Date: Thu, 31 Jan 2002 11:00:44 -0800 From: D S Subject: ALONE/TOGETHER- Chapter 22 ~ ANNUS MIRABILIS, Part Three: To Fall. I've been working on this chapter, on and off, for a while (and thinking about it for even longer). It was difficult to write (in every sense of the word) and, I should warn you, it's intended to be difficult to read - not in the sense of being a challenge to understand or follow (like the Absalom, Absalom chapter, for example), but because the subject matter is stark, emotional, and horrific - and presented in those terms. Or it seems so to me. I won't say that I hope you enjoy what follows, but I do hope you find it moving. Oh, and one more thing: for you sharp readers out there, yes, yes, yes, something occurs in this chapter that is, in fact, inconsistent with an earlier chapter. In the end, there was no way to avoid it. As a result, I will probably rewrite the earlier chapter one of these days. In any case, if you would be kind enough to let me know what you thought of this chapter, you can write me at: denis141@hotmail.com. DEDICATION: This chapter is dedicated to the hundreds of children who have during the last decade endured the ordeal described below. It should happen to no child, but sadly it does - too often. DISCLAIMER: I don't know any member of NSYNC, and this story purely a work of fiction. This story also contains male-male sex (albeit mostly implied), so, if that's not your thing, or if you aren't old enough to read such things, you should stop reading now. CHAPTER 22: ANNUS MIRABILIS ~ Part Three: To Fall. 1 DESPAIRING cries float ceaselessly toward me, day and night, The sad voice of Death-the call of my nearest lover, putting forth, alarmed, uncertain, This sea I am quickly to sail, come tell me, Come tell me where I am speeding-tell me my destination. 2 I understand your anguish, but I cannot help you, I approach, hear, behold-the sad mouth, the look out of the eyes, your mute inquiry, Whither I go from the bed I now recline on, come tell me; Old age, alarmed, uncertain-A young woman's voice appealing to me, for comfort, A young man's voice, Shall I not escape? --Walt Whitman, Despairing Cries, Leaves of Grass (1900). JULY 29, 2007 When the sound of Aaron loudly crying at one in the morning woke Lance from an otherwise untroubled sleep, there was no way for him to know that his life would soon be changed forever. Pulling on his boxers shorts, and then shuffling down the hall toward Aaron's room, Lance didn't worry or wonder or imagine that something might be wrong. He assumed that Aaron had had a bad dream, or been startled by a noise outside, or had maybe wet his bed. All of these things had happened before, and Lance had no reason to think that, on this night, the situation he'd face upon walking into Aaron's room would be in any way different. But it was. "Hey there, big guy," Lance said, bending to lift Aaron up from his bed. "What's this all about, huh?" As soon as Lance lifted him up and into his arms he smelled sharp foul fecal smell of Aaron's dirtied underpants. Aaron had never done this before. "Looks like you had a little accident, huh?" Lance said. Aaron continued to cry loudly as Lance carried him into the bathroom. He flipped the light switch on with his elbow. Aaron's once-white underpants were brown now and soaked through and squishy like a fetid swamp. Lance stood Aaron in the tub and pulled his t-shirt up over his head and removed his dirty underpants. The sharp smell of it made him gasp and hold his breath; and Aaron's crying was more like screaming now, and he wondered if he should get JC to help him. "I know, I know," Lance said, trying to reassure him, and kissing his cheek. Lance turned on the water and adjusted its temperature until it was warm enough. The showerhead was detachable and it was connected to long flexible metal tube. Lance stood up and detached the showerhead and then flipped the metal switch that redirected the water from the faucet. As Aaron continued to scream, Lance washed him with warm water and baby soap and then quickly wrapped him in a fluffy white towel. "Come on A," Lance whispered into Aaron's ear, kissing it repeatedly as he held him tightly to his chest. "It's going to be all right." And believed it would be. * * * * * "Josh," Lance said, using his foot to jostle the bed. "Josh, wake up." JC opened his eyes and slowly sat up in bed, looking around the room as if he was trying to figure out where he was. He looked at Lance for several seconds, alternately blinking and squinting and shaking his head. Lance was holding Aaron in a large bath towel, and only his head was visible as he pressed him to his chest, rocking him gently back and forth. JC couldn't tell if Aaron was asleep, but he knew he wasn't crying. "What's going on," JC said, his voice hoarse from being asleep. "I need you to call Melanie," Lance said. "There's something wrong with Aaron." "What do you mean?" JC said, getting quickly out of bed. "Is he sick?" "I think so," Lance said. "He's had really bad diarrhea all night, like six times." "Oh my god," JC said, gently rubbing the top of Aaron's head. "Poor guy." "Yeah - I don't know what it is. The flu maybe. Like some virus or something." "Probably," JC said. 'I mean it can't be anything too serious." "I hope not," Lance said. "But I think we should call Melanie anyway." "No, you're right," JC said, picking up the phone from beside the bed and dialing her number. "She won't mind." Lance sat down on the edge of the bed and watched JC walk back and forth across the room waiting for Melanie to answer. Lance's neck and upper back hurt from having held Aaron for the last three hours, listening to him cry for most of it, until the little boy had finally become too tired to cry anymore. He had never seen Aaron cry so hard before and it made Lance feel sick to his stomach thinking of it. "Hello," JC said. "Melanie? Yeah, it's me, Joshua. I'm really sorry to wake you, but Aaron is sick, and we're kind of worried about him, and wanted to call - you know, to find out what you thought. Right. Well, Lance said that he's had really bad diarrhea all night, like six times." "What color was it?" JC said, turning to ask Lance. "It was," Lance said, closing his eyes as if trying to better remember it. "I don't know, like..." "Wait," JC said, interrupting Lance. "Let me put her on the speaker-phone." "Melanie?" JC said, after pushing a button on the telephone's base and returning the hand-set to its cradle. "Are you still there?" "Yes," Melanie said, her voice sounding tinny and faraway. "I'm still here." "Okay, good," JC said. "I put you on speaker-phone so Lance could hear too." "That's fine," she said. "Hello Lance." "Hi