SNOW CAME INTO the room and saw a dark-haired preteen flanked by a very worried mom and dad. He and Kirsten had gone over her chart yesterday after the discussion about his parents, and he had to agree with her. It looked like primary pulmonary hypertension might be at the root of the ten-year-old’s lung issues.
“Hello, Gretchen, I’m Dr. Tangredi. I understand that you had an MRI done today.”
The girl drew a deep breath before coughing into the crook of her elbow several times. The coughing could be due to her lungs, but it also could be a sign that her heart was starting to fail as it struggled to pump oxygen to the far reaches of her body. “Yes, I did. Kirsten thinks it will help us understand what’s wrong with me.”
He shot the pulmonologist a look. There was a debate in the medical field about whether patients should be encouraged to use a doctor’s first name rather than their title. He guessed he knew where Kirsten stood on that particular issue. He found that he kind of liked it—it fit her. And he could see how, in pediatrics especially, it might help young patients connect better with their doctors—how it might take away a little of the fear for them to view their caregivers as people rather than someone who was there to poke and prod them.
“I agree with her. I looked at some of the other tests that have been done. Dr.... I mean Kirsten asked me if I would mind coming in and giving her my opinion.”
“She says I might need special care. More than she can give.”
“You might.” He smiled at her, remembering how Kirsten had said Snow was sometimes a patient’s last hope. For some reason, he didn’t want to let her down, if that was the case. “Let’s wait and see what the results of the MRI are.”
Kirsten stepped forward. “We should have them back by Monday.”
The hard thing about having tests done on Friday, was that most of the time a doctor had to sign off on them, so not as much happened on the weekends unless it was a life-or-death situation. Gretchen wasn’t quite there yet, but she might get there if they couldn’t come up with a treatment plan that worked.
Try to repair, so that a transplant isn’t needed.
Those words had come back to him a lot in the two days since Kirsten had spent the night. Telling her about his dad had done just that. It hadn’t fixed all of the awkwardness between them—that would only happen if and when a time machine came into being so he could go back and undo taking her back to his place. But he did find himself more open emotionally than he had been. Her reaction had been nothing like Theresa’s. Kirsten had shown horror, but she had pressed him for more information than he’d been willing to give. And for that he was grateful.
He turned to the child’s parents. “So how is she at home?”
“She has a hard time catching her breath, even walking out to the bus stop in the morning. PE is impossible for her at this point. The school has made a special class in kinesiology just so she doesn’t fail her grade. Homeschooling is an option, but she really wants to stay with her friends if she can.”
“I can’t blame her for that. We’ll see what we can do to help her with that. Kirsten says she told you that there might be high blood pressure in the artery that connects Gretchen’s lungs with her heart.”
“Yes. I’ve been doing some reading online, but some of what I’ve found...” Her mom’s voice fell away and her eyes filled with tears.
He knew how hard it was to stay strong and not worry about someone you loved more than necessary. He’d done that with his mom more times than he wanted to admit. The times when he was overcome with fear that his dad would kill her. Or him. He’d held all of those emotions in so she wouldn’t see it in his eyes.
His glance went to Kirsten and he found her looking at him with...pity?
Oh, hell, no! That was the exact reason he didn’t tell people about his past. But in her case he’d had no choice, really. Well, he had had a choice, but the alternative wasn’t acceptable to him. Pity was better than fear, right?
He vowed no one would ever need to be afraid of him. And although he knew his demeanor didn’t quite reach teddy-bear levels, he hoped he’d kept that promise.
Hoped he would always keep that promise.
“Reading things online is okay, but make sure you get your information from reputable sites, like the big teaching hospitals. And always feel free to ask us anything.”
“Okay, thank you. And I do have a question,” her dad said. “Is our daughter going to need a transplant someday?”
Well, Snow had said to ask him anything, hadn’t he? “Some people with pulmonary hypertension will eventually need a transplant, but some cases can be managed for a long time on medication.”
“And Gretchen?”
The child’s mom spoke up. “Bob, let’s not do this now.”
His eyes closed for a second. “You’re right. I’m just worried.”
“Yes, we both are,” she said. “Let’s let them get the results of the tests from today, and we’ll talk again. Just us.”
