Dear Doctor, page 6
‘I’m happy to do that,’ she said, pushing her plate away as the linguini finally defeated her. ‘But I’d better do some reading up on what’s involved so I don’t give them the wrong information.’
Josh nodded.
‘I’ll give you some books and then, some time this week, run through it all with you. You understand the concept?’
Kirsten heard the excitement in his voice—for someone who avoided commitment in his private life, he had it by the truckload where work was concerned.
‘It’s based on the fact that the poisonous effects of chemo and radiation limit its uses, but if we have donor material we can do full-body radiation and or toxic levels of chemo, destroying all bone marrow and cancerous cells but in the process destroying all the things that keep us alive. Then by infusing bone marrow into the blood, we start new marrow regenerating in the child’s body and, hopefully, provide a chance of a full recovery.’
Josh nodded.
‘A lot of people don’t understand the severity of what we’re doing. They know more about, so think in terms of, organ transplants, but organ transplants are easy compared to this. I mean, a donated kidney, once properly attached within a recipient’s body, will begin to work almost immediately, but bone marrow isn’t like that. It’s not even transplanted in the true sense of the word. We infuse it into the blood, then the stem cells, which are the useful part of it, make their way slowly to the host’s bone, then, even more slowly, have to regenerate before they become useful.’
‘That’s if they don’t reject the host body—it’s the opposite to what happens with other transplants, isn’t it?’ Kirsten said, having read up on it when little Nathan had been so ill. ‘The new material rejects the old.’
‘They call it GVHD, graft versus host disease. And that’s just one of the problems,’ Josh agreed, but far from sounding defeated, he made it sound as if it was a war he had to wage—and that he was armed and ready for it.
His tone re-ignited Kirsten’s own excitement. The opportunity to be part of this was bigger than the silly feelings she’d had for Josh, and with Grant so far away, and only in the city for occasional visits, she’d have the time and energy to devote herself entirely to the project—to really throw herself into work.
‘So, you see,’ she said to Gabi later, when, needing to talk to someone about it, she’d popped, after knocking properly, into her friend’s flat, ‘it all fits in so well, and it’s the kind of thing I’ve always wanted to do. The kids need to be isolated for some seven to ten days before the transplant, then three to five weeks afterwards, so they need a lot of supportive therapy. As well as the images on the walls, if I can swing that, I’ll need other ideas for keeping their minds off their poor sick bodies.’
‘It sounds fantastic from the challenge side of it, but these kids are very ill and some of them won’t make it. Are you prepared for that?’
Kirsten nodded.
‘I know I was upset before, when kids I’d worked with died, but with these particular patients it’s different because without the transplant they’ve no chance at all.’
Gabi smiled and gave her a hug, then stepped away.
‘And Grant—where does he fit into this grand new life? Did you two make any plans?’
Kirsten rubbed her thumb across the inside of the gold band of her engagement ring.
‘Plans? Please! I didn’t know we were engaged until he was getting into his plane. We’ve actually got to get to know each other a bit better before we talk about marriage. But before the ring was produced, when we were just interested in each other, he said he’d be down in a couple of months, then for the agricultural show in August.’
She grinned at Gabi.
‘In between, I guess we’re stuck with phone sex.’
She laughed at the shocked expression on her friend’s face. ‘Of course we don’t—well, not yet, anyway. Most of the time when he phones, it’s to tell me how his day has been. He comes in at dusk, has a shower, then sits on the veranda with a drink and rings me up—says it relaxes him after a busy day—Oh!’
‘What’s up?’ Gabi asked, but Kirsten was too busy remembering—and wondering what to do next—to answer.
When Grant had phoned the previous evening, she’d insisted it was her turn next, and had promised to phone him at seven-thirty. As it was now after ten…
‘What time do farmers go to bed?’ she asked Gabi, her voice so weak with guilt it was a wonder her friend heard it.
‘Earlier than this—but don’t worry. You can talk tomorrow night. Or email him. He’ll understand work had to come first. Wait till the cattle muster starts. You’ll be lucky if you hear from him for a month.’
Kirsten left, but as Gabi shut the door behind her she wondered about the long-distance relationship between her brother and her friend. She’d heard the passion in Kirsten’s voice when she’d talked about the new hospital project. Kirsten threw herself so wholeheartedly into everything she did, but would helping Grant on the family property—eventually—provide her with the same kind of satisfaction as the work she’d trained for?
If only Alex were here, not on duty, she could talk it over with him. But she wouldn’t mention her other worry to Alex—the one about Kirsten working so closely with Josh Phillips.
Again!
Kirsten heard the phone ringing as she unlocked the door, and raced to answer it. It wasn’t Grant, but Josh, to say he’d spoken to his computer-whiz cousin who felt all the ideas she’d suggested should be possible, and that he’d be happy to come up with a program.
‘The bad news is the cost,’ he added, when Kirsten finished expressing her excitement. ‘Not for the program, as Matt will do that for us, but the type of machine we’d need to run the programs, allowing different rooms to have different programs showing, would cost about thirty thousand dollars. It’s too much to take from the money we’ve been granted, Kirsten.’
