Chapter 5
Steve was still in his hospital bed, being pushed now into another room. His father was already talking to the doctor who was standing at the far side of the room inspecting a tray of instruments.
"That'll be five bucks" Jesse joked as he helped the nurses push the bed into place.
Mark turned around "Steve, you remember Dr Jones?"
"Call me Arnie. Pleased to meet you again Steve, your dad continues to update me on your fine career." He extended a hand, which Steve managed to take hold of weakly. "Your father's told you what we brought you down here for?"
"A spinal tap" Steve replied
"We prefer to call it a lumbar puncture"
"Does that make it hurt any less?" Steve joked
"It really shouldn't hurt too much anyway" Jesse told him.
"Have you got any questions about the procedure?" Dr Jones asked.
Steve shook his head with almost mechanical slowness "you can tell more from this than from the blood tests right?"
"It gives us different information, that's all. You just need to roll onto your side, I'll perform the test and then we wait for the results, OK?"
"OK, someone want to give me a hand rolling over?"
Jesse stepped forward to help Dr Jones as Mark looked on. They collapsed the back of the bed and supported Steve's head as they removed his pillow, allowing him to lie flat on his back. Jesse then manoeuvred Steve's arms, folding them across his chest as Dr Jones arranged his legs.
Steve grinned "If they try and saw me in half you'd better stop them" he warned Mark. The truth was he felt so helpless as they twisted and turned him as if he were a puppet who'd had his strings cut.
"On the count of three" Dr Jones instructed "1…2…3".
Steve winced as he found himself being turned onto his side, Jesse pulling pillows down to support his back before putting his arms in a more natural position. Dr Jones bunched Steve's legs up a little and then disappeared from sight. Mark pulled up a stool by Steve's face and took hold of one of his hands.
"Would you mind assisting, Dr Travis" Dr Jones asked "Just hold our patient here in place"
"No" Steve barked
"What's wrong?" Mark asked, taken aback by the sudden outburst "It'll be over in a little while."
Steve closed his eyes "I'm sorry Jess, I'd prefer it to be somebody else, someone I didn't know."
"Not a problem" Jesse chirped though it was evident Steve's words had surprised, and maybe even hurt him "I'll find you a nurse."
Dr Jones looked over at Mark, questioning his presence.
"Steve, do you want me to go too?" he whispered
"No, I want you to stay for this if that's OK?"
"Sure it is" he smiled, smoothing Steve's hair from his forehead "Sure it is".
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"OK Steve" Dr Jones began "I'm just going to mark the right spot here on your back." Steve felt the doctor's fingers walking down his spine and then a sensation he couldn't quite place. "That's L4-L5" he stated, and Steve presumed that information was for his father's benefit.
"Your dad tells me you're not allergic to iodine or lignocaine Steve, is that right"
"Not allergic to anything that I know of"
"Good" he replied "I'll just clean the area off first" Steve felt a small cold patch develop low down on his back. "And now I'll numb the area, nothing special just a regular injection, little prick and that's it."
Though Steve felt something as Dr Jones administered the anaesthetic it wasn't really a pain. In fact Steve's whole body had a remote, desensitised feeling about it.
"All done" Dr Jones chirped, popping the needle into a sharps box. "Just wait for that to kick in."
Mark smiled down at Steve though his eyes darted across to his colleague as he prepared the needles and vials for the procedure. Steve's stomach began to turn somersaults but he tried not to show it.
"Now Mark, if you can make sure Steve keeps his shoulders and head rounded down" the voice from behind Steve instructed "nurse, keep his knees up tight."
Though Steve could feel very little now, his stomach still knotted as he sensed Dr Jones move close to him again. Steve gritted his teeth as the needle entered his flesh and Mark looked over at Dr Jones.
"Sliding in between the vertebrae now, nice and easy does it"
Steve wanted to tell him to shut the hell up, his damn commentary making him feel worse than the needle in his hand, but he lay there unable to speak. He tried to squeeze his father's hand harder and Mark realised it, tightening his own grip. "It's OK son, you're doing well."
Mark watched as the needle slipped further into his sons back, and almost winced himself when it met some resistance.
"OK Steve, I'm going to get the nurse and your dad to straighten you up a bit." Steve felt both comply to the doctors orders. "Moving you like this increases the pressure in your spine, it helps the fluid come out more easily" he heard Dr Jones explain.
Steve closed his eyes and tried to block out the blow by blow account he was receiving. Technical words and impressive phrases littered the air for a few minutes, then everything around Steve suddenly became quiet and still.
