Sorry for the long wait for this chapter guys.
Chapter 13
Around mid day a man entered a run down, sparsely furnished apartment in Hollywood, he was unshaven, tall, with sandy, untrimmed hair. He walked up to a bottle blond girl with short hair, no older than 23. "What could you find out?" She asked looking up from her computer screen. "Not much new... Security all over the show. If it weren't for those retarded fans and the media circus they've created we'd be in so easily. But I found out who does their medical supplies. It's a company called Medi-tech. Do your thing and get me an access card and some supplies for delivery... And read up about what I'm supposed to do, I don't want to look suspicious" he said looking the girl up and down. "Okay, don't you think we could get the other one somewhere else? That would still be first prize" she asked. "I don't think she'll be leaving soon. Apparently Tegan isn't doing too well... Which could actually work in our favor if we can pull this off. But we can't afford mistakes" he said. "Soon Jake, soon this will be done and we'll have everything we've ever dreamed of." she said. He grabbed her violently and threw her on the bed unbuckling his belt.
Tegan was taken for another round of scans and tests. Her support team was sitting in the waiting room, desperate for some good news. Sara was sitting on the edge of the chair staring blankly in front of her. Her leg bouncing up and down in a nervous tick. Sonia put her hand gently on Sara's bouncing thigh causing her to stop and look at her mother with desperation in her eyes. "Mom…. I can't do this without her" she said softly. "Do what sweetie?" asked Sonia nervously. "Everything…. Life… We came into this world together for a reason… I … She… She's got to be okay mom…. She's got to be okay" said Sara, desperately looking into her mom's eyes.
Kate and Teddy Altman, the cardiologist walked into the room looking worried. "Hi guys, we just want to give you an update" said Kate sitting down. "How are you all holding up?" she asked concerned. Everybody nodded and mumbled that they were fine. "I have some bad news news" said Kate, she breathed out pursing her lips causing her cheeks to ball. Lindsey put her hand over her mouth and started crying. "Tegan's condition isn't improving, in fact, her Apache score is up... Up isn't good. We now have definite confirmation that she has developed ARDS or acute respiratory distress syndrome. ARDS is a lung condition that causes the lung's tiny blood vessels to leak more fluid than normal into the lungs' air sacs. This prevents the lungs from filling with air and moving enough oxygen into the bloodstream. It is a direct symptom of the pneumonia. She's hanging in there though; she's fighting very, very hard! We're going to treat this as aggressively as possible…. well that would be my recommendation" said Kate. Teddy looked at Kate as if she was supposed to say something else. Kate kept quiet, purposefully ignoring Teddy's gaze. Teddy shook her head looking slightly annoyed with Kate. "Legally we have to ask you as her next of kin exactly how aggressive we should be" Teddy asked. "I don't understand…. What does that mean?" asked Lindsey looking pale. Kate glared at Teddy looking angry as hell before turning her head to Lindsey. "Right now, she's still coping okay but her lung function may…. And I say may, not will…deteriorate to the point where we need to consider what they call "heroic measures". If her pulse ox falls too low while on the vent we will need to put her on ECMO" said Kate. "Put her on what?" asked Sara confused. "ECMO or Extracorporeal Membrane Oxygenation. I'm sorry guys, I know there's a lot of medical terms that you may find confusing but feel free to ask me as many questions as you need... Okay, so ECMO is a procedure that uses a machine to take over the work of the lungs and sometimes the heart. ECMO will provide time for Tegan's body to rest and recover. Extracorporeal means that the blood circulates outside of the body with the help of a machine. Membrane Oxygenation, referred to as the "artificial lungs," is a special part of the machine that puts oxygen into the blood and takes out carbon dioxide just like our lungs do. The goal of ECMO is to insure that the patient has enough oxygen by taking over the workload of the lungs. ECMO will not heal Tegan's lungs, but it will allow time for them to rest and recover. They are in desperate need of rest. If we do decide to go that route, Tegan can be on ECMO for several days... When the lungs have healed and can work on their own, the support from ECMO will be gradually removed. I'm hoping it doesn't go that far but on the other hand, this could greatly assist her recovery but there are certain risks involved."
Lindsey had her head in her hands and rocked side to side. Kate continued. Lindsey heard so many words that didn't make sense, Murray score, PEEP Values, FiO2 ratio, quadrants, pH, Hematocrit, white blood count... She wanted to Kate to stop talking, she didn't want to hear any of this. She just wanted to pretend it's not happening.
"So... what happens if her pulse ox falls too low and she doesn't go onto this lung thing" asked Erin dejected. "I'm hoping we never get there... Her vital organs such as her kidneys, liver, eventually her heart will start shutting down…. Her brain won't get enough oxygen and she'll….well... we'll lose her" said Kate, emotion breaking in her voice. "I'm sorry guys, I know this is difficult but legally we also need to ask you about a DNR" asked Dr Altman. She was cut off by an angry Sara "I know what that is…. It's when we tell you not to try and get her back if she codes again, well fuck that!" she screamed causing Lindsey to jump. "Tegan is a fighter, she would want you to try everything…. Tegan wants to live…. I can guarantee you that! Why… Why are you even asking us this now?" said Sara fuming. Kate remained calm and took Sara's hand "Sara" she said gently. "Tegan doesn't have a living will. She never made this decision. Therefore, we need to give the family that option when a patient's Apache is above a certain number …. Tegan's score is above that number now" said Kate firmly but gently.
