by Amy Andrews
But despite that, the sense of déjà vu got stronger and stronger as they neared their destination, and the sick feeling she had felt two years ago as she had ridden in the ambulance with Daisy returned and refused to be quelled.
David seriously doubted he’d get to the Children’s Cardiac Hospital in Brisbane without being nabbed by a speed camera. His powerful car ate up the distance and while he wasn’t driving recklessly it was a machine that could handle speed effortlessly.
He just had to get her to hospital as soon as possible. He’d pay a hundred speeding fines if necessary as long as Mirry was in the best place she could be. In Brisbane at the hospital where she’d had her transplant. Where he took her for her regular outpatient appointments. Where there was specialist medical attention.
As he drove he tried to be calm and rational. He was a doctor, for goodness’ sake, even though he was suddenly struck with amnesia about anything medical. His worry and fear were rendering him totally useless! Stop it, damn it! Think man, think!
Clarity finally came to him and he felt less fearful when he could think like a doctor instead of a father. It was probably just a bit of a chest infection that had taken hold. She’d been tired for a couple of days and he’d noticed an occasional dry cough. A chest infection would explain the fine crackles he’d heard on auscultation of her chest also.
He clung to that as he drove because the alternative was too awful to contemplate. Rejection. Even thinking the word sent a chill down his spine. They had been very lucky so far. Miranda had had a very good postoperative course, free from the complications that a lot of patients suffered.
No episodes of rejection. No signs of coronary artery disease. But that didn’t mean she was going to avoid them indefinitely. Knowing rationally that rejection was at its most common in the first year post-transplant didn’t help when he also knew it could strike at any time.
David was also aware that most cardiac transplant patients required several transplants over the course of their lives—particularly paediatric patients, due to their size and growing bodies. He’d been prepared for the eventuality but had hoped that they would buck the trend or at least set the record for the longest transplanted donor heart.
David had adjusted the rear-view mirror into a position where he could see Miranda’s face and he checked it frequently. He could also see Fran’s face and the worry etched between her brows. He realised suddenly that this must be hard for Fran. It must seem eerily familiar and he cursed himself that he’d been selfishly thinking of only himself when he had asked her to come with him.
He glanced back as the car glided to a halt at the first traffic light on the highway. Having to stop was frustrating, but at least he knew they were nearly there.
‘How’s she doing?’ he asked.
‘No change. Still sleeping,’ said Fran. He looked desolate and Fran knew better than anyone how that felt. She touched his shoulder with her spare hand and gave it a squeeze.
David placed his hand over hers and gave her a sad smile. ‘Thank you for being here. I know this can’t be easy for you.’
Fran felt a lump rise in her throat and tears well in her eyes. She nodded, too emotional to speak.
Eight minutes later they were pulling up in the emergency parking bays of the hospital and David rushed Miranda inside. When Fran joined them a few minutes later she found a pale Miranda lying on a narrow trolley, hooked up to a cardiac monitor, nasal prongs delivering a trickle of oxygen, a doctor listening to her chest and a nurse taking blood.
‘Just a scratch, darling,’ said the nurse, whose name tag announced him as John, as he pierced her skin with the needle. Miranda didn’t even murmur. Fran sat next to David and he took her hand and held on tight. The doctor examining Miranda took the stethoscope out of her ears.
‘Well, what do you think?’ asked David, standing. Fran stood with him.
The woman approached. She looked to be in her late forties. She was tall and thin and wore glasses with crazy rainbow frames. She had friendly eyes and the photo on her name tag had a sticker of Shrek stuck over the top.
‘I’m Anne Cahill,’ she said, and held out her hand to Fran.
‘I’m sorry,’ said David, rubbing his hands through his hair. ‘This is Fran. Fran, Anne is the cardiac surgeon who did Miranda’s transplant.’
Fran shook the woman’s hand and felt reassured by her firm grip. She seemed confident and competent.
