Adjust
Waking
Christmas came and went whilst Casey remained in his coma. He received fewer and fewer visitors as the weeks passed by, but Severide's visits remained as regular as clockwork whilst the rest of 51, along with his sister, only flittered by every so often. Casey was now in his own room after being moved from the critical care setting of the ICU, he was breathing on his own and was no longer hooked up to the mechanical ventilator, but his respiration rate was still low so they used an oxygen mask to keep his levels up. He had lost weight but was receiving feeds through an NG tube and fluids. The white bandage that had been wrapped around his damaged head had been removed and replaced with a simple gauze over the incision sight, which was routinely checked for signs of infection. His hair was already growing back, Severide noted the fuzz of fresh blond hair, and his nurses kept him clean shaven and bathed him every day, one of the measures implemented to prevent any pressure sores. They charted his temperature, heartrate, oxygen levels and blood pressure every few hours, and changed his catheter bag when needed. A physical therapist worked with Casey to help preserve his muscle tone and mobility. The staff also worked tirelessly to prevent any systemic complications like pneumonia due to Casey's immobilisation.
"It's 2014 tomorrow, Casey. A whole new year so ya kinda got to wake up, yeah?" Severide quipped softly as he was sitting next to Casey's still form.
But Casey didn't wake up before the New Year and there was no miraculously awakening on the first day of the New Year either.
They received a call from the hospital whilst they were on shift. Severide had feared the worst. He feared that Casey had declined and there was now no hope. The news wasn't great but it wasn't bad either; Casey had woken but not to the extent that he was fully aware. There was spontaneous eye opening and he would visually track another person around his room. Casey was in a minimally conscious state. He seemed aware of his surroundings and he made eye contact to those around him, he would even weakly grip the doctors hand when instructed. When Severide arrived at the hospital after his shift was over he was told that it was good news because it was likely the MCS was a transitional phase. But there was no timeframe or guarantee of further improvement, but Severide insisted that he could tell that his friend was still there.
Dawson visited the next day, she spoke to Casey as if he weren't really there and as she left Severide watched a single tear fall. "Hey, don't do that." He wiped the tear away. "She'll be back, she's just worried, she doesn't know what to say," Severide tried to reassure him but it was difficult, he didn't know what his friend was thinking, he didn't know if Dawson would be back and he was petrified that this was going to be it for Casey.
He wanted to stay positive and enthusiastic around Casey as he seemed to be able to pay more attention then. Every so often he would completely switch off but his doctor said that it wasn't unusual. Severide had asked the doctor if there was anything he could do to contribute to a good recovery, to help Casey wake from this minimal conscious state, where only parts of his brain were awake and processing information but his answer had been inconclusive. It wasn't known whether any repetitive daily cognitive stimulation or other technique would help Casey's recovery at this point. So Severide would sit by his side as the doctor performed his tests each day and spoke to Casey as he normally would.
Casey had opened his eyes to a disorienting, bright and loud world. No one was there so he simply succumbed to sleep. Over the next forty-eight hours the world continued to disorientate him, he saw Severide on more than one occasion but he couldn't reply to anything he asked, the words seemed to get stuck and then he forgot what he was trying to say in the first place. He wondered where Dawson was, shouldn't she be here? Everything was confusing, there were too many people, he didn't recognise them, they asked him questions, told him to squeeze his hands or move some part of himself, he understood them but the instructions didn't seem to penetrate his damaged brain, he wanted to move but he couldn't, he wanted to speak but the words became lost and jumbled in his own mind before they even reached his lips.
Severide watched as Casey struggled to move, his actions were slow, jerky at times and they didn't always correlate to what he had been asked to do. He wondered if Casey was aware that his body wasn't cooperating or if his brain was so damaged that he simply didn't care, he wondered if there was little of the person he knew still left inside his head. Casey didn't even try to speak but the doctor wasn't as concerned as Severide, not yet because he knew this state should improve, he already had improved, he would track objects when asked just as he would naturally track people around his room. He had been in a coma for nearly four weeks, it was going to take time for his consciousness to improve, and then they would see what deficits he was left with from the injury and the operation.
In a few days time when Casey woke he felt much more aware of himself and of his surroundings. The world still seemed like a busy and disorientating place but he felt as if he was in it now rather than just a bystander.
A man greeted him and explained that he was a doctor. "Can you tell me your name?"
Casey desperately wanted to answer but found that the rest of his body seemed disconnected from his thoughts.
"Do you understand me?" he asked softly. The doctor would wait a few minutes before he repeated the question, but he had no need to repeat this time as he watched Casey nod. "Good," he smiled. "We'll nod for yes," the doctor demonstrated, "And shake for no. Ok?"
