Sydney Harbor Hospital – 06 – Bella's Wishlist

by Emily Forbes

  ‘What does the surgery involve?’ Richard asked, and his question answered Bella’s own. His tone said this was a question from a man who wanted information and clarification, not a question from a concerned father.

  ‘Obviously it is major surgery. Bella will be several hours in Theatre. It can take up to twelve hours. She will be placed on a heart bypass machine while both lungs are transplanted via an incision across the bottom of the diaphragm, then she will be transferred to ICU for at least twenty-four hours and then back to the cardiothoracic surgical ward.’

  ‘What are the survival rates?’ As was his style her father was keeping any emotion out of the equation. He preferred to deal with the facts and figures.

  ‘The figures are good. Currently eighty-five per cent of people undergoing bilateral, sequential lung transplants in Australia survive one year and sixty per cent are still alive after five years.’

  Bella heard a sharp intake of breath. For a moment she thought she’d made the sound but then she realised it had come from Lexi.

  Bella knew the odds. She’d lived and breathed them since her last admission. She knew the statistics were good, for the short term at least, but she also knew that to those who hadn’t spent countless hours doing the research she’d done, the odds didn’t sound that fantastic.

  ‘These stats are not just for CF sufferers,’ Sam clarified. ‘They’re for everybody and Bella has age on her side. Although she will still have cystic fibrosis, it won’t be in her lungs.’ Sam looked directly at Bella. ‘If your lungs are functioning properly, you should notice a far improved quality of life. You’ll have more energy, you should gain weight and you’ll be able to be more active.’

  ‘What do you mean, she’ll still have CF?’ Richard was frowning.

  ‘Bella’s lungs will be clear but she will still have CF in her pancreas, sweat glands and reproductive tract. She will still need her enzyme-replacement medication and she will start a course of anti-rejection medication. The transplant is not a cure for the disease, it just eliminates the disease from her lungs, and will hopefully extend her life.’ Sam turned to face her. ‘Bella, do you have any questions?’

  She still hadn’t uttered a word.

  ‘How long do I have?’

  ‘A month, maybe two.’ Sam’s voice was deep and soft but his words were clear and distinct in the absolute silence of the room.

  It was already November. Would she see another Christmas?

  ‘What choice do I have?’

  Her question put an immediate and definite end to the silence. Lexi started to cry and Evie started to reason with Bella. They both knew her choices were limited.

  Bella held up one hand, asking Evie to wait. ‘It was just a question,’ she said. ‘I didn’t say I won’t have a trans plant, I just wanted to hear if I have any other options.’

  ‘Of course you have a choice,’ Sam said, ‘it’s your body. You can choose to have a transplant if we find a suitable donor or you can choose not to. But you don’t have any other options.’ He spoke to her as though they were alone in the room. ‘It’s a big decision and I know how daunting this can be but ultimately I wouldn’t expect you to find it a hard decision to make. The consequences of your decision are self-evident. You’re free to talk to the psychologists and the transplant team in more detail, you can ask them anything you want or need to know, but you don’t have a lot of time to decide. Your lungs are failing. Without a transplant you’re on borrowed time.’

  Borrowed time. She knew that but it made it more important than ever that she get things sorted. There were things she needed to do. She had to prioritise. She needed to think. She closed her eyes. As she’d hoped, Sam took that as a sign to usher everyone out of the room.

  ‘Okay,’ he said, ‘I need to run a couple more tests and Bella needs to rest. You can come back later.’

  Bella thought Lexi was going to argue but she saw her look at Sam before she said anything. Sam gave a slight shake of his head and Lexi stayed quiet. The medical team was leaving the room and Lexi and Evie kissed Bella before they followed. Charlie and Sam were the last ones remaining. Bella looked from one to the other. Charlie was wedged in next to the bathroom doorhandle, he would have to wait until everyone else had left before he’d be able to get out. She needed to ask a favour and if she was running out of time she needed to do it soon. It looked as if Charlie or Sam were her only options. Not that they were bad options. This was a topic she couldn’t discuss with her sisters; she’d tried already and failed, but by the same token she didn’t think it was something to discuss with Sam either.

