Chapter 5: Live Forever
I had pretty much ignored Jasper for the past three weeks. Not Mr Hale of course! He was my first ever all-to-myself patient and therefore got the best care possible. Jasper on the other hand had been left in the dust, I couldn't risk a repeat of that night I drove him home. That wonderful night when his face light up over a stupid building and his eyes sparkled in the yellow street lamp light and his hair was wafting gently against his pale face and his lips…and my lips…no! No no no no! Stop thinking about his lips Dr Cullen, that's an order!
I had pulled the night shift for the past four days, this was my last one. Woo hoo. Just me and three nurses with nothing to do but sit and hope nothing happens. It gave me a great chance to catch up on my studying (I am till a student after all) and an even better chance to not have to see Jasper again… and risk a replay! I can not have inappropriate interactions with a patient. With my patient. So I'll keep my head in the books for the night and keep on top of things.
"Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Nephrotic-range proteinuria is 3 grams per day or more. On a single spot urine collection, it is 2 g of protein per gram of urine creatinine. Common detection involves…"
BEEP, BEEP, BEEP! Shoot, my pager! BEEP, BEEP! BEEP! The screen read "E.R." I picked up the ward phone and quickly dialled 3500.
"This is Dr Cullen," I said.
"Dr Cullen a patient of yours has just been admitted in critical condition," The voice on the other end said quickly. "Please respond as quickly as possible."
"But I'm only a junior I don't know how to deal with that!" I said in a small panicky voice.
"You're the most senior Nephrologist in the building Dr Cullen you're going to have to learn fast!" The line went dead.
"Tanya I'm needed at the E.R. Are you all right up here?" I asked quickly. My hands were shaking, my patient was in the emergency room, I only had one patient. My mind was racing through a thousand possible scenarios. Thy ranged from Emmett jumping out and shouting 'psyche!', to me running down to the E.R. and finding…him lying on a gurney dead. But I tried to dismiss those thoughts quickly, whatever was going on, I was needed, and I couldn't second guess myself the way I just had on the phone. I could not doubt my ability because that could lead to disaster…for everyone.
"Of course," Tanya replied. "We're here if you need us."
I uttered a quick, "Thanks," before making a dash for the stair. Despite what you may see on Grays Anatomy doctors in Seattle in fact use the stairs far more than we use the elevator, and nothing interesting ever happens in the elevators of Virginia Mason Medical Centre even when we do use them.
I reached out for the panel to open the automatic doors as I jumped the last two steps and rushed toward the resuscitation bays of the E.R. I was getting close when I could hear Dr Lahote voice echoing in the corridor, he was barking instructions at the nurses who were all to use to his temper.
"Someone get me her current god damn medical records! Or better yet a bloody Nephrologist." His sharp tones bit into my ears.
"I'm Dr Cullen," I said firmly as I entered resus bay 2. My heart was hammering in my chest from nerves as much as from my excursion down the stairs. But it nearly stopped when I recognised my patient on Dr Lahote's bed, Melissa Jeffery. "I'm Ms Jeffery's doctor."
"You'll have to do," He barked at me. "She presented with atrial fibrillation which soon developed into a full cardiac arrest. We stabilised her for now but I am far from confident about her prognosis."
"Her medical records are in the department," I started.
"Get them!" Dr Lahote ordered while pointing at a young scared looking nurse.
"But I can tell you the most relevant information myself," when Dr Lahote did not interrupt I continued. "She had been in end stage renal failure for twelve years and we recently moved up the transplant list after her GFR dropped significantly. She was allowed to live at home only because her son is a nurse and can administer relevant treatment. The cardiac arrest was most likely caused by sever hyperkalemia, we were trying to keep it under control but electrolyte imbalances can cause devastating problems even when managed. She was currently taking…"
I was interrupted by loud beeping as the monitor next to Melissa signalled a drastic drop in blood pressure. I stepped out the way to allow the emergency medics room to do their jobs, I may be one of the doctors on her case but I was not trained to deal with situations like this in the same way Dr Lahote was. I only supplied information when it was needed.
"She's on furosemide don't use any thalizides!" I warned. "No ESA's! She'll OD!" My brain was frozen and going a mile a minute all at the same time. The machines continued to beep and her blood pressure wasn't stabilising. Eventually I realised that I was shouting at Dr Lahote so much I might as well just treat her myself. Emergency training be damned, I had helped treat her since I first came to the hospital.
The nurses accommodated as I shooed them away from her dialysis access point and set up a small cannulae in her right arm to give her IV fluids and anti-diuretics. It felt strange trying to raise her blood pressure after trying to lower it for so many years.
It was slow but eventually her BP stabilised and, after a brief chat with Dr Lahote and a page to Dr Hoffman (Melissa's primary care giver), I decided to stay with her while she was moved to the ICU. Her kidney function was non-existent so I put onto bypass and she had stopped breathing on her own but she had already been intubated when I got to the E.R. Multi-organ failure qualified you for immediate admission to ICU.
