Enlarged + heart + child

WEDNESDAY IS DOG day. Or dog afternoon, to be more precise. In fact, it's really only a twenty-minute distraction, but when you have so little to cling to you take what you can get.

This week Shelly has Max, a quiet brown Labrador, and Annie has Lulu the poodle. Leone and Ruby have seen them both before, and it's depressing to count back and realise they've now been in ward 3C South for four dog days, which equals four weeks, which is close enough to a month – a length of time too long to countenance.

Ruby is sitting up next to her bed, cheeks still a high pink from the fever which is only just starting to abate, and she takes Leone's hand as soon as she notices Lulu just outside the ward entrance, pulling her down to sit, because Lulu is her favourite, and she wants Leone to stay and watch Lulu's tricks again, rather than going to get a cool drink from the fridge.

'Who's met Lulu before?' Annie asks, and Ruby is the only one in the ward to raise her hand.

The others are all new. Bed 4 came in last night and has complained continuously, shouting at her parents not to touch her, to get her food, no she doesn't want that, why can't she go home, why did this have to happen to her, why not someone else?

Ruby's eyes widen with each outburst, and she turns her head so that only Leone can see her mouth the words: She's got a broken arm, that's all.

Leone would like to tell the girl to shut the fuck up, but of course she doesn't, and each time Bed 4's mother apologises for her daughter's behaviour Leone is appropriately sympathetic.

Now, as Annie brings Lulu to the centre of the ward, Bed 4 tells her to stay away, she doesn't like dogs, keep her back, and her mother is once again saying how sorry she is, her daughter is just scared.

'She's only a little poodle,' she tries.

Bed 4 is having none of it. 'I don't want her near me.'

Bed 1, opposite Ruby, has been lying flat on her back since she came up from surgery two days ago. Cerebral palsy and an operation on her knees to try and keep her out of a wheelchair. Her dad sits by her side, doing the crossword, rousing his daughter from her morphine haze to see the dogs.

'She does tricks,' Ruby explains about Lulu, more to the father than Bed 1 because Bed 1 has not yet been able to lift her head and talk.

He is the joking type and he ruffles his daughter's hair. 'Tricks, hey?' He raises an eyebrow. 'Can she read and write?'

Ruby shakes her head.

'Not interested, then.' He smiles and folds the paper.

Bed 2 is empty and Bed 3 has the curtains drawn. This morning there were social workers with her, and their talk was hushed but still loud enough to catch certain words. An overdose. Second attempt.

There is weariness in the mother's voice each time her daughter begs to be allowed to go home.

'You hate me,' the daughter cries, her voice surprisingly loud. 'You don't want me to come back.'

Ruby listens to it all, the drama both disturbing and better than any of the young-adult books she has been trying to read in between bouts of fever.

Lulu the poodle waits patiently in the middle of the ward for Max to do his rounds. Max has no tricks – he is just a gentle Labrador, with soft eyes and a thick chocolate-brown coat. He wags his tail, back sunk low as he makes his way over to where Ruby waits, eager to run her hands through his fur. She reaches out, her arm long and thin, the veins blue against the white of her skin, and sinks her fingers into the warmth of his coat. Max rests his head in her lap, and Ruby breathes in deeply.

Leone kneels by her side.

'He's beautiful, isn't he?' Leone whispers, not quite trusting herself to talk.

Ruby can only nod.

Every day for the past four weeks, Leone or Jacob has texted photos of Ruby's dog to her. Harry is large and hairy, ridiculous in the outfits that they dress him in for the daily shoot. Jacob even borrowed a child's stethoscope and sent in a picture of Dr Harry. Leone has draped pink cloth over his head, transforming him into Nurse Harry. On other days they leave him just as he is and label their messages Harry In The Raw.

They have plotted sneaking him into the hospital car park and getting Ruby down there, but she always shakes her head, scared he will knock her over in his enthusiasm or pull her cannula out.

'I'll wait,' she tells them.


WHEN THE GP first told them that Ruby had an enlarged heart, Leone did what she knew she shouldn't. She went straight home and googled enlarged + heart + child. The results were alarming.

