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This is an AU based on Casey's accident in 2.10 Not Like This. I'm not a medical professional but the topic is one that I'm very interested in. I have tried my best to make sure the medical side of this story is realistic. I hope you enjoy it as much as I do.
Salvage
Relief had spread through the room after being told the firehouse would not be closing down. The celebrations died down and Shay announced, "Guys, on that happy note Dawson has an announcement to make."
"I do?" Dawson questioned a little uncertainly but she knew exactly what Shay was talking about. She'd not told Casey that she was going ahead with her plan for certain. She'd not done as he'd suggested and got some more information about what it would be like to be a female firefighter, but she had never really intended to. She had her heart set on the idea as soon as she had received the letter through the mail.
"Yeah you do," Shay encouraged.
"Erm..." she began a little cautiously before announcing, "Today I found out that I was officially accepted to the fire academy, to become a firefighter." She didn't miss the look of disappointment on Casey's face. She should have talked it through with him again, she should have taken his advice.
"You'll make a great firefighter, Dawson," Mouch said, and the others added on their thoughts whilst Casey stood with disappointment and perhaps a little annoyance etched across his face. He and Dawson were a couple and it felt like she was doing this without even taking his opinion into account. He tried to wipe the discontent from his features but failed. He carefully slipped out of the room and headed to his quarters without saying anything.
Dawson followed quickly in pursuit despite his stealthy exit. "Matt?" she called after him. He stopped before he could reach his office.
He turned around. "What happened to taking some time to think about it?" He was annoyed she hadn't taken his advice on board, it wasn't as if he didn't know what he was talking about, he'd been with the CFD for over ten years now.
"What? You don't support me on this?" she replied defensively.
"No, I do," he said honestly. Hesitantly he continued, "I just thought, as I suggested, that you talk to some other people, consider all your options."
Stubbornly she responded, "Well, this is happening."
"I can see that," he replied, disappointed that his opinion didn't matter even though they were supposed to be in a relationship together.
The alarms went off and interrupted their conversation. "Truck 81, Squad 3, Ambulance 61, Engine 51, Battalion 25; Apartment fire, 5021 Quincy..."
"You ok, bud?" Severide questioned as he and Casey pulled on their turnout pants and grabbed their jackets.
"Fine," Casey replied stiffly before getting into his truck, leaving Severide to make a mental note to question him again after the call.
The apartment building was already engulfed in flames when fire crews arrived on the scene; Casey jumped out the truck and got to work immediately. "Herrmann with me. We're taking the top floor."
"We'll start right below you," Severide stated and both truck and squad crews entered the apartment.
"How we lookin' in there?" Boden called through the radio.
"It's rollin' Chief," Severide replied.
"Engine 51 looks like we're losing. Hold it back a little longer 'til we clear the building. Then we're gonna back out and go defensive," Boden said to the awaiting engine crew as he watched the building from the outside.
In the building they were searching for victims. "Watch those stairs! Herrmann stay with me," Casey called out as they headed up to the next floor.
"Count on it," Herrmann replied, he followed his lieutenant.
"Truck 81 I need an update," Boden called through the radio.
Casey grabbed his radio. "Chief, we're halfway through the fourth floor. Still more to search."
"Squad 3 coming out!" Casey heard Severide's voice through the radio.
"All right I'm calling it," Boden spoke to those surrounding him before giving his orders into the radio. "Evacuate the building. Evacuate the building right now!"
"Copy, on our way," Casey replied promptly.
Just as the two members of Truck 81 were about to head down the stairs Casey heard something that made him turn, there was a woman crawling towards them, the two of them went straight over to her and heard her crying out. "My baby! Please my baby! Please help me! My baby! She's in her crib!"
"Where?" Casey asked frantically knowing there was little time left.
"She's in the back bedroom," she coughed out.
"Get her out of here," Casey ordered Herrmann. "I'm going after the baby."
"No, Casey! You take her! I'll get the kid!" he argued through the roar of the flames, knowing there was barely time to get themselves out.
"Herrmann, you have a family! I'll get the baby! That's an order!" he yelled through his mask.
