REBIRTHDAY chapter 16
Engraftment
A crooked line crossed the whiteboard in Natalia’s room, zig-zagging gently between 0 and 1. It was Natalia’s white cell count, as charted by Paige, after every morning round, when Dr. Lonergan would read out the daily counts. Sara tried not to discuss the cell numbers too often with Paige, who she suspected might have a touch of her own OCD.
They were playing cards together in Natalia’s room when Dr. Lonergan walked in and raised her phone like a scepter. “I’ve got a spanking new white count for you,” she said, looking around. Her hands dropped to her sides. “Where’s Natalia?”
Paige smacked her cards down on the table. “What is it? Is it good?”
“It’s very good indeed,” she said. “White cells: One point one.”
Paige let her jaw drop. “Shut up,” she said. “For real?”
Sara laid her cards down, noting her racing pulse. “She’s over in Child Life with Linda.”
Dr. Lonergan added the data point to the board, and then Paige took the marker and added confetti, lightning bolts, and exclamation points. “Mom,” she said, “can you take a picture of us?”
Sara said yes, framing them together on the screen. Dr. Lonergan stepped out of the picture right as Paige flashed the peace sign.
“You’re pleased with this?” Sara asked, not sure what else to say.
“I am, very much pleased. And you should be, too.”
“It know it’s like the stock market,” Sara said. “I mean, I know sometimes there’s an outlier.”
“Natalia’s engrafting,” said the doctor. “You can say it out loud.”
“I’ll say it,” Paige muttered, as she thumb texted rapidly beside them.
“But she’s nowhere near the normal range yet,” said Sara. “Let’s not count our eggs before they’re hatched.”
“The lower end of normal would be 3.0, so we still have a ways to go,” said Dr. Lonergan, with a smile. “But you can celebrate a little. We’re not supposed to be superstitious in medicine.” She went to the IV pump. The line was looped on one of the corkscrew pigtails. Her hand ran over its buttons. “I was hoping to catch you all together,” she said. “I have something difficult to say.”
Sara held her breath.
“It’s about Chase,” she went on. “I assume you’ve heard he’s still in the ICU?”
Sara nodded.
Paige looked up, her phone still in front of her. As Dr. Lonergan went on, it sunk slowly on to her lap.
“Things are much worse now.”
“We hadn’t heard anything one way or another,” said Sara.
“This morning, Stacey and Ryan decided to transition Chase to hospice.”
Paige frowned. “He’s seventeen years old.”
“I haven’t been at liberty to tell you much—”
Paige held up her phone like a piece of court evidence. “There’s nothing on his Caring bridge.”
“They’ve been keeping it private, obviously, because it’s so upsetting. I’ve wanted to tell you, but Stacey and Ryan asked us to respect their privacy.”
“Does Maren know?” asked Sara.
“Maren led the meeting with everyone there,” said Dr. Lonergan. “His family was all there. None of them took this decision lightly.”
“I’m sorry,” Sara said. “Only a few days ago, Stacey said she was believing for a transplant. And I saw her in person last week—”
Dr. Lonergan pinned them in place with her gaze. Sara wanted to squirm out of it, to crawl on to different plane of reality.
“Did she ask you to tell us?” asked Paige.
Dr. Lonergan pressed her lips together.
“Well, is he awake?” Paige looked terrified. “Can he talk?”
The lightning bolt on the board wavered unless Sara stayed very still. Chase, she remembered, was Stacey’s only son. When she closed her eyes, the lightning bolt danced in green on her eyelids. “She must be out of her mind,” she said, quietly.
“They’ve asked for prayers and donations to some Christian charity, but no visits,” Dr. Lonergan said. “And obviously, you all need to stay away from the ICU germs, anyway.” She pressed her lips together once more. “Depending on how full the ICU is, they may move him to the hospice wing, but I can’t imagine it will be long once they’ve taken him off the ventilator.”