After a few moments Casey nodded in response. He understood the doctor but everything seemed to take a long time to reach his ears.
"You were in an accident," the doctor informed him. "Do you remember?"
Casey opened his lips to answer but no sound came out, he scrunched his face in frustration and shook his head.
"It's ok if you can't remember, and it's ok that you're not speaking. We're going to work on that," he smiled reassuringly. "You had emergency surgery and you've been in a coma for nearly a month," he explained simply and clearly. "You're on a heavy cocktail of drugs at the moment but we've starting reducing them, hopefully this will make everything feel less clouded. I'm going to ask you some questions and then I'll let you rest."
Casey struggled to concentrate on the doctor, but tried his best to do as he was asked. He squeezed the doctors hands, or at least he thought he did, as he looked down he saw his hands barely gripped the doctors, but the man seemed pleased with him nonetheless. Casey grew concerned when his feet didn't listen to his instructions, and when he began to ask questions with numbers Casey became frustrated, he didn't understand, he didn't know what was wanted so when he was asked to hold up three fingers he just shakily lifted his hand an inch from the bed.
The doctor swivelled the tabled over Casey's lap and placed down five cards. "These cards tell a story. Can you put them in the right order?"
Casey looked down at the cards, he looked at each individual card, they each had a picture, he understood what was happening in each of them but putting them in any sort of order seemed beyond him. He looked up at the doctor, he'd already forgotten what he was supposed to be doing, what were the cards doing in front of him?
"It's ok, there's no time limit, see if you can make a story with them," the doctor smiled.
Looking back down at the cards he wondered if moving them around would help him decide which order they went in. Slowly and stiffly he moved his right hand up to the table. He went to touch the card on the far right, but as he brought his hand down it went nowhere near his intended target, he frowned and tried again.
After three unsuccessful attempts the doctor decided to call it a day. "We'll do it again another time, you're tired but you've done really well." He removed the cards and moved the table before stating, "If you need anything; press this." He indicated to the call button above the bed controls.
Casey nodded in acknowledgement. The call button was small, and if Casey had been more lucid he may have wondered if he'd even be able to press something in such a confined area when he couldn't even place his hand on the card he had wanted.
The doctor was just about to leave the room he heard a barely audible sound, he turned round and Casey tried again, he felt like he was yelling the word inside his head before it finally came out once more. "Sev..."
"Kelly Severide?" the doctor question, the word had been strained and indistinct so he waited for Casey's response.
He nodded.
"He's at work. I'm sure he'll be here tomorrow," he replied. He showed Casey the bold red and white calendar which Severide had provided, they'd been marking off the days, and Casey nodded slowly again in understanding. He wanted to ask so many more questions; was anyone hurt? Where's Dawson? Why can't I say anything? Why can't I move? Why is everything so confusing? He didn't understand what had happened to him, he couldn't remember ever being like this before, he wanted to get up, go home, go to work, do everything he would normally do, why couldn't he? He was exhausted and his head ached. He looked over at the large print on the calendar; he saw so many big black crosses marking off the days, had he been here that long? Why was he here? The last thing he could remember was sitting in the common room at the firehouse.
Severide arrived at the hospital the next day, he'd been to the gym and popped over to Casey's house to fetch some personal items; photographs mainly. He discovered that other than a large collection of books Casey seemed to lack the types of knickknacks that he himself had managed to collect over the years that mind jog some sort of happy memories.
The nurse at the station greeted him with a smile. "Doctor Wright says that Matt asked for you yesterday."
"He did?" Severide beamed. "Is he awake now?"
"He was during my rounds a few minutes ago," she replied.
"Hey, Matt," he greeted as he entered Casey's room. It took a few moments for his friend to acknowledge him but when he did he smiled.
Casey watched as Severide made himself comfortable on the chair. "Sev..." he struggled to make it sound more than a breath of air, but Severide looked up expectantly. "Gabs…" he frowned and shook his head, he'd been practicing since he'd woken up and it still didn't sound right when it left his lips.
"It's ok, take your time," Severide stated when he saw the frustration flash across his friends face but Casey didn't try again. "Gabby?" Severide questioned. "She's at the academy today, I'll call her and let her know you're awake… I should have guessed about you two. How long?"
Casey just smiled a little in response.
"I thought you seemed happier than usual recently... but not happy when she told everyone about becoming a firefighter?"
Casey dropped the eye contact he'd been trying his hardest to maintain, he didn't know what Severide was talking about.
"She has been here, she's just busy," Severide explained. He wondered for a moment why Dawson hadn't been by his side much more now he'd found out they were seeing each other. He'd had his suspicions but Shay had kept her lips sealed on the subject and when the accident had happened he hadn't given it anymore thought. "Let's watch a movie, yeah?" he suggested before turning on the TV and flicking through the channels. He found an old movie they'd both seen before.
