by Tina Beckett
“Sometimes you don’t have a choice.”
“There’s always a choice.”
He didn’t say anything, just quickened his step enough that she had to hurry to keep up. He realized almost immediately and slowed back down with an apology. Something she’d said had struck a nerve. Had he found himself in exactly that situation at one point and been forced to provide support?
But he’d said he didn’t have children. Unless someone had manipulated a situation or lied.
Although she wasn’t going to ask him, if he didn’t want to talk about it. She decided to make small talk instead. “So you know about my dad and have met my mom. What do your parents think of you starting your own clinic?”
He stopped and turned toward her. “What made you ask that?”
“No reason, really. I was just curious. They must be proud of you.”
“Not so much.” He took off walking again. “Our first patient is just ahead.”
And that subject was evidently entèdi, as well. Fine.
But why on earth would he think his parents wouldn’t be proud of him? He had accomplished so much.
As much as his response stung, she found her heart aching for him. What child didn’t seek the approval of his mom and dad? Her father, even though he’d died far too young, had been proud of her accomplishments and had never been shy about telling her.
“So who is this next patient?”
He paused outside a door. “A forty-five-year-old man who was just diagnosed with amyloidosis.”
“That’s young, isn’t it, for that kind of diagnosis? Is it someone from Saint Victoria?”
“Yes. He’d been complaining of gastrointestinal issues for a while. They thought it was IBS, but then some other symptoms came up. Swollen tongue, etc. They referred him here from Saint Victoria Hospital three weeks ago. Testing shows the ATTR form.”
Meaning it was the hereditary form of the condition.
Amyloidosis was a devastating, incurable disease. It was also rare. She hadn’t run into a case of it during her entire career. At least not that she knew of. It was also notoriously hard to diagnose, so like with this patient, it was often mistaken for other conditions.
“Is his heart affected? Lungs?”
“No, not yet. It’s still early enough that we have some treatment options. His hematologist will be in a little later today.”
Nate pushed the door open, and she followed him in. She put on her professional smile and glanced at the patient. She blinked. Blinked again. Her smile faded.
“Sasha, nyès, what are you doing here?” the patient asked.
Nate’s glance went from one to the other. “You two know each other?”
Bondye, this couldn’t be happening. Tears welled up in her eyes, but she forced them back, running a thousand words over in her mind, but rejecting them all. Instead she asked, “Why did you not tell us?”
“I couldn’t. Not yet, anyway. Plus, I did not want to alarm anyone.”
Too late. She was officially alarmed.
She looked at Nate and nodded. “This is Art James. Art is my uncle.”
CHAPTER EIGHT
ART JAMES WAS Sasha’s uncle?
Hell, he should have realized the second he heard the last name.
Sasha sank onto the stool beside the man, just like she had when talking to Merriam Blankenship. But there were none of the smiles or compassion. There was just confusion.
“How could you not tell us you were coming here for tests? We had no idea. At least Mom never mentioned it.”
“I didn’t tell her. I wanted to see if treatment worked. If it does, it will buy me more time. Years maybe.”
She swallowed. “You shouldn’t be going through this alone.”
Art had said he wasn’t married and had no children. He’d made it sound like he didn’t have any close relatives at all, which was another reason the name didn’t click. Then again, Nate and his parents weren’t close, so maybe they were estranged. But Sasha didn’t act like they were.
“I don’t want your mother to know. Not yet. She’s been through enough. But I would have had to tell you. They said this form can be inherited. In a gene. Maybe your dad—”
“Let’s worry about that later. Right now, I want to concentrate on you.” She turned to Nate. “When does he start treatment?”
Art answered. “I do an infusion tomorrow. They said they want to knock this thing back on its ass.” He grinned. “Well, they didn’t quite use that language.”
“I imagine they didn’t.”
Nate smiled. “We’re going to use melphalan and dexamethasone. Hopefully we can achieve remission, and he’ll start to feel better.”
There was no cure for amyloidosis, but if they could slow the rate that amyloids were deposited in the tissues, the body could heal some of the damage done. Patients sometimes lived fairly normal lives for years to come.
“That’s why I’m here, today. To make sure everything looks good for the infusion tomorrow.”
Nate leaned closer to Art. “Now that she’s here, can I share what we’re looking at? I’m pretty sure she’ll want to know. And there’s no more hiding it at this point, since you can’t make yourself invisible.”
“Are you sure about that?” Art chuckled, then got serious again. “Tell her what you told me about the gene test we did. About the fifty percent chance.”
“Let’s deal with you, first.” He softened his response with a smile.
Normally they worried about the inherited form of amyloidosis in children of the patient. But Art had no children. Although Sasha had also said her dad died of a heart attack. Due to undiagnosed amyloidosis?
Hell. He hoped not. His chest contracted at the thought. But he needed to concentrate on this patient right now. They could deal with those other questions later.
