Actions Have Consequences or Rewards.
by Castlefan6
Authors Note: This is Totally AU; Beckett has found a new love, Castle is hiding a deadly secret, Takes place after the punch to the stomach in Headhunters.
Taking Literary License to fill in the blanks.
I don't own Castle; I use the characters for amusement purposes only, except the ones I create.
Also, we take liberties with the timeline from Canon and use events to make this a more believable fiction, thanks.
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Chapter 4
Presbyterian Hospital
Triage Area, VIP Section
Kate had fainted before she received the news that Rick had been rushed back into surgery, apparently, a bleed was missed, or another one developed. He had been moved from his bed to the OR table, and back again, then from the recovery room bed to his bed, so it was possible another bleed had developed, no one would know until the surgeons were able to repair the source of blood loss.
XxX
OR Room 2
Rick was quickly sedated and Dr. Poulos addressed the surgical team, as he began to re-open the incision from a few hours earlier.
"Listen up folks, this is a different ball game than the first time. The patient has suffered traumatic blows to the midsection, so we need to ensure the ribs aren't possibly fractured or split causing the cut in the blood vessel. I don't have to tell you, that if this had happened at home, we wouldn't have this opportunity to save his life, he would have bled out."
"Dr. Poulos, his spleen looks dark and perhaps there is a bleed on the reverse side I missed the first time, also he does have three ribs cracked on the left side, I suggest we remove the spleen, smooth out the ribs as much as possible, then follow protocol for anyone with broken ribs. In this case, I also suggest that we limit him to bed rest for three days as we watch his vitals." Dr. Zalinski, the chief resident for Doctor Poulos said.
"I agree with the assessment, now let's locate that bleeder and get it repaired. I think we should follow aorta surgery protocol, and use cadaver wraps to ensure the sutures have an opportunity to hold the vein together." Doctor Poulos said,
Dr. Zalinski ordered the cadaver wraps, and explained to the nurses, that it was almost like wrapping a washcloth around a burst hose pipe. It wouldn't hold the leak by itself, but it would serve as a cushion in case the sutures were bumped or came loose, that is once they located the bleed.
After a few minutes, Doctor Poulos said, "There you are you little bastard", as he clipped the veins, cauterized them, then added sutures to ensure the bleed was stopped. Dr. Z as they called him had been correct, the spleen had suffered damage to the backside, and the discovery of cancer in the kidney had thrown them off the first time they were in Rick's abdomen.
Dr. Poulos removed it carefully, then inspected a few weak areas where the trauma had taken the full impact. This time each blood supply was wrapped with at least one cadaver wrap and strengthened to allow Rick to begin possible chemo and radiation treatments soon.
Doctor Poulos was worried about having to go back into the same area another time, so he called and received permission from Kate, still, the Medical POA to perform the minimal removal of the kidney, hoping they got all of the cancer and any residual cells would be killed by radiation and or chemo.
The surgical team needed permission from Rick's Medical POA before they could perform the procedure on the kidney, so Doctor Poulos called the floor, praying she would be there. She had just come around and was being comforted by the nurses when she was approached by the head nurse on the floor.
"Detective Beckett, Doctor Poulos is calling from OR 2 for you, you can take it in my office," she said, with little if any emotion,
Kate hurried to the office, picked up the phone, and replied, "This is Kate Beckett, Doctor Poulos, what's wrong?" her voice filled with absolute terror,
"Mr. Castle suffered another internal bleed, it was a good thing Franny was right beside him, it came on so quickly, we have that repaired now. Remember the discussion about the removal of the kidney, I'm afraid, he won't have time to think about it. I need a decision on which surgery we have to perform, he won't be strong enough to be re-opened anytime soon, and each day we delay gives the cancer a better chance to spread. Do you remember the surgeries we spoke about detective?" Dr. Poulos asked,
"Eh, some, but no, I can't make that decision for Rick, I mean"
"Detective, if you won't make the decision, I have no choice but to close him up and pray that the cancer doesn't become more aggressive, which many times it does once exposed to the open atmosphere, so, please.
