Death is Not an Option - 8. Chapter 8

Katie
I checked on Isaac at about three o’clock. I was a little sad that we were going to be losing him. He is so beautiful. It isn’t often we have patients who look like him and it has been fun to giggle and joke about with the girls, vying to get to spend time with him. I am so glad that he is as lovely on the inside. So many times you find that the more perfect the package the more ugly its contents. Not so with Isaac.

He was fast asleep when I went in and I made the decision that, as he was going home the next day I was not going to wake him up to do obs. I did what I could and he didn’t even stir as I took his temperature and pulse and recorded the data on the chart. I had to smile. He had been through so much but you would never have known it. He was completely relaxed, peaceful, curled up like a child.

I remember thinking that I was very glad that he wasn’t a child because if he had been the thoughts I was having would have been illegal. Rick would have killed me for that thought but it isn’t as if I would ever have done anything about it. It’s like looking at male models and hot guys on tv. All very perfect and pretty to look at but not quite real.

I knew that Isaac was beyond me and had no desire for it to be otherwise. I am happy with Rick. He is a special person too and beautiful in his own way. I love him very much and would never have done anything to jeopardise that but... well I’m only human aren’t I? Standing in the semi darkness looking down and watching him sleep I couldn’t help myself. I had to touch his hair and it was so soft. He’d had a shower and when I brought my fingers to my nose they smelled faintly of soap and lemon.

I was busy after that for a time and I didn’t think about Isaac at all. It was almost four when I thought to check in on him again. I was almost there when I bumped into Sandra and she started to tease me about where I was going and why. We were giggling like schoolgirls when we heard the cry and the crash. We called out to Steve, a male nurse who was at the station and didn’t wait for him before going in.

There was a man leaning over the bed. I was shocked even before I saw what the man was doing because there really shouldn’t have been anyone in here at this time of the morning. I was even more shocked when I stepped across the threshold and could see that the man had his hands around Isaac’s neck. I didn’t even pause to shout to him. I didn’t stop to think. I just reacted. I grabbed him and pulled him away swivelling to slam him into the wall. Sandra went to see to Isaac.

The man was big and he pushed me off easily. Fortunately by that time Steve was there and soon had him pinned against the wall. I could see in an instant that Isaac was in trouble and it was pretty clear that it was not just because of the attack.

“What have you done to him?”

The man sneered. “That’s for you to find out although, I have to caution you, you don’t have much time.”

I glanced over at the bed and could see that he was right. Isaac was in real trouble. Sandra was calling his name but it was clear to see that he was way beyond responding. I didn’t have to be told that there wasn’t much time.

I looked around, seeking inspiration as, one look into those cold eyes made it quite clear that he was not going to volunteer any information willingly and, much as I would have liked at that moment to beat it out of him or, better still get Steve to do so, it would have taken too much time. Steve looked as if he would have been happy to comply, he twisted the arm he was holding up behind the man’s back but he only laughed.

That is when I noticed the blood on his hand. I looked more closely and saw that it looked like a puncture mark. I looked around quickly and spotted the syringe on the floor near the wall. I picked it up and put it in front of his face.

“What was in it?”

“Get your lab to analyse it. Of course by then it will be too late but...” He shrugged, a look of gloating triumph on his face.

“Doesn’t it bother you that you are going to be tried for murder?”

“I’m already going down so what’s the difference?”

“What’s the difference? A young life, that’s the difference. Don’t you think he’s been through enough?”

“Oh no... not nearly enough. The only shame is that he has to go so quickly, I would have liked to see him suffer a lot more.”

“We don’t have time for this.” Sandra’s voice behind me was turning urgent and in the distance I heard an alarm sound, she’d pressed the emergency button. My mind was in turmoil, casting around for inspiration, panicking I suppose. I put my face close to his, it made my skin crawl but I wanted the effect and not necessarily for anyone else to hear what I said.

