Hello again to all my readers! So sorry that it has taken me a few days to update, but work has been absolutely crazy this week. I can't wait for 5 PM tomorrow, because then I will have the whole weekend to write! I want to give special shout-outs to NCISchick, govgal, Senuna, BlueTigress, youdontevenknowme07, & LittleLizzieZentara for submitting multiple reviews. You guys rock. And the winner of last chapter's trivia question goes to Keronshara for correctly identifying that the chapter title "Fear Does Not Exist in This Dojo" came from Knockdown when Kate told Rick to go home after he showed up at her apartment to help with the off the books investigation of her mother's case.
There will be a fair amount of medical lingo in the next few chapters and I'm striving to make it as accurate as possible. Some of the stuff I already know due to some health problems of my own which have resulted in 9 surgeries in the last 12 years (meaning I can draw on some of my personal experiences). I also used to volunteer in the ER for several years and am certified in advanced first aid, so hopefully that will come through in my writing. However, I'll try not to make it too technical and hopefully will balance out the medical stuff with lots of hurt/comfort goodness and Caskett-y relationship fun. Okay, let's get back to the story now, shall we?
"Kate sweetheart, anywhere you go, I'm coming with you. I'm not leaving your side, I promise."
And with those words, Kate's eyes slid close once again as the darkness consumed her.
"Kate? Kate! Oh god, Lanie. She's not... she won't... Is she...?" Castle shouted in a blind panic, unable to finish any of the questions and say aloud what he feared most as if he would be daring it to come true. As he sat on the wet earth with Beckett cradled protectively in his arms, medics continued to swarm around Kate's still, pale, limp body.
Lanie put a steadying hand on Castle's shoulder.
"Castle, calm down. We need to give them room to work. Look at her chest. She's still breathing. She just blacked out...probably from the pain or blood loss. The paramedics are here now, and they can help her. You've got to keep it together for her sake, okay? She's a fighter. You know that."
Castle drew in a deep breath and nodded, returning his attention to gently stroking Kate's hair.
Lanie turned to the nearest paramedic to give him an update on Beckett's condition.
"Hi, I'm Dr. Lanie Parrish, Chief NY Medical Examiner. This is Detective Beckett. She was shot approximately 12 minutes ago by a large caliber sniper rifle. She regained consciousness for about 10 minutes after the shooting and passed out again just as you were pulling up to the scene. I checked her vitals about five minutes ago. Heart rate was tachycardic in the 140's, BP 80/60, pulse ox was only 72%. The gunshot wound is to her right upper chest, and I suspect a tension pneumothorax due to decreased breath sounds on the right and poor oxygenation. She's going to need a hospital with a good trauma surgeon on call and maybe a cardiothoracic surgeon as well depending on her internal injuries."
The paramedic gave a nod of confirmation and turned to his partner who was furiously scribbling notes from Dr. Parrish's report.
"Hi, I'm John. Thanks, doctor. Okay Abby, let's start two large bore IVs and push fluids to keep her BP from bottoming out. I'm going to take a quick listen to her chest and then we'll load her up. I'm thinking we should take her to NYU Med since they've got a large trauma staff and it is relatively close. Sir, I want you to keep applying pressure to her chest wound for now, and we'll take over once we have her loaded up and in the ambulance."
Castle nodded at the paramedic. "I'm Rick Castle, and this is Kate. She means the world to me. Please tell me she's going to be okay."
John paused briefly to make eye contact with Castle. "Sir, I'm going to promise you that we'll do everything we possibly can to help her, okay?"
He slid the earpieces of his stethoscope back into his ears and listened carefully to Beckett's breathing and lung sounds on each side. There were almost no breath sounds on her right side and beneath the oxygen mask, he could see that her lips were starting to take on a slightly bluish tint."
"It definitely looks like a collapsed lung to me. We need to move now. Abby, what's her pulse ox?"
The young paramedic looked up from taping down a second IV that she'd carefully placed in the crook of the detective's arm.
"Pulse ox is at 68% and heart rate is 152."
"Shit!" muttered Castle and Lanie in quick succession.
John did his best not to react to those vitals, although he knew without a doubt that they were very, very bad. Instead, he lowered the gurney to the lowest setting in preparation for loading Beckett into the ambulance.
"Okay Abby, let's turn up the oxygen to 3 liters per minute and switch her to a non-rebreather mask. Let me know if her oxygenation drops any lower than that because we may have to intubate her. I'd really like to avoid that if I can though, because it might do more damage to her right lung if it has already collapsed."
