Sweet Angel, page 23
part #5 of Commitment Series
* * *
"Okay, little one," Dr. Berry said. "Let's get you better."
Dr. Berry stood by as a line was connected to Skylar's central venous catheter through which Seth's filtered bone marrow would pass. "Infuse it slowly. We don't need fluid overload. Her kidneys and other internal organs are already compromised."
Dr. Berry watched as the flow of marrow began. She watched both Skylar's physical reaction, as well as the data flashing on the monitors reflecting the child's vital signs and overall stability. When she was satisfied the procedure was going as planned, she walked over to the glass windows separating Skylar's room from the hallway where Cat and Billie were pressed against the pane.
Dr. Berry removed her gloves and placed her left hand flat on the window. On the other side of the pane, Cat placed her hand against Dr. Berry's, and Billie placed hers over Cat's. They remained this way through the remainder of the infusion process.
* * *
"How did she do?" Cat asked as Dr. Berry exited Skylar's room.
"As well as can be expected, considering her condition. I'm pleased her body didn't immediately reject the marrow," Dr. Berry said.
"How can you tell? I mean, she's sedated, so I wouldn't expect a reaction from her," Billie pointed out.
"We would have seen a change in the readout on the monitors, Billie. So far, there has been no significant change in any of the readings, good or bad. That means she's tolerating the infusion," Dr. Berry explained.
"Now we wait to see if her body actually accepts the transplant—not just tolerates it," Cat added.
"Exactly," Dr. Berry concluded.
"How long will that take?" Billie asked.
"That's hard to say, exactly. If the graft worked, the stem cells will begin to multiply and make new blood cells. The amount of time it takes to return to normal blood counts varies with each patient, but it could happen as early as two weeks, or as long as six."
"Are you telling me she'll be hooked up to those machines for possibly another six weeks?" Billie asked incredulously.
"I hope not," Dr. Berry said. "If all goes well, her body will begin to bounce back over the next few days. During that time, we'll give her antibiotics to fight any current infections and stave off any new ones. We'll also give her anti-bacterial, anti-fungal and anti-viral drugs until her white blood cells are high enough to take over. Finally, to give her new immune system a boost, we'll transfuse red blood cells and platelets until her own marrow is producing them again."
"In the meantime, it's all a waiting game," Cat said as she stood in front of the windows, intently staring at her daughter. "All of this will be for naught if we can't get her fever down and get her breathing on her own. Hopefully, Seth's stem cells will be the catalyst she needs to get the ball rolling in the right direction."
"That is indeed our hope," Dr. Berry said. She turned to Cat and Billie. "As for you two…go home and get some sleep. Skylar will be sedated for at least the next twenty-four to forty-eight hours."
"No can do, Alexis," Billie said. "I will, however, take some time out to go see my son. He should be awake by now. Thank God, Jen volunteered to stay with him until we get there."
"I'll go with you, Billie," Cat said before turning to Dr. Berry. "Alexis, I don't have the words to tell you how much we appreciate everything you've done for Skylar. Thank you."
"You can thank me by taking care of yourselves. We still have a long road ahead of us and you'll need your strength to travel down it. You'll be of no use to Skylar…or to Seth or Tara if you don't get enough sleep and nourishment. Doctor's orders."
* * *
Two days later, Cat and Billie heeded Dr. Berry's orders and went to the hospital cafeteria for a light lunch. When they returned to the ICU they found Skylar's room empty.
"What the hell?" Billie said. "Where is she?"
"I'll get to the bottom of this," Cat said as she approached the nurses' station with Billie in tow. "Could you tell me where our daughter is?" she asked.
"What's her name?" the nurse said.
"Skylar Jean Charland."
"Skylar…she's been transferred out of ICU. She's in isolation on Baird 6, room 690."
"Thank you. Come on, Billie. Let's go find our daughter." Cat said.
"What did she mean by isolation, Cat?" Billie asked as they made their way to Baird 6.
"It means she's in a private room where no one can enter without wearing a mask, and maybe protective outer wear."
