Damon:
Feeling edgy and nervous, I can hardly sit still but I'm sure other people in the surgical waiting room want to throttle me for pacing back and forth repeatedly. I'm just so worried about him. They literally have to take his heart out of his body and until the new one is placed inside and they reconnect all of the veins and arteries, my dad is literally without a heart. It's mind boggling when you think about it. Although Finn Mikaelson is his cardiologist, he isn't a cardiac surgeon. But Finn assured us that he would be scrubbing in too and that the surgeon, Dr. Parker, is excellent in his field.
"Damon, come sit down. You're exhausted."
"Grandpa, he can't die."
Giving me a tight smile, he pulls me against his chest, embracing me in a hug. Pulling back, we make eye contact for a moment before I sit back down. By the time we arrived at the hospital, dad was immediately skirted away to do blood work and make sure he's ready for surgery. Finn explained that if his labs showed anything out of line like an elevated white blood cell count which could indicate an infection, they wouldn't be able to do the surgery. I guess someone was smiling down because he's in surgery right now. He also explained to us what we can expect from transplant surgery.
"Believe it or not, Damon, heart transplantation is a relatively simple operation for a cardiac surgeon. The procedure consists of three operations. The first is harvesting the donor heart. The donor is someone who has suffered an irreversible brain injury resulting in brain death. Often these patients have had major trauma to the head, perhaps an MVA. The victims organs other than the brain, of course, work well with the help of medications and life support which may include a respirator or other devices. A team of doctors, nurses and technicians remove the donor organs once brain death of the donor has been determined. The organs are then transported on ice to keep them alive until they can be implanted. With the heart, the time is optimally less than six hours. The organs are flown by airplane or helicopter to the awaiting recipient's hospital.
The second operation involved removing the damaged heart from the recipient. Removing the bad heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery. If there was a previous operation, cutting through the scar tissue may prolong and complicate the removal of it.
The third operation is surprisingly the easiest, the implantation of the donor heart. Today the operation basically involves the creation of five lines of stitches. The suture lines connect the large blood vessels entering and leaving the heart. Remarkably if there are no complications, most heart transplant patients are home about a week after surgery.
"But that's the best case scenario, Finn. What about complications?" I ask, my foot bouncing a rapid cadence against the floor.
"When all potential problems are considered, the results of transplantation are very good really. But you need to keep in mind that heart failure is a very serious and life threatening disease. In patients whose heart failure is severe enough to require transplantation, the one year mortality rate is eighty percent. That is the percent of patients who die within one year. Overall, the five year survival rate with any form of heart failure is less than fifty percent. After heart transplant, five year survival averages about fifty to sixty percent whereas one year survival averages eighty five to ninety percent," he says, trying to reassure me.
"But what happens afterwards, I mean, he'll have to take anti-rejection medicine right?"
"Yes, Damon, he'll have to take medication for the rest of his life. As part of our defenses to fight off infection and even cancers, our bodies have an immune system that recognizes and eliminates foreign tissues such as viruses or bacteria. Unfortunately it also attacks implanted organs. This is what happens when organs are rejected. The new organ is recognized as foreign by the body. Rejection can be controlled with powerful immunosuppressive drugs. If there is not enough immunosuppression the organ can reject acutely. Even when it seems like there is no active rejection, there may be more chronic rejection that consists of the growth of something like scar tissues, which causes blockage of the heart's blood vessels. These blockages are the process that ultimately causes the transplant to fail. It is this chronic rejection that is a major limiting factor for long term success of the heart transplant. Ultimately, though, immunosuppression is a double-edged sword. While immunosuppressive drugs block rejection, it also suppresses the immune system. Transplant patients are more susceptible to infection and even some cancers," he says, giving my shoulder a squeeze.
"What type of symptoms do we need to watch for, Finn?" Grandpa asks, raking his hand through his hair.
"Weakness, fatigue, malaise, fever and flu-like symptoms among others. If you notice any of this, you'll need to seek medical attention immediately. The surgeon will do tests to determine whether or not the heart is functioning normally. The gold standard for monitoring rejection is an endomyocardial biopsy. A piece of tissue will be extracted from the right ventricle and then it'll be sent to the pathologist who will determine if it's indeed rejection. Immunosuppressive therapy can be adjusted if increased rejection is present. But let's not worry about that now, first we need to get him through the surgery, okay?"