Snow couldn’t have said it better if he tried. And he really didn’t want to scare their daughter unnecessarily, so it was probably a discussion they would have just between the grown-ups.
Kirsten smiled at them. “You wouldn’t be normal if you weren’t worried. But I want you to know we’re going to do everything in our power to keep Gretchen as healthy as possible. Maybe even enough to participate in PE within limits.”
She’d said “we.” Was she including him in that statement? Maybe not, but a warm feeling washed up his chest, anyway, despite the look he’d intercepted earlier. Maybe he’d even imagined it, but he didn’t think so.
The girl made a face. “I kind of like learning about muscles.”
Kirsten laughed. “Well, that’s a good thing. I’ll share a secret with you. Kinesiology was one of my favorite subjects in medical school.”
“It was?”
She nodded. “Getting to know how so many things have to come together to get our arm to bend, or our legs to run, is pretty amazing.”
Something else that was pretty amazing was watching the way Kirsten came to life when talking to her patient. Yes, she’d been informative and warm when she’d discussed things with Tanya—his patient—but on her own turf, within her own specialty, there was a special confidence that sparkled in her eyes. That sparkle had been missing when she consulted on his case.
“It’s cool. We’re going to do a project figuring out which muscles help us do what tasks.”
The girl had taken three gulps of air in the course of saying that last sentence, a sign that breathing was hard work, and that she was getting tired.
Kirsten must have sensed it, too, because she said, “Well, we’ll let you get back to your day. Call me if you have any other questions.”
While some doctors might have just said that without giving any real thought as to the actual words, he had a feeling that she knew exactly what she was saying and that she meant it. All of it.
He decided to follow her lead. “Yes, feel free to do the same with me, if you have questions about transplants and the process we use to decide when and if someone needs one.”
He pulled out a card from his wallet and handed it to Gretchen’s dad, since he was the one who held his hand out for it.
Once they’d said their goodbyes and the family had left the room, Kirsten glanced at him. “Thanks for agreeing to see her.”
“Happy to do it.”
She touched his hand, stopping where she was. He halted, as well.
“And thank you for telling me about the other thing. I promise I won’t share the information with anyone.”
He hoped that was true, although she’d asked Nicola about his background. What if someone came to her with the same type of question?
No, he didn’t know why, but he believed her. He wanted to think that even if someone tried to pump her for information, she wouldn’t share his story without his permission. Unless it was for a very good reason.
“Thanks. I appreciate that. It’s not something that comes up in everyday conversation.” Actually it had never come up in any conversation before. Except for with Kaleb’s family. He still bought his friend’s parents gifts for their birthdays and for Christmas. It was the only way he could think of to express his gratitude for them opening their home to a troubled kid. They hadn’t known the extent of the abuse, either, until his dad went to prison, and he’d gone to live with them. His mother never talked about it with anyone, and back then, Snow had been afraid that anything he said would just get his mom in trouble with his dad. So being quiet had been his best bet.
She licked her lips, then said, “Maybe you can get rid of the extra locks one at a time.”
Not happening. They didn’t hurt anyone, and they’d been in his life for a lot longer than she had. Even Theresa had lived with that idiosyncrasy without too many complaints. It had been his lack of ability to connect emotionally that had left her cold.
Well, he wouldn’t have to worry about that with Kirsten. They’d connected on a sexual level, but emotionally? Not so much. There’d been no need. There was still no need.
He decided to keep things vague. “Yeah. Maybe. We’ll have to see what happens.”
It was one way of saying “forget it, not happening,” without actually saying the words.
“Okay. Thanks again. Do you want me to let you know what the MRI results are?”
“Yes, please. I’d like to keep up with the case just in case she does end up needing a transplant, even if it isn’t right away. Maybe it won’t be as bad as we think.”
It was worse than she’d thought.
The right side of Gretchen’s heart, as she’d suspected and noticed on X-rays, had disturbing changes. The walls had thickened and the ventricle itself had enlarged in an effort to hold and pump more blood with each beat. But it was already beginning to backfire, causing more strain on a heart muscle that was quickly becoming weary. She needed to call the family and let them know, but first she needed to talk to Snow and get his opinion. Again.