  Bella needed a sounding board. Charlie had offered his help and even though she knew this wasn’t exactly what he’d pictured, perhaps he wouldn’t mind. After all, this concerned Evie and he knew her better than most.

  Bella hadn’t seen Charlie for some time. He had been a frequent visitor to the Lockheart home but since Evie had moved out into an apartment there was no reason for Charlie to drop by. But she knew from experience that Charlie was a good listener and he could be relied upon for level-headed advice. She and Charlie had a history of heart-to-hearts, albeit a very short one, and perhaps he could help her again.

  Besides, she was running out of time and options. He would have to do.

  ‘Charlie, could I talk to you for a second?’ she asked. She knew he saw himself as family, maybe he could do this for her.

  Bella saw Evie glance back over her shoulder as she left the room. She’d be wondering what on earth Bella needed to talk to Charlie about, wondering why she wasn’t talking to her, but Bella knew this was one thing Evie couldn’t help her with.

  CHAPTER TWO

  EVIE hesitated when she heard Bella ask Charlie to stay. She wondered what that was all about but she didn’t stop. She had to catch her father before he disappeared again. There were things they needed to talk about.

  ‘Richard,’ she called out to him. She hadn’t called him ‘Dad’ since she’d started working at the Harbour Hospital. Evie’s paternal great-grandfather had been instrumental in establishing the hospital and Richard was one of its biggest benefactors. Evie hadn’t wanted to be accused of nepotism when she’d joined the staff. Although the Lockheart surname was a clear indication that there was a relationship there, she hadn’t wanted everyone to know just how close the relationship was.

  He turned and waited for her to catch up.

  ‘Where have you been?’ Evie asked. She was furious that she’d heard nothing from him all morning. ‘Why didn’t you return my messages?’ She must have left him half a dozen in total.

  ‘I tried. Your mobile is switched off.’

  Evie knew there would be no apology. She always switched her phone off at work and Richard knew that. He could have guessed she’d be at the hospital, he could have contacted her through other avenues. ‘You could have paged me.’

  Never one to back down he said, ‘I spoke to Lexi and came straight here. Tell me, how do we fix this? What can I do?’

  ‘You can’t buy lungs,’ she replied, knowing that Richard’s preferred way of dealing with things was just to throw large sums of money at a problem until it went away. That wasn’t going to work this time. ‘We just have to wait.’

  ‘What is Sam doing about this?’

  ‘There’s nothing he can do other than push Bella up the list, which he has done. It’s all dependent on having a suitable donor and convincing Bella to go ahead with the surgery once compatible lungs are found. All we can do is support her through this.’ Her little sister was in dire straits and while Evie had known this day was inevitable it didn’t make it any less heartbreaking.

  She hoped Richard was listening. She hoped, for once, he could be there to support his daughter. She hoped he realised he might never get another shot at this. But she and Lexi would be there for Bella even if her parents weren’t. Which brought her to the next item on her mental checklist.

  ‘Will you tell Miranda?’ Evie asked.

  Evie had s
tarted calling her mother by her first name when she was fifteen, when she had finally admitted that her mother preferred her bottle of gin to her daughters. Miranda’s contact with her offspring was sporadic, associated with brief periods of sobriety mostly, although there had been plenty of times when the girls had seen Miranda far from sober. But despite this Evie felt Miranda needed to know what was happening with her second daughter and she thought it was Richard’s job to inform her.

  Richard’s expression told Evie all she needed to know but she was not going to let him out of this task. ‘You need to tell her. Whether she can understand what’s going on is not your problem, but she has to be told. I need to get back to work. I’ll see you back here later.’ Evie’s final words were not a question. Someone needed to tell Richard what was required and she was happy to do that. But she’d have to wait and see if he listened.

  Bella looked exhausted. She was waiflike, a pale shadow of a figure against the white hospital sheets. She was sitting up in bed and the only exception to her pallor was her auburn curls, which were vibrantly bright against the pillows that were plumped around her. Looking at her, Charlie thought she could pass for eighteen years old but he knew she was in her mid-twenties. She’d been seventeen when they’d first met, almost ten years ago, when he’d gone back to med school and found himself in Evie’s class, and that would make her twenty-six now.

