by Trina Allen
"Hey! Hey, Ray!"
The man walked on, ignoring her plea for him to stop. Thinking maybe he hadn't heard her, Dr. Angel Carter picked up her pace. Her feet hurt, even in her Nikes, and her heart pounded from the short jog. Yet he was still well ahead of her. It was the second time Angel had thought she'd seen him. But her tired imagination must have been playing tricks on her, because Ray Carter had no reason to be at the hospital. He had left Angel two years ago and moved to Georgia to teach high school history. As far as she knew, he hadn't been north of Atlanta since.
Angel's cell phone vibrated as the man disappeared around the corner. She glanced at the text message, "Room 312." That was six-year-old Evelyn Perry's room. Angel unconsciously rubbed the old scar on her own abdomen.
A pediatric hematologist specializing in rare blood disorders of children, Angel suspected complications from the splenectomy Evelyn had the day before. Angel didn't bother with the elevator. Instead, she pulled the stairwell door open and ran up the stairs, two at a time. Evelyn had been born with spherocytosis, a rare blood disorder. Angel had treated Evelyn through crisis after crisis, as her small frail body struggled to fight off infections. Eventually the only remaining course of treatment was the removal of Evelyn's spleen to stop it from destroying her red blood cells at a rate faster than her bone marrow could replace them.
Sprinting past Evelyn's worried-looking mother and through the door to room 312, Angel immediately recognized the signs of crisis. A grim-faced young nurse monitored Evelyn's blood pressure. An older woman, the head pediatric nurse, said, "Dr. Carter, I was about to page you again." Her eyes met Angel's and held for a moment. "Fever's spiked to 103 and she's developed a productive cough."
The young nurse said, "I checked her vitals an hour ago. Her temp was 99 with no cough."
Angel looked at Evelyn's flushed face and said, "Start her on IV penicillin, stat." She suspected Evelyn had pneumonia caused by the bacteria Streptococcus pneumoniae. Until yesterday, Evelyn's spleen had recognized the bacteria as an invader and removed it from her bloodstream. Now, without a spleen, Evelyn's body had no defense against the deadly bacteria. Her patient could die from an infection that a child with a normal immune system would fight off with no complications.
Angel walked back to her office with tears burning her eyes. There were times that she wished she weren't a pediatric doctor. It was too difficult watching her young patients lose the battle against whatever disease they were unlucky enough to catch or inherit. And her own baby's suffering had been the worst, nearly ending her career two years ago.
Alexis Ann Carter had been born with spherocytosis, inherited from her mother. At five days old, Alexis's skin had begun to yellow. She suffered from liver failure as her hemoglobin dipped to dangerously low levels. When Alexis was seven days old, Angel and Ray made the decision to have Alexis's spleen removed. The alternative was to take a chance that their tiny daughter would suffer permanent brain damage.
Ray had never forgiven Angel for arguing for the splenectomy. She swallowed the lump in her throat, remembering the day of Alexis's surgery. She had asked to assist, a decision that she would always regret.
The Chief Pediatric Surgeon's words haunted her. "Let's give this little girl a chance at life." Dr. Scott Hessler's eyes had met hers, steady above his surgical mask. Angel had trusted Hessler to save Alexis, knowing that he and his team were the best in his field.
Working with a laparoscope inserted through a small incision, Hessler expertly closed off the blood supply from Alexis's stomach to her spleen. Then Hessler said, "I'm ready to staple the main blood supply to the spleen. How are her vitals?"
Had she imagined agitation in the anesthesiologist's voice? She observed Alexis's heart line bouncing rhythmically on the heart monitor. Everything must be okay. Her daughter was fine.
"Temp down to 89." There was definite anxiety in the anesthesiologist voice.
The sight of Alexis's small body, shrouded and helpless on the operating table sent a chill to Angel's heart. She hugged herself, unaware that she was shivering.
Hessler removed the stapler from the incision and barked, "Get a warming blanket on her! STAT."