Nate sat down with them and went over the particulars. What he could expect from treatment. Some of the side effects he might face from the chemo drug.
“How long will he be here?”
Sasha’s question wasn’t unexpected, but there wasn’t a simple answer. “We’ll want to keep him overnight after his infusion so we can monitor his immediate reaction to it. Then we’ll send him home.”
Sasha looked at Art. “I’ll come and check in on you at home, the first couple of nights. Do you want me to stay with you?”
Art shook his head. “No. I’ll be fine. I’m a pretty tough old goat.”
“I know that for a fact.” She smiled. “We will need to discuss when and where we tell my mom though.”
At this, her uncle’s chin jutted out just a bit. “We can discuss it, but no promises.”
“It’s a deal.” She got up and hugged him, kissing the top of his head. “I love you, Uncle Art. I’ll be here for your infusion.”
Art frowned. “You don’t have to work?”
“I’m actually off this week, so I asked to put in some hours here at The Island Clinic.”
“Are you sure you want to spend it sitting with me?” asked Art.
“I’m positive.”
Once they left the room, Sasha turned to Nate. “My dad was almost fifteen years older than his brother. Everyone assumed he’d just had a heart attack. Is it possible...”
He knew what she was thinking. If her dad had amyloidosis and they’d found it, maybe he could have been treated.
“Do you want to take a genetic test, just to rule out that you inherited it?”
“I do. Just so I’ll know the risks of having children. And what I might be facing someday.” There was a frown that said she really was worried.
He reached out and squeezed her hand. “Hey, he’s not your father, so the chances of you having the markers might not be as high.”
“No, but I just have this gut feeling, Nate. I think my dad had it. And ju
st didn’t know it. My mom is going to be asking the same questions. If my test comes back negative, it’ll take one worry off her.”
She could very well be right. And he didn’t agree with Art about keeping this from his family.
Maybe it was because his parents had kept their plans from him until it was almost too late. So when they did finally tell him, the damage had been done and trust was broken. Hopefully it hadn’t quite gotten to that point with Art, Tessi and Sasha.
And if Sasha had inherited the gene?
Something in his gut rebelled against that thought. But the only way they would know was if they pulled her blood and sent it in.
And if he hadn’t worn a condom in the water? If she’d gotten pregnant? Damn.
“So you want to be tested? You’re sure?”
“I am. Can you pull the blood?”
“I can, but we have phlebotomists who are very good, if you want me to call one.”
She shook her head. “I’d rather you do it, if that’s okay. The sooner the better. It’s just the shock of seeing him in that room. I never suspected...”
“I know. And if I had realized exactly who he was, I wouldn’t have taken you in there.”
She stopped and looked at him. “So if you had known that Art was my uncle and that he had an inherited form of amyloidosis, you would have kept it from me?”
Would he have? What if Art had chosen never to tell any of his family and Sasha went through her life without knowing and developed it. When it was too late to do anything about it?
“Ethically, I should say yes.”
“And if I had a child who later developed it?”
“I said ethically. What I would have probably done was talk to Art and try to convince him that you deserved to know, the same as if he’d had Huntington’s or any other of the familial conditions.”
“Okay. I can handle that. I’d like to think my uncle would have eventually decided to do the right thing.” She touched his arm. “He’s a good man.”
“I know. I’ve sat and talked to him for a bit. I think he was telling the truth. He wanted to wait and see what form he had.” He paused. “I’ll take you to my office, and then I’ll retrieve the items needed to do the blood draw.”
“Will he be okay alone?”
“The hematologist will be there in a minute. And I’ll check in on him, as well.”
He unlocked his office door and ushered her inside. “Have a seat wherever you’ll be most comfortable, and I’ll be back in a minute.”
* * *
Sasha wandered around Nate’s office for a minute or two, not really seeing anything. Had her father had amyloidosis? It was surreal that he could have died from something that had been eating away at his system for years. But then the early signs tended to be vague, and her dad had always been pretty stoic about his health. By the time of his heart attack, though, he had to have been feeling bad. And yet he’d said nothing.
“Why, Papi? You could have been here with us longer.”
But it wasn’t his fault. He hadn’t known what he had, or he would have tried to get treatment. She caught sight of the doll on Nate’s shelf. Her dad wasn’t to blame, just as that child’s parents weren’t to blame for her death. They couldn’t have known. And Sasha’s dad didn’t know, of that she could be sure.
That helped a little. She had no idea how her mom was going to react. But Sasha felt strongly that she needed to know. And it wasn’t up to her to make decisions for other people.
And if she had it? God, she could kind of understand why Art might hesitate to let her mom know. He’d want to save her the worry. Sasha could see herself wanting to do the same. But that wasn’t fair to her mother.
And what about kids? Did that mean she’d never hold a baby in her arms? Her chest tightened until it was hard to breathe. And marriage? Could she see putting her husband through the pain of watching her slowly waste away if she developed a severe form of the condition?
