Authors Note: Rise and fall...that about all i have to say about this one. Happy reading
Nephrology 21 - Rise and Fall
"Alice will you please just go home?" Jasper said rolling his eyes at me.
"Jasper I would love to," I retorted. "My shift ended three hours ago and I'd love a shower and some hot food but the problem is…I just don't know where my home is?"
"Well if you would just stop being so stubborn and admit that my apartment is better then it would all be settled!"
"Really?! You think I'm being the stubborn one." I shot back. "You won't even listen when I try explain my reasoning's for wanting to move to my place!"
"That's because you're reasons don't go much beyond 'I like it'" He said, doing the best impression of me he could muster…which was actually quite accurate I hated to admit.
"I swear I would beat you up right now if you weren't getting dialysis!" I huffed.
"And once again I'm saved by the miracle of modern medicine," he smiled.
"Oh don't get too smug, you're gonna be finished soon and…" I jumped as my phone started buzzing in my pocket. I quickly whipped it out and checked the caller ID. "It's Edward," I said. "Wonder what he wants?"
"Better answer and find out." Jasper shrugged.
"Yeah well that doesn't mean this discussion is over," I said putting the phone up to my ear. "Hey Teddy bear! What do you need?"
"Teddy bear?" Edwards voice rang with dismay. "Seriously Alice?"
"Don't ask me, the nicknames just flow through my brain. I can't control my genius."
I heard Edward sigh on the other end of the line, nick names always riled him but after all these years I think he's finally learned to just put up with us. "Okay Ali, what ever makes you happy! Anyway, I'm calling because Bella and I have decided to drive home tonight and stay the night instead of heading there in rush hour traffic so do you and Jasper want a lift?"
"Edward what are you talking about?" I asked. "Why are you going home?"
"Alice it's moms birthday! How could you forget that? We're going for a picnic….remember!"
A string of expletives rang in my head but I caught myself before I let them slip out, I was still on my ward after all. "Aw fudge." Was what finally came out my mouth. "I'm sorry Edward I completely forgot! Aw I'm such a horrible daughter I haven't even gotten her anything."
"Don't worry I've written you and Emmett's name on the tag of our present, so do you want picked up or not?" Edward was so prepared; I never knew how he did it.
"Aw thanks Ed!" I gushed. "When are you guys leaving, cause Jasper is still on dialysis so we won't be ready for another couple hours at least."
"Wait a sec," I heard Edward drop the phone from his ear and start speaking to Bella, no doubt asking if that was okay. I glanced back over my shoulder at Jasper who had started playing Tetris on his phone, the sight made me smile. "Yeah that's fine, Bells still needs to finish packing anyway, we're taking some of our stuff down for the new cottage."
"Oh gosh, everyone's moving now! It's so exciting!" I yelped. "I feel like we've all grown up all of a sudden!"
"Yeah I know what you mean, the baby's due next week can you believe that?" Edwards voice was a mixture of excitement and shock.
"You're gonna be such a great Dad Edward honestly…"I was interrupted by Angela bumping into me in a hurry to get somewhere. I turned to see what was going on, Jaspers BP had started to drop. "Edward I got to go, I'll see you tonight." I said quickly before I put the phone in my pocket as quickly as possible and made my way back to Jasper.
"Jasper can you hear me?" I said, kneeling down in front of him. He nodded. "Talk to me Jas how are you feeling?" His posture had become more slumped and relaxed, his head was bowed slightly but he was making a visible effort to stay upright and alert.
"Dizzy," he breathed.
"Move the chair, get him lying flat, I'll get saline." I instructed Angela. I could already start to see Jaspers consciousness escaping him.
I moved quickly and hooked the saline line into his tubing. I shouldn't be treating him myself but he needed this and he needed it now and doing anything else would impair his treatment and I wasn't going to let that happen. His BP started slowly climbing.
He moaned softly as he came to. "Did I faint again?" He asked quietly.
"Yeah babe, you were a real drama queen." I smiled. His BP was still rising, a very good sign. He had these episodes during dialysis quite often now but thankfully it was usually easily reversible. I reached up and stroked the hair away from his eyes.
"I've had a lot of practice," he winked up at me. "Can I sit up now?"
"I think it might be best if you stay lying for the rest of your session, you don't have long left." I said.
"I'll come back to unhook you in about half an hour," Angela said softly to Jasper. She smiled at me and made her way back to the nurses station.
"How are feeling?" I asked.
'Fine," he said, his reflex response.
"Jasper!" I warned.
"Okay okay," he said, his voice still soft and weaker than normal. "Still a bit dizzy…tired…" He scrunched his eyes up like was waiting for something to pass, was he in pain? "A bit nauseous. Actually…pretty nauseous, yeah."
