DASHIELL
I woke a few minutes before the alarm with Alexander wrapped around me, his chest warm against my back beneath the sheets. When I shifted, his arm tightened around my waist and drew me closer, burying me more securely against him.
The alarm vibrated against the nightstand a moment later. I reached over to silence it, and Alexander pressed a brief kiss into my hair before finally loosening his hold enough for me to get out of bed.
We moved through the morning without needing much conversation. By the time I finished dressing for the hospital, Alexander was already waiting near the bedroom door while I fought with the cuff of my shirt.
He noticed before I managed to fix it.
"Give me your hand."
I held it out, and he straightened the cuff. His fingertips brushed the inside of my wrist as he finished, then lingered there just long enough for me to notice.
"Better?"
"Yes."
He released me, and we headed downstairs.
Bianca was muttering in the kitchen before we reached it.
We found her stretched onto her toes in front of an upper cupboard, one arm extended toward a glass jar pushed inconveniently far back.
Her sleep shorts and thin camisole left most of her skin bare as she stretched higher, rising onto the very tips of her toes.
Her fingers brushed the jar, only to push it farther back into the cupboard.
"Oh, come on," she muttered, reaching for it again.
I smiled as we entered. "Good morning."
She turned, brightening when she saw us. "Morning."
Alexander continued toward the refrigerator.
Bianca made another unsuccessful attempt before glancing over her shoulder at him. "Alexander, can you help me?"
He paused with one hand on the refrigerator door.
"I can't reach the coffee."
His eyes traveled to the cupboard and then settled on me.
"Dashiell."
It took me a moment to realize what he wanted.
"Why are you calling me?"
"Your sister needs assistance."
Bianca lowered herself onto her heels and stared at him.
I pressed my lips together to keep from smiling. "You're taller than I am."
"Yes," Alexander replied, as if that had nothing to do with the situation, before opening the refrigerator.
Bianca turned to me with disbelief written across her face. "Seriously?"
I went over and stretched for the jar, managing to hook my fingers around it before handing it to her.
"Thank you," she said.
"You're welcome."
Her gaze slid past me toward Alexander, who continued searching through the refrigerator without so much as looking in our direction. The fact that he'd sent me to help her when he could have reached the jar without any effort left me fighting another smile.
I took my usual seat at the island while Bianca made her coffee. Alexander set a glass of water and orange juice in front of me before returning to the refrigerator for a container
Inside, apple slices had been cut into neat pieces with every bit of skin removed.
"You peeled them."
"You don't like the skin."
"I can eat it."
"But you won't."
He knew me well enough to make arguing useless. I reached for a piece, and the slight shift in his expression as I ate it told me that was exactly what he'd been waiting for.
Across the kitchen, Bianca had stopped stirring her coffee.
Her gaze moved from the container to the orange juice, then finally to Alexander's hand resting against the back of my chair.
"You still need someone doing all that for you?"
I looked at her. "Doing what?"
She gave a small shrug and lifted her coffee. "Peeling your apples. Keeping track of what you drink. You're almost thirty, Dash."
Something in her tone bothered me, although I couldn't identify exactly what it was.
"I know how old I am."
"Then you should be able to peel an apple." She took a sip, studying me over the rim of the cup. "I'm just surprised Alexander has the patience."
Before I could answer, Alexander's hand slid from the chair to the back of my neck, his fingers settling beneath my hair with easy familiarity.
"I don't require patience to care for my husband."
Bianca's cup paused halfway to the counter.
Alexander didn't seem particularly interested in her reaction. His thumb passed once over my nape before he reached for his own coffee.
I looked down at the neatly peeled apple in my hand.
Yesterday, Bianca's attention on him had left an uncomfortable pressure beneath my ribs. This morning, that feeling had changed into something I understood a little better.
She could look at Alexander all she wanted.
She had asked him for one jar of coffee, and he'd sent me to get it.
My apples had been peeled before I even came downstairs.
I bit into another piece, and the satisfaction that followed was probably immature.
I didn't particularly care.
*****
By 7:14 a.m. I was angry.
I knew the time because I had checked the clock three times since opening Daniel's chart. The same line remained where it should not have been.
TRANSFERRED — 04:26
My fingers tapped the workstation in sets of four while I read the overnight notes again.
There was no explanation.
"Where is Daniel?" I asked the resident beside me.
She turned. "Morning, Dr. Astor."
"Where is he?"
The greeting died. "He was transferred overnight."
"The chart says that. Where?"
She hesitated long enough for another set of four.
"Neuropsychiatry."
The rhythm stopped. "Why?"