“I think you may have missed an important point here.” He smiles and it chills me to the core. It suddenly occurs to me that from a distance and in the dark, with his blue eyes darkened by the shadows this man could be mistaken for Isaac. “He stabbed you didn’t he? With the syringe? So whatever was in it is now in you.”

I was clutching at straws but I was desperate. It was very unlikely that there would have been enough of anything in the syringe by the time it went into him to cause any harm but his eyes widen. Clearly he is not entirely certain about that.

“There wasn’t enough.”

“It only takes a tiny amount to get into your blood. Maybe the effects won’t be so immediate or dramatic but it will be there. It will travel through your blood to your heart or your brain and in an hour, a day, a week... bang. By then you will be in no condition to tell anyone what’s happening to you.”

“No... you’re lying to me.”

“Fine... if that’s what you want to believe go ahead. If you are prepared to take that risk....”

I straightened and turned away. The door burst open and there were people everywhere. I was shocked to see Sandra on the bed straddling Isaac, frantically pumping his heart. My heart plummeted. I thought we were already too late. I took a step forwards intending to help.

“Wait. Wait... alright...alright I’ll tell you. I’ll tell you everything. Please... help me... don’t let me die.”

It was hard to turn my back on what was happening to Isaac and look into that face again, but I did it. It wasn’t sneering now. He looked frightened. Good. I wished with all my heart that there was a risk of him suffering, I wanted him to suffer, more than I had ever wanted anything.

I gave him my coldest look. “I will help you... IF you help me. Tell me exactly what you did.”

And he did. It made my heart turn cold.

Now I have to face them, Ruth and Jacob. They came to take their friend home. Full of life, full of hope. They look confused. I have had them taken to a private room. I couldn’t let anyone else tell them. It has to be me. They deserve for it to be me but I wish with all my heart that it could have been anyone else... anyone.

They both look up as I enter, their eyes bright and hopeful. Oh god this is hard. How can I tell them? How can I see that hope die?

“Hi Katie. What’s going on? Is Isaac ready?”

I sit down on the edge of the table. Take a deep breath. Their eyes are uncertain now. I can feel the uncertainty, the unease.

“Caleb was here.”

“Caleb? I... I don’t.... How was he here? He is on the run. Why would he come here? Why?”

“He came for Isaac.”

“For Isaac? What do you mean? Is he alright? Is Isaac alright?”

“No. I’m afraid he isn’t.”

“What did he do? What did Caleb do?”

“He poisoned him. He poisoned Isaac.”

“No!” They were both on their feet, pleading with their stances, begging with their eyes. “Please no. Don’t say he’s dead just don’t... don’t do that. Please... please...”

“Be calm Ruth. He’s not dead.” The relief that flooded them both was painful to see. Perhaps it would have been better, easier for them if he had been dead. “The poison was lethal. Caleb meant to kill him. Fortunately we found out what it was in time to treat him.”

“So is he alright? Is he going to be alright?”

“At the moment we don’t know. The poison affected his heart and it stopped. We had some trouble starting it again and it’s very unstable. We don’t know yet whether there has been permanent damage.”

“But.... but.... he’s going to be alright isn’t he. He is going to be alright?”

“We don’t know Ruth. It’s very early days. We don’t know if his heart has been seriously damaged and we don’t know if it has affected his brain. He is very, very ill and he... You need to be prepared, both of you, Isaac could die at any time. If his heart stops again then we won’t be able to do anything for him.”

Their eyes are huge. At the moment shock is most prominent, grief is close behind but it hasn’t hit them yet. They are still in total disbelief.

“But he was.... he was so.... he was coming home today.”

“I know it’s a shock, but you have to be strong. We are doing everything we can for him. He is a strong boy, even though he’s been through a lot lately. There is a chance.”

“How much of a chance? How much?”

“I can’t say. I’m sorry but it’s just too early to tell.” I hate this. This is the worst part of the job and this time... this time... They are so young, so eager, so full of hope. How can I crush that? How can I see those bright eyes dimmed. “There’s more you should be aware of. If Isaac survives... IF he does then it is very likely that he... that won’t be the same.”

“What do you mean ‘not the same’?”