"So, she's getting worse... She's that sick now, that you think she's not going to make it?" asked Sonia in tears. "No Sonia, she is indeed very sick and her condition has deteriorated but I'm still positive that she can pull through this, but we have to give you these options". Sara was still angry. Not at Kate though, at this hospital for asking this, at the world, at God. She could feel the anger coursing through her veins. "Well I think I speak for us all when I say do what you need to do, do the lung thing if you need to and there's no fucking way we're giving up on Tee by signing that DNR…. She's going to be fine… She's going to be okay" she said passionately. Everybody shook their heads in agreement. "I agree Sara… I hundred percent agree" said Kate with a smile, relief flooding over her. She didn't want the opportunity to try everything she could to save her friend taken away from her. "She's receiving a lot of physical therapy as you know. They turn her onto her stomach a few times a day to improve oxygen perfusion and they vibrate the lungs to loosen the mucus for suction. It seems to be having a positive effect so we're going to up the frequency of those sessions. The thing is, the pneumonia is actually under control and very much better. Her temperature is almost back to normal but her lungs have taken such a beating that they are just not working the way they should right now and we're starting to see the effects of that on her kidney function. But we're doing everything we can. I'm NOT giving up on her any time soon… Tegan's a fighter…. She's fighting this thing… You need to stay positive, she needs all the positive energy she can get right now. Keep talking to her, she may be able to hear you. Positive things only please" said Kate.
Kate left the family room and felt her eyes tear up. She changed course quickly throwing open the door to the emergency stairwell. She stopped behind the door, took a deep breath and started running up the stairs, leaping them two at a time. She sat down out of breath on the stairs about two flights up. "Fuck!" She whispered through her tears. She hated every second of this, of seeing her friend sick, seeing her other friends in so much pain. "This isn't happening. She's got to be okay... Why? Why Tegan?"
Nancy came walking up the stairs slowly, she took a seat next to Kate and put her hand on her shaking shoulder. It was clear she cared deeply for her. She kissed her forehead and whispered "You okay?" Kate shook her head "Uh huh….. Umm... no, not so much" she said as her voice changed pitch. "Wanna talk about it?" asked Nancy. "Not really….. yeah…. I don't know..." said Kate trying to control her sobs. "I'm listening" said Nancy before kissing Kate's hand. "I just want... I just want you to hold me for a while, tell me it's going to be okay" Nancy put her arm around Kate's slender shoulders "All right, let it out..."she whispered. "It's just, it's silly – this is, it's, it's just getting to me. I'm an ICU specialist for fuck sakes! I should be able to handle this!" said Kate sounding a mixture of embarrassed and annoyed. "This is different. There's nothing wrong with this getting to you, she's your friend..." said Nancy. "I'm scared that this will start affecting my judgement, my work … I don't know. It's already affected my judgement! Weber wants me off the case, says I'm too close." "What did you say?" asked Nancy with a raised eyebrow. "I basically told him to go fuck himself... Told him that if he takes me off the case I'll make sure the family moves Tegan to another hospital so fast his head will spin... Fuck, I can't believe I said that! Career limiting move..." said Kate shaking her head again. "Richard knows you and he knows that your passion is what makes you a great doctor. Keep your wits about you and he won't do a thing. He knows you're the best he's got" said Nancy reassuringly. "Thanks I guess" said Kate with a half hearted smile. "I'm going to sound like a total asshole now but... it's difficult to be the strong one, the together doctor when my friend is lying there in critical condition... I'm not supposed to cry, be scared, I'm the doctor you know and I can't…. do this…." said Kate, tears welling up again. "I don't think anyone will blame you if you do" said Nancy rubbing Kate's back. "They won't blame me but when I show vulnerability... it scares them... because I'm the one that's supposed to tell them... to know that she's going to be okay and truth is….. I don't!" said Kate staring at the floor. "Okay, It's good to let it out…" cooed Nancy. "Shit! Actually, I'm just so scared and tired and frustrated….and I just needed a fucking good cry I guess" said Kate. "I know, I know" said Nancy taking Kate's head and putting it on her shoulder. The sobs started again. They sat in silence for a few minutes, Kate's irregular sobs and sniffs the only sounds. "You're a really good friend Nance… Thank you!" said Kate seemingly calming down a bit. They sat in the stairwell for a while when Kate got up. "I've got to go check on her" she said. "I've told the nurses to page us if there's any change, just take it easy for a few minutes. You need the break" said Nancy. "In that case I could use a cigarette" Kate hardly ever smoked but she had a sudden craving for the calming effect of nicotine. They walked up to the roof where and Nancy took a box of cigarettes from their hiding place. Kate stared at the dark storm clouds in the distance and took a drag trying to still her mind.