WARNING! This update may be a little upsetting. Please grab some tissues now. I cried whilst writing this, so be warned! Otherwise, enjoy and I'll see you on the flip side.
There are days when I hate being a doctor. Working with poorly babies and young children on a day-to-day basis, week in week out is challenging at the best of times but when you have a patient that you know has very little chance of survival, it makes you question why you're in this job.
My eyes darted across the MRI scan I held in my hand and I sighed heavily, gaining the attention of a fellow doctor as I did so. He peered over my shoulder and frowned. "Ah, shit," was all he said, vocalising my thoughts. Lewis runs a hand down his face and shakes his head as he processes the image before us. "I was hoping that we were both wrong."
"Me too," I agree. Setting the scan down on the desk, I throw myself down onto the sofa that we have in the staff room and look upwards towards the ceiling. "I'll be the one to talk to the parents. No offence, but I think it will be better coming from me."
Lewis smiled sadly at me. As much as I liked him, he was severely lacking in the empathy department when it came to discussing matters with parents; with the patients, he was great and you wouldn't want anyone better than Lewis to treat your child but when delivering bad news, I was the man for the job.
And how I hated it.
Our patient was a seven-month-old little girl named Marina and she was utterly adorable. She had been referred to us by a doctor in another hospital, asking us to take a look at Marina's case. Her symptoms weren't consistent with anything her previous doctor was familiar with so he sent her to see us, hoping we could provide answers. Lewis had been the first to see Marina but after meeting the parents, he brought me in on the case, too.
I had to agree that the symptoms were vague- fevers and vomiting, problems feeding and crying incessantly, seizures and muscle spasms... it could be a number of things, which is why it took us the better part of three days to come to a diagnosis. Even then, I prayed that we were wrong. If we were right, there was nothing we could do.
Nothing we could do is my most hated phrase in the world. Used in any combination, it was proof that we had failed in our duty to heal a patient and I often struggle to reconcile the fact that I want to be able to do everything in my power to treat my patients and knowing that, despite everything, there really is nothing that I can do.
I knocked on the door of Marina's room, peeking inside to see her parents sitting in agonising limbo, waiting to hear the prognosis. Julie, Marina's mum was the first to look at me, offering me a hopeful smile that I couldn't reciprocate. She noticed. She whispered at her husband, forcing him to focus on me.
"Hi, both," I address them. I have to remember to be calm and professional but on the inside, my guts are constricting with nerves and sadness. "May I have a word with you both?"
Julie nods. "Sure, Dr Fletcher." Conscious of the fact that I didn't want to take them away from their daughter when time was precious, I hold my hand up to them and pull a chair over to the side of the hospital bed. "So, what's the verdict?"
A sombre mood took over as I opened Marina's file and pulled out the scan we'd received today as well as the results from the blood we took and the skin biopsy that we sent off for. I looked at the words that stared back at me, noticing that nothing here was in plain English.
Galactosylceramidase. Myelin. Genetic mutation. GALC. Galactolipids.
"Henrik, Julie," I address them by their names. When I was delivering life changing news, I had to treat them as people and not distance myself from them. I was human- a parent- just like them, not a robot. I closed the file and placed it on the table. "I so wish that I had good news for you. We received Marina's scan results and unfortunately, it confirms what we first thought and what the results from the lab told us."
I take a deep breath. "Marina has something called Krabbe Disease. It's complicated to explain but I'm going to try and do my best. Krabbe Disease is a genetic mutation that is very rare and affects the nervous system." Julie gasps and grips Henrik's hand tightly. "Krabbe Disease means that Marina's body doesn't create enough of an enzyme is needed to make something called myelin. Myelin surrounds and protects nerve fibres, almost like it insulates the nerves in the brain."
I pause, mainly to let the words that I say sink in but also because I need to compose myself for what I'm about to say next. In the silence that lingers, I see how Marina's parents both turn to look at her, desperation and sorrow seeping out of them. Henrik, a hulk of a man, crumbles as the tears stream down his face while Julie tries to keep it together long enough to squeeze his hand.
"What does that mean?" Julie asks me. "What's the prognosis, Dr Fletcher?"
I close my eyes tightly, wishing away the burning sensation behind my eyelids. When I finally open them, I look down at Marina, wishing that things could be different. "Without that protection, the cells in the brain die and the nerves in the body start to stop working like they should. That explains why Marina's muscles have weakened recently. Julie, Henrik, Krabbe Disease is incurable. There are treatments available to help ease symptoms but there is no cure."
"No cure," Julie echoes. "How long?"
It devastates me whenever someone asks this question because that's it, it's final. Once they know 'how long' is left, people start making plans for the end and a future without this beautiful child is suddenly a reality. I had to force the lump in my throat away.
"Early-onset Krabbe Disease has a very poor outlook." I pause for a second before the next words come out, choosing them carefully because once I've given them this information, that's it- a death sentence. "On average, children with early-onset Krabbe Disease... they, uh, die before the age of two-years-old."
A heartbreaking sob fills the room. Julie buries her face in the blankets that cover Marina's legs and Henrik places his chin on the crown of his wife's head. His tears come quickly yet fall silently down his cheeks. I can see him trying to be strong for Julie, but who will be strong for him?
"Dr Fletcher?" Henrik gains my attention. Immediately, I look at him, hoping that they can see how devastating it is for the staff here; it would never be the same as what Henrik and Julie are going through, but we feel these outcomes too. "Thank you for telling us but right now, I think Jules and I need time to process this and spend the evening with Marina. Could we, uh, continue this in the morning, please?"