"Why?"
"Usually so the patient doesn't infect their visitors or the staff…or so their visitors don't infect them. In this case, it would be the latter."
"That's a good thing, isn't it? I mean, the fact that she's out of ICU?" Billie asked.
"I would think so, love. Here's Baird 6. Now, to find room 690."
"There it is, Cat. Fourth room on the left," Billie said.
"Here, put this on," Cat said, pulling two masks out of the box on the wall outside the door.
Cat and Billie stepped inside the room and immediately saw Dr. Berry standing beside the bed with her back to them. She was blocking their view of the patient in the bed.
"Alexis?" Cat said.
Dr. Berry swung around. "Cat! Billie!" she said.
"Mama? Mommy?" said a small voice from behind Dr. Berry.
"Sky? Sky-baby, are you awake?" Cat said.
Dr. Berry stepped aside so Skylar could see her mothers.
Skylar giggled. "You look funny in those masks," she said in a soft raspy voice.
Cat covered her mouth with one hand while grabbing Billie's arm with the other. Tears clouded her vision as she looked at Billie. Billie smiled back at her through her own veil of tears.
"She's awake," Billie whispered hoarsely. "Our baby is awake."
They cautiously moved forward, parting like the Red Sea so they could each approach from opposite sides of the bed. In turn, they leaned over the little girl and kissed her on the forehead as she smiled up at them.
"She's still warm, but not hot," Cat said, glancing at Dr. Berry.
"Her temp has come down considerably since the infusion. Some of that is due to the antibiotics and anti-viral meds, but I choose to believe it is also an early sign that the stem cells are beginning to do their job. It will be a few days before we actually know for sure. The biggest improvement though is in her breathing. You'll notice she's off the ventilator."
"Hey, sweet angel," Billie cooed. "How are you feeling?"
"I'm hungry, Mommy. Can I have some jello?"
Billie smiled broadly and looked at Dr. Berry. "Can she?"
Dr. Berry approached the foot of the bed and squeezed Skylar's foot. "I'll tell you what…it's too early for you to have solids, but I think I might be able to find you a juice box. Does that sound okay? I promise you can have jello in a day or two."
Skylar frowned. "I guess so," she pouted.
Billie chuckled. "She so looks like you when she pouts, Cat."
Cat looked at Billie, prepared to refute her statement, but when their eyes met, an amazing rush of love filled her every pore. She was totally unprepared for such an intense feeling as her eyes filled with tears and her breath caught in her throat. She reached forward and touched the side of Billie's face.
"I love you, Billie," she whispered.
Billie closed her eyes and pressed her cheek into Cat's hand. She inhaled deeply and allowed the tears to escape her lids.
"I love you too, Cat, with everything that I am."
Just then, Dr. Berry came back into the room carrying a box of fruit punch. She inserted the plastic straw and gave it to Billie.
"Here you go, dumpling. It's not jello, but it's the next best thing," Billie said as she held the straw to Skylar's mouth.
Cat came around the bed to talk to Dr. Berry while Billie fed the fruit juice to Skylar.
"She looks so much better than she did two days ago, Alexis," Cat said.
"Yes she does, but we're not out of the woods yet. As you mentioned, she continues to run a fever. That means there is still an infection raging inside her. Once we get that under control, we should see a marked improvement in her responsiveness. We won't know if the stem cells are actually working for another week."
"But there's reason to hope?" Cat asked.
"There is always reason to hope," Dr. Berry said.
"We can't thank you enough for all you've done for Skylar," Cat said.
"You're welcome. Now go spend a little time with her then I want both of you to go home and get some sleep. Forgive me for saying this, but you look like hell. Call in a family member to sit with her while you take some time for yourselves if that makes you feel better, but go home and get some rest."
"I couldn't agree more," a male voice said from the doorway.
"Daddy!" Cat said as she ran into her father's arms.
Doc held her close. "Alexis is right. You'll be of no use to your daughter if you fall sick from neglecting your own health."