“It’s possible that his brain was affected by the poison, and by lack of oxygen when his heart wasn’t working properly. We won’t be able to tell for certain for some time but... he may have suffered brain damage.”

This is the last straw. Ruth collapsed and Jacob catches her although he doesn’t look much better himself. “I’m sorry. I didn’t want to burden you with this but there’s no one else. Isaac is going to need someone and the only ones he has are you two.”

“It’s alright. I... Thank you for being straight with us. It would have been worse if you hadn’t told us the truth. I... I’ll take care of Ruth. And I’ll take care of Isaac too. It isn’t as if I’m alone. Everyone at the community will help... they all know they did a bad thing and want to make it right. Isaac will be taken care of.”

“I know that. I have no doubt.”

“Can we see him?”

“Of course. We’ve moved him to intensive care so we can keep a close eye on him and take better care of him. You can spend as much time with him as you like, stay here if you want. It’s good for him to know there is someone close.”

Ruth can barely walk but I know that she will get better as we go which is why I don’t waste any more time. Jacob supports her with such strength and tenderness that I know she will be alright. She will be taken care of no matter what.

Outside Isaac’s room I pause. I need to prepare them for this. “Don't be afraid.”

“Afraid? Why would we be afraid?”

“There is a lot of equipment. It can seem a little frightening.”

“Oh.”

“Isaac’s heart is still very unstable and it is important that it is as unstressed as possible. We have taken as much pressure off as we can. Isaac is asleep, we’re keeping him deeply sedated, and he is connected to a machine that is breathing for him. It isn't that he can't breathe for himself but it is just to give his body a complete rest. Remember that.”

They nod, their eyes enormous, and I wonder if I am doing the right thing. They are barely out of childhood. It is a lot for them to cope with.

“We’re okay. We’ll be strong for him.”

“I know you will. Come on, I’ll take you in.”

It never gets routine for me. Every time I walk into one of these rooms, as soon as I hear the beeping of the monitors the hair on the back of my neck stand on end. I have never been interested in becoming and ICU nurse, this is too close to the edge for me. I like the interaction with patients, I like to help them be comfortable and to see them getting better. Here, in this quiet cocoon like world, patients are unconscious as often as not and as soon as they start getting better they are transferred out onto a general ward.

Many of my friends love this environment, working close to the edge where every single day they make life or death decisions, the things they do make all the difference, one way or the other. It was too stressful for me. I hate the coldness, the equipment, the things they do to people just to keep them alive for one more day, one more hour. I hate the fact that the patient here are not really here at all... they are somewhere far, far away and we just don’t know where that is. Death is an ever present shadow, a breath on the back of your neck and this time it’s worse. This time it’s personal.

I don’t know exactly when it happened, when I slipped from professional to personal. It wasn’t something I had sought; indeed it was something I fought against. But when I was struggling with Caleb there was desperation in the way I fought for Isaac, a terrible pressure on my heart knowing that every second that passed his life was slipping away.

And when it was over and I knew what we were dealing with and I got the drugs to counteract the poison... and when I came back and the crash team were working on Isaac and it looked as though it was all over, I was paralysed. It has never happened to me before, not even when I was training. I have never been so caught up with a patient, so frightened about what was happening to them, that I was frozen by that fear.

Sandra was still there and she saw what had happened and took the drugs from my hand, moving me aside to a place where I would not get in the way. I watched wide eyed and horrified until they got to the point where Isaac was out of immediate danger. To be fair to him Dr Marsden was fantastic. He didn’t give up, not even when it seemed hopeless. He was inspired and full of passion. Whether that came from guilt about the way he had treated Isaac before or whether it was because Isaac had infected him with the same caring he had caused in the rest of us, I don’t know.

I had stood for a long time, after they had finished, while they were arranging the transfer to the ICU, just looking at him, staring down at his face, assaulted by feelings that ranged from anger to grief. How did I get to be so involved, so caught up with someone I really don’t know? It wasn't a sexual attraction, never that. I love Rick too much to have my head turned by a pretty face. It was something different, something less definable. There is something about Isaac, something sweet and pure. Even when he was lost in the depths of despair, wanting to die, there was a life about him, a pure energy that had meant that I had never believed that he was capable of doing what he had been accused of.

