"You're in a good mood," Jon said, entering the kitchen. He'd discarded his tie, white coat, and briefcase, and crossed to the drawer where he kept his glucose monitor. He glanced over to where Kai stood, one hand braced on the counter, adding various spices to a bowl. "I take it the study session went well?"
Kai glanced over his shoulder and grinned.
"That good, huh?" Jon pricked his finger with the lancet and squeezed some blood onto the test strip. "Is she going to help you pass history, or just sex ed?" Jon chuckled.
Kai stopped what he was doing, both hands gripping the counter now. He took a deep breath before turning his head enough to look at Jon. "Speaking of good moods . . . ?" He raised an eyebrow.
Jon held his meter in one hand, waiting for the reading. He couldn't help smiling. "I think I have a date."
"That's great," Kai said, his voice clipped. Supporting himself with one hand on the countertop, he reached for a mixing spoon. Jon heard Kai’s breath hitch, saw his forearm tense. "Wait. What do you mean 'you think'?" Jon listened carefully to Kai’s voice, but it seemed normal enough, watching as his brother stirred everything together, coating the chickpeas with spices.
Jon noticed the oven was preheating and Kai had set a cookie sheet on the stove top. He put his meter back in the drawer and grabbed the foil, gesturing with it. Kai nodded, so he began covering it as he spoke.
"Vicky asked me to go to a party with her."
"Vicky. As in, pulm section office manager, Vicky?"
Jon nodded, a slight blush pinking his cheeks.
Jon was surprised when Kai merely smiled, rather than laughing. "I always thought she had a thing for you. Poor woman." Kai accepted the tray from his brother and sprayed it with Pam. Jon observed Kai moved stiffly, cautiously, despite his joviality.
"Funny. Can I do something?"
As soon as Kai set the cookie sheet back on the stovetop, he resumed his earlier posture, gripping the counter, shoulders tensed. Jon’s eyes scanned down, surprised to see Kai's right leg bent at the knee. Kai rarely favored his left leg, and alarm flags that Jon had struggled to suppress began to fly.
"Yeah. I'm making chickpea tacos." Kai’s knuckles whitened, his sentences clipped. "If you want . . . to chop . . . some lettuce . . . and tomatoes . . ."
Jon resisted the urge to say anything, shuffling to the fridge and grabbing the produce. "It's a costume party, if you can believe it."
This time, Kai laughed a controlled chuckle and released his deathgrip on the counter. Maybe he was just tired, Jon reasoned, watching as Kai spooned the legumes onto the cookie sheet.
"Now that I can't wait to see. You should go as a pill. It'd be fitting on many levels."
"And aren't you a comedian." Jon shook the lettuce off in the sink, water dripping. Then he grabbed a cutting board. "Hand me a knife?"
Kai again braced himself with one hand on the counter while he stretched to pull a knife from the block. He grimaced, paused, before handing the knife to his brother.
"You OK?" Jon took it, but focused on Kai, who was trying to keep his face neutral and not succeeding very well. Jon could see Kai's hands clenched on the counter's edge.
Kai's head was bowed, his eyes tightly shut. He took a few slow, careful breaths. "I’m fine," Kai said through clenched teeth, but his grip grew tighter, and he didn’t open his eyes. He tried to shift his weight; looked for a moment like he was going to lose his balance, let out a muffled, indistinct sound before taking a few more cautious breaths.
Jon set the knife down. "Kai, you’re not fine."
Kai didn’t answer immediately. He was holding himself as still as he could, although he wavered slightly, his forearms tensing. Finally, he shook his head.
Jon set the knife down. "Spasms?"
Kai sucked in a breath, lifted his head. A slight nod. "I . . ." Kai's voice cut off. Jon could see his brother had shifted so he leaned even more heavily on the counter, as if he were trying to bear as much of his weight as possible with his upper body. His right knee remained partially bent, his foot pointed. Jon couldn't tell, but he suspected Kai's right posterior thigh and calf muscles were spasming.