Anne ushered them to the chairs. ‘I’m pretty sure you’re right, David. I think it’s just an opportunistic chest infection that’s taken advantage of Miranda’s suppressed immune system. But I want some bloods, a chest X-ray, a sputum sample and an echo before I make any definitive diagnosis. Let’s get that all organised first and then we’ll talk again. OK?’
David nodded and tried not to look miserable. Miranda looked so still. It was hard to feel reassured when his little dynamo, his whirly-gig, his bundle of energy was lying so motionless. As a doctor he had to think of all the possibilities, including the worst-case scenario, and he knew Anne Cahill well enough to know that rejection was at the back of her mind, too. As a father the only scenario playing in his mind was the worst.
Fran and David sat together listening to the rapid blip of the monitor indicating Miranda’s heartbeat as activity went on all around them. John came in and hooked up some IV fluids to the cannula he’d left in Miranda’s arm when he had taken blood earlier. The portable X-ray machine was wheeled in and two films were taken of her chest from different views.
Anne came back in with the heavy, portable echocardiogram machine and perched herself on the trolley beside Miranda. It was similar to an ultrasound machine used for foetal sonography but was specifically designed to view the heart. The transducer was similar and the gel she squeezed onto Miranda’s chest to improve the view was also the same.
She asked John to turn the overhead lights off and Fran and David watched the screen as an image of Miranda’s heart came onto the screen.
Anne gave them a running commentary as she manipulated the transducer through the gel, angling it different ways to achieve the best view. ‘No enlargement or oedema of the walls…. Good blood flow…. No regurg…. No growths on the valve leaflets…. Good left ventricular function…. Ejection fraction…fifty-nine per cent…. Could be better but not too bad….’
David shut his eyes. Fifty-nine? On her last echo the ejection fraction had been sixty-seven. Still, Anne was right, it could be much worse. Pre-transplant it had been twelve per cent!
Anne finished up and wiped the goo off Miranda’s chest. Miranda’s eyes fluttered open. ‘Hey, there, poppet,’ Anne crooned. ‘Not feeling so good?’
David squeezed his daughter’s hand and kissed her forehead, greatly relieved to see that the IV fluids were rallying her a little.
‘Hi, Dr Anne,’ said Miranda in a very small voice. ‘I’m tired and it hurts to cough.’
‘We’re going to fix that, I promise.’ Anne smiled.
Miranda nodded and drifted back to sleep.
‘We’re getting her to the ward and I’m starting her on some broad-spectrum antibiotics until we know what we’re dealing with. I’ll talk to you upstairs some more when the blood results come back.’
David nodded. He knew that Anne wanted to be in possession of all the facts before she spoke to him—he’d want to if the positions were reversed. For the moment Miranda seemed OK and was in the best place possible. He looked at Fran and she smiled reassuringly. And Fran was here, too. He just had to try and stay positive.
They were moved to the ward shortly after and David and Miranda were greeted enthusiastically by the staff. It was no cliché to David to describe them as family. The many familiar faces had seen them both through thick and thin and the entire medical team had always treated them like one of their own.
Fran sat beside Mirry’s bed and watched her chest rise and fall and her rib cage reverberate with each pound of her heart. David paced around the room, then prowle
d up and down the corridor and then came back and paced some more. Mirry had a bit of colour in her cheeks now and Fran was relieved by Anne’s prediction that it was probably just a chest infection.
Last time she had sat beside a young girl’s hospital bed the news had been very grim. She knew David was concerned but, comparatively, this was good news. Surely he could see that? He seemed very worried still and Fran wondered if there was something he wasn’t telling her.
He smiled at her every time he re-entered the room and seemed pleased that she was there. She wanted to say something to ease his torture but she knew how trite words were in these situations. Hopefully her quiet presence was enough.
Anne entered the room, took one look at David and said, ‘You look awful.’
‘I feel awful.’
‘I just came to say that there’s been a hiccup at the lab and the tests, all the hospital’s blood tests, have been delayed. But I can see we need to talk. Come on, you know the way.’