And I feel it again now. Even unconscious Isaac shines. It is more than physical beauty, more than a sweet nature... it is just indefinable. I can’t imagine what Ruth and Jacob must be feeling. As much as I dislike this side of nursing it is still part of my job, still fairly routine. I know every piece of equipment, what all the readings mean; the purpose of everything. I know why and what and I know that in the end, what it all comes down to is the person in the middle of it. They are staring at him as if they can barely believe what they are seeing.

I smile and nod at the nurse who is sitting with him. Another job I hate. It is as if you are waiting for something to go wrong, ticking of the minutes of someone’s life waiting for it to end. She nods back and leaves, without question.

“Don’t be afraid. You can talk to him, touch him. He’s just Isaac. All this stuff doesn’t take that away.”

“Can he hear us?”

“Maybe. He’s just asleep.”

“Is he in a coma?”

“Not exactly. It’s only the drugs that are keeping his asleep. When we stop giving them to him he will wake up.”

“When will you do that?”

“When he’s stable. When we know his heart is up to it.”

“When will that be?”

“We can’t say at this stage. As I told you he’s very poorly right now. His heart is unstable and he’s having mini seizures every few minutes unless we keep him deeply asleep. We are keeping everything under constant review. As soon as he stabilises we will start lightening the sedation and once he can come up without seizing we will take him off the breathing machine and see what happens. It’s all trial and error at the moment.”

“And at any minute his heart could fail and... and that will be the end.”

“I’m afraid that at the moment it’s a very real possibility.”

“How long before we know?”

“It’s impossible to say. If he remains this unstable for twenty four hours then the chances are his heart is permanently damaged and will never recover.”

“And if that happens....?”

“If that happens we’ll deal with it when it comes.”

“No. I need to know. If he doesn’t stabilise. If his heart is damaged...what... what will happen?”

“If he doesn’t improve in the next 24 hours then it’s likely he won’t improve at all... he will only deteriorate and, I’m afraid, it will then be just a matter of time. We’ll be effectively waiting for him to die.”

“No. That isn’t going to happen though is it? It isn’t going to happen. He is going to improve. He is going to get stable and get better. I know it. I... I won’t let him die... I will pray for him. I will make him be alright. I will... I will.....”

Jacob puts his arm around her shoulders and she rests her head on his shoulder. I feel as though I am intruding and so I leave them to it. I move around to the other side of the bed and check the readouts on the equipment. They are not reassuring. I press my fingers against his wrist. The pulse is strong but erratic, fluttering against my fingers, like the wings of a bird fighting to break free.

He is fighting, I can tell. I can always tell. I seem to be able to know instinctively the ones who are fighting to live and the ones who are sinking, falling willingly into the arms of death. But sometimes fighting isn't enough, the will to live sometimes only makes it harder to face the inevitable. Sometimes I have sat at the side of a bed very much like this one, whispering a comfort that is not about clinging on but about letting go. Not about living at all costs but about dying with grace and dignity. I pray that I am not going to have to do that this time. I know that Isaac would never just give up and I pray that I am not going to have to be the one to try and convince him otherwise.

“Katie.....why did this happen? Why? Isaac is such a good person. He’s been through so much, why now? Why this? Why would Caleb do this? He’s not a bad man. He’s never been a bad man. Why would he do this to Isaac? I know he never liked him, I don’t know why, but I never thought he would hurt him, not like this.”

“If it’s any consolation to you I believe he was mad, at least when he did this to Isaac, possibly the whole time. He was the one who raped that girl wasn’t he?” Ruth nods, her eyes enormous. “Was it the first time that something like that has happened, that Caleb has been violent, brutal?”

