The car ride to the hospital was the slowest and fastest car ride of Kate's life. The dark highway was a blur of dim light as they sped from East Hampton to the closest medical center that Rick knew would be equipped to handle their emergency. Stony Brook Southampton Hospital would have typically been a 20 minute drive but Rick did it in 12, still cautious of fellow drivers, but otherwise driving as fast as he possibly could. When they arrived at the emergency room, Rick pulled the car up to the entrance, shoved the car into park, and scooped Ruby up from the back seat. Kate hadn't even registered that they were at the hospital by the time Rick was inside and pleading the triage staff for help. Ruby was floating in and out of consciousness from the amount blood she'd lost, her hands freezing cold as Kate held onto one as the nursing staff rushed her to a trauma suite.
Then came the barrage of questions. Still in a fog, Rick and Kate did their best to answer them, but if you'd ask them what they'd answered 20 minutes from now, they'd have no idea. Almost as quickly as they'd arrived in the trauma room, the doctor that had been paged to the ER had made the decision that Ruby needed immediate surgery to find the source of the bleeding. Rick and Kate consented, and within seconds they were alone together.
"Kate..." Rick croaks through his tears. They wordlessly and without hesitation grab hold of the other's hand, tears blurring their vision. Rick sniffs back the waterfall and rubs his eyes. He looks down at Kate's body and is utterly mortified. "Kate...your shirt," is all he can muster.
Kate looks down and nearly gasps. It's soaked, with tears and drops of blood, rendering the silky pajamas unwearable. She lingers on the sight for a moment, and then suddenly rushes to the sink in the corner of the room, hit with a wave of nausea. "Oh, god," she groans as dinner and dessert expel into the sink. Castle follows closely behind her, a comforting hand on her back and the other holding her hair away from her face.
The nurse that had met them at the emergency room entrance walks into the trauma suite and hands Kate a clean towel to clean up with. "Are you...are you okay? If you're sick, it would be good to let your daughter's doctors know..."
"No, I'm...I'm okay," Kate insists as she takes the towel.
"She's pregnant," Rick explains. "And we're both a bit...overwhelmed." He makes a gesture to Kate's blood spattered top.
"Completely understandable," the nurse says with a sympathetic smile. "Why don't I grab you some juice and I can take you to a quiet waiting room upstairs."
"That would be nice," Rick says, helping Kate back to her seat.
"I'll see what I can do about the top, too," she says as she leaves the room. When she returns with a bottle of cranberry cocktail and a scrub top in her hand, the nurse announces to Rick and Kate, "I'm Jessie, by the way. I'm very sorry that we're meeting like this."
Kate quickly changes out of the pajama top into the loose fitting, purple scrub top and they follow the nurse to the waiting room. "A doctor from your daughter's surgical team will be here to update you shortly. Is there anything else I can grab for you?"
"No, no, uh, thank you, Jessie," Rick nods. The nurse leaves and the couple is left alone in the silent, sterile, hospital waiting room.
"I should probably call Alexis...my mom, your dad, let them know what's going on," Rick sighs as he pulls out his cell phone. "Lanie and the boys too?"
"Rick, let's just...let's wait," Kate urges her husband not to stand up from the couch they were sharing. "Wait until we know more."
Rick sighs. "Okay," he says. "I just...don't want to feel like I'm doing nothing."
"You're not doing nothing," Kate says, tightening her grip on his arm. "You're being here for your family when we need you."
He reaches up to grab Kate's hand and pulls her closer into his side. "She's going to be okay," he insists.
"She has to be," Kate agrees. She closes her eyes and tries to relax while they wait for an update.
"Ruby's parents?" A young doctor still dressed in surgery scrubs asks from the entrance of the small waiting room. The arrival shakes Kate and Rick from their fatigue and feel the rush of adrenaline take over their bodies. They stand up to meet the doctor with hopeful eyes.
"I'm Dr. Anderson," she says. "I am here to talk you through what we know so far and to ask you a few family history questions that would be helpful."
"Ruby's adopted, so we only know a little bit about her family history," Kate says. "But we know a lot about her own medical history."