"Steve" he heard his father call after a short while
"I'm OK" he replied, and apart from the butterflies in his stomach he really didn't feel any pain now.
"Arnie will just take a couple more samples and then he'll test the pressure in your subarachnoid space again."
Steve smiled faintly and opened his eyes. Mark looked down at him puzzled.
"You sound like a doctor" Steve explained.
"One more to go" Dr Jones interrupted from someplace out of Steve's view.
Mark watched his colleague as the stylet was drawn back, for a few seconds there was nothing then slowly fluid began to fill the clear tube. Steve's breathing suddenly became more ragged, so Mark lent closer to him.
"I know" he whispered "almost there, just breathe evenly, in through your nose, out through your mouth." He demonstrated and Steve attempted to copy him, trying not to think about how stupid those husbands always looked in pre-natal classes.
"Almost done" Dr Jones' words were like music to Steve's ears "I just need to check the pressure again and then we're done."
Steve lay still for what felt like an eternity before anyone spoke again. "Everything seems normal so I'm going to slide the needle out now." Steve sucked in a quick breath as he did so, causing him to make a little hissing sound between his teeth. "And that's it, done and dusted." Steve let out an inaudible sigh of relief, and looked up at Mark.
"You did just fine" his father assured him as Dr Jones wiped the site around the needle mark clean.
"You've got to lie still for a few hours, on your stomach or you back, whichever you prefer, then we'll move you to a more comfortable position after that."
"My back" Steve replied and sluggishly nodded his understanding as Dr Jones filled out the paper work. When he'd finished he helped the nurse roll him onto his back as Mark supported his head.
"OK, I'll run this down to the lab, it'll take a few hours at least to get the full results. You rest here for a while then we'll move you to your own room, OK?"
Mark nodded "Thanks Arnie, and thanks again for coming out so late." He turned his attention back to Steve who'd screwed his eyes tightly closed. "Are you OK?" he asked but Steve didn't answer. Jesse and Amanda poked their heads around the door and Mark hastily beckoned them in. "Steve?" he asked again.
Steve opened his eyes which were slightly reddened "feel sick" was all he managed to croak. Amanda grabbed a bowl from the trolley and reached over to Steve just in time.
"Is that better?" Mark asked, dabbing a paper towel to his sons mouth and Steve blinked in reply
"Sorry about that Amanda" he croaked, looking like he wanted the ground to open up and swallow him whole.
"Don't worry, I'm a doctor and a mother, I've seen worse. And if you splashed me you'll get the dry cleaning bill" she shot a worried glance at Mark.
"Are you sure you're OK?" Mark asked again but Steve didn't reply.
"I've heard of post spinal tap headaches" Jesse began "but it shouldn't make you nauseous."
"I think it was just….nerves" Steve admitted bashfully.
"Nothing for you to worry about now, that's it over with" Mark reminded him.
Steve noticed Jesse still standing by the doorway "Sorry for kicking you out Jesse, but that nurse was prettier than you y'know?" Jesse ginned "Oh and thanks for lying, first Dr Evil says EMG's are painless then you tell me spinal taps are a walk in the park. How do you doctors ever gain patients trust?"
Mark looked down realising he was still tightly gripping Steve's hand. He gently slipped lose and stood up. "I'm leaving Amanda here to make sure you don't move, I have to make a quick call, I'll be back in a little while OK?"
"OK dad" Steve replied as Amanda occupied Marks seat. She placed her small hand on Steve's bare arm, though he knew she was touching him he could barely feel it, her skin on his was as faint as if it were her breath.
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"There you are" Jesse observed as he found Mark sitting alone in the doctors lounge. Mark's head flinched up and his worried eyes met Jesse's "It's OK, I just came to tell you we settled Steve into a room up on three, Arnie said the results shouldn't be long now."
Mark nodded, but Jesse could see he was lost in a world of his own. "He'll be OK, the lumbar puncture has to give us a clue."
"I hate to see him like this Jess, especially when I don't know how to help him. I just had to get out before, sorry I left you and Amanda to deal with it."
"He needs you there when Dr Jones comes back Mark, I think we should go up there now."
Mark nodded wearily and followed Jesse out into the corridor.
"Dr Sloan!"
Mark turned sharply as the stern voice called out behind him. Chief Masters and a second younger man paced down the corridor towards him. Masters extended a hand which Mark accepted, though he was intent on keeping their meeting as brief as possible.
"How is he?" Masters cut to the chase.
When Mark didn't reply Jesse stepped in "We're waiting on some more test results."