“No. He has been.... he has... There have been times before when he has forced himself on women but it has always been members of the community and they have not been able to complain. For many years Caleb has been the ruler of the community even though he is only supposed to be one of the council. It has been a long time since the council has had any real power, certainly not to overrule him. And so no one could do anything. But this time he looked outside the community. The girl was a traveller, she was hiking and she came to us looking for directions to the nearest town. Caleb stalked her and when it got dark.... too dark to see him clearly he attacked her.

“There were times when I wondered whether he set it all up deliberately, whether he deliberately set out to set Isaac up for the attack. It was all just so slick, so planned. We were all swept away, there was never a chance that anyone could stop it.

“But I thought that he.... that he would never do that to Isaac. I knew that he had a problem with him but I thought... I thought it was just because he was so.... so... challenging. He made things difficult for Caleb but even he... even Caleb needed Isaac, even Caleb turned to him... all the time. He was... he was the heart of the community. No one would admit it but they all relied on him, all needed him.”

“It’s a shame they weren’t there when he needed them.”

“Yes. But they will be. Every one of them. They will be.” She says it fiercely as if she is convincing herself it is true or deciding to make sure that it is true.

“I am sure they will. Whatever happens he is going to need them.”

“That’s scary. Zac has never needed anyone. He’s always been so... private. Closed. He likes to be alone. We weren’t supposed to spend time on our own, except when we were praying or studying. Zac used to sneak off into the woods, or up onto the mountain to watch the sunset. I knew even then that one day... I knew that he would leave. As much as it hurt me, as much as I wanted it to not be true... I always knew one day I would lose him. But not like this. Not like this.”

Jacob tightens his grip around her shoulders and she turns her face into him, sobbing. I move to her side and add my arm.

“Try not to think about it Ruth. Try to stay positive. Isaac needs you; he needs to hear you talk to him, to feel you hold his hand. He needs to hear that you have faith in him.”

“Faith? Of course I have faith in him. I have always had faith in him. I have always loved him, even when I knew it was hopeless, that he would break my heart and leave me. I couldn’t help it. We were best friends. We sneaked off together and watched the sunset. I called him Zac and he called me Ruthie. Because we weren’t allowed to. And then Jay started to come along and everything changed. Now there were three of us and it wasn’t just me and him any more.”

“I’m sorry Ruthie, I didn’t know.”

“Don’t be sorry.” She looks up at him, her eyes anxious. “It isn’t.... I didn’t mind. I knew there was no chance for us, for me and Zac. Even now... even when he was kissing me, holding me, I knew he would leave. And I knew you would stay. It has always been that way.”

“I know.”

“I don’t want to hurt you Jay, I’ve never wanted that. You know that.”

“I know a lot of things. I know I never had a chance of competing with him. I know you love him and I know he loves you in his own way. But I always knew he would hurt you. He never loved you like I do.”

“Jay....”

“It’s alright Ruthie, you don’t have to say anything. I don’t expect anything from you, I never have. But I will always be here. Always.”

“I... I can’t think of that now Jay. I can’t even begin.... Zac needs me.”

“I know. It’s alright, I know and I’m cool with it. I love him too.”

It is painful to see the look that passes between them, painful but beautiful at the same time. I know that they will be alright. I let go of Ruth’s shoulder and take a step back. She looks up at me, startled as if she had forgotten I am here. I smile and she returns it, shakily, through her tears.

“It’s alright Ruth. It will be alright. Go to him.”

Looking uncertain Ruth takes a few steps forward, her whole attention now focussed on Isaac. She pauses at the side of the bed and stares down at him. I can feel the tension in her, the fear. She is afraid to touch him, they often are. It is hard to see someone you love in that situation. The equipment is so alien it makes them seem somehow shut away, changed, removed, not the person they were.

“He’s just the same Ruth, the same as he always was. He needs you. Be strong now.”

She looks up and me and nods then turns back to Isaac and reaches out her hand, shaking, to touch his face. For a moment it looks as though she was about to pull it back but in the end lets her fingers linger on his cheek.

“He’s warm. I thought he would be cold.”

“I told you he is just the same as always. He is just asleep.”