Casey's mind wondered from the movie, and by the time he found himself concentrating on the screen again he realised he had absolutely no idea what was happening. He soon let himself drift off to sleep.
Dawson was just about to head home when she saw a missed called from Severide, she called him back and was happy to hear that Casey was awake and talking. "How is he?" she asked hurriedly.
"He's… he's ok," Severide replied.
"Ok? What? What does that mean? You said he's talking?" she questioned.
"Yeah he is, he's just struggling with it, his doctor says he understands everything we're saying, he doesn't seem to think there's any problems with his long term memory, he doesn't remember the accident though," he replied.
"I'll come now, are you there now?" she asked.
"No, he's been asleep most the day, which they say is still normal," Severide explained.
"Do they say he's going to improve?" she asked with trepidation.
"Yes, no, maybe… There's no real answer but he has improved, so he should improve more. He's going to start seeing a load of different doctors, therapists and stuff, but right now just being awake is exhausting for him. Just go see him, there's only an hour or so left of visiting hours. He wants to see you," he implored.
Dawson had thought now that Casey was awake he'd seem more like himself, but he barely looked like the Casey she knew, like the man she'd been going out with for over a month. She watched him struggle to sit up, she felt pity as she watched him, a feeling she didn't think she'd ever have towards him, she took over and raised the bed slightly for him. He struggled to keep eye contact with her and then continued to struggle to say anything intelligible.
"I'm sorry that this happened," she said.
He looked confused.
"I... I don't know what to say... I'm sorry, Matt."
After a few moments he shook his head, he wanted to tell her that it was ok but he didn't even try, she seemed uncomfortable around him, he didn't understand why. He tried to moved his hand to comfort her but hit the side of the bed instead. She understood his attempt thought and took his hand in hers, careful of the IV cannula, and squeezed it comfortingly, she didn't know what else to do, this wasn't the man she knew. What if this was it for him? How could she have a meaningful relationship with him? She glanced at the time and excused herself, leaving Casey alone wondering when she'd come back because she had never said.
Over the next week Casey began to make progress with his speech therapist. The damage to the Wernicke's area of his brain caused his aphasia. For him it meant he had trouble finding the right word but his ability to speak was transient. At times he could be fully understood despite the odd misplacement of a word or two, and at other times he would struggle to pronounce even one word. It seemed to correlate with his level of fatigue. To his credit it was a deficit that didn't seem to frustrate him, he took it in his stride and continued after each mistake, and after only working with the speech therapist for a short time he was being understood and communicating much more clearly once again.
They found he'd lost the ability to write, Severide had joked by saying his own handwriting was finally better, but the sarcasm had gone straight over Casey's head so he ignored the comment. He struggled to hold the pen, his grip was weak and his movements sluggish, his intention had been to write his name but he looked puzzled to see that he'd only managed a few random lines on the paper. His strength improved with the help of a physical therapy, but his fine motor skills like writing and picking up small objects still eluded him.
He had started sitting up with no support and had been assisted in taking a few steps around his room, but his legs wouldn't cooperate with him and he asked to stop. Once activities became less tiring he would be taken down to the physical therapy suite and begin his physical rehabilitation, the doctors believed his speech would improve and the ability to walk would come back to him, they were less hopeful about his fine motor skills and strength but implemented a rehab programme to increase all of his skills.
Eventually they performed a neuropsychological test to clarify which cognitive abilities were impaired or preserved, it would help to predict how well he would respond to different forms of treatment or rehabilitation. Casey's examination took four hours and the psychologist had barely scratched the surface, but he knew he wouldn't for his first test. Casey was still sleeping most of the time and it was clear before the tests had begun that he struggled to concentrate, his gaze would wonder and he quickly lost track of what was being spoken about so questions had to be repeated more than once. He'd struggled mostly when sequencing like he had during the picture arrangement test when he'd first woken. His lack of executive function was most concerning for everyone around him, but Casey was not fazed by it even though the loss of executive function essentially meant the loss of his independence. Executive function skills were essential to formulate, plan and carry out plans effectively.
Severide arrived at the hospital after his shift had ended, he would usually stay for a few hours each day whilst Casey was awake. He tried to help Casey grab hold of a pen so he could attempt to write, because although what he wrote made little sense, he seemed to enjoy trying. He would try and copy words that had been written at the top of the page in big bold letters, he got closer each time he tried, but each day he tried he would be back at square one and would have to work his way back up.
Casey had just drifted off to sleep, an hour of concentrating had tired him, and Severide was clearing up the pens and paper when one of the nurses walked in to do the usual checks and then to help bathe him. As she went about her work she spoke to Severide, "You're a very good friend."