Melanie," Lance said. "Um, it was kind of green-brown, sort of like the color of mulched grass. But the last two times, it was more like muddy water." "Did he seem to be in pain?" "Yes," Lance said. "He was crying really hard. I couldn't get him to stop. And he kept saying his stomach hurt." "How is he now?" Melanie asked. "Is he still crying." "No," Lance said. "He's not crying now. But I think it's because he's exhausted. He's sleeping." "How's his color? Is he ashen or pale or what?" "What do you think Josh?" Lance said, pulling the bath towel further down from where it partly obscured Aaron's face. "I don't know," JC said. "He's a little pale, but not too bad. He's got color in his cheeks." "All right," Melanie said. "Now I want you to look at the back of his hand and pinch a small amount of skin between your thumb and forefinger. Then quickly release it and see if the skin stays pinched or smoothes back out." "Okay," Lance said, taking Aaron's arm from inside the towel and then looking at JC. "Josh, can you do it?" "Sure," JC said, crouching down and doing as Melanie had instructed. "It stayed pinched," Lance said. "That means he may be dehydrated," Melanie said. "Do you have any Pedialyte?" "Do we?" Lance asked, looking up at JC, his face clouded with worry. "Yes," JC said. "I have a case of it in the basement." "Great," Melanie said. "Get him to drink as much of it as you can. It's important that he stay hydrated. And go ahead and bring him in tomorrow, sometime around noon, so I can examine him - all right?" "We will," Lance said. "Thanks so much, Melanie." "It's really no problem," Melanie said. "That's why I'm here. And be sure to call me if his condition worsens in any way." "We will," JC said. "And thanks again." "You're welcome," Melanie said, hanging up. Lance and JC said simultaneous good-byes and then JC switched off the phone. It was five-thirty in the morning. Lance's eyes were puffy and red, and it looked almost as if he was about to cry. JC walked over to where he was sitting on the bed and kissed the back of his neck and rubbed his shoulders. "I'll go get the Pedialyte," JC said. "Then I'll take over for a while. You need to get some sleep." "No," Lance said. "I'm fine. Really." "No you aren't," JC said. "And I mean it. You need to get some sleep." "All right," Lance said. "I'll try." "Good. I'll be right back then." * * * * * Lance woke up and looked at the clock next to the bed. It was five past nine. As he sat up a sharp pain ran down the back of his neck and radiated across his left shoulder. He thought about taking some ibuprofen, and he wondered if there would be any in the medicine cabinet. Probably. Standing up, Lance walked slowly into the bathroom. His feet felt heavy and his legs numb. Standing over the toilet, he pulled his penis through the opening in the front of his boxers and began to urinate. He needed a shower, and wanted to shave and brush his teeth, but first he wanted to see how Aaron was doing. Lance shook the urine off the end of his penis, tucked it back into his boxers, flushed the toilet, and went to look for JC. Aaron was asleep in JC's arms, and both of them were curled up on the couch in the music room. Except for the fact that they were not in bed, sleeping where they usually would, nothing about this scene seemed unusual or even unexpected. Lance felt reassured finding them there - asleep and seemingly at peace. He decided to leave the two of them undisturbed for now while he showered and shaved. As he was about to leave the room, Lance heard someone stir behind him, and he quickly turned. It was Aaron, and he looked like he was about to start crying again. Then he did. JC woke up immediately. He stood up and nearly ran into Lance as he exited the room and headed toward the bathroom. "Is he still going?" Lance called after JC, following him. "Yeah," JC said, walking quickly now. "But not so bad as before." Lance stood in the doorway to the bathroom and watched as JC lowered Aaron on to the toilet. He was still wrapped in a bath towel and JC was careful to pull it out of the way so that Aaron wouldn't soil it. Crouching in front of Aaron, JC looked into his boy's eyes and smiled at him and held his two small hands together in his own, and kissed the tips of each of his fingers. "Does your tummy still hurt," JC asked him softly. Aaron nodded his head and continued to whimper. JC could hear the sound of liquid leaking into the toilet and he waited for it to stop. When it did, JC cleaned Aaron with a moist washcloth and then wrapped the bath towel fully around him again. "Can you flush that?" JC said, looking at Lance, and trying to smile. "Sure," Lance said, stepping past JC and reaching for the toilet handle, but then stopping. "Oh fuck," Lance said. "It's blood." * * * * * Justin had called Melanie from the car on the way to her office, but she told them to meet her in the emergency room instead, at San Diego Children's Hospital. It was now six hours later, and Lance and JC were sitting on plastic folding chairs on each side of Aaron's hospital bed. They were watching him as he slept and listening to the slow monotonous drip of the intravenous saline being fed to him through a vein on the inside of his left arm. Lance had pulled the blinds closed and the only light in the room was that which leaked through the open door from the hallway. JC looked up and saw Melanie enter the room and signal them to come out into the hall. "Lance," JC whispered, startling him. "Mel's here." "Oh, right," Lance said, his voice weak and drained of all inflection. Once out in the hallway, Melanie looked at each of them in turn and then began to speak. Her voice was quiet, nearly conspiratorial, but full of authority too, without any trace of uncertainty or fear. Although it was relatively noisy in the hallway, neither JC nor Lance could hear anything other than Melanie's voice as she spoke to them. "I've just been speaking to Dr. Suchida. She's the pediatric gastroenterologist on-call today. She tells me that Aaron's lab tests are back." "What's wrong?" Lance and JC said, nearly in unison. "Now, listen to me," Melanie said, her voice becoming stern. "You need to try to relax a little. I know that's difficult, but you are not going to understand any of if this if you're both in a frazzle. All right?" "All right," Lance said, taking a deep breath and reaching for JC's hand. "Aaron has hemorrhagic gastroenteritis, which means his intestines are inflamed and bleeding. That's why his stool became grossly bloody like it did." "But what caused it, this thing he has," JC asked, looking back and forth between Lance and Melanie. "We can't be certain as of yet," Melanie continued. "However, his