Anne left the room and David turned to Fran. He wanted to have this talk but he was frightened of what he would hear. He needed Fran by his side. ‘Come with me? Please?’
Fran nodded. David needed her and she loved him. How bad could the news be?
‘OK, to recap,’ said Anne, once they were sitting in a small cosy room on deep comfortable chairs. David held Fran’s hand and she stroked his reassuringly.
‘I think all this is is a chest infection. Because of Mirry’s immunosuppression, it’s taken a real hold. She has a fever and her X-ray shows pulmonary congestion. I’m going to treat her with the antibiotics and some medication for her ejection fraction. I think the chest infection is playing havoc with her lungs, which is in turn causing right-sided congestion.’
She stopped to see that Fran and David were taking it in and they both nodded at her.
‘Now the other possibility, and we’ll know for sure when the tests come back, is rejection.’
David felt a hot fist slam into his chest. The word had been mentioned out loud and he was being forced to confront it for the first time.
Rejection? Fran sat a little straighter. Rejection? She hadn’t even thought about that.
Anne held her hand up. ‘I don’t believe it is for a moment. I only mention it because I know you’re driving yourself crazy, David Ross.’
‘Her symptoms could also indicate rejection.’
She looked at him. They could? Fran didn’t know enough about transplant medicine to decide.
‘Yes, they could.’
‘So what happens if it’s that?’
‘It’s not. Her echo is good.’
‘What if it is?’ David insisted. Why, he didn’t know. He knew what would happen if it was. He just needed to hear it from her mouth.
‘We’d need a biopsy to confirm and then try her on different anti-rejection medication.’
‘And if that didn’t work?’
‘David,’ said Anne gently, ‘stop this. This is pointless. It’s not rejection.’
Miranda could be rejecting her heart? Fran started to feel the darkness claim her again. She was going to have to watch another little girl die. She couldn’t. She just couldn’t.
‘What, then?’ David demanded. He knew Anne was right but he just had to hear the worst-case scenario.
‘She’d need to be relisted.’
David sagged back in the chair, his worst fears realised. Fran looked at the utter desolation on his face.
‘I don’t think I can go there again, Anne,’ he said quietly.
‘David…the bloods are going to come back with a raised white cell count. Her sputum will grow a bug. We’re going to treat Mirry with antibiotics and you can take her back home.’
‘Of course,’ he said, giving himself a shake. Now he’d confronted the worst, he needed to concentrate on the most probable. ‘I’m sorry, Anne, I just needed to know it all.’
She nodded and smiled. ‘I’ll come and find you as soon as I have the results—I promise.’
Anne rose and left and David felt immeasurably better for reasons he couldn’t explain. It was as if by confronting his worst fear, acknowledging it and plotting a course of action to combat, it had taken the power out of his fear. And Anne’s certainty that Mirry wasn’t rejecting her heart bolstered his confidence.
He turned to Fran and was surprised to see tears tracking down her cheeks. ‘Fran?’ She didn’t answer him. She just sat there, very still, staring at the floor, her hands gripping the arms of the chair, her knuckles white. ‘Fran?’ he said again.
She could hear him calling her. Somewhere through the fog of jumbled thoughts and emotions and the thunder of her heart echoing in her ears she could hear his voice. But the voice saying Get out, run away, you can’t do this again was louder. It wasn’t until his third try that she was able to pull herself out of the escalating panic settling around her and engage her mouth.
‘I can’t do this. I have to go.’ She got up, put her bag over her shoulder and walked out of the room.
David sat staring after her for a few seconds. Had he asked too much of her? Probably, but, damn it all, she’d been through this kind of thing before and knew how frightening and worrying it was. Was it asking too much for her to just be there for him?
