The Proud Italian Page 13

  ‘She’s breathing fast.’ The consultant stepped closer to where Abbie was holding Ella, rocking her. ‘And she’s feeling rather warm, don’t you think?’

  ‘She’s been crying for a long time.’

  ‘She must still be in pain,’ Rafael said. ‘Can we not give her something more for it?’

  ‘I don’t think it’s her hip that’s bothering her.’ The consultant was frowning as her fingers pressed against Ella’s upper arm, taking her pulse. ‘I want a full set of vital signs done and a blood count.’ She looked from Abbie to Rafael. ‘I don’t want to worry you but I have a feeling she might have picked up a bug of some kind.’

  The blood-test results came back almost as fast as the results on the bone marrow had, but this time the news was very different.

  Thanks to the strain on her immune system for so long, Ella had been unable to fight off whatever infection had sneaked past all their precautions.

  Her cancer might have been beaten but there was a new enemy to fight now and it looked like a fierce one.

  Over the rest of that day Ella’s condition deteriorated bit by bit. Her heart and breathing rate increased. Her oxygen saturation dropped. Her temperature climbed. Various specialists were called in to assess her and, by that evening, they were all looking concerned.

  ‘I’m so sorry,’ one of them said to Rafael and Abbie, ‘but this is looking serious. I’m afraid we need to shift Ella to Intensive Care.’

  CHAPTER TEN

  THEY’D BEEN HERE before but this was different.

  The end of the road?

  Abbie was beyond exhausted.

  Beyond hope?

  Ella had been intubated shortly after arriving in the intensive-care unit and the breathing tube attached to the ventilator had quickly been joined by other invasive monitoring devices, including an arterial line to measure blood gases, a second venous line to administer fluids, a urinary catheter and a nasogastric tube. She was transferred to an isolation room, X-rays taken and antibiotics started.

  Now all they could do was watch and wait. To try and offer life support until such time as Ella’s tiny body could muster the resources to overcome whatever new enemy had made its unwelcome appearance. The decisions that might need to be made if the situation got any worse were just too awful to contemplate.

  They’d been so close to victory.

  So close to fitting all those pieces of the perfect life back together again where they could have made a picture that was stronger and brighter than it had ever been before.

  But now the colours had been muted. Virtually erased. Everything looked clinical and white and frightening in here. The only hint of colour around Ella was the faded pink of the bedraggled old toy, Ears, which Abbie had insisted on bringing with them and which now sagged forlornly at the far end of her bed, well out of the way. The sparkly pink ballerina bear had been left behind in the ward, seemingly along with all the other bright colours and hopes. Even Ella’s pretty pink pyjamas were gone. She wore nothing more than a nappy in this warm space because her chest had to be bare due to all the electrodes that were stuck to her skin and easy access was needed to all the tubes invading her small body.

  The sparkle of that new closeness with Rafael had gone, too. Things felt brittle between them again. As tense as they had been when she’d returned with Ella from New York. Far too similar to what things had been like just before she’d left when huge decisions had had to be made and they had been on such different pages. Just before that terrible row that had ended the marriage they’d had until then.

  They were both in this small space with their daughter but the gap between them had widened. For Abbie it was too close to where she’d been when Ella had been so sick in New York and she had been there by herself, watching every breath her baby had taken in case it had been her last. Feeling…betrayed, because Rafael hadn’t been there beside her.

  He was here physically now but he seemed to be distancing himself, just like he had in the past. Standing back emotionally and weighing up whether it was fair to put a tiny person through so much suffering when…when there was no hope?

  He was sitting on a chair in the corner of the room at the moment, his head tipped back and his eyes closed. His face was grey but neither of them had had any sleep since Ella had been brought into this intense place where small lives hovered between life and death. She hoped he was actually asleep now and not just trying to shut himself further away but it seemed unlikely given that two of the PICU doctors and a nurse were in here, quietly reassessing their newest admission after her first twelve hours of intensive care.