I rubbed his arm sympathetically. Unfortunately there was nothing I could do but be here beside him. His kidneys were too fragile to give him medication that would help because it would end up doing more harm than good. So I sat beside his head and ran my fingers up and down his arm. It's times like this the helplessness felt like a physical knot in my stomach.
I started talking to Jasper to keep his mind off it. I told him about my moms forgotten about birthday picnic we had planned and that we were staying tonight in forks. Then we argued a bit more about whose apartment to live in, to no avail. Before we knew it Angela was back to unhook Jasper and we were free to go.
"Take it slow babe," I said as Jasper as he started to get up. He was still a bit grey, we'd managed to get his BP up to 90/50 mmHg, which was still on the low side, but better than it was. Unfortunately after being taken off the saline it was likely to drop again. "Take my arm," I ordered him, sticking out my elbow in his direction. "You look like you're gonna collapse any second."
"And taking your arm is going to do what? Make sure I drag you down with me?" He laughed, taking my arm all the same.
By the time we got out to my car I could feel Jaspers relief. He was completely worn out. Before I pulled out the parking lot I turned to him. "I can call Edward and tell him not to come pick us up. We don't need to make the journey tonight."
"No don't do that! I'm not too bad; this will pass in an hour or so. I've had way worse, and besides, if we don't go down tonight it'll be a nightmare in the morning." His eyes were pleading with me. I just knew how hard dialysis hit him sometimes and it really felt like one of those times that he needed a good sleep and not a three-hour car journey. But he knew his own body better than I did and I had to trust him, that didn't mean I wasn't constantly worried about him though.
"If you're sure," I mumbled. "But please tell me of you're not feeling up to it." He nodded in response and I started the car. We drove to his apartment first to pick up some stuff and then back to mine to meet Edward. Instead of packing my usual overnight bag I put some clothes into my doctors bag and checked it was stocked up. I'm sure Jasper would be okay but…you could never be too careful. It had been nearly an hour since he stopped dialysis and he still looked like death. I couldn't control the worry that bubbled inside me if id wanted to…which I did because he kept insisting he was still fine to travel.
"I just think this place is too small for two of us." Jasper said looking around.
"It's not too small its…just right!" I argued. "We could both fit in here easily, look your desk could go over there and there would still be loads of room."
"I think 'loads of room' is a bit of an exaggeration dear, there would barely be room to breath if we put more stuff in here."
"Oh now who's exaggerating? You really are going for the drama queen thing today aren't you?"
"Well," he smirked. "If it will get you to admit my place is better…"
I took a breath to respond but my phone started ringing and flashing with Edwards name before I could get the words out. "Hey, is that you outside?" I said in way of a greeting.
"Yeah, do you mind just coming down?" Edwards voice rang in my ear.
"Yeah sure we'll be down in a sec," I replied and hung up. "Time to get going Miss America!" I teased Jasper. He rolled his eyes at me and made to get up off my small sofa. I watched him rise, just to make sure he could, he was slow but he made it. Maybe he wasn't as bad as he looked. I grabbed both our bags and ushered him out the apartment.
"Okay Jas last chance, are you sure you're up for this?" I asked. He shot me an irritated look and I raised my hands in surrender, well as much as I could carrying two bags anyway. The elevator in this building was faulty at the best of times and today apparently was not the best of times, it had been working okay when we came up but apparently it had decided to take the night off. By the time we got to the bottom of the stairs Jasper really looked like he was about to pass out on me. I had taken it slow and he had stopped to catch his breath half way down but he still looked like hell. His skin had a grey hue with a sheen of sweat and I could hear his breathing fast and a bit too shallow for me to be comfortable.
"I'm gonna sit here just for a sec," He breathed weakly. I nodded and sat down beside him on the bottom step. I put the bags down and started rubbing slow circles in his back. I wanted to ask him questions but I knew answering them would just leave him even more breathless so I held my tongue. He slowly started to come round and started looking more like he had when we set off from the apartment, still not good but a bit better.
"Edward is gonna be wondering where we got to," I said as I stood and reached out a hand to help him up. "And he's going to get annoyed because he's Edward and he gets annoyed by the world turning."
Jasper laughed and took hold of my hand gratefully. "You guys are so hard on the poor guy." He laughed.
"Well he just makes himself such an easy target." I shrugged.
It wasn't a long walk to where Edward had parked but it seemed to wipe Jasper out, I'd only seen him this bad after dialysis once before and it was not fun. It was about a week after he started the more intensive dialysis regime and, like tonight, he had a severely low blood pressure which we stabilised but he got really ill that night, dizzy with nausea and sever flank pain which ended in him being quite violently ill. I prayed this wasn't going to be a repeat of that.
You should make him stay here Alice, what are you doing? But he said he was okay. And you know he's lying.
My inner debate was interrupted when we got into the car and greeted Edward and Bella. My goodness Bella was huge; she looked like she was ready to pop any second. "Wow Bella are you sure it's next week you're due?" I blurted out.
