They sat in the doctor's office, hands clasped together. Soon she would join them again and bring with her whatever piece of news it was that required they come in immediately that afternoon. When they'd arrived several things had happened. First, more blood was drawn from Kate, the nurse informing her that they were checking her blood for a protein.
Soon she was on the examination table and their doctor was examining an ultrasound. The fact that several residents were with her, all looking at the small screen did nothing to calm the nerves that Kate was currently struggling with. Judging from the look on Castle's face, she could tell that her husband was facing the same problem.
The doctors all spoke in uttered phrases, as if they weren't in the room, and it was starting to piss an already terrified Beckett off. She couldn't understand what they were talking about as they sought to gain different angles and pictures of her unborn daughter. Had she known that they would ignore her, she wouldn't have consented to let the student doctors join them.
It didn't make sense because all she heard were things like, "The baby's head looks perfectly normal to me." This was followed by nods of agreement from the other doctors. Next she heard someone mutter, "Get a close up of the cervical vertebra if you can."
"That looks normal too. The neck looks well formed." The doctor requesting a look at the baby's neck spoke.
"Her AFP levels?" Another doctor asked.
"Elevated. Considerably elevated." Their doctor spoke.
They all nodded and stepped back. Their doctor finally looked to them and smiled softly, "Ok. Why don't you get dressed and meet me in my office." She requested.
So there they were, two very concerned parents waiting to hear whatever news they had come to receive. As the door opened, both Castle and Beckett turned to look at the doctor with worry evident on their faces. Their doctor simply looked over the chart in her hands as she made her way to sit at her desk.
"Ok." She began, looking up to them. "I'm sorry to bring you in here so suddenly, but we needed to get a look at your baby to rule some things out." She explained. Kate let out a sigh of relief,
"So there is nothing wrong with our baby?" She spoke, a smile appearing on her face. The doctor didn't smile back though, which quickly wiped the expression from Kate as her heart dropped again.
"Kate, Rick." She began, we found that you've got heightened levels of a specific protein in the amniotic fluid sample we took.
"What does that mean?" Rick asked, squeezing his wife's hand.
"Well," the doctor began. "I'm sorry to have to tell you this, but this protein level is consistent with a set of very specific neural tube defects." Kate and Rick both went pale, their hands never letting go of one another.
"Wha…What does that mean?" Kate asked for clarification.
"It means that during the early stages of your baby's development something went wrong and caused a problem with your baby's brain." Kate had no words, she simply listened as tears gathered in her eyes.
"Now. When we looked at your ultrasound we saw a normally forming skull, which rules out a great many possibilities, including Anencephaly, which is good." She waited a moment before she continued.
"Your baby's neck is also completely formed, as well as their back, which rules out Spina Bifida."
"So where does that lead us?" Rick asked, his voice breaking.
"We think that we're dealing with what is called a Cephalic disorder." She spoke. At their blank, terrified faces, she continued.
"Because there appears to be no damage to the head or neck, we think we are dealing with a condition called Hydraencephaly."
"Hydra what?" Rick asked, tears streaming down his face. Kate was still pale and asked no questions.
"It is a condition where, for some reason, the frontal lobe and brainstem fully form and function, but the left and right hemispheres are replaced with sacs filled with cerebrospinal fluid." Kate's hand flew to her mouth as the doctor spoke.
"We can't officially diagnose until after you've delivered though Kate. The only way we can be sure is with an MRI when she arrives." She offered, "but you need to be prepared for this."
"Prepare how?" Rick asked. "Our baby is going to be born without most of her brain and you want us to prepare?" He asked incredulously. "How can anyone be prepared for that." He shook his head, squeezing his eyes closed to stop the tears.
"I understand this is difficult." The doctor acknowledged.
"So what happens now?" Kate asked.
"Well, if you choose to carry her to term, she will continue to grow. You will give birth naturally and she will be able to engage in all of the rudimentary behaviors because of her functioning frontal lobe. She will cry, and move, and most likely will be able to eat and drink normally." She looked at both parents again to give them a chance to allow it all to set in.
"You'll notice delays quite soon though. She'll loose her muscle tension, she won't be able to regulate her own body temperature." She continued, "blindness and deafness are also common, and seizures will likely occur too." She paused again before getting her last sentences out.
"Rick. Kate. The majority of children born with Hydraencephalis die before they turn 1. Those who do survive usually die by age 4. Although it has to be your choice, most doctors consider termination of the pregnancy a viable option." She waited for them to absorb the information.
After a few minutes Kate spoke again. "What? You want me to terminate the pregnancy? She doesn't even get a chance?" Her voice was shaking.
"I've survived cancer. I thought I was infertile. She-" Kate motioned to her stomach while tears streamed down her face, "is a miracle and she deserves a chance, especially if you can't be sure that she's got this." Kate stood then, Castle rising with her.
"I think we'll get a second opinion." He spoke as they walked from the room. Their doctor nodded in understanding before she spoke again,
"If you choose to continue with the pregnancy I am happy to help you both to the best of my abilities."
Kate turned and nodded, "Thank you." She spoke.
That night they lay in bed together, both utterly heartbroken. Kate simply couldn't understand why this was happening. She'd been warned that something could go wrong if there was damage to her egg, but in all the research they'd done after arriving at the loft, they found no connection with chemotherapy. There were vague references of pharmaceutical causes, but her drugs were not listed specifically.