"Great," says the doctor. "Well, right now, the surgeons are repairing a perforation in Ruby's stomach lining, which was the source of her bleeding. After that repair is completed, they are going to explore the abdomen for any other signs of organ damage. Since the procedure is exploratory, it's hard to estimate how long it will take, but I'll continue to update you if any other concerns come up."
"A perforation? What could have caused that?" Rick asks.
"Oh, a number of things. It's not uncommon for body tissues to become thinner or more fragile in cancer patients. It's actually a fairly common adverse effect of the medications they're prescribed."
"Ruby's in remission," Rick says. "Has been for about a year now. She takes two daily medications to help prevent recurrence."
"Was Ruby complaining of any other symptoms before she started throwing up blood?"
"She had a headache," Kate sighs. "I gave her ibuprofen before bed, but before she started getting sick she told me it was pounding, that she felt cold even though she was sweating, and that she was feeling dizzy."
"Okay, that's very helpful, thank you," says Doctor Anderson. "We were able to pull her file from her doctor in the city, so that answered a bunch of our other questions. It looks like her last scan was 6 months ago. Is that the case, or did she have one more recently?"
"No, that's the most recent one. She visited her oncologist a few weeks ago to change back to her normal medications after they'd been changed by another doctor for a few months. She's supposed to be getting another scan next week," Kate explains.
"Could this be...is her cancer back?" Rick asks.
"As you know, it's certainly possible, but we don't have reason to believe that right now. I'm going to get back to the operating room and I'll be back with another update soon," Dr. Anderson says.
Dr. Anderson returned a lot sooner than they were expecting, which Rick seemed very happy about, but Kate's skepticism told her that was not a good sign.
"We successfully repaired the perforation in Ruby's stomach lining," she tells them right away.
"That's great news," Rick says. "When can we see her?"
"Um, she's still in surgery," says the doctor. "While exploring Ruby's abdomen, we discovered several masses in her liver and small bowel. I'm here to ask for your consent to remove the masses and biopsy then so that we can see what we might be working with."
"So, her...her cancer is back," Kate gulps. Rick's hand instinctively reaches for hers and he squeezes hers three times.
"It's likely, given Ruby's history, but the biopsy will let us know for sure," Dr. Anderson explains.
"It's already been a couple of hours, can she stay under anesthesia for that long?" Rick asks.
"We expect the excision will take another one to two hours, which is still a safe range to be under anesthesia," says the doctor. "If at any time we believe that it's not safe for Ruby to continue, we will close her up and allow her body to rest."
"Okay, okay, uh, do it," Kate says, glancing over to Rick who nods in agreement. She scribbles her signature on the consent form and watches the doctor head back to the operating room.
"Castle..."
"I know, Kate, I know," Rick sighs. "She's strong. She's a fighter. She can beat this again."
"Um, I think...since we're going to be here for a while, that Ruby would probably like to have some of her things here when she wakes up," Kate says. "Could you...could you go home and get her phone and a few books for her? If you're not too tired.."
"No, yeah, that's a good idea," Rick agrees. "I'll, uh, I'll make those calls from the road. Now that we know a little more."
"Okay," Kate says. "Could you...grab my anti-nausea pills for me? And different clothes?"
"Of course. Anything else?" Rick asks. Kate shrugs as she takes a seat back on the couch. "Okay, then, I should be back in an hour or so. I love you."
"Mhmm," Kate mumbles as she closes her eyes and turns her head into the couch cushion.
As Rick arrives at the emergency room exit, Rick fishes for his keys and his phone. When he looks up, he realizes his car was still parked in the spot that he left it when they'd arrived, which wasn't really a parking spot. Before pulling open the driver side door, he breathes in the late night, crisp spring air. The smell of the salty ocean tickles his nose as he lets out a cathartic sigh. As he looks down at his car, he can't help but notice that crime scene in the back seat. He gasps as he digests what he sees.
Blood, splattered on the seats, spilling out of the bedroom trash can and staining the floor.
Blood.
So much blood.