“But he won’t wake up.”

“Not yet.”

“I... I’m afraid. I’m so afraid. I’m afraid for him.”

“I know. It’s only natural. I know this is hard Ruth, it's terribly hard but Isaac doesn’t have anyone else to help him. Try to put the fear behind you and be positive for him. Talk to him. You too Jacob. Tell him about things that are going on at the community, about the people he knows. Normal things. Unimportant things. I don’t know if he can hear you but I do know that he will know you are here. He will respond, maybe not immediately but he will.”

“How do you know?”

“I have worked in the hospital for a long time. I have seen a lot of people in this situation. Some have died, some have got better and they got better faster when they have someone here with them, talking to them, touching them, being with them.”

“Have you... have you seen... I mean have there been....?”

“Don’t Ruth. I can’t give you any more than I already have. At the moment we don’t know. It may be a long time before we do, so don’t tear yourself apart in the waiting. Just be with him, make the most of whatever you have.”

“Please Katie. It’s really important to me. And I won’t freak out or anything I promise. But I really, really need to know what you think. Do you think Isaac is going to be alright?”

“Ruth.... I can’t.....”

“Yes you can. You can tell me what you think. I know you don’t know. I know you might be wrong but I need to know what you think.”

“It would be very unprofessional of me to tell you that. It isn’t my place. You need to speak to the doctor.”

“But I don’t trust the doctor. I trust you. Please Katie. Please.”

I feel trapped. Her eyes are pleading, earnest. How can I turn away? How can I let her down? But how can I tell her what I think, what I fear? She needs hope. She needs to be able to give him hope.

I run my eyes over the screens again. I look at his face, the long sweep of coal black lashes, longer than a woman’s brushing his pale, pale cheeks. I find myself biting my lip. It takes real effort to meet her eyes.

“I think that you should cherish every moment with him.”

“You think he’s going to die?”

“I think that.... he is very ill... he...” I can’t bring myself to speak aloud my thoughts. “I think you should prepare for the worst and hope for the best. It’s all that any of us can do in the end.”

“Thank you Katie.” This time she reaches out with one hand and grabs Jacob’s. He moves to stand close to her and they both take Isaac’s hand, holding it between their own. I am suddenly very tired. I feel that I am intruding and should leave but I can’t. There has to be someone here at all times. If anything goes wrong it is vital that there is someone here to notice it at the earliest opportunity and intervene as soon as possible. Isaac’s life might depend on it although I think that if it gets to that point, now, after everything his body has been through then it doesn’t matter how quickly help comes, it will be too late.

I busy myself as best I can, checking whatever I can find to check, recording data, reading the notes and making sure they are clear and up to date. Then I check everything again, hoping that something will have changed, or to be more precise that they have not changed, that the numbers and symbols displayed on the screens have steadied, have become regular, unchanging, but they have not, they are, if anything, more erratic than ever.

Come on Isaac. I know that you can do this. I can’t say it out loud to you because I don’t want to upset the others but I am frightened for you. If this keeps up for much longer you are going to crash and then you will die and that will destroy me. I can’t bear the thought of losing you. You have been through so much, you have come through it with grace and dignity and now to come to this....

Come on boy, I believe in you. Fight this. Don’t let Caleb win, don’t let him defeat you, not now, not after everything that has happened. Don’t give up. Don’t let go. Don't die. Even as I think it, even as I hope, even as I pray I watch the struggle. Jacob and Ruth are unaware. They are lost in their own world, a circle of friendship and love that is immune from everything outside it, untouchable.

I wish that I had the luxury of ignorance. I don’t. I know exactly what is happening. I can see every time his heart falters, every time it stutters and dips, every time it almost stops but kicks back in at almost the last minute. It is happening too often, coming too close. Watching that I can't hold on to hope, I can’t hold on to belief, I can't hold on to anything but fear.

Shit! I have to divert myself. I stopped breathing then. It came so close. I can’t bear it. This is so fucking unprofessional, so unlike me. Isaac, hold on; please, please hold on