Paige sat down all at once, her hands went slack, her face drew into a mask. Silvery spots formed under her glasses. Silent sobs shook her shoulders, until a painful-sounding hiccup formed deep in her chest. Sara went to her, caging her shoulders. For a moment, they were linked, but Paige pushed off and turned her wet, slick face to Dr. Lonergan, her voice cracking in unexpected words. “What physically happened?” she asked. “They took the infected port out. Did they try different antibiotics? What if it’s a fungus or something?”
This went on for a while, until Paige became incoherent. Every time Sara laid a hand on her, she’d twitch away.
“Honey,” Sara said, lowering her voice, “the details aren’t important.”
Paige turned to her, horror-stricken. “It matters to me,” she said, pounding her chest so hard that Sara winced. “You’ve got to tell me everything,” she said. Here Dr. Lonergan came close, squatting to eye level with them. She clasped Paige’s hands and held them tightly together.
“It was extremely fast. You’ve heard of sepsis, right?”
Paige nodded miserably.
“The sepsis returned, which does sometimes happen, and this made his blood pressure drop suddenly. And that damaged his kidneys. Do you understand?”
Paige nodded and coughed. “Go on.”
“They tried very hard to help him. They used dialysis to replace his kidneys, they broadened the antibiotics, they tested him for every possible infection, but the fever continued. And in the midst of all that, he had a stroke.”
Paige worked to keep her face still.
“A clot traveled to his brain. After that, he couldn’t breathe for himself.”
Paige nodded as Dr. Lonergan held her hands together. “Paige, dear, it’s not right, what’s happening to him. What’s happening to your friend isn’t right.”
Paige pressed her eyes shut. She keened and bent forward.
“His mum wants his suffering to stop.”
Paige shook her head. Her eyes opened wide. She jerked her hands away. “Nattie. Someone’s got to tell Nattie.” She pushed off the seat, swaying to her feet.
“We’ll tell her when she’s back,” Sara said.
“No. Now.”
Dr. Lonergan got up painfully. “Take a minute to collect yourself,” she said, trying to move closer. Paige stepped out of her reached and backed toward the door. “I’m calm,” she called, arms outstretched, wiping her sleeve across her wet face.
“Paige, please stay here,” said Sara, but she was gone, moving in a deranged speed walk around the curve of the unit, breaking into a half-run at the double doors. Sara and Dr. Lonergan followed behind as she stopped to open the Child Life door. Inside, Linda and Natalia wore masks at one of the round tables.
They watched Paige in bemusement as she held a warning hand back to Sara and Dr. Lonergan. “Let me tell her,” she said. “I can do it.”
Linda shifted, catching Dr. Lonergan’s eye. Silence fell as Paige caught her breath. “We got some bad news,” she said. “about Chase.”
Natalia frowned.
“He’s on life support. He’s got a clot in his brain.” Here her hand cradled the top of her head. “They think he’ll never wake up.”
Natalia went blank-faced, but her voice was sharp. “Stop making things up,” she said. “Who said that?”
Paige flung her arm toward Dr. Lonergan. “She just told us.”
Natalia turned to Sara. “Mom?”
Sara considered lying for a split-second. A burning pain blossomed in both temples. “Listen to Dr. Lonergan.”
Natalia had begun blinking, and her face and neck and scalp were turning pink. She faced Dr. Lonergan. “Tell me,” she said.
“Let’s go back to your room—”
“She’s going to tell you the exact same thing,” said Paige frantically. “And guess what? We can’t even say goodbye. We’re supposed to respect their privacy.”
“You need to shut up,” Natalia said.
“I can’t,” Paige said, with a pathetic whine. “Chase is going to die, and also, your cells came back measurable, and it’s all happening at once—”
“I mean it, Paige,” Natalia barked. “Shut up now. Are you trying to practice breaking bad news to me?”
Paige squirmed. “No,” she said.
