Chapter 12
Often times on the weekends, when Callie is here with her daughter, she gets a hotel room. This weekend however, she feels a need to be here with Katie.
She spent the evening going back and forth between Katie's records and just watching her little girl sleep. Finally, with heavy eyes, she decides it's time to call it a night. She heads over to the couch and pulls it out, putting the fitted sheet on first, then laying the other sheet on top, she decides to forgo a heavy blanket. It's been warm in the room all evening and the sheet will be more than enough.
Walking over to Katie, she leans down and gives the little brunette a kiss on the forehead and then makes her way back over to the couch. Grabbing her trashy romance novel that she picked up a few weeks ago, she lays down and tries to make herself comfortable.
As she lies there, she opens the book to where her bookmark has been holding her spot, and begins to read. Reading at night always seems to lull her to sleep. At this point in the book, things are getting a little steamy between the characters. She reads a scene and pauses, holding the book down. Her mind drifts to the face of a blonde-haired woman with the bluest eyes. She remembers the feel of the woman up against her, the feel of Arizona's hand trailing along her jawline. She remembers how it felt to have Arizona's lips against her cheek, if only for a few seconds. She felt more in that moment than she has ever felt before.
Thinking ahead to Monday, she can't help but ponder how the night might possibly play out. How should she dress? Should she wear a dress or something more casual? She wonders if women talk about things like that beforehand…. Maybe she should ask Arizona what to wear. Will they eat dinner at the table or take it to the living room and eat while lounging on the couch? She knows she has to tell her about Katie, so she wonders what Arizona's reaction will be. Arizona told her the next time she kisses her, it would not be on the cheek. Is she really ready for that? She begins to think of how the moment might occur and she finds herself smiling. She imagines it would be sweet and gentle and suddenly, Callie realizes she is looking forward to that possible moment. She wonders briefly what it might feel like… If Arizona's lips are much different from a man's lips.
Suddenly, she hears talking down the hall which breaks her out of her pleasant thoughts. She smiles and picks her book back up, continuing to read. Eventually she can't keep her eyes open, so she rolls over and pulls the sheet up, ready for some much-needed sleep.
XXXXXXX
Dr. Tanner is talking to her husband, the other Dr. Tanner, when Arizona rounds the corner. "Dr. Robbins, it's good to finally see you again," lady Dr. Tanner says, sticking out her hand.
"Dr. Tanner, it's good to see you too," Arizona says, reaching for her hand.
"Please... call me Beth. We should all stick to first names so it won't get too confusing with both of us here," she says, pointing to her husband. "Arizona, this is Jeff Tanner, my husband. He has been the one overseeing Katherine's care since she was transferred here."
"Jeff, it's nice to meet you."
"Same here, especially if you have some thoughts on what's going on."
"I do. Do you have somewhere we can talk?"
"Absolutely, follow me," Jeff says as he begins to walk down the hall. They come to a meeting room and he enters, turning the lights on. "Here we go. Can I get you anything to drink? Or a snack?" Jeff points to the small kitchenette off to the side.
"Oh, no thanks. I had something on my way."
Jeff nods and then has a seat by his wife. "So, I'm more than interested in hearing what your latest thoughts are," Jeff says, folding his hands together and putting them on top of the table. "Because we are at a standstill and I hate to see the family continue on in this state. It's hard on them."
"Yeah, I would agree. I can only imagine how difficult it must be. So..." Arizona drawls as she pulls out a file from her satchel. "I do have a theory. And I could be way off, but I have a feeling I'm not. Have you looked back over Katherine's file before she suffered from the fall?"
"Yes, of course. We didn't see anything of any importance though. Nothing that set off red flags" Jeff says.
"Well, that's what I thought at first too. But then I started thinking. Everything done up until now is thought to have happened because of the fall. I know there were a lot of tests initially done to rule out a lot of scenarios, as well as many tests since then. But... I think we have been looking for the wrong things."
"I'm listening...," Jeff says, leaning forward."
"She had bronchitis. Two months before her accident. By all accounts, bronchitis is an everyday common occurrence, especially for a child in a public daycare. It is diagnosed daily in children and usually with treatment, clears up within a few weeks. In her case, no problems were reported after treatment and at the time of the accident, was thought to have been cleared up. And, naturally, nothing else was thought about it."
"Ok. But I don't see what the connection is. If it was cleared up, what does that have to do with her falling? Seems like two totally separate issues."
"Sometimes, bronchitis can be a sign of something more serious. Maybe even a misdiagnosis. Are you familiar with juvenile myasthenia gravis?"
"Yes. It's very rare."
"You are correct. Almost all cases of MG don't occur until over the age of forty. Considering that, juvenile MG is even more rare. With MG, the nerves and the muscles can't talk. There is a breakdown in the connection between the two. The signal is sent but not received by the muscles allowing them to move. You see, what I believe happened, is that the bronchitis was actually MG starting to make itself known. Many patients are diagnosed with multiple cases of bronchitis in the beginning stages because the MG is actually starting to affect the diaphragm. It is diagnosed as bronchitis at first if there are no other indicators that something else could be causing the issue. In Katherine's case, she exhibited no other symptoms. I believe that when she fell, the MG could have possibly affected muscle movement, causing the fall. When a patient has a flare up, they can lose all muscle control. They can't move, can't talk, can't swallow... and unfortunately, can't breathe. The nerves and muscles can't talk, prohibiting the diaphragm from working which is why she is still on a ventilator. It also explains when nerve tests are done, why she doesn't respond... It's because she can't!"
