Marissa spent as much time as she could with Charlie, though he was doing a lot better than she was. She hadn't said anything to her parents, but her pain was worsening, despite the fact she was taking her medication as directed. She did not want to worry or upset them, so she only went to the house for meals, but she had no appetite and ate the minimum she could get away with.

Sunday, she started packing to go to Denver as she was flying out Tuesday morning. It had been decided, given recent events, that Gael and Irene would catch a red eye early Friday, in order to reduce the amount of time they would be away from the farm. Marissa had wanted to delay her surgery so she could be home during Charlie's entire convalescence but her parents talked her out of it, reminding her that she would not be able to travel for six to eight weeks after the operation, and she wanted to be home before Christmas. She had no idea how she was going to handle the flight with the amount of pain she was in.

Monday evening, Marissa did not heed the dinner bell when it rang. Gael went to the horse barn to retrieve her. He found her curled up on her side in Charlie's stall. The steer was lying beside her with his head resting on her shoulder. He seemed to know something was wrong with his owner. Gael knelt down beside his daughter. “Rissa, are you coming for supper?” he asked.

“No, Daddy.”

“Are you sick, honey?” He put his hand on her forehead. It was warm.

“Sort of.”

“In pain?” She nodded her head. “Bad?” She nodded again. “When did you last take your pills?”

“A couple hours ago.” She had been keeping the vial with her in the barn so she wouldn't have to go back to the house to get the medication.

“I'm calling Brent.” Gael had his phone out and pulled up his contact list. “Brent?” he asked when his friend and family physician answered. “It's Marissa. She's in a lot of pain, she's on the floor of her steer's stall, curled up, and she's a bit warm to the touch.”

“Has she taken her pain meds?” the doctor asked.

“A couple hours ago. Oh God, she just threw up. What should I do, Brent?” Gael was getting a bit frantic with worry over his daughter, who had been through so much and still had a lot ahead of her.

“Get her to the hospital in Edson”, Brent replied. “Take her to the ER. I'll meet you there.”

Gael bent down and picked Marissa up. “I'm taking you to the hospital, Rissa. Geez, baby, you are light as a feather. You need to get some weight on you.”

“No, Daddy. No hospital. I have to go to Denver tomorrow.”

“I doubt that you'll be flying anywhere tomorrow, honey. I'll call Gideon from the hospital and let him know.” He was already halfway to the house, walking as fast as he dared without risking dropping his daughter. When he got there, he banged on the door with his foot. After a moment, Patsy opened it. Gael entered the porch. “I'm taking Rissa to the hospital on the advice of Brent Evans. Can you tell your mother?”

“What happened, Daddy?” Patsy asked with concern.

“She's in too much pain and she's throwing up.”

“I need my purse”, Marissa said. “It has my insurance card in it.”

“Where is it?” Patsy asked.

“In my room.”

“I'll get it.” She took off at a run, telling Irene as she went through the kitchen that her father was taking her sister to the hospital. Irene dropped what she was doing and went to the door, but Gael had already gone to the car. She yelled up the stairs for Patsy to get her purse from the master bedroom and that she'd be in the car.

Out at the car, Gael had put Marissa in the backseat. Irene ran up and told him she was coming, too. “I didn't think you'd stay home”, he said to her as she got in the back with Marissa. She sat in the middle of the seat so her daughter could lean on her. While they waited for Patsy, he told his wife what was going on. As soon as Patsy put the purses in the front seat, he drove off after telling her “I know you and Vicky can take care of the house. We'll call you when we know something.”

Gael prayed he would not encounter a cop on the way to the hospital. He went as fast as he dared - fortunately, traffic was almost non existent after sundown out there in the country. “My crutches!” Marissa cried from the backseat.

“You won't need them”, Gael told her. “We'll get them there if Brent admits you.”

At the hospital, he pulled up to the ER entrance. “Wait here”, he directed as he got out of the car. A security guard met him at the door. “I need a wheelchair for my daughter”, he said. “She can't walk right now.” The guard got him a chair and he took it out to the car. He got Marissa into it and Irene pushed her through the ER door as Gael parked the car in a patient parking spot.