"Nice to see you too Alice," Bella said in mock offence. I started to apologise but she cut me off. "It's fine, don't worry about it, I feel like a house! Thankfully we managed to pack the rest of our stuff up tonight so we're actually officially moving back to fork tonight!"
"Aw that's so exciting! Just in time for the baby, perfect!" I squealed. "Wait…does that mean we're losing our lift back to Seattle?"
Edward laughed. "Emmett is going to bring you back up tomorrow evening, don't worry."
"Aw that's good! Some of us still have sick people to help." I joked.
"Hey! I'm still gonna be a doctor!" Edward retorted.
"Yeah but in forks? Good luck with the runny noses and fishing hooks stuck in fingers." I teased him.
"She has a point honey," Bella supplied.
Edward huffed a bit and then we all burst out laughing. It was a nice night for a drive actually, for once it wasn't raining or overcast and the stars were pretty to drive under. We chatted easily among the three of us, I kept an eye on Jasper but I think he'd fallen asleep which is definitely for the best.
"You're quiet Jasper," Edward inquired as he tried to look in the mirror to catch Jaspers eye.
"I think he's sleeping," I said, trying to keep my voice low like I had been doing the whole journey. "He had a hypotensive crisis during dialysis and it hit him pretty hard."
"Oh damn," Edward said. "Is he alright?"
"I don't know, he should be, it's not unusual to feel a bit rubbish after dialysis. He'll be back to normal in the morning." I said.
"Okay, well let me know if you need me to pull over or anything." He said, also lowering his voice. "How has he been since the pulmonary oedema?"
Suddenly a lump appeared in my throat that would declare its presence as soon as I started speaking. Where did that come from? Hold it together Alice, just answer the question. "Better…for now." was all I managed to squeeze out before speaking caused the tears to start flowing. I swallowed loudly hoping it would make the lump in my throat disappear, but all it did was make a really loud gulping sound. Great, they probably heard that.
I must have looked over to make sure Jasper was okay about a million times during the car ride, every time he was sleeping and I was grateful for that. The logical part of my brain was saying that he just needed a good nights sleep and he would be fine, this had happened before loads of times and he just needed sleep. But there was this feeling in the pit of my stomach that I couldn't get rid off, this feeling that told me to keep looking over at him. This feeling that told me sleep wasn't enough this time.
I don't know why I did it, but after a few hours of looking him up and down every three seconds I reached over and felt for his radial pulse. I dug my fingers into the flesh of his wrist hoping to feel the usual tap tap of blood running through the artery, but there was nothing. Panic started to rise in my chest as I dug my fingers in deeper and deeper, hard enough it would bruise. But still…nothing.
"Jasper," I said forcefully. "Jasper can you hear me? You need to wake up."
Everything else in the world disappeared as reached my fingers up to his throat, I had to feel something there. My eyes bored into his chest. It was moving. It was moving! That was good, but it wasn't moving enough, his breathing had gotten shallow. I pressed my fingers harder and harder into his neck this time. I took a deep breath trying to stop my hands from shaking.
I felt something. A pulse.
But it was so weak. He was alive, but he was going into a hypotensive crisis. Shock for all I knew. Fuck, fuck, FUCK. How had I missed that?
"Edward go to the hospital NOW." I shouted.
"Alice what's.." he started to ask. But I didn't have time for questions.
"DRIVE FASTER!"
I started shaking Jasper to try to wake him up, there wasn't much I could do in the back of car but I lay him down with his head on my lap and started rummaging through my bag to find my sphig. I took it would and wrapped the cuff round his upper arm, pushing the diaphragm of my stethoscope into the crook of his arm. I pumped up and cuff and watched as the needle dropped.
I was trying to listen for the familiar tap tapping of blood against an artery. I'd done it a million times. The first time I heard something would be his systolic pressure and the when the sounds stopped, that was his diastolic pressure. I'd done it a million times and I'd never thought anything of it, but the reading I got this time was so important. So very important.
But the needle kept dropping and I couldn't hear a sound. I held my breath and my heart was beating against my chest so forcefully it felt like it was trying to escape. The needle dropped past 80, still no sound. It kept moving.
70, no sound.
65, no sound.
60, it has to be sixty. It can't be lower.
60, no sound.
50, no sound.
I have to be hearing it wrong, this can't be right.
But then I heard it, tapping rang in my ears like Christmas bells, I listened until that stopped and I could have cheered that id heard anything at all. Until I realised this blood pressure was 47/24.
I'd never even heard of a BP so low.
"His BP's 47 over 24, Edward hurry." I said, my voice rang hollow in my own ears. There was nothing I could do, nothing. We had to wait to get to the hospital. "Common Jas, please wake up." I repeated to him over and over again. But he wouldn't wake up, not right now. With a BP that low it was miracle it was holding steady enough for him to keep breathing. Nether the less I rubbing his chest trying to rouse him, I guess maybe its was just because it was the only thing I could do.