I nod. "Of course."
I leave the room. I don't tell them that I am sorry. Sorry won't fix anything and they always know that 'I'm sorry' is just empty words. I often get parents asking me if I have any children because unless I do, I could never begin to imagine what they are going through. I never tell them that, yes, I do have a daughter and another on the way because what use is that? Martha is healthy and thriving and while Nugget has a congenital heart defect, there were cures for it. What my patients go through is off the scale in comparison.
When I get back to the staff room, Lewis waits for me. As soon as the door is shut, he hands me a warm mug of tea and quietly exits the room. Before the door closes, I see him slide the signage to DO NOT DISTURB. We deal with far too many sensitive cases on this ward that sometimes, we need to just be left alone to deal with what is going on around us. I don't drink my tea- it won't fix a thing.
I feel my eyes grow heavier with unshed tears and after trying to keep it together, I break down. It doesn't last long but to be honest, it doesn't have to. I just need to experience it so that I am reminded that I'm not a heartless bastard.
After a minute of crying, I wipe away the tears and head towards my locker, opening it and searching for my phone. Quickly going to my contacts, I scroll down the list until I find the name I'm looking for and hit the call button. It rings four times before a voice fills my ears.
"Could you please tell Charlotte to stop fucking texting me to see if I'm still alive?" Martha's irritated voice somehow provides the comfort I was looking for. She was most definitely still alive and even if she was climbing mountains with a man that I was sure was slightly deranged, I was glad that she was ok. "Honestly, I love the woman but she's driving me stir crazy."
I smile to myself. "I love you, Martha."
"Huh?"
"I love you," I tell her again. "I don't know what I'd do without you, bindi. You and Nugget are the best things I've ever done in my life and I don't know how I'd survive without you. I need you to know that I love you so very much that it breaks my heart when you're not with me."
Silence greeted me. "Daddy, are you ok?" For once, Martha's words weren't dripping with sarcasm, instead, she was genuinely concerned. "Is Charlotte ok? Is the baby ok?"
"Lottie and the baby are fine," I hasten to tell her. I didn't want her to think the worst when she was still away. For a trip that was supposed to only take Martha away from London for thirty-six hours, maximum, she'd been gone for days and I was desperately counting down the hours until she was home. I just really wanted to hug her. "I'm having a bad day at work and it puts everything into perspective, that's all. When are you coming back?"
I can hear some muffled voices in the background, one that sounds distinctly like Jimmy Delaney and another that sounds like Lucas Delaney. "Dad, Jimmy says we're climbing Snowdon tomorrow and we'll be back by late afternoon," Martha informs me. "Daddy, are you sure you're ok?"
"I will be," I tell her. "Once you're home so I can give you a big hug and a kiss, I'll be great."
Martha laughs, tells me she loves me, too, and demands that I go home so I can bestow the same treatment on Lottie and the baby. "Give them both a kiss and a hug from me!" Martha said before ending the call.
Not needing to be told twice, I grab my things and slid my jacket on. It was almost ten pm and I was pretty sure that Lottie would be asleep by the time I got home but that didn't stop me from rushing back to the houseboat.
As I predicted, the boat was pitch dark when I arrived. Quietly, I slipped the key into the lock and let myself inside. Lottie hadn't been sleeping well recently and I would hate to wake her up. I ditched my bag, shoes and jacket at the door, locked up, and tiptoed down to the bedroom. The door creaked slightly as I opened it but it wasn't enough to stir Lottie. She was still completely out of it. She looked beautiful as she slept, a serenity embedded in her feature. I couldn't help but notice her hand cradling the bump, under which our baby was probably moving around endlessly. Nugget was a night owl, we have discovered.
After changing quickly and pulling on only a pair of pyjama bottoms, I slide into the bed next to Lottie, reaching my hand out so that it splayed out over the bump and grazes Lottie's fingertips. Lottie sighed happily in her sleep and shuffled closer to me, her nose nuzzling my neck.
"Hey," she sleep-talks.
"Hey, yourself," I whisper back at her. With her lips that close, I lean forward and kiss her gently. "I love you, Charlotte Louise Clément-Delaney."
Under my palm, Nugget kicks. "I didn't forget about you, Nugget," I speak to the baby. "Daddy loves you to the end of the world and back, infinitely. I cannot wait to meet you and hold you in my arms, bindi. Once you're here, our family will be complete. Well, until Mummy has Burger and then Fries, and McFlurry and maybe even Diet Coke. We'll see."
"You're an idiot," Lottie giggles at my side. Her hand moves from her bump and softly traces along my jawline until her thumb tickles my lips. She leans in for a kiss. "But we all love you the same, nonetheless."
Every time I think about Isaac and Martha's relationship, I think of this song!
Now, before you all go thinking that Nugget is a girl because of the title of this update- 'Daughters' refers to Martha and the little girl mentioned in the chapter- Marina. So, yeah... it's not a sign!
Did anyone need their tissues?
Could Isaac get any more adorable?
Nugget... Burger, Fries, McFlurry and Diet Coke? And a lot of you said that Martha was a terrible name when she first came along!
Anyway, here is a gift to you from me. I told you that there would be more stories from this universe and I teased you the cover for the next one but it was pixelated and my OCD wouldn't let me keep it, so I've changed it. Oh, and here are the covers for the final 2 stories in the series (Five is my maximum!)
See you on Sunday! Have a great end of the week and a super Saturday.
Sarah, xx