But Melissa Jeffery didn't make it to the ICU. I had just received her chart and was noting down recent events when a flashing red light caught my eye, a second before the alarms sounded. The defib trolley was still sitting beside her bed and before I knew it the paddles were in my hands. I looked up the see the nurse that had brought me Melissa's chart standing over her pounding hard on her chest. "Clear," I heard my own crisp voice announce loudly before I placed one paddle in the centre of her chest, one panel on her left side, and pushed down the small red buttons to release the charge.
Melissa's body jerked awkwardly under the influence of 360 volts. But her heart rhythm stayed the same.
"Charging," I said as the young nurse pounded. "Clear!"
"Charging…Clear!"
"Charging…Clear!"
"Charging…Clear!"
Times seemed to slow to a stop as I tried to force life into the woman lying in front of me.
"Charging…Clear!"
Nothing changed. Her heart was still seizing. Her blood pressure was dropping. My body went numb as Melissa's jerked on the table.
"Charging…Clear!"
"Charging…"
"Alice, stop!" A voice said in my ear. The erratic beeping stopped and was replaced by a monotone squeal. "Alice she's gone." Dr Lahote said softly. I still did not release my iron grip on the defib paddles. I'm her doctor, I can save her. I could hear myself breathing in short gasps as someone slowly separated my small hands from the cold plastic of the paddles. I looked up to see Dr Lahote's dark eyes looking into mine. They were not angry and hostile the way I was used to, they were soft, understanding. I let him take the paddles from me, but as I felt them slip from my fingers I felt panic rising in my chest. I will not give up on my patient.
"Call it Dr Cullen," the voice in my ear said firmly. My brain had shut down and his words didn't make any sense to me. My blank stare prompted him to expand. "She's your patient Dr Cullen; you have to call time of death."
I looked up at the plain white clock above me and without even thinking I said, "Time of death 02:41."
Then I started walking, I walked through the E.R. without really knowing where I was going. I know the hospital like the back of my hand but every corridor suddenly looked the same. It was all just white walls and blue floors. White walls and blue floors. After what seemed like hours wandering around that endless maze I found the exit, as soon as the cold night air hit my face I bent over double and vomited.
I looked down at my hands, they were shaking. I felt like my whole body was convulsing and I sat down on the cold stone ground before I fell down. I put my head between my knees and concentrated on breathing. I don't know how long I had sat there when I felt some lay a warm hand on my shoulder.
"You're freezing Alice." Came the voice of Dr Lahote. "May I call you Alice; feel free to call me Paul."
I nodded slightly as I raised my head from my knees. Why was he being so nice, Dr Lahote (Paul) was infamous for being bad-tempered and moody.
"So…your first?" He was asking if that was my first patient to die. He knew the answer even with out my confirmation, but I gave it anyway.
"I thought…" I started to say, but my voice caught in my throat and I knew I couldn't continue.
"You thought you could handle it? That it would be easier? That you knew hat you were in for? That you were prepared?" Paul finished for me. "We all think that, and we all find out we're wrong. Unfortunately we all find out the hard way."
He paused for a moment and sighed, it was starting to rain and I could feel small specks of water brush against my cheeks.
"I've informed her son so you don't need to worry about that. But he's still in the waiting area if you want to talk to him, I don't know about the rest of the family." Paul continued.
"Her husband died years ago, her daughter lives in Wisconsin. Apart from her son Jason she doesn't really have any other family." I said in a small voice. "I should speak to him; it might make it easier if he see's a doctor he knows."
"Take your time Alice; take care of yourself before you start lookin' after everyone else. Now come one, let's get inside out of the rain." Paul stood and helped me to my feet. The shaking had stopped and I felt steadier.
The rest of the night was a bit of a blur; I splashed some cold water on my face and talked to Jason. I didn't really say much, I didn't need to. And what was I supposed to say anyway? He just lost his mom. Nothing I could possible say would make that any better, so I didn't try. Word must have reached my ward by the time I made my way back up there because so one said a word I took up my chair behind the nurses' station.
The whole place was solemn faces and sad smiles. Angela's eyes were red and puffy from crying but I didn't hear a peep out of her all night, or any of the other nurses for that matter. After all they had known Meli… the patient for longer than I had. I didn't try to study the rest of the night. I kept an eye on the nocturnal dialysis patients. I focused my attention on making sure they had been prescribed the right doses of the right things. I sorted through some blood work and changed prescriptions accordingly. I kept my head down, and I didn't think about what had just happened. It felt better to not think about it.
I had just finished unhooking my last nocturne patient when I heard someone clearing their throat; I looked up to see Dr Hoffman. "The hospital called me last night about Melissa Jeffery; Dr Lahote told me you handled it very well. I'm sorry you had to deal with that on your own," Dr Hoffman was slowly getting closer and I jerked away before he got too close. He was a fantastic doctor but I had never felt completely comfortable around him. I could never quite put my finger on why.