Kai’s face contorted, his jaw tensing. Despite his best efforts, quiet grunts escaped his lips. Either the pain had lasted long enough it was chipping away his defenses, or the spasms were getting worse.
"Kai, I can finish this, if . . ."
Kai finally looked at Jon, his eyes wide, his face pale and strained. "I thought . . ." He paused, took a few quick, shallow breaths. ". . . I could work through it."
Jon glanced at the tray of their half-prepped dinner and realized Kai had hoped to beat the pain by keeping busy; obviously, he’d misjudged the severity of the attack. "Kai--"
"Jon," Kai said suddenly through gritted teeth. "I need to take my braces off, now." Kai’s previously steady voice broke. His face was flushed, sweat standing out on his forehead. "My left hamstrings feel like they're trying to rip off the bone." Pain colored his words, his breathing labored.
Kai kept his left brace locked. If his hamstrings were spasming severely enough--trying to bend his knee--the orthotic could break, or the muscles or tendon could tear. And because Kai's right was also spasming, unlocking the left would make it impossible for Kai to stay upright.
"I'll get your chair."
Oh, fuck, he hurt. This wasn't a mild attack, or even a moderate one. All the stress of the past few days had built up. Kai had to get off his feet, had to unlock his left knee. Carefully, he lowered himself to the floor, the muscles in his feet and calves twitching. Immediately, he reached over to release the lock on his left brace, his leg pulling up, knee bent, as if the lock had been a spring under pressure and all the energy released at once. Kai bit back a scream, sweat breaking out on his forehead.
Kai's body, from his mid back to his toes, hurt, pain flaring up as a muscle would spasm, sometimes relaxing and giving him a moment's relief. Mostly they'd stayed taunt, as if the various muscle fibers were competing to see who could tense the most and longest. Like some twisted, painful variation on a staring contest. Although Jon was likely only gone a minute or two, the waiting was literal agony, and Kai hated that he had to rely on his brother. It was partially his own fault, he knew; the early warning signs of an attack had been there all afternoon, but he'd ignored them. And now he was paying for it.
He clenched his teeth as the spasms in the back of both legs intensified. Hoping for some relief, Kai worked his left hand under his left thigh, pressing up, struggling to rub away some of the pain through the denim of his jeans and the leather backing of his brace. A pulling pain in his right knee distracted him. Already, it seemed, his quads were battling with his hamstrings, straining the tendons and ligaments of his knee joint. It felt like his kneecap was going to rip off, the muscles around his knee tensing to their limit, then partially relaxing, before tensing again. Each time, the contractions grew worse: tighter, holding longer, the reprieves shorter.
Jon reappeared, pushing Kai's chair. "I brought your MR," Jon said, frowning at Kai's position on the floor, offering him some pills.
"Already did," Kai said, leaning his head back against the cabinet, not wanting to say more.
Jon nodded, shoved the pills in his pocket. Without another word, Jon maneuvered Kai's wheelchair closer and set the brake.
Kai's glutes had joined the pain parade, making shifting from his current position even less appealing, But he desperately wanted to go to his room so he could take his braces off, try to massage the worst of the spasms away and hope the sedative effect of the meds kicked in and knocked him out before things got much worse.
"Looks like you had a better weekend than me," Diane said, dumping her bag on the floor and sinking into the couch with a groan. "Remind me again why I go home?"
Renee was still buzzing from her afternoon with Kai, eager to discuss it with her roomie, but she knew Diane had a love-hate relationship with her family, and often came back from her visits more stressed than when she'd left.
"You love them?" Renee attempted, curling up next to Diane and offering her a sideways hug.
Diane sank into the embrace, resting her head on Renee's shoulder. "So. Tell me why you're particularly effervescent this evening."
Renee giggled and shifted so she faced Diane, practically bouncing on her knees, her legs tucked under her. "He kissed me."
