5/V. Were It Not For Grace (Remastered)
“Heart…” What is this shooting pain… in my… chest? I can’t… breathe…
As Arthur was closing the Holy Book, a sharp sting suddenly overwhelmed his breathing.
He continued to weaken in every gasp of air, and Matthew noticed the kid’s clenching his fists at his chest.
“Art, are you okay? Art? Art?” He stroke the chest of the child trying to relieve the pain that he’s feeling.
“Matt? What’s happening to Art?” Both of the two panicked as Arthur showed feeling of distress and difficulty in breathing.
[SFX: Pant, Pant, Pant]
“Wait, wait, nine-one-one, get the phone, get the phone, Johnny!” Johnny scurried off to the phone on the dining room.
Arthur panted with his mouth wide open.
What… is… happening with my body, this… is this death? Have you come to collect my spirit, my sister, Ray?
“Hellow, is this nine-one-one? Yes, we need an ambuwance, my brother can’t bweathe. Ouw addwess is nine-one-two Noth-East, Fawaday Stweet, Gweenhills, Los Angeles.” Johnny seemed to be more timid when talking to other people - he twisted his l and r’s as w.
“Johnny, give me the phone.” The long wringing cord of the telephone stretched out as Johnny dragged the phone back to the bedroom from the dining room.
“Hello, please we need an ambulance, one of my – ” Matthew stopped in his tracks, his son? It’s not his family, how can he… No, don’t think of that now, just, we just need to go to the hospital real quick and have Arthur relieved from this pain.
“One of my kids is having difficulty breathing, he’s clenching his fist at his chest, I don’t know… please… send an ambulance.” Matthew’s teary eyes- this can be the last thing that I will see before I go back home?
Arthur slowly wiped Matt’s cheek and eyes off of any tear as his consciousness continually faded away.
“Is the patient breathing?” The dispatcher went on with the protocol questions.
“Yes, he’s breathing, but he has difficulty breathing and has been clenching his chest.” Matthew spoke for Arthur to the dispatcher.
“We’ve located your address, and I am now sending an ambulance. Please stay with me, sir, you also need to keep the patient engaged. Can you ask the patient if he experiences pain on his chest and describe it.” The dispatcher on the other line needs to drive the conversation.
“Art, are you feeling pain on your chest?” Matthew’s worried sick face showed utter concern to the kid.
Arthur can only nod in pain. “Can you tell me or describe it?” It’s a ridiculous question, but he needed Arthur awake. “St- St- Stinging…” between the pants of air, he formed the word and answered the question of the dispatcher.
“Art… art, just hang in there, buddy.” He passed the phone back to Johnny and held onto the Arthur’s hands as it slid down from his cheeks.
“The ambulance is on its way, Mister…” Johnny held the phone on Matthew’s ears as they continue their conversation with the dispatcher.
“Smith, Mister Smith, please…”
Johnny opened the adjacent room from their bedroom, and frantically checked the study table of their father.
He quickly grabbed his father’s identification cards and health insurance cards on the far-right drawer of the study table, and sprinted back to the bedroom and gave it to Matthew.
This kid… he knows…
He quickly carried Arthur down to the hallway at the entrance of the mansion and grabbed the keys and turned on the security alarm of the house.
Johnny marched down to follow the butler.
Matthew laid Arthur in the bench at the porch of the mansion and continuously pumped his heart from his chest, providing CPR (Cardiopulmonary Resuscitation) to the four-year old kid.
This… this isn’t happening, I haven’t been with you four years and this… is… is this the end of all that? No… no, no, no, I refuse to believe this is the end. I will make sure you live for more years to come. You have to save and protect more people.
SFX: Cough, cough, cough, pant, pant, pant
Arthur’s heart stopped momentarily but Matthew was able to bring him back round through resuscitation. As he came around, he continued to gasped for air.
Not two minutes has passed, Matthew heard the sirens echoing in the air, the ambulance arrived faster than what he expected, is this the hand of God?
“Dispatch, is this the mansion?” The responders quickly barged out of the back of the ambulance with a stretcher in both of their hands assessing the situation while inquiring about the medical concern.
“Yes. The family is already near the gate waiting.” The 911 Dispatcher from the other line that’s in touch with the EMT located the address.
