rene lowered her hand, letting it rest on her knee as she leaned her head against the back of the couch she was sitting on. Her eyes fell closed, as she did her best to calm the sudden rush of emotions that Nathaniel’s letter had dug up within her. It didn’t help that the last few days had brought her to her near breaking point, starting with the conversation she had with her oncologist followed by losing a kid last night.
She was still beating herself up about that. The code blue had been paged overhead while she was in the on-call room, half-asleep. At first, she hadn’t realized the operator had said “Pediatric ICU” until they had repeated the announcement again. It was while she was scrambling out of the bed that her phone started ringing. She answered it, keeping the device between her shoulder and ear as she leaned down to tie her shoes. “Talk to me.”
“It’s Jamie.”
“Shit,” she breathed out, getting to her feet. Jamie had been admitted last week, after being involved in a motor vehicle accident. He had severe burns, the damage to the car causing it to go up in flames; personally, Irene had wondered how the boy was still alive when EMS had gotten to the scene. In addition to having second and third degree burns covering most of his body, he had a broken arm and fractured ribs on the right side, leading to a punctured lung. So far, they had managed to keep him stable, but his lab results the morning of her shift were suggesting possible sepsis.
He was only seven years of age.
“He was having difficulty breathing, his heart rate was one-hundred and eighty-three, blood pressure eighty over thirty-eight.”
Irene rushed out the door and into the hallway, already having a hunch as to what was going on. Acute Respiratory Distress Syndrome, a condition that seemed to only occur in those that experienced immense physical trauma. “And you didn’t call a Rapid?”
“We were about to when he became unresponsive,” the charge nurse said over the line just as the female resident spotted her with the mobile computer. Their eyes met, and Irene promptly hung up, placing the phone in her pocket before entering the room.
Nurses surrounded the hospital bed. One had already begun chest compressions while the other was hanging bags of fluids, already anticipating the orders Irene was about to give. “I want both of his IVs connected, and just let it flow. Ignore the pump. Where’s the code cart?” she asked, slipping on a pair of gloves as she glanced at the monitor over the bed.
“Marnie went to get it.”
“I want blood gases ordered STAT. Chest x-ray to follow.” They were likely going to puncture his other lung, at this rate. “Is respiratory here yet?” And he was going to need to be intubated.
She switched off with the nurse doing compressions, allowing her a small break. It had already been two minutes at this point, and Jamie didn’t seem to be responding to anything they were doing. A sense of dread came over her, and she had to remind herself to keep the pace. Going faster or harder with compressions would do the boy no good.
“Where’s the damn code cart?” she shouted out to the charge nurse, a scowl pulling on her normally friendly features. She paused a moment to let a nurse bag him before resuming her movements.
“I’m here! I’m here!” Marnie, one of the nurses, rushed into the room with the cart followed by two respiratory therapists and an anesthesiologist. One RT set to work drawing the ABG while the other began to set up supplies for intubation.
“Get the defibrillator ready.”
Irene didn’t move from Jamie until they were putting the paddles on him. The first shock did nothing. They resumed CPR until the anesthesiologist was ready to intubate. By the time they had him hooked up to a vent, nearly ten minutes had passed.
A second shock was administered. Nothing.
It was at that point that Irene could feel eyes on her. The monitor’s alarms were going off. No heart rate detected.
“One more round,” she breathed out the words, positioning herself over the young boy’s body to begin compressions once more. “Then...I’ll call it.”
She did not rest until the next morning. Following Jamie’s death, she had to make a phone call to his, already quite distraught, parents. She told them, using the gentlest of tones and words, what had happened. Of course, they wanted to come in and see him right away. Irene didn’t blame them; she would stay as long as they needed her to. So in addition to all the paperwork and charting she had to do, she spent three hours at the bedside with Jamie’s parents. They had questions, and she did her best to answer them. His poor mother could barely get words out; she was inconsolable, and in the end, it frustrated Irene that she could do little more than offer words of comfort.
When they left, she hugged them both, again apologizing for their loss.
They didn’t place the blame on her. Irene could tell from their heartfelt thank you as well as the way they looked at her. But she had trouble letting it go. She always did. At home, laying in her own bed, instead of attempting to fall asleep, she played the code over and over again. Was there anything she could have done differently? Maybe, if she had gotten there faster Jamie might be alive. Before she had gone to the on-call room, had she missed something? Should they have tried resuscitating longer? New scenarios of how the situation could have panned out had she done something else were abundant and time-consuming. After hours of this with no sleep, she had gotten up, going about her normal routine. She got the mail later in the day, after managing to get a short nap in. Nathaniel’s letter had been among the pile of envelopes, and instead of making dinner--she didn’t have much of an appetite--she sat in the darkness of her living room to read it.
