Susan paused for a moment inside the ambulance bay doors to steady herself, wipe her eyes. This was bad. Even if it was, in fact, 'the flu', the flu could kill Luka with remarkable efficiency, as weak as he already was.
Taking a deep breath, Susan entered the ER and grabbed a wheelchair from against the wall. She spotted one of the nurses and said, "Sam! Find me a room, and a doc. I'm bringing in Luka in a second. He's really sick."
"Need help getting him inside?"
"No, I've got it. Just find me a room!"
She ran back outside with the wheelchair. Luka looked worse than he had two minutes before. His head lolled back against the seatback, and even in the dimly lit bay, she could see that his color was much worse. He had fallen asleep, or passed out. His breathing was labored.
"Luka! I told you to stay awake!"
His eyes fluttered a little but didn't open. "Not ... asleep ..."
"Like hell you weren't! Come on ... into the chair." She reached around and unbuckled the seat-belt. He was too weak to really help himself now, and Susan debated going back inside to get more help, but she somehow got him into the chair. He slumped forward a little, and for a moment Susan feared he would slide out of it again, but he managed to straighten up, and she pushed the chair inside again.
Carter was waiting inside the doors. "Trauma 2," he said. She must have looked surprised; this wasn't a trauma, Luka was just sick, because he added, "It's what's open right now. We're pretty busy tonight." But what Susan was mostly noticing was the alarm on Carter's face as he looked down at Luka. She followed his gaze, and in the brightly lit ER, was shocked at how bad he looked - how much worse than he'd looked when they had left the apartment little more than 10 minutes before. He was still shaking despite the warmth of the lobby. His skin was ashy gray, and covered with a sheen of sweat. And every breath was a struggle. He needed oxygen - desperately.
"911, Susan," Carter muttered to her, under his breath. "Ever heard of it?"
In the trauma room, Susan gently helped Luka off with his coat, and said "We're just going to help you climb up on the table now, sweetheart, so Carter can examine you." But it wasn't a matter of 'helping.' Carter, Coop and Sam lifted Luka onto the table.
He was barely responsive any more, too weak to help.
"O2 by mask, 15 liters," said Carter briskly. "Start an IV and lets get a CBC, ABG and blood cultures, and we'll need a portable chest."
From Sam came "Resps are 20, pressure's 80 palp, he's a little tachy at 110."
"How long has he been like this?" asked Carter. "Susan?"
Susan had been unbuttoning his shirt. It would have been faster, of course, to have cut it, so they could get the monitors onto his chest, examine him properly, but somehow, she didn't want them to do that. He'd worked so hard to get it buttoned.
"What?" She hadn't really heard the question.
"How long has he been sick?"
"I'm not sure. He wasn't this bad when we left. He was alert ... talking ... You'll have to ask him when it started."
The oxygen seemed to be helping. Luka's sats still showed a rather alarming 85% on the monitor, but they were coming up slowly. His eyes had opened and his color looked a little better.
"Luka?" Carter said gently. "You with us?"
"Yeah."
"When did all this start?"
Luka shook his head. "Was ok yesterday. Just tired. Then Susan woke me up ... said I had ... fever."
"You take your temp every day?" Luka nodded. "No fever yesterday?"
"Little bit. Under 100."
"It's 105.2 now," said Sam softly.
"It's gone up a whole degree in the last half hour," Susan said. Fevers didn't mean anything, she reminded herself. A person could be really sick with little fever at all, or run a very high fever with a mild illness. But this wasn't a mild illness. That was too clear.
"Any pain?" Coop asked.
"Just hard to breathe ... hurts a little. And I'm cold. Chills, I think."
Carter listened to his lungs. "You're not moving much air, Luka."
"Oxygen's helping ... a lot."
He was definitely more alert than he'd been a few minutes before, but he was still not satting well, and the effort required to breathe at all was going to exhaust him quickly.
Finishing his brief but thorough exam, Carter said, "Ok, we'll have to wait for the x-ray, but it sounds like pneumonia."
"Again ..." Luka said wearily.
"But not PCP?" Susan said.