"He remained stable. No further generalized seizures, blood pressure improved enough to discontinue the norepinephrine, and psychiatry reassessed because the agitation and behavioral symptoms were still…"
"No."
Her mouth closed and I turned the monitor toward her.
"The behavioral changes preceded the seizures. EEG showed temporal slowing, MRI showed medial temporal abnormalities, antibody panel still pending. Which of those findings changed overnight?"
"None, but the overnight attending thought…"
"I'm not asking what he thought. I'm asking what changed clinically."
Her lips pressed together.
A metal tray crashed somewhere behind me, the sudden sound making my shoulders jerk. I pressed my thumb hard against the side of my index finger, but the noise had already broken whatever barrier had been keeping the rest of the ward at a distance.
The monitor down the corridor became impossible to ignore, voices crowded over one another near the nurses' station, and every pass of the printer behind me scraped against my concentration. I pressed my thumb harder against my finger and focused on the conversation instead.
"Who medically cleared him?" I asked.
"Dr. Patel."
"And Neurology?"
The resident hesitated. "They didn't clear him, but his seizures had stopped."
"That isn't the same thing."
The words came out sharper than I intended, drawing a glance from one of the nurses nearby. I lowered my voice before continuing.
"Visible seizure activity stopping does not mean the underlying process has resolved. Abrupt behavioral changes, abnormal investigations, vasopressor support yesterday. An improved blood pressure does not cancel the rest."
I opened yesterday's note. The plan was exactly as I'd written it.
Continue close neurological monitoring. Transfer only following neurology reassessment.
I turned the screen. "I documented that at 18:43 and someone acknowledged it at 19:06."
"I see that."
"So they read the recommendation and made a different decision."
She didn't answer.
I reached for the phone. "I'm transferring him back."
"Dr. Astor, you'll need to speak with…"
Her pager went off.
The sound made me tense, but the change in her face pushed everything else aside.
"What is it?"
She was already reaching for the hospital phone. "It's Daniel."
"What happened?"
She listened. "They can't wake him."
I was on my feet.
"Vitals?"
She followed me toward the elevators, relaying. "Ninety-two over fifty-four, heart rate fifty-one, saturation ninety-six."
"Respiratory rate?"
"Ten."
"Pupils?"
"Equal and reactive."
I pressed the elevator button and waited, watching the illuminated numbers above the doors as the car made its way toward us. It was already coming, but when the doors failed to open quickly enough, I pressed the button again despite knowing it wouldn't make a difference.
"Has he received anything since the transfer?"
Her steps faltered.
"What?"
"They medicated him for agitation at 5:12."
"With what?"
The doors opened and we stepped inside.
"Haloperidol. Five milligrams IM."
They had transferred a patient with an unresolved neurological condition because the obvious symptoms looked psychiatric, then treated those symptoms as if the findings had ceased to exist.
"When was he last responsive?"
"At 6:35. Drowsy, but the nurse could still get appropriate answers."
"And now?"
"No response to voice. Minimal to pain."
She lowered the phone. "Could the haloperidol have sedated him this much?"
"It could contribute. We're not deciding that's the explanation before anyone examines him."
Between floors the noise upstairs disappeared. There was only Daniel: the timing of the medication, declining consciousness, unresolved findings, every possibility we could miss by taking the easiest answer.
The doors opened. I headed into the corridor.
"Get continuous EEG ready and call Neurology down now. Repeat metabolic panel, CBC, blood gas, glucose, CK and lactate. Tell ICU we may need the bed again."
The resident kept pace. "You think he could be seizing?"
"I think we find out before we call it sedation."
A nurse was waiting outside the room. The urgency in the way she came toward us quickened my pace.
"He started doing something strange a few seconds ago."
"What?"
"Something with his mouth and his right hand. It keeps repeating."
I went straight in.
Daniel lay still enough that from the doorway he might have appeared asleep. At the bedside the movement was impossible to miss.
His right fingers curled inward, relaxed, then repeated a few seconds later. One corner of his mouth pulled faintly to the side.
"Daniel?"
No response.
I leaned closer, watching rather than touching as the same movements returned with almost identical timing.
"Get EEG in here now."
The nurse immediately reached for the phone while the resident moved closer to the bedside.
"Do you think it's another seizure?"
"Possibly focal. We confirm it before we assume."
Daniel's eyes opened.
Relief tried to rise within me, but his gaze didn't settle. He stared past me without focusing while his lips moved soundlessly.
I leaned closer. "Daniel, can you hear me?"
His mouth moved again.
This time the shape was unmistakable.
Help.