John turned to Mr. Castle. "Okay sir, we need to move her onto the gurney. Can you help me slide her over? Try to keep pressure on her wound if you can."
Castle gently slid his free hand underneath Kate's head and neck, supporting her upper body in the crook of his elbow. John slid an arm underneath her knees and another behind her lower back and they gently lifted her together while Abby trailed right behind them, carrying Beckett's IV bags and oxygen tank.
As they gently lowered her onto the gurney and began strapping her in place, Kate let out a soft moan, her eyes still shut tightly and her body still. Castle's right hand remained over her gunshot wound, applying firm steady pressure, but his left hand immediately went to her forehead, gently stroking her temple as he called out to her.
"Kate? Can you hear me? Sweetheart, open your eyes for me, okay? Come on, Kate."
Unfortunately, this time he got no response. Castle's heart sank and he hoped for the millionth time that day that he would get another chance to speak with her, to tell her how much she meant to him, to let her know exactly how he felt about her.
John and Abby finished securing her to the gurney and began to push it towards the waiting ambulance. Castle followed right beside them, his hand still firmly placed over the bullet wound to Kate's chest.
Lanie turned to Esposito and gave him a quick kiss on the cheek. "Javier, please be careful. I don't think I could take it if another person I love got hurt or killed this week. I'm going to ride with them to the hospital in case Kate starts to crash and they need a doctor. They are taking her to NYU Med. I know you and Ryan have to stay on the scene for now, but call me to give me an update when you can, okay? I love you."
Javier surprised Lanie by pulling her back in for a tight hug. As he pulled back, he gently placed a kiss on her forehead. "I love you too, Lanie. Take care of yourself. I'm going to send a couple of black and whites to be posted at the hospital with you and Beckett just in case the shooter tries to come back to hurt her or to hurt one of you to get at her. Keep me updated on Beckett, okay? She's a fighter, Lanie. Don't let them give up on her, alright?"
Lanie gave him a sad smile. "Please... have you seen Castle? He'd never give up on her. I think he is going to literally will her to stay alive. She'll pull through. I'll call you as soon as I know something." And with that, Lanie took off at a jog to catch up to the stretcher carrying Beckett.
As they reached the ambulance, Abby helped John gently slide the gurney onto the ambulance lift, folding up the legs of the gurney as they did so. Castle was directed to climb in next so that he could continue to hold pressure on the wound as they slid the stretcher into place. Once Castle and Beckett were loaded in the ambulance and the stretcher was secured, Abby ran around front to start up the engine to the ambulance and call in a report to NYU's ER. John leaned forward and was just about to close the doors to the back of the ambulance when Lanie approached.
"Dr. Parrish, we're headed to NYU Med. You can meet us there." said John tentatively.
"Like hell I will," spoke Lanie forcefully. "I'm riding with you."
"I'm sorry, doctor, but patients can only have one person accompany them. If Mr. Castle would rather drive and meet us there, then you can..."
"Not a chance," spoke Rick with finality. "Lanie, I promised her I wouldn't leave."
"I know, Castle. I don't expect you to get out. Lanie turned and directed her attention to the young paramedic again. "Look, what happens when you need to intubate her? How many intubations have you done before? I've done hundreds. Also, she'll need a needle decompression for her collapsed lung if her oxygen sats keep dropping before we can get her to the hospital. When was the last time you did one of those?"
John felt his face go hot as the doctor questioned his training and experience. Sure, he looked young, but he'd been a paramedic for eight years now. He may not have done hundreds of intubations, but he'd certainly done dozens. But a needle decompression for a collapsed lung in the field? That scared him. He'd only done the procedure twice before and once had been on a high-tech practice dummy for medical simulations. He felt ill at the thought of having to do one with a doctor and famous author breathing down his neck, not to mention the danger of performing such a delicate procedure with a very green newbie driving the rig over bumpy roads. Yes, that was just a recipe for disaster. Screw protocol, he decided. I'm going to do what's best for my patient.
"Fine," John said somewhat reluctantly. "But if you are going to treat her, I need a next of kin or emergency contact to sign a release form first."
Lanie simply nodded and climbed into the ambulance. John tapped on the partition separating the treatment bay in the back and the driver's seat up front and shouted. "Let's go, Abby. Lights and sirens all the way to NYU Med. Be sure to tell them to have a chest tube kit and trauma surgeon on standby for when we get there, okay? We're going to have to a procedure back here though, so try to keep the bumps to a minimum."
"Alright," John started, turning back to his patient. "I've got a few questions for you. First, is she on any medications?"
Lanie nodded. "She's on Ortho-Tricycline for birth control and she takes Imitrex for migraines."