"What?" Diane sat up. "Hot blond? 'He's completely out of my league, but I'll moon over him anyway'? I thought you said he had a girlfriend."
Renee deflated. She'd managed to forget the phone call, focusing on the feel of his lips against hers, but Diane was right. "I think he does."
Diane's eyebrows dipped, growing angry. "So, what, he thinks you'll just give it up for him and be a nice piece of ass he can enjoy on the side? You said you weren't going to do the asshole guy thing again."
Renee sighed, but she smiled despite herself, fingertips touching her lips. "I don't think he is, though. I think . . . I don't know the whole story, but I think. . . ." Renee looked at Diane, trying to convey through her eyes what she couldn't seem to find words for. "When he kissed me . . . it was like I was the only woman in the world. It was . . . incredible."
Diane sighed. "So he's a good kisser. Probably has had lots of practice," Diane muttered.
Renee pouted. "I have a good feeling about Kai."
"And I bet you felt the same way about Jude when you first met him. Or that guy from freshman year, what was his name?"
"Mark," Renee said reluctantly. "This is different, though."
Diane pushed herself to her feet, yawning. "Think I'll crash." She bent for her bag. "Just . . . be careful, OK? I don't want you hurt because some dreamy player ensnared you in his web. And I don't care how big he is: I'll kick his ass if he uses you."
#Kai opened his eyes slowly, with a grunt. He lay on his right side, back to the wall, curled up in an almost fetal position. His legs refused to relax, and as consciousness returned, so did the pain, slamming into him like a freight train. He groaned again before he realized he wasn't alone. Jon sat in a chair beside Kai's bed, a medical journal open in his lap. His face was lined with worry and concern. As soon as Jon realized his brother was awake, he lay a cautious hand on Kai's arm.
"It's OK, Kai. I'm here."
Kai tried to reach down to his toes to hopefully stretch them out of the position in which they were locked, which felt like someone was trying to pull them off his body. It was as if an invisible hand held them in a firm grip, flexed up or down, and was straining with all its strength to rend flesh from bone. But Kai couldn't reach, not without bending, and his locked back and hip muscles wouldn't allow it. The little movement he could manage was dizzyingly painful, and after a few attempts, seeing stars, Kai had to give up. He struggled to breathe, not easy with his tight back, so he settled for short, quick, shallow breaths.
Kai felt Jon's hands on one foot, trying to work out some of the tension. When he spoke, his voice was apologetic. "I tried to massage out the hypertonia while you slept, but . . . I couldn't. Not without risking injury. I'm sorry. How bad is the pain?"
Kai didn't answer. He felt nauseated, whether from the pain, or the drugs, or an empty stomach, he wasn't sure. He had to remind himself to breathe, even though not doing so meant a slight reprieve from some of the pain. His eyes drifted closed. Jon stroked Kai's arm soothingly.
"I know it hurts, but you need to breathe," Jon said in a soft voice.
Kai concentrated on taking slow, deep breaths. Breathing this way was less painful than trying to breathe normally, and less risky than the near hyperventilation of earlier.
Jon sighed heavily and smoothed some of Kai's hair out of his face, where it had stuck, plastered with sweat. "It's only been two hours, and your breathing isn't great as-is. I can't risk it."
Kai forced his eyes open to meet his brother's gaze. Jon looked helpless and heartbroken, and Kai realized his brother had never seen his MLS this bad. It didn't often exacerbate this severely, thankfully, but Kai had been stressing about so much lately, it was honestly a miracle it hadn't happened sooner.
Kai said nothing. His hips ached all the way down to the bone, as if pain radiated up from the marrow, the tiny tendons and ligaments inside his pelvis stretched and angry. He took in as deep a breath as he could, braced his left hip with one hand, and pressed tentatively on his thigh.
He had to clench his teeth hard to stifle a scream. His leg wasn't going anywhere; Jon hadn't lied about that. Kai closed his eyes, concentrated on breathing through the pain that seemed to hum through his left leg. Two hours until he could have another dose. That seemed like an eternity. Reflexively, he moaned. Jon took his hand and squeezed it supportively.