I knew the car was gaining speed, I could feel Edward dodging traffic as my body jerked with the sharp movements, I could hear the tires skidding and horns blaring at us but it all just felt so detached from me. All that was on my world was the immanent danger Jasper was facing.
I kept my fingers pressed into his neck, feeling his pulse weakly beat against my fingers. It wasn't much but it was there, and it was proof he was alive. I closed my eyes and prayed we made it to the hospital soon.
This is okay Alice, this happens, he has end stage renal failure, a hypotensive crisis is to be expected, especially after this evening, it's okay.
The car suddenly stopped and I jerked forward sharply, before I knew it the door was being flung open and someone was yelling for help and hands…hands were everywhere, grabbing onto my Jasper. It took me a second to realise we were at the hospital and these people were helping. They placed Jasper on a gurney and I scrambled out the car after them.
Words started pouring out my mouth as I ran behind them into the ER. "He has stage 5 CKD, BP 47/24, had hypotensive crisis during dialysis earlier…"
Someone grabbed me and pulled me back away from the Doctors in the resus bay. "NO!" I cried out. "I'm a doctor, I'm his doctor you need to let me help!"
"Alice!" Edward said, putting his face right up to mine. "What should they do!"
"Blood and saline," I blurted out. Edward gave the doctors a nod and they got to work. He kept me held back, away from Jasper. I struggled against his grip but he didn't let go. I wanted to treat him and make him better, that was what I did!
You have to stay back Alice.
I kept struggling as I watched a team of coloured scrubs flurry around Jasper, hooking things up to him, plugging him in, putting things into his body and taking things out.
It's hard to tell how long I stood watching people flurry around my Jasper's pale, unmoving body as I stood caged in my brothers arms.
I watched the BP monitor and held my breath as the numbers changed. My head was so muddled that at first I couldn't work out if the numbers were going up or down.
"Alice his BP's rising," Edward said in my ear. "Look, the numbers are going up, he's okay!"
I look a shaky breath as my muscles relaxed, the only thing that kept me standing was Edwards arms around me. Slowly the medical team dispersed as his numbers rose to a normal level. I'm not sure how many more of these emergencies my heart could take, I could feel it struggling to keep beating after working so hard to escape my chest the last hour.
Colour was flushing his cheeks again and he looked like him. I looked him up and down, revelling in the fact that he was stable. I never thought I'd be in a position where the only thing I wanted from the love of my life was for his blood pressure to be stable. My eyes shot to his hand when I saw movement out the corner of my eye.
"Jasper?" I asked, escaping from Edwards grip as I dashed to his bedside. "Jasper can you hear me? Did you just move your hand?"
I took his hand in mine and held it firmly, taking joy in the heat I felt radiating from it. He was warm, he was safe and warm.
"Did I… fall a…sleep?" Jasper murmured softly. A smile spread across my face and tears wet my cheeks at the sound of his voice.
"Yeah babe, you fell asleep a little bit." I laughed through the tears that wouldn't stop running down my cheeks. Happy tears. Relived tears.
Jasper shifted and moved like he wanted to sit up. "Stay down for now Jas, you have lots of tubes coming in and out of you."
"Wait…what? Why?" He opened his eyes and started looking around, frowning in confusion.
"You're BP plummeted in the car and we had to get you into hospital, they managed to stabilise it quickly and you'll be fine." I explained. "you had us scared for a while there."
Jasper groaned in annoyance. "Don't tell Rose." He said clearly. I opened my mouth to defend Rosalie's overbearing nature but he spoke again before I could say a word. "I'm serious Ally."
"Okay," I relented. "But only because this one ended up okay. But if this is going to keep happening you have to tell people Jasper, they have to know what to look out for if you have a sudden drop."
"I know," He whispered.
Machines were bleeping and burring around us and people were moving and shouting and working. But it was still just me and Jasper, just the two of us in our little bubble of relief.
"Don't' scare me like that again Jas, I love you too much to watch this keep happening." I said softly.
"I love you too much to watch this keeping happening to you too, Alice," he whispered.
His eyes met mine, I could see a flash of pain in them…or was it guilt?
"We need a new place," He said softly. I frowned and he continued on. "We need a place to live thats ours, together, not mine or yours, but ours."
I smiled and nodded. The tears that had been threatening behind my eyes finally feel free.
Ours.
The only thing stopping me from crawling into bed with him and wrapping my body around his were the variety of cables and wires running in and out of his body. Instead I settled for sweeping his hair away from his eyes and resting my head on his chest, feeling it rise and fall, rise and fall.
Rise and fall.
Rise
Fall
Rise
Fall