Chapter 8
“Ventilator associated pneumonia,” Sirius hears the ER physician on duty say. “Due to his already vulnerable health, he will need to be admitted into the cardiac ICU, we have already contacted Dr. Dearborn who agrees that hospitalization is the right call.”
Remus is probably so upset, is all that Sirius thinks when hearing these words. He can imagine the look of disappointment on Remus’ face when they tell him that he can’t go home tonight.
Surely, Remus realized already he’d be too sick to make it home, but that still doesn’t make it easier.
Regulus and James walk Sirius up to CICU, each with an arm looped through one of Sirius’ on either side. Keeping him steady and upright.
When they arrive at Remus’ room, Sirius sinks into the chair at the bedside.
Remus is already laden with extra tubes in his arms for IVs and his face is drawn and slack. They must have sedated him at some point because, when Sirius takes a look at the medications attached to the infusion pump, he sees propofol along with the antibiotic he’s being given to fight the pneumonia.
Remus’s arms are already cuffed to the bed in the soft blue restraints Sirius has come to expect from hospital visits like these.
Somehow, it’s the reappearance of the wrist restraints that make Sirius realize and accept that this is truly a bad, bad situation they’re in. Somehow he’d let himself hope up to this point that it was a small infection and that all Remus would need is some antibiotics and that he’d go home in a couple of days.
Seeing him here now, he realizes that is far from the case.
Sirius looks over to the table to see that somebody has taken out Remus’ hearing aids. He’d insisted on Remus wearing the during the ambulance ride because they hadn’t allowed Sirius to go with him.
He picks them up, checking to make sure the batteries are still good since somebody had neglected to turn them off and then he gently affixes them to Remus’ ear. Since Remus’ last stay, Sirius has done a lot of private reading up on ICU delirium and how to mitigate the effects and prevent it all together.
Several studies he read had shown that patients who are given access to their hearing aids during ICU sedation, experience a decrease in delirium as it eliminates one more thing causing confusion.
With Remus’ aids firmly in place, Sirius assumes his usual position. He crawls into the bed, untying one of Remus’ wrists, he takes Remus’ hand and holds it firmly in his own, his head lying gently on Remus’ bicep. He’s always been thankful during hospital stays that Remus is such a big guy because they are forced to use the specialty, extra long beds to accommodate his height which, naturally, leaves a little extra room on the sides for Sirius to sneak into bed with him.
“Hey sweetie, I’m here,” Sirius coos gently. “Don’t worry, I’m right here with you. I’m not going anywhere.”
James’ heart shatters into tiny little pieces.
James has seen Sirius assume this same position of loving comfort at Remus’ hospital bedside dozens of times over the past decade. But something extra twists in his gut this time. He finds himself wondering whether or not this will be the hospital stay where they have to say goodbye to Remus.
The thought makes him want to cry out in anguish. Anguish for Sirius and Lily, for Remus, and for himself, too. What will they do if Remus dies? James has no idea.
He’s just called coach to let him know the situation and that there's no way that Sirius will make it to tomorrow’s morning skate.
Coach is understanding and tells James he understands if he needs to skip practice, too. And James does appreciate the gesture, but he declines. He needs hockey like oxygen during times like these. The ice is the only thing that keeps his mind off of horrors like what he’s seeing right now.
He quietly pulls up a chair next to Sirius and puts a soothing hand on his best friend’s back.
He can feel the vibration in Sirius’ back before he hears the sound. Sirius is humming some kind of soothing tune to Remus, low and comforting.
Sirius doesn’t stir at the touch. Just continues to hold Remus’ hand and hum to him softly.
James feels lost, he wants to make this better for his best friends but he can’t. There’s nothing he can do and that kills him a bit inside.
Caradoc Dearborn isn’t sure when he went from being ‘Doc’, short for Caradoc, and ‘Doc’, short for Doctor Dearborn.
He finds it a bit difficult to conceptualize that it’s been a little over fifteen years since he finished medical school and that now he’s an attending physician at one of Gryffindor’s best hospitals for critical cardiac intensive care.
Caradoc learned long ago that there will always be patients and situations that stick out clearly to him as a doctor. Patients who have died that he will never forget and patients who have recovered that he rarely sees. Then there are the patients in between.
The ones who, no matter what he does, always seem to end back up under his watchful eye in the CICU.
When he met Remus Lupin when Remus was a brand new eighteen-year-old college student, nearly ten years ago now, he’d known his relationship with this patient was going to be different. It was rare that he had to care for somebody who was so young and also so sick.
He’d been stricken by Remus’ attitude of acceptance around his health and had been inspired to see how he took all of his health and mobility challenges in stride. He rarely gets to deal with patients who don’t get angry at him, not that he blames patients who are angry. Anger is a natural response to dying and it’s hard to know where to direct that anger when it’s your own body that is betraying you.