"Grandpa?" Skylar said softly.
Doc looked across the room to the small figure lying in the bed. "We're not finished here, Caitlain. Give me a minute with my granddaughter."
Doc walked toward the bed and embraced Billie, then shooed her away so he could spend time with Skylar. He stood by the bedside and crossed his arms. In a firm voice, he said, "Someone told me there was a sick little girl in this room. I had to come see for myself…and what do I find? I find my own granddaughter lying there. What do you have to say for yourself, little one?"
Skylar lifted her hands out to the sides and shook her head side to side. "I'm tryin' to get better, Grandpa. I'm tryin' real hard."
"Well that's good, because I'm planning a backyard camping trip, complete with bonfire and s'mores, and I'd sure hate for you to miss it." He grinned broadly at her.
"Really? Can we cook hot dogs in the fire too?"
"Of course. It wouldn't be camping without them."
Doc sat on the edge of Skylar's bed and took her hand. "You need to work really hard to get better, kitten. Do everything Dr. Berry tells you to do, without an argument. Okay?"
"Okay, Grandpa. I will."
Doc placed a tender kiss on Skylar's forehead. "That's a good girl. Now, I have a few patients to see, but I will be back to visit with you while your moms go home to get some sleep. Is that okay with you?"
"Can you read to me?" Skylar asked.
"You betcha."
"Okay."
Doc walked back to where Cat and Billie were standing. He looked at them sternly. "You have one hour to spend with your daughter. After that, you are to go home and sleep for at least six hours. Do you understand? I will call both your mothers, and between the three of us we will stay with Skylar while you're gone."
Cat and Billie exchanged nervous glances.
"No argument, daughters. Do you understand?" he said again, gruffly.
"But…," Cat began.
"But, nothing. Both of you are on the verge of collapsing right where you stand. Enough is enough. One hour."
Doc glanced at Dr. Berry, who tried very hard to hide a smile at the scolding. "Alexis, I'd like to chat about Skylar's progress when I return."
"I'd like that," Dr. Berry said.
Cat looked at Billie. "I guess we have one hour," she said.
"I guess so," Billie replied.
"Mama," Skylar said from her bed. "Grandpa will put you in timeout if you're not a good girl."
"I think he just did, sweetling. I think he just did."
CHAPTER 20
Within a week, Skylar was out of bed and taking short walks down the hallway while wearing a mask and pushing a child-sized walker in front of her. Her color was beginning to return, as well as a dusting of red-blonde peach fuzz on her head. Billie or Cat…or sometimes both, would accompany her on her walks, while pushing her IV along with them.
Near the end of the first week after her infusion of bone marrow, Billie, Cat and Skylar were about to embark on their walk, when Dr. Berry came into the room.
"Hey there, scamp," Dr. Berry said to the little girl.
"I'm goin' for a walk. Wanna come?" Skylar said.
"Actually, I'd like to talk to one of your moms about your progress while you're gone for a walk. Is that okay?" she asked.
"Which one?" Skylar asked.
Dr. Berry looked between Billie and Cat. Billie was the first to speak. "Cat, why don't you stay? If there are any questions, you're more qualified to ask them. You can fill me in later."
"Okay," Cat said. She kissed Skylar's cheek, then Billie's. "Enjoy your walk."
After Billie and Skylar left the room, Dr. Berry turned to Cat. "I have to say that you and Billie are looking much more rested than I've seen you in weeks. I was worried about the two of you."
"You have small children, Alexis. Would you have done it any differently?" Cat asked.
"Busted!"
"Busted is right. A mom is a mom. We just can't help ourselves," Cat said.
"You're right. Okay, so let's talk about Skylar," Dr. Berry said. "First let me say that I am very pleased with her progress over the past week."
"We are too, but I'm still a little concerned that she's not eating well. I mean, her color is better and she has more energy, but she's just not eating much yet."
"That's to be expected. The antibiotics and anti-fungal meds we have her on tend to suppress appetite. One of the things I want to talk to you about is weaning her off those meds. It needs to be done slowly in order to be sure we're not inhibiting the grafting in any way."