"Mr. Castle listed you as his Medical POA for a reason, you know him better than anyone, so what would he do? That's the decision you have to make now. There is no wrong decision, EXCEPT if you refuse to make any, then you will have let your friend down, and presented greater challenges for him to overcome in an already very serious fight for his life." He pleaded,
"What were the surgery types again Doctor, I'm sorry, but"
Doctor Poulos calm voice repeated, "In a partial nephrectomy, the tumor or the part of the kidney with the tumor is removed to leave behind as much of the kidney as possible
"In a radical nephrectomy, the entire kidney is removed. If needed, the surrounding tissues and lymph nodes may also be removed. So, detective Beckett, which surgery, partial, or radical?" he pressed, "I need to know so we can complete the surgery and return Mr. Castle to his normal breathing."
"I don't know, which one do you recommend doctor?" she cried into the phone
"If you're asking me, which surgery I would choose if it were my loved one, based on what I know I would choose the partial. If for some reason it doesn't respond the additional surgery could be performed when his body is not so weak, we are risking his life the longer he is under"
"PARTIAL" Kate yelled out, figuring, she had to take the least extreme path, praying Rick would agree and forgive her once he was awake and aware of the circumstances.
"We have your permission for a partial nephrectomy to be performed on Mr. Richard Castle, and you swear you are his Medical POA on record, this is being recorded Miss Beckett," Doctor Poulos asked again,
"Yes," she yelled and heard the click as the doctor returned to the operating room.
Doctor Poulos held up one finger, signifying the procedure was to be the partial nephrectomy then the thumbs-up sign to doctor Z, indicating they had received permission as he started to re-scrub to enter the operating room. The process was going to take another three to four hours, and hopefully would result in almost no loss in kidney function, once fully healed.
Doctor Z was busy clamping the blood vessels going into and out of the kidney temporarily and packing the entire area around the kidney with ice. If things went as they had been taught in med school, in three to four hours, once the tumor had been removed along with all of the questionable cells, they could unclamp the blood supply to the kidney, and it would turn bright pink, indicating a healthy supply of blood to the repaired organ.
That would be the optimum outcome, but far too many times real life wasn't anywhere near what was taught in med school. They had already removed his spleen, due to a tear and rupture, combined with his blood disorder it was a weight of risks. With the spleen gone, Rick was going to be more likely to develop infections, especially dangerous ones such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae
Each of these could cause its own complications to a healthy life. Streptococcus pneumoniae (pneumococcus) can cause a range of different illnesses including sinusitis, ear infections, including the middle ear, pneumonia. Bacteraemia, often a precursor to leukemia because of the highly infectious bacteria in the bloodstream, as well as causing arthritis and meningitis.
Neisseria Meningitidis, or Meningococcal meningitis was a rare but serious bacterial infection. It caused the membranes that cover the brain and spinal cord to become inflamed. It can not only be painful but cause dysfunction in a person's daily life, leading to potential loss of life.
The last of the major Risks was Haemophilus influenzae, a type of bacteria that could cause many different kinds of infections. These infections range from mild, ear infections, to serious, like bloodstream infections, most commonly the cause of pneumonia.
Doctor Z remembered the crazy answers the class gave when asked what was the function of the spleen, like most people they had no idea. They soon learned that the spleen plays a crucial role in the body's ability to fight off bacteria, living without the organ makes you more likely to develop infections, especially dangerous ones.
Life was never going to return to the old normal for Rick, not after the blood disorder, the surgeries to repair internal bleeding, and the removal of his spleen and partial kidney. Life was going to change for him, in a big way.
XxX
Rick's Floor,
Nurses Conference Room
Franny had pulled Kate into their conference room to allow them some privacy. She knew that regardless of what Rick had professed, he cared deeply about this woman, and if her eyes were telling the truth, the feelings were mutual. She did have some sympathy for the lady sitting on the couch, it wasn't her fault the asshat Josh cheated on them both.