"If the pain is . . ." Jon hesitated. "We could go to the hospital. They have more powerful muscle relaxants and analgesics, and they can give you respiratory support if you need it. . . ."
"You're such a doctor sometimes," Kai said, trying for levity, but pain leaked into his voice. The truth was, he wanted the pain to remit, for his muscles to relax, but he didn't want another trip to the ER. He didn't want to be intubated, either, which he knew they would do if they had to give him the strong, full-body paralytic muscle relaxants normally used for surgical anesthesia, the only meds that worked when his MLS got this bad. Although the reality was, once his muscles locked like this, only time and physically massaging them loose could do the trick. The main issue was pain. Could he wait until he could take another dose of meds that would knock him out? Could he bear the agony of trying to manually relax his muscles?
Kai opened his eyes and met his brother's frown, realizing his breathing had become irregular again.
"If you won't let me take you to the hospital, then I should call your neurologist."
Kai wanted to protest, but could see in Jon's face that his brother needed to do something. If calling would make Jon relax, then so be it. And it'd give Kai some time alone, hopefully, to try to stretch out anything he could bear to.
"OK. Help me sit up." Although Kai knew he could manage without Jon, it would make his brother feel useful and probably be less painful this way. "My back against the wall."
Kai took a few steadying breaths, then offered Jon his hand. Pushing with his right hand against the bed, and tugging his left through Jon's grip, Kai pulled himself into the semblance of a seated position, withholding a grunt as his back complained from the shift. His legs were still folded, but gravity pushed them down slightly, his hips screaming in complaint and making him pant with pain. Dizziness washed over him suddenly, and he had to use his hands to prop himself up. He clenched his eyes shut.
"Kai?" Jon said, alarmed.
Kai focused, calmed his breathing, tried to let his body relax into its new position as much as possible. Now that he was upright, he found himself clinging to consciousness, the pain in his back, hips, and legs threatening to overwhelm him. Nausea hovered in the back of his throat. He vaguely felt the mattress dip, and a hand stroking his arm.
"It'll be 'K, K," Jon said.
Kai let his head fall back against the wall and cautiously opened his eyes. He still felt off, but the pain had subsided enough that he was no longer on the brink of passing out. Jon's hand moved over his and he let his brother grip him supportively.
"Has it ever been this bad?" Jon's voice was a cracked whisper.
Kai focused on taking slow, regular breaths. "Yes. Not in a long time, but. . . . When I was in high school . . ." Kai hesitated. "It happened enough my neuro put me on Mexitil."
Jon squeezed Kai's hand, his brows furrowed. "Isn't that an antiarrhythmic?"
"Yeah, but it also works on skeletal muscle." Kai sighed, then groaned as the expansion of his chest tweaked his taunt back muscles. He managed to reach his right foot and start working his fingers on his toes, trying to relieve the tension there.
"Hmm. It decreases action potential duration, making it harder for the muscle to sustain the contraction. So your muscles relax more easily, and it's more difficult for myotonia to set in. Would prevent tetanization," Jon muttered to himself. "Did it work?"
Kai gritted his teeth as he managed to free his index toe from its locked state. "Yeah. Kept my legs from locking up like this." Kai hissed as he shifted to another toe, kneading the flesh of the base of his toes with his fingers, trying to loosen the taunt muscles.
"If it helped, why did you stop taking it?"
Kai sighed. "The side effects. I took it a couple years, then decided I’d rather deal with the pain." Kai closed his eyes, remembering. He’d gained twenty pounds after coming off the drug, because it had caused such severe nausea he’d barely been able to keep anything down. And he’d needed his crutches less, too, since he no longer had the dizziness and coordination problems the Mexitil caused. Or the constant juggling of his theophylline dose, which left him in a relentless swing between frequent respiratory attacks and the near-overdose that sent his heart racing terrifyingly in his chest. Kai smoothed his hand over his foot. Then he braced the ankle, using his other hand to bend the joint, cautiously stretching his tight calf muscles.
