By the time Brennan reached the hospital Hank had already been admitted, preliminarily diagnosed with a case of bacterial pneumonia. She knew the odds in his favor weren't the best.
Identifying herself at the reception desk of the surgical floor, Brennan asked whether the intubation procedure was over-the one Booth told her he had browbeat his grandfather into getting.
The one which might be Pop's only remaining life-line.
"Ma'am, Mr. Booth is still in the operating room. They should be done with him anytime now," the lady at the desk told her. "The waiting area for relatives is just down the hall."
The anthropologist quickened her pace.
She'd done everything within her power to get to the hospital earlier in order to be with Booth when the surgeon first came to speak with him about the logistics of the procedure, but it just didn't work out. It went without saying that in stressful situations of a personal nature, her husband wasn't always the best at listening with any attention to detail-especially when it came to medical parlance. She was his eyes and ears in that department, and he had to be feeling lost without her in the impersonal, foreign hospital setting given where his mind was at.
She recalled the time he had his brain surgery, which even to this day, he knew almost nothing about. He was pleading with her to go into the OR with him because he wasn't sure what they were doing inside his head, and as he put it, she would know if they 'messed up'.
She wouldn't really know, not to the extent Booth was giving her credit for because she wasn't a neurologist, but she stayed anyway. If nothing else, at least to give him some peace of mind.
Of more recent vintage, the incident with Parker's broken arm had only reaffirmed the notion that Booth didn't cope well with medical emergencies. At least not when family was involved.
He'd been out of his mind with worry over his son, repeatedly interrupting the pediatric orthopedist in the emergency room with questions about future mobility issues while railing against both the very large player on the opposing football team who caused the injury and the boy's admittedly annoying bully of a coach. In the end, it took all her reasoning skills to calm Booth down and convince him that this particular type of game-inflicted injury was extremely common, typically accidental, and unlikely to have any material future impact on the use of Parker's arm.
She couldn't have reached Booth any sooner today if she had wings, though.
Before she could make her way over to him, she had to finish collecting the evidence at the pool and then arrange for Hodgins and Angela to pick Christine up from preschool and little Hank from the Jeffersonian's daycare.
A quick stop at home and once again back to the Jeffersonian to drop off the kids' supplies, and the scientist was finally on her way to the hospital.
She and Booth were very fortunate to have such good, loyal friends in their lives, Brennan acknowledged. As soon as they heard about Hank, Angela and Hodgins immediately offered to watch their two children and to keep them overnight if that was what was required of them. It was definitely an imposition, of course, even when it was being done with a genuine smile; the couple had an extremely active little boy of their own to contend with. But with Max was out of town on one of his many mysterious outings, there was little other choice.
Brennan finally found Booth sitting by himself in a corner of the ICU's waiting area, head hanging down and hands knitted tightly together on his lap. He looked spent and fairly disheveled, with his tie askew and his shirt wrinkled and still unbuttoned at the top. He also looked incredibly sad. A five-o'clock shadow was starting to darken his cheeks making them look hollow, while the swarm of mosquitoes from this afternoon had definitely left their vicious imprint on him, in the form of nickel-sized pink welts all over his neck and ears.
She made a mental note to put ointment on them as soon as they got home so he didn't wind up scratching them bloody.
The second he sensed she was nearby he stood up, his drawn face immediately lighting up. It had sure been a lonely, nail-biting four and a half hours since he'd gotten here.
"Hey Bones. Thanks for coming."
"You don't need to thank me, Booth. I wanted to be here, for you and for Hank. How is he doing?"
"Not too well" Booth replied, trying to keep his voice from giving away how completely down-and-out he felt. "I think they're still working on him; I don't know, no one's come out yet. They had to run all these other tests first, and then there was the mountain of paperwork I had to sign before they could start. They said his oxygen whatever levels were pretty low when he came in, like 65 percent or something."
Brennan's eyebrows rose when she heard the dangerously low number, but she didn't think it was wise to say anything about it.
"Oxygen saturation levels," she explained. "It's a measure of the percentage of hemoglobin binding sites occupied by oxygen in a person's bloodstream ."
"Huh?" he said, shaking his head in confusion.
"Simply stated, it represents a measure of oxygen levels in the blood. Higher numbers are better."
Booth shrugged his shoulders, still looking confused.
"The worst part is that they could only give him local anesthesia and some sort of other wussy tranquilizer for the procedure-they were afraid if they put him under, he might not wake up."
"Yes, general anesthesia and opiates tend to depress the respiratory system. If that system is already failing, they might cause breathing to come to a complete stop. I'm sure they didn't want to take any risks because of Hank's age."
"God" he added despairingly, looking away from his wife as he ran one of his hands through his hair. "Pops hates all that garbage-the machines, the IVs. He always told me not to let doctors get to him with stuff like this, and I practically blackmailed him into letting them do it. He's got to be hating me for that."
Booth's eyes were watery and bloodshot and Brennan recognized the kind of struggle going on inside him, born of filial respect and devotion and, in this case, the apparently contradictory desire to keep his grandfather alive at all costs.