The next day the diagnosis was made by the specialist. Pericarditis, or the collection of excessive fluid between the two walls that surround the chambers. They were shown pictures of Ruby's heart on a computer screen. Leone held her breath as she watched it beat beautifully, a regular pulsing as it pumped blood, the valve opening and closing, opening and closing, with a steady rhythm. The doctor examined it from each angle, capturing shots every few seconds. There were times when the heart looked like a gorilla's nose, Leone thought, black and wet, the nostrils breathing in and out.

The doctor pointed out the fluid, and the fibrous strands that had collected, like jellyfish tentacles. The walls had thickened. He told them it was surprising the function appeared perfectly normal.

'The danger is the movement of the heart will be constricted,' he explained. 'And that's why we need to operate.'

'I must have a very strong heart,' Ruby said after he left.

Leone could only nod.

That night she was wheeled into theatre. Jacob stayed with her as she went under. Leone couldn't face it.

He joined Leone in the small waiting room off intensive care soon after, his face pale. 'It was like watching her die,' he said.

She held his hand as his shoulders heaved, and then he took a deep breath and together they waited.

The surgery went well. An hour later Ruby was brought into intensive care, bleary and complaining about the oxygen mask, her skin waxy, white-blond hair tangled around her face.

'I didn't feel a thing,' she told them, before lapsing once again into a deep sleep.


FOUR WEEKS LATER and they are still here.

Leone looks at Ruby, with Max's head resting in her lap, and she wonders how much longer they can bear this unexplained deterioration. When she washes Ruby in the shower she can see each bone, the skeletal frame delicate like a bird's, pressing against taut skin.

Everyone had thought Ruby would be heading home within a fortnight of surgery, but a week after the operation the fevers began. Two or three a day, each reaching forty or forty-one degrees, and no explanation to be found. There were teams of doctors, and they tested constantly – the wall of her heart, fluid from her lungs, blood from her veins, sputum and urine, all extracted and analysed. Her body never gave a clue.

'A fever can only last so long,' one of the nurses said, 'before another symptom appears.'

And so they continued to wait and see, not knowing what it was that they were waiting for, what they were expecting to see, while Ruby grew weaker, and the days of hospital routine ground the three of them down: splinters and grit, pieces that no longer held together.


MAX THE LABRADOR thumps his tail against the floor as Ruby scratches behind his ears.

'He likes you,' Shelly tells her, and Ruby smiles.

Shelly is a grey-haired, tough old woman who only has time for animals and children, and even that is limited. She lets Ruby pat Max a little longer and then, aware that the clock is ticking, she leads him over to Bed 1.

'Look, sweetheart.' The father tries to help his daughter raise herself slightly, but she can't.

Shelly offers to put Max up on the bed.

'Is he allowed?' Ruby asks Leone, in a very quiet whisper.

She shrugs and tells her that he must be.

Shelly lays a towel down and then taps the side of the bed. Max is up, his leap quick and light, and then he lies, long and soft, against the girl's body as she utters a small, and very drugged, laugh.

'Oh,' she croaks to her father, as she runs a hand down the softness of Max's fur.

And they leave him there as Lulu gets ready for her turn.

Annie is friendlier than Shelly. Small and spry with brilliant blue eyes, she enjoys showing Lulu off.

The curtains around Bed 3 are pulled back, and the mother sits perched on the edge of the mattress while her daughter lies behind her, curled into a ball. She doesn't even attempt to rouse her or encourage her to enjoy the show. She just stares blankly as Lulu begins to prance on her hind legs, delicate like a ballerina. Ridiculous, in fact.

'Now backwards,' Annie tells her, clicking her fingers, and Lulu is down on all fours, walking the wrong way, round and round in a circle.

'How does she know how to do that?' Ruby asks, as she asks every week.

Next is the skateboard trick, Ruby's favourite. She sits forward in the purple vinyl chair, and Leone brushes her daughter's lank hair back behind her ears. It's been a few days since she's been able to get her in the shower, the times between fevers are becoming shorter and she is always tired now.

'Can't I just sit?' Ruby usually asks, and most of the time Leone gives in, sponging her down with a wipe from the storeroom.

Annie puts a skateboard down on the floor and clicks her fingers again.

Bed 3 uncurls, long lean legs in tight jeans and an oversized T-shirt that does nothing to hide the smallness of her body. She tries to close the curtain, but her mother has it firm in her grasp.

'I want to shut it,' Bed 3 complains, her voice cracked and low but still loud enough for them all to hear.

Leone can see the white of the mother's knuckles as she clutches the nylon and mutters to her daughter. They will pull it off the railing, Leone thinks.