This did not ease their concerns, as little was known about what caused the rare disorder their daughter was suspected of having. Castle found another study that did bring them hope, although the outcome of the study was devastating.
"Kate." He spoke to her while reading from his laptop. "This is a case study of a woman whose daughter was diagnosed with this when she was 18 weeks pregnant. She chose to terminate the pregnancy only to discover after the autopsy that the infant was normal and the tests were wrong." Kate looked at him.
"That is terrible." She said, becoming upset again.
"Yes it is, but Kate, they've made a mistake before, maybe they made one again here." He crawled into bed beside her and took her into his arms. She leaned her head into the crook of his neck and inhaled.
"Do you think that I'm wrong Rick?" He turned to her with a look of confusion on his face.
"Do I think you're wrong about what?" As he questioned her his fingers began to caress small circles into her shoulder blade. She turned her head into his neck, seeking the warmth and the comfort that she needed him to provide.
"Do you think that I'm greedy for refusing to terminate this pregnancy?" She swallowed, waiting for him to answer her. His soothing motions continued as he leaned his head further to hers and placed kisses onto the top of her head.
"No, Kate. I don't." He whispered. "I don't think it is greedy at all to hope for the best." As she nodded into him he could feel the warm moisture from her tears against the skin on his neck. He continued speaking, partially to soothe her and partially to give her a moment to work through her emotions.
"Kate, no matter what happens, this baby is ours. This little girl is a miracle and we made her. I am going to treasure every precious moment we get to have her in our arms, no matter how short that may be."
She shook harder as she completely broke into sobs, allowing him to turn into her and take her fully into his arms as she wept. Even through his own tears he soothed her, whispering "shhhh" into her as he ran his fingers through her hair. He Held her for awhile and she laid there, in their bed, arms wrapped around the child in her stomach as if keeping her there could protect her from the harsh realities of the world.
Over the next week they did get a second opinion, the same issues arising. The blood tests and amniocentesis indicated a neural tube defect of some sort, whereas the ultrasound looked normal. The final doctor they saw, a middle aged woman named Dr. Perkins, was the first to offer them a bit of hope.
When Rick spoke of the study he'd read, of the misdiagnosis she acknowledged that it may have been a possibility, but also gave them a dose of reality in telling them that the tests were almost never wrong. She did spend some time explaining the nature of the tests that they'd conducted. She also spent some time questioning Kate about her conception.
"Kate, I want you to tell me the details surrounding when you think you conceived." Dr. Perkins spoke.
She thought to herself and turned to look at her husband, who was holding her hand. "Well," she began, I found out right before we got married, which was June 26th. When I went to the doctor for my first appointment I was about 7 weeks. " She began.
"So I guess early May?" She looked up at the doctor, who nodded before speaking again.
"Well, Kate. I see from your medical records that you underwent chemotherapy until the fall of 2012. When did you start ovulating again?"
"Actually, I'm not sure. I mean, I'm pretty sure we got pregnant before we knew I was ovulating." The doctor nodded again and replied, "so your first ovulation resulted in a pregnancy before you knew you were fertile again?"
"I guess so, yeah." Kate confirmed.
"Ok." The doctor spoke. "What I am about to tell you is just a possibility, not something that I can guarantee. Do you understand?"
Both Castle and Beckett nodded at the doctor.
"Most people don't realize this, but due dates are calculated based on when you last ovulated. Because you got pregnant on your first known ovulation, you didn't have a chance to calculate your menstrual cycles after your body became fertile again." Both Castle and Beckett nodded, urging her to continue.
"It is very possible that the estimate you were given during your early appointment was wrong." The doctor spoke, shocking the both of them.
"If this is true then it is possible that you are further along in your pregnancy than anticipated. This could explain why your protein levels were elevated, but your ultrasound was normal." Both of their faces lit up as the weight of her words sank in.
"However, I cannot say that this is the case. You are dealing with a defect that cannot be confirmed until after birth, methods of dating that aren't fool proof, and a unique situation in that we can't predict when you ovulated exactly. Not to mention you are still in a high risk group Kate." She looked at them kindly, but sternly to be sure that they weren't too hopeful.
"I am simply offering a potential alternative explanation, one that we can continue to explore as your baby continues to grow."
"So," Kate asked, "How far along am I? How do we know that?" The doctor nodded and explained to her,
"Dating is an estimate Kate, it can be as much as 2 weeks off in either direction, anything more and the ultrasound would most likely have indicated otherwise." The doctor looked back down to her chart and noted that Kate seemed to be measuring slightly big as of the last few appointments, although nothing out of the realm of normal.
"Each baby grows somewhat differently, at different rates that is. So it is not abnormal to be a bit off with due dates, I like to think about it more as a due month. So, given your measurements I would estimate that you could be as much as 25 weeks instead of 23 weeks now Kate."
"So," Rick spoke, 25 weeks and that would make the baby's due date when? Late February?"
The doctor nodded, "Sometime around then. I usually find that babies rarely come on their due dates anyhow, arriving instead when they're ready to greet the world."
Kate's head spun, the knowledge that the baby may come sooner than they'd expected was a shock, but it was well worth it when they considered the hope that this doctor had just given them.
That was the hope that they were going to have to cling to as they prepared for Kate's third and final trimester, unsure of what life was going to hold for their baby girl.
I was going to split this information into two chapters, but decided that it would be nicer to leave you all with some hope for the best until I get the next one finished and uploaded.