Chapter 3
Sirius is sleeping again, Lily sitting beside him with her hand in Sirius’s black curls. In her other hand she’s holding a book, reading silently as she gently cards her hands through Sirius’ hair absentmindedly.
James is sitting in the chair at the bedside, Harry in his lap playing a game on his switch. The nurses have just left the room, having changed and repositioned Remus. Harry shifts restlessly in James’ lap and pauses his game.
“Dad, do you think Moony is going to be able to come to my birthday next week?” Harry is innocent. He’s lived his entire life with the knowledge that his Uncle Moony is sick but he still carries the innocence and optimism of childhood. It makes James want to smile while simultaneously breaking his heart.
James fears that Harry is going to get a huge reality check in the next couple of days. Remus is sicker than Harry has ever seen, maybe sicker than any of them have ever seen, even Lily, which is really saying something considering Lily has known Remus since early childhood.
James’ heart warms knowing that his boy doesn’t look at Remus and see a sick, dying man lying in that bed but just sees this hospital stay as something his Uncle Moony does sometimes. He sighs, taking Harry’s switch gently from his hands, putting it on the table beside the chair.
“Haz, Moony is really sick,” James starts his explanation, holding his son’s hand, looking at his fingers that still bear some of the remnants of baby fat despite him being an almost eight-year-old. “You know, Moony was so excited for your birthday party. But I don’t think the doctors are going to let him leave the hospital before next weekend.”
Harry looked dejected but nodded his head in understanding, “Do you think Moony is sad that he's in the hospital?”
James’ eyes leave his son’s questioning face and move over to observe Remus lying in the bed beside where he and Harry are sitting. His belly is distended with bloating, his feet and legs swollen, the skin tight and discolored. His lips are chapped and cracking at the corners around the breathing tube and James can see the dark purple bruising peeking out over the collar of Remus’ gown from where he’d received CPR just a few hours prior.
Remus’ wrists are still restrained in the blue padded cuffs but his left hand rests on the stuffed wolf Harry bought for him at the toy store earlier that morning when he’d been taken out for a treat with Effie and Monty. His long fingers were slightly gripping the soft fur of the toy, highlighting the fact that Remus was likely a bit more aware than he could show. Noting that Remus is likely aware in some capacity, James reaches out to grab his friend’s free hand, giving it a tight squeeze and holding on to him.
James knows that Remus isn’t wearing his hearing aids currently but wants Remus to make sure that Remus knows that somebody is here and that his family is with him.
It’s so unfair. Remus is probably the kindest, most gentle soul James has ever met.
He doesn’t deserve this. Nobody really deserves this but especially not Remus.
James would give his NHL career and all of the money in the world if Remus could just live without pain, without hospital visits and uncertainty. He fleetingly wishes it were him lying there but the thought also makes him feel guilty.
He knows Remus would tell him that was not a good thought, that his family needs him and that Remus is fine and he’s coping and he’s happy with his body and who he is, despite the pain and the uncertainty of it all. He knows that such wishful thinking is not helpful because it doesn’t change reality and only invites negativity. James wouldn’t want to end up sick alongside Moony.
James finally looks back at Harry, who is still looking at him expectantly, waiting on the answer to his question.
“I think Moony is happy that he’s in a place where they can take care of him and he’s happy that all of his family are able to come see him and keep him company,” James’ knows this answer is diplomatic, but that it's true. He knows that Remus would rather not be in the hospital but he also knows that Remus is pragmatic and logical when it comes to his health. “But I know that he is so, so sorry he won’t be able to come to your birthday. You know he’d come if he could.”
“Yeah Dad, I know,” Harry says, laying back against his dad’s shoulder, seeking warm and comfort.
It’s 4 pm before the doctors finally show back up and Regulus, Marlene, and James’ parents are back at the hospital with James, Lily, Harry, and Sirius.
Marlene grabs Harry’s hand and ushers him out of the room with the promise of McDonald’s and his favorite chocolate chip cookie dough ice cream.
Sirius is sitting on the edge of Remus’ bed, a hand carding through his husband’s honey colored curls, head looking expectantly toward the doctor. He’s silently begging the universe for good news. Please, good news.
“He’s officially in end stage heart failure,” Dr. Dearborn explains, his face heavy with sympathy. “He’s going to need a heart transplant in order to survive this.”
Sirius bites his lip, hard. He lets the doctor finish his spiel before asking any of the questions quickly coming to the forefront of his mind.