"When I saw him at your house he said it was fatigue, nothing more. Now I hear he's paralysed."
Mark grimaced at the insensitivity of his statement. "We don't know for sure what's wrong with Steve" he barked "if you'll excuse us I want to be with my son now."
"I've some questions for him, we'll come with you" Masters asserted and made a move to follow the two doctors. Mark shot him an angry glare. "This is Agent Malcolm Reynolds, FBI" he waved an arm apologetically at the young man beside him.
"I'm not concerned who he is at the moment, Steve is unwell and the last thing he needs is…."
"I don't think you understand sir" Reynolds cut in. "Your son is involved in a very high profile case and…."
"And that gives you no right to interfere at a time like this!"
"Dr Sloan" Masters' tone had mellowed in an attempt to influence his decision. "How about we go and ask Steve how he feels about talking to us?"
Mark looked at Jesse and fought to keep his reply courteous. "I'm warning you, he's very weak and very agitated at the moment. If he doesn't want to talk to you nobody is going to make him."
"We just need some answers" Reynolds replied smugly.
"And Steve needs his privacy" Mark hissed back.
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Cheryl perched hesitantly on the foot of Steve's bed as Amanda stood by the window; Mark and Jesse were nowhere in sight. The two women looked at each other, each hoping the other would initiate some sort of conversation to break the deafening silence. Their glances soon fell back to Steve, who was lying motionless on the bed, head slightly raised now though he wasn't fully sitting up.
"It's been three hours" he murmured.
"I'm sure they'll have the results soon" Amanda assured him, but Steve just sighed. She realised he was enquiring about the whereabouts of his father, not the test results.
As if on cue, the door opened and Mark and Jesse entered.
"Full house" Jesse smiled,
Mark seemed to ignore his son and instead turned to Cheryl. "Oh, you're back, good. Did you pack a bag?"
Cheryl nodded shyly. "Listen" she started, tapping Steve's foot. "Jesse's right, it's getting crowded in here so I'll leave you guys to it for a while, OK?"
Steve wanted to tell her it wasn't OK, but he didn't want to embarrass her in front of the others either. So he smiled and watched as she shuffled her way out of the room.
"Chief Masters is outside and some guy from the FBI, they want to talk to you but I told them they'd have to wait a while." Steve thought about it and shrugged.
"These results should show something right?" The question was a rhetorical one "so when we know more I'll speak to them."
Mark checked his watch, sat down in the spot left vacant by Cheryl's departure and drummed his fingers on his knee. He looked at his watch again and ran a finger across his lips "maybe I should go and find Arnie".
He was about to get up when there was a light knock on the door. Dr Jones pushed his head into the room and smiled towards Steve in a well-rehearsed fashion. "Steve" he began "do you mind if I have a word with your dad?" and nodded towards Mark.
Steve looked puzzled "If it's the results then you can just tell me"
"I know, but there's something I want to check with your father first, do I have your permission to do that?"
"You're not trying to keep something from me?" he asked nervously
Dr Jones shook his head "not at all" and then to Mark "can we step outside?"
Both doctors tried to make their exit as casual as possible but Mark's mind was a buzz with reasons for the consultation.
Once in the corridor Dr Jones signalled for Mark to move further away from the room. At the other side of the doorway Cheryl was deep in discussion with Masters and Reynolds.
"Arnie what is it?" Mark asked impatiently.
In a slightly hushed voice he began, "Spinal fluid showed greatly increased protein levels, coupled with the results of the EMG and NCV and the fact that everything else was in order" he sighed "It all points to Guillain-Barré."
"Guillain-Barré" Mark gasped "Of course, of course" he held his palm to his forehead, scolding himself for not making the diagnosis. Then the realisation hit him; his son had Guillain-Barré syndrome.
"Mark, I've only diagnosed a handful of cases in my whole career and I'm meant to be a specialist, you couldn't have known. I'm going to suggest we start plasmapheresis as soon as possible. Mark, Mark"
Mark looked up quickly, focusing intently on Arnie's words now. "Yes, go on" he requested.
"What I'm most worried about" Arnie continued "is what Steve's reaction will be if we go in there and give it a name. You know how people are with the 'C' word for example, mention cancer and they don't hear the statistics you give them, they're already sure it's the end of the road. Most of my patients would never have heard of the condition but I know Steve is already familiar with it from Kate Delieb's trial. That's why I asked you out here. Any ideas on how I should handle it, or would you like to tell him yourself?"
