Chapter 7
"Breathe in for me nice and deep Castle."
"I can't." Castle groaned.
Beckett sat beside him on the couch, one hand wrapped reassuringly around his shoulders to help steady him. His shirt was open as Josh listened to his heart and lungs to try and establish a possible cause of Castle's chest pain, but it was difficult when the pain was beginning to impede on his breathing. He didn't like the look of Castle's complexion. He had quickly deduced that the problem wasn't in his lungs but had now already lingered with the stethoscope for far too long over the area of his heart for Beckett's liking.
His expression was also making her nervous.
Josh stood back and sighed. He placed a hand to Castle's forehead and could feel that he had a fever without the need for a thermometer.
"How long have you had the pain?" He asked him. He secured the cuff of the blood pressure machine he had brought with him around Castle's upper arm and inflated it with the touch of button.
"A few days." Castle responded. "But it's been getting progressively worse."
Josh nodded. He waited for the monitor to take the reading.
"It's low." He said, analysing the data once the numbers appeared on the screen.
"He had the flu about a week ago." Beckett told him.
"And you say that it's a sharp pain as opposed to a dull ache?" He questioned him further, removing the cuff.
Castle nodded. "It's worse when I lie down or take a deep breath." He explained. But the effort of talking caused more spiteful tendrils of pain to creep searchingly through his chest.
He whimpered.
"It's like a knife – like I'm being stabbed… repeatedly." He grimaced.
"It's alright Castle." Josh sighed. He then turned to look at Kate and observed her anxious expression. She looked at Castle with such affection in her eyes – every fine line of her beautiful face accentuated by the concern she felt for the man in her arms. He didn't think he'd ever seen her look at him in quite the same way.
Richard Castle completed her. He made her happy – he made her content in a way that Josh knew he never had – and instead of making him feel jealous he was surprised that instead it made him smile.
"Really Kate…" He did his best to reassure her. "It's alright. It's not a heart attack."
"Then what is it?" She asked him.
He held her worried gaze. At this stage he didn't have enough information to comment with any degree of certainty, but there was an abnormality which he had picked up on whilst listening to Castle's heart which needed further investigation, and Josh would have been lying if he'd said he wasn't concerned.
"Well I'm not yet sure." He said.
Josh gently massaged the area either side of Castle's jaw bone – checking his lymph nodes for any swelling – before placing two fingers to one abnormally limp wrist and feeling for a pulse.
"Based on his symptoms I'm concerned that it might be something called endocarditis." He told her.
"Is that bad?" She pressed him.
"I won't lie to you Kate. If it is, then yes, it's potentially very serious." He explained. "But it's also incredibly rare in healthy hearts."
"Would that explain the chest pain?" Castle asked.
"Well, that's the thing, based on the type and intensity of your pain I'd say that it's almost certainly more suggestive of pericarditis, which is still a serious heart infection, but significantly more common." He responded.
Castle stiffened. Josh saw the fear in his eyes as he said this – it was the fear experienced by most people when they were delivered the blow of a potential heart condition – and he swallowed hard. When he spoke he somehow managed to keep the tremor out of his voice for the most part however.
"Ok…" He took as deep a breath as he could manage. "So where do we go from here?" He asked.
"Well we need to get you into hospital and do some tests to confirm a diagnosis." Josh told him. "If it is endocarditis then we need to act quickly. Either way we need to start you on IV anti-biotics as soon as possible to prevent the spread and worsening of the infection."
"What, right now?" Kate asked.
"I'm afraid so." Josh nodded.
"Well, should I call for an ambulance?" She asked him - feeling guilty that this was something somebody should have probably done in the first place, but her instincts had told her to call Josh.
But Josh shook his head.
"By the time they get here, we can actually get him there a lot quicker ourselves if we get a move on." He told her.
"I'll call Alexis and Martha." She said, getting to her feet, but Castle reached out a shaky hand to grab her arm and stop her.
"No Kate," He protested – the movement causing his body to stiffen as more pain surged through his chest. It was strange - it seemed to her as though so long as he stayed propped upright, didn't take any deep breaths, and didn't make any sudden movements he was alright - but as soon as he did any of these things the pain came back with a vengeance. She could feel his fingers constrict around her arm – his skin cold and sticky.
"Let them enjoy the rest of their trip, they'll be back in a few days anyway." He pleaded with her.
"Castle!" She exclaimed. "We don't even know how serious this might be! You can't keep this from them!"
He looked back at her – his face full of fear and worry. He was doing his best to appear strong, she could see that, but he was only human. He knew that she was right of course, he was only trying to protect his family but he knew that they wouldn't thank him in the long term for keeping this from them.
"It's going to be alright you know." She smiled at him at him, and she gently squeezed his hand. He tried to smile back at her, but his heart wasn't really in the gesture and the smile didn't make it past his cheekbones.