“After his cardiac arrest this morning, we strongly suggest fitting Remus with a ventricular assist device,” the doctor continues. “It will help bridge him to transplant, keep him stable and hopefully prevent any further codes. It could be many, many months before a compatible heart becomes available. The LVAD will give him the best chance of successfully making it to transplant.”
The doctor pauses and Sirius knows that he’s giving an opportunity for questions and concerns.
“So, the ventricular assist device and the heart transplant,” Sirius begins, he’s using his advocacy voice now. “Are these solutions going to merely prolong his life or will the transplant save his life?”
Sirius knows that Remus would not want to undergo such an invasive procedure such as an LVAD for just a little bit of extra time. He knows that Remus only wants extraordinary measures if it’s going to save his life. He’d rather be made comfortable and allowed to go peacefully if there is nothing to be done, rather than putting extra stress on his already overly-taxed body.
“I am confident that a heart transplant will give Remus a good chance at a long life,” Dr. Dearborn says diplomatically. “Of course, we cannot predict the future and every patient outcome is different. But I’m confident that, yes, transplant will save his life.”
Sirius feels like he’s going to throw up. It’s so unfair that he has to make these decisions alone. He and Remus had always known that they’d likely have to make these kinds of decisions eventually but Sirius has, stupidly, always assumed that Remus would be able to give his input and make the ultimate decision.
This is so unfair. Remus is only twenty-seven. They haven’t even been married a year and they had an appointment next month with the surrogacy agency to begin the surrogacy process to try and start their family. Remus wasn’t supposed to be dying yet. There was supposed to be more time.
But, Sirius supposes, that’s what Dr. Dearborn is offering. The only chance at more time, the only chance they have now at one day being able to have a family and be parents together. Now it’s up to him to decide, to take the offer or not, and he has to hope that he isn’t upsetting his husband by making drastic decisions about his body for him.
“Okay,” Sirius nods slowly. “Okay, yes to the LVAD and yes to getting on the transplant list. Remus deserves a fighting chance.”
Over the next few hours, there is a flurry of paperwork and surgery prep and, before Sirius realizes what’s happening, the transport team is there to take Remus away for surgery to have his LVAD placed.
Sirius cries and cries. Oh, how he wishes it were him. James pulls him back from where he’s kissing Remus’ cheeks over and over. He knows they need to take Remus back but how can he possibly let his love go? How can he possibly let go when he knows that the next time he sees him, their lives will be drastically different than it was just a couple of days ago.
The nurses wheel Remus away and Sirius slumps against James. He can only hope that when he emerges from surgery, Remus will be able to be weaned from sedation and that he can finally talk to his husband and see his eyes again. He hopes Remus won’t be angered by Sirius’ choices on his behalf.
Sirius just wants to give his love a fighting chance to survive, to start the life together they’d dreamed of for so long. He cries, oh how he cries and cries and cries.
After Remus has been gone for half an hour, Marlene finally brings Harry back from their outing. Sirius pulls Harry in close and clings to the little boy, letting his chatter about hockey and video games and his upcoming birthday party distract from the way his imagination is trying to imagine the way the surgeons are slicing his husband up and abusing his already abused body, once again.
The two snuggle under a warm blanket in the OR waiting room, Harry eventually falling asleep against his Padfoot’s chest. Sirius doesn’t sleep now and he refuses any further anxiety medication that James tries to coax him to take. He wants to be alert when the doctors come to give an update and he wants to be wide awake when Remus is taken back to this room.
The surgery takes nearly seven hours to complete, by which time it's almost midnight. Lily and Harry and James’ parents have gone home, now it's just James, Sirius, Regulus, and Marlene in the waiting room when the doctors come out to give the update.
Remus did well and seems to be tolerating the new device well and as expected. Remus didn’t code on the table during the procedure which Sirius was fearful of and they’re told that Remus will be brought back up to his room in the CICU within the hour as long as there are no complications in the recovery room.
The four of them trudge back up to the CICU to wait and Remus arrives thirty-five minutes later. He’s still sedated and on the ventilator, but his gown is gone and his new bandages are on display. He’s got drainage tubes jutting from his chest and abdomen and his skin around the bandages is mottled and sore looking and bruising already.
Sirius is at his side immediately, placing gentle kisses onto his husband’s forehead, over and over and over again.
“I missed you, I missed you, I missed you,” Sirius chants over and over again. He knows that if Remus were at all aware that he wouldn’t necessarily be able to understand his words because he’s not wearing his aids but, he says them anyway.