"You don't remember me do you Kate?" she asked, softly,
"If you mean, I was unknowingly the other woman in your relationship with a certain doctor I won't mention his name, yes Franny, I remember you. I was hoping that we could still be friendly, I mean I had no idea he had been seeing you, much less for almost six months before he met me. I am sorry I played any role in that; I hope you know that." Kate said,
"I know you didn't, and I know you were just as hurt as I was when you found out, I don't know how you found out, but I'm glad you did," she said,
"I guess it was a few months after you told him to take a hike, he suddenly had more time for me, but then reverted back to the emergency cases, only he could perform that procedure, I'm sure you've heard his BS. Anyway, I worked late one night, the entire team was there, even Castle who had tried to warn me very gently and I bit his head off, more than once.
"That night, the frustration had built up, I just surprised him here at the hospital and caught him in the supply room with some big boobed nurse, needless to say, it was over. How did you find out about the two-timer?" Kate asked,
"Rick and I are friends, good friends, I mean nothing has ever gone on, but I love him to death and he knows it. I had just returned from my Mom's funeral in San Diego, he paid the expenses because I was still having trouble financially, and met me at the airport when I returned. Something was off with him, so I pressed, and pressed, I guess you noticed my subtle side." She laughed softly, and Kate forced a smile,
"I finally got him to admit that my JD, and your Josh, were one and the same. I guess he had seen a picture of us together when he drove me to the airstrip, to meet Janice his pilot, and fly me home to spend time with my dying mom. She passed two weeks after I returned and I was in a better spot when I returned this time, at least good enough to see my friend was hurting inside.
"I finally got him to admit what he knew of the two-timing bastard; it didn't take much to prove he was right. The next time he came over, probably from your house, he fell asleep with his phone unlocked and I went through his pictures, that's when I saw you two on your trip to Hawaii. I felt like such a fool, I woke his ass up and threw him out that very night." She said the anger still blazing in those emerald eyes
"I'm so very sorry Franny, I never knew, Rick didn't say a word to me, hell, I wouldn't have let him anyway, so I was the biggest fool of all," Kate said,
"Kate, I work in this hospital, I have friends in almost every department, male, female, old, young, and none, not one person would step forward except Rick. He told me that he thought JD, AKA Josh, had found his true love and was still using me, he didn't want to see me hurt. He told me he wouldn't be surprised if you came into the precinct any day engaged, or even married.
"He had tears in his eyes when we talked, I thought then that he was feeling my pain, but now, I know it was him letting go of you so you could be happy. If you don't see what so many others see Kate, including me, you need a seeing-eye dog, he loves you."
Kate blushed, coughed, and suddenly felt very uncomfortable discussing her love life with one of Josh's extras. "things between Castle and I are complicated" she said, She thought to herself where the hell did Castle get the thought that she and Josh were close to being married, OH SHIT, she was bragging about making him put a ring on it, in front of Lanie once they returned from Hawaii
"Yeah, he told me you'd say that the only reason they are is that you're making them complicated." Just then her beeper went off, and she dialed a number. It was a message from a friend in the surgical update, letting her know that Rick was still in surgery, at least for another two hours, then four hours estimated in recovery. She thanked the person and then hung up,
"Was that an update on Rick? Is he OK, he has to be OK," Kate was panicking again,
"Easy Kate, yes it was an update, they are about halfway completed with the partial nephrectomy, seeing the blank look on Kate's face, the kidney surgery Kate, it's going to be another two hours or so, then recovery room for at least three hours. Are you sure you don't want to go somewhere to lie down, I mean, it's a long time Kate?" Franny asked,
"I don't see any Holiday Inn signs anywhere on this floor, and Franny, I won't leave him, not now," Kate said in more desperation, now.
"I know, I know, look we have day rooms, I'm not supposed to, oh what the hell, he built the God Damn pediatrics ward, we can at least provide a bed for you. Come on, but stay quiet, if anyone knocks just say occupied two times, meaning two people are getting it on, usually people will respect that.
