When It All Falls Apart (Book One) (4 page)

“They said they’ll send someone in soon,” he said.

We stood next to her bed in silence, listening to the beep and hum of the machines hooked up to her body.

“Should we try to wake her up?” I asked.

“The nurses said we should let her sleep. She’s probably fighting off some infection and her body needs sleep.”

I hadn’t thought about an infection. Maybe she had another bad bladder infection. It wouldn’t explain why she threw up, but maybe it was why she was so tired and having such a hard time waking up. It was a few more minutes before a man pushed through the curtain behind me.

“I’m Dr. Yang,” he said. He was a short man with carefully cropped hair and a white collared shirt half haphazardly tucked into his pants. He stuck out his hand to David first and then me. We eagerly shook hands, anxious to be done with the formality. He took a seat on a stool and propped himself up against the wall.

“What’s going on?” David was clearly annoyed with his casual approach.

“Well, I don’t really know. We’re not sure. We took some blood and there are some abnormalities in–”

David interrupted. “What kind of abnormalities?”

I placed my hand on his arm. “Give him a second to explain.”

“Her white blood cell count is a bit elevated, but it’s not completely out of the normal range. Her blood sugar is a 42 which is very low. She’s hypoglycemic and really dehydrated. The IV fluids should take care of raising her blood sugar and we should start seeing it come back up,” he explained slowly. “I’m not sure why her blood sugar is so low, though. How many times did you say she threw up?”

“Three.” David responded quickly. “And just since this morning. How could she get so dehydrated in only a few hours?”

“It’s a bit on the unusual side. You typically wouldn’t see a child get severely dehydrated so quickly. Usually you would see a child become this dehydrated after they had been throwing up repeatedly for days...”

“So, what does that mean?” I asked.

“It could mean a few things.”

I waited for him to go on, but he didn’t. I was beginning to get annoyed and I knew David had already reached his limit. “Like what?”

“Well, we haven’t gotten any urine and it’s important that we do because we need to take a look at it and see if there’s any kind of infection. It’s possible there might be some kind of infection. It will also tell us whether there are ketones in her urine.”

“What are ketones?” The only time I’d heard of ketones was when everyone had gone on the Atkins diet in the early 90s. I thought they were a good thing because all of the Atkins books described them as being positive, but maybe they weren’t.

“Ketones are associated with the proteins in your body and fat. If you have a significant amount of ketones in your urine then it usually means a person is dehydrated or it can also signal other issues that might be present. In this case, we would expect to see ketones in the urine because we already know she’s dehydrated. We just want to see how high her levels are to make sure nothing else is going on. However, I’m a confused by her other results.”

“What are the other results?” David and I talked on top of each other.

“Her bicarbonate level is a 7.” His forehead lined with concern. Both of us waited for more but he didn’t have anything more to give us as if he expected us to somehow know what a bicarbonate level was. I’d never even heard the word and I was certain David hadn’t either.

“What’s a bicarbonate level?” I asked.

“Whenever we see a child whose dehydrated we run an electrolyte blood panel to see how dehydrated the child is. One of the electrolytes that the blood panel measures is bicarbonate along with sodium, potassium, and chloride. Her electrolytes show severe dehydration but her bicarbonate level is very low, much lower than we would expect to see from dehydration alone.”

“So what does that mean?” David asked.

“Well, we don’t know. It’s hard to say. We’re going to have to run some additional tests.”

“But it’s because she has the stomach flu?” I pressed.

“It’s being exasperated by her being sick, but we wouldn’t typically see a bicarbonate level this low because of the stomach flu.”

“Then, what’s going on?” I asked at the same time David asked, “What’s wrong with her?”

“Unfortunately, I can’t say. We’re going to have to admit her. We’ve already started her on IV fluids which should help her blood sugar levels come back up and she’s going to have to be monitored closely to see how her bicarbonate level responds. The pediatric doctors are going to be able to answer your questions better than I can. I’ve put in the order for a bed on the pediatric unit and you should be moved up to the fifth floor shortly.”