"Thank you, Finn for being candid with us." Nodding, he shakes both my hand and grandpa's before leaving us alone with our thoughts.
"Damon, grandpa, have you heard anything yet?" When I hear her voice, I look up, grateful that Katherine is here. Standing up, I give her a hug, burying my face in her hair for a moment till I get my bearings back. Katherine and I have had our ups and downs given that she's ten years older than I am but we were able to put all of that behind us and we're close now.
"He's still in surgery, Katherine," grandpa interrupts, giving her a hug too.
"How long has he been in surgery?"
"About two hours, I suppose."
"Any idea how long it'll take?"
"Finn said anywhere from three to ten hours," I tell her, glancing at the clock again.
"Um, do you want to get some coffee?" she asks. And by the look on her face, I can clearly see that she's just as on edge as I am.
"Let's all go downstairs for a little bit."
"But grandpa, what if they call for us while we're gone?"
"See that lady over there," he starts, pointing to the receptionist. "We'll tell her that we're just going to step outside for a few minutes and we can give her one of our cell numbers so she can call us if need be. And I want to give Lena a call anyway."
"Okay, grandpa," I finally concede. The three of us stop at the desk. After giving the clerk out information, we go downstairs to the cafeteria. It's still early in the morning but since this is a huge hospital, they do have a small selection of food available for overnights. After filling a coffee cup, I take a seat beside Katherine. She reaches out and gives my hand a squeeze when our eyes meet.
"He'll be okay, Damon. He's not ready to leave us yet."
"I hope you're right," I muse, sighing heavily.
"Did grandpa go outside?"
"Yeah, he said he'd be right back, he wanted to try to call his fiance'," she adds, smiling at me.
"It's hard to imagine grandpa as a ladies man but he sure swept Lena off of her feet. I'm happy for him, you know?"
"I am too, Damon. I should probably call home and let them know what's going on. I'll be back shortly."
"Sure," I agree, giving her a tight smile. "I'm going to go back upstairs just in case." Nodding, she goes outside in search of grandpa. After taking the time to refill my coffee cup, I get into the elevator to go back upstairs. Taking a breath, I step out as soon as it dings and hurry back to the surgical family waiting room.
"I just wanted to tell you that I'm back. I'm waiting for word on my dad, Joe Salvatore."
"I don't see a Joe, I see a Giuseppe."
"That's his real first name. He's always gone by Joe. Giuseppe is a family name."
"Oh, well hopefully you'll hear something soon."
"I do too." I give her a tight smile and then take the same chair I was in before we left. Taking a seat, I lay my head back and wait some more, barely looking up when grandpa comes back inside. Soon after Katherine comes back, she drops onto the couch beside me. After giving me a tense smile, she lays her head on my shoulder and the two of us just stare at the clock for who knows how long.
"He has to be okay, Katherine. He just has to," I whisper, dropping my face into my hands. When I feel her hand rubbing my back, I sit up and pull her into my arms, giving her a hug. We sit there for another hour or so. Realizing it could still be a few hours before we hear anything, I drop my head back and let my eyes fall closed.
Elena:
I didn't want to let go when they took him away. When Brady tried to tear me loose from him, I lashed out, striking him with my fists till I finally collapsed in his arms. Although I admit that my vision was blurry due to an endless flow of tears, I know I saw the sheet pulled up over his face. Aside from my family's death, I've never felt such deep visceral, soul-sucking pain before. Feeling completely overwhelmed, I drop onto the sidewalk, my head in my hands. When my eyes drift down, I cringe, my heart splitting in pieces all over again when I realize that my hands are still covered in his blood as are my clothes. I don't know if it'll ever wash free. Will I see his broken, bloodied body every time I look at my hands from now on?
I see no reason to follow after him. The police will tell his family what happened. Dawning on me that his creatures will need food and water, I look around till I see my bag laying in the gutter at the side of the road. After picking it up, I notice that my phone is in pieces. Shaking my head, my tears start falling anew over something so stupid in light of what's already happened but I just can't help it. Rather than pick up the pieces, I just stomp on it with my boots till it's unrecognizable. It's then that I remember all the pictures of Kol and me that are now destroyed.