Brent was waiting for them. “Come this way”, he said and led them to a bay. “We'll get you registered after I've looked at you, Marissa. Let's get you onto the bed.” Once she was lying down, he said he'd get a gown for her to change into. “Can you help her, Irene? Or do you need a nurse?”

“I can do it, Brent.”

Brent talked to Gael out in the waiting area while Irene helped Marissa into her gown. Gael told him of the events of a couple nights ago. “I don't know if that has anything to do with her pain or not”, he finished. “She will barely leave her steer's side.”

“Stress can certainly make pain worse, but I would think it would have happened sooner. Or do you think she's been hiding it from you?”

“She was so focused on what was going on that night that if she were in any amount of pain, she wouldn't have shown it. But she has seemed fine since - until tonight. Is there something else that it could be?”

“I'm concerned that a stone has got stuck in her ureter”, Brent replied. “The ureter is the tube that carries urine from the kidney, where it's produced, to the bladder. Extreme pain in someone with stones is a classic symptom of a blockage.”

“What can you do for that?” Gael asked, worry showing in his voice.

“There are a few procedures to choose from, depending on the size and shape of the stone - if that is what is going on. Don't worry, it can be taken care of.”

Brent entered Marissa's bay. A nurse had been by to get her vitals. His patient was lying on her side, her face in a grimace. “Hi Marissa, can you show me where the pain is?” Irene joined her husband outside the bay to give her and Brent some privacy while he examined her.

“It's in my back right here.” She pointed to her mid back.

Brent felt around the area and she yelped when he hit the painful area. “Sorry, sweetie, does the pain go down here?” He touched her lower back. She nodded. “Is it constant or does it come and go?”

“It comes and goes but it's more coming right now.”

“Any nausea or vomitting?” Once again, she nodded her head.

“Which or both?”

“Both. I've been throwing up but please don't tell my parents, they are worried enough about me.”

“I can't tell them anything you don't want me to, Marissa, but I think you should be honest with them. Haven't they noticed?”

“No, I've been in Charlie's stall most of the time and I've been cleaning it up so they wouldn't see.”

“Your dad told me about what happened the other night. I'm glad that Charlie is going to be okay.”

“Me, too.”

“I'd like to listen to your heart and lungs, okay?” She nodded her consent. When he was finished, he said “Marissa, I'm concerned that you might have a stone stuck in the tube that carries urine from your kidney to your bladder. I'm going to get the portable ultrasound machine and do a scan.”

“What happens if it is?”

“We can do a procedure to break the stone up and then it will pass without any problem. I'm also concerned that you have a bit of a fever. You could have an infection starting in that kidney.” He went to get the ultrasound machine. He set it up and scanned Marissa's kidney and bladder. “It looks like that is the case”, he said as he packed the machine back up. “I'm going to send you downstairs for a CT scan to find out exactly how big it is and we'll go from there. But first, I will give you some pain medication. You don't have any drug allergies, do you?”

“No.”

“I didn't think so. I'll be back in a few minutes.”

Gael and Irene came into the bay while they waited. Irene sat in the chair beside the bed and Gael stood. “I'm sorry to be such a pain in your butts”, Marissa apologized.

“You aren't, honey”, Irene replied. “We just want you to get better.”

“That's right, Rissa. We want you to be healthy - and alive.” Gael was choking up. He hated seeing his daughter in such pain and he knew his wife did, too.

Porters soon came to take Marissa for her CT scan. While she was gone, Brent called the 24/7 number for her insurance company to get authorization for a procedure to break up the stone. The agent he spoke with, Carlo Vega, was reluctant to approve it given that Marissa was having the kidney removed. Dr Maynard had already obtained authorization for that. “The surgery for the nephrectomy is scheduled for Friday. Can it wait until then?”

“No, it cannot. I know she's having the kidney out, but she needs this procedure *now*, as in tonight. Or maybe we could just do the nephrectomy here instead of her going to Denver.”

“I can't authorize that. The patient is out of the country so all I can approve is what is needed right now at the lowest cost.”

“Then please approve the procedure I'm asking for. If the blockage is not cleared, Ms Brennan will go septic and die.”

“Can she get to Denver to have it done?”

“No, she *cannot* travel with the amount of pain she is having. Unless you will pay for a med flight.” He knew they wouldn't as that was very expensive.

“Is there a cheaper procedure that will tide her over until the nephrectomy?