“Hi, I’m Cramer, and this is Lee. Dispatch suspects heart attack, right?” The EMTs were a tag team, one man and one woman.
“Difficulty in breathing, he had been clenching his chest since… since seven minutes ago, we just ate and we were reading a book.” Matthew traced their steps from the door to the events from before Arthur felt the shooting pain.
The responders meticulously placed Arthur in the stretcher while wheeling him inside the back of the ambulance.
The first EMT that wheeled Arthur inside the ambulance quickly scrambled their boxes inside one of the cabinets and pulled out the automated external defibrillator.
“What’s that?” Matthew inquired as he and Johnny followed the EMT inside the ambulance.
“Defib, this will keep his heart going until we reach downtown. What’s your relation to the kid?”
She cut up Arthur’s shirt to get access to his chest, and carefully peeled the paper side from the pad and stick the one pad near the center of the chest of Arthur, and the other pad on the skin near his lower left rib.
An electric shock was sent from the device to Arthur’s heart as the EMT proceeded on chest compressions.
“I’m their dad.” He acted more like a doting parent, with his worried stares and his clenching fists.
“His pulse is getting weak, his heart beat and pressure is getting weaker, drive carefully, but quickly. There’s no obstruction in the airway. You said you were eating before reading? What were you eating?” One of the responders, a lady, delicately located Arthur’s pulse and attaching the pulses wires to his chest to detect his heart beat and checking his airway.
“I prepared broccoli with cheese for about 10 servings, I think we splurged on those and there’s nothing left.”
“You were lucky we were an extra ambulance.” The EMT on the other side held down the stretcher as the vehicle wobbles at the light-speed style of the driver.
“Extra?” Matthew curiously asked.
“There were some extreme athletes that went through raft-riding on that wild strong river at the back of the White Wolves’ Forest, two of them fell off the raft on one of the strong currents and two ambulances were sent on the scene.” The EMT who handled the CPR just sighed, almost frustrated.
“What happened?” Johnny looked at the two desperate EMTs with pity in his eyes.
“They were found after two hours, and…” He continued the story.
“Shhh. There’s a kid here.” The lady EMT that handled the defib interrupted
Johnny tightly grips Matthew’s hands. Anxiety soon set in for both of them, a reassuring look from the responder made Matthew calmer by the second and he quickly faced Johnny and looked him in the eye.
“He’s not choking, is the child taking any medications? Any allergies?” The paramedics continued on the barrage of questions.
She then, pulled out a bag valve mask and placed the mask onto Arthur’s airways and continued to pump the valve.
“Arthur is going to be okay. Don’t worry.” Matthew gently stroke Johnny’s cheek.
“Mmmkay.” The kid held his tears, and tried to look strong and composed.
“Cheese... Is he allergic? Lactose-intolerant? No, forget I asked that, the airway wasn’t blocked as I checked earlier.” The lady prepped the electrocardiograph machine to monitor his heartbeat as the ambulance drove to the hospital.
“I closely monitor the kids’ food, I prepare them myself, I know if they have allergies or not, he doesn’t have any allergy with milk or any dairy products.” Mathew felt like he was being questioned on how he cares for the kids, but nonetheless answered the responder truthfully.
“Thank you for the information.” The lady nodded as he inspected his heart rate on the heart monitor, blood pressure continued to decline, and the heart rate is rapid and weakening.
This is a case of a heart attack. It’s weird to the responder since the butler told her that he had been experiencing difficulty breathing since seven to ten minutes ago.
Myocardial Infarction (MI) was the most likely suspect, a mild one, since the kid was still hanging on to dear life.
As the ambulance arrived at the nearest hospital downtown, California Medical Centre, the responders desperately tried to maintain Arthur’s heartbeat by doing chest compressions, the lady jumped on to the stretcher over Arthur as the stretcher was wheeled in by the other responder, quickly to the Emergency Room.
“Kid is having a heart attack-stinging sharp pain in the chest. We’ve tried to maintain his heart in the ambulance. Male, four year old, O2 saturation is at 80 and declining. BP and heart rate is increasing by the minute, and fever is rising from 105.8 degrees to higher.” The EMT informed the Emergency room staff of the medical state of the child.