She heard the regret in his voice, and knew he was as disappointed for her as he was for the children they’d be treating.
‘Leave that to me,’ she told him. ‘May I contact your cousin so I can get details of what we need, and which firms manufacture or distribute these machines? Maybe I can wangle a donation, or get some service clubs interested in fund-raising for it.’
They talked on, sparking ideas off each other, discussing strategies for helping parents as well as children cope with the long, drawn-out process of marrow regeneration.
‘I’ll see you tomorrow, then,’ Josh said, when Kirsten, realising an hour had passed and she still had to email Grant, brought the conversation to an end.
The flicker of excitement was purely because of the work—the challenge—she told herself, then, just in case it wasn’t, she spent another hour writing a long email to Grant, telling him all about the new job and her ideas for keeping the children occupied during their extended hospitalisation.
That’d serve him right for telling her about the crutching.
Josh finished the email he was sending to a colleague in the US, sent it winging through the ether and pushed his chair back from the desk. He’d wanted to check on some recent research into separating stem cells from the rest of bone marrow, but he knew that if he started, one site would lead to another and he’d be up for half the night.
But if he went to bed, would he sleep? Or would he think of Kirsten, and how she’d felt when he’d held her in his arms?
Trembling in his arms…
He opened a search engine and set it to tracking down the latest information. Better to put his sleeplessness to some use.
Betty was on duty in Ward 6C when Kirsten arrived for duty next morning.
‘Josh left a heap of books and papers for you. They’re in the tearoom. He said it’s a good thing you like learning because there’s heaps there, and he’s marked the interesting bits.’
Kirsten nodded, relieved to hear Josh had already visited the ward. She’d brought her laptop to work, intending to have a fiddle with some designs for the walls, but now, if she had any spare time, she’d be reading up on bone-marrow transplants instead.
As part of her ‘being available’ to parents, she was taking over all the OT work in 6C, so she began her ‘real’ work with a quick read-through of the notes left by the previous incumbent. She was pleased to see the play therapy program she’d devised more than twelve months ago was still being followed, though naturally adapted to meet the needs of whoever was in the ward at the time.
A number of children on the ward had been diagnosed early in their lives with some form of cancer. Hospitalisation and treatment had interrupted the stages of their physical development, and some of them were behind in both their fine motor skills, which controlled things like finger movement, and their gross motor skills—walking, running, climbing. Because practising these skills helped with the development of a child’s brain, it was important to interest them in games that incorporated different movements.
As Kirsten read through the notes, she got a better idea of the children with whom she’d be working, and their developmental stages. The older ones required very little OT as such, though strategies for oral care were important, and care of the shunt, a small plastic tube inserted for ease of delivering drugs, which a number of them had implanted in their chests, was also essential.
Teenagers, eager to be like their peers, could sometimes neglect these things. Just as those on oral medication—usually for acute lymphoblastic leukaemia, which required up to two years of daily tablet-taking—often neglected to take their tablets. As many as one in five behaved this way, according to one survey done in the UK.
For a few minutes she puzzled over how this could be overcome—could she persuade those in the danger ages to treat the tablets as vitamins and take them automatically? Or devise some interesting form of reminder like a watch alarm, so, instead of seeing themselves as ‘different’, they could see themselves as ‘special’.
Or a peer partner who oversaw the taking of medication? Would that be more acceptable to a teenager?
Realising it wasn’t a problem that could be solved immediately, she set it aside for the moment, hoping her subconscious might come up with something, and again read through the patient notes.
Having only one new patient in the ward made Kirsten’s choice of who to see first easy.
‘The chemotherapy not only destroys cancerous cells, it destroys a lot of good cells as well,’ she explained a little later to Lily, a thirteen-year-old admitted for her first treatment for the second most common childhood cancer, acute myeloid leukaemia, or AML. The young girl was pale and tired-looking, and had been sitting up in bed as if not sure what else there was to do.
‘And because it affects the mucous lining in your mouth, it can cause mouth ulcers and other irritations—very painful stuff! That’s why looking after your mouth is very important.’
She took Lily through the procedure, showing her samples of the mouthwash, antifungal gel and lozenges that patients used. Lily asked questions, mostly about her treatment, but of course the subject of hair loss, always a major concern for a teenager, came up.
‘It looks to me as if you’ve got a great-shaped head,’ Kirsten told her, feeling Lily’s head so the girl didn’t think it a patronising conversational gambit. ‘And shaved heads, both for males and females, are far more common now. It doesn’t automatically label you as a cancer sufferer.’
‘I know—I’m looking forward to it,’ Lily said. ‘I wanted to shave my head last year for the cancer appeal, but Mum wouldn’t let me so I cut it really short and dyed it green. But once I’m bald I’m going to get a tattoo right here.’
She pointed to a spot behind her left ear.
‘Try a stick-on one first,’ Kirsten suggested. ‘I know there’s less emphasis on steering clear of infection these days, but getting a real tattoo with a real tattoo needle and real ink might be pushing the envelope a little. I’m sure Dr Phillips wouldn’t approve.’