"Why?" I scream aloud to no one to everyone. It's only when I hear footsteps coming towards me that I look up just as another police car arrives on the scene. The place is crawling with them now. Wanting nothing more than to get out of here, I say fuck it. Not caring who's following me, I practically break into a sprint to reach my car. Just as I reach for the door handle, I hear my name, looking up at the same time that Brady reaches me.
"I'm so, so sorry, Elena," he says, opening his arms and pulling me into a hug when my tears start to fall unbidden again.
"Why would anyone do this, Brady?" I ask, my chest heaving as the emotions slam into me full force again tonight.
"I don't think this was meant for Kol. I think it was meant for you."
"What?"
"Think about it, Elena. I just talked to Esther. Despite the state she's in, she said that he walked her outside to her car and that he was still there when she pulled away. If this was meant for him, whoever would've tried to run him down then."
"Oh my God, it's my fault that he's... But why would anyone want to kill me?" I ask, unable to comprehend anything else tonight. My head hurts so bad now that I can literally feel my pulse throbbing against my temples.
"Of course it's too early to know for sure and something else could come up but Elena, you and Damon have been investigating the Bradley cases."
"Brady, I... I... do you think this means that Amber was killed too?"
"I don't know, Elena. You and Damon haven't presented anything on your show about her, it's all been about Ben. But someone must think you two are getting too close. Again, Elena, this could be totally unrelated but my gut instinct is screaming at me that it's this case. Do you have some place where you could get lost?"
"I don't know, Brady. I can't think about anything but Kol. My mind is a blur."
"Does your family still have the lake house? It's very remote and I know for a fact that you know how to use a gun," he adds, looking at me pointedly.
"Do you really think that's necessary? You can't protect me?"
"I don't know, Elena. I'd like to think that I can trust everyone on my staff but I don't know. For now, I want you to go there and not tell anyone."
"But I have to tell my grams and Jenna. And what about Damon? Is his life in danger too?"
"I'll talk to your family and Damon. And yes, if this is indeed what I think it is, then Damon is in danger too. Do you know where he is?"
"He left the station hours ago. His father finally got a heart so he left in blur to get his dad to the hospital in Richmond," I explain, taking the handkerchief he offers to blow my nose and wipe my eyes.
"I'll need to get in touch with him. Now get out of here, Elena," he demands. He walks alongside me to my car.
"Are you safe to drive?"
"I have to be," I whisper. When I place my hand on the door handle, I see his blood again. I close my eyes as tightly as I can but I can't stop them. Brady puts his hands on my shoulders and turns me around, pulling me to his chest again. The only thing I can do to calm myself is to take several deep fortifying breathes. Finally I step back and after sharing an intense stare with him, he gives me a nod. As quickly as I can I jump behind the wheel, squealing my tires when I pull out of the parking lot and onto the street. Just before I reach the exit to get onto the highway, I remember Ulysses and Achilles. Determined not to leave them to die in his house, I look to make sure the road is clear before spinning around and pressing on the gas pedal to hurry back to his place. When I arrive, I breathe a sigh of relief that I don't see any cops around yet. After parking in a secluded spot, I grab his house key out of my purse then quickly run to his back door, unlock it and step inside. It's so eerily quiet. I hate the emptiness that suddenly pervades every cell in my body. When I see the picture of the two of us on top of his fireplace mantle, I reach for it, holding it close when I collapse to the floor in despair.
With a wispy touch, I run my fingertips over his smiling face, which soon becomes clouded when my eyes again fill with tears. Knowing that my life depends on getting myself out of Mystic Falls, I quickly slip the frame into my purse before hurrying over the cage. Using utmost caution, I carefully put Ulysses in his carrier and although I'm not a spider lover either, I somehow find the strength to put him in his carrier too. Just as I'm ready to leave, I realize that I have nothing to feed these creatures with. Rather than take them with me, I pick up Kol's land line phone. Dialing Elijah's cell phone, tears start to well up again when he doesn't answer. All I can do is leave him a message that he'll need to take care of them because no matter where Kol is, he would never ever forgive us if something happened to his beloved pets. While I wait to hear from Elijah, I put them back in their cages. As soon as Elijah replies, telling me not to worry about them, I hightail it out of Kol's place, throw myself back in my car and speed away, leaving a trail of smoke behind me.
Damon:
"Damon, wake up," I hear Katherine say at the same time she starts to jostle my arm.