The ER staff removed the big valve mask and the AED from Arthur’s airway and chest and began intubating the child. The large tubes were connected to an oxygen tank and connected small pads to the ECG and vitals monitor.
One of the doctors in the ER suspected a blood clot in one of the arteries and ordered the nurse to do a venous ultrasound to check further.
“Get an ice pack. We need to lower his temperature as well!” The doctor ordered. He pulled out the ultrasound from another curtain and pressed a gold gel on the feverish chest of the kid and began an ultrasound.
“Doc, the ultrasound showed a blood clot-VCI near the inferior vena cava.” The statement of the nurse surprised the doctor as well as the imaging in the ultrasound.
“Is that…?” He curled his brows and looked at the child struggling to breathe.
“Get the COS of CTS down here, and inject 75 milligrams of Clopidogrel to thin the blood and release the clot. If his temp rises, get more ice pack.”
“Yes, doc.”
[CTS = Cardiothoracic Surgery]
[COS = Chief of Surgeon/Head of Surgery]
[ECG = Electrocardiogram]
The nurses rushed to page the best cardiologist in the hospital, especially after taking the name of the kid and the father.
“Doctor, we have a new case here. Four year old, male, thirty-five pounds, suffered a coronary occlusion about twenty to twenty five minutes prior.” The resident handed over the nurse’s form to the cardiologist.
“What did A&E find out?”
“A&E treated the myocardial infarction and the high temp. Doctor Blake from A&E told the nurse to put the kid on ice pack and blood thinner as we detected blood clot near the inferior vena cava using ultrasound.” He discussed the patient’s file with the attending nurse present.
[A&E – Accident and Emergency Department]
“We also discovered two tears in the patient’s heart. There’s a tearing in the septal wall between the right and the left ventricle.” The resident continued.
“How large?” The COS of CTS crossed his brow as he turned his eyes to the chart.
“The one on the left side is about ten millimeters, and the one on the right side is about thirteen millimeters.” The unsuspecting resident discussed the child’s condition further.
“His temp is still high - effect of the blood thinner, we would need to keep him stable first before moving him to the lab for another EKG test.” Chief-Of-Surgery Doctor Daniel Blake of the A&E entered the curtain and butted in the diagnosis.
SFX: WOOOOOSH As the COS of CTS entered A&E and into the curtain roll of Arthur’s, the resident slide the curtains to cover the space.
“It may be VCD.” The doctor sighed. This child is still too young, too small.
“If this is the case, the tears are small, but considering his size, I’m sure it’ll enlarge more once he grows.” He continued his diagnosis and pulled out one of the pads directly at the heart, and laid his cold-ice stethoscope on Arthur’s chest.
A&E, that time, was chaotic. Everyone was doing business on their own, not trying to mind the other’s noises, but the CTS needed silence for a moment, for that brief moment.
Arthur slowly opened his eyes, feverish, but maintaining his consciousness and thought process, he wanted to help the doctor identify what’s wrong with his physical body.
He closed his eyes again, slowly, creating a vacuum of sound within the borders of the curtain, drowning out the sounds beyond the curtains, and with the power of Manipulation, he bent the laws of nature into his own will.
“I’m hearing a murmur, request a cardiac imaging for this kid.” He handed the chart to the interim resident and pulled out his stethoscope from his ear.
“Where is the family?” The resident and Doctor Blake looked eye to eye as the Cardiologist inquired about the family.
“At the waiting room, oh, uhm, I’ll lead you to them, doc.” The resident shuffled his way to the Visitors Room with the Doctor of Cardiology, Doctor Jemmy Lancaster-Miles.
“Good morning.” He extended his arms to greet the family.
“Good morning, Doctor, how’s Arthur?” Matthew stretched out his arms and shook his hands with the doctor.
The doctor appeared to be puzzled, snatched the medical chart from the intern and asked, “I’m sorry, I think we have the wrong family.”
He crossed his brows and glanced at the chart then back to Matthew, with a puzzled look on his face once more.
“No, no, I’m… I’m Mister Smith, Edward. Arthur is the kid’s nickname.” He held Johnny close to his arms as there were nurses and patients waiting with them at the hospital’s lounge.
“Oh! Thank you for clarifying that, I’m Doctor Jem, from CTS - Cardiology. Can you tell me more about the kid?” The doctor raised his left brow, trying to test the man’s credibility.
