's voice to know she was asking how everything was. Castle made no effort to answer her or even to seem to know who it was that was speaking to him. Martha finally forcibly removed the phone from his hands. She quickly reassured Paula that Richard was fine and that they were with him, supporting him. It was clear they had to cancel the remainder of the tour, so Paula sent her best wishes for them via Martha and hung up to start making the necessary phone calls.

His phone jangled in Martha's hand again about five minutes later. This time Castle didn't allow himself to hope. He clung to Kate's hand; eyes cast down as he listened to his mother answer the phone. It was them. Suddenly he could breathe again; finally he could start to get some answers.

"Rick?" was the first thing he heard after reclaiming his phone from his mother. "Rick, what's going on?"

"I don't know Jim. She wasn't feeling well this past week, told me she had the flu. Then I couldn't get in touch with her over the last two days. I knew something was wrong, so I flew back and…and we found her…" He couldn't go on as his mind replayed the horrific scene in their bedroom that he and Alexis had found just hours earlier.

"Is she going to be ok?" Jim's voice was tight, taut.

"I don't know. She's in the ICU. She's on a ventilator and she won't respond to anything."

"Do they know what's wrong?"

"They can't tell me. I'm not considered next of kin."

Jim was silent for a minute. He was struggling to process this detonation that had turned his life inside out. He'd been out fishing on the lake, enjoying a beautiful sunset and hours of time just being alone out on the water. He'd found a man pacing up and down his dock when he'd motored back and when he got close enough to identify him as Detective Esposito he knew something was terribly wrong. They'd called Rick as soon as the boat was tied up.

Lanie had left the room as soon as she heard that it was Jim calling. She returned with Kate's nurse who took the phone from Castle and spoke with Jim briefly. After confirming that he was Kate's father and that he consented to Castle and the others to being present for medical information she had Castle put the phone on speaker.

"Mr. Beckett, I'm going to page the attending physician to come and speak at length to you. If you can stay on the phone for a few minutes he should be here shortly."

She left to page the physician and Martha and the others all made some small talk with Jim as they waited for news. He was planning on rushing back to the city as soon as he heard from the doctor. Catching one of the myriad flights to DC wouldn't pose much of a problem once he got back to New York.

Another eternity seemed to drag by before the attending came back in the room. Rick sat up straighter, clutched Kate's hand harder. Finally, he would know more about what was happening.

"Hello everyone, I'm Dr. Baker. I'm the attending physician taking care of Ms. Beckett."

Jim's voice was loud through the speaker. "Dr. Baker, this is Katie's father. Can you please tell me what's wrong with my daughter?"

Dr. Baker again established with Jim that it was ok to speak in front of Castle and the others and had Jim verbally consent to allowing Castle to make medical decisions and receive all information about Kate's condition.

"Sorry, that is a legality that we cannot ignore. Anyway, Mr. Beckett, your daughter presented with profound dehydration and hyponatremia, which is low sodium levels in her blood, after what appears to be days of intractable vomiting. Let me go from head to toe in describing her condition and then we'll discuss what could be causing it."

Rick was hanging on every word. Knowing what was going on was the first step in fixing it so she'd get back to him, back to normal.

"We'll start at the top. When she was found she was unresponsive to voice. With painful stimuli she flexes her arms inward a bit."

Dr. Baker moved closer to the bed and showed the people in the room what that looked like. Rick hadn't even noticed this previously, too scared out of his mind to see what the medical team had been doing to her and her response to them.

"Is that good?" Jim asked.

"Well, it's not good. Though it's not necessarily bad either; it's a reflection of how sick she is. We measure neurologic response on a scale of 15. It's called the Glasgow Coma Scale. Normal, no issues would score 15. Miss Beckett had a score of 5 on arrival. This is severe, but knowing how dehydrated she was probably explains this. As she improves, if she survives this, I expect her neurologic status to improve."

Rick felt the floor open beneath him. He was falling, the only thing keeping him safe was his hand clutching hers.

"Did you say if she survives?" demanded Jim. He had no idea it was this bad.