She didn’t really want to do it by phone, though. So she headed for his office. Knocking, she noticed the lock was still there. But it wasn’t like he could just pull it off and toss it. Taking it off would leave an ugly defect in the wood and would leave space to get a finger or two in that could unlatch the lock on the knob.
The door opened and there stood Snow. “You got the results back this morning, didn’t you?”
“Yes. I was hoping you were here. Can we go somewhere to talk? Or are you busy right now?”
He glanced inside his office, but evidently decided—like she had—that meeting in a less private area would be better. “Do you want to go down to the foyer? There are a few seating areas off to the side. Maybe we can snag one of them.”
“That’s a great idea.”
The hospital entryway always impressed her with its towering ceiling and chandelier. And despite its massive size it made everything look...welcoming.
They made their way to the elevator and headed down. And then they were in the busiest area of the hospital, where visitors and patients alike hurried in and out.
Surprisingly, they were able to find a four-chair grouping in one of the far corners of the space and Kirsten sat down, setting her computer in front of her. “So there’s probably still the possibility of managing Gretchen’s condition with medication, but I want us to be on the same page as far as treatment goes.”
They discussed the ins and out of the MRI results and Snow outlined the steps that they would need to do in order to be placed on the transplant list.
“I don’t think we’re at that point yet, but unless something drastically changes, she’ll probably be on it within a year.”
“I was thinking the same thing, but wanted to hear your take on everything.”
“Do you want me there when you talk to the parents?”
“Yes, if you don’t mind, since you can speak to the transplant side of the equation.”
He nodded, leaning forward to look at her computer screen as if looking for something they’d missed. “It’s not going to be an easy conversation. And I’ll have to be honest and tell them that wait times are often horrendous.”
“I know all about wait times.”
“I know you do.” He paused. “Is it hard?”
“Hard?”
“Treating patients who are sometimes in the same position your mom was. Sometimes worse.”
“Sometimes.” She sighed. Her mom’s image still came up from time to time when she was talking to a patient. She wondered if that would ever go away. “It’s harder in cases like this, when I know there aren’t a whole lot of treatment options to slow the progress and when a transplant is a very real possibility.”
Looking at Snow, who still struggled with issues from his past, she imagined he understood more than he realized. His trauma had lasted for a lot longer than hers had.
“What will you do if he gets out of prison?” The question came out before she could stop it.
“Nothing.” He didn’t ask what she was talking about. It was pretty obvious.
“And if he tries to contact you? Or your mom?”
“I think he knows better than that.” Snow’s face had taken on a hardness that actually had her worried for his father’s safety, as ironic as that was. The boy who’d once needed protection from a monster might pose a threat to that very monster.
“I hope so.”
“Sorry, I had no business asking that.”
He nudged her shoulder with his. “It’s okay. Believe me, I’ve asked myself that very question for more years than I can count.”
“How long is he in for?”
“Twenty. So he still has quite a few years to go. He’s been turned down for parole five times in a row.”
That made her nervous. “So they still think he’s a threat.”
“Not very much chance of a man like that changing his stripes.”
But people could change. She wasn’t sure about people like his dad, but surely a person could change for the better if they really wanted to. If they worked hard, they could exchange their old habits for something better. Something that helped rather than harmed those around them.
Kirsten had changed as a result of her mom’s death. Snow had asked if it was hard. Yes, it was damn hard, but the alternative was to turn her back on what had happened to her mother and pretend people like her didn’t exist. She couldn’t bring herself to do that.
So here she was in a hospital wing talking about a young girl’s fate. At least Kirsten could play a part in advocating for her patient, to help make sure she got what she needed, even if what she needed most was a transplant. Getting her on that list in a timely fashion was crucial to giving her the best possible chance for survival. She was pretty sure Gretchen’s parents would agree with her on that.
And if she couldn’t make that happen?
She wasn’t going to think about that right now. It was why she’d enlisted Snow’s help. He knew how the system worked—he’d been playing the game for years.
Except this wasn’t a game. It was deadly serious.
She went back to the subject they’d been discussing. “I hope your father leaves you and your mom the hell alone, then.”
He looked surprised by the words for a second, then said, “Don’t worry. I’ll make sure of that.”