stool culture tested positive on a presumptive basis, for the presence of a pathogenic bacteria, E. coli O157:H7. Confirmation will take another 24-48 hours, but the presumptive test we use these days is quite accurate, so I suspect it will be confirmed." "Then what?" Lance said. "This kind of infection is usually self-limiting" Melanie said. "So we'll provide supportive care, mainly making sure he remains hydrated and well-nourished. There's really nothing else we can do except to wait for it to run its course." "He's going to be fine then," JC said, his shoulders slumping as his whole body visibly relaxed. "He'll get better." "He should be fine," Melanie said. "But we're going to keep him here a few days so we can monitor his course. So you'll need to be patient." "But what about his pain," Lance said, his voice wavering as he tried to keep it under control. "He wakes up screaming." "You have to understand that giving him pain medication will only prolong the acute symptoms by reducing peristalsis -wave-like contractions that the intestines use to rid the body of waste and, in this case, toxins. Were we to give him pain medication, we would increase the likelihood that toxins enter his bloodstream. And we don't want that." "All right," Lance said. "I understand." "It's just so hard to see him in such pain," JC said, gasping unexpectedly, as if someone had knocked the breath out of him, and then started to cry. "I know," Melanie said, watching Lance pull JC into his arms and hold him. AUGUST 1, 2007 JC's Journal: Today was good. It feels like things are finally starting to look up and the worst is over. Aaron went almost the whole day without any cramps or crying and his diarrhea finally stopped. He hates being here, which is not too hard to understand. Mel said that he'll probably be discharged tomorrow if his blood tests come back okay. Lance has to leave the room when they draw blood because he can't stand to see it, and nearly fainted the one time he tried to watch. I hold Aaron when they do it, and try to distract him, but he knows what's going on, and he's too smart to be fooled. He doesn't cry though, and I think that's what kills me the most - him being brave like that, braver than me, and he's not even four years old. Nursing Notes: Patient appears happy and without obvious pain. He is alert and attends to instruction. Blood was drawn and IV removed, both without problem. Pulse, breathing, and blood pressure all normal. Awaiting test results from lab. To be discharged tomorrow on orders of Nancy Suchida, M.D. Signed and authenticated, DS * * * * * "Hey, hey A," Justin said, bounding into the room and waving at Aaron. "Hi Uncle J," Aaron answered, his voice subdued and noticeably weak. "Hey Justin," JC said, standing up from where he'd been sitting on the edge of Aaron's bed, reading to him from one of the several picture books he'd brought back with him from the house. "When did you get into town?" "Just now," Justin said, the cheerfulness in his voice beginning to sound forced. "I had to come hang with my main man here. So how you doing Big A? Everything cool?" "I want to go home," Aaron said. "I bet you do," Justin said, surprised by the directness of Aaron's statement. "Josh?" Aaron said, leaning back against his pillow. "Can I sleep now?" "Sure," JC said, pulling the blanket up under Aaron's neck and kissing him on his forehead. "You go to sleep, and Justin and I will be here when you wake up." "Okay," Aaron said. "I love you, A," JC said, kissing Aaron again. "You too," Aaron said, closing his eyes but then suddenly opening them again. "Wait. Is Lance being here too?" "Yes," JC said, gently smoothing Aaron's hair. "He'll be right here too." "Okay," Aaron said, leaning back into his pillow and closing his eyes once more. * * * * * As Lance walked up the hall toward where JC stood speaking with Dr. Suchida he could tell from the look on JC's face that something was wrong and it suddenly felt as if someone had punched him hard in the stomach. He could hardly breathe and his forehead was immediately covered in sweat. "What's wrong?" Lance asked, his voice catching in his throat. "This is Dr. Suchida," JC said, grabbing Lance's arm. "I know," Lance said, impatiently. "What's wrong?" "The results from Aaron's most recent lab tests just came back," Dr. Suchida said. "All right," Lance said. And?" "And Aaron's blood tests show an elevated serum creatinine level. He also has a slightly low red blood cell count." "What does that all mean?" JC asked. "The red blood cell count may indicate he's becoming anemic. More troubling is the elevated serum creatinine, which may suggest a gradual loss in kidney function." "What?" Lance said, his voice louder than he realized. "You mean his kidneys aren't working? How can that be?" "No, that's not what I said," Dr. Suchida said, speaking sternly, and lowering her voice as if to compensate for how loudly Lance had spoken. "His kidneys are working. And so long as he continues to produce urine, we can assume it's nothing serious. But I called in a pediatric nephrologist for a consult, just to be on the safe side. He should be able to tell you more once he's had an opportunity to examine Aaron." "Does he still get to go home tomorrow?" JC asked. "I don't know," Dr. Suchida said. "We'll just have to wait and see." August 2, 2007 JC's Journal: Aaron didn't get to go home today, which made him cry for the first time in two days. It was horrible. I had to leave the room because I started crying too, and I didn't want him to see me. Lance stayed with him, and Justin took me down to the cafeteria for coffee. We talked to Dr. Roberts. He's Aaron's kidney doctor. He's a no-nonsense guy, and not really friendly but he seems to know what he's talking about. He told us that it was just a 'watch-and-wait' thing now, and that we should hope that Aaron doesn't develop something called hemolytic uremic syndrome (which I can spell only because Lance made the doctor write it down). Dr. Roberts was also worried about the low red blood cell stuff and told us that Aaron might need a transfusion. Lance came unglued when he heard that. This is so hard on him, and on me too. I just want Aaron to be okay. That's all I ask, and it's all I care about right now. Nursing Notes: Patient is resting comfortably. Both parents in room, notably anxious and questioning. Fluid intake remains normal, but appetite decreased. Discharge on hold for now. 10cc of blood obtained without complication. Breathing, pulse, and blood pressure normal. Temperature elevated at 99.8 F. Signed and authenticated, DS * * * * * The four of them stood in a tight cluster just outside the door to Aaron's hospital room - Melanie, Justin, JC, and Lance. Lance had his arm around JC's shoulder. JC was biting his lower lip and looked as if he was in shock. Justin stared into the empty Pepsi can he was holding and tapped the sides of it with his index finger. Melanie watched Dr. Roberts walk away down the hall. He had just updated them on Aaron's condition. "I don't know what to say," Lance said, shaking his head slowly from side to side, his voice a flat and stunned monotone. "This...this - it's just too much. He was doing okay. He was supposed to go home today. And now they're moving him to the intensive care unit. And he need's a blood transfusion...and, and..." "Let me donate the blood," Justin said, blurting the words out. "I'm B-positive, just like Aaron. Please let me do it." "It's not necessary," Melanie said, speaking softly and touching Justin's forearm. "I'm sure they'll have compatible blood on hand." "No," Justin said, stomping his foot. "He shouldn't have some stranger's blood in him. It's not right." "Justin," Lance said, looking at him but not really seeing him, his vision clouded by the anguish he felt. "You don't have to do that. Really." "No," Justin pleaded. "I want to. Please. I want to do something to help." "Let him," JC whispered, almost inaudibly, his head resting on Lance's shoulder now. "If he wants to. It's okay." "That's fine," Lance said. "Sure." "Can you show me where to go?" Justin asked, looking at Mel. "Of course." "Thank you," Lance said loudly as he watched the two of them walk away. "I'm going to get Aaron's stuff together before they come to move him," JC said. "Okay," Lance said, taking his arm from around JC's shoulders. "I'll help you." AUGUST 2, 2007 JC's Journal: Aaron's in the pediatric intensive care unit now. There's not much privacy because the nurses are in and out constantly. Poor Aaron has his IV back in and he hates it. He keeps asking me to take it out and it just kills to keep telling him that I can't. Then he says, "But it hurts" - and it takes all I can do to not fall apart. I try to keep him distracted by reading to him, or letting him play his Gameboy, but nothing helps for long. He knows he's somewhere he doesn't want to be and you can tell it makes him sad. Melanie's been great about explaining what's going on. Aaron's kidney doctor, Dr. Roberts, is lousy at it. He assumes you know what all the big words mean and so half the time he might as well be talking in German or something. It's frustrating, especially for Lance, because he hates it if he doesn't understand something, and doesn't feel in control. This afternoon he yelled at one of the nurses and he wouldn't let her change the bag on Aaron's IV until she'd explained what she was doing and why. Justin is bringing Lance his laptop from home tomorrow morning so that he can look stuff up on the internet. I don't know if that will make things better or worse for him. We're still waiting to see whether Aaron develops HUS. Melanie explained what it was, but the main thing I remember - or can't forget - is that she said "There's no therapy to halt its progress." So I pray to God he doesn't get it. It's bad enough as it is. I don't know if I can stand it being any worse. Nursing Notes: Patient no longer producing a normal amount of urine, despite IV fluids for a full day. Probable oliguria. IV fluids discontinued and oral intake of fluids restricted. Blood tests show doubling of serum creatinine levels. Platelet counts also low. Consent for transfusion obtained from both legal guardians. Transfusion was started at 1900 hours, and is ongoing. Signed and authenticated, DS * * * * * The sky looked like a seamless expanse of silver-gray silk pulled taut across the horizon. The sun had disappeared an hour earlier and it looked like it might rain. Lance stood at the edge of the hospital parking lot. His hands were clenched into fists. His fists were pressed against his temples as if he was trying to crush his head between them. He could smell the sour sweat that clinged to the clothes he'd worn for the last two days now. His mouth was dry and his lips were chapped. People who he didn't know walked by him on the way to their cars. He hated them for being able to leave, being able to drive away, to go home, and to be rid of this hellish place. He'd just found out that his little boy had HUS. * * * * * Justin stood at the window, watching Lance stand in the rain. He'd been out there for nearly an hour now. Just standing there, with fists pressed to his forehead. It looked as if he was screaming at the sky. It was chilling to see, and it made Justin shudder. AUGUST 3, 2007 JC's Journal: I spent the morning calling everyone, giving them the bad news about Aaron, and asking them to pray for him. I called Lance's Mom last, because I knew I'd cry talking to her and that I'd never be able to make any more calls after that. She asked how Lance was doing, and I didn't know what to say, because I can't really tell how he's doing - or how I'm doing, for that matter. Like I said to him last night, while we were sitting with Aaron, it's just about getting through this now, because there's no time or energy for anything other than that. We just need to keep kicking our feet and hope we can make it to shore before our strength gives out. Nursing Notes: Patient underwent the placement of a right femoral catheter. Placement done to make it easier to obtain blood samples, administer medications, and to provide transfusions. Once the catheter was in place, patient received a transfusion of platelets for treatment of thrombocytopenia. Urine production has stopped. Blood test show creatinine and blood urea nitrogen (BUN) levels both markedly elevated. Signed and authenticated, DS. * * * * * Dr. Roberts was seated in the waiting room speaking to JC and Lance. It was a long rectangular room that contained two long couches, and three overstuffed chair, all upholstered in burgundy velour. There were stacks of old magazines on several of the side tables, and two brass floor lamps. The only other light in the room came from an overhead fluorescent light that made a harsh buzzing noise. "Aaron is now anuric," Dr. Roberts said, continuing with his explanation of Aaron's condition. "Which means that he's stopped producing urine. This could be a temporary set-back, just a blip in renal function. Or, more seriously, it could mean that's he's progressing into kidney failure." "Kidney failure?" JC said, whispering the two words, as if speaking too loudly might make them true. "What happens then," Lance asked. "If it's kidney failure." "He'll need to be put on dialysis," Dr. Roberts said. "Otherwise he'd die as his system is flooded with the waste that the kidneys