Chapter 4: Setting a Routine

In hindsight I know that I never had a chance to stay 'professionally distant' to Keith. He had grabbed me and holds me in his ban to this day. Before I even examined him, I knew that he wouldn't die of his heart condition … I had read about his diagnosis with cancer, though. He wouldn't die on my watch, but I had no illusions that he would die. When Tom had been diagnosed with prostate cancer, I had fought, tooth and nail, and had denied the inevitable. I had yelled at Tom for being so goddamn calm and accepting of his impending death – now I regret my rash words and wish I could take them back. He had understood, though, taking me into his arms and holding me while I sobbed my heart out. Never before had the age difference between us been more obvious. While I refused to even think about death, let alone his death, Tom had quietly stated that he had had a wonderful, blessed life and no real regrets.

Now I can admit what of Keith reminded me most of Tom. It was his goddamn acceptance, his assumed fearlessness of death. He had admitted as much to me during his treatment.

"I can't change it, so why make it harder for me?" he had stated with the same irritating calm as had Tom.

oOoOoOo

"Good morning, Keith," Catherine greeted her newest patient with a smile. Today would be his first day of treatment – well, more detailed diagnosis and then the appropriate treatment for it. "Have you settled in?"

"Oh yeah, Dr. Cat," Keith said, grinning and nodding. "Hope has been a great help, showing me all the ropes and giving me the grand tour." He stopped himself, then admitted quietly, "She's really nice."

Catherine smiled. It would be like pulling teeth to get Keith to admit more – typical teenager. Keith and Hope, with their 16 years each, were the two oldest residents of the paediatric cardiology ward. Catherine had known that Hope would open up more to someone her own age than to her or a nurse. As for Keith, it was quite plain to see that he longed to take on responsibilities. Hope was one such responsibility. It did him good - she could already see that.

"Well, I'm glad you have made a friend. This room you haven't seen yet – and hopefully you won't be here often. It is my main examination room. As you can see, we have a ECG machine and ultra sound devise in here. Both are instruments that allow us to see and hear your heart, giving us a clearer picture of what is amiss and how we proceed from here on out," Catherine explained patiently. It was a speech she had given innumerable times. She had learned early on that most parents didn't really explain what was happening or what was wrong to their children. They were scared by all the strange, cold instruments and only knew that they hurt and that Mummy cried a lot because of them. Catherine had broken the circle on her first work day. Painstakingly she had built a less intimidating and exceedingly friendlier atmosphere. Explaining what she would do, why and how it would work, helped to build trust and she felt her young patients relax – it wouldn't hurt them after all and wasn't scary.

Keith nodded attentively. His father was usually the one who talked to the doctors, Keith getting shoved into the background. It was the first time he sat in a doctor's office alone, without his dad or social worker. Keith had thought he would be nervous, but he wasn't. Dr. Cat was reassuring and kind. Keith knew he was in good hands, having a doctor who would do everything in her power to make him feel better.

"For today, I think, we will start with a ECG test. Well, two of them really," Catherine went on, still smiling reassuringly.

Keith frowned. "Why two of 'em? Isn't one enough?" he wanted to know.

Catherine chuckled softly, shaking her head. "As a matter of fact, it wouldn't be enough. We do one when you are relaxed, say reclining on a bed, and we do the other while you're riding a bicycle or jogging. That's called a stress- ECG."

"See, Doc, and that's where we have a problem," Keith said. "Due to my cancer I'm fair weak and get tired very fast. At school I'm not allowed to do sports."

"You must be joking," Catherine interrupted, clearly confused and appalled in equal measures. "I mean, how are you expected to build strength and stamina?" Her forehead was creased into a frown, instead of the usual alabaster plain. Catherine seemed genuinely worried for Keith. "Does not matter," she said imperiously, "we will simply have to change that. Sport is vital for heart patients. It regulates the blood circulation and heartbeat." Her voice had adapted an almost schoolmasterly tone and for the first time she looked strict and somewhat foreboding.

"Aye, aye captain!" Keith just couldn't help himself as he mock-saluted her. He had to grin, though, because she reminded him of a mother hen. "So when do we start?" Now that he knew what awaited him he was eager to get started. The sooner he knew what was wrong with his heart, the sooner he could get treatment, and the sooner he could return to school. He would miss Hope and Dr. Cat, though …

'Now where had that thought come from?' he asked himself silently, eyes widening slightly.

"Now is as perfect a time as any, wouldn't you agree?" Catherine asked him mockingly, not noticing his averted eyes and the very faint rose hue in his cheeks.

oOoOoOo

After the ECG tests, which proved that Keith really was in miserable physical shape, Catherine sat in her office and went over the results. They were as she had expected. Nodding to herself, she scanned the sheaves of paper with a graphic of his heart rate and all irregularities from the ECG test. Judging by these results only, she was certain that his heart had been corrupted by the chemotherapy.

Slowly she got up from her desk and took the few steps necessary to reach her bookshelf with its vast collection of medical journals, books and charts. With sure hands she took out one book and leafed through it, finding the article almost immediately.

Cardiotoxicity: A side effect on the heart from chemotherapy is called cardiotoxicity. The term cardiotoxicity refers to general heart damage, and can cause early or late heart damage. Early damage can occur immediately, or within one to two days after the chemotherapy medication is given. Late damage typically begins about one year later, and can appear up to two or three years after chemotherapy. When cardiotoxicity is severe, it could cause congestive heart failure. Cardiotoxicity is the occurrence of heart electrophysiology dysfunction or/and muscle damage. The heart becomes weaker and is not as efficient in pumping and therefore circulating blood. Cardiotoxicity may be caused by chemotherapy treatment. (Wikipedia and another medical site)

Catherine hoped that tomorrows ultra sound would only show a weakened heart muscle. It would be much worse if it was indeed a electrophysiological dysfunction. Due to Keith's cancer and his chemotherapy an operation to insert a pace maker was almost impossible. The chemotherapy had destroyed his immune system and a small infection of the incision would be fatal. As it were, they already had to take extra precautions against all manner of infections, isolating him from patients with a touch of the flu for instance. Catherine sighed and rubbed the bridge of her nose. There was only speculation and worry left for her tonight. She should go home and sleep. Tomorrow would give her something real to work with.

oOoOoOo

I hadn't found sleep that night. Keith's father, Henry, had called me just in time to stop me on my way out. He had just gotten a new job and had been held up at work, trusting me to take care of his son properly and actually trusting his son to be old enough to handle the diagnostic process. Henry had known that we would do a thorough check-up before beginning any treatment. I told him about the results of the first ECG tests and my preliminary diagnosis. He seemed relieved to hear that and wanted to know how that would affect Keith's chemotherapy. I told him that I couldn't be sure yet and had to wait for the results of the ultra sound test the next day. Henry assured me that he would be there no matter what.

After the call I went home to my solitary dinner and an empty house. As a doctor I'm used to calls at all hours of the night, so it didn't come as a surprise when I got a call at 6 am in the morning. The surprise was that the Police was on the other end of the line. There had been an accident.