Kai found his muscles were beginning to relax as he spoke. They were still tight, and it'd take massage to fully relax everything, but maybe talking, distracting himself, had helped. Or maybe simply enough time had elapsed. Either way, he found he could stretch a little without screaming or passing out, and that was relieving enough.
Jon frowned deeply. "So if I call your neuro, he's going to suggest you go back on Mexitil."
Kai nodded. "If I start having episodes like this often, I'll consider it. But otherwise . . ." Kai carefully set his foot back down and let his head fall back against the wall, his eyes sliding shut. His pain level was still high, and he suddenly realized how exhausted he was. It'd been such a long time since he'd had a severe MLS attack, he'd forgotten that it was more draining than the most rigorous workout or PT session. Add to the fact that he was still recovering from the other night, and. . . .
The bed shifted again, and he felt Jon's hands on his left ankle. "Can I help?"
Kai nodded slowly. "Start with my right," he said, forcing out the words. The muscles of his left leg still felt strained, as if they were the strings on a guitar, over-tuned and threatening to snap.
Jon obeyed, cautiously stretching Kai's Achilles, trying to loosen the contracted muscle fibers in Kai's calf. "I'm sorry," Jon said as he worked.
"For what? Last time I checked, you didn’t make my muscles lock," Kai said, his voice strained. He forced his eyes open, hoping Jon would see the joke in them, even if he couldn’t seem to manage the effort to put it into his tone or expression.
"Just . . . for everything. For not always being there when you needed me." Jon’s voice was broken, sad.
Kai sighed, but it hitched from pain, and he forced himself to breathe out slowly. "Jon. I'm not going to say this again." He clenched his teeth, working his fingers into the back of his knee. "What happened with Jenny. . . . If you think focusing on your work--on me--is some kind of penance. . . ."
While Jon continued to work on Kai's right leg, Kai carefully kneaded the muscles of his left thigh.
"Go out with Vicky. Have fun with her. Or whomever. Just . . . be happy, Jon." Kai bit back a cry, his eyes beginning to fill as Jon managed to partially stretch Kai's full right leg, his knee remaining only partially bent. "For your own sake." Kai paused to take several shallow breaths. "If . . . when . . . I'm gone, I'd like to know you're happy."
Jon dropped Kai's leg so suddenly Kai screamed. "Sorry," Jon muttered quickly. "What do you mean, 'When I'm gone'?!"
Kai's head swam in dizziness, struggling to breathe. Tears escaped his eyes as he cradled his right leg, his hands seeking to soothe the overly stretched hamstrings. His vision darkened on its edges.
"Jon . . ." Kai's eyes shut, but he still felt like he was swaying, unconsciousness tugging at him. His hands fell away, his shoulders sagged, and he let the darkness take him.
"Fuck, Kai." Jon rushed to ease his brother's slumped form down on the bed, carefully arranging stiff legs. Jon had known the pain had to have been bad, could see and feel the severity of the contracted muscles, but Kai was even better at masking himself than Jon thought, if he'd lost consciousness.
"I'm sorry," Jon whispered, smoothing hair off Kai's face. He realized his brother's clothes were damp with sweat, even though Kai had changed only a couple hours earlier, when he'd removed his orthotics. Jon rose and crossed to the dresser, pulling out a fresh T-shirt and cotton drawstring pants.
Jon couldn't do much, and he hated feeling helpless or useless, but he could get Kai into fresh clothes, maybe stretch him. Hopefully, by the time Kai woke again, he'd feel better. If only marginally so, it was still something.
Carefully, Jon eased Kai's arms out of his shirt, getting it over his head and tossing it aside. Kai's breathing was low, but even. Jon's eyes were immediately drawn to two healing bruises and scabs on Kai's shoulders. He leaned forward to examine the marks. They had healed well, and were beginning to fade, the ring of scabs clearly indicative of a human bite. Jon frowned. He could imagine how Kai had gotten them.