“Cardio? Does Arthur have a heart problem?” The usual reaction of the family was anxiety.
The doctor just sighed, seeing as Matthew was as clueless as ever, even when Arthur had been vocally expressing chest pains.
“We’re still doing several tests, for now, his vitals and heart will be closely monitored by Dr. Blake and I.” The doctor tried to reassure Matthew.
But he also knew false hope won’t help. “We’re gonna be requesting cardiac imaging to check further his heart as we have detected on an ultrasound a small tear in it.”
“He’s still unstable for now. He has a fever, and we would need to cool his body down.” Dr. Blake agreed with the imaging that Miles requested.
“We also detected a clot. That was the main cause of the heart attack – we’re releasing it using Clopidogrel. We’ll move him to the ICU for further monitoring, once he’s more stable, we’ll get him to the lab to confirm the heart defect and what we can do further about it.” Miles explained further.
“Thank you. Arthur… he…” Matthew seemed to hesitate, the doctor was quite sensitive and felt the hesitation in his tone. He asked the intern to take Johnny for a walk.
“Can you take the kid for a walk while we talk?”
“Yes, doctor, sure!”
Johnny, untrusting and doubtful, quickly hid behind Matthew and tugged on his shirt. Matthew knelt and faced Johnny to reassure him, “Johnny, be good now, okay, I just need to talk with the doctor, alright?”
“Hmmmmkay.” The kid timidly approached the intern and held his hands.
“Please… don’t go to populated places, and if possible, please stay inside the hospital.”
“Sure! We have a kids’ play pen in the second floor, the paediatrics ward.” The resident smiled at Johnny sweetly.
“Thank you.”
“Shall we go to my office so that we can talk privately?” Miles reached out his hand to Matthew and lead him to the CTS Department.
“Yes, thank you, doctor.”
Matthew and the doctor stride towards the elevator up to the third floor to the CTS Department and opened the personal office of the cardiologist.
As they entered the office, Matthew visibly showed disgust at the collection of organs on the next room noticeable by the large open door halfway of the office.
“That’s for my students.” Matthew awkwardly changed his expression from disgust to apologetic.
“Ah, sorry, I was just… I… I can’t take seeing blood.” The man clearly has a problem with seeing the organs and blood of the human body. His cold sweat obviously peered down from his face down his cheeks and neck.
“Please, sit.”
“Thank you.” Matthew can’t shake off a feeling of dread and anxiety ever since he entered the hospital, a usual reaction to death and blood around, but there’s something even greater to be worried at, he doesn’t know it yet, but –
“I… I also wanted to speak with you privately as… I know Edward.” Edward? Crap! I’m using his identity!
Matthew and Edward has similar features, you may say that they visibly look the same, but there are some part of the faces that you can differentiate, especially if you know the true face of Edward.
“I… I’m sorry, I was too worried about the kids…”
“I know, I know that you are their butler.” Matthew evidently sweated more and more as he found out that the doctor is a close friend of the Smith household.
“Don’t worry about it, and just… tell me the truth about Arthur, I need every detail.” The doctor appeared to be sincere in his words, truthful and repenting, Matthew told the doctor of the medical history of Arthur and their everyday habits.
-------------------- // --------------------
“So… they’re triplets…” Matthew discussed the history of Arthur from birth up to the present day – medically, biologically, and physically.
“Yes.” The butler’s answer seemed like he’s hesitating. He must be hiding something.
“Have you informed Edward about this?” The doctor’s next set of questions set off the puzzle.
“Not yet, Miss Emily wishes to keep it to herself.” That’s why he’s acting so weird.
“I see, I understand, don’t worry, I swore whatever we discussed will stay within these walls - patient’s confidentiality.” Miles gently closed Arthur’s folder and file information as he looked at the child’s picture.
“Thank you.”
“Since they’re triplets, this may have contributing factor in the development of the organs, congenital heart disease is common for twins, or multiple children in one birthing.” The doctor scribbled in his notes and typed the summary of the medical history to his computer.
“Thank you, doctor, for helping us.”
“Sure! I already contacted Emily and Edward, Emily told me that she will be here after her shift, and Edward, he… he told me to pass the message, Handle It quietly, Matt.” The statement sounded so threatening, but how it was delivered was much more.
