I know this episode is very heavy on the medical terminology but I felt like it needed to be there, there will be a few more chapters that are also quite medical heavy before the story ends but I will try and make them as accurate as possible.
6. "When you're sure you've had enough of this life, well hang on, don't let yourself go, 'cos everybody cries, and everybody hurts, sometime."
Holding Nikki's hand tightly in his Harry ignored the nurses as they pleaded with him to move, the rational part of his brain knew he was in the way, but the other part, the bigger part, couldn't break it's promise of just seconds earlier. So instead he tried to make himself as small as possible as the emergency team continued to work around him.
"Temp is 39.4."
"O2 levels are 90% in 15litres."
"She's barely shifting any air we need a chest x-ray now."
"Tachycardic at 145, we need to get some fluids into her and put a rush on those blood results. Now."
"There's a large purpuric rash to the abdomen and I can feel a spleen. We don't have time to wait for the cross match I need 4 units now."
Closing his eyes Harry tried to block out what was happening around him and concentrate only on Nikki's hand in his, but that became impossible when he heard the doctor utter the truth he had been trying to ignore.
"I think we're looking at meningococcal septicaemia, we need to get antibiotics and blood into her now," the lead doctor announced.
"No," Harry muttered, shaking his head, this couldn't be happening, not now and not to Nikki.
Immediately the doctor was at his side as everyone else followed his orders in the bid to save Nikki's life. "How long has Ms Alexander been unwell for?"
"Er a few days … maybe a week … I don't know," Harry admitted, the guilt eating away at him.
The doctor nodded. "And she's normally well? No chronic medical problems?"
"No, she's perfect," Harry cried, the gravity of the situation finally becoming more than he could handle.
"And she's not allergic to any medication that you know of?" the doctor asked.
Harry shook his head. "No nothing."
With a silent nod he gave one of his colleagues the go ahead to push the antibiotics before turning his attention to his patient's distraught companion. "We'll need to wait for the bloods … and probably do an LP when she's more stable but I think we're looking at meningococcal septicaemia, Ms Alexander is showing all of the signs of septic shock as well as the early stages of DIC, that's-"
"I know what it is," Harry snapped. "I'm a doctor … we both are."
"Right," the consultant nodded. "Then as I'm sure you're aware Dr. Alexander is in a very serious conditions, the next hours will be crucial."
Turning his attention back to Nikki he nodded, leaning down so that he was whispering in her ear. "You hear that Nikki? The next few hours are crucial so I need you to put that stubborn steak of yours to good use and fight this. Understand?"
"Understand," Nikki croaked, letting Harry know that she was still there, still hanging on albeit by a very thin thread.
The sound of her voice was like music to his ears as Harry gently stroked her hair back from her face. "You didn't have to go to such lengths to get my attention Niks."
Closing her eyes Nikki licked her lips under the oxygen mask. "I-"
"Because you've always had it," Harry added with a whisper.
A new wave of commotion seemed to ripple through the resuscitation room as a technician arrived with the blood and the nurses started hooking it up to one of Nikki's IV lines.
Taking a step back from the commotion the doctor began to reassess his patients condition whilst a portable x-ray was taken of her chest.
"Oxygen levels are still low, page the anaesthetist as we might have to start thinking about more adequate respiratory support," he said, his eyes never leaving his patient.
"You want to ventilate her?" Harry asked, his voice full of panic.
The doctor drew Harry's attention to the monitor recording Nikki's vitals. "It might be our only option."
"Leo, I need to call Leo," Harry muttered, knowing that Nikki would want him there and also needing the support and input of his friend and colleague.
"There's a family room next door, you can use your phone there," one of the nurses told him.
Harry nodded before gently leaning down so that he could whisper in Nikki's ear. "I'll be back in seconds," he reassured her as he slowly let go of her hand.
"Sick," Nikki muttered, scrambling with the oxygen mask as she leaned towards the side of the bed and wretched violently,
All thoughts of calling Leo were forgotten as Harry rushed back to Nikki's side and rubbed gentle circles across her back as she brought up what little was in her stomach.