ordinarily remove from the blood." JC stood up and walked to the far end of the room and leaned his forehead against the wall, and then his hands too, as if he was trying to push it over and flee. His legs were shaking as he pushed against the wall, and seeing him Lance feared he might collapse. Lance walked up behind him and put his hands on JC's shoulders. "Josh," Lance said. "Come sit down. Please." "Yeah, okay," JC said, taking a deep breath and sitting back down next to Lance. "I'm sorry Doctor." "No, it's all right," Dr. Roberts said, speaking in calm, well-practiced tones. "This is always difficult news to receive." "So how does it work," Lance asked. "The dialysis." "With a child of Aaron's age, peritoneal dialysis is indicated," Dr. Roberts said. "We'll need to insert a second catheter, this time into his abdomen." "Oh Lord," Lance said, clutching his stomach. "We'll do it under general anesthesia," Dr. Roberts added. "He won't feel it, at least not its insertion. Then, once the catheter is in place, we'll dialyze him, probably once daily until kidney function returns." "When will that be?" JC asked. "Impossible to predict. It can range from one day to thirty." "But what if it doesn't return?" Lance asked. "What then?" "We'd have to consider a transplant," Dr. Roberts said, lowering his voice. "I assume you're in contact with Aaron's biological parents, since they would be the most likely compatible donors." "No," Lance said. "His biological parents are dead." "I see," Dr. Roberts said. "Well, that's not our only option and, besides, kidney function returns in approximately ninety percent of the cases." "What about other complications," JC asked. "I mean, can this..." "Yes, it can be fatal," Dr. Roberts said, anticipating the question. "But typically it's not. The fatality rate is only five percent." "But you said there was only a five percent chance of him developing HUS," JC said, his voice angry and confused. "So how much comfort is that supposed to be?" "I understand your anger," Dr. Roberts said, smoothly. "I do. I would be angry to if it was my son. But all I can do is provide you with as much information as I can. I cannot predict the future, and I would by lying to you if I said I could." "We know that, Doctor," Lance said, standing up and shaking the doctor's hand. "And we appreciate you taking the time to explain this all to us. Thank you." "Yes, thank you," JC said, standing up now too. Lance and JC walked slowly back to Aaron's room and found that he was asleep. Looking at his face alone, and the gentle curve of his lips, and loose curls of his light brown hair falling wave-like across his forehead, Aaron appeared almost normal, almost healthy, almost perfect. But it was this incongruity, between appearance and reality, that was - at that moment - so difficult for Lance and JC to understand or endure. Because the reality of the catheters and the IV fluids and the hospital bed and antiseptic smell that defined this place was undeniable; and it denied them solace, and robbed them of words. So standing there, terrified of what else the future might hold for them, they knew there was no safe shore to which to escape, and there only hope was to be found in courage. AUGUST 4, 2007 JC's Journal: This morning Aaron went into surgery. Seeing Aaron wheeled on that gurney, through the door into the operating room - it was the hardest thing I've ever had to watch. At least for about two hours it was, because later that afternoon was his first dialysis session. Aaron was terrified. He cried the whole time and was screaming "Daddy, no! Daddy, no! Make them stop. They're hurting me" while Lance had to hold him down to the bed. I thought I was going to die. Nursing Notes: Second IV line inserted in left femoral artery to provide Total Parenteral Nutrition. No urine production. Hemolytic anemia noted. Platelet count still low. Second transfusion ordered. Stool culture confirmed positive for E. coli O157:H7. State Department of Health notified. Signed and authenticated, DS. * * * * * Lance and JC were together in bed for the first time in seven days. Melanie had insisted that they go home for the night, promising to stay with Aaron herself, and to call them if he woke up, or if anything else happened at all. It was ten o'clock. "Josh?" "Yeah?" "Do you..." "Yes." "It's not wrong, is it?" "No." "Because I really want to." "I know. Me too." JC slid slowly up to where Lance lay on his back and then crawled on top of him so that his body was stretched the length of him. Interlacing his fingers with Lance's fingers, JC kissed him, opening his mouth and immediately felt the plunge of his tongue. Wrapping their arms around each other, they began to rub furiously against the flesh of the other, as if trying for as much contact as possible. They did not notice the loudness of their moaning gasps, but it was louder than it had been before; it was an unbridled noise, and raucous, and full of sobs now too, as each was overcome by orgasm and anguish at the same time, clinging together, in the throes of both, coming together, then, without moving, falling deeply asleep. AUGUST 5, 2007 JC's Journal: This afternoon, I fell asleep in one of the chairs in Aaron's room. When I woke up, Lance was sitting on the floor in front of me, leaning against my legs. He was still asleep, and was holding my legs so tight that my feet were numb. His face was on my lap too. I don't know why he'd gotten out of his chair, but I was glad he had, and was there with me when I woke up. Nursing Notes: Patient is stable, but otherwise notably unimproved. Significant for pallor and lethargy. White blood cell count climbed sharply over night. Temperature is now 101.6 F. More blood tests ordered. Dr. Suchida prescribed vancompcin and tobramycin. Signed and authenticated, DS. * * * * * JC had brought the double wedding-ring quilt from home and tucked it around Aaron even though the nurses said it might get blood-stained. "Are you sure," they'd said. "It's so beautiful and it'd be horrible if it got stained." "No," JC said. "It needs to be here." AUGUST 6, 2007 JC's Journal: This is the worst. He doesn't look like Aaron anymore. Not at all. The press is all over, and I had to go downstairs to meet with hospital's communication director, who wants us to issue a statement of some kind. I suggested that the statement say "Leave us the fuck alone," but he didn't think that was very funny. I finally told him that Lance's manager would take care of it. When I got back to Aaron's room, and I walked up to his bed, I thought I was in the wrong place. Then I finally recognized him and I started to cry. He was swollen up like a balloon, and his skin had turned