Arizona is on a roll now, and doesn't stop to let the other doctors get a word in. "It's not that there isn't brain activity occurring, it's because there are no signals from any presented stimulation reaching the brain. This is why I think we need to test for it. Of all the tests that were ran, there were none that specifically would have tested for this. I would like to perform an edrophonium test. If you aren't familiar with it, we would inject a chemical into some muscle, which could possibly let the nerves and muscles communicate. It is possible we might get some sort of muscle reaction if this works. It would be temporary and the reaction would be very slight, given her current state, but it is a start."
"Dr. Robbins, I don't know what to say," Jeff says, looking back and forth between Arizona and Beth.
Arizona looks at Jeff, then at Beth, and she is confused. She thought they would be as excited as she is. "Dr. Tanners, I know it is rare, and usually, it only comes in spurts. It waxes and wanes and the patients are typically not in this state. Oh! Also, her heart rate is increased some. This was thought to be somehow related to the brain trauma. Because, I do believe when she fell, she did in fact suffer from some trauma to her brain. However, I think the increased heart rate may possibly be due to the fact that she can hear you, but can't communicate… causing stress on her body and her heart rate to be slightly elevated. Because of this elevated heart rate, she has been on a beta blocker. I would like to see the beta blocker stopped immediately. Beta blockers may worsen the MG. So it is possible to have been making her worse unintentionally. Doing that may also help with the test I want to run. I think it might not be out of the realm of possibilities to take several days of tests to get the desired outcome. Having said that, we found find positive results with the first one we run. I just... I don't know for sure... But I believe we need to do this. She deserves this. Her family deserves this. Now that we suspect this, we can also run some bloodwork to test for the specific antibodies that are associated with this as well. Please, Dr. Tanner. We need to do this. If this is what it is, we can help her."
"Arizona, I didn't know what to say because I think you may have possibly just saved this little girl. I wasn't going to disagree. I was just... honestly speechless."
"Oh."
Smiling, Jeff stands up and looks at his wife. "You were right about her. She is something else."
"I'm always right honey," Beth smiles. "Arizona, if you are right, we can start her on IV meds and blood-filtering therapy to filter out the antibodies helping to block the signal from the muscles and the nerves. We might be able to wake this little girl up," Beth says, finally realizing the weight of this discovery. "And, actually..."
"...she may not even be in a coma," Arizona finishes.
"Exactly…" Beth concurs.
"Because although some of the tests haven't been favorable for brain activity, there is a chance of false readings. If it is in fact, juvenile MG, she may be unable to open her eyes, meaning she has possibly been able to hear everything going on."
"Let's hurry and get her moved to the main clinic. We only have limited facilities here and we can do everything we need to there," Beth says.
Jeff nods. "Her mom is here tonight, I looked in before I met you two and she was still in the room with her. Let's go have a chat and let her know what we are thinking and what we are going to do. She is a doctor as well so she should follow along easily. If is in fact juvenile MG, it will probably go down as one of the most, if not the most severe case we have seen."
The women nod and stand to follow Jeff to Katherine's room. On the way to the room, Jeff and Beth decide to stop and make a few arrangements. Jeff will go ahead and arrange transport and Beth will call Mayo and have a room ready. Jeff said that as soon as the mom found out, she would want her moved immediately, so they may as well get the ball rolling. While waiting on them, Arizona looks over at the chart Jeff has, and sees what room Katherine is in. She decides to go ahead and make her way there, motioning to Beth to let her know that is where she is going.
Approaching Katherine's room, Arizona peaks in to see the little girl. She heads right to the little girl's bed, taking note of her appearance. She has a beautiful head of dark brown hair. She is wearing purple and gray butterfly pajamas, which makes her smile. She used to love butterflies when she was a little girl. Her hands are folded neatly on top of her stomach, as if placed there perfectly.
Looking around, she sees someone asleep on the couch, facing the other direction, with the sheet pulled up around her. Trying not to wake her until the two Dr. Tanners get here, she sees the seat next to the bed. She reaches down and quietly pulls the chair a little closer to the bed.
Whispering, she leans close to the little girl. "Hey there, Katherine. My name is Arizona. I know you have been sick for a while and I am so sorry about that. I know it's not fair. We are going to take you somewhere else and we are going to run a few tests. If things go the way I hope they do, we might be able to help you communicate with us and help you feel better. I'm sure your mommy over there will be so excited to hear your little voice again. I promise, we are going to do everything we can to help you. You are probably very scared, but I can tell you, you are such a brave little girl."
Arizona sits with the little girl for a few more minutes until she hears some noise behind her. She stands and quietly puts the chair back into place as the two doctors join her.
"She is a beautiful little girl," Arizona says, whispering.
"She is. She looks just like her mom," Jeff says, receiving a look from his wife which makes Arizona chuckle.
"Anyway" Jeff says, half smiling, "I hate to wake her, but we need to. Transport will be here in about thirty minutes." He walks over to where Callie is and reaches down and shakes her shoulder. She awakens on the first shake and Callie then sits up abruptly.
She sees Dr. Tanner and immediately goes on alert. She quickly jumps up out of bed, trying to get her bearings. "Dr. Tanner. What's wrong?" Callie asks, looking frantically over at her daughter.
"Callie?"
Looking over behind Jeff, Callie sees the woman belonging to the voice she just heard. The same woman who was just occupying her thoughts. "Arizona? What... what are you doing here? What's going on?"
AN: Thanks for all the reviews on the last chapter. Glad you are enjoying it. Once again, all medical stuff comes from Google. I am not a doctor. If something doesn't seem plausible in real life, there is a reason for that.