"What?" I ask, slowly sitting upright. I'm really exhausted. When I look up, I see Dr. Parker and Finn walking towards us. Just before reaching us, Finn's cell rings. Raising a finger to us, he walks closer to the wall where he can have some privacy for his call. When I happen to notice the clock, it's already six thirty in the morning. It seems a lifetime ago since I picked up dad and grandpa to drive to Richmond last evening.
"How is my dad?" I blurt out before Dr. Parker even has a chance to speak.
"Your dad is doing well. He'll be in intensive care for the next couple to three days depending on his recovery. I am very pleased with the way surgery went," he explains, reassuring us. When I just happen to glance over at Finn, I can't help but notice how the color drains from his face. Without even giving us a second glance, he hurries out of the waiting room, disappearing into the elevator that's just across the hall. Figuring he must have another medical emergency, I brush it off. As soon as the doctor finishes explaining everything, he asks us to follow him to the SICU waiting room. Once we get there, we talk to the nurse. She then escorts us to his room, allowing each of us can spend a few moments with him. I squeeze his fingers and tell him I love him. Since he's sedated I can't talk to him. After brushing a kiss to his forehead and giving his hand one more squeeze, I get up to let grandpa have his turn.
Looking at my watch, I see that it's now almost eight am. Knowing that I'm in no shape to go to work tonight, I tell Katherine that I'm going to go outside to get some air and to call Elijah to tell him that I won't be in today. But then my mind drifts to Elena. Smiling when I think about that kiss, I quickly call her but there's no response at all, not even the automated tone about leaving a message. I dial again with the same result so I give up and phone Elijah. Although I try calling him repeatedly, I keep getting voicemail. Frustrated, I call the station, relieved when I hear his secretary's voice.
"Hi Agnes, it's Damon Salvatore. Is Elijah handy?"
"No, haven't you heard?" she asks, her voice thick and emotional sounding.
"Heard what?"
"It's Kol..." She goes on to tell me what happened last evening. Unable to comprehend such madness, a feeling of numbness causes me to collapse onto the bench behind me. Even though my heart is breaking for his family, I'm relieved beyond measure that 'she's' okay, at least physically. And then It dawns on me that Elena must be beside herself with grief. Although I want nothing more than to go to her right now, I know that I need to tell my family where I'm going. By the time I get back to the ICU, grandpa has an uneasy look on his face too. Looking around, I don't see Katherine so I realize that she must still be with dad.
"You know?"
"I just talked to Lena."
"Grandpa, I need to go to Elena. Please keep me up to speed on dad. I know he'll understand."
"Of course he will. I'll tell Lena that you're on your way." Nodding I give him a one armed hug. "Tell Katherine where I went, okay?"
"Yes, go now," he tells me. Without wasting another second, I hurry to the elevator, jumping in as soon as the doors slide open. Once I get to my car, I too stunned to even begin to know what to say to her. Just by observing Elena with Kol, their connection is undeniable. Taking a breath, I'm just about to start the ignition when I feel my phone vibrating in my pocket. Pulling it out, I look to see who it is then click it on.
"Hello?"
"Damon?"
"Yeah, Brady, it's me. I just heard about Kol. I'm on my way back to town."
"No Damon," he says firmly before continuing, "Do you know where the Gilbert lake house is?"
"I think so. Why?"
"Because I believe Elena was the real target last night. Kol shoved her out of the way and that's how he was hit."
"Why would anyone want to harm Elena?"
"My theory is that it has to do with the Bradley cases which means you're potentially in danger too. Go to the lake house. I'll get away as soon as I can to drive up there to talk to you both. Don't go back to the station."
"Elena must be reeling?"
"She is, Damon. She is. There's safety in numbers so go to her. I'm going to hang up now."
Hearing the dial tone, I click off my phone and toss it onto the passenger seat. Stopping only to fill my gas tank, I also purchase an energy drink and a diet Coke when I pay the bill. As soon as I buckle my seatbelt, I begin the drive into the back woods of Virginia.
Thank you so much, Eva. Love you very, very much.
And thank you to all of you for your reviews. They really mean a lot to me.
Chapter title: 'Dream On' by Aerosmith.
I just posted the final chapter of 'Nothing Left to Fear'. 'The Game of Life' was updated yesterday.
Please let me know what you think.
Be safe, be aware and have an awesome weekend.