the color of butter-scotch candy. I was almost afraid to touch him because I thought, if I did, he might burst. Seeing him like this, I wondered if we would ever get Aaron back, back like he was before. I know that I'll never be the same again. I hate this so much. Nursing Notes: Blood tests showed marked increase in amylase and lipase levels. Temperature 102.5F. Antibiotic therapy continues. Breathing rapid and labored. Patient in obvious discomfort. Signed and authenticated, DS. * * * * * As JC stared at it, he tried to remember when he'd last eaten Jell-O. He knew he'd never liked it, even when his Mom - when she was still alive - had slathered it in Cool-Whip. Now he just watched it jiggle, the movement caused by the people walking by the table at which he and Lance sat holding hands, unable to eat even one bite of food. Justin lurked at the edge of the room, waiting for Melanie to arrive; and when she did, he led her to their table and sat down with her. Neither JC nor Lance looked up. "They've called in another doctor," she said. "An endocrinologist." "A what?" JC said, slapping the table and nearly knocking over his milk. "An endocrinologist," Melanie said. "Aaron's lipase and amylase levels are... well, his pancreas is not functioning normally. It's inflamed. This is...it is...uh, well - it's expected sometimes, with HUS. And, unfortunately, it's quite painful. So, we may need to sedate him. You see, the idea would be to induce a kind of coma so he's not in such pain. It will make the dialysis easier too, and less traumatic." Lance stood up. Then JC too. Justin - without giving any thought to it - took Melanie's hand in his own and squeezed it tightly. Two people standing in line to pay for their food swung around to stare as Lance and JC standing there. It was as if everyone in the room knew that something was about to happen. And then it did. "But what if he doesn't wake up?" JC said, suddenly shouting. "What then? Or are we just supposed to say good-bye now - you know, just in case, and then let you put him to sleep like he's some fucking animal." "No," Melanie said, her voice jagged and raw. "That's not it." "That's not what she meant," Justin said, cutting in angrily and grabbing Lance's arm. "It's not what she meant. For Christ's sake, Lance - she's your friend." "Fine," Lance said, gritting his teeth together. "I know that. And I'm sorry Mel. But we just can't say good-bye to him, not like that, not just in case." "No. And we won't say good-bye either," JC said, shaking his head, and staring at Melanie as if she had just spit on him. "And don't you dare tell us we should. We are NOT letting him go. And I swear I will kill anyone who tries to make us!" "Josh," Lance whispered, fiercely pulling free of Justin's grip and moving toward JC who was seemed so frantic he feared he might hurt himself. "Calm down." "NO!" JC screamed. "I won't calm down. I'm tired of being calm. And I'm tired of being patient. And I'm fucking sick and tired of everyone telling me 'Josh, you just have to wait and see.' Well - I don't want to wait and see anymore. I want Aaron back! And I want to take him home! And I want things to be like they were before!" Melanie and Justin and Lance watched as JC kicked over two chairs and threw his bowl of Jell-O against the wall. The small glass bowl that had contained it shattered loudly, and bits of Jell-O flew in all directions, splattering several bystanders. A security guard appeared at the doorway to the cafeteria and Melanie ran over to where he stood and explained what had happened and led him away. Justin followed her out of the room, and he could see she was crying. Lance walked toward the wall on which JC was now leaning and tried to pull him away from it so he'd stop hitting it with his fists and kicking at it. He knew everyone was staring at them, but he didn't care at all. "Josh," Lance whispered, wrapping his arms tightly around JC's chest. "Don't. Don't do this. Please." "I'm not weak," JC said, spinning around and facing him. "I'm not." "I know you aren't," Lance said. "You've been as strong as anyone I've ever seen. And you've been fighting hard all along, right by my side Josh. And I love you for it - more than I can even say." "I'm just so fucking angry," JC said, looking into Lance's eyes, pleading. "So am I," Lance said. "And I'm tired and I'm scared. But this isn't going to help. It really won't." "I know," JC said, pulling Lance into his arms, and holding him. "It's just that I don't know what else to do." AUGUST 7, 2007 JC's Journal: Aaron is having trouble breathing. The fluids he's not getting rid of by peeing are putting pressure on his lungs. His fever is higher now too because - they say - he has an infection. The dialysis is easier now because, at least, Aaron just lays there. To be honest, though, I'd rather have him screaming because at least then he seemed like he was fighting it. I hope to God he hasn't given up. Nursing Notes: White blood cells elevated. Abdomen distended, discolored, and tender. Femoral catheter showing traces of blood; removed and replaced with subclavian line. Significant for pulmonary edema. Started on 60% oxygen per order of Dr. Suchida. Lasix also administered, per same. Signed and authenticated, DS. * * * * * Lance and JC had spent the last two hours with relatives: Joey's parents, Lance's parents, JC's dad and brother, and Joey's brother, Steve. Chris had flown into town too and was now at the house with Justin. Lance and JC hadn't eaten in more than a day, despite being reminded to constantly by everyone. It was just past four in the afternoon, and they were sitting together on one of the reclining chairs next to Aaron's bed, JC on Lance's lap, his arms around him, and his head resting on his shoulder. JC was nearly asleep when Dr. Roberts and Dr. Suchida walked into the room. "Gentlemen," Dr. Roberts said. "Oh, hi" Lance said, poking JC in the side to wake him. "What?" JC said, standing up and looking around, the disorientation plain on his face. "What's going on? Where's Aaron?" "He's right there," Dr. Roberts said, pointing to where he lay asleep in his bed. "Oh, okay," JC said, rubbing his eyes. "Sorry." "No, it's fine," Dr. Suchida said. "But we need to consult with you both for a moment about Aaron's most recent blood tests." "What about then?" JC asked, the panic plain in his voice. "Aaron has an infection," Dr. Suchida said. "We suspect it's peritonitis, which is a potentially serious complication. And it leaves us with two options. We can suspend the dialysis and remove the catheter line that we suspect is the source of the infection, or we can continue antibiotic therapy and hope that it eventually takes