62. TESSA
TESSA
“It came back positive?” My voice trembled with disbelief.
“See for yourself.” Blake handed me the results, his eyes bright.
For over a year, not a single test had shown anything. Not one. I stared at the paper in my hands, the letters blurring as tears threatened.
“Oh my God,” I whispered. “What does it mean?”
We sat in Blake’s office at the hospital. Well, I sat. Blake was too anxious to stay still, wearing a path in the floor as he paced. It was strange, seeing him like this. The usually composed Dr. Morrison was practically vibrating with barely contained energy.
“This is why I wanted my colleague, Dr. Benjamin Hayes, to join us,” Blake said, gesturing to the other doctor. “He’s an expert in this particular area.”
Dr. Hayes leaned forward in his chair, his manner gentle but direct. “Tessa, you recall we took your latest round of blood two weeks ago?”
After the dinner party.
I nodded, my heart hammering against my ribs.
“And then we followed that up with a urine test to confirm our suspicion.”
“Right,” I said, placing the paper down so I could twist my fingers on my lap. “But no one told me why because they didn’t want to get my hopes up.” Especially since I’d been feeling downright lousy lately.
“That initial blood test showed an elevated level of tryptase.”
“Tryptase?” The word felt foreign on my tongue. “No doctor has ever mentioned tryptase to me before.”
Dr. Hayes smiled slightly and nodded. “It’s not something doctors typically test for unless they’re specifically looking for it.
When that test came back elevated, we followed it up with a urine test, looking for 11-beta-prostaglandin F2α, prostaglandin D2, and leukotriene E4. They’re specific markers.”
He started to list off some complicated medical terms, but Blake cleared his throat gently when he saw the confused look on my face.
“Right, sorry.” Dr. Hayes softened his approach. “Tessa, after all the tests we’ve run, with these positive markers, we finally have some answers. You have something called mast cell activation syndrome, or MCAS. It’s a rare and complex disorder, and I want to walk you through what that means.”
The words hit me like a tornado. I hadn’t been overreacting. There was something wrong with my body. This was real.
My vision blurred more as additional tears welled up.
“Mast cell activation syndrome?” My voice cracked. “I’ve never heard of that, not even in all my hours of research, trying to self-diagnose on Google.”
Dr. Hayes remained patient, his smile gentle. I glanced at Blake, catching the relief cascading through his shoulders, the slight upturn of his lips. Whatever this was, it must not be fatal then. The knot in my chest loosened slightly.
“Your body has immune cells called mast cells that are supposed to help fight infections and respond to injuries,” Dr. Hayes explained.
“They release chemicals like histamine, prostaglandins, and leukotrienes to protect you. But in MCAS, these cells become overly sensitive. They activate when they shouldn’t and release too many compounds, causing a cascade of symptoms all over your body, even when there’s no real threat. ”
“Symptoms like mine?” The question tumbled out before I could stop it.
This felt too good to be true. Tears spilled down my cheeks before I even knew what this meant.
For crying out loud, I should wait to feel this elated until he confirmed I shouldn’t go pick out a coffin during my afternoon errands.
Dr. Hayes nodded. “Mast cells live throughout your body, but they’re concentrated in your GI tract, your lungs, and your skin. Symptoms vary with patients because of that. They can mimic allergies, autoimmune disorders, or even anxiety too.”
“But you’re confident I have this?” I pressed, hardly daring to breathe.
“I am.”
A sob caught in my throat. “Why didn’t anyone else diagnose it? I’ve seen so many doctors over the last year, and none of them even mentioned this as a possibility.”
“MCAS is notoriously difficult to diagnose,” Dr. Hayes explained. “One of the biggest reasons is that its symptoms can overlap with other conditions, sending doctors chasing the wrong illness.”
I glanced between Blake and Dr. Hayes.
“So, why did you guys figure it out?” They exchanged an amused look, and I rushed to clarify, “I didn’t mean that like it sounded. I just meant … why now? Why did you test for this?”
Blake stopped pacing, running a hand through his hair. “Remember that dinner party a couple of weeks ago, when I noticed that red mark on your arm? I noticed you sniffling?”
“Yeah, you were worried I had been crying.”
Something softened in Blake’s expression.
“That’s exactly it. I noticed because I was worried about you.
” He paused, seeming to wrestle with something.
“The sniffling, the allergies, the hives, the gastrointestinal issues, the fatigue … I remembered a conference presentation about MCAS last year. Something clicked, and when it did, I called Dr. Hayes.”
My heart squeezed. This was the Iceman, who normally kept his distance from everyone. The only reason he’d figured this out was by allowing himself to become emotionally invested.
#Irony
“So, what does this mean?” I asked, my voice small. “Is it terminal? Curable?”
Dr. Hayes shook his head. “It’s not terminal.
MCAS can’t be cured, but it can be managed.
The goal is to stabilize your mast cells and block the chemicals they release through antihistamines, H2 blockers to reduce the histamine in your stomach, mast cell stabilizers, and potentially Leukotriene Inhibitors to block inflammatory chemicals.
Now, the trick with mast cells it that something is triggering them.
It can be triggered by all sorts of everyday things: allergies, certain foods, fragrances, even mild illnesses.
Our first step is to get your current flare under control.
Then we’ll work on identifying what specific triggers are causing these reactions.
Once we understand those patterns, we can look at tapering down your medications, potentially using them only when you experience flares. ”
I nodded.
“We’ll monitor your symptoms and adjust your medications as needed.”
“You’re positive I have this?” I repeated.
“I am.”
“And you think this is why I got sick a year ago?”
“What I’ve typically seen with cases like this is that there is some inciting trigger in your body.