Jon used Kai's dirty shirt to dry his skin, taking the opportunity to check the rest of his torso for marks. First, he noticed the bruising on Kai's left wrist, around the rubber band. Jon frowned. He scanned up the rest of Kai's arm, gasping when he saw another healing scab surrounded by bruising in the nook of Kai's left elbow. This mark was fresher than those on his neck. And it was a single scab, looking like it came from a needle, perhaps a 20 gauge.
Jon's stomach clenched, glancing up at Kai's sleeping face. There had to be a perfectly innocent explanation. Maybe Kai had had blood taken recently. Kai certainly didn't tell Jon everything. Maybe he'd had a follow-up with Dr. J or his nephrologist. That had to be it. Post transplant, Kai's life was filled with regular bloodwork, to check for infection, to monitor his kidney and liver function, and to make sure the dosage of his immunosuppressants was still satisfactory.
Still, Jon's stomach churned uneasily. He checked Kai's other arm, grateful to find it unmarred except for the faintest hint of bruising mid-forearm, probably from the cuff of his crutch. Jon pulled his fingers through his hair several times, feeling like his head was spinning. He still heard Kai's words echoing: when I'm gone. What had he meant by that?
Jon knew Kai's body could reject his lungs at any time, that he could develop an opportunistic infection, that five-year survival was 50%; ten, less than 30%. Kai knew this, too. It could be what he meant, but somehow, the way Kai had said it. . . .
Jon's eyes flew to Kai's scars, his fingers searching them for any sign of new wounds. The long line down his sternum, then the less obvious hemicircles below his pecs, then the smaller mark on his abdomen. None were fresh. Perhaps Jon was taking Kai's behavior and transferring his own history on his brother, seeing signs that weren't there.
Kai continued to sleep, so Jon gently slipped the new shirt on him, moving next to Kai's pants. He debated not disturbing Kai's legs, but felt he had to prove his fears unfounded by checking the scars on Kai's thighs. Carefully, slowly, he eased Kai's sweaty pants off, relieved Kai's muscles seemed to be relaxing. Jon might be able to stretch him at last.
Jon searched out the scars, mostly hidden by the light dusting of golden-brown hair that coated Kai's legs. Jon knew the best place to hide fresh cuts was in old scars, in places no one would see because clothing obscured them. Kai had explained that these marks--when Jon had first asked about them--came from a pair of ill-fitting braces when he was younger. Although Jon was relieved the skin wasn't freshly broken, he began to question the truth of Kai's story. Perhaps, growing up, Kai had found his own way of coping, a method Jon was all-too familiar with. Jon knew what that dark voice was like, how it didn’t respond to logic or reason. It threatened to overwhelm, with seemingly only one way to escape its haunting grasp.
Diagnosis wasn't much different than detective work. You took the clues you had and used them to arrive at your conclusion. It was part science, part skill, and part gut feeling. And although Jon knew he could explain away Kai's behavior, moodiness, and minor injuries individually, experience taught Jon coincidence was an illusion. If a patient came in with seemingly disparate signs and symptoms, it was possible they had several things wrong with them. But more likely, it meant one thing was at the root of it all.
For some time now, Jon's instinct had been screaming worrying thoughts about his brother. It had taken years for Jon to overcome his own demons; he still battled with guilt on a daily basis, but had managed to substitute work to satisfy the voice. Jon had kept truths from Kai about his own past, about their mother, deciding that sometimes, ignorance was bliss. But maybe it was time for Jon to confront Kai. To tell his brother the truth.
Dun dun dun!!! I might be taking a brief respite from the story. It can be a bit emotionally draining, and so much stuff has been going on in Kai's world I needed a bit of a break. But I promise I won't be gone too long!
Continue to September 8, 2000 - Part I ----->