Chapter 53.
Everybody Dies.
September 4, 2019.
Cristina turned into the hospital mechanically, forgetting that she was meant to be going home. She was already in a parking spot when she noticed. It was early morning and she had only just arrived in Seattle, just got off the plane, just got her son to stop crying about leaving Saul behind – and she was already back at work.
She shut the car off. "We can just go in for a minute to check on one of my patients, okay, Col? Her name is Juliet. You good with that?"
He stared at her from the backseat, silent as ever.
"I thought you would say that."
It was quiet in the hospital, and chilly in the halls. Cristina went up to the breakroom first, thankful to find Callie slumped on the couch, sleeping, with a bagel in one hand.
She put Collin on the couch beside her and whispered, "Stay here. I'll be right back."
Juliet was just down the hall, in a room on the left near the stairwell. Cristina was halfway there, a few strides away, when she felt that something was off. Juliet usually kept her TV on all the time because she hated the quiet. She was usually up by now, harassing the nurses to play cards.
Cristina stepped into the doorway.
It was strange, at first, to see such a change in only a few days. Cristina had left the girl mostly healthy, smiling and laughing, on the road to recovery, and now she was back, and Juliet had sallow skin, and she was lying with the bed flat, with Alex hovering over her. Her parents were on the other side, holding her hand, their eyes wide and afraid.
When he saw her standing there, Alex stood straight. He beckoned her over. "Her temperature became elevated a few hours ago and she started getting pale. She complained of a headache. I ordered a full blood panel and got her started on an IV."
Cristina went straight into work mode, forgetting that the parents were there, forgetting that her own son was somewhere in the hospital. "How are the sutures?" She drew the covers away and unbuttoned Juliet's gown, revealing a long, pink incision down her chest. Cristina had made it when she gave the girl new lungs. "It looks fine… healing… Did you get those results yet?"
"Should be on the way. I sent Dr. Maddison to check."
"Good. Juliet, can you hear me? Can you talk to me?" Cristina stole a penlight from Alex and shone it over the girl. Juliet flinched away from the light but did not look at her. "Juliet, I need you to talk to me. Can you do that?"
She said nothing. Cristina looked at Alex. "She was talking twenty minutes ago," he said, squeezing her hand. "Juliet, sweetie, can you move your fingers for me?"
"What is wrong with her?" Gina Cortez asked. "Juliet, baby, talk to the doctors!"
Cristina made a snap decision. "We need to take her into surgery right now. I need you two to stay here and trust me, okay?" Cristina looked sharply at the parents, who were in the middle of losing their minds. She was already unlocked the bed wheels. "Alex, get an OR ready."
"Do you think its her lungs?" Alex demanded, swinging to the other side of the bed to undo the locks. Soon they were rolling down the hall. "Her incision looks fine!"
"Nothing else could cause such a rapid slide."
"I'll meet you downstairs!" he said as he ran for the stairwell.
Cristina went to the elevator, beckoning Lawson as he appeared around the corner. He had the results in his hand. "Give me those. Come with me."
Lawson stuck to her side. "What happened?"
Cristina opened the folder in the elevator, "What is the fastest way to spread infection?"
"In the blood," he responded immediately.
"What's the fastest way for an infection to get into the blood?"
"Um, puncture-"
"How does pneumonia spread from the lungs to the blood?"
"Via the alveoli?"
"No, via the epithelial tissue. Bacteria enters the epithelial cells that protect the bloodstream from the lungs and kills them, opening up a path for bacterial pneumonia to become sepsis. Transplant patients are at exceptionally high risk for sepsis because we suppress their immune system."
"Is she rejecting the lungs?" his fear turned to horror. "We don't have replacements!"
"I know that. I know that." Cristina shone the penlight over Juliet again, but the girl did not flinch away. "Juliet, I'm going to take you down to surgery to try and make you better." And then she murmured to herself, "Alex was supposed to be watching you."
"He was. I mean, we were," Lawson said.
Cristina glared at him but said nothing. He shut his mouth.
She rushed down the hall with the bed, looking for Alex. He popped out of a nearby room and called them in. "Here. We have a team waiting. I'll run up and get the parents to sign consent. Is he scrubbing in?"
Lawson perked up, but Cristina answered, "No," immediately.
"But, Dr. Yang, I-"
"Did I ask you to speak?" she snapped. "Go work up a report for everything I missed. I want vitals on all my patients for the last twenty-four hours!"
"But I was with-"
"Yes, you were with her, and you did a hell of a job," Cristina mocked, shooing him. "Go."
She scrubbed in, and then waited by the table with the anesthesiologist. Alex returned and showed the paperwork around, and the procedure began. She was put under. Alex scrubbed in and stood on the opposite side of the table as Cristina.
She cracked the chest, finding the lungs in reasonable condition.