Nurse Karl comes in to see Remus and he gives Sirius a reassuring hug. Promising that he’s seen LVADs change the lives of some of his most sick patients. Sirius feels, for the first time, like he hasn’t just made the worst choice of his life.
Remus remains sedated for the better part of the next two days, recovering from surgery and letting his body begin to heal the incisions. However, the doctor’s want him weaned off of sedation as soon as possible so that he can begin rehabilitation. Remus’ brain injury and cognitive difficulties mean that the longer he is sedated the more likely it is for him to lose cognitive functions and have to relearn them.
Sirius sits with Remus as the doctors and nurses crowd around the bed as well, waiting to see the outcome now that the sedatives have been stopped.
He sees the moment that Remus becomes aware because his face becomes a mask of pain, his mouth attempting to grimace around the breathing tube and tape on his face.
In preparation, Sirius has already put Remus’ hearing aids in so when Dr. Dearborn speaks to Remus, he does respond.
“Remus, can you open your eyes for me?” Dr. Dearborn says, his voice overly loud and his words overly-enunciated.
Remus blinks his eyes open slowly and he continues to grimace in pain, his eyes frantically searching the room until they land on Sirius and then they stay there.
“Hi baby,” Sirius coos, his voice steady and soft. Soothing. “Take it easy, love. Try not to move around so much, you’ve had open heart surgery. Are you in pain?”
Remus nods his head minutely, gagging as the tube in his throat jostles with the movement.
“That’s okay, Remus,” Dr. Dearborn tells him upon seeing his response. “We’re going to push some pain medicine now okay? Once you’re comfortable we want to try extubating you, okay?”
Remus doesn’t really respond but he squeezes his eyes shut at the pain and leans into Sirius’ hand in his hair. The nurse pushes the painkiller into his line and the doctors discuss different numbers amongst themselves, checking in every few minutes until Remus indicates that he is finally comfortable and that the pain is managed.
The anesthesiologist looms over Remus, his large form casting a shadow over the bed. However, his eyes are kind and Remus can see the smile in them despite the mask. He’s trembling again, Sirius can feel it under his palm.
They give him a 3-2-1 countdown and then are pulling the tube out in one swift motion, Remus gagging and coughing as it makes its way up and out of his throat.
The respiratory therapist is affixing the CPAP to his nose and Remus is breathing on his own for the first time in nearly a week.
“Pads,” Remus croaks, his head turning toward his husband. “Pads, I’m scared.”
Sirius can see that Remus is suffering from a bit of ICU delirium again and his breathing is labored and requiring all of his effort.
“It’s okay baby,” Sirius soothes, carding his hand in the honey curls. “It’s okay baby, I’m right here. I haven’t left your side and I won’t. I promise.”
The doctors and nurses and respiratory therapists continue to monitor Remus but by the end of the first ten minutes of his extubation, it is determined that his breathing is far too labored and his O2 Sats are far too poor. The call is made to re-intubate him which causes Remus to begin crying and begging for Sirius again.
“Please, no more sedation, please,” his eyes are wide and fearful. “Please, I’m scared Sirius. I don’t want to be sedated.”
“Shh, Rem, shh,” Sirius has a comforting hand on Remus’ cheek. “Let’s get you breathing then we can make decisions about sedation, okay love?”
Remus is trembling, his whole body seeming to vibrate as the anesthesiologist numbs his throat and airway and the tube is being passed down and secured to his face with more tape.
Once the doctors are satisfied with Remus’ 02 sats again, Dr. Dearborn and the anesthesiologist send the rest of the team away and settle in to have a discussion.
It’s explained to Remus and Sirius that Remus’ lungs are likely too damaged by his weakening heart and his two cardiac arrests in the last week that extubation may be impossible.
The only option is the endotracheal tube and at least mild sedation or a tracheostomy, which would allow Remus to forego further sedation based solely on needing mechanical ventilation.
Remus is crying again and now Sirius and Lily and James are all at his side, hands on him, soothing words. Sirius is using gentle thumbs to wipe his tears, featherlight kisses on his cheek.
“What do you think, Rem?” Sirius asks, capturing his husband's gaze with his own. “I know you don’t want to be sedated and you might need the ventilator for a long time. The tracheostomy might be the best way forward but we won’t make that choice without your blessing, love. Promise.”
Lily is squeezing Remus’ restrained hand and he’s squeezing back, James’s hand in Remus’ other hand is mirroring Lily.
