by K. S. Ruff
“No,” was so tangled around my heart it came out sounding strangled.
Rafael looked at me. “Hospice? What is hospice?”
“Hospice is taking her home to die.” I stared at Dr. Graham accusingly.
Rafael’s jaw clenched. “I want to speak with the nephrologist and the gastroenterologist. Now.” The tension rolling off his body raised the hair on my arms.
The neonatologist bolted from the room.
Within minutes we were seated inside a private counseling room. I insisted my parents; Father McHugh; Faddwa, our favorite NICU nurse; Brady; Jase; Kadyn; and Shae join us. I wanted them to hear the prognosis and our treatment options first hand. I didn’t want to repeat any of this. Ever.
Dr. Graham began by summarizing his concerns. I tried not to hear my mother and Shae crying when he encouraged us toward hospice. He made his case a bit more vehemently than before. There was an awkward silence after he spoke.
Rafael looked at the nephrologist. “At what point do you recommend dialysis?”
She leaned forward in her chair. “We recommend dialysis when the creatinine hits two point zero for infants. We need a day or two to secure a surgeon and an operating room and a few days after the dialysis catheter is placed to begin peritoneal dialysis. So dialysis would not begin until four or five days after that decision is made.”
Rafael shifted his attention to the gastroenterologist. “We started phototherapy three days ago. Do you typically see improvement in the bilirubin within that amount of time?”
“Not necessarily.” She shifted uncomfortably. “Gabriella has only been exposed to conventional phototherapy. I’d like to see how she responds to intensive phototherapy before drawing any conclusions about her liver.”
Rafael and I exchanged glances. “You don’t recommend transfusion?”
She shook her head. “No. That’s an option of last resort, and I don’t think we’re quite there yet.”
I slowly released the breath I was holding. “Do you share Dr. Graham’s concerns about brain damage?”
Her cheeks heated. “No. I think we can turn the bilirubin around before it reaches that point. She’s keeping her food down; her muscle tone and startle reflex are fine. I’m not seeing any evidence of Kernicterus.” Her eyes slid toward the neonatologist. “You should request a neurology consult if you’re concerned about brain damage.”
He nodded. Once.
The gastroenterologist looked at me. “Livers are very resilient organs. They can take a huge hit and recover, but they are slow to recover. Intensive phototherapy is very effective. Even if that doesn’t work, your daughter still has options. She just needs time.”
Hope, I thought. She’s offering us hope. My throat clogged with tears.
Rafael sandwiched my ice cold hands between his. “Dr. Graham, do you have any children of your own?”
“No,” he grumbled.
Rafael looked at the nephrologist. “Do you?”
She smiled. “Two girls.”
“What would you do if this was your daughter?” he asked.
The room fell silent.
She took a deep breath and blew it out. “I’d start dialysis.”
Rafael turned to the gastroenterologist. “And you?”
Her eyes grew fierce. “My son is six months old. I’d demand every possible intervention. I’d fight to save his life.”
Rafael pulled me close. “Then we fight. We’d like to start intensive phototherapy as soon as possible. We won’t pursue dialysis unless her creatinine hits two point zero.”
We remained seated while the physicians cleared out. Father McHugh encouraged us to join hands as we began to pray.
* * * * *
Rafael dropped onto one knee. His lips met mine in a surprisingly passionate kiss when he crawled onto the blanket. “You look beautiful this morning.”
I stared at him, stunned. I’d been so focused on Gabriella, I’d forgotten what it felt like to be… us.
He reached for the thermos of coffee. “Thanks for bringing breakfast.”
I’d purchased nearly every pastry La Madeleine had to offer, packed a thermos of coffee, two mugs, our picnic blanket, and Bosco so we could eat outside. The cafeteria was wearing on me. The whole hospital was, really. “How’s Gabriella? Any news on her labs?”
Rafael handed me a mug of coffee. “Her bilirubin dropped, but the creatinine inched up. She’s at one point nine now.”