She went to the couch and sank into the deep leather cushions. They smelled clean and masculine. Like Nate’s scent when he’d held her on that beach. She breathed deeply, allowing it to calm her spirit, to bring her back from the panic that had welled inside her. As a surgeon, she knew that treatments for amyloidosis had drastically improved. It couldn’t be cured, but it could be managed. Sometimes for a relatively long period of time.
She sighed. Why couldn’t things be simple? Like Nate’s lingering scent that clung to his couch. But they weren’t. And neither was Nate.
Even by virtue of his offer to go and get the supplies needed to draw her blood. Not just anyone could take it on themselves to do that. Only someone with clout...or money, could bypass the normal protocol of things like that. She’d seen that in Austin in a lot of little ways. When he went to a professor to ask something, that professor almost always made himself available. It had impressed her at first. But then she started to question the way it reinforced feelings of entitlement and being above the rules that others had to follow. And the way Austin could just move to New York with never a thought as to what it would do to Sasha. He’d just done it because...he could. Because he took it for granted that he could always find someone else.
And yet, in asking Nate to draw her blood, wasn’t she falling into the same trap? Using her familiarity with him to gain a favor? So wasn’t she just as guilty?
Probably. And it made her slightly nauseous. She didn’t want to take advantage or use people for what she could get from them.
He came back in with a carry tray and a couple of vials, before she could go very far down that avenue of thought. “You’re sure.”
Now would be the time to say she’d made a mistake and ask him to please call one of the phlebotomists. Or say that she didn’t want to be tested. But she didn’t. Instead, she nodded.
Then he slowly knelt in front of her and took her hand in his.
She swallowed. Would she ever have children? Would someone kneel in front of her like this and ask her to marry him, if it turned out she’d inherited the condition? Would they even want to, knowing the possibilities? Damn! She needed to get a hold of herself. All of this speculating was doing her no good.
“Which arm?”
“Right one.” He wasn’t proposing to her. Nor would he ever. And she didn’t want him to.
“Make a fist.”
She stretched out her arm, watching as he pulled a piece of rubber strapping tight around her upper arm. He tapped the crook of her elbow, looking for a likely vein. Then he slid the needle home, getting the right spot on the very first try. Clicking a vial onto the end, he let the suction pull blood into the container.
“Release your fist.” When the first vial was full, he popped it off and put the second one on. And yes, he definitely smelled like his couch.
The vials were already labeled with her name. “What’s your date of birth?”
She told him and he printed it on the sides of both tubes of blood. “I’ll take these down to the lab, so they can send them off.”
“How long will it take?”
“Two to four weeks. I’ll put a rush on it.”
She gripped his wrist. “No, don’t. Please. Just send it off as you would anyone else’s blood.”
His head cocked as he looked at her, but he nodded. “Okay, but we ask for lab tests to be rushed all the time.”
It reminded her of when he’d offered to have the helicopter pick her up at Saint Victoria Hospital. Her answer was just the same now as it was then. “I’d rather save that option for the people who really need it.”
Maybe he remembered that incident too, because he gave a slight shrug and climbed to his feet and left the room, taking the tote with him.
Two to four weeks and she would know if she was likely to develop amyloidosis. She almost wished she’d opted to remain in the dark. But that would be u
nethical, especially if she met someone someday who actually wanted to have children with her. It was an autosomal-dominant trait, so all that was needed was one copy of the gene to pass it on. Her copy. So her children would have a 50 percent chance of inheriting the mutated gene. The odds were bad enough that she might not risk having children if she was a carrier of the trait. Unless she was willing to take a prenatal test and consider terminating the pregnancy if the fetus carried the gene. The thought of making a decision like that...
Maybe she should tell him to forget about sending her blood off until later, when her emotions had settled down.
But it was too late for that. Besides, she’d rather know now...start treatment early.
He was back in a minute or two, sans the blood kit. “Thank you for doing that for me. I probably shouldn’t have asked.”
“Yes, you should have. And I know it’s a shock. But there’s a good chance you don’t have the gene.”
“If my dad had it, there’s a good chance that I do.”
He sat down beside her. “Let’s just wait and see what the findings are.”
“Okay.” She forced herself to shake off the sense of melancholy that had enveloped her. “Are there other patients to see?”
“I had someone else take over rounds this morning.”
Something else he had the option of doing because of his position. And yet, again, it was because of her. “I’m sorry. I’ve disrupted your whole routine. I think I should go.”
“You haven’t disrupted anything. I normally do rounds just because I feel a duty to the clinic to follow up on its patients.”
That made sense.
He went on. “Your uncle never married.”
“No. He was engaged once, but it didn’t work out. Her parents had very high standards and didn’t think he was good enough for her. And even though she didn’t agree with that assessment, they succeeded in putting a wedge between them. They were embarrassed that their daughter might marry someone from a poorer background. Can you imagine a parent acting like that? Shouldn’t they have wanted her to be...happy?”
