A week before Halloween, Rick went on a business trip to Washington, DC to meet with a contact for his next book. The day he left, Mackenzie's health took at turn for the worse and Kate checked her back into the hospital. They ran a battery of tests and found that the cancer had returned in Mackenzie's brain and spinal cord. The speed of her relapse took them all by surprise. Kate met with the doctors to discuss her treatment. When they confirmed to her that the high-dose chemotherapy along with stem cell transplantation was her best option, her heart sank. Kate knew they didn't have a compatible donor available.
When Mackenzie had first been diagnosed, Kate asked everyone to get tested for compatibility, but none was found. Hers was the closest, but only as a partial match.
She shook her head in frustration, checking her watch. She knew she needed to call her father, to get him tested for compatibility, but she still felt nervous. Come on, Katie. It's Mackenzie's life you're messing with here! So she went to the lobby pay phone and made the call. Kate heard a muffled voice on the other end as she nervously shifted her weight from one foot to the other.
"Katie? Is that you?"
Kate rolled her eyes at her father's slurred words. "Yes Dad. Listen, I got a big favor to ask of you. My daughter, Mackenzie, is really sick. She has Leukemia."
"Louka who?"
"Leukemia - it's cancer. She needs a transplant. I need you to get tested to see if your cells are compatible."
"You need my cell phone?"
Kate closed her eyes and counted to ten in her head. If only her mother were still alive.
"Just do me a favor and meet me at St. Vincent's Cancer Center at 2 today. Come to the lab and let them take a blood sample." Her impatience leaked through in her voice. He didn't answer right away and Kate started to worry that he wouldn't come, so she swallowed her pride and asked again.
"Please Dad, this is really important. It will only take a few minutes and it could save her life"
"Okay Katie, I'll see you at 2."
Kate thanked him and hung up. She dreaded seeing him again, but she would try anything to save her daughter's life. Two o'clock rolled around and Jim Beckett came for the test. He tried to hug Kate, but she kept her distance and just offered him a head nod. This man was a shell of the father she had grown up with.
Together they walked together towards the Lab. Kate stayed with him until the technician finished drawing blood, waiting for the results. Negative. Not even a partial match. She thanked him, called him a cab and they parted ways. She shook her head in frustration, checking her watch. Almost 3. It was already time for Aiden and Alexis to get home from school. She picked up the phone to call Martha.
"Martha Rodgers."
"Hi, Martha? I'm so sorry to bother, but I'll be late to meet the kids when they get home from school. I had to check Mackenzie back into the hospital and...she...um...she..."
Kate's voice broke and the tears rushed to her eyes.
"I can bring the children by in an hour, or is Mackenzie too sick for visitors?"
Kate smiled at Martha's thoughtfulness. "That would be wonderful."
An hour later, the Aiden and Alexis arrived with flowers and laughter. As the children gathered around Mackenzie's bed, Martha and Kate discussed the situation in the hallway. After realizing that anyone could be a donor, Martha left immediately to get tested for compatibility. When she returned, with a negative result, she assured her that Richard would want to get checked as well.
"Have you phoned him yet?"
"No, he has his lecture today. I didn't want to bother him. Besides, I know Alexis's blood type, and no one in the family could be a match. I'm afraid, my partial match is the closest we're going to get."
Kate phoned her friends, who came right over to be with her and Mackenzie. Martha offered to watch Aiden and Alexis and took them home when Lanie arrived. Kate sat in the lobby discussing the options when Dr. Clarke arrived and invited them into her office.
"Kate, I need to be honest with you. Given Mackenzie's violent allergic reaction to the majority of chemotherapy drugs, I cannot recommend their use, and the chance of success using your stem cells is minimal." She looked seriously at Kate. "If she doesn't tolerate the transplant, Mackenzie will have even less time, and will probably spend it in a great deal of pain."
Kate's heart sank. She would do anything to save her baby, but didn't want to shorten her life or hurt her. Lanie took Kate's hand and held it tightly. Turning to the doctor, she asked, "So what are the chances of success?"
Dr. Clarke smiled sadly and responded, "15% maybe. If you decide to proceed, we will do the best we can to minimize the negative impact on her body." The doctor's smile faded. "Kate, no matter what you decide, you need to consider end-of-life care."
Kate wanted to protest, to yell and scream at the doctor to not give up, but she just sat there, unable to respond. She heard Lanie ask a couple more questions and take some pamphlets from her, but didn't really comprehend what they were saying. Something inside her convinced her to listen. She knew the doctor spoke the truth and she'd seen enough of the cancer center's pediatric patients to know what to do. She nodded and couldn't hold back the tears any longer. She began to sob and the doctor reached across her desk to hold her other hand.
"Kate, give us a couple of days to check for any new donors and research other options for her. If no match can be found and you decide not to proceed with the partial match transplant, you can take her home at that time."
Kate split the next two days between the Castle family and the hospital, always making sure that her or Lanie could be with Mackenzie when she left for the loft. She tried to keep a cheerful face on for Aiden and Alexis, but inside she felt like going crazy with frustration and anger.
She had just helped Aiden and Alexis start their homework when the phone rang. She knew it was for her and she knew it was bad news from the hospital. She stood still, waiting with a sense of dread as Martha handed her the phone. Dr. Davidson called personally with the bad news.
"I'm so sorry, Kate. We couldn't find any other donors and we already know Mackenzie wouldn't survive the necessary high-dose chemotherapy and radiation due to her allergies."
She dropped her head and sighed, "So, what can we expect now?"
"At five years old, she's too young to understand death as a permanent thing. Just let her know how much everyone loves her and the positive impact she's had on everyone around her. She'll need to say goodbye."
Kate took a shaky breath. "That's it?"
"No. Also, kids this age don't necessarily voice their concerns or fears, but she will have them. Try to be sensitive to that."
"And...how much time do we have left?"
Dr. Davidson sighed, "A few weeks, maybe a month. Do you want her to stay here, or care for her at home?"
Kate struggled to answer. She successfully held back her tears long enough to say she'd talk to Mackenzie about it and said goodbye. She dropped her head as the handset slipped from her fingers.
When she turned around, Martha opened her arms to comfort her. She fell into them and she cried until she didn't have any tears left. An hour later, she went to the hospital. She talked with Mackenzie for a long time about what was happening. Mackenzie seemed to understand what they explained and was determined about spending her remaining time with the Castle family. Kate met with the Dr. Davidson and the hospice nurse about her pain medication and final visits, then took Mackenzie home.