Missing Parts

by Lucinda Berry

  “Meet me at Cedars Sinai! Now!”

  “What–I don’t–what’s going on?”

  “It’s Rori. I can’t wake her up.”

  My head swirled, threatening to roll off my neck. “What do you mean? You can’t wake her up?”

  “I. CAN’T. WAKE. HER.UP.”

  It didn’t make sense. What was he talking about? He couldn’t wake her up?

  “Is she going to be okay?”

  “Dammit, Celeste. I have no idea what the fuck is going on. She threw up two more times and then fell asleep. I didn’t really think it was that big of a deal like she was just sleeping because she was sick. She slept for two hours so I thought maybe I’d try to see if I could get her to drink a sip of water. You know, give her fluids or something. But she wouldn’t wake up. Not at all. She didn’t even move. She still hasn’t moved. Not even when the paramedics got here.” His voice was shaking.

  “It’s going to be okay. I’m sure it is. I’m on my way. I’ll meet you there.”

  I grabbed my purse and ran for the elevator. I didn’t bother to talk to anyone or tell them where I was going. I tapped the down button as if the more times I hit it, the quicker it would arrive. My stomach was in my throat. Finally, it arrived and I chewed my fingernails as it brought me to the parking garage. The hospital was only a few miles away. I considered putting my hazards on and blowing through the red lights, but it was too dangerous and we didn’t need both of us to end up in the hospital. I arrived at the hospital and pulled into the emergency room drop off. I jumped out of the car not caring if it was in the wrong spot and got towed.

  I sprinted through the door and almost ran into a tall homeless man stumbling out the doorway. My eyes searched for David and Rori as I ran to the nurse behind the glass cubicle who checked in people as they entered.

  “Please, you’ve got to help me. My daughter is sick. She came in by ambulance with my husband. Please, I’ve got to find them. You have to help me.”

  “Ma’am, slow down–”

  “But please, please, help me.” My heart was pounding in my chest. My throat was so dry I couldn’t swallow.

  “Ma’am, I understand. I do. But, I need to know her name. I can’t help you unless I know her name,” she said.

  “It’s Aurora. Aurora Reynolds.”

  The nurse looked down at her computer and began typing. I sent David a text letting him know I was there.

  “Found her. She’s in 3C.” She pointed toward one of the hallways on the left leading out of the waiting room. “Follow it around the corner until you get to the T at the end. Make a right and you’ll see the beds.”

  I held myself back from running down the hallway and worked on assuring myself that David had to be overreacting. Unlike David, Rori was a deep sleeper and could be hard to wake up. She was probably sleeping so deeply because she was sick. Hopefully, she was awake by now.

  By the time I reached the corner, I’d calmed my heart and my breathing was starting to return to normal. When I rounded the corner, I ran into a bustling nurses’ station with nurses, doctors, and emergency personnel rushing everywhere. No one was still. Patients were being wheeled in and out. Loud cries and moans were coming from behind one of the blue curtains. I walked up to the desk and interrupted a man in a white coat who was flipping through files.

  “Excuse me. I’m looking for my daughter. She’s in 3C.”

  He gestured across from us without looking up. I turned around and took a deep breath before pulling the curtain back. Rori looked so small. Her body only covered half the hospital bed. She was lying on her back still dressed in her Dora pajamas from the night before. Her eyes were closed, but she didn’t look like she was sick or in any distress. She looked like she was sleeping and would open her eyes to smile up at us at any moment. David stood next to the bed, running his hand through her dark hair over and over again. The air in the room was still as if none of the frantic energy going on outside the curtain was happening. I moved to stand next to David and put my arm around him. He turned to look at me.

  He looked horrible. All the color had gone out of his face. His eyes were wide and his hair was sticking up from running his hands through it like he did every time he got nervous.

  “Has she woken up?” I asked.

  “Yes. Thank God. When they put the IV in her. They said it was a good sign. She’s opened her eyes and mumbled something since then. She’s kinda acting like she has a fever even though she doesn’t. She hasn’t run a temp all morning. I’ve been checking.”

  I leaned over next to her and kissed her on the cheek. “Hi, honey. Mommy’s here,” I said softly. I kissed her again. Her eyes stayed closed. I caressed her arm and noticed her other arm was taped up in a splint like it was broken. The needle from her IV went into her arm and there was white tape wound around it with a flat board underneath it. “Why’s her arm like that?”

  “I guess they do it to all the little kids. It keeps them from pulling the IV out because they move so much.”

  “What’d the doctor say?”

  “No one has even been in here to see her yet. It’s just been nurses. They took a bunch of blood while they were putting her IV in. They’re going to run some tests on it. Oh, and if she has to go to the bathroom, we have to have collect her urine.” He pointed to a sealed plastic specimen container on the small white counter next to her bed.

  “Did they say when she’ll see a doctor?”

  He shook his head. “This is ridiculous. She needs to see a doctor. Like now. We need to know what the hell is going on.”

  I squeezed his shoulder. “I’m sure it’s fine.”

  “Fine? She’s laid out in the emergency room. She’s not fine.” He jerked his arm away.