"Okay," nodded John while writing the information down. "Any drug allergies?"
Lanie shook her head. "None that I know of..."
Castle cleared his throat before speaking up. "Actually, she's allergic to cephalosporins and penicillins."
Lanie gave Castle a strange look. "Really? I've been her best friend for ten years and had no idea. How do you know that?"
"Beckett told me a story about getting her tonsils out as a little girl. Afterwards they gave her Amoxicillin to prevent an infection and she broke out in hives and her throat started to swell up. She ended up having to stay in the hospital for two extra days and her mother made her wear oven mitts on her hands because she couldn't stop scratching at the hives. They did allergy testing when she was in the hospital and figured out that she was allergic to cephalosporins too. Apparently it is pretty common to be allergic to both if you are allergic to one of them."
Lanie could only nod her head in amazement at Castle's response. It was so like him to remember little details like this about Kate.
"Okay, next question," said John. "Are there any other major medical problems I should be aware of? Diabetes, high blood pressure, asthma? Any major surgeries besides the tonsilectomy?"
Lanie responded, "Yes, she had her appendix taken out three years ago, but other than that, she is healthy as a horse. No chronic illnesses or conditions."
"Great. Healthy is good. People who take care of themselves and are in good shape like her have a much lower risk of complications from an injury like this," John said reassuringly. "Just one last question for now. Who's her emergency contact? I'll need that person to sign this consent."
Castle looked to Lanie expectantly, assuming that she was listed as Kate's emergency contact. Lanie looked at Castle, thinking the same thing about him. Finally, Lanie spoke up.
"Hmm, I'm not 100% sure. I think she updated it fairly recently after she almost died of hypothermia. Long story..." she added to the paramedic who looked very confused. "I think she normally enters it in her cell under ICE for in case of emergency. Castle, have you seen her phone?"
Castle reached down and gently extracted Kate's phone from her pants pocket. The cell phone was old and worn down, one of those cheap, pay-as-you-go burner phones. I'm going to have to bring her up to speed with 2011, thought Castle wryly. First she doesn't know what Twitter is and now she has quite possibly the only phone in America that you can ONLY use to make calls. After several seconds, he finally located the contacts button and began to scroll through the contacts until he made his way to ICE. He selected the contact in order to see more and was shocked to see his own cell phone number and address listed along with his name and her medication allergies.
Rick looked up at Lanie and John. "Well, it looks like I'm her emergency contact. What do you need me to sign?"
Lanie looked a bit surprised but said nothing. This is an interesting new development, she thought. Although it's lucky for Writer Boy because the hospital most likely wouldn't have released any information to him about Kate's condition without her listing him as her primary contact.
John pulled out a clipboard with several sheets of paper and a pen clipped to the top and leaned over the gurney, handing it to Castle.
Castle started to reach for it before realizing that one of this hands was still occupied with holding the now blood-soaked coat and gauze pads to Beckett's chest. Lanie recognized his dilemma and turned to John.
"It looks like she's soaked through the bandage. Could I get a few more gauze pads so I can take over for Rick here? Do you have any gloves?"
John nodded, pulling open a small drawer and ripping open five sterile gauze pads and stacking them one on top of the other. He also reached into another drawer and pulled out a pair of latex gloves.
"I'm guessing you wear a medium. Will these work?"
Lanie nodded and quickly pulled them onto her hands. She turned to Castle who was seated closest to Kate's head while she was sitting down near her feet. "
"Okay Castle, I'm going to climb over you and slide these gauze pads on top." Lanie slowly stood, her head hunched to avoid hitting her head against the low ceiling. She stepped over Castle's legs. Next, she carefully laid the gauze pads next to Castle's hand.
"Okay, Castle. Lift your hand up and I'm going to slide these gauze pads over the bloody bandage."
Castle did as he was told and Lanie seamlessly slid her hand over Kate's wound, continuing to apply firm, steady pressure. Castle scooted down the bench seat to give Lanie room to sit. He looked down to his lap to see his hand covered in Kate's blood. The look, feel, and smell of her blood on his hands made him feel sick to stomach.
John looked on sympathetically and handed him a moist towel to use to wipe off the blood. Castle quickly did so and took the clipboard from John in order to sign the paperwork. John turned his attention back to his patient, pushing several buttons to inflate the automatic blood pressure cuff to check the detective's blood pressure and then clipped a small pulse ox monitor to her index finger. He noticed the coolness of her skin as he connected the monitors and reached into an overhead cabinet to retrieve a bag of IV saline from the warmer, hoping that bringing her temperature up might slow down her descent into shock. He was just finishing connecting the new bag of warmed saline to one of her IV ports when the alarm on the pulse ox monitor went off.