"The antibiotics we're giving her can cause vomiting," one of the nurses told him, not wanting to panic him more.
"Hear that Nikki, it's just the antibiotics," Harry told her, although her gaze was so unfocused he wasn't sure how aware she really was.
Rolling back over Nikki closed her eyes as someone readjusted her oxygen mask whilst the consultant looked at the x-ray.
"Her left lung is practically a white out, no wonder she's hardly shifting any air," he frowned as he took in the image before him.
"May I?" Harry asked.
The doctor nodded, stepping aside so that Harry could see the computer screen. "I'll leave it up, I'm going to go and chase the blood results."
Looking at the black and white image of Nikki's lungs Harry couldn't help but wonder how she had still been standing right until yesterday. "Stubborn fool," he muttered under his breath as he looked at the woman on the bed.
Walking back to the bed Harry picked up her hand once again. "I'm so sorry I've been such a fool these last few weeks. I was just proud, and angry with myself because I realised that you know me better than I do. I know it's selfish but I need you in my life Nikki Alexander, so don't go giving up on me. Ever."
"Sleep," Nikki mumbled, almost as if she was asking his permission to give in to the overwhelming exhaustion that she had been fighting.
Kissing her burning hot forehead gently Harry nodded. "I'll be right here when you wake up."
In a dream like state Harry walked into the family room, sitting down on the sofa he took a series of deep breath as he fought back the tears, the emotion and pain of the day finally catching up with him.
Pulling out his mobile phone he speed dialled Leo's number. "Leo," Harry sobbed down the phone.
"Harry?" Leo questioned, immediately sensing the absolute anguish in Harry's tone.
"It's Nikki," Harry finally managed to choke out. "She's sick Leo, really sick."
Leo balanced his phone under his chin as he saved his work and grabbed his keys. "Where are you?"
"UCLH," Harry cried.
"I'm on my way," Leo informed him as he locked the building behind him.
Hanging up the phone Harry held his head in his hands, trying to gain control of his emotions he ignored the multiple missed calls from Emma, she could wait, right now Nikki needed him and he intended to be here for her, every step of the way.
"Pull yourself together Harry Cunningham," he muttered under his breath, trying to get a grip, Nikki needed him to stay strong right now, he could fall apart later.
Standing up Harry ran his hands down his trousers as he walked back into the resuscitation room, alarmed to find a flurry of activity around Nikki. "What's happening?" he demanded to know.
"We got the blood test results back," the doctor explained, stepping away from the bed.
"And," Harry prodded, needing to know what they knew.
The doctor looked across at Harry. "Do you want me to speak to you like a doctor or a relative?"
"Doctor," Harry insisted, needing to know everything.
The doctor moved Harry even further away from the drama that was unravelling around Nikki's bedside. He could see the young man's reluctance to leave his friend but he needed to be able to talk to him away from the action.
"As expected Nikki's clotting factors were all over the place," the doctor began.
Harry nodded. "DIC?"
"Yes," he agreed. "What we weren't expecting however was the rest of the full blood count results. Her haemoglobin level was dangerously low 3.4-"
"That could be a direct result of the sepsis and DIC," Harry reasoned.
The doctor nodded. "It could, but her platelets were only 7 - which yes, that could also be the result of DIC and sepsis - however a white cell count of 219 with circulating peripheral blast-"
"No, no, no," Harry stammered, not liking where the doctor was going.
Stepping towards the bed Harry watched as blood and platelet infusions were set up whilst in the centre of all of the drama Nikki slept, oblivious to the latest development.
"No," Harry repeated, refusing to believe the truth he was being confronted with. He had only just started to wrap his head around the fact that Nikki could have meningitis only to have his world turned upside down again as a different evil emerged.
The doctor could see the young man's internal struggle. "I'm sorry but I'm afraid it looks like we're not dealing with meningitis after all, but rather a very atypical presentation of acute leukaemia."