  “Kids get sick all the time. I’m sure she has some nasty flu. Everyone who gets sick this year gets really sick. Even adults. I think it has something to do with the flu shot. I swear. I really do.”

  He didn’t bother to respond. He just kept staring at her.

  “I can’t stand this. I’m going to find someone.”

  “David, just–”

  He wasn’t listening anyway. He was already on the other side of the curtain. My gaze returned to Rori. She was going to be okay. She had to be. I stared at her chest, watching it move up and down in a rhythmic motion. It wasn’t long before David returned looking dejected.

  “They said they’ll send someone in soon.”

  We stood next to her bed in silence, listening to the beep and hum of the machines hooked up to her body.

  “Should we try to wake her up?” I asked.

  “The nurses said we should let her sleep. She’s probably fighting off some infection and her body needs sleep.”

  I hadn’t thought about an infection. Maybe she had another bad bladder infection. It wouldn’t explain why she threw up, but maybe it was why she was so tired and having a hard time waking up. It was a few more minutes before a man pushed through the curtain behind me.

  “I’m Dr. Yang,” he said.

  He was a short man with carefully cropped hair and a white collared shirt half haphazardly tucked into his pants. He stuck out his hand to David first and then me. We eagerly shook hands, anxious to be done with the formality. He took a seat on a stool and propped himself up against the wall.

  “What’s going on?” David was clearly annoyed with his casual approach.

  “I don’t really know. We’re not sure. We took some blood and there are some abnormalities in–”

  “What kind of abnormalities?” David asked.

  I placed my hand on his arm. “Give him a second to explain.”

  “Her white blood cell count is a bit elevated, but it’s not completely out of the normal range. Her blood sugar is a 42 which is very low. She’s hypoglycemic and really dehydrated. The IV fluids should take care of raising her blood sugar and we should start seeing it come back up. I’m not sure why her blood sugar is so low, though. How many times did you say she threw up?”


  “Three. And just since this morning. How could she get so dehydrated in only a few hours?” David asked.

  “It’s unusual. You typically wouldn’t see a child get severely dehydrated so quickly. Usually, you would see a child become this dehydrated after they’d been throwing up for days.”

  “So, what does that mean?” I asked.

  “It could mean a few things.”

  I waited for him to go on, but he didn’t. I was beginning to get annoyed and David had already reached his limit. “Like what?”

  “We haven’t gotten any urine and it’s important that we do because we need to take a look at it and see if there’s any kind of infection. It’s possible there might be an infection. It will also tell us whether there are ketones in her urine.”

  “What are ketones?” The only time I’d heard of ketones was when everyone had gone on the Atkins diet in the early 90s. I thought they were a good thing because all the Atkins books described them as being positive, but maybe they weren’t.

  “Ketones are associated with the proteins in your body and fat. If you have a significant amount of ketones in your urine, then it usually means a person is dehydrated or it can also signal other issues that might be present. In this case, we’d expect to see ketones in the urine because we already know she’s dehydrated. We just want to see how high her levels are to make sure nothing else is going on. However, I’m a confused by her other results.”

  “What are the other results?” David and I talked on top of each other.

  “Her bicarbonate level is a 7.” His forehead lined with concern. Both of us waited for more but he didn’t have anything more to give us as if he expected us to somehow know what a bicarbonate level was. I’d never even heard the word and I was certain David hadn’t either.

  “What’s a bicarbonate level?” I asked.

  “Whenever we see a child whose dehydrated, we run an electrolyte blood panel to see how dehydrated the child is. One of the electrolytes the blood panel measures is bicarbonate along with sodium, potassium, and chloride. Her electrolytes show severe dehydration, but her bicarbonate level is very low, much lower than we’d expect to see from dehydration alone.”

  “So what does that mean?” David asked.

  “We don’t know. It’s hard to say. We’re going to have to run some additional tests.”

  “But it’s because she has the stomach flu?” I asked.

  “It’s being exasperated by her being sick, but we wouldn’t typically see a bicarbonate level this low because of the stomach flu.”

  “Then, what’s going on?” I asked at the same time David asked, “What’s wrong with her?”

  “Unfortunately, I can’t say. We’re going to have to admit her. We’ve already started her on IV fluids which should help her blood sugar levels come back up and she’s going to have to be monitored closely to see how her bicarbonate level responds. The pediatric doctors are going to be able to answer your questions better than I can. I’ve put in the order for a bed on the pediatric unit and you should be moved up to the fifth floor shortly.”

  I looked at David. He was staring at Rori, grinding his jaw back and forth.

  “So, you’re sure it’s not the flu?”

  David shot me an icy stare. “He already said it isn’t the flu. Something is wrong with her.”

  “I’m sorry I don’t have more answers for you, but the emergency room is only the first step. Once she’s been admitted and the results come back from the other tests we’ve taken, we’ll start to have more helpful information. We need to gather more information about what’s going on.”

  We thanked him as he left, pulling the curtain back around us. I stared at David waiting for him to say something. I didn’t have to wait long.

  “I knew something was wrong with her,” he said without looking up. His gaze was still fixed on Rori, who continued to look like she was taking a nap.