However, Remus never seems to get angry, not even when Caradoc feels like he’s the one in the CICU with the most reasons to be angry. Most times when Remus is in CICU, he’s the youngest patient in the ward.
As time has gone on, Remus has proven to be one of the sicker patients he’s ever had. In and out of the hospital constantly, and when he came into the hospital after suffering the first cardiac arrest last July, Caradoc knew that the other shoe had finally dropped.
He’s not sure if he’s ever seen Remus be emotional about his situation before but during that initial stay in the summer when Caradoc installed Remus’ LVAD and authorized his tracheostomy, Caradoc saw that Remus was crying more often than he wasn’t.
It breaks his heart. He wants to do better for this man. If there’s ever a patient he’s wanted to work miracles for, it’s Remus Lupin. And it kills him a bit inside to know that he’s just not sure there’s anything more he can do.
Pneumonia has killed stronger patients of his and he hates that it’s him that has to break that news to Sirius. Sirius, one of the most dedicated spouses Caradoc has ever had the pleasure of knowing. A tough hockey player with a formidable reputation who turns into a soft, sweet caring husband behind the closed ICU doors.
—
James is hearing what Dr. Dearborn is saying but his ears are also ringing heavily. He’s got his arm around Lily and a hand on Sirius’ shoulder.
“I know that Remus has expressed wishes to not be sedated if at all possible,” Dr. Dearborn starts apologetically. “However, as I’m sure you all know, this is a very dangerous situation Remus is in. Pneumonia in a patient as vulnerable and weak as Remus can be deadly very, very quickly.”
James feels Sirius stiffen at this comment but Sirius remains quiet.
“However, I can assure you that we are doing all we can to help him. We have him on the most aggressive treatment for the pneumonia that we feel his body can handle and he has a leg up already by having the tracheostomy instead of needing to have an endotracheal tube. Tracheostomies have been associated with better outcomes in situations like these. We have also used extra measures to make sure that Remus is comfortably sedated so that hopefully there won’t be any instances of delirium that have him waking up despite the sedatives,” Dr. Dearborn finishes.
He looks up at Remus’ loved ones and he and James make eye contact, James trying to remain strong and calm in the face of such fear and uncertainty.
“Where is he on the transplant list? Do you know?” Sirius asks, his voice is hoarse as if he’s been crying recently, there are deep purple bags under his eyes. “I haven’t had a chance to speak to his transplant coordinator yet today.”
Dr. Dearborn smiles, “I have already sent her a request for him to be moved as close to the top of the list as possible. That doesn’t mean he’ll definitely become the guaranteed next person to receive the next available compatible heart, but it does mean that he’ll be much closer to transplant than he was a few days ago before he became sick with the pneumonia. That said, we'll need to get this pneumonia cleared up before he can receive his transplant. He would be far too unstable to operate on just now.”
Sirius acknowledges Dr. Dearborn’s words and thanks the doctor as he leaves the room.
Sirius reassumes one of his typical positions at Remus’ bedside, his head lying gently on Remus’ thigh, his hand holding Remus’ hand, the one Sirius had re-restrained when the doctor came in and Sirius had crawled out of the bed.
He sees the moment that the exhaustion takes hold of Sirius because his breath becomes even and he begins to snore lightly.
He allows Sirius to sleep like that for an hour or so but eventually decides he can’t allow Sirius to abuse his spine any longer and gently, he lifts his best friend into his arms and carries him over to the fold-out bed under the window, tucking him in under a warm hospital provided blanket. Thankfully, he manages not to wake Sirius up.
He sits at the bedside across from Lily. She’s got a loving hand on Remus, his bicep gently gripped in one of her small, delicate hands and she’s just staring at his sleeping face, the features softened by unconsciousness.
“James,” Lily whispers. “James, I’m scared. I think he might… I think he really might die this time.”
And James doesn’t know what to say to that because, she’s not wrong. He’s been thinking the same thing.
“We can’t predict what will happen beyond this moment, right now Lils,” James says, reaching a hand across the bed to lay his hand on top of hers where it rests on Remus’ arm. “At least we’re here with him and he knows that, I know he knows we’re here. Let’s just hope that he has a little bit of that fighting spirit left.”
Lily holds baby Emma's sleeping form closer to her chest where she’s been snoozing in her wrap. James observes the gesture and begs the universe for a miracle. He knows they’ve asked for a lot when it comes to Remus, but he begs just one more time.
His baby deserves to know her Uncle Moony, his wife deserves to grow old with her best friend, and Sirius deserves to be able to start the life with Remus the two had always planned on. Sirius and Remus have both suffered enough, he begs that they will be granted just this one mercy.