  There had to be hope. Surely Abbie would be able to find it again when the stunning effect of this new blow wore off? Or when a new blood-test result came in that showed that one of the raft of antibiotics and other drugs was already helping to get the infection under control.

  Abbie stared at the bank of monitors around the bed as the doctors spoke quietly to each other.

  ‘Have you got a blood-gas syringe there?’

  ‘Yes. Here it is. Do you want venous samples as well?’

  ‘Yes. Let’s get a full blood count and electrolytes. We need to keep a close eye on renal function, too.’

  ‘What’s the central pressure at the moment?’

  ‘Down to nine. Let’s get some more fluids up. I don’t want it dropping any further.’

  ‘Happy with sedation levels?’

  ‘Yes. We’ll keep the fentanyl and midazolam infusion going.’

  The tracing of Ella’s heartbeat blipped across the screen. Too fast but at least it was steady. Even a single missed beat right now and it might be too much for Abbie. She stared at the screen, willing it to continue.

  One of the doctors handed a tiny syringe of arterial blood to the nurse, who whisked it away to test the oxygen levels. He checked all the figures being displayed on the ventilator and then glanced sideways.

  ‘How are you doing, Abbie?’

  Abbie shrugged. Goodness…had she caught such an Italian gesture from Rafael? She tried to swallow the huge lump in her throat.

  ‘Oh…you know. We…really weren’t expecting this…’ ‘I know.’ The tone was full of sympathy. The doctor turned to look at Rafael. ‘Things are stable at the moment. You two look like you need some rest. You know there’s a bed that you can use? The nurse can show you where it is. You could take it in turns to get a bit of sleep.’

  Rafael’s eyes opened slowly, revealing how aware he was of everything going on in the room. ‘I’m not going anywhere,’ he said. ‘Not this time.’

  For a short time, when the doctors had done all they could for the moment, Rafael and Abbie were left alone with their daughter.

  ‘Are you going to call your parents?’

  Abbie shook her head. Any hope of the birth of a grandchild ending the estrangement had evaporated when her parents had disappeared from contact after learning that Ella was so sick. Such an obvious lack of support was the last thing she needed to be reminded of right now.

  She only had Rafael, didn’t she?

  She’d thought he would be all she ever needed in the way of family but the way he was pulling into himself with this latest crisis was leaving her feeling horribly isolated.

  Desperately frightened, in fact.

  Abbie had believed she was over the grief of losing the closeness she should have had with her own parents but it wasn’t buried that deeply, after all, was it?

  ‘Are you going to call yours?’

  ‘Si. Of course.’ But Rafael rubbed at his forehead and pushed his fingers through his hair. ‘Even if it will worry them, they need to know. They are la mia famiglia. Fiorella’s family.’

  It was much later in the day before Rafael took the time to call Italy, however, and when he came back he went straight to Ella’s bedside, where he stood staring down at the unconscious baby, resting a hand lightly on the top of her head. He looked tense enough to explode into a million shards.

  ‘What’s
wrong?’ Abbie asked.

  ‘My mother… I can’t believe she didn’t tell me. She said she didn’t want to worry me and it was nothing. But it’s not nothing… It’s…’ The hand that wasn’t touching Ella curled into a fist.

  Abbie’s heart sank to a new low. The world was spinning out of control with increasing intensity. ‘What’s happened?’

  ‘My father. Apparently he had a heart attack two days ago.’

  ‘Oh, my God… How bad was it?’

  ‘I don’t know. I need to clear my head a little before I try and ring the hospital. My mother’s version of events was somewhat garbled. She said he’s fine. That my father was far too stubborn to let something like a heart attack kill him.’

  ‘Is she all right?’

  A huff of sound came from Rafael. ‘She made it sound as if it’s nothing more than a head cold. As if…as if she doesn’t actually care.’

  The shaft of pain in Abbie’s chest made her wonder if it was physically possible for a little piece of heart to break off.

  Rafael was a passionate man who cared very deeply about the people he loved but had he been taught at an early age to step back from the worst of the pain that that sort of caring brought with it? To use dispassion as protection?