At that moment Alexis's tiny heart stopped. The monitor flatlined. Time slowed and seemed to stop for Angel. The slaughterhouse smell of blood accompanied by the frantic sounds of unsuccessful resuscitation burned a place into Angel's memory along with Hessler's words, "Time of death, ten minutes after eleven."
Her colleague removed his mask and looked away before meeting her eyes. "I'm sorry."
Sobs shook Angel. She didn't know how long she held Alexis's small hand, the smell of death and blood heavy in the cold sterile room. Finally, staring through tears at the litter of blood-stained gauze on the floor, she was aware that a nurse was asking if she could move Alexis.
Angel left the small body lying on the operating table, but like her daughter, Angel never recovered from Alexis's surgery.
Angel shook her head, willing the memory away. She locked her office and walked to her car in a state of exhaustion. As she pulled onto the highway, traffic slowed. Angel glanced at the speedometer, sighing at the mere 23 mph she was traveling. At this speed, it would take her an hour to drive the ten miles home from Duke Children's Hospital.
More memories from two years ago surfaced. Ray carrying two steaming cups of coffee into their bedroom. She had run her fingers through his dark curls and then over his muscular chest, pulling his robe open in invitation. Ray had growled in pleasure and covered her body with his.
But she hadn't enjoyed the lovemaking then, or for months afterward. As time passed, guilt and thoughts of Alexis in her small grave made Angel distant. Ray became angry and frustrated. She began spending more time at the hospital to avoid Ray's cold silence.
The corduroy hum of her tires on the shoulder startled Angel back to the present. As she straightened her car back in the lane, an old grey Toyota truck pulled in front of her. She cursed under her breath and felt a hot flush rise from her throat to her face. Angel strained to get a better look at the driver, but the Toyota was already several cars ahead of her. The driver's window had been down. Not many people drove in North Carolina's summer heat with their windows down. She swallowed. Ray had always rolled his windows down to smoke, his shoulder-length hair unruly in the wind. The memory shot a thrill through her.
Angel switched lanes and pulled closer to the Toyota, but was far enough back that the driver wouldn't recognize her. He flipped a spent cigarette out the window, the gesture so like Ray that a chill ran down her back. Ray had driven a grey Toyota two years ago. She unclenched one hand from the steering wheel, and wiped it on her pants.
The next afternoon Angel rubbed her tired eyes and glanced at her watch. Four o'clock. She had one patient left to see. Today might be a rare occasion when she left the hospital at a decent time. She might even find the energy to work out at the gym.
Hanging her stethoscope around her neck, Angel left her office and knocked on exam room one. Entering, she winked at the six-year-old girl on the clinic bed. Jessica Stern was one of Angel's favorite patients. Always cheerful, Jessica was pretty with dark almond shaped eyes. She imagined Alexis might have looked like Jessica, who was so similar in coloring to Ray's childhood pictures.
"Mrs. Stern, hello." Angel nodded at Jessica's mother, noting the bleary eyes, in skin stretched from lack of sleep. Then Angel turned toward the child, who was dressed in jeans and a T-shirt, "How are you today, Jessica?"
Jessica's face lit up with a gap-toothed smile. "I'm good, Dr. Carter. I learned to tie my shoes. I can do it all by myself, see."
Watching Jessica demonstrate the new skill … renewed longing for Alexis welled in Angel's heart. Speaking over the lump in her throat, she asked, "Any more bleeding in your mouth, Jessica?"
At Jessica's shake of her head, Angel looked at Mrs. Stern, who had taken the chair next to the exam table. "Any bleeding of the gums?"
"No bleeding, Dr. Carter," Mrs. Stern replied dully.
Jessica had several nosebleeds a year ago. Robert Nelson, her pediatrician, was concerned about the bruising on her arms, legs and torso and had referred her to Angel. With a low platelet count, Jessica's blood wasn't clotting normally.