"Lieutenant, no! Casey!"
But his lieutenant had already left in search of the baby; Herrmann grabbed the woman and made his way to the exit.
Casey found the room and had to kick down the door to get through to the baby in the crib. He picked her up carefully. "Hold on sweetie," he said soothingly amongst the noise of the fire and buckling building. "Hold on. I've got you." He opened up the top of his turnout jacket and gently put her inside before turning around to see his only exit was engulfed in fire, he steadied himself before quickly running through hoping the rest of the corridor wasn't immersed in flames. Thankfully it wasn't so he continued quickly towards the stairs, he doubted they would remain upright for much longer.
"Casey, I need an update," Boden demanded through the radio.
"Almost there," he replied as he reached the top of the stairs. They were surrounded by flames so he charged down. He felt relieved when he could just about see the light of the exit. As he headed to the open door the stairs gave way behind him and parts of the ceiling began cascading down around him. He looked up just as a large beam came crashing down.
Boden watched as smoke and debris shot out of the front exit and windows. "Structural collapse! Mayday! Help Casey! Help Casey!" He ran towards the building with Severide and several other squad members.
Severide knelt down in front of the building to put his mask on, his heart was pounding, once his mask was on he walked into the building. "Casey?" he called out, he could hear his PASS alarm blaring and the baby crying. His heart felt like it would burst through his chest at any moment.
"Severide, here!" Boden called out from ahead.
"Oh God..." he muttered as he saw Casey through the smoke. The impact of the beam had knocked his helmet clean off and forced him to the ground. He now lay wedged and trapped beneath it. Severide's immediate worry was that the beam holding him in place rested all its weight on his fallen friend, but after a quick glance he saw that one side was being supported higher than the other with the help of the fallen stairs. It wasn't crushing Casey.
"You two, grab that side, we'll take this side. Severide, slide him out when we lift it up!" Boden ordered. Severide took hold of Casey ready to pull him out as the others lifted the beam. "And lift!" Boden commanded.
Severide pulled Casey free from underneath the beam as carefully as he could. Casey was still unconscious when Boden took the baby out of his turnout jacket. Severide couldn't rouse him before the four of them carried him out of the building and onto the waiting gurney. They had slipped off his mask and oxygen tank, blood was dripping sickeningly down his face but Severide couldn't see any lacerations through the thick substance and mattered blond hair. He jumped into the back of the ambulance with Dawson whilst Shay got into the front and drove off.
In the ambulance they quickly took the rest of his gear off, opening his turnout jacket and cutting through his tops to check for injuries. There was blood everywhere but they hadn't found its source. Dawson slipped an oxygen mask over his head, stuck ECG sensors onto his bloody chest, inserted an IV cannula into the top of his hand for quick access, and placed a pulse oximeter on his finger before examining him further.
"Oh God..." Dawson pulled her hands back from his head, they were slick with blood. "Shay, call in and tell them we have a severe TBI incoming!"
"Dawson!" Severide called as he saw Casey's eyes flicker. He leant closer over him. "Case? Buddy?"
Casey's flicked open once again and a small whimper escaped his lips.
"You're going to be ok," he said but Casey's eyes closed and a resounding alarm went off.
"His O2 stats are dropping, I'm going to intubate," she said and she began rapid sequence intubation. She injected the Lidocaine into the cannula at the top of his hand to supress his cough reflex in a matter of seconds. She then grabbed another syringe, continuing the intubation process. She positioned the endotracheal tube and inserted it, she checked its location before attaching the ambu-bag. The whole process took only a few moments and quickly Casey's lungs were being manually ventilated, and his oxygen stats rose as Dawson squeezed the bag.
At the hospital Casey was whisked away to the awaiting neurosurgeon and team of doctors and nurses, leaving Severide standing in the entranceway staring at the path his friends gurney had just taken. Shay walked up to him and gently spoke, "Kelly? Come on, we can't do anything now let's…" She was interrupted.
One of the doctors walked up to them. "We're taking him straight up to the OR, you should contact any family," he said sternly.