I looked at David. He was staring at Rori grinding his jaw back and forth.

“So, you’re sure it’s not the flu?”

David shot me an icy stare. “He already said it isn’t the flu. Something is wrong with her.”

“I’m sorry I don’t have more answers for you, but the emergency room is only the first step. Once she’s been admitted and the results come back from the other tests we’ve taken, we’ll start to have more helpful information. We need to gather more information about what’s going on.” He looked genuinely sorry.

We thanked him as he left, pulling the curtain back around us. I stared at David waiting for him to say something. I didn’t have to wait long.

“I knew something was wrong with her,” he said without looking up. His gaze was still fixed on Rori who continued to look like she was taking a nap.

“He didn’t say it was serious. He just said it wasn’t what they’d expect. We don’t know anything yet. He hasn’t given us any real information. I’m sure she’s going to be fine.”

David blew everything out of proportion when it came to Rori. When she was learning to walk, he was convinced we needed to get her a helmet because he was afraid she’d hit her head when she fell and get brain damage. Once she accidently ate a vitamin and he went into a frenzied panic because he was convinced she was going to get iron poisoning. It didn’t matter that a representative from poison control assured us one pill was harmless and that most likely the pill had gotten stuck in her teeth before she swallowed it. It had taken me forever to calm him down and talk him out of taking her to the emergency room to get her stomach pumped.

“Something’s wrong. I can feel it.”

I shook my head maintaining my stance. “Everything is going to be fine. You’ll see.”

I wasn’t jumping to any unnecessary conclusions. I refused to get alarmed unless the doctors gave us a reason to be alarmed and so far, nobody had given us a legitimate reason to be overly concerned. Dr. Yang hadn’t acted like it was a life or death situation. He’d seemed more confused than anything else. He probably couldn’t figure it out because he didn’t work with children, but I was sure the pediatric doctors would have answers for us after they examined her.

I scrolled through my phone browsing countless medical pages looking for an explanation of the bicarbonate level that made sense while we waited for someone to take us up to the pediatric ward. Everything I read referred to something called the anion gap and other medical jargon I didn’t understand. Most of what I found contained chemical formulas. I loved math and I was good it at, but I liked math with actual numbers. When you started throwing in letters, you were no longer doing math and I was no longer able to follow any of it.

Rori didn’t open her eyes when they transferred her from the emergency room bed into the hospital bed in her room. I’d never been in a pediatric hospital room and was surprised it didn’t look different from other hospital rooms I’d been in. The only noticeable difference was the Mickey Mouse border encircling the room, but other than that it was the same as every other hospital room—a stiff white bed as the focal point and two hard backed chairs with metal legs next to it. The off white walls were in need of a new paint job even though we were at one of the most expensive and respected hospitals in Los Angeles. She had her own bathroom with a small toilet and sink. There was even a standing shower. I was glad we had a window even if the only view it provided was the other hospital wing directly across the street. I moved to stand next to David as a nurse in the doorway made her way into the room and began connecting Rori’s IV and other wires to the machine next to her hospital bed.

“She’s going to be okay,” I assured him for the tenth time, hoping my words were true.

“S
he’s experiencing metabolic acidosis. The blood draw that we took at 3 still shows her bicarbonate level is at 7–”

David interrupted, “It’s still the same? But, we’ve been here for over six hours and she’s been on an IV the entire time. Shouldn’t it have gone up? The doctor in the ER said IV fluids would help her. Why aren’t they helping?”

“The good news is they’re helping with her dehydration. Her potassium, sodium, and chloride levels are coming back up.”

I was having a hard time focusing on what the attending pediatric physician, Dr. Koven, was explaining because I hadn’t been able to stop staring at her pregnant belly. I guessed she was at least seven months pregnant by how extended she was coupled with the way she waddled when she walked and how she held her hand against her back for support while she stood. I never thought about doctors who worked with sick kids having kids of their own. I couldn’t imagine how she did her job every day and wasn’t plagued with constant fears about her unborn child. Every pregnant woman I knew obsessed about the potential diseases that could affect their children, but we kept them at bay because we didn’t have to see them. How could you combat the fear when you had to see sick kids every day?