He was right, of course, and she was too drained to begin telling him so.
Instead, while holding back tears, she got her cell phone and dialed her mother’s number.
“Hello?”
“Hi, Mama.” Her voice cracked.
“What’s wrong, sweetie?” She knew instantly, her tone heavy with concern.
“Can you stop by?” Irene sniffled, swallowing thickly as her fingers played with the edges of the papers in her lap. “I have something I have to tell you.”
“Of course, baby. I’ll be right over.”
“Can Dad come, too?” she lifted a hand to wipe at her eyes.
“Yes. I’ll bring him with me. Okay? Give us fifteen minutes.”
~*~*~
Those fifteen minutes felt like one of the longest waits of her life. Irene passed the first couple of minutes putting away Nathaniel’s letter, not wanting her parents to see it. They could easily assume it was from Tom, and her mother was the type to read through her mail. Privacy had never been a thing, back when she lived with her. To explain why she was keeping in contact with her boyfriend’s friend rather than her boyfriend himself would be...awkward. Especially since she didn’t quite know why herself. Although, Tom could write to her at any point, really.
Up until there was an actual knock on her front door, Irene couldn’t keep still. She paced around the front portion of the house, pulling on the sleeves of her sweatshirt, fiddling with the claddagh ring she wore on her right ring finger, worrying her bottom lip until she accidentally bit it. That put an end to that.
When her parents finally did arrive in her father’s pick-up, she watched through the front window as they hurried up the walkway. They only managed to knock once before she had thrown open the door, stepping to the side to allow them in. For once, her mother didn’t say a word; she just slipped off her shoes in the entryway before getting out of her husband’s way. He was silent, too, hands buried deep into the pockets of his jean jacket; he didn’t bother taking off his cap. They both looked at their daughter, who still seemed a bit unsure how to start.
“Why don’t we go sit down?” Irene suggested, gesturing with her hand to the couch in the living room.
It was when they were all settled in the living room, her parents taking the love-seat while she sat in the armchair across from them, that Irene’s mother seemed unable to keep her curiosity to herself any longer. “Are you pregnant?” There was a slight giddiness hidden beneath the seriousness of her tone, and for some reason, Irene found herself irritated by the question.
“No,” she said softly, folding her hands in her lap.
“Then what is it, baby? You terrified me with that phone call, you know.”
“Donna,” her father warned, sending a glare his wife’s way. He knew she was really worried, just as he was, but pressuring Irene into spitting out whatever was bothering her wasn’t the way to go about this. Clearly, their daughter was pretty upset, and she hadn’t thought about how to break whatever it was to them.
Donna pressed her red lips together. She knew something had been going on with Irene. Call it mother’s intuition, but she hadn’t been the same, bubbly, smiley girl since Tom had told them that he would be going overseas again. At first, she had attributed the depressed mood to his absence, but as time passed, she had a hunch that it was something much more than that.
Silence settled over them again as Irene struggled with how to talk about this. She honestly didn’t want to go into detail about how she discovered the lump that had brought her to her gynecologist in the first place. She also didn’t have the energy or the emotional strength at the moment to give them a long story, going through each of the referrals and doctor’s visits and biopsies and imaging...In the end, it would just be easier to cut to the chase.
“I have breast cancer.” And for some reason, saying those four short words seemed to lift an invisible weight off her chest.
Only for it to return as she gauged her parents’ reactions. Her father didn’t seem to understand. His dark brows were furrowed in confusion, as if she had just spoken gibberish to him. He blinked, his lips parting for a moment as if ready to pose a question, before shutting once more. Her mother, meanwhile, had fully grasped the gravity of what she had just revealed, so she got up from her spot on the sofa and rushed over to Irene.
Donna’s hug was near bone-crushing, but her daughter was used to it. The familiarity and warmth of her hold was enough to bring fresh tears to her eyes. Surrendering to it, she wrapped her arms around her mother, her face buried in her shoulder.
“I’m so, so sorry, honey.” Her voice was soft as she smoothed a hand over Irene’s hair. “When were you diagnosed?”
“A little over a month and a half ago…” Irene pulled away a bit, wiping her cheeks with both palms. “I didn’t want you both to worry until I knew exactly what was going on.”
