Chapter 10

Josh was paged but by the time he arrived Castle had already been stabilised and Kate arrived soon after. Josh seemed concerned by the deterioration he observed in Castle's condition. The doctor on call had already started him on oxygen therapy through a cannula in his nose, but he was concerned that he still seemed somewhat uncomfortable and so replaced it with an oxygen mask. He gave him a painkiller to try and relieve some of his distress and Castle fell asleep without the need for a sedative shortly after.

Castle's condition still hadn't improved a few days later. He tried to hide it from Kate and his family but he couldn't conceal it from Josh.

After several days with very little sign of improvement to his condition he was still in pain, he still couldn't fully lie down and preferred to sleep partially upright – propped up with pillows – in the bed, and he had started to experience some difficulty breathing which was not associated with residual pain.

Josh ordered another set of chest X-rays, and an ultrasound and ECG – he had his suspicions about what was happening to Castle but he needed the results of further tests to substantiate it. Josh revealed the results to Castle during a routine examination a few days later.

"So, how's your pain?" He asked him, moving the stethoscope carefully over the surface of his chest, whilst Castle took a few deep breaths – which still weren't quite deep enough – before he took a step back, looping his stethoscope back around his neck. He looked down at Castle, waiting for an answer.

Castle sighed. "It's not so good." He replied.

"About the same? Any worse?" Josh questioned.

"A little worse." He admitted.

"Having trouble breathing?"

"Yeah," Castle nodded, "and there's a pressure here." He explained, pointing to his sternham. "It feels like there's a two tone weight pressing down on my chest."

Josh nodded – he had obviously just confirmed his suspicions.

"I had to ask you I'm afraid." He explained, as he placed two fingers to Castle's wrist to check his pulse. "But I can see that you're having some difficulty. You're breathing isn't currently significantly compromised, but I can hear that you already have some breathlessness. The thing is it's like I explained to you the other day, there is a lot of infected fluid trapped in the space around your heart, and the anti-biotics don't appear to be working. We need to drain the fluid to relieve some of the pressure, and then you should start to feel better."

Castle looked at him – a strange expression passed across his face. Josh thought he looked afraid – which wouldn't be unusual given the circumstances. When he next spoke his voice shook slightly, seeming to confirm his anxiety.

Castle swallowed nervously. He took a deep breath and then grimaced.

"How do you propose to do that?" He asked.

"Well, there are a couple of options," Josh explained, "but given the amount of fluid present and the fact that anti-biotics have proved ineffective I'd recommend something called a pericardial window, and a chest tube to enable the fluid to drain away slowly over the course of a few days."

"You mean surgery?" Castle asked. He sounded alarmed by this.

"It is a surgical procedure, yes." Josh confirmed.

"Any risks?"

He thought he noticed Castle's hand begin to tremble.

"All surgery carries risk Rick," He smiled as he spoke – heart surgery was a daunting prospect for most people, but as a heart surgeon Josh was as skilled with dealing with frightened patients as he was in the operating theatre, "but I'll go through all these with you in due course." He assured him.

Castle nodded.

"Would you like me to let your family know?" Josh asked.

"You'd probably explain things to them better than me." He said. "I'd probably end up scaring them."

Josh nodded. He suspected that whatever anybody said would end up worrying them at the moment – fear would be a natural reaction to this situation – but with fear came a lot of questions which Castle was not up to answering.

"Just try to take it easy." He advised him. "No getting up, no trying to prove to us all that you're superman. Rest is your friend, not your enemy at the moment."

He patted Castle reassuringly on the shoulder.

"I'll be back to check on you and explain the procedure to you in a bit more depth later, if you think of any questions in the meantime you can ask me then."

"Yeah… thanks Josh." Castle nodded, as the man turned to go and he watched him leave. He waited for the doctor to close the door behind him before giving himself over to his fears and releasing a pent up breath which caused a sudden surge of pain to ricochet through his chest like a bullet out of a barrel. He whimpered.

He may have no longer been a child, and he knew that adults were supposed to be able to handle news like this in a way he didn't seem to know how – but in that moment Richard Castle really wished that he'd had his mother by his side when Josh had delivered the news - to hold his hand, and hug him, and tell him that everything was going to be alright..