He sighed.
"Ok… call them." He finally nodded.
"I'll call ahead." Josh told them. "Let the hospital know that we're coming, see if they can have a room ready by the time we arrive. When you've done that Kate do you think you could throw Castle a few things together whilst I help him down to the car? He's going to be in for a while I'm afraid."
Kate nodded, but as Josh turned away from her, fumbling for his phone in his jacket pocket, she tapped him on the shoulder and drew him aside.
"Josh, can you be absolutely sure this isn't a heart attack?" She asked him, concerned.
"I can promise you this isn't a heart attack Kate." He assured her. "Many heart conditions have the same symptoms, including pain and shortness of breath, and to the untrained eye all episodes of chest pain can be misconstrued as a heart attack, but his symptoms subside when he sits up and are worse when he takes a deep breath, which is a key symptom of some kind of infection. I also heard a slight abnormality, known as a pericardial rub, whilst listening to his chest, meaning that his pericardium is descended. That is what is causing him pain."
She nodded.
"The sooner we get him on anti-biotics and painkillers the sooner he should start to feel better." He told her. "But we won't know the full extent of the infection or any damage done until we've performed a few tests."
"How serious is this likely to be though?" She asked him. "I mean, are we talking a few days in hospital, a short course of anti-biotics, and then back home again within a week, or something more serious here?"
"Look I'm going to level with you here Kate." Josh sighed. "At best he's probably looking at at least a week on IV anti-biotics and a few days bed rest." He told her. "At worst though, and depending on how advanced the infection is, he may need surgery. As I say I can't be sure how severe things are at the moment. I need to do a number of tests to confirm a diagnosis and then work out a suitable treatment plan once I have all the data in front of me. You wouldn't convict a man of murder without all the evidence would you?" He smiled.
"No." She shook her head.
"You have to trust me though." He said. "Whatever needs to happen Castle is going to be alright, but I have to call the hospital now and I need you to go and call Martha and Alexis. The sooner we start the ball rolling with this the better."
She nodded, but as she turned away she quickly turned back to face him.
"I want to thank you Josh, for coming, and for... doing everything you can for us." She told him. "I know I probably should have called an ambulance, but I immediately thought of you. I mean, I'm too close to Castle. Normally as a cop you're able to rationalise things, to do the practicle thing, but it's harder when it's somebody you love. I just wanted the very best care for him."
"It's alright." Josh smiled at her. It wasn't the sort of smile she had once been used to receiving from him, but it was a reassuring one non-the-less.
"Even so, it's not like me." She said.
"Who knows how they would react in this situation. You did what you thought was the right thing at the time." He sighed. "And your instincts are rarely wrong Kate." He told her. "I can get him admitted a lot quicker than if he'd been taken in by ambulance."
Castle again shifted uncomfortably in his seat and as Kate made a bee-line for the bedroom she turned and smiled at him. Josh meanwhile bent down beside him as he punched in the number for hospital admissions - comfortingly close. He was on the phone with hospital administrations only a couple of minutes, and when he finally hung up the reciever he turned to him.
"How you doing?" He asked him, placing two fingers to the side of his wrist to check his pulse.
"Alright, I guess, at the moment." Castle nodded, voice still sounding a little strained though. Josh took note of the rhythmic beating beneath his fingertips, before withdrawing his hand.
"Then how about we see if we can't get you down to the car?" He asked him.
Castle nodded, although Josh could tell that he was probably going to struggle. He still seemed breathless and grimaced as he helped him to stand. He had to take things slow - he moved stiffly - and the cold sweat ran down his face from the exertion. Josh helped to steady him, but as he helped Castle to carefully ease himself up off the sofa the man whimpered and froze, doubled over - it taking him a few seconds to compose himself as he waited for the fresh wave of pain to subside.
"Car?" Castle asked, a pained grimace still etched into his face, once Josh had helped him to his feet and he had managed to compose himself again. "Whatever happened to the motorcycle?"
"Well I just figured I was getting a little old." Josh told him. "When it started to become a bit of a running joke with the guys at the hospital I realised the time had come to trade it in for something more sensible."
"So I guess motorcycle boy is no more then?" Castle grinned.
"I suppose we all have to grow up sometime." Josh smiled, and Castle supposed that he was right. He wanted to return the gesture - to say something suitably poignant in response, but as he took a step towards the door - putting one foot gingerly in front of the other - lack of food, and dehydration, coupled with exhaustion and pain worked to make him feel suddenly light headed, and his head began to spin. He stopped.
Noticing a subtle change come over him Josh frowned. Something was defiantly seriously wrong. Castle was clearly very unwell, and the sooner they could get him into hospital and on medication the better the outcome was likely to be.
