“Good morning,” Nate called softly, knocking on the door to Lauren Ellison’s room. She’d been moved from Cardiac Care to ICU where her, now very compromised immune system, could be protected. He washed his hands and put on a surgical mask to shield her from any germs and stepped into the room. Lauren was sleeping fitfully so he moved as quietly as he could. He pressed the bell and diaphragm of his stethoscope between his gloved hands in an effort to remove the chill before peeling Lauren’s PJ’s aside to have a listen. The child wheezed softly and her little eyes fluttered. She was sullen and weak. Her skin was scaly and she had little sores on her mouth and burns on her body from the treatments she was going through. His heart broke a little. He was losing; something he didn’t accept very well and, right or wrong, he had become attached to his young patient.
Lauren wheezed again and coughed this time fluttering her eyes opened and offering Nate a sweet, though very weak smile. “Hi, Dr. Nate.” she croaked, sleepily
“Hey,” he smiled back. With all that she had been through in her short life, the surgeries, the meds that made her feel worse, the radiation that caused her pain, not to mention the hundreds of times she’d been stuck with needles and IVs, Lauren Ellison had remained sweet. It made Nate feel that much more desperate for a solution. She was a baby and deserved a chance to be a kid; to learn how to roller skate or ride a bike or for that matter to know what it was like to fall off a bike or skin her knees… normal kid stuff. Lauren’s normal from the time she had been 2 years old had been hospital rooms, tubes shoved in her arms and up her nose, and him. She’d spent more time with him then she had with members of her own family.
“Morning,” Penny called cheerfully as she entered the room, coffee in one hand and a danish in the other. She smiled and struggled to sound upbeat but Nate could see that she had been crying.
“Good morning,” he answered, sympathetically. and turned his attention back to Lauren. “One more treatment, kiddo. You ready?”
“And then I get to feel better?” Lauren asked, her blue eyes looking up at him hopefully. Over the past nine weeks, he’d subjected her to steroid treatments and some pretty aggressive radiation in an attempt to stop her immune system from attacking her transplanted heart. After today they’d begin to see if it would work.
“I hope so,” he nodded.
“She’s getting sicker,” Penny complained.
“It’s hard to watch, I know.” Nate agreed. “But, this was our best shot. It’s almost over.”
“So after today, then what?” Penny asked.
Nate patted Lauren’s leg. “After today, kiddo, it’s all up to you. No more radiation, no more needles for a little while, and no medicine at all.”
“Really?” Lauren grinned. “So all the white blood thingys are dead?”
Nate laughed, “No, not exactly. They’re called white blood cells and they aren’t bad. Your body makes them when you’re sick but because your new heart was, well, new, your white blood cells didn’t think it belonged inside your body. And the only way to make them stop attacking…” He made a stabbing motion with his pen causing Lauren to laugh, “was to make them really sick too.”
“That’s why you don’t feel well a lot of the time,” Penny chimed. “Because they can’t fight other germs either ”
“Are they really white, Dr. Nate?”
“Yeah, they kinda are.” She was so cute.
“And they’re good?”
“They are good. You need them…usually.”
“But,” she scrunched her tiny face, “if they come back, will they try to hurt my new heart again?”
“No,” he sighed. How did he explain this? “It’s like… you know how I’m really good at checkers and I beat you most of the time?”
She rolled her eyes at him.
“It’s like that. Like I almost beat you at checkers but instead, we flipped all the checkers off the board and started over. After today, it’s like a whole new game. Your white blood cells are not very strong and your heart isn’t very strong but they will get stronger together instead of fighting.
“So we both win!,” she nodded in understanding.
“Let’s hope,” he breathed softly. “Do you have any other questions?” The question was for both of them but he made sure he directed it right at Lauren.
“Can we talk outside?” Penny asked, somberly.
“No!,” Lauren surprised them both the power of her little voice, considering the small amount of energy she had. “Outside is where you talk about stuff you don’t want me to know about. And where Mommy goes to cry.”
A look passed between Dr. Dorough and Penny. She nodded her head sadly and sat on the edge of her daughter’s bed. Nate pulled up a stool and looked the child eye to eye.
“Your mommy cries because she worries that this won’t work. And sometimes it’s really hard. It’s her job to worry and it’s my job to do everything I can to make this work. And you…you have a job too, and that’s to stay positive and believe that you’ll get better. We talk about things outside so you can do that.”
Penny sighed in relief. In the years that they’d known him, Dr. Dorough had always found a way to explain things in a way that they could both understand. Sometimes, like right now, she was sure he pulled it out of his ass but it worked all the same. They were nearing the end, she could feel it and whether that meant that her daughter lived or not, she’d try to remember to be grateful for him.
Penny met Dr. Dorough out in the hallway and followed him to a quiet room, a lounge area of sorts, with vending machines and a few couches and chairs. He sat first, running his hands through his hair.
“It’s alright,” Penny assured him.
“That’s my line,” he smiled at her, his eyes moistening. He quickly blinked, shaking it off. “and, I’m being unprofessional.”
“We’ve known each other a long time, Dr. Dorough. I know we’re at the end. I need you to tell me what to do.”
“Not the end. Not…”
She interrupted him. “Please don’t tell me things that aren’t true.”
“I won’t, Penny. I’m not allowed and the truth is, I care way too much to lie to you.” he began. “Do you trust me?”
“More than most people,” she promised. “But she’s hurting and I don’t know how much more either of us can take.”
“I know. Listen, I walk a very thin line sometimes but there is a difference between hurt and harm. I took an oath to do no harm and I have to constantly monitor to make sure I stay on this side of that line. I’m not done. I’m asking you to hang in here with me.”
“Okay,” she nodded.
“You have to right to tell me when enough is enough. And I will back you on it. We’re at that place but you have my word that I will tell you when I can’t do anything more.”
“Level with me then. You’re out of ideas, aren’t you?”
“I’m not out of ideas. We’re out of time, Penny. We’ll know in the next days and weeks if what we’ve done worked. If it doesn’t, it still bought us a little more time and another heart could show up when we need it.”
“If that doesn’t happen?”
“That’s when we start having ‘end of life’ discussions. But she needs you, as hard as it is, to stay positive. If the time comes to let go, you’ll know it. You’ll hate it but you’ll know. We aren’t there so please, don’t give up hope.”
“Alright,” she stood and cracked her neck. “Better get my game face on.”
“I’ll see you both in a little while,” he promised.