"Yes, I'm afraid so. She came in near death as it was. One hour later I don't think she would have survived. She was having agonal respirations, which is a very bad sign. She was in hypovolemic shock which means she'd lost so much fluid from her body that she could no longer maintain an adequate blood pressure to supply all her organs. Now, like I was saying, we won't know until she starts to wake up more if there has been brain damage. When she's more stable we can do a head CT, which is quick to do and gives a rough picture of things. Or if we're very concerned we'll do a head MRI which takes much longer but gives better details of things. It all depends on how she responds. If she wakes up with no deficits, then we won't need to do any of those studies. I do want to stress however that currently she has had no sedation of any kind. We've put her through some pretty noxious stimuli in the last few hours and if she had responded in any way that seemed to indicate discomfort or pain we would have given her something. Unfortunately that has not been the case. You can imagine if she were back to normal she would not tolerate for a second the breathing tube in her mouth or the catheters in her nose and bladder. Yet she hasn't shown any awareness of them. This is very concerning; it may resolve quickly or very slowly. Or not at all."

Dr. Baker paused for a minute; saw no one had any questions as they struggled to process his words.

"From a respiratory standpoint, her lungs are fine. However, with her GCS being so low and her agonal respirations she required airway protection and assistance. This is why we placed the endotracheal tube and put her on a ventilator. As soon as she shows signs of neurologic improvement we'll be able to remove it. From a cardiovascular standpoint, her heart rate and blood pressure are improving with fluids. She has not required any pressors to assist her blood pressure so far. This may be necessary if her pressure starts to fall and we can't give more fluid. We did an ECHO to check her cardiac function due to her old gunshot wound. Her heart is working normally. It had to pump very fast to send what little fluid it had out to her body but there is no sign that it's been strained or is struggling. Normally we would have put in large bore IVs in her arms, but with the degree of dehydration she had that was impossible. In the ER they had to make an incision in her neck to find the jugular vein and the central line was then placed directly into this site. Once she is rehydrated and more stable this will be removed after we place another IV or two."

Another pause. Another silence unbroken except for Kate's monitors.

"As far as the gastrointestinal system, well this is the most complicated in some ways. She was clearly vomiting for some time; likely days. She appears to have lost a lot of weight both from lack of fluid and nutrition. We've placed a nasogastric tube that is hooked up to intermittent suction to keep her stomach empty. That's the tube that goes in her nose. We also need to keep detailed measures of her fluid intake and output. Her only intake at this point is normal saline, which is what is going in the IV bag. There is a Foley catheter in her bladder that drains any urine into this bag." He indicated the bag the nurse had emptied a short while ago.

"Why is her urine so dark?" Rick asked.

"Her kidneys were getting decreased blood flow due to her shock. The dark urine is a reflection of that and the dehydration itself will make the urine look very concentrated. Fortunately, her liver numbers look fine. The human body tries to preserve blood flow to the brain at the cost of all other organs. The fact that her liver looks ok makes me feel better about the degree of shock; it was perhaps not as bad as it could have been."

Rick nodded, accepting this small comfort as a victory. It was hard to imagine things could be worse though.

Dr. Baker continued his description of her condition. "Her sodium was very low when she came in. Normal is 135 to 145. She was at 122. This is due to the vomiting, losing her electrolytes through the intractable puking. Typically in severe dehydration without vomiting the sodium is very high. Now, low sodium is quite dangerous. If we were to replace it very rapidly, she would likely develop a particular kind of brain damage called central pontine myelinosis. We have to replace the sodium very, very slowly. This is why the nurses are taking blood samples every two hours. When we get the results back, we adjust the rate the fluids are infusing. Going so slowly is probably going to keep her from waking up quickly, but it will also protect her from having further damage. We're also replacing her potassium and some other electrolytes that were low, but the sodium is the most critical one. We've started her on some vitamins and put her on a proton pump inhibitor which keeps her from producing stomach acid. This is more of a preventative measure. Once she starts to wake up we'll be able to start some liquid formula and see if she starts vomiting again, but that's probably days from now. We've not given her any glucose yet; we have to wait for the vitamins, but if her sugar starts to fall we'll add that to the IV fluids."

Rick felt like he could barely breathe. He'd wanted to know everything, but the details were so overwhelming he wasn't sure he'd heard much after 'if she survives'. He was glad Lanie was there. With her medical background she would understand everything and would be able to explain it to him over and over until he got it.