And what about Miranda? His daughter adored her. Even if it was just a chest infection, with Mirry’s immunosuppressed state she was sicker and would take longer to bounce back. Fran had become such a fixture in Miranda’s life and the little girl worshipped the ground Fran walked on. And if the worst happened? If it was rejection? Mirry would have enough to cope with without the confusion of Fran deserting her.
David felt his worry and frustration mix into a potent brew. His desperate need to have Fran by his side sparked his legs into action and he was out the door and following her down the corridor. He caught up with her as she got into the lift and he managed to get his hand between the two doors before they slid shut.
Fran looked terrible. Her pale blue eyes looked like they had the day he’d first met her on the beach. Empty. Void. It was only the reddened rims, the muted sobs and the stream of tears that showed him her anguish.
‘Please, don’t leave,’ he said quietly as the lift took them downwards. He heard a gurgling in her throat and she started to sob louder. ‘I know this must be really hard for you and I’m being selfish because I love you and I’m scared for Mirry and I need you. And Mirry needs you, too. She loves you as well. Don’t desert her in her hour of greatest need. Don’t desert us.’
He put out his arms to hug her but Fran shook her head and took a step back. She was crying hard now, her face completely crumpled as tears fell unchecked and her distressed sobs echoed loudly in the lift. Her nose was running and mixing with her tears and she knew she must look a complete wreck but she didn’t care.
‘How…long,’ she fumbled between hiccupy sobs, ‘have you known…about the poss-possibility…of rejection?’
The lift pinged and she stalked out. David followed.
‘I was worried about it the minute I listened to her chest and heard how wet it was,’ he said, following her out the sliding entrance doors into the warm night.
So he had known of the possibility hours ago. Why hadn’t he said anything? Fran had been out of nursing too long and didn’t know enough about the transplant specialty to have thought about the awful possibility. If he had used the R-word back in Ashworth Bay she would never have come. She kicked on some more speed. She had to get away from there.
‘Where are you going?’ he asked as she charged on.
‘Taxi rank,’ she choked out around her sobs.
David caught up with her and gently pulled on her shoulder until she spun around to face him. ‘Fran, if you must go, take my car.’ He fished in his pocket for the keys. ‘I won’t be needing it for a while.’
She reached for his keys but he pulled them away. ‘Not until we talk.’ They were standing in a grassy area at the front of the hospital. It was away from the ma
in lighting and reasonably private.
Fran’s initial crying had waned a little, leaving her with a few dying sniffly sobs. ‘Forget it. I’ll get a taxi,’ she said. Fran didn’t want to talk. Yes, she was running away. She knew that. But the alternative was too much to bear.
She’d sat and watched her daughter die two years ago and the possibility that this was the beginning of the end for Miranda was too painful to bear.
‘Fran, please!’ said David, catching her and stopping her progress again. He was starting to feel frantic. He knew this was about more than Mirry being sick but he’d be damned if he’d let the best thing that had happened in his life walk away without fighting for her.
‘I can’t make you stay. I can’t make you love us. But I can ask you to give me one good reason why you’re walking away when we need you most. You owe me that at least.’
Fran felt tears well in her eyes again as a bubble of hysteria built in her chest. ‘At the moment I can think of about a million,’ she said bitterly.
David could feel his frustration mounting. Mirry was sick and he needed to be with her. ‘You know, Fran, I really don’t need this now. My daughter is sick. At best she has a serious chest infection, at worst she could be rejecting her heart. I understand that you’ve been through worse than this. But I don’t have time to play guessing games or outdo each other with who’s suffered the most.’
Fran looked at David and knew he was right. He looked haggard and she saw lines on his face that she’d never noticed before. He didn’t need her hysterics now but she still couldn’t stay. She sat on the grass, plonking her bag beside her.
‘What are the odds that she’s in rejection?’ she asked. She noticed the catch in her breath and how much even saying the word out loud hurt.
She felt him sit beside her and turned to face him. His five o’clock shadow added to his look of profound tiredness.
‘You heard Anne. Remote. But it is a possibility. I was worried about it before but I’m feeling much more positive now.’