I wondered how it was possible to feel both fear and relief at the exact same time. I blew the steam off the coffee before taking a tentative sip. “I’m glad her liver is doing better.”
Rafael bit into a ham and cheese croissant. “The neurologist will be evaluating her today. Do you want me to stay?” He handed Bosco a piece of ham.
Bosco swallowed the morsel whole. He sat perfectly still while waiting for another piece.
I chuckled softly. Bosco was watching Rafael so intently. “You should go home and get some sleep. Brady’s bringing my parents by. I’ll make sure one of them is with me when the neurologist arrives.”
“The neonatologist wants to schedule the surgery to place the dialysis catheter,” he revealed tiredly.
My heart began to ache. “I want to hold her before she goes through surgery. I want Gabriella to know she’s loved. She deserves something good, something comforting and kind, before enduring any more painful experiences.”
He handed Bosco another piece of ham. “Faddwa is working today. She would be the most likely to consent. Will you text me if she approves? I’ll come back to the hospital so I can hold her too.”
I picked at a chocolate filled croissant. “Of course. We should be together for that.”
We watched a yellow medevac helicopter land on top of the hospital. Rafael sipped his coffee, thoughtfully. “I’ve been meaning to ask you…”
My eyes met his.
He continued cautiously. “You mentioned something about Michael when you were wheeled out of recovery. Do you remember?”
“I remember.” I stared at the palm of my hands. I could still feel the crosses the priest had drawn.
“Why were you talking about Michael?” he whispered.
I shook my head. “I don’t know how to explain this when I can barely comprehend it myself.”
“Try,” he encouraged softly.
“You’ll never believe me.” I sighed.
He lifted my chin so I was forced to look at him. “I promise you, I will.”
My heart clenched. “I saw Michael and Genevieve when I was in surgery.”
Rafael paled.
I took a deep breath and slowly released it. “I asked him if we were dead. He said, ‘Love never dies.’”
Rafael swallowed. Hard.
I picked at a blade of grass. “Michael said I had to go back, that God wasn’t finished with me yet. He said not to be scared. He wanted me to be happy. He said, ‘Take care of my brother and our girl.’ I was confused because I thought he was talking about Genevieve. But now I know. He was talking about Gabriella.”
My eyes widened when I saw Rafael was crying. I crawled onto his lap.
He clung to me while he rocked. “I believe you,” he sobbed again and again.
* * * * *
I rested my head on Rafael’s lap, hoping to catch a nap. The nurse shift change was nearing an end. I was planning to stay the night since Gabriella was scheduled for surgery first thing in the morning. In less than twelve hours, some stranger would be cutting into our child. I kept having to remind myself that this was a life-saving intervention. Operating on a child who weighed less than two pounds felt so wrong. I closed my eyes with a ragged sigh.
“Kristine?”
“Maxim?” I bolted upright. My stitches pulled. My face sheeted white.
Maxim fell to his knees. “Oni told me what happened. I came as quickly as I could.”
I stared, dumbfounded, before bursting into tears.
Maxim pulled me into his arms. He whispered soot
hingly in Russian while I cried.
I brushed my tears aside with a deep, shuddering breath. “I’m sorry. I got your suit wet.”
He shook his head. “It is only a suit.”
A smile teased my lips. “I can’t believe you came.”
“I wish you would have called me. I did not like hearing this news from Oni.” He looked at Rafael. “Is it true she nearly died?”
Rafael nodded. “Her heart stopped, but it began beating on its own a few seconds later.”
I stilled. “I thought you said Gabriella’s heart was strong?”
Rafael glanced at me in surprise. “Gabriella’s heart is strong. It was your heart that stopped.”
My jaw dropped.
He frowned. “You don’t remember?”
“How could she possibly remember? She was on Morphine and magnesium sulfate when Dr. Meinig told her.” Jase set a large paper bag on the coffee table. He was treating us to dinner tonight.