  He waited until Bella’s room had emptied itself of all the other occupants before he dragged a chair closer to the bed and sat. ‘What can I do for you?’ he asked. When he’d offered his help he hadn’t expected there would be anything he could do, but his offer had been made in good faith and if Bella needed assistance he would do his best to give it to her.

  ‘I need an unbiased pair of ears.’

  Charlie frowned. Bella wasn’t maintaining eye contact. Instead, she was fidgeting with the bed covers, repeatedly pleating them in her fingers before smoothing them out. He wondered what was bothering her. ‘Is this about the transplant?’

  ‘Sort of,’ she replied.

  ‘You are planning on going ahead with it?’

  ‘Yes.’ Bella nodded and her auburn curls bounced. ‘But I don’t want to talk to you about the actual operation or anything medical. I’m worried about Evie.’ She looked up at him then but her fingers continued to fiddle with the bed sheets.

  ‘Evie?’ He’d expected that she wanted to discuss the transplant. He had expected to advise her to talk to Sam. Charlie was an orthopaedic surgeon. Lung transplants were Sam’s area of expertise, not his. ‘I don’t understand.’

  ‘You heard Sam, I’m on borrowed time. I’m not ready to give up yet but there’s no guarantee that a suitable donor will be found in time.’

  Her breathing was laboured and when she paused to catch her breath he could hear a faint wheeze. She had an oxygen tube resting on her top lip and out of habit he checked the flow and her oxygen sats on the monitor to make sure she was getting an adequate supply. The flow was fine so he returned his attention to Bella.

  ‘If I’m running out of time,’ she was saying, ‘I want to make sure my sisters are okay.’

  His frowned deepened. ‘Sam has just told you that your last hope is to find a suitable donor for new lungs and you’re worried about your sisters?’ Charlie was amazed. If he were in the same situation he doubted he’d be able to think about anything except whether he was going to live or die.

  Bella shrugged. ‘There’s nothing I can do about finding a donor but making sure Evie is okay might be something I can have some influence over.’

  ‘What’s wrong with her?’ He hadn’t noticed anything amiss but, to be honest, he hadn’t seen a lot of Evie lately.

  ‘I know this whole donor thing is stressing Evie out. She feels responsible for me. She always has ever since our mother walked out on us. But, really, this situation isn’t unexpected, we all knew this day would come. But Evie doesn’t seem to be coping as well as I would have thought.’

  Bella stopped, interrupted by a coughing fit, and Charlie could only watch as her slight frame shuddered with each spasm. She had asked him to stay behind. There must be something she needed. ‘What did you want me to do?’ he asked as he poured some water into a glass for her and waited while she sipped it.

  ‘Thanks,’ she said as she moistened her throat before she continued to speak in a voice that was just louder than a whisper. ‘She seems on edge, which isn’t like her, and she’s been like that for a little while. Something is bothering her but she won’t tell me what it is. Have you noticed anything?’

  ‘I haven’t seen that much of her lately,’ he admitted. But if Bella was right and Evie was troubled, he was pretty sure he knew what the problem was. The sisters were extraordinarily close and he could just imagine how much this situation was tearing Evie apart. ‘I imagine she’s just worried about you and doesn’t want to burden you with her concerns.’ He wished he felt like he was doing a better job of comforting Bella but he didn’t think he’d be improving her spirits with this clumsy attempt at reassurance.

  ‘I think it’s something unrelated to me,’ Bella admitted.

  ‘Like what?’

  ‘I don’t know. Sometimes it’s as though she has the weight of the world on her shoulders and you know what she’s like, she doesn’t like to burden people with her troubles. A couple of the nurses were talking about Evie and they mentioned Finn Kennedy. I wondered if something had happened between them, something that would upset her. Have you heard anything?’