  That would explain so much.

  ‘You know that’s not true,’ she said softly. ‘You know she cares very much. She’s trying to protect you. Protect herself…’

  Rafael stood there motionless for a long moment and then gave a terse nod. ‘I’m sure you’re right. They might have always fought a lot but they’d be lost without each other. She must be very afraid at the moment.’

  ‘Why don’t you go and ring the hospital? Ella’s good. There’s been no change.’

  Good was hardly the word to describe Ella’s condition, but while there’d been no improvement neither had there been any further deterioration, and maybe that was enough to qualify as ‘good’ for now.

  It was nearly an hour later that Rafael returned again and this time some of the tension had gone.

  ‘He is all right,’ he told Abbie. ‘I spoke to him and I spoke with his doctors. It was a small heart attack and he got to the hospital in good time. He’s had several stents put in, which has probably saved him from having a much worse attack. Saved his life even…’

  As before, Rafael had gone straight to Ella’s bedside and was touching her again. A soft touch. And this time it was accompanied by the hint of a smile. Was he trying to transfer the hope from the news about his father to his daughter? Hoping against hope that another life was about to be saved?

  Oddly, it made Abbie feel more isolated. She was relieved for Rafael and his family, of course she was, but did this end justify the means? Make it acceptable to put up those emotional barriers when things got tough?

  ‘I…might go and have a shower,’ she said. ‘And see if I can get a couple of hours’ sleep. If you’re okay to stay with Ella?’

  ‘Of course.’ This time it was Abbie who received that gentle touch. ‘I’m here. You do whatever it is you need to do.’

  They couldn’t spend every minute of every day in that small isolation room with Ella, no matter how hard it was to be away from her.

  They had to eat. They had to use the bathroom. They had professional obligations that became more of an issue as the hours ticked into the third day of this crisis, even though their colleagues were only too happy to be covering for them.

  ‘The MacDonalds want to speak to us before Angus is discharged,’ Rafael said after a phone call. ‘Maybe I should go and see them. It would be bad if they caused trouble for the clinic by making another complaint.’

  ‘I’m sure Ethan could handle it.’ But Abbie glanced at a message on her own pager. ‘Annabelle’s due to have the dressing taken off her new ear today. I do feel bad about missing that.’ She tilted her head back to rest on the chair, covering her eyes with her hand. How long could you go on like this? Was there a point where physical and emotional exhaustion simply became too much? What happened then? A numbness that never left? Did you have to go through life like a robot? Going through the motions but incapable of feeling anything, good or bad?

  ‘Ella’s stable. Maybe it would be a good idea if we had more of a break than we’ve been getting. As long as one of us is here with her. We don’t know how long this is going to go on for.’

  Or how it was going to end. Ella was clearly fighting hard for life because the holding pattern was continuing and she wasn’t getting any worse. But they all knew that she could reach the limit of her physical resources at any time. That she could crash and there would be nothing that any of them could do to keep supporting her.

  Abbie took her hand from her eyes to find Rafael’s concerned gaze resting on her. He wanted to help, didn’t he? He just didn’t know how because he was too far away. Emotionally distant. Protecting himself.

  This was no time to attack him for something he probably couldn’t help. Or change. And yet this was the kernel of why their marriage had got into trouble. The part of each other that they didn’t get. Abbie thought she could understand why Rafael was like he was now but the real question still remained. Was he capable of giving her what she needed for the rest of her life?

  Maybe nobody could. Maybe her expectations were simply too high.

  The whole issue of their relationship was too much for her exhausted mind and body. Yes. Maybe they did need a break from being in here with Ella.

  Maybe they needed a break from being with each other.

  ‘You go and see the MacDonalds.’ It wasn’t as though it would be a new experience to be keeping this kind of a vigil by herself. ‘I’ll decide later about Annabelle.’

  But Rafael was reluctant to go. ‘Are you sure? I want to be here for you this time. For every minute.’