"What? Not me, what the hell are you thinking?" she asked, after Kate gave her a look, "I already told you, there's been nothing between Rick and me, not because of me, being honest." She said they were right about Franny, she opened her mouth and said exactly what she thought, with no regard to who was around.
She led the way to the day rooms and got one more shot in before she turned to leave, "Kate, Rick knows about the man you're sleeping with now, so please don't lie to him about it. He told me that you had found your lover and I would be his caregiver, no strings attached once he got home. Get some rest, I'm not leaving until I see him, either." She closed the door and left Kate standing stunned.
Kate looked around and there was a bed, nightstand, and small desk with a phone charger, and a private bathroom. She placed her phone on the charger and decided to lay down, just to rest her eyes, she was out in less than five minutes.
XxX
12th Precinct
Captain Gates Office
Same Time Frame
Gates had received the calls from Kate, including one that he had been rushed back into surgery. She thought highly of Mr. Castle, but she also knew that any blowback that came from him getting injured in her precinct would rest solely on her shoulders, not a good place to be when he was best friends with your boss's, boss's, boss.
She knew her command of the 12th would be short-lived if she didn't have answers and soon. She was just fortunate that Mr. Mayor was away at a conference this week, or she would have already been on the hot seat.
"Detectives Ryan and Esposito, my office now" she bellowed. She knew one or both of these characters was behind the whole ordeal, or knew exactly what was going on. It was time for her to show them that 26 years in Internal Affairs had taught her how to interrogate COPS, more than suspects.
"Yes Sir, you wanted to see us Sir" they took turns with the lines,
"No, I wanted a ham and cheese on rye, I called for you didn't I, come in and close the door." Her smart-ass comment let the boys know they were in for anything but fun.
"OK, I've spoken to Detective Beckett a few times, she's pretty rattled so I need to get the facts straight." She said, looking over her glasses at a report.
"Sir, how is Castle, the last we heard he was out of surgery and in his room," Ryan said with concern,
"Yeah, that's old news, he's in surgery again, I guess he had to be rushed back into the OR, shortly after being moved to his room. HIPPA laws won't allow anyone to divulge anything specific, but I understand it's very serious.
"That makes this discussion even more important, so I don't have to warn either of you the ramifications of providing any false or even misleading information, do I? You know as soon as Mr. Mayor is back from his conference, he's going to want to know what the hell happened to his best friend, especially since he arrived at the ER in one of your cars."
"Yes Sir, I can explain that sir" Kevin started,
"One moment Mr. Ryan, just so there's no confusion should we need this testimony for a disciplinary hearing, it will be documented." She pulled a small tape recorder out and placed it on her desk. She observed the Holy Shit looks exchanged by the partners; this wasn't her first rodeo dealing with getting information from cops.
Espo looked at Ryan, and it was obvious that they had facts they didn't want to divulge, but they also didn't want to face disciplinary actions either.
"OK, as she spoke into the recorder This is the fourth day of June, present in my office, Captain, Victoria Gates, NYPD, 12th precinct, are Detectives First Class, Kevin Ryan, and Javier Esposito. The purpose today is to answer informal questions concerning how the civilian consultant, Mr. Richard Castle came to be injured and is now currently in his second surgery at Presbyterian Hospital.
"Detective Ryan, I understand from the reports that you were the one transporting Mr. Castle to the hospital, is that correct?"
"Yes Sir, I took Rick, eh Mr. Castle to the ER, as my partner Detective Esposito followed us in his car," Ryan answered
"Can you explain how that came to be? What were the events that preceded the trip to the ER?"
"We were briefing Mr. Castle about the current case, he couldn't make it to the crime scene the night before and when he showed up this morning, Detective Beckett instructed my partner and me to brief him. During our discussion, we received a call that one suspect had been identified and located, so we left the precinct.
"Castle rode with me, as we headed to the scene, but halfway there, he instructed me to pull over, which I did. He immediately threw up once he cleared the car, I radioed my partner the status and he pulled up behind us, and noticed the contents were not of food, or beverage, but blood, a lot of blood."