  “He didn’t say it was serious. He just said it wasn’t what they’d expect. We don’t know anything yet. He hasn’t given us any real information. I’m sure she’s going to be fine.”

  David blew everything out of proportion when it came to Rori. When she was learning to walk, he was convinced we needed to get her a helmet because he was afraid she’d hit her head when she fell and get brain damage. Once she accidently ate a vitamin, and he went into a frenzied panic because he was convinced she was going to get iron poisoning. It didn’t matter that a representative from poison control assured us one pill was harmless and the pill had probably gotten stuck in her teeth before she swallowed it. It took me forever to calm him down and talk him out of taking her to the emergency room to get her stomach pumped.

  “Something’s wrong. I can feel it.”

  I shook my head maintaining my stance. “Everything is going to be fine. You’ll see.”

  I wasn’t jumping to any unnecessary conclusions. I refused to get alarmed unless the doctors gave us a reason to be alarmed and so far, nobody had given us a legitimate reason to be overly concerned. Dr. Yang hadn’t acted like it was a life or death situation. He’d seemed more confused than anything else. He probably couldn’t figure it out because he didn’t work with children, but I was sure the pediatric doctors would have answers for us after they examined her.

  I scrolled through my phone browsing countless medical pages looking for an explanation of the bicarbonate level that made sense while we waited for someone to take us up to the pediatric ward. Everything I read referred to something called the anion gap and other medical jargon I didn’t understand. Most of what I found contained chemical formulas. I loved math and was good it at, but I liked math with actual numbers. When you started throwing in letters, you were no longer doing math and I couldn’t follow any of it.

  Rori didn’t open her eyes when they transferred her from the emergency room bed into the hospital bed in her room. I’d never been in a pediatric hospital room and was surprised it didn’t look different from other hospital rooms I’d been in. The only noticeable difference was the Mickey Mouse border encircling the room, but other than that it was the same as every other hospital room—a stiff white bed as the focal point and two hard-backed chairs with metal legs next to it. The off-white walls were in need of a new paint job even though we were at one of the most expensive and respected hospitals in Los Angeles. She had her own bathroom with a small toilet and sink. There was even a standing shower. I was glad we had a window even if the only view it provided was the other hospital wing directly across the street. I moved to stand next to David as a nurse in the doorway made her way into the room and began connecting Rori’s IV and other wires to the machine next to her hospital bed.

  “She’s going to be okay,” I assured him for the tenth time, hoping my words were true.

  Chapter Four

  “She’s experiencing metabolic acidosis. The blood draw we took at three still shows her bicarbonate level is at 7–”

  David interrupted, “It’s still the same? But, we’ve been here for over six hours and she’s been on an IV the entire time. Shouldn’t it have gone up? The doctor in the ER said IV fluids would help her. Why aren’t they helping?”

  “The good news is they’re helping with her dehydration. Her potassium, sodium, and chloride levels are coming back up.”

  I was having a hard time focusing on what the attending pediatric physician, Dr. Koven, was explaining because I couldn’t stop staring at her pregnant belly. I guessed she was at least seven months pregnant by how extended she was coupled with the way she waddled when she walked and how she held her hand against her back for support while she stood. I never thought about doctors who worked with sick kids having kids of their own. I couldn’t imagine how she did her job every day and wasn’t plagued with constant fears about her unborn child. Every pregnant woman I knew obsessed about the potential diseases that could affect their children, but we kept them at bay because we didn’t have to see them. How could you combat the fear when you had to see sick kids every d
ay?

  “However, we are also concerned about the level of ketones in her blood. Those are elevated too. We would’ve hoped to see those levels come down as well through rehydrating her, but they’re still in the high range.”

  David ran his hands through his hair which was sticking up haphazardly because he’d run his hands through it so many times. “I don’t understand what’s going on with her. None of this makes sense.”

  “I wish we had more answers to give you, but when we see something unusual like we’re seeing with Rori, it can take a while to narrow down what’s going on. We have to start wide and rule things out as we go and there’s not a quick way to do it. I wish there was.” She was hovering over the computer screen where the nurses made notations after they’d checked on Rori.

  “What sort of things are we looking at? Where are we starting?” I asked.

  “Our biggest concern is that she’s acidotic. We’ll begin by looking at some of the most common reasons we would see a kid become acidotic. We’ll be looking at things like diabetes and other endocrine disorders because she’s experiencing ketoacidosis, but diabetes is highly unlikely because her sugar levels are quite low whereas with diabetes we would expect them to be high. But, we will definitely be ruling out a diagnosis of diabetes just to be sure. In addition, we’ll be looking at whether her kidney and liver functioning are normal. We’ll want to make sure all her major body systems are functioning appropriately and there isn’t anything going on with her organs. Usually, when children become acidotic, they become acidotic because there’s a problem somewhere in their organs or their metabolic functioning.”

  “How long until you know what’s wrong with her?” I asked.

  “We’re going to have the lab come and do another round of blood draws in about forty-five minutes. Those labs will be sent out to run much more specialized tests. We’ll also look at her electrolytes and bicarbonate levels again to see if they’re improving. Once the results are back, we’ll go from there. Have you gotten a urine sample yet?”