Kate's worst fears came to pass in the coming days, with more concerned doctors evaluating Mia's progress. Indeed, Mia's Creatinine levels continued to rise and her doctors were soon prompted to act.
"Kate, we're worried about Mia's kidney functioning, she appears to be in the early stages of renal failure." Mia's physician began, "It isn't unsurprising to find imbalances after a crush injury, but usually we're able to tell fairly soon if there's been a significant compromise. I've ordered a consult with a urologist to evaluate Mia further."
The detective's face went pale upon hearing the words renal failure, but the doctor reassured her. "There are many treatments and people live long lives with the assistance of medical technology. This is not a death sentence, Kate."
Kate nodded, once again unaware that Castle had come to stand behind her until she felt the warmth of his palm against her lower back.
"Creatinine is a waste product that our kidney's filter out and Mia's kidneys aren't doing that job anymore. I think that in order to avoid any further complications with organ functioning, we need to start Mia on a round of dialysis." Kate's eyes widened once again.
Kate had heard of dialysis, but always imagined that it was something that older people went through, or chronically sick people. She never considered that a child would need such treatment. She was pulled from her thoughts by the doctor's further elaboration.
"The dialysis will filter her blood, essentially doing the work of the kidneys and keep her body as healthy as possible while we figure out a way to proceed."
Castle and Beckett looked to one another with trepidation, and nodded to the doctor. "Do what you think is best for her." Kate stated, feeling Castle's lips against the top of her head as he held her against him in support.
Soon Mia was started on a round of dialysis, her blood gradually removed through tubing, filtered and cleansed by a machine and allowed to enter back into her body.
"Well," the girl muttered, "this is certainly not a fashion statement I would have thought of." Her sarcastic tones gave away her frustration, despite her best attempts to be strong in the face of yet another obstacle. The use of sarcasm was yet another trait she'd inherited from her mother.
The truth was that being reliant on yet another machine made her feel weak and feeble. If there was one thing that Mia prided herself on it was her independence. She survived, no matter what the circumstances and her resiliency pulled her through. Hell, Mia had been responsible for Emmanuella's survival. She was strong and self-reliant. Now she felt as if she was helpless, worthless.
"We could bedazzle it if you wanted to." Castle suggested, earning an eye-roll from Mia. As usual, he fulfilled his role to bring light into an otherwise bleak situation. She was growing fonder of Castle every day. Not the famous author she'd sought out for such a long time while looking for her birth mother, but the sensitive man and father. She was learning to love the writer who clearly loved her mother.
Castle sat at the edge of her bed and wrapped his arms around Mia's shoulders, using care not to disrupt the tubing connecting Mia to the dialysis machine. His gesture earned a sigh from the teen as she rested her head against his shoulder. "You're going to get through this." He spoke softly.
Kate watched the exchange, something familiar stirring inside of her. It was the same feeling she had when she first realized that she wanted to spend her life with the writer. The feeling she'd had again whilst nestled in his arms over the past several nights. Standing in Mia's hospital room, she found herself struck with the same sentiment. He's it for me. He's not going anywhere. We've been through hell again and again. What am I waiting for?
It had been a while since she'd let herself truly look at him, to take in the man before her. He was devoted in his attention to his family, and Kate considered herself honored to be included in that circle. She loved him even more because Mia was too finding a home.
She saw her daughter attempt to move, whimpering with the discomfort it caused her yet still trying to mask the pain. It was at that moment that Kate was then struck with an overwhelming sense of guilt. Focus, Kate. She berated herself, directing her attention back to the only person who needed to matter at this point in her mind-Mia.
Kate then considered Mia again, truly looked at the feeble body of her daughter. She had a pale demeanor and her skin took on a nearly yellowish, sickly tone. Mia tried to hide it, but the pain she experienced on a daily basis was there for all to see. She was recovering, but still so vulnerable. Her daughter had been through so much had survived the impossible. Yet when she needed Kate, needed her mother, she'd let her down. It had been a feeling of guilt that she carried since the accident, yet she didn't know how to express it. She couldn't find the right words to tell Mia that she was sorry, that she was there and would continue to be there. While her words failed her actions were loud and clear. Kate remained by her daughter's side, holding her hand and caressing her brow. Mia accepted the comfort, as she soon became too distracted by the pain and the long road ahead to question Kate's motives.
