Dr VC was an older man, with decades of experience, a mature face, and a kind, no-nonsense sort of manner. “C’mon then, Jen,” he said, “let’s go for a little stroll.”
They were back within moments. Jen was panting. Dr VC picked up the phone and made a call. “Yes, please, Sister,” he said. “An oximeter. Will you send someone up with it?”
The small blue and white oximeter was duly brought up from the hospital ward below his office. Dr VC placed it onto Jenna’s thumb and checked her oxygen (O2) saturation levels. Then they walked down the passage again, stopping every couple of paces so that he could check the levels. Dr VC didn’t look happy. “Jenna’s oxygen levels are dropping as she walks,” he said. I could hear from his voice this was significant, but I didn’t understand why. I would later find out that whether one walks up a hill, runs a marathon or takes part in the Olympics, one’s oxygen saturation levels (the levels of O2 present in your blood) will remain stable. Even when we get out of breath, our oxygen saturation levels will remain relatively the same. This was not the case with Jenna. It was not a good sign. It was serious.
Dr VC spoke gently but firmly and carefully. “So,” he said, “that test that we didn’t think was necessary last year? I am going to send you to do it now. It’s a sophisticated and expensive assessment, but the indication is that we should go ahead. In fact, we are definitely going ahead.”
“Now?” said Jen. “I have things to do before school tomorrow.”
“Yes, now,” he replied.
He picked up the phone again and called his colleague. “Right,” he said, turning towards us. “He will be ready for you in half an hour. It is just around the corner. I suggest you get something to eat and then go straight there. He will tell you what to do when he has the results. Okay, Jen?”
“Yes, Dr VC,” Jen said. Jen was no rebel, she would do exactly what the doctor suggested. So would I.
We chatted cheerfully in the car, relieved that at least something was being done to finally get to the bottom of this. “I can’t wait to see everyone at school, Mom, and hear everyone’s exchange stories. I’ve missed them all so much! Also, I want to do some past papers tomorrow, it’s been a whole term of no maths, and I’m a bit worried about that.”
“You’ll be fine, Jen,” I said, “I know you will. Rather rest and get completely ready for the term. There will be lots of time to catch up.”
We sat and shared a cheese and ham sandwich in reception while we waited, Jen scrolling through her phone.
“Jenna Lowe?” the technician called out.
“Here,” she said, smiling, putting her phone away instantly.
“Right, so I am going to have to give you a little injection before we can do the test,” he said. Jen was a co-operative patient.
“No problem,” she said, smiling brightly.
I was asked to wait in reception. I phoned Stuart. “She’s gone inside,” I said. “I’ll keep you updated.”
Fifteen minutes later Jen joined me. I looked at her quizzically. “And?”
“It was no big deal,” she said. We sat quietly together and waited for the results. Half an hour went past. I was not comfortable.
“Mrs Lowe? Are you Mrs Lowe?” The tone of the technician’s voice was far too caring. And he was looking straight at me, no longer making eye contact with Jen. “Um, here are the test results,” he said, adjusting his glasses as he handed me a large brown envelope. “I need you both to go straight back to Dr VC. I just spoke with him – he is expecting you.”
“What’s going on?” I said. “What did you find?”
He looked at Jen and then back at me. “Her ventilation perfusion is not normal,” he said.
“What does that mean?” I asked, confused.
“It looks as though there are clots in her lungs,” he said deadpan. He didn’t move. Neither did I. A weird feeling crawled up my spine.
“Clots?” I said carefully. “I don’t know what that means?”
“I’m sure the doctor will explain everything,” he said.
I took the envelope, took Jen’s hand and we walked to the car. Subdued, we drove back to Dr VC’s rooms. Inside, my mind was racing. Clots?! Why would a young girl have clots? What did this mean?
“So, Jen,” Dr VC said, looking at her directly, “your VQ scan shows multiple areas of ventilation perfusion mismatch indicative of multiple pulmonary emboli – blood clots – which would explain why you are finding it hard to breathe.” He took a deep breath and then said, “I need to hospitalise you for more tests and monitor you. You will go onto blood thinners immediately and then we will take it from there, okay?”
Hospital? Blood thinners? I thought only older people took blood thinners. Questions were racing through my head, but I forced myself to stay calm. I reached over and took Jen’s hand. She squeezed mine and then looked at him.
“Thank you, Dr VC,” she said, “but please can I go in on Saturday? I start school on Wednesday, and I really don’t want to miss any. Can we do the tests on Saturday?”
He talked slowly and deliberately. “No, Jenna, I’m sorry, there will be no delay. You and Mom are going to go straight back home, collect some pyjamas, a toothbrush and a few things, and I will meet you at the hospital in 20 minutes, okay?”
“Okay,” I said, taking over and gathering Jenna up. “Come, my love, let’s get you sorted.”
We drove home, stunned, and called Stu on the way. Within half an hour we were all at the hospital.
Kristi was calm and contained, chatting lightly to Jen and laying out her stuff for her while Jen lay tentatively under the crisp white hospital sheets. She set out Jen’s toiletries, moved a few chairs around and improved the room, and plugged in Jen’s cellphone charger and laptop. She kept Jen company while Stu and I met with Dr VC at a small table in the passage. I remember every mark on the wall, the uncomfortable chair, the body language and looks on the faces of visiting families. The foot rug was skew. Our meeting would be a long one so Stu phoned Ali. She came to sit with Jen and then take Kristi for supper. She did that a few times that week. Stuart and I were in shock. On auto-pilot. Dr VC was concerned. That was clear.
It was hard to leave Jen at the hospital that night. I wanted to stay. She looked so little in that blue gown. Stuart and I barely slept. I played the last three weeks over and over again in my mind. Images of the VQ scan haunted me. This was clearly something Dr VC had not seen before. He explained there could be many causes for the emboli, but for now all we knew was that Jenna was in trouble and she had to be monitored closely.
There were many more tests to come, but that night she started oral blood thinners. Warfarin, an anticoagulant, was originally intended as rat poison when, in 1983, scientists unexpectedly discovered its magical ability to thin the blood. How peculiar. As soon as we’d settled her into the ward the pathology lab technician took bloods.
“We are checking your INR,” she explained.
“What’s that?” asked Jen.
“It stands for Internationally Normalised Ratio, and is a measurement of how long it takes for your blood to coagulate. Mostly one’s INR level is at around 1.1. But the doctor wants yours at around 2.2, so we need to monitor you regularly. You will see me again tomorrow. Okay, Jenna?”
“Okay.” Jen smiled at her. She didn’t flinch as the needle went in. She wanted to make this poor woman’s job easier. It was the first of many ongoing blood tests.
Turns out it’s quite a thing to keep your INR levels stable. If your INR becomes too high, it greatly increases your risk of internal bleeding.