hold." "But how can we stop the dialysis," Lance said. "His kidneys still aren't working, are they?" "No," Dr. Roberts said. "There's been no return of kidney function. However, if the infection manages to enter the bloodstream, Aaron could go into septic shock and he could die quite suddenly, before we had a chance to do anything about it." "Oh my god," JC said, swiftly exiting the room and walking into the hallway. "Perhaps you too should discuss this," Dr. Suchida said to Lance. "We can wait in here while you decide what you want to do." "This just isn't fair," JC said, feeling a hand on his shoulder and turning around. "No, it's not," Lance said, barely able to speak. "But none of it has been." "What should we do then?" JC said. "Should we call Melanie? And ask her?" "No," Lance said. "This is on us, Josh. We need to decide ourselves." "Then I say we keep him on dialysis," JC said. "He's only been on the antibiotics for three days. Maybe it hasn't had time to work yet." "Is that what you'd want me to do if it was you in there," Lance said, taking JC's hand and holding it to his chest. JC closed his eyes and his shoulders slumped. He had repeatedly wished it was him in that bed, and not Aaron, but he'd never thought about it in the way that Lance had just posed. What would he want Lance to do, if he couldn't decide for himself? "I'd want you to keep me on dialysis," JC said, opening his eyes and looking at Lance. "That's what I say too," Lance said. "I'll go tell them." August 8, 2007 JC's Journal: The days all run together now, and I hardly know what day of the week it is anymore. I never look at my watch anymore, because it doesn't matter what time it is. I have no appointments to keep, or places to be, except here, by Aaron's bed. The nurses have been nice enough to teach me how to do certain things, like how to change the sheets on his bed without disturbing him. And I wash him now, every day, and rub lotion on his skin. The lotion smells bad, but it keeps his skin from cracking. I can change the bag on his privates too, which is there to collect urine. I do it every day, morning and at night, hoping that there will be something in it, but there never is. It's about 7:30 and Lance went down to the cafeteria to get something to eat. He's lost like 10 pounds, and I've been bugging him to eat more. Of course, then he calls me a hypocrite, because I've not been eating much either. Everyone brings us food from home. Like yesterday his Mom brought fried chicken she'd made. Lance had one piece, and I had a bite, but then we gave the rest to the nurses - who loved it. Lance should be back soon, so I guess this will do for tonight. Nursing Notes: White blood cell count finally falling. Patient irritable, restless, and easily agitated. Neurological consult ordered for diagnosis of possible diffuse neuropathy secondary to hemolytic uremic syndrome. Subclavian line is clear and no infection noted at site. Patient continues on 100% oxygen. Peritoneal dialysis completed without complication. Signed and authenticated, DS. * * * * * The click-hiss click-hiss of the ventilator filled the room with noise both soothing and reassuring. JC hardly noticed it anymore; but he knew he'd immediately notice it not being there. For him it meant that Aaron was breathing and alive and still there. He had put his journal away and was now standing beside Aaron's bed, facing away from the door, looking out the window. The sky was black and the window was a mirror in which he could see the door to the hallway behind him. He closed his eyes for a moment. When he opened them, Lance was standing there, holding a cupcake with a candle stuck in it. "They wouldn't let me light the candle," Lance said. "What?" JC said, turning around. "I don't understand." "About the candle?" Lance asked. "No. I mean yes." "The oxygen," Lance said, smiling at JC. "We'd blow up." "No," JC said, still puzzled. "I know that, but why's there a candle - at all?" "Happy Birthday," Lance said, handing JC the cupcake. "What?" JC said. "You mean it's ...already?" "Yeah, I know," Lance said, laying his hands on JC's hips and pulling him closer. "We've been here eleven days. But I wanted to do something for you, even if it was only a stupid cafeteria cupcake." "Thank you." "You're welcome." "You know," JC said. "Lately, I haven't felt like a very lucky guy. I mean, with everything that's happened and all. But, I want to tell you something Lance. Standing here, right now, I feel like the luckiest guy in the world. I do." "I guess I'm glad they wouldn't give me a match then," Lance said, smiling. And at that moment, if someone had been standing out in the hallway, listening to the sounds within this hospital room, they would have heard the soft click-hiss click-hiss of the ventilator; but they would have heard another sound too, a sound that had not been heard in this room before: laughter. August 12, 2007 JC's Journal: We've been here fifteen days and it seems like fifteen years. All I think about now is losing Aaron. Last night I went into the chapel, not so much to pray, although I wanted to do that too, but just to be someplace quiet and alone. Lance and his Mom were sitting with Aaron, and told them I was going to go for a walk. I went to the chapel instead because I thought it would make me feel better. It made me feel worse. If there's really a God in this world, how could something as horrible as this be happening to Aaron? Wasn't it enough that he lost his parents? It makes no sense to me. None at all. And so now I wonder if I can ever believe in God or miracles again. Nursing Notes: White blood cell count is high normal now. Abdomen is still distended, discolored, and tender. Subclavian line is free of blood and not infection noted at insertion site. Patient drank small amounts of fluid, but is still producing no urine. No other signs of improvement. Dialysis continues. Signed and authenticated, DS. * * * * * It was late afternoon, nearly four o'clock, and the sun shining through the trellis overhead made a lattice-work of shadows on the table. Justin and Melanie watched as the waiter removed their half-eaten salads and refilled their water glasses. The waiter moved silently, and with the brisk efficiency of someone who knew he was intruding. "Will there be anything else?" the waiter asked. "No, just the check," Justin said, placing a credit card on the table. The waiter picked up the credit card, acknowledging it with a small nod of his head, and then he walked back into the restaurant. They were at Montana's American Grille, a small restaurant on University Avenue in the Hillcrest section of San Diego. Justin had picked Melanie up at her office an hour ago and