"He's a fighter Booth, and it's not as if pneumonia is an automatic death sentence. With the proper medications and certain-admittedly uncomfortable-procedures, a patient can easily recover. A while ago Hank gave you his power of attorney in the event he wasn't in a position to make decisions for himself because he trusts your judgment; he values your ability to choose what's right for him even when the choices are difficult. He wouldn't have agreed to the intubation if he didn't respect your opinion on the matter. It's not as if it was done against his will."
She put a hand on his arm.
"You did the right thing," she continued softly. "If there's any possibility that he might pull through, you have a moral obligation to provide him with the means to do so, which in this case included talking him into something he may not have originally wanted. Don't let his irritation and possible anger at you be your sole guide in this situation."
"I know; that's why I did it-tried talking some sense into him. I mean, I couldn't just let him die, could I?" he asked, searching Brennan's features for some sort of affirmation. "And there's probably no way without that breathing tube that he would make it, is there?"
She sensed he was looking for a truthful answer, but that he also wanted to hear that he hadn't done the wrong thing.
At least for now, she could give him both.
"I don't know the particulars of his case, but given the doctor's diagnosis, Hank's age, and the fact that he's apparently been suffering from the condition for a few days, I doubt it. It's critical to be aggressive in the early stages of pneumonia; more so if the patient is elderly. Once the disease has progressed, it becomes much harder to treat."
It was a helpful answer, but it clearly wasn't enough.
"I should've called him this week-I didn't even stop by on Sunday. I would've known something was wrong."
The comment made Brennan want to both grab him by the shoulders and shake some sense into him, and bash her own head against the wall. She understood that Booth's childhood had caused him to see himself as a scapegoat whenever there was a possibility for blame, and that even years of her many assurances and those of others had done little to change that behavior-but it still drove her absolutely crazy.
"Booth" she began patiently, keeping her incipient frustration to herself, "you're very diligent about staying in touch with Hank. You see him regularly, you speak to him on the phone at least once a week. Parker was with you this weekend, and he wanted to go to the amusement park on Sunday. You've got a commitment not only to your grandfather, but to your son as well. You've always done the very best that you could for everyone in your family, which now includes two other small children-no one could possibly ask for more. Besides, you're forgetting that Hank lives in a very good facility with twenty-four hour nursing care. If they didn't think anything was seriously wrong with him until today with all of their years of experience, how could you have possibly known three days ago?"
Yet another helpful answer, but Booth's brain refused to stop looking for a culprit. If it wasn't his fault, then whose was it? In his mind, his grandfather was in the hospital-suffering unnecessarily-with an illness that should probably have been caught much sooner by somebody.
"How could they not tell he was this sick if they're so experienced? You tell me. Apparently, he had a fever for a couple of days. He was coughing. Put two and two together and you get four."
Brennan immediately came to the nursing home's defense. She'd witnessed how kind and solicitous the staff there always was with Hank despite his occasional cantankerousness, as well as how chronically under-manned these type of places were.
Even the very best ones.
"Unfortunately, your grandfather is exactly like you. Taciturn about the things that are bothering or hurting him. And like you, he's an expert in deflecting attention away from himself when he has a problem."
Booth glared at his wife for this characterization of him and Pops, but some part of him recognized that maybe what she was saying, just maybe for the sake of argument, wasn't too far from the truth.
"These people aren't psychics, Booth," she continued. "They also have other people to look after. A cold isn't necessarily indicative of a more serious condition-it could be a passing virus. If your grandfather made light of his symptoms or outright chose to hide them because he didn't want to be fussed over, the nursing home staff shouldn't be blamed for their failure to act more expeditiously. What matters is that as soon as they understood the severity of the situation, they immediately called an ambulance, as they should have. There really wasn't much else they could do."
"Why are you defending them?" Booth asked heatedly, glare still in place. "Pops is always complaining about that place, that they don't do as much as they should."
"Hank can be rather..."
He looked at her with clouds of anger in his eyes.
"What?"
Brennan debated her choice of words carefully, eventually opting for complete candor.
Truth was best.
"He can be a challenging to look after-you know that as well as I do. And occasionally, he can also be quite unreasonable. You can't take all of his complaints seriously; in the past, he's scolded you for things which we both knew were not your fault. Elderly people are extremely attached to routine, and it can be difficult for them to adjust to new situations and experiences. An institutional environment with all its rules and regulations contains elements which by their very nature are bound to make older people unhappy. The feeling of losing of control over one's life can result in unwarranted criticism and misplaced anger-does any of this seem familiar to you at this very moment?" she asked quietly, tilting her head knowingly as she looked at him.
"What are you now, a Sweets clone?"
Despite the snarky comment, Booth had to admit his wife hit a home run with her assessment of both grandfather and grandson. Yes, he fessed up, she was right; like Pops, he too was feeling like he was quickly losing control over things. He didn't understand the medical lingo and he wasn't in a position to do a darned thing to help Pops beyond signing papers.
Papers.
It was enough to make a man want to run down the street screaming. He was an action guy used to getting the job done, and now he had to sit ringside and watch his grandfather struggle for his life. In essence, to do nothing.