“So what does this mean? They can cure it, right?” her father finally spoke up, his brown eyes on the two of them.
“I hope so. Dr. Rosen, the oncologist, wants to do the surgery as soon as possible,” Irene informed them, looking from her father to her mother. “He wants to remove the right breast completely while, hopefully, only having to do a lumpectomy on the left.”
“Have you talked to a plastic surgeon? What about the lymph nodes?” her mother questioned, moving to sit on the arm of Irene’s chair and crossing her legs. Donna knew a bit more about this, as breast cancer ran in her side of the family; however, all the women in her family weren’t diagnosed with it until they were well into their post-menopausal years.
“He gave me a list of surgeons in the area, and as for the lymph, he said he would do a biopsy during the surgery itself.”
Their conversation lasted for at least an hour. Some of the time had to be spent bringing Irene’s father up to speed; he wasn’t big into the medical stuff, and even though Donna had been a housewife, she found the medical field and health care quite interesting. In fact, when her daughter had still been at home, she often helped her study, learning some things herself.
Then, they moved onto actually talking about the plan going forward. Irene explained to them that she had to make an appointment with a plastic surgeon before she could decide on a date for the actual procedure.
“May I see the list he gave you?” her mother asked, curious as to who Dr. Rosen was recommending. A few of her friends had gotten plastic surgery, and she wanted to make sure that her daughter wasn’t seeing any of their surgeons.
Irene disappeared into her bedroom for a moment before coming back with the piece of paper she had been provided with. Already, she had crossed off a few names, after having done some research of her own. She handed the list of providers to Donna, who looked it over with a grave expression. At one point, she leaned over to pick up a pen from the coffee table and began to mark up the page. By the time Irene got the sheet of paper back, more than half of the remaining names had been crossed off.
“How are you going to afford all this?” was her father’s next question.
While Irene did make some money as a resident, she didn’t make nearly as much as a doctor did, and most of it was split up between bills and her student loan debt. She had decent health insurance, but she wasn’t sure if it covered all the plastic surgery she intended on having.
“I’m still not too sure how much this is all going to cost,” she answered honestly, not wanting to stress over the finances just yet. She was more worried about her health and what this meant to her career. For the surgery, she’d have to take time off, and if the lymph node came back positive…
“We’ll figure it out, Robert,” her mother added, waving off the topic with a manicured hand. “Worst case, we’ll help out a little. No big deal.”
“Does Tom know?”
Irene looked down at her hands, which rested in her lap. A part of her was kind of hoping Tom wouldn’t have been brought up. She hadn’t heard from him since he left, and while Nathaniel had assured her not to take it personally, that he was just busy, she had thought he might be concerned enough to write back and ask.
“He knew I was going for tests, but I haven’t been able to tell him about the diagnosis,” she answered honestly.
“Well, don’t you think he should know?” Donna asked, using her fingers to push some of the hair back from Irene’s forehead.
Irene didn’t have an answer to that other than, “I’d rather tell him in person than in a letter.”
“But he’s probably worried sick, Irene,” her father interjected with a frown, knowing he would be if he were in Tom’s place, and Donna was the one with cancer.
“I know. Hopefully, I’ll be able to contact him soon,” she said, recalling Nathaniel’s letter. She’d rather tell him over Skype, as face to face as they could get at this point.
She didn’t know if her parents had actually been satisfied by her answer or if they had taken notice of just how exhausted she was. In the current moment, she was slumped back into the armchair, her eyes barely able to keep open, and her mother’s comforting touch on her forehead wasn’t helping her stay awake.
Nothing else was asked, and it seemed that everyone understood that this conversation could be continued at another date.
“It’s late,” her father pointed out, getting to his feet and placing his hands back in his jacket pockets. “And I think we could all use a good night’s rest.”
His wife nodded in agreement, her eyes moving from his face to rest on their daughter’s. “Do you want me to come with you when you go to the plastic surgeon?”
Under normal circumstances, Irene would have gone to all her doctor’s appointments by herself. She had been since she could first drive. The only times she ever had her mother present at a medical visit or procedure was when she could not drive home afterwards, due to anesthesia. Until now, though, she had never had any sort of surgery, unless one counted wisdom tooth extraction as much. The idea of going under the knife terrified her, and even though this was just an appointment, she wanted someone there.
“Sure.” She nodded with a tired smile as she slowly stood. “Thanks, Mama.”
“Of course, baby,” her mother replied, pulling her into another tight hug. “We’ll support you through this. I know it seems scary, but it’s going to be okay.”