“Because you suck at it so hard,” Natalia said. She turned to Dr. Lonergan. “Can I say hi from the hall or something?”
Dr. Lonergan tilted her head. “He can’t see you, dear.”
“How long has he been on the machines?”
“It’s been several days now.”
Natalia bent over the table, staring into the middle distance, absently palming her phone. “How long do you think he’s got?”
“Once they remove support,” she said. “not long at all.”
Natalia lowered her head to the table. Her voice, already muffled by the mask, was distorted by the hard surface. “What’s this about my cells?”
Before Paige could speak, Sara moved in.
“That’s enough for now,” she said, taking Natalia by the hand. “Get up, honey.”
When Paige made a move to follow, Sara said, “You stay here. Talk to Linda.”
She led Natalia back to her room and shut the door, leaving Paige wide-eyed, standing between Linda, who remained seated with upturned hands, and Dr. Lonergan, who drew a long, quiet breath.
Natalia, Sara, and Paige were together when Stacey came back to the pediatrics floor. She entered through the double doors and nurses got up, went to her, hugged her, held her at arm’s length by the shoulders, and hugged her again. Stacey looked as if she hadn’t changed clothes in a few days, though she stood with good posture, almost exaggeratedly, like how a ballerina would stand, with her shoulders pressed flat back. She reached up and patted the nurse’s arm, releasing herself gently, but with a clear intention to free herself, and then she walked up to Natalia’s room, reaching in to knock on the open door.
Sara was on her feet before Stacey saw her.
“Stacey,” she said, reaching out. Without hesitation, Stacey grasped Sara’s hands but kept her off, no hugging yet.
Sara swallowed against the thatch in her throat. “We heard a little about what’s happening from Dr. Lonergan. I hope that’s okay.”
Stacey nodded quickly. “Yes, we’re going to hospice today. We’re removing all the tubes and everything. As soon as our family’s all here.”
Sara wondered how she was standing there with her shoulders pressed back. She said, “I’m so sorry.”
“I’m not,” Stacey blurted out, as if she were on a sitcom. “I’m jealous, he gets to meet Jesus today.”
She gripped Sara’s hands tensely. Sara felt herself nodding along.
“He’s not going to suffer any more, thank you Jesus.” A nervous cough overtook Stacey for a minute; she looked behind Sara, to the bed, where Natalia and Paige sat close to one another in a desperate silence. “I’m here to deliver a message from Chase. He made me promise.”
“Of course,” said Sara. “Anything. What can we do?”
“We love Chase,” Paige said in a small voice.
“We do,” Natalia echoed.
“When he was first diagnosed, they had him bank his sperm for a future family,” Stacey said. “So, Nattie, if you ever need a donor, he wants you to have it.” She paused, concentrating on controlling her voice. “His sperm.”
Natalia, to Sara’s relief, didn’t look disgusted or put off or even surprised by any of this. Paige linked arms with her sister, nodding along.
“I don’t know what to say,” Sara said, “that’s incredibly generous. He’s been so sick…to have the foresight.” Sara felt a spasm in her throat.
“He donated before he’d had any of the chemo,” Stacey was quick to say. “We were lucky, he had time to donate.” Her hand went to Natalia. “I know for you, it was different. He donated three times,” she laughed weakly, “so there’s plenty there.”
“I know,” Natalia said. “He told me.”
Stacey’s eyes got wide. “Oh? I didn’t know he’d told you.”
“Is there anything I need to do?” Natalia asked. “Do I have to sign something?”
“No, nothing. Ryan and I just learned about all these recently, but we did talk it over, and we’ve decided to store it indefinitely, or at least for the rest of our lives.” Her hand went to her chest. “So we’ll keep it for you, and if you ever need it, you’ve got my number.”
“I know it was really important to him,” Natalia said.
“It is important to him,” Paige said.