Espo spoke up, "Sir it's been my experience that anyone losing that much blood, especially in that manner would need immediate medical attention. I instructed my partner to transport Castle to Presbyterian Hospital, the closest hospital to our location." He stopped, speaking, everything he had said had been the truth, but he wasn't offering anything else, so it was a red flag to Gates.
"OK, so we've determined that Mr. Castle arrived with the injury this morning to the precinct, do either of you detectives know what caused the potential life-threatening injury? I will remind you, if Mr. Castle was assaulted, the perpetrator could be facing serious charges, regardless of their position. Mr. Esposito, please continue with ALL the facts you know of this case."
He glanced at Kevin who gave him the shrug of the shoulder meaning tell the truth and let the chips fall where they may.
"Yes Sir, Castle was working with a detective out of the gang squad since Detective Beckett had been assigned to work with the DA's office for the Boylan Plazza case. Detective Ethan Slaughter, to be polite sir, his last name fits him, he is a rogue cop, and when Castle had enough of his bullying techniques, he asked Detective Beckett to help him.
"The result was one of his prize arrests had to be released since there was no evidence against him, he sucker-punched Castle very hard in the stomach once Detective Beckett released Vales, the gang suspect to his attorney,"
"Wait, wait, under whose authorization was a rouge detective working out of my precinct?" Gates asked, peering over her glasses,
"Castle brought him here to use the interrogation room, unauthorized, but finally got Beckett to approve the use of the rooms only." Espo finished,
"Who saw the punch from this Detective Slaughter that as you have described as doubling Mr. Castle over, and why wasn't he sent for medical evaluation at that time?"
"We all saw it Sir" Ryan stepped in.
"Who is all for the record Detective Ryan, and again why wasn't he evaluated then for medical injuries?" Gates continued, she wasn't letting go,
"Detectives Beckett, Esposito, and myself Detective Kevin Ryan. Once he began talking to Detective Beckett, my partner and I left the two to follow another lead on a different case that Roz Karpowski's team is working on, Sir" Ryan said
"So, to your knowledge, Detective Beckett was the last detective to witness the punch, the impact on Mr. Castle, and then speak with him afterward, as you and your partner returned to a case under Detective Karpowski, is that correct Detective Ryan?" she peered over her glasses.
"Yes Sir, as far as I can remember sir" Ryan replied, knowing he was sealing deep trouble for his friend and lead detective, but there was nothing he could do about it, not without perjuring himself.
"Very well, Detective Esposito, anything to add?"
"Sir, I tried to call Castle about the new case, the one without fingertips and he reacted strangely, sir?"
"How so, detective?" Gates asked,
"Well, when I attempted to give him the address of the crime scene, he interrupted me and told me he couldn't make it tonight, he was writing," Espo said
"What was his tone Detective? Could he already have been feeling the pain caused by the assault by Detective Slaughter?" Gates asked,
"He could have sir, he wasn't drunk, but he certainly wasn't himself, perhaps because he was trying to get relief from the pain. Sir, I saw the blood after my partner pulled over, it looked like a very dangerous situation" Espo added,
Gates turned to the recorder, "This will conclude interview one, Castle injury case, time of day 1507, June 4th," and hit the stop button.
"OK gentlemen, that's all for now, but I don't have to tell you, that this isn't over, not by a long shot.
TBC
A/N: Thanks for all of the reads and reviews, even those from guests that don't get posted. For everyone saying it couldn't possibly end up Caskett, hold your powder. You've only read two or three chapters to this point. Life events have a way of magnifying the important elements of your life, neither or BOTH were to blame for the lack of hookup after the Boylan Square episode. Rick acted like a petulant child, and Kate chose the easy way out rather than chase him down and make him talk. They were both free to date, or sleep with whomever you please, the more the merrier, to borrow a line from the show. We have a lot more story to tell, thanks for going along on this journey,
Tim
