“I’ve got to call my coach and tell him I’m not playing on Sunday.” Noah folded his arms over his chest. “I’m not going to leave Ang.”
I opened my mouth to say something, but Emma spoke before I could. “You have to do what you feel is right, Noah, but I don’t think Angela will want you to miss a game.”
“You’re saying I should justleaveher here? By herself?” He sounded incredulous.
“I’m saying that this is a marathon, not a sprint. Right now, Angela is in the best place she could be, and she’s not alone. Deacon is on the case, and so is Jenny, and so am I. Figuring out how to help Angela is our top priority. If thisisgraft versus host disease, she could be in the hospital for weeks. Are you going to miss all those games?”
He slumped against the back of the chair. “I guess that’s not realistic.”
“Let’s take this one day at a time,” I suggested. “It’s getting late. Why don’t we order you a cot to sleep on tonight in Angela’s room? That way, you can be together, and maybe you’ll feel better about everything in the morning. Then tomorrow, you can decide you want to do about the game this weekend.”
“Okay. Thanks.” Noah stood up, his huge body making Emma’s office feel even smaller. He looked down at her anxiously. “And you’ll look into what you can do to help Ang feel better? Even if it’s not traditional medicine?”
“Absolutely,” she promised. “I’ll go into research mode now.”
He nodded, and I stood aside to let him by me as he headed out to return to Angela’s room. Once he’d left, it seemed that all of the air went out of Emma. Her shoulders sagged, and she leaned her head into her hand.
“Hey.” I eased her aside on the sofa, moving her over so I could sit down, too. I slid my arm around her and drew her close to me. “Are you all right?”
“No.” She shook her head, burying her face in my chest. “He’s just so . . . defeated. And I tried to give him hope, but I can’t make promises that his wife is going to beat this.” She raised her eyes to mine. “Do you think it’s GVHD, Deacon?”
“That would be the most probable scenario,” I admitted. “Is it possible that she picked up a virus or some kind of infection? Sure. Is it likely?” I shook my head. “If it were another patient, I’d say maybe, but Noah and Angela are the type to follow our recommendations to the letter. Noah’s had nurses and aides at the house since Angela went home. She’s had the best care possible. That doesn’t mean her symptoms show she’s definitely rejecting the transplant, but it makes it more probable.”
“I know you’re going to remind me about boundaries and not letting my emotions interfere with my practice of medicine, but I can’t help it, Deacon. I really thought once Angela made it through the stem cell transplant, she was going to beat this. But I saw her tonight, and God, Deacon. She looks bad.”
“When GVHD hits the gut, it’s hard on the patient. The fever, the digestive tract distress—it saps what little energy she has, and it’s tough on her body. But we can fight it. Angela’s young, and she’s strong.” I wrapped a strand of her hair around my finger. “And I’m not going to harass you about boundaries and emotions, Emma. I’d be a hypocrite if I said that, because when I heard Angela was back and why, I felt . . . sick. Like it was a failure on my part, even though I know we did everything possible to give her a good outcome.”
“I’m happy to know we’re both shitty at maintaining a healthy emotional distance from our patients.” Emma inhaled and sat up. “Okay. Wallowing time is over. I’m going to start researching what I can do for Angela.”
“Did you eat dinner?” I tracked her with my eyes as she circled her desk and dropped into the chair behind it.
“Not yet. Did you?”
“Nope. How about I go get us some take out, and we’ll work on this together?”
Emma smiled and opened her laptop. “That sounds great. I’d love a salad from Gerome’s.”
“Roasted vegetables and tempeh?” I’d gotten used to Emma’s vegan tastes. I might never understand why anyone would stop eating meat, but I could respect it.
“Yum. That would be perfect.”
I leaned over her desk and lightly kissed her lips. “Be right back.”
* * *
By Sunday afternoon, Angela had developed a maculopapular rash on her neck, ears and shoulders, confirming for me what had become increasingly apparent throughout the weekend, with each new test result. Angela was dealing with graft versus host disease, and it was time to step up her treatment.
“Let’s start her on glucocorticoid and cyclosporine.” I stood with Jenny just outside Angela’s room. “I think we need to be aggressive.” I rubbed a spot in the center of my forehead where a headache had been forming all day. “She’s getting worse, not any better.”
“But we haven’t gone full-throttle on her treatment yet. Not really,” Jenny pointed out. “Once we get the extra steroids and immunosuppresives on board, she’ll probably bounce back pretty quick.”
I tried to share some of Jenny’s optimism. “Let’s hope so.” I stared at Angela’s latest numbers on the tablet in my hand. “She’s young. Generally, we don’t see acute GVHD as often in patients under forty. Not with a donor who was a full blood sibling, with a decent HLA match.”
Jenny shrugged. “What is that you tell us all the time, Deacon? Medicine is not always exact and predictable. We do what we can, and we make decisions based on what we know. We’re doctors and nurses, not psychics . . . we can’t know for sure how each patient is going to respond.”
“It’s all so simple when we talk about things in the abstract. It’s a hell of a lot harder when it’s people we’ve gotten to know, patients we genuinely like.” I shook my head ruefully. “Okay. I’m going to talk to Angela now and explain what’s going on.”
“I’ll order the meds.” Jenny patted my arm. “Hang in there, Deacon. I know it’s harder on you, but the truth is that doctors who care do a better job than those who couldn’t give a damn. Caring is what makes you a great doc.”
