It had been a long time. Luka knew that, but he wasn't sure just how long. Dim impressions of people talking to him, voices and faces he knew, and some he didn't, swimming in and out of a misty fog of fever and pain. Of hands that felt very cold, touching him, and holding his own hands. He tried to pull away, but didn't seem to have the strength. Of the beeping of monitors, and the humming of machines. Of the constant pressure of something forcing air into his lungs. And of thirst ... he tried to ask for water, but couldn't seem to do that either.
He finally woke up, fought his way out of the fog. Nothing had changed. The monitors and machines still beeped and hummed. Air still moved in and out of his lungs without any effort on his part. He was still terribly thirsty, and someone still held his hand. He tried again to ask for water, and still, nothing happened.
"Luka." Susan's voice. "Don't try to talk. Can you hear me?" Luka managed to move his head, focus on her, then he nodded. "You still have a tube in your throat; you're on a vent." A moment's hesitation. "Do you remember what happened?"
Luka nodded again. How could he forget? Drowning, suffocating, an ambulance ride, Kerry looking down at him ... He touched the tube, and Susan quickly moved his hand away.
"Don't touch it. It will come out soon. Just as soon as you're a little bit stronger and can breathe on your own."
He had to know, but could he bear to know? Luka mimed writing on his palm, and Susan handed him a notepad and pencil from the bedside table.
Luka hesitated. He'd denied it for so long, he couldn't any more. Not now. His hands were weak. He had to grip the pencil in his fist. He started to write an 'A' on the paper, the scribbled it out and wrote "PCP?" and showed the pad to Susan.
Susan looked at the pad, then at her lap. "Luka, Dr. Heneley will be by to see you soon. He can answer all your questions, tell you everything you want to know." Luka just underlined the 3 letters on the paper. Circled them. The pencil point broke.
And Susan nodded finally. "Yeah." Then more brightly. "You;ve had a rough couple of days. You had us all pretty scared for a while, but you're doing much better now. Another few days, if you continue to do well, they should be able to extubate you, then move you out of the ICU and into a regular room."
Luka could only nod, try to smile around the tube, for Susan's benefit. 'Had us all pretty scared?' Who, besides Susan, would really care, even now, if he lived or died?
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When he woke again, Dr. Heneley was there, looking at his chart. He smiled at Luka. "Good morning, Luka," he said, and sat down. "I'm sure you have a lot of questions. We'll talk more after you've been extubated, when we can have an actual conversation, but right now I'll try to let you know what's happening, and anticipate as many questions as I can, without wearing you out too much. Ok?"
Luka nodded. Did he really want to hear this? Maybe he could just go back to sleep. Pretend it wasn't happening.
Dr. Heneley only saw the nod, not the doubt, because he promptly went on, his voice crisp and professional. "You have pneumocystis pneumonia, a pretty serious case. Your condition is still critical, but you are improving. The HIV test was positive, and PCP is, as I'm sure you know, an AIDS-defining infection. I'm not sure exactly what's going on here yet. You were taking the prophylaxis. Even if it didn't keep you from seroconverting, it should have kept you asymptomatic for some time. But we do know that some of the African strains are resistant and particularly aggressive. That, with the delay in starting treatment, and your debilitated condition during those first few weeks, may have been enough to make the difference. I don't know. What we do know is that your CD4 count is under 100, and your viral load over 100,000. It's not at all surprising that you got sick."
Luka picked up the pad, and the pen that Heneley handed him, and wrote "I'm dead."
Heneley took the pad from his hand, and his tone changed, became gentler, more personal. "No, you are not dead. I'm going to refer you to Marty DeAngelo. He's the best infectious disease guy in town. There are other anti-retrovirals, and new ones being developed all the time. We just need to find a combination that works on this strain. Then we can get it back under control and you can stay healthy for a long time. But the other thing, Luka is that you are going to have to take better care of yourself. This should never have happened; you should not be lying in the ICU with a damn tube down your throat. Dr. Lewis told me that you'd been sick for weeks, my nurse said you canceled an appointment with me. We could have caught this early. You should never have allowed it to go on this long."