I don’t want any trouble here on the hospital.
“Th- Th- Thank you, I haven’t had the time to reach them since this morning, it all happened so quickly.” Matthew only smiled back awkwardly.
“You’d have to carefully monitor his diet and maintenance. We will be confirming my diagnosis through the imaging and ECG, once he’s stable, we’ll schedule the lab.” The doctor reached out his hands for a hand-shake.
“Thank you.” Matthew took it and cowered as he grinned.
The doctor paged the intern with Johnny and the two went to ride the elevator up to the third floor from the Paediatrics Ward to the CTS Department.
“How… do you know my employer, Doctor?” Matthew was overcomed with curiosity while they were waiting for Johnny and the intern.
“Uhmmm… you’re better off not knowing, confidential matter about the government.”
“Oh, sorry, I’m sorry I asked.”
“No, it’s… it’s fine, it’s normal to feel curious.”
“I… I was always alone with the kids, I took care of them by myself, their mother is too swamped with her work, and so as their father. I… I don’t know who to rely to especially in these emergency situations.”
“It’s natural to feel that way.” It’s unnatural but the sound of the keyboard as the doctor typed slowly eroded the anxiety Matthew has been feeling.
The silent dread and the emotions mixing into a big blob of ugliness were carried away by the noise in the room.
After a typing frenzy, the printer moved in slow speeds, ate the white bond paper, and the outgoing sheet turned to black and white.
“I have already requested the schedule for the imaging and ECG for Arthur. Here.” The doctor flawlessly picked up the printed form and handed it over to Matthew.
“What’re…” Matthew held out his open palm to receive the papers.
“Consent form for the imaging and ECG.” Oh…
“Shouldn’t you have gotten this first with me before…?”
This man…
“Nah, it’s fine, I already got a verbal consent from Edward, we just need his formal consent via the paperworks. We will do the lab with his heart, and I will discuss the matter with Edward and the best course of treatment.” The doctor reassured Matthew several times as this is the first time that Matt will be dealing with the kids’ health.
“Then… I shouldn’t sign this, I’m not…”
“Don’t worry about it, Edward already told me. You have his POA right?” The doctor handed over a black sign pen.
[POA = Power of Attorney]
“Oh! Uhm.. yes! Why didn’t I think of that?” Matthew nonchalantly reached out his hand and took hold of the pen.
His cursive strokes added to the noise avoiding awkwardness between the two in the room.
[SFX: Tok, tok, tok]
The intern knocked gently at the doctor’s office with Johnny holding his left hands as they walk together down the hallway.
“Come in.” The intern twisted the silver knob and the two entered the room, Johnny was taken aback as he actively observed the room and the other divided by the large opened door.
“Ahhh!” Matthew scribbled his way out of the chair and desperately closed the door in a quick fashion but failed to do so.
“Too late…” The doctor facepalmed as he laughed in amusement.
“What are these?” The timid kid quickly transformed to a curious one as he surveyed the bottles on the next room.
“You can stay here at my office while I check on Arthur, Dan, come with me.”
“Yes, doc.”
-------------------- // --------------------
After three hours…
The shuffling noise woke Arthur from his sleep at the Intensive Care Unit.
His eyes scarcely opened, his heartbeat suddenly spiked and gone back to normal as his vision got clearer.
He felt a slight pinch from his fingers, and the doctor clipped a digital monitor at his left hand index finger.
The doctor carefully lifted Arthur’s medical garment as he came to consciousness and removed the temporary intubation and replaced it with a bag valve mask and directed the tube to the oxygen instead of the valve.
Miles pulled out six or seven patches wired through the Electrocardiogram machine.
He carefully placed them in his chest and began the ECG test.
The result is so close from what the doctor diagnosed, the normal P waves were absent, and there were multiple Q waves in the V sections, indicating the signs of the previous myocardial infarction.
There were several abnormalities in the ST segments of the V sections.
All in all, the test confirmed what the doctor had already diagnosed.
“What… do I have?” Arthur weakly spoke as the ECG prints the test results. Good thing was that the doctor has good hearing and heard the young patient.