"Mr. Booth?"
The couple turned around to find a petite, 30-something dark-haired woman in a doctor's coat looking at them inquisitively.
"Yes?"
"Actually, it's Agent Booth. He's a special agent for the Federal Bureau of Investigations."
"Bones..."
"What? I thought it might make it easier for the staff to distinguish you from your grandfather when they're speaking about Hank," Brennan stated in a helpful voice.
"We spoke earlier, Agent Booth" the attractive woman said with a smile, clearly fascinated by the strange interplay of the two people in front of her. "I'm Dr. Lisa Freeman; I admitted your grandfather a few hours ago. I just wanted to let you know that we finished intubating him and he's on a ventilator now. He'll be in his room shortly. His oxygen saturation levels have risen dramatically since he had the procedure. They're much better now, but we're hoping they'll go up even higher during the night."
Brennan extended her hand. "Hi, I'm Temperance Brennan; I'm Booth's wife and work partner. Hank's granddaughter-in-law."
Even though he was still a little annoyed at her for her defense of the nursing home and the unnecessary 'agent' addendum, Booth felt touched by how Bones had just represented herself to the doctor. It didn't even occur to him that to an outsider, the fact that his wife was calling him by his last name might appear extremely odd.
"Dr. Freeman, do you happen to know whether Mr. Booth's pneumonia is of a viral or bacterial nature? If it's bacterial, it would require a much more aggressive form of treatment."
"Oh, are you a doctor as well?" the woman asked with interest.
"My primary doctorate is in forensic anthropology; I also have several other degrees in related fields. I'm employed at the Jeffersonian Institute and I'm a consultant on forensic matters for the FBI. As a requirement of my job, I've researched the epidemiology of numerous diseases and their impact on the human body, including pneumonia."
"Very impressive" the woman replied, nodding at the list of accomplishments. "To answer your question, we don't know yet. We're culturing samples, but those won't come back for a few days. The end of tomorrow, it we're fortunate. However, given the quick onslaught of symptoms and the severity of the patient's condition as well as the group setting he was living in, I would venture a guess that even if the disease started out as a virus, it's probably become bacterial by now. We're treating it accordingly. He's on an intravenous full-spectrum antibiotic. If he doesn't improve at least somewhat in the next twelve hours, we'll reevaluate our options."
"It's that serious?"
Booth's worry was quickly turning into full-fledged terror.
"Unfortunately, your grandfather's not a young man, Agent Booth; pneumonia in patients his age can be difficult to treat. We're staying guardedly optimistic though," she added with a smile. "By the way, I noticed that there were some dark spots coming up in Mr. Booth's chest x-rays; I'm pretty sure it's a form of emphysema. Was he a smoker?"
"Yeah, but he quit a long time ago-more than thirty years back." Booth's befuddled eyes focused on Brennan. "He stopped when he took me and Jared in. Why would that even be an issue now?" he asked, turning once again to the physician.
"The effects of emphysema can make themselves felt long after someone has stopped smoking," Dr. Freeman said. "The damage that occurred while the person was smoking is irreversible, although if they quit early enough, at least the condition doesn't usually worsen. But the bottom line is that any previous injury to the lungs makes it harder for them to fight infection. We'll keep our fingers crossed, though. Other than this issue he's facing, Mr. Booth is in relatively decent shape considering his age. His heart is very strong and that's important, because compromised breathing really puts a strain on the heart muscle. Hopefully we've caught this early enough," she added, aiming to leave her audience with something good to hold onto.
"He's sedated and we would like him to rest, but you can stop in and see him briefly in about ten minutes, when the nurses finish setting him up in his room. ICU is on the sixth floor."
"Can I stay with him?" Booth asked.
The physician shook her head.
"I'm sorry, no over-night stays allowed in the ICU except in rare cases, particularly when there's an infection involved. It's for everyone's safety, both the patients' and the visitors'. But you can come back early tomorrow morning, starting at 8:00. Visiting hours are posted by the nurses' station."
"Thanks-please have them call me day or night, if anything-anything-changes. I want to be there for him-I don't care what time it is" Booth said.
"I'll make a note of that-I believe we already have all your contact information. Nice meeting you both."
The doctor walked away, leaving Booth and Brennan alone in the waiting area.
Visiting hours were winding down, and the few stragglers that were there when Brennan first arrived at the hospital were all gone now. she stole a sideways glimpse at her mate. He was standing next to her in absolute silence, checking his watch obsessively. Waiting for those interminably long ten minutes to be up so he could see his beloved grandfather.
"Booth, I'm very sorry about Pops. But you shouldn't dwell on a worst-case scenario" she argued, trying to sound as upbeat as possible. "You're the one always telling me that it's important to retain a positive outlook. You heard what Dr. Freeman said about Hank's heart-I think it's very reasonable to remain optimistic given what we know."
When he didn't say anything, Brennan took a step over to her husband and slid a hand around his back, until it settled on his hip. He put his arm around her and looked down at her with a threadbare smile.
"Yeah, Pops has a really good, strong heart-always has."
Brennan tightened her hold on him.
"So does his grandson."