“However, we are also concerned about the level of ketones in her blood. Those are elevated as well. We would’ve hoped to see those levels come down as well through re-hydrating her, but they’re still in the high range.”

David ran his hands through his hair which was sticking up haphazardly because he’d run his hands through it so many times. “I don’t understand what’s going on with her. None of this makes sense.”

“I wish we had more answers to give you but when we see something unusual like we’re seeing with Rori, it can take a while to narrow down what’s going on. We have to start wide and rule things out as we go and there’s not a quick way to do it. I wish there was.” She was hovering over the computer screen where the nurses made notations after they’d checked on Rori.

“So what sorts of things are we looking at? Where are we starting?” David asked.

“Our biggest concern is that she’s acidotic. We’ll begin by looking at some of the most common reasons we would see a kid become acidotic. We’ll be looking at things like diabetes and other endocrine disorders because she’s experiencing ketoacidosis, but diabetes is highly unlikely because her sugar levels are quite low whereas with diabetes we would expect them to be high. But, we will definitely be ruling out a diagnosis of diabetes just to be sure. In addition, we’ll be looking at whether her kidney and liver functioning are normal. We’ll want to make sure all of her major body systems are functioning appropriately and that there isn’t anything going on with her organs. Usually when children become acidotic, they become acidotic because there’s a problem somewhere in their organs or in their metabolic functioning.”

“How long until you know what’s wrong with her?” I asked.

“We’re going to have the lab come and do another round of blood draws in about 45 minutes. Those labs will be sent out to run much more specialized tests. We’ll also look at her electrolytes and her bicarbonate levels again to see if they’re improving. Once the results are back, we’ll go from there. Have you been able to get a urine sample yet?”

David and I shook our heads. They’d given us a urine cup when we were in the emergency room and a small bowl on the inside of the toilet once we’d gotten to our room on the pediatric ward to catch her urine when she went. Ironically, she’d spent the last few months going to the bathroom constantly but there hadn’t been a drop since we’d arrived at the hospital.

“Do you have any more questions?” Dr. Koven asked.

We shook our heads again even though we had lots of questions but we’d been asking them all day and the only answer we got was “wait and see.” Nobody had any answers for us and I’d annoyed the resident we’d seen a few hours ago with my rapid-fire questions. Our session ended with her telling me she often advised parents to stay off the Internet because of all the misinformation and that it tended to scare parents rather than help them.

“She seemed nice,” I said tentatively as Dr. Koven closed the door behind her. I could tell David was upset with me again. He was loving and doting on Rori, speaking to her in a sweet, soothing voice each time a nurse or doctor began poking and prodding her, talking her through each blood draw even though she didn’t even flinch. But every time I tried to ask him a question, the loving voice disappeared. His body tightened and he worked his jaw as he talked to me. He hadn’t touched me since we’d been at the hospital and each time I touched him he flinched instinctively.

“I guess,” he shrugged.

“How are you feeling?”

“How do you think I’m feeling, Celeste? Our daughter is in the hospital and there’s something really wrong with her. How are you feeling?”

“We don’t know if there’s something seriously wrong with her yet. They haven’t told us that it’s something major.”

He sighed. “Really? She seems pretty sick to me. She hasn’t woken up since this morning and she acts like she’s in a damn coma. What kid doesn’t wake up when they stick a needle in her?”

I looked at him from the other side of the bed. “I understand you’re upset. I–”

“Yes, I’m upset. Of course I’m upset. I’ve been saying something is wrong with her for weeks. What I don’t understand is why you’re not upset!”

“I refuse to get upset until I know there’s something to get upset about. I’m going to be level headed about this thing until I know otherwise.” I wanted to remind him that he used to be the one with a level head. Did he even remember how he used to be?