By buying more locks for his mom’s door? And his? Or by doing something more drastic?
Kirsten did what he’d done earlier and jabbed her shoulder into his arm. “Just make sure you don’t wind up in jail yourself. You have a lot of people counting on you.” In case he got the wrong idea, she hurriedly added, “Your patients, I mean. And your mom.”
He smiled. “I knew what you meant. And don’t worry. I made myself a vow a long time ago that I would be nothing like my father.”
“From what I can see, you’ve kept that vow. I’m sure your mom is very proud of the man you’ve become. You said she lives in Massena? Is that how you pronounce it?”
“Yes, on both counts. It’s where Kaleb and I grew up. My dad worked at one of the locks on the Saint Lawrence Seaway.”
“Locks?” She had no idea what that was.
He smiled. “It’s not like that lock on my bedroom door. It’s actually a way that ships can travel between areas of a canal that have different water levels. The boats are held in a watertight box while water either fills or leaves the box until it matches the next stretch of canal. Then it’s free to continue on its way.”
Her face had heated at the reference to his bedroom, but by the time his explanation was finished, she’d pretty much forgotten about her momentary embarrassment. She was instead fascinated by how the ships moved forward.
“So, in a way, the boxes are a kind of lock. The ship is locked in, right?”
“Hmm...right. I’m not sure what the origin of the word is for this particular kind of lock.”
She thought for a few seconds. “I don’t know that we even have locks in Lebanon. I’ve never heard of them before.”
“It’s an interesting sight. You should try to visit one and see what happens.”
“Maybe I will.” It was one more thing to add to what she wanted to do before leaving the country. If she left. The thought of that wasn’t quite as appealing as it once was. Because of Snow?
God, she hoped not. And she still had a while before she’d have to let the hospital know, if she decided to go that route. She’d also have to let her dad know so they could try to find a hospital that would accept her credentials. And although Arabic was her mother tongue, she’d learned a lot of technical words in English. She wasn’t sure she knew what they all were in Arabic. Maybe she should start trying to review them.
She snapped the lid on her laptop closed. “I’ll call Gretchen’s parents and set up the meeting. Is there a time that’s better for you?”
“I’ll check.” He opened his phone and scrolled through what must be his calendar. “I have patients to meet with the first part of the week, and, of course, if an organ comes available, I can’t always promise I won’t be in surgery.”
“I know.” She had a thought, since she was thinking about researching things for her possible move. “I’d really like to observe transplant surgery being done at NYC Memorial, if that’s possible.”
“Thinking of changing fields?”
“No. I’m pretty happy where I am. But it would be nice to actually see what goes on, so that I can explain things to my patients a little bit better. Especially if you’re not around to help me do that.”
“That makes sense.” He studied his phone for another minute or two. “I have two patients that are close to the top of the list and are just waiting on an organ to be found. How about if I call you before the next one goes into surgery, and if you’re free, you can come observe.”
Excitement bubbled in her system. Because of the possibility of watching, not because it was Snow. “Really?”
“Yes, Really. I have one heart transplant patient and one heart-lung patient on my list.”
“Thank you.” There was something bittersweet in watching something that her mom had missed out on. But she liked to think that her mother would approve, if she knew. And it would be one more way that she could empathize and relate to her patients.
He stood. “Well, I’d probably better get back to work, but let me know when you schedule the meeting with Gretchen’s parents and I’ll do my best to be there, how’s that?”
“That is all I can ask. Thank you again.”
“You’re welcome, Kirs. Happy to do it.”
The shortening of her name made her throat tighten. Her mom had called her that. In fact, she was the last person to have called her Kirs. If anyone else had tried, she probably would have set them straight in a hurry, but somehow with Snow, it sounded natural. Right. She wasn’t even sure he was aware that he’d done it. But she liked it.
“I’ll see you later, then.”
“Yes, see you.”
He turned and walked away. Kirsten watched as he headed down the corridor, his steps firm and confident, his lanky form looking like he hadn’t a care in the world.
She knew differently, though. He did have a care. Lots of them, in fact. And she wasn’t sure that the man who had so many locks on his doors didn’t have an equal number of them on his heart.