“Your mother’s right.” Her father came over to the two of them, placing a hand on Irene’s shoulder. When his wife had finally relinquished their daughter, he gave her a squeeze into his side.
The three of them said their goodbyes, and Irene walked them to the door, giving her mother one last hug in the threshold before watching them walk to the truck. Once they had driven off, she locked up the house and let out a heavy sigh of relief, wondering why she hadn’t just told them earlier. Of course, she had been worried about worrying them, but they had seemed to handle it well. Better than she had, in some capacities.
She’d have to thank Nathaniel, but for now, she’d get some much needed rest.
~*~*~
Dear Nathaniel,
I never doubted Tom’s intelligence or his ability to lead. Hearing you praise him makes me proud. However, he still can be a stubborn ass at times, as I’m sure you know, and I don’t know what he’s like there with you. There are times he still behaves like a child, acting like my two college-age brothers. They would get into a lot of mischief together on my Uncle’s farm, when we visited. I’m glad he’s being responsible at work, though; that’s where it counts.
As for being a lawyer, I don’t know. He’s never mentioned it to me, but I could see it. I’d support him if he wanted to pursue law.
Don’t worry about the letter. I’m not angry with you or him. In some ways, I think it was a good thing, that you read it and he asked you to respond to it. Otherwise, I don’t think we’d still be in contact, and I definitely wouldn’t have told my parents that I have cancer just yet. I want to thank you for that. I sat them down yesterday, after I read your reply. We had a good talk, and they took it pretty well, all things considered. My mother is going with me to my next appointment, and I know, if I ask, she’ll take care of me during my recovery. We haven’t settled on a date for the surgery yet, but my oncologist is pushing it to be sooner rather than later. I understand why, but I won’t lie that it’s pretty terrifying to me. I’ve only ever had my wisdom teeth pulled. Nothing more than that.
But I’m sure I can brave this, if you and Tom can brave what you’re going through. Sometimes I forget just where these letters are going and why.
You’re also right about it not being your place to tell Tom. I overstepped by asking you to make that decision. I just don’t want my choices to impact your safety. The last thing I want is to have Tom get distracted again and put lives at risk. So for now, don’t tell him. I’ll talk with him, hopefully, if and when a Skype call is a possibility. Worst case, I’ll just have to deal with sending him another letter. He has the right to know for sure, and in some ways, it’s unfair leaving him in limbo like this. But I really would rather tell him as close to in person as possible. That way, I can explain things, if he has any questions, maybe even assure him that I’ll be okay.
By the way, your grandfather sounds like a really wise man, and I’m glad he was there to raise you and love you when you needed someone to. I am sorry about your parents, though. Reading that and complaining about feeling alone, I want to apologize for being so insensitive. Still, I do appreciate you telling me about your gramps; it really opened my eyes to what I needed to do. It sounds like you love him a lot, too, and I hope you’re finding ways to keep in touch with him, even now.
I lied to you, also, if you remember, but I suppose you’re right about Tom wanting to protect something that was private.
I’m happy to hear that your comrade made it. That must have been difficult, trying to assure him when you were pretty terrified of the opposite happening. But sometimes lies are needed. Even in healthcare, we tell patients and family members all the time that things will be okay when we can’t really guarantee it. In school, they tell us never to be dishonest, but I feel that giving them some sort of hope to cling onto makes whatever time they have left a bit less petrifying. At least, in my experience. So I think you didn’t do anything wrong. If anything, you made that soldier feel a bit better.
Ah. I hadn’t thought of that, so good thing I sent the picture, then. I almost didn’t, figuring Tom had already shown you the photos we had sent. I hadn’t considered that you might not know who is who. As for what you said about my smile, I appreciate it. Honestly, I used to be a bit insecure about it, growing up, especially when I had braces.
I’ll keep writing to you as long as you want me to. I enjoy it, actually, and I look forward to hearing from you. In the end, it’s no trouble for me; I’m more worried about you having time to rest. So if you can’t respond right away or at all, I’ll understand. To be quite honest, I didn’t expect for this back and forth to go as long as it has. Let me know about the Skype call. If possible, it’d be nice to say a quick hello to you, too. I’d also like to say thank you to your face. I don’t think I can express just how grateful I am for your advice and updates; I wouldn’t have the support I have now, if it weren’t for your letters.
If I can do anything in return, let me know. I can send another care package, if needed.
Keep safe and well.
Irene
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