"What do you mean?" Cat asked.
"It's been a week since the infusion and just this morning, I received the preliminary blood results monitoring her hemoglobin, ANC, and platelets. You will recall, a week or so ago, her levels were 8, 500 and 20,000 respectively. As I'm sure you also know, the average hemoglobin is 13.5 for a child her age. Normal ANC is between 3,000 and 5,000, and normal platelets are between 150,000 and 400,000. Comparatively, her numbers a week ago were critical. It's no wonder she was feverish and lethargic."
"So, what are her numbers now?" Cat asked.
"Keep in mind, it's only been a week since the transplant, but her hemoglobin is at 10, ANC is at 1,000 and platelets are hovering around 100,000. They're not where they need to be yet, but they are definitely improving. My concern about reducing the antibiotics and anti-fungal meds, is not knowing whether these two drugs are helping the grafting progress along. I won't know unless we discontinue the drugs," Dr. Berry explained."
"You started her on the drugs to begin with to bring her fever down. You were obviously targeting the infection that was in her body. Do you have any idea yet what caused the infection…or better yet, is the infection gone?" Cat asked.
"Good question, but one I don't know how to answer at this point. I'm not completely sure if her numbers are up because the grafting is working, or if they're up because the drugs are ridding her body of the infection. The easiest way to find out is by discontinuing the drugs and keeping a close eye on her numbers. If they continue to go up, the grafting is most likely working and the drugs may no longer be needed. If they go down, it may only be the drugs that are making her feel better and the grafting may not have worked at all."
Cat's eyes grew wide. "Don't say that, Alexis. I can't imagine putting our sweet angel through this only to have it fail."
"As critical as she was when we infused her, Cat, you knew there was a chance it wouldn't work. Let's hope that's not the case, but it is a possibility we need to be prepared for."
"So, where do we go from here?" Cat asked.
"Plan A is to slowly reduce the levels of meds in her system over the next few days, then to watch her numbers daily. If they level out or rise, we're good. If they fall, we'll need to put her back on the meds and hope she survives long enough for us to come up with a plan B."
* * *
Cat sat across Billie's lap on the one reclining chair in Skylar's room while Skylar slept peacefully on the bed. Cat's head was on Billie's shoulder. Billie stroked Cat's arm as she stared at the little girl on the bed.
"She's making such good progress. Maybe it's a bad idea to take her off the meds," Billie said.
"Alexis implied it was the only good way to know if the transplant is working. I don't see where we have any choice," Cat replied. "She'll begin by giving her half doses for the next two days, then quarter doses for two more before stopping them altogether."
"She's come so far in the past week. I'd hate to see her take even one step backward, Cat."
"I agree."
Billie kissed the side of Cat's head. "It's nearly eight o'clock, love. You should head home and spend some time with Seth and Tara before they go to bed. I think Skylar is pretty much out for the night."
Cat sat up and kissed Billie tenderly on the lips. "I will see you in the morning, then. I hope you sleep well, my love."
"I'll slip in beside Sky in a few minutes. Kiss the kids and mom for me, will you?" Billie asked.
"Of course."
Cat walked to the bed and kissed Skylar on the cheek.
"Sleep well, sweet angel," she said, then turned back to Billie. "Good night, Billie."
"Good night, Cat. I love you."
"I love you more."
* * *
Five days later, Dr. Berry entered Skylar's room carrying a folder of test results.
"Okay, yesterday was her last day of meds. The blood work we drew this morning will be used as a baseline for determining whether the graft is taking hold." Dr. Berry opened the folder and extracted a piece of paper. "For the record, her baseline numbers are 10.5 for hemoglobin, 1,500 for ANC and 125,000 for platelets."
Cat's eyebrows arched. "Those numbers are higher than they were five days ago," she said.
"Yes they are, albeit, slightly," Dr. Berry said. "That's a good sign, considering we have been steadily lowering her dose of meds for the past four days."