Remus is still crying and Sirius is still wiping tears, feathering gentle kisses and he asks again, “What do you think, Rem? Do you want to do the tracheostomy? Can you tell me yes or no?”
Sirius’ question is gentle and he looks down to Remus’ hand where he’s attempting the sign for ‘Yes’, his closed fist moving up and down.
“You’re saying ‘yes’?” Sirius asks once more, double checking for the benefit of the doctors and Remus nods his head as much as he can and the doctor’s acknowledge Remus’ choice and get him prepped for, yet another, surgery.
The tracheostomy procedure can be performed bedside but the staff make Sirius, James, and Lily leave the room.
Remus watches them go, tears still in his eyes. He can’t believe how emotional he’s been today but it’s been an emotional week. The sedation has caused so many instances of delirium and awful hallucinations and night terrors that he shudders just thinking about them.
He’s terrified of having a tracheostomy and relying on a ventilator but the nurse has just pushed something into his IV that makes him feel calm and relaxed. His hands are secured to a second point on the bed so that his arms stay firmly out of the doctors’ way as they work.
He feels the lidocaine injection and mentally prepares himself for a horrific experience. He wants Sirius here. He needs somebody to comfort him and tell him everything is going to be okay, to distract him from the scary looking instruments the doctors are wielding.
As if he manifested him at his bedside, suddenly Karl is there. Remus’ favorite nurse who has taken care of him countless times in the CICU over the years, and his got a hand in Remus’ hair and he’s speaking calmly and soothingly to him.
“It’s okay Remus,” Karl begins and Remus starts to feel a tugging and forceful pressure at his neck but, mercifully, no pain yet.
“Little Harry was here the other day,” Karl beings and Remus knows he’s trying to distract him from the procedure and Remus is trying to allow himself to be distracted. “He was telling me he’s going to be turning 8-years-old next week. I can hardly believe that. He was telling me he’s going to have a Super Mario Bros. themed party and that he can’t wait.”
Remus’ eyes find Karl’s and he locks them there as, suddenly, he feels a dramatic pressure change in his airway and something is being shoved into his neck, the pressure is intense. He begins to feel like he can’t breathe and his eyes grow fearful as he begins to get the sensation of drowning.
“You’re okay, Remus, the procedure is going really, really well,” Karl assures him and continues to talk about Harry. “I’ve already talked to the child-life team and they’re going to throw Harry a birthday party this coming Thursday on his actual birthday so that you can be a part of the festivities. That will be so nice, yeah?”
Suddenly, there’s a hand in Remus’s face and the breathing tube is being pulled from his mouth, he must have missed the 3-2-1 countdown this time. And he’s breathing again, mercifully, there is oxygen and the fuzziness he’d just begun feeling as the ventilator was detached from his airway has already begun to recede.
“You did so well, Remus, so well,” Karl says kindly, Remus can see a smile in his eyes above his mask. “They’re going to clean you up and then Sirius can come back in, okay?”
Remus swallows and gags slightly at the feeling and then the ventilator is being taken away again and a small, thin tube is being threaded into his airway. It’s only seconds and then he’s getting air again.
He lets his eyes fall closed as the doctors and nurses dress his new wound and attach a soft velcro collar around his neck to keep his new tube in its proper place.
He swallows again, his throat dry and painful and he plans to ask Sirius for some ice chips when he sees him again. A nurse pushes more painkillers and it helps because the ache in his chest has returned and the fluttery anxiety is threatening to errupt from him again.
Once the doctor’s have monitored him for thirty minutes, Sirius is allowed to come back to his bedside and James and Lily are there and Regulus and Marlene are with them now, too. The nurse loosens his restraints again and he’s leaning into Sirius’ hand which is back in his hair.
He mouths the word ‘ice’ to Sirius but he can’t seem to figure out what Remus is saying and instinctively Sirius’ eyes flicker to Remus’ hands and he flexes his hands from flat palms down to palms down with curled fingers several times signing ‘ice’, ‘ice’, ‘ice’.
Sirius understands now and fetches a cup of ice chips and begins feeding Remus little bites of ice chips until he refuses, his eyes drooping closed.
He’s tired, oh so tired . He wants to sleep, wants to be cuddled but knows that Sirius can’t get in the bed right now because Remus’ chest and abdomen and neck are covered with fresh wounds. So, he settles for his husband's hand in his hair and his kisses on his cheeks. As he falls asleep, he feels Lily spreading vaseline onto his painful, dry lips and Sirius’ soft voice singing him a song. Those are the last sensations he registers before he falls into sleep.