  Bella’s earlier nervousness had disappeared. She’d stopped fidgeting and Charlie wondered whether he’d only imagined her to be on edge. He shook his head. ‘I’ve heard nothing. There’s been the usual gossip about the staff and usual complaints about the doctors’ egos, but I’ve heard nothing about Evie specifically.’

  ‘Will you promise me that if anything happens to me, you’ll look out for her?’ Bella asked. ‘She needs somebody to take care of her and she’s so independent, which makes it tough. At least she might let you close.’

  Charlie nodded. ‘I promise I’ll make sure she’s okay.’ He could do that. He wished he could tell Bella that she’d be able to keep an eye on Evie herself but they both knew that might not be the case. They both knew what the reality was.

  He could hear Bella wheezing as she breathed and he knew she needed to rest. He should leave and let her recover but he needed to know that everything was under control first. ‘Is anything else bothering you?’ he asked.

  ‘Well, I also want to see Lexi happily married to Sam but I don’t think you can help me there.’ Bella smiled and Charlie caught a glimpse of humour despite her circumstances.

  ‘Why wouldn’t they get married?’ he asked.

  Bella shook her head. ‘I’m sure they will but I want to be there when they do. Lexi wants time to organise a huge circus, and I know it’s her wedding …’ She smiled. ‘Their wedding,’ she corrected, ‘but I wish she’d agree to hurry things up. I don’t want to miss out.’

  Her smile had gone and the tension had returned to her shoulders. She had the bed sheet bunched up tight in her right hand and her knuckles were white with the effort. Maybe it had been stress he’d been witnessing all along.

  Charlie wished again that there was something he could do to reassure her. ‘You need to be positive. You have to believe you will get a second chance.’ He knew his words were hopelessly inadequate but he was out of his depth.

  ‘All right, I’ll go along with your fairy-tale for now,’ Bella replied. ‘Let’s say a donor is found in time, before Lexi and Sam have a chance to get married. What if something happens to me during the surgery? That’s a risk too. Sam is my surgeon. How do you think that will affect their relationship? I know the idea of me dying terrifies Lexi but if they’re already married they’ll have to get past it, but if they’re not …’ Bella paused and shrugged her bony shoulders. ‘I don’t want to be responsible for something happening and coming between them.’

 
‘How can what happens in surgery be your responsibility?’

  ‘It’s my decision to have the surgery and the other alternative if something goes wrong is for it to be Sam’s responsibility. If I don’t have the surgery then that pressure is removed.’

  ‘If you don’t have the surgery, you’ll die.’ Charlie knew he was being blunt but he also knew Bella understood the facts. ‘It’s Sam’s job to make sure nothing happens to you. He’s a surgeon, that goes with the territory.’

  ‘Don’t get me wrong. If a donor is found, I will have the transplant, but I’d just prefer it if Lexi and Sam were married first. Does that make sense?’

  Charlie nodded. In some strange roundabout way it did make perfect sense. He could understand her logic. ‘I assume you’ve spoken to Lexi about this?’

  She nodded. ‘But Lexi has a tendency to get her own way and she wants it all to be perfect. In Lexi’s mind the wedding will happen when I’ve had a transplant and life is going on for everyone just as it should. She won’t consider the possibility that I might not make it. She won’t admit that waiting might mean she doesn’t get perfection. She thinks if she ignores the facts, it’ll all go away. She thinks wishing it will make it so. I don’t want to make a fuss but it’s a big deal to me.’

  ‘What about having someone else perform the surgery? Someone other than Sam?’

  ‘Like who?’ Bella asked. ‘Evie told me Sam is one of the best. If I’m going to have a lung transplant, I want the best odds I can get.’

  Charlie thought about Bella’s options. Finn Kennedy, Head of Surgery at Sydney Harbour Hospital, was one of the best cardiac surgeons in Australia but he wasn’t a heart-lung specialist. If Charlie had needed heart surgery, he’d happily choose Finn to operate on him, but if he needed a lung transplant his money would be on Sam.

  ‘I guess Sam is your man,’ he agreed. ‘But if Lexi isn’t listening, why don’t you talk to Sam? See if you can get him to persuade Lexi to speed things up. Get him to explain the urgency to her.’