John, Castle, and Lanie all looked up simultaneously, panicking as they read her vital signs. Pulse ox: 65% and heart rate 156. Seconds later, a second alarm sounded, this one coming from the blood pressure monitor. The monitor readout simply said "Error, cannot get reading."
John immediately pulled open the remaining buttons on the detective's uniform, exposing her chalky white skin that had been stained with blood. He slid the stethoscope back into his ears and carefully listened to her chest, starting with her right side. He waited for several seconds breathlessly before concluding that Beckett's right lung was no longer moving any air at all. The left side of her chest was rising and falling at an alarming rate and it appeared as if her left lung was hyper-inflated in an attempt to compensate for the damaged right lung. He glanced up front and through the windshield, taking in their surroundings. They were at least seven minutes from NYU and Detective Beckett clearly did not have that long before she would go into cardiac arrest due to lack of oxygen.
Lanie was the next to move into action. "John, how does her chest sound? What are we dealing with here? Is it still her lung or is she starting to go into an arrhythmia?"
"I'm not getting any breath sounds at all on the right and her left lung is hyper-inflating to try to compensate. She's still tachycardic but I don't hear an arrhythmia just yet. We're still 7-10 minutes out from NYU and her heart can't take that long without oxygen."
Lanie glanced at her friend's pale, lifeless body and felt her heart racing at the thought of losing her. She shook her head as if to clear the image from her memory, took a breath, and steeled herself to see Kate as she would any other nameless patient.
"Okay, here's what we're going to do. Castle, I want you to take over for me and put pressure on her wound. John, let's go ahead and put on the portable defibrillator pads and hope we don't need them. I'm going to need some betadine, gauze, tape, and a 22 gauge syringe so I can do a needle decompression. It won't hold her for long, but hopefully it will bring her oxygen up enough for us to get her to the hospital without her going into cardiac arrest."
Castle carefully climbed over Lanie and slid his hand to replace Lanie's over Kate's gunshot wound, just as Lanie had done only minutes earlier. He felt so helpless sitting there, knowing the only thing he could do to help was to hold her hand and pray that she'd make it. He brushed a stray lock of hair from her forehead with one hand before intertwining Kate's small, cold hand with his. He leaned forward so that his mouth was just inches from her ear and began talking to her in a low, soothing voice.
"Kate, you've got to stay with us, okay. Honey please, I can't lose you. Not like this. Kate, you are a fighter. You are the toughest, bravest woman I've ever met and don't you forget it. That's why you've got to keep fighting, okay? There are so many people that love you Kate, and they couldn't take it if something happened to you. Sweetheart, I love you. I need you to come back to me. Please, Kate. Please?" Castle broke off in a sob, his eyes filling with tears at the thought of losing her. He closed his eyes briefly and took several deep breaths, trying to quiet his racing thoughts and shaking body. Kate needed him. He needed to be strong for her. He couldn't break down when she needed him most.
Lanie set the supplies out on a small tray. She turned to John who nodded to indicate that he was ready. She opened a sterile swab and used it to spread Betadine on a small area over the intercostal space between two of Kate's ribs. Lanie gently poked the soft flesh of Kate's chest until she found the landmark she was looking for. She kept one finger over the injection site as she reached down to uncap the large syringe with her other hand. Taking a deep breath, she brought the needle down hard, driving it through the tough cartilage surrounding her ribs and sliding it into the pleural space that surrounded her lung. She slowly drew back on the syringe, draining blood that had been filling the space around Kate's lung until the pressure was so great that it collapsed her lung. She drained about 50cc of blood when suddenly she heard Kate draw in a gasping breath and open her eyes.
Castle had been watching the procedure, holding his breath while he waited to see if it would work, if it would be enough to help her breathe until they could get her to the hospital. Suddenly, he heard Kate draw in a gasp and looked down to see her eyes fly open, though they were cloudy with confusion and pain as she attempted to take in her surroundings.
Beckett's eyes scanned the surroundings, taking in the many tubes and wires attached to her, the incessant beeping of some kind of monitor and a very worried looking Lanie looking down at her, holding a large syringe that was embedded in her chest. Kate heard the beeping from the monitor getting faster and faster as she started to panic, not seeing the one face that put her at ease.
"Lanie..." Beckett gasped out. "Oh god, what...where's...Castle?" In her panic, Kate tried to lift her head off the pillow in order to see where she was. Three pairs of strong hands were on her at once, holding her body firmly against the gurney.