Brent was getting frustrated. “We could do a nephrostomy but she will need to be on pain medication.”

“I will approve the nephrostomy.” It wasn't what Brent wanted, but it was better than nothing. He understood the insurance company's position - the ureter would be removed in the nephrectomy so why pay for an obstruction to be cleared if it could be avoided. They were in it to make money and if they didn't make money, they wouldn't exist. Had the agent denied coverage, the hospital would still have done the nephrostomy as Marissa's life was in danger without it. It would not do a more expensive procedure on a patient without insurance to cover it. However, getting it approved by her insurance company meant that the hospital would get paid without Marissa's family paying. Though he knew they would be good for it, he did not want them to incur another bill if it could be helped. They had enough with the loan they'd had to take out for their security system.

When Marissa came up from the imaging department, Brent checked the computer for the results of her CT. The stone in her ureter was fairly large. He doubted a lithotripsy - the use of sound waves to break it up - would have worked. Maybe this was the way to go. He'd consult with Gideon Maynard after talking to Marissa and her parents.

Gael and Irene were in Marissa's bay. “We have the results, and they confirm that a stone has made it's way into Marissa's ureter and got stuck there”, Brent told them. We are going to do a procedure called 'nephrostomy'. That means we will put a tube into your kidney, Marissa, which will drain off the urine that can't get past the stone. We'll leave the tube in until you have the nephrectomy in Denver. We'll attach a bag to it to collect the urine and tape it to your thigh, just like if you had a catheter and we'll show you how to empty and change the bag. I'm going to go call Dr Maynard and let him know what's going on and see if he agrees that this is doable.”

After Brent left the bay, Marissa said “I want to go home as soon as they are finished.”

“That will be up to Brent, honey”, Irene replied. “He may want to keep you here.”

“I want to go home and see Charlie”, she whined.

“You aren't sleeping in the barn tonight, Rissa”, Gael said in a stern tone.

“Oh, Daddy, I have to! Charlie is going back in his pasture tomorrow.”

“I think Charlie can stay in the barn one more night, so you can sleep out there tomorrow night if Brent says it's okay, honey”, Irene suggested, not wanting to see her husband and daughter fighting. It was a rare occurrence, but when it happened, it could get bad very quickly.

“Can I come in or will I get my head bit off? Brent poked his head through the curtain around Marissa's bed.

“That depends on what you have to say”, she replied irritably.

“Maybe you can settle this dispute, Brent”, Gael said. “Rissa wants to sleep in her steer's stall tonight.”

“Absolutely not!” the physician exclaimed.

“Marissa has been practically living out there”, Irene broke in. “She slept in the barn last night and she's insisting on doing it again tonight.”

“Marissa, not tonight and I'll tell you why”, he said, reading the defiant look on her face. He sat down on her bed. Normally, he would not do this with a patient, but the Brennans were like family.

“You have to be very careful as you don't want to get an infection around the nephrostomy tube. Sleeping in Charlie's stall could result in bacteria getting in - as you know, cattle are not the cleanest of animals.”

“His stall is being kept clean”, Marissa assured him. Gael had told her that he told Brent about what had happened a couple nights ago. “Daddy and my brothers are taking turns and cleaning out the manure a few times a day and putting more clean straw down. He has to be kept clean so germs don't get in his wounds.”

“That may be, but a barn is still not a clean place. I'd rather you not be out there until you come home from Denver. I talked to Dr Maynard and he's going to reschedule your surgery for next week. He'll be in touch with you to let you know when.”

“You mean I have to pee into a bag for over a week?” Marissa asked incredulously.

“It's not quite peeing into a bag since the tube is not in your urethra, but yes, you need to collect urine from your kidney for a week. If you don't and it stays in your kidney, you could go septic and die. We don't want that to happen. I think you may already have an infection there, for which I will give you antibiotics.”

“Do I have to stay here, Brent?” she asked, hoping the answer would be 'no'.

“Only for a few hours after the procedure, just to make sure you are all right. Then you can go home. The interventional radiologist is on her way in, so it shouldn't be too long before they take you down.”

“Thank you, but Brent, there is no way I can be at home for a week without seeing Charlie, especially since I will be gone for at least six weeks. I'm sorry, I just can't do it.”