  Didn’t he want to be here for Ella? Had he given up hope on her again? Abbie had to blink back tears. She was being irrational but it was hard not to be when you felt this fragile. She had to get a grip. For Ella’s sake as well as her own. She couldn’t help her precious child if she fell apart herself.

  ‘Go,’ she said. ‘You’ll be back here soon enough. I’ll be okay.’

  Except she wasn’t. Even if Rafael was holding himself distant emotionally, his presence had been more comforting than she’d realised. Being the only parent with nothing to do but watch and hold the tiny hand that emerged from the bandages covering the tubes was so lonely. So heartbreaking.

  Maybe that was why Abbie allowed herself to be persuaded to take a break herself when Rafael came back with the news that a very happy MacDonald family was on its way home.

  Her registrar and the ward nurse were surprised to see her appear in the treatment room.

  ‘We weren’t expecting you.’

  ‘I needed a break,’ Abbie told her colleagues quietly. There was no need for her patient’s family to know that she had personal issues that outweighed any professional responsibilities. They were here with their precious child. The world outside Ella’s room was continuing to revolve and maybe it was a good thing to be reminded of that.

  ‘How’s it going?’ her registrar asked.

  ‘As well as it can. No change yet.’ Abbie raised her voice, turning to the nurse, who was carefully melting the sticky side of tape with an alcohol-dampened cotton bud. ‘How’s it going here?’

  It was a fiddly business, removing the elaborate dressing that had been protecting Annabelle’s new ear since her surgery. The plastic cup had been taped to her face and bandaged in place. Inside the cup were layers of soft dressings around and inside the ear.

  ‘You’re being very brave,’ Abbie told her small patient. ‘I know it’s a bit sore when things stick like this.’

  ‘Can I see it?’ Annabelle asked. ‘Can I see my new ear?’

  ‘You sure can. It’s going to look a bit pink and funny for a while, though. It takes time for the swelling to go down.’

  ‘I want to see it.’

  Abbie t
ook a hand mirror from the nurse and held it for Annabelle, who tilted her head and stared intently at her image. The smile that lit up her face moments later was heart-warming.

  ‘Do you like it?’

  Annabelle nodded happily. ‘I’ve got two earrings.’

  ‘We’ll have to put a new big dressing on it and hide it away for another couple of weeks but it’s looking great.’ Abbie smiled at Annabelle’s mother. ‘I’m really happy with the result.’

  ‘Oh, so are we, Mrs de Luca. Thank you so much.’

  It had been a good idea to take the short break. To connect with the world beyond what was happening to Ella. The warmth of Annabelle’s smile stayed with Abbie as she hurried back, feeling stronger than she had when she’d left.

  The smile with which Rafael greeted her return was also heart-warming. He was beside Ella, stroking her wispy, dark curls and talking to her quietly as a nurse took a set of vital-sign recordings. Abbie waited until the nurse was finished before going close enough to press a kiss to Ella’s forehead.

  ‘Hey, baby girl. How are you doing?’

  ‘Still no better,’ Rafael said quietly. ‘But no worse either. We can only wait. How was Annabelle? Are you happy with the ear?’

  Abbie nodded but she didn’t want to talk about it. Already, the outside world had vanished again and the only thing that mattered was here in this room. She watched Ella breathing for a minute. Touched her hand that lay upturned, with the fingers curled in complete relaxation, as though she was having a natural sleep.

  But this was anything but natural. This was state-of-the-art technology and a battery of medication that was keeping her baby alive. Needing comfort, Abbie picked up Ears. She turned away as she cuddled the toy under her chin. She could smell Ella on the toy and it made her want to cry.

  ‘What’s that?’

  The fat file open on the chair Rafael had been sitting on distracted her.

  ‘I’ve been reading Ella’s story,’ he told Abbie. ‘From the first admission. I’d forgotten that we thought she’d just had a cold.’

  Abbie sat down and picked up the file. The paediatrician had made meticulous notes.