Typically, that is a virus or bacteria that activates your mast cells.
It’s likely you had an infection over a year ago, and that’s what started all this.
And once your mast cells were angry, for lack of a better word, they have been misbehaving ever since. ”
Yes. I was sick with that flu/lung thing right before this all started.
“Do you have any questions?”
“Probably,” I admitted. “Not that I can think of right now; to be honest, this is a lot to digest.”
After Dr. Hayes left, promising to send in prescriptions and schedule a follow-up, I sat there in stunned silence. Blake moved to sit across from me, his eyes intent on my face.
“I didn’t realize how much I’d given up until now.
” My voice paused on account of thick emotions strangling it.
“After everything … I convinced myself that freedom meant accepting I’d never get answers.
” I swallowed hard. “But avoiding my health—that wasn’t freedom.
Getting this answer, facing it head-on …
that’s the only way I’d have ever been free.
” And now, at long last, I had it. I smiled.
“You have no idea what this feels like.”
“I don’t,” Blake said softly. “But I want to. Please try to describe it to me.”
I eyed him curiously. “Why?”
“First of all, anything to do with you, I want to understand completely. Understanding what you’re going through helps me support you better.”
My heart stumbled in my chest. How did he manage to say exactly the right thing with such simple sincerity?
“You said, ‘first of all,’ which means there’s something else?”
He scrubbed his jaw, settling more deeply into his chair. “I suppose the doctor in me needs to hear this too.”
“Really? From what Ryker always told me, you keep an emotional distance from your patients and their cases.”
So, why would the medical professional in him wonder what this feels like emotionally ?
Blake was quiet for a long moment, his eyes distant. When he finally spoke, his voice was raw with honesty. He told me about the teenage patient he’d lost, about how his belief that it was his emotions that resulted in her death that shaped his approach to medicine.
“But I only found this diagnosis because I let myself care. That night, it wasn’t medical training that made me notice your sniffling; it was the thought of you crying alone that kept me listening.
All these years, I’ve been fighting against the very thing that led me to the answer.
” He scratched his temple. “Makes me wonder if maybe I got it wrong. If caring isn’t a liability at all, but something that makes me see what the tests and textbooks might miss. ”
I could see the change in him in the softening of his features.
“Please,” he said finally, his eyes finding mine, “tell me what this feels like for you.”
I took a deep breath, running a hand through my hair. “I think I’m in shock.” Behind that shock was a tsunami of emotions. I could feel it pricking the back of my eyes with tears, constricting my throat, making my chest ache as I replayed the last year of my life.
“It’s weird,” I continued, my voice wavering. “You’d think right now, all I would feel is elation. And I do. God, I do. I finally have a diagnosis, a treatment plan. I finally have hope that I’ll feel better.”
My hands twisted together in my lap. “But there are so many people out there right now who are suffering, being told by the medical community that nothing’s wrong with them. My heart breaks for them.”
Blake leaned forward, his elbows on his knees, waiting for me to continue.
“You know, after my experience, I’ve come to believe there’s a bell curve of doctors. The vast majority are good, doing their best. But there’s a small percentage that give everyone else a bad name, and when you meet those doctors …” My voice cracked. “It’s soul-crushing.”
Blake’s hand found mine, his thumb tracing circles on my palm.
“Most people are incredibly busy,” I continued.
“If someone’s going out of their way to set up appointments with doctors, it means something’s wrong.
They’re reaching out for help. If the doctor doesn’t have the answer, that’s okay.
What’s not okay is tossing them around like a hot potato with no follow-up.
What’s not okay is implying, or downright telling them, that there’s nothing wrong with them, that it’s all in their head. ”
Blake’s entire body stiffened. “Someone said that to you?”
I nodded, the memory sharp as glass. “Six minutes. That’s how long I was in his exam room.
He spent the first minute telling me all my tests were normal, that he found no physical evidence of my symptoms. He spent the next five minutes telling me it was all in my head, that he thought I had psychological issues, in the most patronizing, condescending tone imaginable. ”
Blake’s jaw hardened, his eyes midnight dark. “What was his name?”
“I’m not telling you this so you can avenge my honor.
” I wiped a tear. “I’m telling you this because as a doctor, you need to hear what some patients go through before they land in your emergency room.
A lot of patients are fighting a war with their bodies, with the medical system, with medical professionals who make them feel hopeless or like their concerns aren’t valid.
” My voice dropped to barely above a whisper.
“And when enough people don’t believe you, it starts to take its toll.
There’s nothing more isolating than having the very people who’ve taken an oath to protect you be the ones who hurt you. ”
Blake’s shoulders rose with a deep, angry breath.
“You start to wonder if maybe it is all in your head. And you go through your days, getting sicker and sicker, those words echoing in your mind: that you’re doing this to yourself.
” The tears were flowing freely now. “I spent over 365 days in this battle, and there were times when I’d lay my head down at night, alone in my bed, sobbing, wondering if I could cope with another day of it. ”
I wiped my cheeks with my free hand. “By the time I landed in your emergency room, I had decided to give up fighting for answers. Not because I wasn’t a fighter, but because I couldn’t take it anymore.
I needed to get off that roller coaster.
It seemed no one believed I was sick anyway.
But thankfully, you encouraged me to keep going.
One last time. And now, it’s finally over. ”
Blake stood, pulling me up with him and into his arms. I pressed my face into his chest, breathing in the familiar scent of him.
“Thank you,” I whispered against his shirt. “For giving me my life back.”
His arms tightened around me, and I felt him press a kiss to the top of my head. We stood there in silence, the weight of the past year finally beginning to lift, replaced by something light, something beautiful.
If only it could have lasted.