"The crisis seems to be over," Angel said, looking at Jessica's mother. Her heart went out to the woman, a single parent struggling to support a sick child on a waitress's salary. "Jessica's platelet count has returned to normal on its own. I would continue to avoid aspirin and other anti-inflammatory agents like ibuprofen for the next few months, Mrs. Stern, but I think Jessica is out of the woods."
"Thank God," Mrs. Stern said, weakly.
"Jessica, you can go back to your gym classes at school and play outside again." Pulling a sheet of animal stickers from her pocket, Angel handed them to Jessica just as her cell phone vibrated. Ignoring it for the moment, she asked, "What does a duck like to eat with soup?"
"What?" Jessica asked.
"Quackers." The little girl's smile tugged at Angel's heart.
Sprinting down the steps to the ER, Angel imagined for the hundredth time what Alexis would have been like had she lived.
She heard the infant's screams as soon as she opened the stairwell door. Angel followed the sound to an ER exam table where a rumpled young woman hovered over an infant whose tiny face was red from the exertion of its cries. Angel swallowed her emotion at the sight of an IV already taped to one small foot. The small legs kicked in rhythm with the child's screams, the IV line following the tiny feet in circular jiggles.
Angel pulled the curtain around the exam table and introduced herself. She scanned the baby's chart. As she suspected, Daniel Rothstein had been given no pain meds. She made a note in his chart in bold ink, pressing down so hard with the pen it slid off the chart and skittered across the floor. Staring at the pen to avoid eye contact with his parents, she shouted orders for the infant, then retrieved the pen before administering the medication into his IV line herself.
"How long has Daniel been bleeding?" Angel said, finally looking at the mother and then the father.
Mr. Rothstein crossed his arms and said, "Since the ceremony early this morning."
Angel examined the baby's incision, noting the blood still seeping from the wound. "Any family history of bleeding disorders, Mrs. Rothstein?"
"My sister died delivering her baby," the woman said, wringing her hands. "The doctors couldn't stop the bleeding. Is that important?"
"It could be." Angel knew that if Daniel had afibrinogenemia, he had inherited the abnormal gene from both parents, like all recessive disorders.
"Mr. Rothstein, is there any history of bleeding disorders in your family?"
"No. The Rothsteins are notoriously healthy," he said, glaring at his wife, who cowered in silence.
Angel nodded and then listened to the baby's heart, ignoring Mr. Rothstein for the moment. The boy's tiny screams had slowed. His lips quivered with exhaustion, but he seemed painfree. Angel was still angry that this baby had suffered needlessly. The local anaesthesia that the rabbi had administered would have worn off a few minutes after the circumcision.
Angel ordered plasma to supply the clotting agent the infant needed and ordered a series of tests. If the results came back as she expected, she'd have to tell his parents that Daniel Rothstein had been born missing a certain protein known as fibrinogen, or coagulation factor I. Daniel would need transfusions to supply the clotting factor fibrinogen for the rest of his lifenews Mr. Rothstein would probably not take well.
Angel walked to her office and threw Daniel's chart onto her desk. She rubbed her eyes and then massaged the muscles in her neck. She and Ray had held on so hard to the hope that little Alexis would recover from her surgery.
The message light on her office phone blinked. Angel hesitated before playing her messages, dreading another crisis.
"Angel, uh—" Adrenalin flooded her at the sound of his voice.
"Listen, I—" Ray cleared his throat, "I'm here in Durham for a few days. I have been offered an assistant principal job in Orange County."
Angel felt her face flush.
"I wanted to see you in person, Angel, so I stopped by the hospital, but you had an emergency with a patient. Anyway, call me on my cell if you'd like to get together while I'm in town."
She pushed delete, got up, paced, and reached for the phone. She cleared her throat, dialed and then hung up before it rang. She walked toward the door of her office, turned once and looked at the phone before closing the door behind her.
She found Daniel asleep, his skin tinged with a healthy flush. Angel warmed her stethoscope before listening to the steady beat of his heart. He was breathing easily and appeared free of pain.
"Remission." Word Catalyst (September, 2008).