"No, probably not," Carter said. "He had pneumonia twice in the Congo," he explained. "His lungs probably aren't in the best of shape after three bouts with it in the past nine months. He's going to be more and more susceptible to pulmonary infections."
The chest x-ray confirmed the diagnosis. Consolidations in both lungs. "Pneumonia it is," Carter said cheerfully, though Susan recognized it as the same false cheer she had put on at home. "What the causative bug is, we don't know yet. Could be any of the many things you're susceptible to with the HIV, or it could be a standard variety of pneumonia that you picked up at work, or on the el. We'll have to wait for the cultures to come back from the lab. In the meantime, we'll get you upstairs, and start you on IV antibiotics."
Luka shook his head. "Just write me prescriptions. Susan can take me home. I feel a lot better." He tried to sit up, but couldn't quite manage it.
"You feel better because of the oxygen," Susan told him. "You need to be admitted. It won't be for very long." She looked up at Carter. "Right?"
"Right," Carter said firmly. "Just for a few days. Once we know what's causing this, and you're satting well on room air, you should be able to go home with oral antibiotics." A smile. "You're going to be fine, Luka."
Half an hour later Luka was settled into the ICU again. Susan pulled the chair close beside the bed, sat beside him. He looked a little better, but the numbers of the monitors were still worrisome, sats hovering around 90, even with oxygen, and a temperature staying stubbornly at 105, despite a dose of acetaminophen.
Luka looked at her for a moment. "This is it ... isn't it?" he said softly.
"You're going to be fine, Luka. We got you here quickly."
"Don't mean that ... mean ... this is my life now. In and out of hospitals ... well for a few days, few weeks, then sick again. Until my body can't take any more. Or I can't do it any more."
Susan blinked back tears. "It's winter. Everyone gets sick more in the winter. It's almost spring. You'll get through this, and then it will be spring, and you'll do so much better. Your t-cells are up ... this is just a fluke, right? A spell of bad luck. Anyone can get pneumonia."
"You look ... healthy enough."
"I never get sick, you know that."
Luka nodded, closed his eyes. He was exhausted by the brief conversation, and the oxygen mask made talking difficult anyway. "I love you." He reached his hand across the bed. Susan took his hand a little cautiously, would he realize what he was doing? Pull away? He squeezed her hand, held on. His hand was so hot.
"You get some sleep now," she said, when she knew she could speak without bursting into tears.
"That's what I was doing ... 'fore you woke me up, dragged me in here." He opened his eyes again, looked at her for a long moment, then smiled at her from under the oxygen mask. His eyes closed again and, a moment later, his hand relaxed and she knew he was asleep.
She must have fallen asleep herself after a while, because she suddenly heard a voice calling her name softly. Luka was still asleep. His breathing was hoarse and more than a little bit labored, but he seemed to be fairly comfortable. And Carter was there, squatting beside her chair.
"How's he doing?" he asked.
"About the same," Susan whispered. "Resting comfortably."
"Good." Carter looked at Luka for a moment, then at the monitors. Gently, "He'll probably need to be tubed soon."
Susan didn't let herself look at the monitors. She shook her head. "He's doing fine."
Carter's hand was on her arm. "And how are you doing?"
Susan could just shake her head again. She carefully set down Luka's hand and went to stand in the doorway, where they could talk more easily without disturbing his sleep. "It's so hard, John. I never thought it would be this hard - being with him, seeing him in so much pain. But I know that not being with him would be even harder, so I guess I'm kind of stuck, aren't I?"
"I think they call it love, Susan, not 'being stuck.'"
"That ... or co-dependence, but I'm pretty sure it's love." Susan smiled a little. "And I knew that as unhappy as he is, he's happier being with me ... so that helped." Then she had to blink back tears again. "But ... I'm not so sure now. He got back into therapy a few weeks ago ... counseling. He'd been so miserable, he's just ... not getting over what happened to him ... I insisted that he go. I thought it would help, he said it was helping, but to me he looked worse ... he was barely eating, having horrible nightmares, not getting any rest, getting so run-down. I'm sure that's what caused this. If I hadn't insisted that he go ..."