"Hey Kate, I'm right here honey," spoke a quiet, soothing voice from behind her while a warm hand gently squeezed her own cold, shaking hand.
Kate slowly turned her head, her eyes finally landing on Castle, his normally lively face looking pale, drawn, and worried as he gave her a sad smile. Again, Kate tried to lift her head and reach for him, but his gentle hand slowly pushed her back down to the mattress.
"Kate, you're in the ambulance. You've been shot. Don't try to get up, honey. It's going to be okay. We're almost to the hospital. I won't leave you, I promise. Just try to relax and breathe right now, okay? Everything's going to be fine."
A single tear trickled down Beckett's cheek as Castle tried to reassure her in a low, soothing voice. She glanced down at her chest and again noticed the large syringe sticking out of the right side of her chest. Lanie was wrapping gauze around the base of the syringe and carefully taping it securely to her chest. Kate drew in a sharp breath and again tried to sit up.
Castle's hand was on her arm again in seconds, holding her still.
Kate please, don't try to get up. You're going to hurt yourself. Just let the paramedic and Lanie take care of you, okay?" Castle commanded a bit more forcefully this time.
"Castle?" whispered Beckett, her eyes slipping closed.
"Yeah Kate? Do you need something?"
Kate opened her eyes slowly, looking up to his worried face.
"Castle...I can't...breathe. I need to...sit up. Help me..."
Castle's worried eyes flew from Kate to look at Lanie questioningly. Lanie nodded, and responded to Beckett.
"Okay, Kate. We're going to raise the head of the gurney, so you don't need to do any of the work. Just lay there and we'll get you up."
John reached for the lever on the side of the gurney and slowly lifted the head of the stretcher until Kate was propped up in a near sitting position.
"How's that, Kate? Is it getting any easier to breathe?" asked Castle worriedly.
Kate nodded slightly. "A little bit," she whispered. Suddenly, her face contorted with pain and she her eyes squeezed shut, causing tears to stream down her cheeks. She remained motionless for several seconds, her face tightened in pain and her breaths coming in short gasps. Kate reached up for her oxygen mask and pulled it down around her neck, slowly opening her eyes to look at Castle as she did so.
"Rick...it...oh god...it hurts," cried Kate desperately, struggling to get the words out between gasps of air.
Castle's face crumpled at her cries, a single tear escaping his eye and falling onto his cheek. He gently reached up and replaced the oxygen mask over her nose and mouth before reaching down to stroke her hair.
"Shh...Kate, I know. I know how bad it hurts, sweetheart, but you are doing great. We're almost to the hospital. Just squeeze my hand, okay?" he finished, sliding his free hand back into hers.
Castle turned to Lanie and John frustratedly. "She's hurting so much. Can't you give her something for the pain? This is torture watching her go through this."
John shook his head sadly. "Look, I know this seems inhumane, but she's barely breathing at the moment and pain medications tend to depress the respiratory system. If we give her painkillers, she would probably pass out again and then we'd end up having to intubate her. As soon as we get her to the hospital and they put in the chest tube, they'll be able to give her pain medications and sedate her if necessary. Just keep talking to her and keep her calm, okay?"
Kate continued to tightly grasp Castle's hand, holding onto it like the lifeline that it truly was. She felt dizzy from the pain, lightheaded from lack of oxygen, and woozy from the blood loss. The only thing anchoring her to the ground, to reality, was him. She could hear the familiar buzzing in her ears that signaled that the blackness was coming once more. Earlier, she had welcomed this escape from the pain. But now, all she could think about was the feel of Castle's warm hand in hers and her strong desire to stay in the light with him. She was scared that if she went back into the darkness, she might never find her way back out. Rick was her partner, her best friend, her confidant, her plucky sidekick, her supporter and champion, and most of all, the man that promised that he would be there, that he would have her back, always. Always. That was a big promise to make, especially since they both knew nothing is forever. But for now, Kate would try her best to stay in the light and Castle would not leave her side, would not stop fighting for her, and would be there for her. Always.
Whew! These chapters just keep getting longer and longer. Hopefully, you won't mind that too much! So, how did I do with this chapter? Too technical? Not enough Caskett? Or did I get the balance right in this chapter? I'm going to try to post another chapter tomorrow night since I've got rough outlines for the next 3-4 chapters, but I really want some feedback from you, dear readers, before I put up the next chapter (hint, hint). Please tell me what you liked about this chapter, what you didn't like, and anything you would want to see happen in upcoming chapters as I'm always open to plot suggestions Thanks for reading (and reviewing)!