"I have to go now Dr Hoffman," I said quietly slipping out of the small room. Angela was still sitting at the nurses' station when I was on my way out, I offered her a ride home and accepted with a small smile. I knew she didn't have a car and I didn't want her walking back to her apartment in the rain.
My car smelled like BBQ pizza, it might have been funny under different circumstances. I knew Angela was a bit of a neat freak, he apartment always smelled like some sort of flower and I knew the stench of old pizza must have driven her crazy. But she didn't say a word, didn't even scrunch up her nose. She was clearly really upset, but I didn't know what to say to her. How could I help her when I didn't even know what the hell was going on in my own head?
What I finally got home I fell into bed without bothering to shower, or brush my hair, or eat. In fact I didn't even take my clothes off. I just lay with my head buried in my pillow and my rain jacket still damp around my shoulders.
I didn't really sleep, when ever I did my dreams were filled with flat lining monitors and defib paddles that didn't work. No matter how many times I tried to push the buttons they wouldn't work. I pushed them over and over and over again and nothing happened. You didn't have to be Sigmund Freud to interpret those dreams. I gave up at about 7:00 pm, went for a shower and heat up some left over mac and cheese, which, in the end, I didn't touch. After a while of being completely uninterested in a bunch of tall, skinny brats crying over getting their hair cut I grabbed my coat and went for a walk.
For once the city of Seattle was dry and I decided to risk not taking an umbrella. It was pitch black but I couldn't see any stars, you never could in the city. It was a little sad actually, I missed looking up at the stars the way I could back home.
My dad used to take me out all by myself and point out all the constellations to me, it was nice to spend some time alone with my dad. Growing up with two big brothers meant I didn't really get much of a chance to spend some one on one time with my parents. And I was a daddy's girl through and through. He always knew what to say when things were tough, always knew what to do, never got worked up and always kept calm. I don't know how he does it.
I wrapped my arms around myself as the wind picked up and I suddenly realised how cold it was. Crisp brown leaves were being blown from naked trees and I could hear them crunching under my feet. I had always liked this time of year, but tonight it just seemed sad somehow. Instead of the bare trees waiting for a new set of bright green leaves all I could see were dead brown clumps being crushed under my feet. It was wrong, so wrong.
I wanted so badly to call my dad but I knew I couldn't, knew I wouldn't.
"Dr Cullen?" I heard a familiar voice question. "Dr Cullen are you alright? What are doing out by yourself this time of night?"
"Hello Jasper," I said quietly keeping my head down. "Shouldn't I be asking you those questions?"
"I'm walking home from the hospital," Duh! "So what's your excuse for being out at 11pm?" I kept my head down and tried to work up the nerve to speak. When I stayed silent he took a step toward me, "Alice," He said slowly leaning in slightly too took at my face. "Are you okay?"
Then I made a big mistake, I looked up. I looked up into his blue eyes so filed with concern, his face frowning slightly at my silence. I could feel my throat tighten and knew then I couldn't hold it in any longer. I only had time to shake my head before tears started rolling down my face and my knees buckled under me.
He caught me before I fell and wrapped his arms around me. I buried my face into his shoulder and he held on tighter when ragged sobs racked through my small frame. He didn't say a thing, he just held me while I cried. I tried to speak, maybe I was trying to explain my behaviour or maybe I just needed to talk about it. But all that came out was strangled sobs. "She died," I sobbed into his shoulder. "I tried…but she just…she …she..."
For a while I forgot he was my patient and I was his doctor, I felt so safe in his arms. He wouldn't let anything happen to me, he would keep holding onto me as long as I needed him too. And by God I needed him too. I don't know why I felt like this with him, I barely knew him. It just felt so right to be wrapped in his arms, we fit together.
I don't know how long we sat there, on the damp sidewalk of Seattle. Thankfully this was not a busy walkway at eleven o'clock at night. When I finally stopped crying I looked up from his shoulder and tried to apologise. But he immediately stopped me.
"You take care of me," He said simply. "It's my turn."
"I couldn't save her," I whispered bowing my head.
"It was Melissa's time Alice, no one lives forever." He said softly. "It's not your fault…Alice look at me," I looked at his face, so close to mine, so full of understanding and kindness. "It is not your fault."
I put my arms around his waist and held on tight, he was the only thing keeping me above water right now and I couldn't bear to let him go. I put my head against his chest and could feel his heart beating in my ear, I found the sound comforting. He still didn't let me go…and I didn't let him go either.
Tomorrow was a new day, but tonight there was just us. And that was all I needed.
Authors Note: I am so sorry for how long this one took me to post, I'm not going to make any excuses I'm just very sorry!
Not much Jasper I know but I needed some Alice time. Reviews keep me writing, so let me know what you think! Please?
Thanks for reading. ~SM