Mark didn't hesitate "I'll tell him"
"OK, do you want me there? I can be if you want or I can go and get the plasma exchange set up, call in on Steve later to answer any questions he may have."
"You go and do what you need to, I'll talk to Steve, and Amanda and Jesse will be there to help me out." With that Mark took a deep breath and headed back towards Steve's room. Masters and Reynolds leant on opposite walls further down the corridor now, Cheryl sat on a chair just outside Steve's room and with a nod of the head Mark beckoned her inside with him.
Steve smiled seeing them both walk in and he restrained himself from asking the obvious question. Mark shot serious looks at both Amanda and Jesse.
"Do you want us to go?" Jesse asked, the question directed towards both Steve and Mark.
"No, you might as well all be here, save telling the details over" Steve sighed.
Mark poised himself and started to speak, his tone pitched somewhere between physician and father. "Now Steve, all the results are back and Arnie, Dr Jones, has been able to make a diagnosis. The good news is we've caught this early, Arnie's arranging for you're first course of treatment as we speak, and there's a good chance that you'll make a full recovery."
Steve nodded weakly in understanding and waited for his father to expand on the information.
"As you know the EMG and NCV indicated that your nerves aren't receiving signals as they should. Sometimes the body gets confused, and instead of fighting an infection for example, it turns on the nerves." He paused, wondering if Steve may remember the details of Kate Delieb's trial and make the connection himself.
"Is that like multiple sclerosis?" Steve asked anxiously
"Not quite" his father tried to explain "and in MS the effects would be much more gradual than this."
"So what's wrong with me?" Steve asked impatiently
"The lumbar puncture showed raised protein levels…"
"Dad" Steve snapped.
Mark realised he could put it off no longer. "I want you to remember what I said Steve, the prognosis is good OK?" Mark took a gulp off air. "Steve, we believe you have Guillain-Barré syndrome" he paused expectantly. "I know what you're thinking" he added hurriedly "but you have to understand Steve, in a man your age and given your medical record there is a very good chance that you'll make a full recovery."
Steve desperately wanted to believe him.
"I know you're probably a little scared given by what you saw and heard about David Goodman during Kate Delieb's trial."
Steve wanted to nod but couldn't, wanted to scream but he couldn't seem to open his mouth. Instead he scrunched his eyes tightly closed for a minute. All he wanted to do was shut this awful reality out.
Mark stepped closer and laid a hand on Steve's arm. "The first step in your treatment is a plasma exchange, I know this is all a shock right now but Arnie's checking the set up, when it's ready they'll arrange for somebody to transfer you. Once it's underway Arnie will be on hand for any questions you have, until then you can ask us anything you want to." Mark looked up at Jesse and Amanda who were both nodding sympathetically.
"Your dad's right" Amanda said soothingly, seeing Steve's distress "starting treatment so quickly is really beneficial, it could make a big difference."
"I could still end up like David Goodman though" Mark shook his head defiantly but Steve continued "only communicating by blinking, having to hope somebody puts me out of my misery."
"No, Steve, David Goodman was a very rare case. The Guillain-Barré was very severe and he was in a tiny percentage of people who get a reoccurrence" Mark reasoned.
"But from what I understood the onset of Guillain-Barré was rarely as rapid as this."
"That's true" Jesse butted in "but rapid onset doesn't mean the final prognosis is necessarily anymore severe."
"On the contrary" Amanda tried to reassure him "if this had crept up on you over a few weeks instead of a few days, it would have taken longer for anybody to take it seriously, diagnosis would have been much slower. This way you get treated fast, honestly Steve, the effects of this condition are extremely variable, you can't compare yourself to any other case."
Cheryl wrapped he arms tightly around herself and half-turned away from Steve. His eyes flicked across the room to her, and he realised she didn't understand the condition like he did. She must have a thousand questions he thought, and no doubt this medical jargon was as frightening for her as it often was for him.
"Cheryl?" he croaked. She turned to face him but didn't reply. "Could you and Jesse go and explain this to Masters and that jerk Reynolds. I don't want to be going through it all with them, besides, as soon as they know it isn't voodoo they'll probably be out of here like a shot."
Despite his dismissive tone everybody in the room knew what he was trying to achieve. Jesse and Cheryl silently left, and before they could shut the door behind themselves Amanda made her excuse to follow. "I'll just go and check in with my babysitter, be back soon."
As the door closed both Mark and Steve smiled at the way the room had emptied so quickly.
"So tell me Dr Sloan" Steve began half mocking "Just how much is this plasma exchange going to hurt?"
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