‘You mean Josh? He told me to call him Josh. Isn’t he dishy? Wouldn’t you kill to end up with a fellow like him?’
‘Perhaps not kill,’ Kirsten said faintly. ‘And wait until you meet Dr Granger—he’s the resident attached to this ward. Tall and dark with those smouldering kind of eyes.’
‘Talking about me, are you, girls?’
As Kirsten spun to confront the first man they’d been discussing, she wondered how much he’d heard.
‘Your eyes don’t smoulder,’ she told him firmly, hoping to counter the look of adoration Lily was giving him.
‘I bet I could make them smoulder,’ he said, turning to Lily and pulling such an appalling face she giggled helplessly.
Lily’s mother arrived at that moment, and though she waited to be introduced, as soon as the civilities were done, Kirsten excused herself and moved away. Children not scheduled for treatment were gathering in the play area in the centre of the ward, while others were already hooked up to bags of fluid, enduring the slow drip of the chemical cocktails into their blood.
Arabella, so slight it was a wonder her bones didn’t break, was organising the others, setting up a ‘school’. Kirsten took her place as a pupil, and from her small chair guided and encouraged the children to use various muscle groups in their play.
Parents came in, those whose children were long-term patients less obviously stressed now they knew the system. They settled by their child’s bed if he or she was receiving treatment or too ill from the after-effects to participate in the games. Others joined Kirsten as ‘pupils’ at Arabella’s school, delighting the little girl by entering into the spirit of the game.
By lunchtime Kirsten was feeling the effects of the physical exercise. She’d led the children, an aide and a couple of parents on a ‘follow the leader’ through and around the various bits of equipment in the ward.
‘Strokes was never this energetic,’ she said to Betty, who chuckled, though sympathetically.
Sitting down in the tearoom, she checked the pile of books Josh had left. She’d need all her remaining energy just to carry them home. But rather than start on them now, she phoned Josh’s cousin to ask who would be most likely to help by providing the equipment they’d need, searched a Yellow Pages for the requisite phone numbers, then began to beg.
Experience told her the direct approach was best, so she contacted six firms, asking for the name of the person in charge, and when it might be possible to make an appointment to see him or her. She also explained what she wanted, because busy executives who were giving up their time to see her would need to know why. Going in cold, she’d found, often resulted in a flat and non-negotiable refusal.
In the end, she had four appointments for the following week, and from various junior people knew exactly what she’d need to tell Maintenance in anticipation of getting the equipment.
The afternoon play session was less lively, most of the children content to do puzzles or play games on various hand-held toys. Kirsten sat with Arabella at one of the computers, showing her how to move the mouse and click on it to change the pictures on the screen.
‘We have times when the computer has to be pre-booked so all who want a turn get one, and other times when no one’s using it.’ Sally, a young aide on the ward, came to stand behind them. ‘This is the first time Arabella’s tried to do things herself.’
Kirsten understood why. Although the mouse was ergonomically correct, it was made that way for an adult hand, and Arabella’s small hand, further weakened by her illness, found it difficult to manipulate. When Kirsten had been in the ward previously, she’d had a range of mice available, but rummaging through drawers at the computer desk failed to produce any of them.
She fetched her own laptop, which used a touch sensitive pad to manipulate the cursor, and soon had Arabella shifting images about the screen and opening boxes to reveal new pictures and games.
‘The touch pad is obviously the way to go.’ This time it was a deeper voice speaking over her shoulder, and the diamond flashing on her finger wasn’t enough to stop her skin reacting to his presence, or tiny goose-bumps rising on her forearms.
‘Yes,’ she said. ‘I’m meeting your cousin after work so we’ll talk to him about how we can incorporate it into the system.’
’My cousin Matt?’
Josh sounded so surprised Kirsten turned to look at him.
‘Yes. We’re meeting at Mickey’s for a drink and a chat. You gave me his phone number, remember. I’ve appointments to see some video people next week so I need to know exactly what I’m asking for, and I also want to talk to him about patterns and designs for the wall. I can visualise something like a kaleidoscope but don’t know how to go about making that work.’
The explanation didn’t help Josh in the slightest. His mind had stalled back when Kirsten had mentioned meeting Matt. It had nothing to do with the fact that Matt had more than his share of the Phillips good looks—he’d probably got a bit of Josh’s as well—but he was also the renowned playboy of the clan.
In fact, his reputation was far worse than Josh’s own. Single, married or engaged, as far as women were concerned, it made no difference to Matt. Once he saw a woman he fancied, he pursued her with a relentless single-minded intensity which even the most assured and blasé of women seemed to find irresistible.
And it was useless to hope Kirsten wouldn’t take his fancy. She was only the most fanciable woman in the entire hospital, red-haired or not!
He hid a groan that threatened to escape, then realised all was not lost. After all, who was the head of this unit? Who would have to approve any expenditure? Even approve the introduction of equipment not essential to the patients’ physical health?
He excused himself and left to phone Matt.
Which was his first mistake.
Actually joining them for a drink was the second, he realised much later as he sat and watched his cousin, not at all put out by Josh’s presence, flirting with Kirsten.