"If our roles were reversed I know he'd…" Severide began.
"Be with you whenever he was free," she smiled.
He nodded before sighing heavily. "God... he must feel so alone, so confused…"
"Maybe, he doesn't seem unhappy though," she responded.
"I hate to see him getting frustrated, I think he remembers how to do all this stuff but he can't do it now," Severide replied. Casey's lack of strength and coordination frustrated him the most, he didn't mind the inability to write anything intelligible, and his speech had improved enough that he could hold a short conversation if he wasn't tired.
"He's just frustrated because he thinks he should be able to do it, but those connections, those pathways in his brain; they're damaged now," she explained.
"And everyone he's seeing, they're helping to fix them? He's talking much more freely than before so everything else will start improving soon as well." Like everyone else Severide was concerned about his friends new attention deficits, his inability to organise and to remember things he had just been told.
Softly she said, "Once parts of the brain are damaged, when cells have died they don't come back, the brain has to find ways around it, new pathways if you like. The brain has to adjust."
"He's already getting better," he repeated.
"Yeah, but at some point that progress will stop, they can't improve his concentration, they can't magically make him understand how to make plans and carry them out but they will give him ways to adapt, to compensate," she replied.
"He's a firefighter, an officer, he commands men, how do I tell him he can't do that, that things will never be the same," he spoke worriedly, his friends life had completely changed.
"You don't have to, at the moment he's living right here in the present, he's not able to plan or think of consequences to any actions he takes," she replied gently.
"He can't go home? How's he going to look after himself? He's the most independent person I know. Why... why did this happen to him? He's not got a bad bone in his body…" Severide hadn't thought about it before but now he was concerned about who was going to look after him, to help him, for some reason he'd had it in his head that Casey would just get better and then get to go home but what if he never reached that stage in recovery.
"There are specialist facilities that…" she began.
"Care homes?" he scoffed. "No. Sometimes people get better, don't they? Like waking up from ten year long comas and being fine? He'll prove you all wrong, he will."
"Sev..." Casey was looking blearily towards him. "Home?" he questioned. He'd not heard much of the conversation but he could distinctly remember that word. Home meant not here where everyone kept asking him questions, making him say things and constantly testing him.
"Soon," Severide nodded assuredly.
Another week passed by. Shay was sitting on the end of Casey's bed, they were playing snap with the set of cards she had brought for him, or at least that's what it looked like from Severide's viewpoint by the doorway where he stood with Doctor Wright and Christie.
"What are you doing?" Severide asked after he walked into the room and saw the mess of cards on the table. He tried to hide his distress brought on by the conversation he'd just been apart of, Shay recognised Severide's mood immediately, but even if Casey weren't immersed in the card game he wouldn't have picked up on it, he'd been awake for two hours and that was usually the limit of his focus.
"Snap," Shay smiled. "With colours," she added. They were playing with an ordinary card pack. Matching the black and red cards. Severide made a note to get Casey a proper pack of cards for the game.
"Ah!" Severide now understood why Casey had been smiling happily away whilst he had been talking to his sister and doctor. He didn't understand the numbers and the shapes but he understood that red went with red and black went with black, it was an improvement, they would be impressed with it at his next neuro exam; he was sequencing. "Snap with colours is my favourite, can I join?"
Casey looked up but didn't say anything before looking back down at his pile of cards. Shay watched as he froze, he became distracted easily and she had to keep reminding him to pick a card up and look at its colour. His concentration was worse when he was tired so she decided to end the game. "You and Kelly can play later. You should rest now."
Casey fell asleep quickly and Shay stepped out the room with Severide. "What were they saying?"
"Since Hallie was still listed as his emergency contact and his mother's not been in contact, Christie is his next of kin," Severide stated.
"Go on..." Shay urged.
"She says she can't have him at home, not with her kid," he sighed, "He's medically stable, they can't really keep him here forever. Christie's looking at specialist facilities."
"He doesn't need that."
"He can't be on his own, not yet, maybe not ever," he explained sadly.
"Shouldn't he be with family not in some centre? Although he barely interacts with her when she's in the room..."
"He wants to go home, I told him that he would, I didn't say he'd leave this hospital and go somewhere that's like a hospital. He's always hated people looking after him," Severide said.
"He needs…" Shay began.
"He needs to go home. What about the next best thing? He could stay with us," he said as the idea struck him.
"Or he could go home, and one of us can stay with him. With Otis, our place would be pretty crowded with him, too busy for him, he struggles to concentrate when there's more than one of us in the room. He remembers home, it's only right that he gets to go there," she agreed.
Severide nodded. "I'll speak to Christie."
TBC