The struggle tore at Kate, a sense of conflict arising within her when she thought about her duties for Mia and her desire for Castle. I don't have the time or the right to be focusing on anything else but Mia right now, especially not repairing a relationship. Kate thought to herself guiltily, torn between her responsibilities to helping her daughter recover, to caring for her, and her desire to just be with Castle once again. Even spending the days side by side as Mia recuperated, she missed the intimacy they'd had before their break up. Before the loss of their own unborn child.
She swallowed back her sadness, her regret. She wanted to be with Castle, but she felt that once again it would have to wait. My daughter needs me, and for once I'm going to be there for her. No distractions. The irony was that she depended on Castle to help her step into this new role of parent.
Dialysis became a continuous process in the days and weeks that followed, and as Mia's future prognosis weighed heavily on their minds, her primary doctor finally approached Castle and Beckett, pulling them aside.
"Mia is stable and she's doing very well with the treatments. Her Creatinine levels have declined and strength is returning each day." She spoke in hushed tones to avoid alerting Mia and Alexis, who were deep in conversation.
"The problem is that when we discontinue, her levels return to abnormal. Now, Mia is strong, and all things considered she is healthy. Her chances of recovery and leading a normal life are remarkable considering what she's been through."
"But…" Castle asked, waiting for the other shoe to drop.
The doctor nodded, "but I've spoken at length with her urologist and at this point if she were to be released from the hospital she would be required to return regularly to have her blood filtered."
"Are you telling me that she's going to be reliant on dialysis for the rest of her life?" Kate blurted, fear and disbelief in her voice.
"I'm trying to tell you that given the low percentage of functioning... I think your daughter is a prime candidate for a kidney transplant."
Castle and Beckett listened in stunned silence as the doctor described in great detail the process of becoming a transplant candidate.
Words such as UNOS and Allocation Calculator were tossed around, as well as concerns about finding an adequate match, an extensive waiting list and compromises to quality of life while waiting.
Kate swallowed back her tears as she listened,
"The first step would be to try to find a match, a family member would be ideal." The doctor stated.
"I'm her biological mother" Kate volunteered, "I'll give her one of mine." She stated.
"Isn't it true that we only need one kidney to survive?" Castle asked hopefully.
The doctor nodded and smiled to Kate, "That is true, and while I appreciate your willingness, and a family member is the best option, there is no guarantee that you will be a match. Kidney transplants need to match both in blood and tissue type."
Kate nodded, "but you can test?" She pressed.
"Yes, we can." The doctor offered, a supportive smile on her face.
"Then let's get started." Kate demanded.
The news was broken to Mia softly, but was still difficult for the teen to absorb. After everything she'd been through; Now this. The thought of having a transplant was terrifying, the thought of relying on a machine to filter her blood even more so. As she processed the news she leaned against Kate, who sat on one side of her bed, but looked to Rick, who was seated on the other. They'd both become parents to the girl, her birth mom and her surrogate dad.
"We'll get through this," Kate spoke, pulling Mia against her, "We'll get through this together and I promise you that we're not going anywhere."
Mia nodded, silent as she processed the news. She had never been so glad to have found her biological mother, a living relative, as hope of an actual match was at hand.
The doctors explained everything at length to both Kate and Mia, they explained the process of testing blood type, antigens, as well as conducting a cross match.
"A cross match is where we test to see how Mia's cells will react to your cells, Kate." The doctor explained, "Will her cells accept your tissues and incorporate them, or will they treat the cells as foreign invaders and reject them..." The doctor laid out both possibilities.
"Some level of reaction is not abnormal, and we can place Mia on immunosuppressant drugs for the time being if we find a good enough match."
"In other words, the Cross match test will tell us whether you are compatible. Then, if we find you are a match, we'll do a full workup to test your own nutritional panel and kidney function. We need to be sure your body can handle the transplant." The doctor looked around the room, expecting more questions.
"If only relatives could donate then a national transplant list wouldn't exist." Castle volunteered,
"Could I be a match?"
"Could any of us be a match?" Esposito followed up. The boys, Lanie, Alexis and Martha were all listening intently to the doctor's news.
The physician explained, "It is worth testing any family member or friend who would be willing to donate. Probability is highest for relatives, for people who have the same racial or ethnic background and we are required to be sure the donor is over 18 but under 70." Martha threw her hands up and rolled her eyes, causing Mia and Alexis both to smile in spite of the difficult situation.
"We can test anyone who meets those standards, but chances will be highest with a blood relative." She looked back to Beckett.
In that moment Kate felt as if all hope for Mia's future rested on her shoulders.
AN: And the cookie goes to Fbobs for calling the crush injury related to kidney failure; one of the more common causes of renal failure.