"Wait, wait..." Severide called out as the doctor began to walk away. "What do you mean? What's wrong? I'm family," he spoke hurriedly.
"It's a crush injury, he has a depressed skull fracture, they need to act fast and salvage what they can. Someone will inform you when we know more," the doctor told him and before Severide could question him further he was called away by another member of staff.
"Salvage?" he repeated, his breath caught in his throat, his heart was racing and his stomach tightened. "Oh God… But he woke up… in the ambo he woke up… he looked at me… salvage?"
"Kelly, come on, we're in the way here," Shay spoke softly to him and took his arm.
"Shay?" his voice shook.
She looked up into his eyes that were brimming with tears and spoke firmly, "He's just as stubborn as you are, Kelly."
Whilst Severide, Shay and Dawson made their way to the waiting room Casey was being prepped for surgery to save his life. He had a crushing head injury. His skull had a depressed fracture and the force of the beam had further fragmented the bone; several small pieces of his skull had penetrated his brain. Casey was firmly secured to the table, his hair was shaved away, the wound site was cleaned and Mannitol was administered to maintain intracranial pressure. During the length of the surgery his oxygen levels, heart rate, anaesthesia, ICP, and GSC score would be constantly monitored. The surgeon began by making a horseshoe shaped incision over the depression. Once the incision was made he elevated the fragments and carefully retracted the pieces that had penetrated his brain before repairing the dura. The bony fragments were soaked in antibiotic solution before reassembled; the larger pieces had to be wired together. The surgery would take hours.
Boden and the rest of 51 arrived at the hospital to discover Severide pacing around the waiting room and Shay sat worriedly with her head in her hands. "What do we know?" he asked.
Severide just shook his head and Boden looked towards Shay.
"They rushed him to surgery when we got here, he's in there now; that's all we really know," she replied.
Boden nodded. "Where's Dawson?"
"Calling his mom and sister," Shay replied.
Half way through Casey's surgery they were updated, and Shay finally managed to convince Severide to take off his turnout jacket and sit down with the others.
Casey was taken into the ICU after the surgeon closed the incision with staples, it was messy but quick and Casey had already been in surgery for most of the night. The wound was covered in a thick white gauze with a tensor bandage wrapped around his head, securing it and the ICP monitor in place. The surgery had gone well but there was now the risk of an intracranial hematoma and blood clots developing, so along with the usual immediate postoperative care these were kept in mind by all the staff working with him. Casey's GSC score of nine when he had been admitted had dropped to a dangerously low seven and the surgeon went to inform his family and friends.
"Family and friends of Matthew Casey?" he questioned as he walked into the waiting room, he discovered at least nine firefighters who all stood up immediately upon hearing his patients name. "The surgery went as well as expected, I managed to remove the fragmented pieces of bone, elevate the fracture and repair it. There was enough bone to fix it together with wire rather than use a metal plate. However he was barely responsive before the surgery and he's now slipped into a coma, I'm sorry."
Severide frowned. "You're sorry? He's not dead."
"The likelihood of waking from the coma with no permanent damage after a severe brain injury isn't unlikely, it's impossible, the damage is too severe…"
"But he will wake up?" Severide questioned.
"The next twenty-four hours are critical, we're hoping to know more soon," the doctor explained.
"Hoping?" Severide repeated.
"Every brain injury is different but he's alive; there is brain activity but he's not responding to any stimulus at the moment," he tried to reassure them all. Casey's pupils were unreactive to light because of his depressed brainstem reflexes, and except for some reflex movements there was no response to painful stimuli.
"When he wakes up…" Severide began, he was now stood next to the doctor, mostly out of earshot from the others.
The doctor interjected, "I'm afraid it's an if, not a when."
"You don't know him; it's a when," Severide stated with determination. "When he wakes what will happen?"
"We salvaged as much as we could during the surgery but it was difficult; fragments of his skull had broken off and infiltrated both the frontal and temporal lobes," the doctor explained. The frontal lobe involved motor skills, emotions, memory, problem solving, language and social behaviour. Damage to which could cause concentration and executive function difficulties, memory impairment, personality changes and communication problems. Damage to the temporal lobe also suggested there could be an impaired ability to comprehend language, and an inability to pay attention to what he saw or heard.