Luka nodded. His vision was suddenly blurred. Something wet slid down his temples. Heneley smiled at him, put a hand on his shoulder. "You're going to fight this, Luka." And Luka managed to nod again, wipe away the tears.
Recovery was painfully slow. Luka's fever slowly dropped, his oxygen levels improved, and after 2 more days, Heneley finally removed the tube from his throat. As the tube came out, and Luka coughed and gagged, he told himself that he'd never again be so cavalier about intubating patients.
Susan gave him a drink of water, holding the straw to his lips, and Luka sipped it gratefully. His throat was raw, both from the tube and from the thrush he was still battling, but the cold water felt good. He lay back wearily against the pillows. Another few days, Heneley had told him, and he'd be out of this fishbowl and into a regular room. And then he'd go home.
God ... he hated hospitals. They were fine to work in, he loved being a doctor, but being a patient was something else entirely. He'd been one for so long, and now it was all going to start again. How much time would he spend in hospital beds before it finally ended? One thing he was sure of ...
"Susan?" His voice was a faint rasp.
"Don't talk yet. Give your throat a chance to feel better."
Luka went on as if she hadn't spoken. "When the time comes ..."
"Luka, we're not going to talk about ... we don't have to talk about this now. You have lots of time. Years. If ... when ... it's important ... you can tell me then."
"I don't want to die in the hospital. I'm going to die at home."
Susan smiled, tears brightening her eyes. "Yeah," she said. "Of old age."
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He was picking at his dinner of soup and jello - all he could swallow easily yet, even after 2 days, not that he had an appetite anyway - when Kerry came in.
"You're looking much better, Luka," she said brightly.
"Couldn't look much worse then when you saw me last," he said. He was still a little breathless. More than a little.
"That's true." Kerry smiled. Then, "We need to talk about your job."
Luka put down his spoon, said slowly, "I was pretty out of it when I came in, Kerry. But I do seem to remember somebody saying that it didn't matter, as my boss, if I was HIV positive or not." AIDS. He still couldn't say that.
"And it doesn't. I'm not firing you, Luka. I'm just concerned about you. The ER isn't the safest place to work for someone in good health, with an intact immune system. It's a very high stress environment, you're exposed to ..."
"I need to work, Kerry." Luka interrupted firmly. "I need to work. If I can't work, you and Susan should have just let me die downstairs in the ER ... or she should never have brought me in at all; let me die at home. I don't have anything else. I don't have a family. I don't have very many friends. If I can't work, I will just be going home and waiting to die, because there won't be anything else for me."
"There's other work. You could teach."
"I'm not a teacher. That's not what I do, what I love. ER medicine is what I do ... it's all I've ever done. The six months I was off work, all that kept me going was knowing that I'd be coming back to work again as soon as I could walk. If you take that away from me, Kerry, I'm dead. Heneley and DeAngelo can give me all the drugs they want, but I am telling you now, I will be dead.
Kerry nodded, sighed. "You'll need to be fully recovered from this first, and your lab picture will need to look better."
"They've got me on a new combination already. It should start working soon. My CD4 counts should be coming up."
"Good." Kerry rose. "You get some rest. I hope you'll be ready to come back soon."
Her words rang with insincerity.
Left alone again (as alone as he could be in the fishbowl of the ICU), Luka lay back on the pillow. The long conversation had left him gasping and breathless. He remembered something Kerry had told him years ago, something Mark had told her before he died. Mark had stopped working to spend his last months with his family. "Don't let your work become your life," he'd told her. But Mark had a family. Luka's work was his life. That had been true ever since Danijela had died. (And true, in a sense, even before that - hadn't he sacrificed her and his children for his work?) He had nothing else. When he could no longer work, and that time would come, he knew, he would have nothing left to live for.
