*You knew it couldn't go off without a hitch, didn't you? ::Sigh:: Curse the addiction to suspense...
Caleb was startled out of his mind when Leonardo burst into the Lab, the turtle breathing so quickly that he could hardly put two words together.
"Doc-Mike-"
Luke was on his feet in a flash. "Leo, where is he? What's wrong?"
"Donny's coming, he was right-"
Before Leonardo could finish, the purple-masked turtle raced into the room with Michelangelo braced over his shoulder. "He's de-saturated; blood oxygen level is down to 70%! I think he might be in respiratory failure!"
Caleb's mind told his feet to move, but his legs wouldn't obey. All he could do was watch while Luke swung into action.
"Get him over here, Don! Is he still breathing on his own?"
"I can't detect any respiration, not within the last minute! Katherine said he was still breathing when he collapsed."
"We'll go to the mechanical ventilator," Luke said immediately.
Caleb was still frozen in time while he watched the blond doctor rapidly prepare the dreaded machine that had been set aside in case it was needed, and Marcus dashed into the room.
"What's going on?" Marcus demanded, running to join Donatello beside the orange-masked turtle.
The turtle was staring at the screen of his scanner and didn't respond right away. "He's in acute respiratory failure, and there's pulmonary distress on top of it! Marc, help me get his airway open while Doc finishes with the machine! Let's get him intubated so the tube is ready to be hooked up to the ventilator." When Donatello looked up, he must have noticed his blue-masked brother hovering nearby. "Leo - out!" he commanded with more force than Caleb had ever heard come from his mouth.
Marcus used a laryngoscope to smoothly insert a tube down Mike's throat while Donatello was concentrating on interpreting his vitals, and Luke was dragging the mechanical ventilator over to the bed.
"What were you saying about pulmonary distress, Donny?" Luke asked.
Donatello was reading from the screen of his scanner even as he responded to Luke. "I think hypoxia might have settled into the heart muscle; its function is already decreasing."
"Ephifine, Marc, GO!" Luke ordered, taking the other end of the endotracheal tube from the man so he could finish attaching it to the ventilator. "We need a steel gauge needle to get to his heart!" he reminded him.
Marcus hurried across the room to the refrigerator, and returned in seconds with a bluish vial. Caleb watched the man load a special needle, but Donatello reached to take it from him.
"I'll do it, Marc," Donatello insisted, and took a deep breath.
Caleb's eyes widened as the purple-masked turtle plunged the needle into the general area of where Mike's heart would be. As the numb disbelief began to give way, panic was threatening to overwhelm the man's mind. He wasn't trained for this, wasn't prepared to deal with the possible consequences of how the cells he'd created could affect the orange-masked turtle. Caleb had known and accepted the risks when he'd taken on the job, but it didn't make it any easier to watch the situation unfolding in front of him.
"Can I...is there something I can be doing?" he finally faltered, feeling lost and inadequate. I did this to him, something in the calculations must have been wrong. I caused this, and I can't even do anything to fix it.
"Not quite yet," Luke answered evenly. "Give us a chance to get him stable, then we can focus on the imaging software and another biopsy. Don, what are you getting on his cardiac output?"
"It's increasing a little, but not enough for my liking."
"He may require a larger dose of the ephifine, Donny, as much as I'd like to avoid that. Marc, will you go ahead and get the external monitor set up so we can keep an eye on his vitals easier?" Luke requested.
I don't understand how they do this. I don't. They're best friends, family even. How can they possibly remain this rational when they're dealing with one of their own dying right in front of them?
Caleb felt useless for the first time in months. Intensive work had led them to this point, and the encouragement he'd received from the success of the first round of stem cells had left the man feeling cautiously confident. Now he felt like nothing more than a fool for believing he had a shot of delivering Mike from the deadly genetic condition with so little groundwork laid. He willfully looked away from the orange-masked turtle, unable to take another second of the image of Mike in the throes of death.
I didn't go into genetics to practice medicine. I didn't want to be the one implementing cures. I wanted to study and discover solutions from a safe distance. It can't really be ending right now, can it? Caleb's legs felt weak as he backed away from the others, reaching a hand behind him to find a desk chair as his body trembled. I should have been prepared for the eventuality, I should have known...
Caleb slumped down in a chair, resting his elbows heavily on top of his legs. I don't know where I went wrong, and I probably won't until I get a good picture of his lungs. The mutated cells may been more powerful than I anticipated. The iPs cells may not have been stable enough to hold their own against the defective ones. I should be going through the other cultures I'm developing, finding out how quickly the cells could be brought up to speed and ready for implantation, not sitting here in shock while he dies in front of me.
Caleb's initial intention in coming to Lotus Salvus had been to try and remain separate and impartial from the strange family unit. He'd achieved it rather easily for the first couple of weeks, finding it simple to avoid contact with the others. He couldn't avoid dealing with Michelangelo, however; the orange-masked turtle was the entire reason he was here. Despite his effort to remain objective, the turtle had drawn Caleb in with his good-natured spirit, his humor, and his courage.
And now I'm attached - me. The one who was so caught up in my own discoveries that I couldn't take a minute to notice what was happening with my wife. I discounted the anemia, took no notice of the severity of her symptoms until it was too late to do anything but watch her die. If I'd only paid more attention, if they'd caught it earlier, the doctors could have treated the tumors. I didn't deserve Susan, and I don't deserve to be here. I've done nothing but get their hopes up.
Tears rose as he buried his head between his arms. The room had become silent, except for the hum of machines and the steady rhythm of the monitoring equipment.