Stacey smiled. “You’re both so young, I know this is all way off in the future. You might not need it at all, and that’s fine.” A sob wrenched out of her, then, taking her breath. “This is weird, weirder than anything I’ve ever had to do—”
“Not weird,” said Natalia. “I’m not weirded out—”
“It’s heroic,” Paige said.
This drew a luminous smile, and then Stacey’s face crumpled. Sara pulled her closer, and for a moment, their heads touched. “We love Chase,” Sara said. “Thank you so much for sharing him with us.”
Natalia and Paige came up, too, and received hugs. Stacey got a glimpse of the clock. “I won’t bother you guys again,” she said. “But we’re here for you, Natalia. Remember us.”
“Can you do something for me?” Natalia asked. “Can you tell him thank you?”
“I will, yes.” Stacey was backing toward the door now, her spine went erect, and she was nearly out when she turned back. “Natalia, you’re going to fly through this transplant. You will.”
And she left them there, skirting around the nurses, light on her feet, not stopping until she was out the door.
Later that night, a new message appeared on Chase’s Caring Bridge. “I still believe in his full and complete recovery, whether he’s made whole here on earth or in heaven. Our family is gathering to say goodbye as I write this. We covet your prayers as we start this part of Chase’s journey. Love in Christ, Chase, Stacey, and Ryan.”
Sara read it out to Natalia, who lay silently on the window seat. Her hand was resting, palm-out, on the windowpane.
“Mom?” she said, after a minute. “Do you believe in miracles?”
“You mean the way Stacey does? Like supernatural miracles?”
“I guess so,” said Natalia. “She says she’s still believing in a cure.”
“I think it’s her way of never giving up.”
“But they are giving up,” Natalia said. “Aren’t they? They’re letting him go.”
“I can’t imagine being in her spot.”
Natalia pressed her palm flat. “I don’t know if I can believe in that kind of miracle.” She faced Sara. “If you were desperate, do you think you’d pray for a miracle? For me?”
“Yes. Definitely.”
“Even if you didn’t really believe?”
“I’d make myself believe,” Sara said. “There’s no harm in that.”
“But what if it gave someone false hope?”
“I don’t think that’s a problem for them,” Sara said. “Whatever she needs to do or say, I think we should support her.”
“I told Chase no,” Natalia said. “Was that the wrong thing?”
“No, baby.”
“I might have hurt his feelings a little.”
They sat in the quiet together for a few minutes, until Natalia shifted to face Sara.
“One time, when Dad and I were driving to town from Grandma’s house, we almost hit a semi.”
“What? When was this?”
“It was a blizzard, and we slid on the ice, you know how there’s that slope down to the stop sign? We slid on the gravel past the sign. We were this close to the truck.” Her hand swiped a broad line across her eyes. “It was right there.”
“Fucking hell, Natalia.” Sara knew the stop sign, the slope of the road, the instinctive, halting way she’d approach it when there was weather. Her stomach lurched.
“He told me that, while we were skidding, he thought we were goners. He swore out loud.”
“How long ago was this?”
“I don’t know, I must have been ten? It was a Christmas break. He said he didn’t want to scare you.”
“Well I’m scared now.”
“Dad says that God stopped the car that day,” Natalia said. “And I want to believe that, too.” She sat up then, swinging her feet off the seat. “What do you think is going to happen to Chase?”
“I think he’s going to be free from his suffering soon.”
Natalia slumped. “Well, that’s fucking grim.”
“Please don’t say fuck around me, Nattie.”
Natalia had trouble falling asleep that night, and finally, Sara called the nurse, who brought a trazodone. She fell into a thrashing sleep, and eventually settled, so sara could retreat to her bed with her phone.
She texted Stacey. “Thank you so much for coming,” she began, but not knowing how to finish, she hesitated. “She didn’t send it and she didn’t delete it, so it auto-saved as a draft, and every time she saw Stacey’s name, the unsent messaged popped up in hopeful italics.
Totally heartbreaking.
Well written, thank you.