Rafael’s voice gentled. “Your heart stopped beating shortly after they began the C-section. You were in shock from the blood loss. That’s why you received the blood transfusion.”
“I received a blood transfusion?” You would think I’d remember this conversation. “Did they have to use a defibrillator?”
Rafael shook his head. “Your heart resumed beating on its own.”
“You should have called me.” Maxim glowered at Rafael.
“How did Oni know?” I reclaimed the chair next to Rafael.
“Shae told her.” Maxim eased into the chair next to me. “How’s your daughter?”
When I couldn’t answer, Rafael answered for me. “Gabriella’s kidneys are failing. She’s scheduled for surgery first thing in the morning so they can place a dialysis catheter.”
Maxim’s jaw clenched.
I slid my hand in his. “Would you like to meet her?”
He stared at me, speechless.
“Do you mind?” I asked Rafael.
He patted my leg, reassuringly. “Maxim came all the way from Ukraine. He should meet her.”
I led Maxim to the window where we had to check in. “We’d like to see Gabriella Garcia.”
The receptionist’s eyes narrowed. “Another brother, Mrs. Garcia?”
I shook my head. “This is Maxim Markov. He’s the president of Ukraine and a very dear friend of mine. He’s flown a considerable distance and will only be here a short time.”
Her jaw dropped. She promptly snapped it shut. “He has to scrub up, just like everyone else.”
Maxim removed his suit jacket. He set it next to Rafael before joining me at the sink. He removed his cufflinks, rolled up his shirt sleeves, and followed my lead.
The doors clicked open. I stopped at the metal shelf. I handed Maxim a gown before pulling one over my arms.
He tugged the gown over his dress shirt while we walked to NICU room two. He stopped abruptly when he saw the Isolettes. “Kristine,” he pleaded brokenly. He closed his eyes against the image.
“She’s over here,” I whispered soothingly. I knew how difficult it was to see all those babies fighting for their lives.
His eyes widened when we neared her Isolette. “She’s no bigger than my hand.”
I opened the little round door. Gabriella squirmed when I rested my hand on her chest. “Would you like to hold her hand?”
Maxim’s eyes glistened with unshed tears. He moved to the other side of the Isolette, opened the door, and offered her his pinky finger. His breath caught when Gabriella grasped his finger.
He inventoried every patch, tube, bandage, and wire while I tried to wish the jaundice away. Thank God her liver was doing better.
Maxim’s hand covered mine so Gabriella’s chest rose and fell against both our hands. “Will you pray with me?”
“Yes.” Every thought, every breath was a prayer these days. We joined hands over the top of the Isolette.
“Ancient of Days, Father Most High, this is yet another thing I cannot endure without you. Gabriella is your child. Guide her parents and physicians. Allow them to feel your presence. Heal Gabriella’s kidneys; ease her pain and suffering. You alone can heal this child. You are our strength, our Savior, our hope. I pray this in the name of the Father, the Son, and the Holy Ghost.”
Together we whispered, “Amen.”
One of the night nurses approached the Isolette. “Faddwa told me you asked to hold Gabriella before her surgery. She was worried the neonatologist would intervene earlier today. He’s not working this evening, and things are much quieter now. Would you like to hold her?”
“Yes, please.” I choked back tears.
Frustration rolled through Maxim’s eyes. “They wouldn’t allow you to hold your child?”
I shook my head. “This will be the first time.”
Gently, he caressed Gabriella’s head. “I’ll retrieve Rafael. He should be here when you hold his child.” He kissed me on the forehead. “I’m going to check into my hotel, but I’ll return in the morning. What time is her surgery?”
“Seven o’clock.” I cringed. “I don’t know if the hospital will allow visitors at that hour.”
Maxim’s fists clenched. “Trust me. They will allow it.”
I grabbed his arm as he turned to go. “About the wedding.”
His eyes darkened.
I stepped back, warily. “Were you there?”
He frowned. “Of course I was there. Surely, you found the matryoshka dolls?”