"Salvaged?" Severide questioned worriedly. This was the second time a doctor had used the word and in had no positive connotations in regards to injury.
"There will be no return to his previous self, but there may be some function," the doctor explained bluntly.
"Some function... What do you mean?"
"Walking, talking, thinking, remembering and understanding," the doctor listed. "Some of them, maybe even all of them may be effected. Like I said, brain injuries are tricky to evaluate, we'll know more if he wakes up."
It was now Severide realised he was glad Casey hadn't decided upon no extraordinary measures, because what the doctors had done to keep him alive certainly was extraordinary, but what if he didn't wake up? What if he was in a permanently vegetative state? Who would make his decisions for him? He'd not updated his next of kin since Hallie had died, and so far they'd not managed to contact his mom. He assumed his sister would be the one making the decisions if his mom wasn't reached, and he only hoped she'd make the right decisions. He shook his head as his morbid thoughts. Casey would make it through this.
"Can we see him?" Severide asked the doctor hopefully.
"One on one visits only. A nurse will come and inform you when you can go in, it won't be too long," the doctor replied. "His family?" he turned and questioned all those there for Casey.
"His sister will be here in a few hours," Boden, who had kept quiet out of concern previously, spoke up and explained.
"Let her know I'm available for any questions she has," the doctor said curtly and left the members of House 51 to comprehend the news they had just received. Shay had her arm around Dawson who was crying, and Severide had the urge to tell her that he wasn't dead yet, but everyone seemed to be acting like he was.
Soon Severide was able to enter the ICU to see Casey. The nurse had warned him but he still wasn't prepared to see Casey lying so still and pale surrounded by so many different monitors and attached to so many different tubes and wires. A ventilator provided much needed oxygen, there were numerous intravenous lines delivering medication and fluid. There was an arterial line measuring his blood pressure, ECG electrodes on his chest were monitoring his heart rate, a pulse oximeter on his finger measuring the amount of oxygen in his system, a catheter to relieve his bladder, and an ICP monitor that indicated the amount of pressure in his brain through a small hole in his skull. Severide could already tell by the lack of hair sticking out from under the bandage that they had been forced to shave all his friends blond hair, the skin around his eyes was bruised and sunken; he looked so small and fragile surrounded by all the equipment, almost unrecognisable.
"Can he hear me?" he questioned quietly.
The nurse nodded. "Talk to him."
Severide moved closer. "Hey, Case..." he began brightly but then he didn't really know what to say, he sighed and his gaze remained fixed on Casey's closed eyes, he could hear the sound of the ventilator and the constant noise of the heartrate monitor, it all seemed so unreal, like he had stepped into a nightmare.
"Just talk to him like you normally would, sometimes patients wake from comas and can remember their family and friends being around," the nurse said softly.
He nodded and began again. "You're an idiot but that baby, she's gonna be fine, and her mom, they'll both be home in a couple of days. You've got everyone worried about you, I know you don't like that, so you should hurry up and wake up, I mean, even I'm worried and that's not good for my reputation, right?"
A few hours later Christie arrived and spoke to the doctor before visiting her brother in the ICU. Meanwhile Severide was sitting in the waiting room, praying for the twenty-four hours of critical time to hurry in hope of good news. But as he was waiting he was researching brain injuries and comas using the internet on his phone, it did very little to raise his hopes. Dawson was on the phone to her brother, explaining what had happened to Casey and on a lighter note how she'd decided to go for the firefighting training, but the tone changed when she became concerned about how she would need to help Casey when he woke, then all of a sudden she was distraught.
Severide was tired of Dawson's melodramatics, he put down his phone. "Do you know how likely it is that someone will wake up from a coma? And even then not be in some sort of vegetative state? So quit worrying about what he's going to be like when he wakes up! This isn't about you, so stop being so selfish, all our thoughts need to be praying that there aren't any complications and that he will wake up!"
TBC