they had stopped here before heading to the hospital. Justin could see the dark circles under Melanie's eyes, dark circles she had not tried to hide with make-up. It seemed beautiful to him, if only in its honesty. "Have you been there yet today?" Melanie asked, staring at condensation on the side of her water glass and then drawing a line in it with her forefinger. "At the hospital." "No," Justin said. "I was at the house - their house. I mowed the lawn, and tried to straighten things up a little for them." "That was nice of you." "I didn't know what else to do," Justin said, crossing his arms across his chest and then uncrossing them again. "I wanted to do something." "I know. It's frustrating." "So how's he doing," Justin asked. "Did you talk to Aaron's doctors yet today?" "Yes. I spoke with Lane Roberts, the attending nephrologist. Aaron was dialyzed again today, and there's no sign of his kidney function returning. None as of yet." "That doesn't sound good." "Well, it's not encouraging." "Mel?" Justin said, leaning forward in his chair and clasping his hands together. "Is he..." The words trailed off. Tears appeared in Melanie's eyes as she turned to watch the waiter walk toward their table. "I don't know," she said, and then stood up and quickly walked away. August 18, 2007 JC's Journal: Three weeks in hell and no end in sight. Aaron is barely conscious, barely there. He doesn't say anything. His eyes hardly follow me anymore. I read to him and it's like he can't hear me. But I keep reading, his old favorites, and some new ones I bought for him. And we play music for him too. Chris bought him a little CD player with speakers that we can clip to the side of Aaron's bed. He bought him like 50 CD's too. It was really nice of him. He said he didn't know what else to do. No one knows what else to do anymore, including me. So I keep reading to him, and washing him, and rubbing lotion on him, and combing his hair, and dressing him in something different every day. Just like before. Nursing Notes: Patient is afebrile and white blood cell count is within the normal range. Platelet counts also dramatically improved. Fluid intake increased moderately for treatment of dehydration. Serum creatinine and BUN still elevated, but less than before. Patient remains listless and largely unresponsive to all but the most forceful commands. Neurological consult is normal, but continuing to monitor for possible CNS involvement. Subclavian catheter removed over concerns about possible infection. Replacement lines inserted into left subclavian and right femoral areas. Signed and authenticated, DS. * * * * * Lance stepped off the elevator and headed once more to Aaron's room. He had made this walk a hundred times already; but each time he made it, he felt like he was entering alien territory, a place he'd never been to before, a place whose language and manners he would never learn, nor fully comprehend, no matter how long he stayed, a place that puzzled and frightened him in equal measures, a place to which he hoped to never return. He was carrying a brown paper bag that contained the dinner he had hardly touched, despite his Mom's non-stop protest that he needed to eat to keep us his strength. He knew that; but everything he ate anymore - or tried to eat - tasted like dirt, or tasted like nothing at all. It was as if his senses were abandoning him, his ability to taste, to see, to feel, to hear - all that connected him with the world external to his own lived-in one. As Lance approached to the door to Aaron's room, JC burst out of it and ran into him at full force, knocking him down. He expected to see JC hysterical, and he steeled himself to hear more horrifying news, although he couldn't imagine what more was left except maybe to find out that Aaron was dead. "Lance!" JC screamed, pulling him up off the floor. "He peed! Aaron peed!" He didn't hear these words at first. But then he did, heard them and understood them. And when he did, he picked JC up and spun him around, like he would have done to a child he was trying to make laugh and squeal with joy, which was exactly what the both of them did: laugh and squeal with joy. August 23, 2007 JC's Journal: They removed Aaron's dialysis catheter today and moved us out of the PICU. Holding his hand as they pushed his bed down the hall, I could hardly walk my legs were shaking so much. Not because I was afraid, or nervous, but because I was just so overcome by it all. It was almost as if I was afraid it wasn't happening, and that it was really just a dream. But it wasn't a dream. And now we're in a regular room, and Aaron is sitting up in bed, and he's drawing a picture for me. The picture has a big yellow sun in it. And a house. He told me it was our house. It's beautiful. Nursing Notes: Patient aware, alert, smiling this morning. He is producing near normal amounts of urine. Pallor and swelling is mostly gone. Left subclavian and right femoral lines removed. Temperature 98.6F and breathing normal. Blood pressure elevated but near normal. Awaiting results of blood tests. Signed and authenticated, DS. * * * * * There was a small park near the hospital, and Lance had often gone there to walk around when the pressure and pain of Aaron's illness threatened to overwhelm him. This time he had brought JC with him, and they were sitting side-by-side on a bench, quietly holding hands, and watching the full moon climb into the sky. They could hear the sound of traffic on the nearby highway. It sounded like the ocean, or the rushing roar of a river. JC had kicked off his sandals and sunk his toes in the long grass growing there, enjoying its cool slightly damp feel. Neither one said anything. They just sat there staring straight ahead, their chests not so tight anymore, and their anguish receding like a wave pulling slowly back into the sea. August 26, 2007 It was three o'clock in the afternoon, on Sunday. Lance was sitting in the driver's seat of JC's Volvo, waiting for him to finish securing Aaron in the car safety-seat. When JC was done, he climbed in next to Aaron, pulled the door closed, and locked it. Aaron was sucking on a grape Jolly-Rancher stick and his lips were purple from it. He hummed as he sucked on it and bounced in his seat. "All set," JC said, buckling his seatbelt. "Okay," Lance said. "Let's go." "Wave to Melanie," JC said, pointing to her through the window. Aaron took one hand off his candy and waved at Melanie and then watched as she waved back. Looking back toward the front of the car, at Lance, Aaron pulled the candy from his mouth and said, "Where we going Daddy?" "We're going home A," Lance said, his voice catching in his throat. "You and me and Josh are going home."