"Pink and healthy… then what…?" Cristina palpated the lobes, growing more frustrated every minute, "No signs of lumps… no hardness… What is that?" She leaned, and Alex shone a light at the top of the right lung. It had a laceration in it and some hardening along the outer edge. "I need suction here… Are you seeing this?"
"It looks like an abrasion," Alex said. He came around to her side, "But from what?"
Cristina began to explore the chest cavity for abnormalities. She probed the lining she had cut away for hard spots that could have damaged the lungs, and then the ribcage itself. It was normal.
"Her heartrate is up; blood pressure is up."
"I can read the monitor," Cristina said. She felt around the lung again, confounded. "I put in a perfectly good set of lungs. No lacerations, no abrasions."
"She must have some debris from the explosion still in her chest," he suggested.
"Where?" She pulled the lining, slipping her fingers over it, and even inspected the skin. "It must be small, and persistent. It might just be the irritation elevating her temperature. No, no. I had the labs. Lawson had the labs."
"Infection?"
Cristina looked up, finally stopping her search. Alex had stopped the suction. "What are you doing? I need visualization."
"You know what's happening," Alex said solemnly.
"I know you're being stupid. Suction!" Cristina stared at him, and he stared back, making no move to help her. "Dr. Karev, suction the chest cavity!"
He stirred at last, suctioning the blood that pooled around her fingers. Cristina searched the cavity stubbornly for the source of the abrasions, and eventually found a small sliver of plastic lodged in her pleural membrane. It was scraping her right lung every time the girl breathed. She pulled it out triumphantly and closed the chest, keeping her eyes carefully away from Alex.
When it was done, she stepped away from the table.
Juliet had a quick pulse and a high temperature. She was taken to recovery, but Cristina did not follow. She stayed there, in the OR. Alex stood with her, slowly pulling his gloves off, his gown, his mask. His face was sunken, his eyes on the floor.
"You were supposed to be watching her," Cristina said quietly.
"I was."
"Not closely enough, apparently."
"I couldn't have seen this or stopped this. You know that."
"Do I? Do I know that?" Cristina pulled off her gloves and dropped them on the floor.
Alex came closer, lowering his voice, "It happens with transplant patients. You know it does."
She looked away, burning inside, from both anger and grief. One ruled over the other, and then they switched places. She let the fury take over. Cristina slapped him. "This is your fault!"
He grabbed her arm before she could hit him again, "This is no one's fault."
"We could still take the lungs out," Cristina said. "We could give her a battery of antibiotics."
"We would be drawing this out for no reason," he responded, dragging her toward the door. "Juliet is going into multi-organ failure. In a few hours…"
He let his sentence hang in the air, unfinished, and started washing his hands. Cristina joined him, but only stood by the sink, staring at the faucet. She thought about all the hours she had put in with that little girl, the court case they were preparing, the hell that company put her family through. She was reminded of that little girl in Switzerland again, Holly, and of all the patients she had lost in the interim. It was starting to seem pointless.
Alex took her hands and put them under the water, washing them for her. "I'll talk to her parents, see what they want to do. But I'm going to recommend they let her go. If we take the lungs out her quality of life will be terrible, and the infection will still be there."
When her hands were dry, she curled them up to her body. "But she could live."
"Yeah, as a vegetable in an artificial lung, with burns all over her face and hands."
Cristina pictured it, pictured how tragic an end that would be for her, and how grueling that would be for her family. He was right. It was all downhill from here. It was like the decision had already been made and the girl was already gone.
They walked back upstairs. Alex went in to talk with the parents and Cristina went down to the parking lot. She got in her car, glanced at the empty seat in the back, and then drove home.
It was like she was driving with a mouthful of scalding water, waiting to spit it out, but unable. As soon as she made it to their driveway, to their house, she lunged out of her seat and hit her knees on the gravel, vomiting. It was cold and damp outside, gritty under her hands.
Owen opened the front door, and Cristina made it just in time to yank the screen open. She had not seen him in days, but she said nothing to him. Owen wrapped her up in his arms and drew her inside, and they stood together in the living room.
She did not cry.
He stroked her hair, "What happened?"
"I'm so sick of this," she said.
Owen got his hand on the side of her face and repeated, "What happened?"
"Juliet. She died. Or she will, very soon."
He held onto her for another few moments, and then, "Where's Collin?"
"I left him with Callie. We should probably… go get him."
"I will. Call Meredith. She called looking for you anyway. Or I can. I can tell her to come over."
Cristina nodded into his chest, and reluctantly parted with him.
"Stay here, okay? Kids are all still asleep. Just lay down. Or sit down, at least."
She had not even thought of the kids – but that was given, considering she left one at the hospital. Cristina sunk onto the couch and drew a pillow over her face, intending to scream into it, or smother herself, but ending up just staring at the dark threads.
She heard Owen say, "I'll be back soon!" and then the door closed.
Cristina let the pillow fall away and stared at the ceiling, still far away from tears, and in a confused emotional state. She did not know what made Juliet so special to her, only that she was special, and soon she would be no more.