"He needed to go," Carter said firmly. "You said so yourself, and I've seen him. You're right, he isn't happy. He needs to deal with what happened to him; with what's happening to him now. He's been carrying this baggage around with him for far too long. And you didn't cause him to get pneumonia. He got pneumonia because he has an impaired immune system." Carter tilted Susan's chin up to make her look at him. "No unnecessary guilt, Susan. Luka's got more than enough for both of you."
And Susan had to smile a little. "I know. And he is going to be fine."
"Yeah. Look, I just got off. If you want to get some rest, I can sit with him."
"No, you've been on all night. And DeAngelo should be here soon to see him. I need to be here." Just then Susan saw, through the glass, Sam waiting outside. "And don't you have someone waiting for you?"
Carter smiled, and Susan could have sworn he blushed a little. "We're just going to get some breakfast."
"And after breakfast?"
"Alex will have left for school by then. So who knows ..."
"Go. Have your fun! Someone should be having some."
Carter put his arms around her, held her tightly for a moment. "Everything's going to be fine, Susan. You're both strong. I'll be back later."
"Thanks."
Cater left, and Susan returned to her post beside Luka's bed. He was still sleeping, though more restlessly now. Susan forced herself to look at the monitors. His sats had dropped again. Only 83 now. They'd been drifting down, slowly but relentlessly for the past few hours. Susan gently adjusted the oxygen mask, making sure it was firmly against his damp face. It didn't help.
The door opened and DeAngelo was there. He greeted Susan briefly, then picked up Luka's chart and looked over it. A quick examination, which didn't wake Luka.
"Susan, we need to intubate him. He's not moving air any more."
Susan shook her head quickly. "I don't know ... if he wants that."
"He just needs a little help."
"I know that, but it's just not my decision. Or yours!"
Control. One thing Susan had begun to sense more and more, even though Luka hadn't said it in so many words, was his need to keep some sort of control. The painfully detailed advance directive, prepared long before it was likely to be needed; his fear of therapy, of opening up more memories; his frustrations with the disease that was steadily chipping away at his life. He would be furious, she knew, if he woke up to find a tube down his throat. He had lost control of his life, Susan knew too well. And he needed, desperately, to be able to control whatever things he could, however small. And even now, she knew ... perhaps especially now ... he would willingly die if it meant keeping control.
Susan shook Luka gently. "Luka, sweetheart. You need to wake up." Luka groaned faintly, choked, but didn't open his eyes.
"As low as his sats are, he may not be able to right now," DeAngelo said softly.
But just then Luka's eyes flickered and opened. They were dull and glassy. He choked again and started to cough. Thick, rattling, bringing up blood streaked sputum. When the spasm was over, he collapsed back onto the pillow, shaking a little. His eyes were closed again.
"Luka, we need you to open your eyes. Marty needs to talk to you."
His eyes opened again. Still dull, but he said, very faintly, "I'm here."
DeAngelo said, "Luka, we need to get you onto a vent, it will help you breathe."
"No."
"You aren't getting enough oxygen. You are barely moving air, and you are exhausting yourself."
"I can breathe ... just ... stay awake now ..." His sats had crept up a few points, whether due to the mucus he'd cleared from his lungs when he coughed, or to being awake, Susan didn't know.
"You have to rest. You can't do that if you are fighting for air. It will just be for a day or two, just until the antibiotics kick in."
"No ... vent ..."
DeAngelo sighed. "Luka, it will make you much more comfortable ... whatever happens."
Susan's heart fell into her stomach. And Luka's eyes moved to look at her, unspoken questions in them.
"Whatever you want to do, sweetheart," she said, her voice remarkably calm. "It's your decision." But her heart was screaming, 'Don't give up ... please ... not yet ...'
And Luka nodded slightly. "Just ... few days ..."
"Absolutely." DeAngelo took the syringe that the nurse had ready. "Ok, Luka, you know how this all works. You'll go to sleep, and when you wake up, there will be a tube in your throat. You won't be able to speak, but you'll be much more comfortable."
"Whatever ... happens ..." Luka murmured.
"You are going to be fine!" Susan told him firmly, and felt his hand go slack as the induction meds took effect.
She had watched a thousand intubations over the years. Done at least that many herself. But she couldn't watch this one.