"Caleb?" Luke called.
He looked up to meet his friend's blue eyes, trying to convey all of the sorrow that was crashing down inside of him for the mistake he must have made with Michelangelo. No amount of repentance would be able to make up for it.
"Caleb, are you..." Luke didn't finish, resting a hand on the older man's shoulder. "You don't look good. Um...don't try to get up, okay? We've already got the imaging scanner prepared, so we'll take the new footage, and we'll need your expertise to decipher it."
"My expertise?" he echoed shakily. "You mean the expertise that's succeeding in killing him?"
"He isn't dead, Caleb-"
"A blood oxygen content of 70%? Luke, I may not be a part of your medical community, but I understand how dire the situation is. How quickly you had to bring out the ventilator proves that. How stable can you determine he is?"
Luke inhaled a breath, and slowly let it out. "He isn't breathing on his own. He needs the support of the machine and an increased flow of oxygen to maintain any kind of airway."
"What about his heart?"
"Mike suffered from a lapse in cardiac output, probably due to hypoxia that was brought on by the respiratory failure. By supporting his breathing, we're dealing with the complication to his heart."
"What did Donatello do with that shot he gave him?"
"We were concerned that Mike's heart was going to stop altogether. Ephifine is a special compound that's designed both to ward off the possibility of shock, and take drastic action with the heart when it's required. It's kind of a kick-start in the form on an injection."
Caleb stared at Donatello, suddenly seeing the turtle in an entirely new light. He'd long been aware of Don's genius, but he'd still been surprised by his calm, rapid reaction to his brother's condition. Donatello had never panicked, not even now that the initial adrenaline had to have worn off.
"I'm sorry." Caleb barely breathed the words. "I'm sorry, Luke. I was wrong to attempt this, wrong to think that it could be accomplished this quickly."
"Caleb, he isn't dead," Luke repeated firmly.
"Luke, I'm not an idiot. I look at him, and I know the situation isn't good."
"I didn't say it was good," Luke countered. "But we don't give up hope in this family, not until the last light goes out. That hasn't happened, and God willing, it isn't going to. You sit here and get the program open on this side, because we're going to get the scanner running on Michelangelo."
Caleb's silent worthlessness continued for a few more minutes while he waited on first the software, then the imaging to align with each other, and produce the picture of the turtle's lungs. He stared vapidly at the computer screen while he waited, as if it might actually hold the answer to the puzzle in front of them. What puzzle is there to figure out? The science wasn't ready to support this, and I couldn't pull it off. I can create tissue, but I can't shut down the missiles that are destroying it.
As the images began loading, he silenced every ounce of self-doubt, and tried to focus on interpreting where he'd gone so wrong.
Luke had argued with Caleb for over forty minutes about delivering the prognosis to the group, but the older man remained adamant about doing some of the talking. It was his own miscalculation that had likely triggered the respiratory failure, and he felt responsible for explaining it.
Once he was inside the Great Room with everyone looking at him, his knees suddenly felt weak again. Be strong. For once in your life do what needs to be done, at the time it needs to be done.
Caleb scanned the faces of the turtles and humans he'd only known for a couple of months, and was amazed by the variety of emotions he was faced with. He was so caught up in watching the reactions of the others, he only heard the tail-end of Luke's speech.
"...The truth is, we don't know what's going to happen. I'd like to tell you that there's a simple solution, where Mike could just stay on the ventilator for 'x' amount of time, and he'll begin to breathe on his own. We're hoping that his body will be able to support itself again, and we're taking steps to help the process along." Luke glanced at Caleb as he finished.
The older man took a shuddering breath as he approached center stage. "I knew going into this about the risks and the possible complications, but it's still very difficult to stand in front of all of you right now. From the images I've studied over the last two hours, I can surmise that something went awry with the new iPs cells that were transplanted. I don't know what happened to the cells we manipulated - I can't even find them.
"My guess is that the mutated cells proved much more difficult to overcome than I assumed they would be. When I performed tests in the Lab involving the defective cells and the created iPs cells in a controlled environment, the mutated ones couldn't stand up against the new cultures. I believe I may have made a mistake in the number of iPs cells that were transplanted, because I thought the defective cells would go down easier.
"It appears that I didn't implant enough of the new cultures to make an impact on the mutated cells, and only succeeded in creating the traumatic event that was probably caused by their clash. I'm guessing that the iPs cells that were recently implanted are already dead, and that whatever happened inside of his lungs contributed to the respiratory failure." Caleb finally took another breath, and finished more quietly. "I take responsibility for this event."
The room was so quiet, you could have heard a pin drop. It remained that way until the blue-masked turtle rose to his feet.
"Medicine isn't perfect, Caleb, you aren't perfect. You warned all of us coming in that nothing was certain. All we want to know is what happens next. Do you have any kind of steps that you can take?"
I'd like to take my hands off completely, before I drive him into an impending grave, Caleb thought inwardly. "I have a couple more strains of iPs cells that are nearly mature, in addition to the cultures that are ready to be implanted. If I only implant the ones that are ready as of this moment, I'm afraid they'll be killed by the mutated cells just as quickly as the last batch. Or worse, they could induce another dramatic plunge in his blood oxygenation. My thought is to help the manipulated cells gang up on the defective ones, by implanting more of them at once."
"But you said the other cultures weren't quite ready," Leonardo verified.
"I need a couple of days, at the very least," Caleb affirmed.
"In the meantime, we're monitoring Mike, and hoping for the best," Luke added.
Caleb looked at the floor. I only hope I'm not signing his death certificate by waiting.