“From what your father had told me, you are quite a genius boy, however, even with an immeasurable intelligence quotient, and even if I tell you, you wouldn’t-” The doctor stretched the thin sheet of paper that was still connected to the EKG machine and turned his head in amazement.
“Please… I want to know.” As the man turned his head, his eyes glimmered, his interest piqued as he read the rest of the test.
“Int’resting…” He squinted his eyes, and removed his prescription glasses.
“It shows here on the test that you have moderately restrictive perimembranous ventricular septal defect, I still have to scan your heart to confirm the exact place of the holes you have in your ventricles. There may be leakages on your lung due to the holes.” The doctor continued as he sat down beside the bed with the machine still going on as Arthur breathe weakly using the oxygen support.
“Con… congenital heart disease, hmmmmmmm…” The doctor was taken aback; the child accurately specified the defect he has with his heart.
“Wow, you really are a genius boy.” He grinned as he observed the further results on the printer.
“There’s no cure, but… it’ll close up eventually, right?” The tone came across as terrified. You’re really just a kid.
The doctor thought the way of Arthur’s conversing was a bit confident and arrogant when he named his disease, but came out afraid confirming the diagnosis with the doctor.
“It depends on the result of the imaging. You need to rest first, once you are stable, we’ll be able to do the imaging.” He still couldn’t give a definitive answer.
Specifying a disease in the body takes several tests, diagnosis, and it’s closely similar to investigating a case.
[SFX: Tok, tok, tok]
Matthew and Johnny were just outside the window glass pane of the ICU, waiting for the ECG results and the doctor.
“I need to go, I need to schedule the imaging for locating the holes in your heart.” He slowly stood up from the stool, nearby the machine, still printing the readings about the heartbeat.
“Doc… can I ask you… a favour?” The child slowly and weakly reached out his arms, still shaking for being fever-ish, and he grabbed the doctor’s white sleeve.
Arthur hesitated, and he was right to do so, Jemmy was one of the contractors of Edward, when necessary, but still, Arthur was willing to throw his cards.
“Sure, what is it?” The doctor mirrored the hesitation, and he placed his hands on top of Arthur hands, and reassured him that there’s nothing to worry about.
“Can you… can you keep my…” Arthur averted his eyes. “This a secret?” The desperation in his eyes reflected as the light hit his teary, glassy eyes.
“You mean you want a patient confidentiality on this?” The doctor was astonished by how much the four year old kid knows.
“Maybe… maybe not from Matt and my brother, but…”
“You- you want me to keep this a secret from YOUR FATHER?” The doctor reacted in an outrage, understandable, knowing that Arthur was only four years old at the time, and cannot make legal medical decisions by himself.
The doctor carefully inserted back the temporary pacemaker and carefully considered what Arthur requested.
He remembered Matthew’s words, “I… I was always alone with the kids, I took care of them by myself, their mother is too swamped with her work, and so as their father. I… I don’t know who to rely on especially in these emergency situations.”
“What… do you say?” The pinch was more painful that the first one since the doctor is inserting it back.
“Why?” He sanitized the wound and looked Arthur in the eye.
Arthur couldn’t look back, not because he was lying, but… “They are my only family.”
The doctor was stunned by the kid’s reply, and he felt pity for the kid.
He has an eight year old kid and even though the hospital work was too consuming, he made sure to make time for his child to make sure that he feel loved.
No, he needs his father, especially in these times.
“No, I cannot do that. I cannot exclude your biological family out of the picture. You’re still a child, an immature one at that.” He tried to scold the kid, started strong, but ended up being soft.
He grabbed his glasses and strode out of the room, as he brought Matthew and Johnny on the next room where he discussed the next procedures.
Arthur slightly smiled as the two fades away from his sight. His hands weakly reached the patches attached to his chest.
“Is this… my punishment? For… for looking down on humans, for underestimating what humanity can and cannot do, and looking at their life at the same value of an animal? Is this… my punishment, Father?”
He weakly voiced out his concern. It’s as if he is talking to an imaginary friend, by speaking without someone receiving his words.
If… I were to die here and now, I would have no regrets, at the most, I have brought souls back to Father…
The feeling was too familiar, like a fleeting ship out to the see of the vast oceans, knowing there are horrors on the journey and hardships on the winding storm and wild seas. It’s as if, he felt this way before…