Lulu is on the board now, and she and Ruby and even Bed 4 (who has been surprisingly silent since she made it clear she didn't want a dog near her) are all staring at her, but they are also attuned to the conflict opposite, aware that the show could suddenly move to a different stage.

'Close it,' Bed 3 insists, while Lulu does her best, one leg down on the waxed lino floor, pushing herself along with perky dexterity – round and round she goes, but no one is really paying attention.

The mother does not move.

'I want to go home. I don't want to be here.'

Oh God, Leone thinks.

'Why won't you let me leave?'

Lulu shakes her head, the clasp on her collar tinkling slightly as she stands on her hind legs. The board wobbles, but she doesn't topple.

'I don't want to watch a poodle.' Bed 3's voice is louder now, more desperate, and they cannot pretend not to hear.

Leone tries to catch the mother's eye and grimace in sympathy, but the woman's gaze stays fixed on the floor.

Bed 3 swing her legs down and stands up, all bones, long blond hair hiding her face. Ruby reaches for Leone's hand, anxious now, her fingers frail and slightly sweaty, as Lulu lowers herself back on to all fours. She is waiting for the applause. There is none.

'I don't care about a fucking poodle.' Bed 3 takes her mother's shoulders in her hands, wanting her mother to look at her. 'Can't you hear me?' she wails. And then she leans close, right into her mother's face, shouting now. 'I don't care about a fucking poodle!'

It's all Leone can do not to join her, not to say, None of us care about a fucking poodle, all of us want to get out of here, God in heaven help us, but she just holds Ruby's hand tight and tells her it will be okay, it's nothing to worry about, really, nothing at all.

The male nurse comes in and takes Bed 3 by the arm, trying to calm her down, soothing her, as the mother walks out of the ward.

Annie packs up Lulu and the board, and Shelly clicks her fingers to Max, who leaps down, his job done.

Opposite, the father of Bed 1 looks up from his crossword, and shakes his head. His daughter reaches for her morphine button and he kisses her on the forehead.

'Think we could all do with a go of that,' he says.

Leone tries to smile.


LATER, IN THE EVENING, as Leone sits at home alone, she weeps. This is what she does most nights, sometimes as soon as she gets inside the front door to the emptiness of the house, a meal left by a friend on the kitchen table, everything clean and tidy, other times not until the depths of the night, when she wakes with a start, aware that her daughter and her partner are not there with her but are in a ward under fluorescent lights, the television on, Jacob sponging Ruby's forehead, cooling her in the hope she will sleep.

On the floor of the kitchen, Leone holds her knees to her chest and is terrified.

She no longer knows what to google: unexplained + fever, prolonged + temperature, post-operative +infections, pericarditis + complications? None of them will give her the answer she desperately wants to the question she hardly dares ask: will it be all right?

And so she cries, sick with fear, each nerve ending spliced and raw, the bile rising as she rocks backwards and forwards, weeping, unable to stop until Harry the dog slinks over, anxious and unsure of what to do.

He noses her, nudging and whimpering, forcing her to stretch her legs out in front of her. He is large, the size of an Alsatian, but he tries to curl up, smaller than Lulu, desperate to keep his entire body on her lap, and she holds him tight until she can breathe without sobbing, until she is still.

It is late and she hasn't sent through the picture to Ruby.

Wiping at her eyes, she stands slowly, exhausted. There is nothing immediately to hand, no outfit she can think of that will work, and she feels so very tired, but she knows Ruby likes the dress-up photographs best.

And then she sees it, Ruby's football scarf hanging on a hook in the kitchen, and in her room there is the jersey that she made Jacob buy her so long ago, in the time when she was well.

Harry the Brownlow medallist. She hangs a medal around his neck to complete the look and then texts the picture off. Ruby will like it, and tomorrow is Thursday, Leone realises, football day, when the players come to hand out plastic crap and have their photos taken with the sick kids. Not even vaguely entertaining the first time round – but she knows that when she goes into the ward in the morning she will tell Ruby that the Swans or Tigers or Eels are coming in today, and they will both try to be excited, grateful for the team bag and drink bottle, the autographs and teddy bears dressed in team colours. And then, as soon as the players leave, Leone will put all the junk in a bag, ready to bring home, where it will wait, unpacked, in the corner of Ruby's room.

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