“I know what he means to you, sweetie. You can see him outside, but not in the barn, okay?” Marissa's eyes lit up. “But you stay out of his pasture.”

“I rarely go into it anyway, Charlie jumps the fence and we visit beside the pasture.”

“Good. I was prepared for a big fight - you surprised me.” Brent was relieved at how easy that was.

“I'm going to be sick,” Brent picked up the emesis basin on her table and held it for her.

When she was finished, he got her a glass of water to rinse her mouth out and a wet facecloth to clean her face. “Don't swallow any of that water”, he instructed.

“I'm thirsty.”

“Sorry, Marissa. You'll be under anesthesia so you can't have anything by mouth until after the procedure. I'm going to go see if Dr Yang is here yet.” He left the bay with a promise to be back as soon as he found out.

“I'm sorry, Mama and Daddy, I've been such a pain to you”, Marissa apologized once more. “And here I am, being a pain again.”

“As we said earlier, you aren't a pain, honey”, Irene replied. “We love you and we just want you to be well and happy.”

Gael sat in the spot on the bed Brent had vacated. “That's right, Rissa. We will do anything for you.”

They chatted a bit while waiting for news on Marissa's procedure. Finally, Brent was back with a nurse, who was to start an IV for the anesthesia. She approached her left side. “Could you put that in my right hand, please?” Marissa asked. “I'm left handed.”

“Sure”, the nurse replied.

When the porters came to take her down to Imaging for the nephrostomy, Brent said good night. “I'm sorry I can't stay to take care of you, I have to get some sleep before my office opens in the morning. You are in good hands with Dr Flores, she's working the ER alone tonight. I'll come out to see you in a couple days, okay?”

“Thank you, Brent. You didn't have to stay this long.”

“It was no trouble, Goober”, he said with a wink, using Bill's pet name for her.

Marissa started to drift off to sleep, her parents quietly at her side, but she was woken by her phone. It was Gideon Maynard. “Hi, Dr Maynard”, she said when she answered.

“Hi Marissa. I've been apprised of your situation. I'm sorry that we have to postpone removing that kidney.”

“It's okay, I am glad that I will be able to stay on the farm while Charlie recovers.”

“What happened to Charlie?” Gideon asked with alarm. He had a bit of a soft spot for Marissa's steer and he knew how much the animal meant to her.

“He got shot”, Marissa answered. “He's going to be okay, though.” She told him what had happened.

“I'm glad he wasn't hurt worse, but gunshot wounds are quite painful, even when the bullet goes right through. Do you give pain medication to cattle?”

“Oh, yes, he's on banamine. It also reduces inflammation. It's working well, he's eating fine and that is almost always a sign that the animal is better or okay.”

“Just like with humans.” Marissa chuckled. “I'll let you go, good luck with the nephrostomy - I'll call you later. Call or text me if you need anything.”

Porters came shortly to take Marissa for her procedure. Her parents were allowed to go downstairs with her, but they had to wait in a waiting area outside the room.

Dr Yang came in and introduced herself before the nurses got her turned over on her front. Then she was put under anesthesia.

A few hours later, the Brennans were on their way home with instructions on how to care for Marissa's nephrostomy and antibiotics to treat her infection. Patsy was a nurse, so she would help. Marissa was still feeling the effects of the anesthesia, but she wanted to see Charlie. “You can't go to him right now, Rissa”, Gael said as he parked the car. “but he can come to you. I'll be back in a couple minutes.”

Marissa's father returned with her steer. She opened her door and Charlie came up to her, lowering his head for pets and ear scratches. “Oh, Charlie, I'm sorry I couldn't stay with you last night”, she apologized. Charlie sensed there was something different about his human and zeroed in on the nephrostomy tube, sniffing her sweater where it was located. Irene was not impressed.

“Don't let him near your tube, honey”, she said. “you don't want the site to get infected or the tube dislodged”.

“He's not hurting it, Mama. He's just curious.”

Gael let them visit for a few minutes, then told Charlie to go to his babies. It was time for him to be back in his pasture. A couple minutes later, they could hear the happy moos of the reunion. “Ok, Rissa, let's get you into the house and to bed”, he said to her as he lifted her out of the car and carried her to the house.

Ten minutes later, Marissa was sound asleep.