My voice softened. “Why didn’t you sit where I could see you, speak to us, or stay for the reception?”
He stepped closer. “As painful as that moment was, it was important for me to see. I wanted you to know I respect your decision, but I did not wish to ruin your day.”
A tear stole silently down my cheek.
Maxim pulled me close. “I meant what I said in Ukraine. I will wait… as long as it takes.” He stole my tear with his thumb, pressed a kiss to my cheek, and walked away.
* * * * *
I stared at the nurse in disbelief.
“Cancelled?” Rafael repeated incredulously. “Her surgery has been cancelled?”
She nodded. “The nephrologist cancelled the surgery when she saw Gabriella’s lab results.” The phlebotomist drew Gabriella’s blood earlier this morning in advance of the surgery.
“What were the results?” I inquired breathlessly.
She flipped through a couple of pages on her clipboard. “Her creatinine dropped to one point six, and her BUN is at thirty-three. Her kidneys and liver are improving.”
“Thank God.” Rafael pulled me into his arms.
Gently, she patted my arm. “We’ll remove her arterial line if those numbers continue to improve. Your friends will be allowed to see her, and you’ll be able to hold her as often as you like once that line is removed.”
I relinquished all of the fear and all of the tears that had accumulated over night.
Rafael held me while I cried. “The nurse shift change is about to begin. Let’s grab some breakfast and call your parents.” We walked out of the NICU arm in arm.
My eyes widened when I saw everyone sitting in the waiting room. My eyes slid toward Maxim. He looked smug. “You managed to get them all in before visiting hours?”
He nodded. Once.
Rafael eyed our family and friends. “Gabriella’s blood was drawn early this morning. Her liver and her kidneys are improving. She doesn’t need surgery.”
Their cheers echoed down the hall.
* * * * *
Time moves like molasses when you’re living in fear. With faith and hope, time moves surprisingly fast. Our NICU days poured into weeks, then months. We celebrated every accomplishment… the day the arterial line was removed, the night the feeding tube was removed, the day the phototherapy was discontinued, and the day Gabriella graduated to the “feed and grow room.”
Gabriella spent very little time in her Isolette once that arterial line was removed. Our friends proved anxious to cud
dle with her. Our nurses wrestled her away a time or two, just so they could hold her. Cenia and Shae threw a baby shower at the hospital when Gabriella was transferred to the “feed and grow room.”
Our daughter was in the NICU for ten weeks. She weighed a whopping four pounds the day we drove her home. My parents surprised us by purchasing an elegant white crib, a blue rocker recliner, and a beautiful chest of drawers. Magically, our Santorini room was transformed into a whimsical nursery.
Gabriella thrived. She ate well, cooed, and giggled, all the while wrapping us around her little finger. My parents returned home. Lexie entered the fray and quickly won Gabriella’s affections. Benjamim, Eva, Chief D’Souza, and Mariana spent a week with us. Brady, Jase, Kadyn, Oni, and Shae continued jockeying for our guest rooms.
I felt happy… blessed… content. So content, I was hesitant to climb out of bed. Rafael was wrapped around me, radiating heat and strength. The cedar and cloves from his cologne was coaxing me back to sleep. The house was still and dark. Still, Gabriella had conditioned me to wake every three hours. I didn’t mind. This, too, was a blessing; the fact that I could nurse my child. Gabriella called to me without making a sound.
I eased out from beneath Rafael’s arm, pressed a kiss against his prickly cheek, and slid from bed. Quietly, I tiptoed to Gabriella’s room. Jase was sprawled out, dozing in the recliner next to her crib. She lie nestled against his chest. I thanked God for him before pressing a kiss to her head.
I admired my daughter’s perky nose, her little bow lips, tousled hair, and the long eyelashes that dusted her soft pink cheeks. I’d been praying every day… praying that life wouldn’t break her the way it had broken me… but I knew, as surely as God was resting his hand on my shoulder and peering down at her too, that she’d never be broken and alone. She’d be broken together until the day he called her home.
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