"She has no signs of infection, so we've not started any antibiotics. She was not anemic when she came in. However, with all the fluid resuscitation for the dehydration she may become anemic. If her hemoglobin drops far enough we may have to give her a blood transfusion. Her clotting numbers look ok for now. They can become abnormal with shock. Since hers are normal, we're placed her on a medicine called enoxaparin, which is an injection of low molecular weight heparin. This keeps her blood from being too sticky; she is at high risk for developing clots for several reasons, though the dehydration is the main issue. She's lying in bed, unmoving. And, well, then there is the reason that I think that led to all this."

He paused, a bit uncomfortable. He wasn't sure if they knew. Probably not since she'd been alone when all this had happened.

"So, now that you know what we're doing for her, it's time to discuss why this all happened. The dehydration and the hyponatremia are explainable by the intractable vomiting. We've run several tests to look into the vomiting. Not all of them are back yet. For example, we've sent tox screens for several things. We've ruled out infectious processes like a urinary tract infection or hepatitis. There are ear problems, like labyrinthitis and Ménière's disease that we can't look into until she's more stable. However, I think we know the answer. One of the tests we send on all women on admission is a blood, or serum, measure of human chorionic gonadotropin or hCG. Miss Beckett's level is quite elevated."

Rick heard Lanie gasp and her hand flew to her mouth. Clearly this elevated level of whatever was a significant problem based on Lanie's reaction. None of the rest of them had a clue about it though.

"Is it curable?" asked Jim from the phone.

Dr. Baker knew he'd paused too long. He hadn't meant to, was going to explain it, but Dr. Parish's reaction had distracted him and now everyone was confused.

"I'm sorry, I didn't explain that well. It's not something you fix. Well, I suppose you could…" he was digging himself in more. Before anyone could voice more questions to muddy the water further he held up his hand to keep them from speaking for a second. "Human chorionic gonadotropin is elevated when you're pregnant. Ms. Beckett was vomiting because she's pregnant. The serum level of the hCG indicates she's about 10 weeks. Congratulations!"

As the meaning of his words slowly percolated through his head, Rick saw and heard the happy reactions of everyone around him. Pregnant! She was pregnant. They were going to have a baby. He clutched her hand to his chest, tears falling unnoticed from his eyes. They had talked about kids a bit; both wanted them, though neither had been ready this early. Jim was asking a few more questions of Dr. Baker but Rick couldn't hear anything but the last few sentences the attending had spoken to them earlier. She was 10 weeks pregnant! Now, if only she'd wake up and they could celebrate together. His brain kept replaying the conversation, the joy of their baby overcoming slightly the despair he'd had earlier about how sick she was. Surely if she knew she was pregnant she'd fight with all her might to get back to him, to them.

"Ok, any more questions then?" Dr. Baker was about to leave.

Alexis had a strange look on her face. "Did you say she's 10 weeks pregnant?"

"Yes, based roughly on the serum levels of hCG. We'll have to do an ultrasound to confirm it all."

"And that's based on the last menstrual period? So you add two weeks, right?"

Castle stared at her, not understanding the questions or why she looked so pensive.

"Yes, that's right. All pregnancies are dated from the LMP, even if we don't know when that was. You subtract 2 weeks from it for conception. So, technically I guess she's just 8 weeks pregnant" said the doctor.

Alexis was staring at him intently. She wasn't going to say anything more, didn't want to be the one to say it out loud.

"Alexis, what does it matter when conception was? Why do you care?" Martha asked.

Rick felt the ground opening again, but this time he'd dropped Kate's hand and wasn't touching her at all. It mattered. It mattered a lot. Because 8 weeks ago, 7 weeks ago and 9 weeks ago he'd not been with her. He'd been in New York.

A/N: I spent the first 10 years of my life after finishing all my training as an attending in a very busy Pediatric Intensive Care Unit until a variety of issues made me realize I had to move away from it to preserve my sanity. I've given hundreds, maybe thousands, of summaries like the one here where you describe where you're at and where you're going with a patient to a family who is trying mentally to process the condition of the patient. There's a fine line of being too technical so they don't understand you or not telling them enough. Sometimes families just don't want to know; others want to know everything. This conversation is how I would describe Beckett's condition initially. As you forge a relationship with a family you learn what they want to know and how they want to know it.