"But the rash, the sepsis, the DIC it all looks like meningococcal septicaemia," Harry stammered, he didn't want it to be either but meningitis felt like the lesser of 2 evils in that very moment.
"I've contacted one of our oncology specialists down for a consult until then-"
Harry cut the doctor off mid sentence. "But you must have some idea, I mean when you hear hooves think horses right?"
"Right," the doctor agreed.
"So why are we suddenly faced with zebras?" Harry needed to know.
The doctor considered his words carefully before speaking. "We won't know for certain until we get a bone marrow biopsy and run the cytogenics but due to the way Dr. Alexander has presented with the low platelets and DIC I can only assume that we may be dealing with acute promyelocytic leukaemia."
"Oh God … Nikki," Harry whispered, his voice nothing more than a heartbroken whisper.
"As soon as we have Dr. Alexander stabilised we'll be moving her to one of the high dependency rooms on the oncology ward, we have one of the best cancer centres in the UK here," the doctor told him, trying to allow him some hope.
Harry shook his head, trying to clear the cotton wool that seemed to have taken over his brain. "I know that. I know all of that but what I need to know … what I don't know is … how do we … how do I tell her?"
"We can tell her for you," the doctor offered.
"No," Harry sobbed. "I should do it, I should be the one to tell her … it should come from someone she knows … someone who cares … loves her."
Walking back over to his patient the doctor left Harry alone, however he wasn't alone for long as just minutes later a terrified looking Leo came running into the room, stopping in his tracks as he spotted his critically ill colleague.
"Harry?" Leo called out, as he approached the younger pathologist.
Harry felt his legs almost buckle under him as he approached his friend and mentor. "Leo. Nikki, she's …"
"It's going to be alright," Leo tried to reassure him, although as he caught sight of Nikki out the corner of his eye he struggled to believe his own words.
"No, nothing is alright, it's wrong all wrong," Harry stammered, struggling over his words.
Leo carefully led Harry towards the back of the room, he knew from past experiences that they had a family room just off to the side. "Coffee. Let's get you a coffee."
"I don't want a coffee," Harry said, sitting down on the well-worn sofa. "I want to wake up and find out that this is all some horrible nightmare.
Leo subconsciously paced the floor in front of Harry. "What do they think is wrong?"
"Nikki," Harry stammered.
"Yes with Nikki," Leo added, trying to bring Harry back from the edge of despair.
Looking down at his hands Harry suddenly realised how empty they felt now he no longer held Nikki's hand in his. "Her blood … DIC … shock … Nikki …"
"How? I don't understand," Leo worried, his concern for his colleague almost overwhelming him.
"That's because it doesn't make any sense, no of it makes any bloody sense, it's senseless," Harry rambled, standing up and kicking his feet angrily against the sofa.
Grabbing hold of Harry's arm Leo stopped his frantic rambling. "Harry, why is all of this happening?"
"Meningitis that's what they thought," Harry sighed heavily.
"DIC, meningitis … she's got meningococcal septicaemia," Leo figured, putting 2 and 2 together and coming up with the same conclusion the doctors had.
Harry shook his head. "No. That's what they thought but the bloods didn't match and she had blasts, it's leukaemia, acute leukaemia and the doctor he thinks it's APML because of the -"
"Because of the clotting abnormalities," Leo finished for him.
Almost shadowing each other both men slumped down on the sofa as they struggled to face the reality of the situation.
"What happens now?" Leo asked.
Harry shrugged his shoulders. "I don't know. But I do know one thing for sure; whatever happens, whatever Nikki needs I'm going to be there for her, these last few weeks have been hell and I don't care what anyone says or who it upsets but Nikki has to come first. She comes first."
"Nikki first," Leo agreed, his heart breaking at the devastating diagnosis that had been dealt the young pathologist who he loved and cared for like she was his own.
Leo didn't want to have to think of the possibility of Nikki no longer being in his life, but as he watched Harry struggle to control his grief at the situation he couldn't help but fear that if something happened to Nikki the world would lose not 1 but 2 brilliant pathologists.