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Chapter 4

Queens Medical Center

Friday, 1835 hours

Nearly three hours and several cups of stale coffee later, they were still sitting and waiting. The ICU waiting room was a subdued place as people came and went, checking on loved ones during the scant minutes every hour the patients could have visitors. The team members had taken up residence in a corner, sitting on a love seat and matching chair; fully functional pieces of furniture, but about as comfortable as bleachers in the ball park.

"Wonder if Steve is back from the tests yet?" Kono asked, stretching her shoulders and neck.

"Hope so," Danny replied. "I just wish the doctor would get here."

"Yeah. He told them he wanted results STAT," Chin complained. "What constitutes STAT around this place?"

"Chin Ho Kelly, you need to be patient," his wife said, walking into the room and stepping into his hug as he quickly stood up.

"Have you heard anything?" he asked after giving her a quick kiss on the lips.

She smiled and rubbed a touch of lipstick away from his mouth. "I just talked to Don. He should be up here soon."

"Can you give us a hint?" Danny asked her, standing to work the kinks out of his own back.

"Patience, Detective," Dr. Makani said from the doorway of the waiting area. "If you would like to follow me, I think we would be more comfortable down the hall." He turned and walked down the hallway, confident they would all follow. As they entered the conference room, Malia closed the door and took a seat next to Chin.

"Before we begin," Malia told them, "I want you all to know that Dr. Makani is the best Neuro we've got here. Steve is very lucky that Don was the attending when he was brought in."

"Thanks for the endorsement, Malia." Makani grinned at her then quickly got down to business. "OK, got the results back," he began and laid out some papers on the conference table, looking them over once again. "After talking to Malia and checking these results, it appears the commander may have a concussion secondary to the one he received in Korea." He glanced up at the group. "Yes, she filled me in on everything. And it is considered privileged information, so don't worry, my lips are sealed."

Malia held up her hand and looked at them, saying, "I felt, for Steve's sake, that it was necessary."

Danny nodded, motioning for the doctor to continue.

"The fluid we cultured from his nose did come back positive as cerebrospinal fluid, which indicates he does have a leak somewhere along his spinal column. That, in addition to the concussion, has caused his mood swings and irritability over the last few days."

"How can you fix him?" Danny asked bluntly.

"Well, we're going to do a couple of things," Dr. Makani replied. "First, the commander needs to lie nearly flat in bed. The headaches associated with this condition are much worse when the patient is upright. And in many cases, bed rest alone allows the leak to close on its own. He'll also have IV fluids and we'll give him caffeinated drinks as well. Some studies show that caffeine helps with this type of headache."

"Then that's good news, right?" Danny asked.

"Yes, of course. But the tricky part is that we need to learn where the leak is located. For that, I plan to perform a lumbar puncture in the morning and insert dye into the CSF so we can track it on a scan. We will know more once we learn the location of the leak."

"So, with rest, he should return to himself?" Kono asked.

"I hope that is the case. In some instances, the leak has to be plugged, but if need be, we'll deal with that later."

Malia joined the conversation. "Chin said that Steve has not been acting like himself?" She looked at Danny and Kono for confirmation. "I want to assure you that with an injury like this, he has not been in control of his mental faculties. A leak of this nature can have disastrous effects."

Danny shook his head and replied, "Malia, Steve hasn't been… well, Steve for the last few days."

"And I can understand why." She pointed to the documents on the table. "Hopefully Don and I can explain this to you."

"Yes, of course," Makani continued, and held up a photo showing a brain inside the skull. With his pen, he pointed at the diagram. "This is a perfectly positioned brain. Notice this layer of cerebrospinal fluid around it which cushions the brain from injury and allows the brain to sort of float inside the skull. The same fluid extends down the spinal column." He set down the diagram and picked up a color scan. "This is Commander McGarrett's scan from an hour ago. Notice that while you can still see a thin layer of fluid around the brain, there isn't as much cushion. See how the base of the brain itself has dropped down in this area?"

Malia continued the explanation while he pointed to the scan. "The fluid is leaking out and while our bodies continually produce it, a leak of any kind isn't good. Some is leaking from his nostril, which Don discovered in the ER. If that isn't stopped, it can lead to a very dangerous infection. When Steve sits or stands, gravity pulls the fluid and his brain downward, causing the excruciating headaches. You need to understand that most people with CSF headaches are so debilitated that they can't even function. For him to be upright and even coherent says a lot about his stamina and willpower."

"Is it wrong to wish he was a little less coherent?" Danny asked with a sheepish smile.

The group chuckled. "Probably not," Makani agreed.

"So, the test tomorrow," Kono asked, "Is it dangerous?"

"No, not really," Makani replied. "There is minimal risk as in any procedure, but I believe the test is necessary. The dye will be injected early morning and then we'll run the test and repeat it at six hours and again after twelve hours."

"How is he doing?" Chin asked. "You took him to ICU, right?"

Malia nodded. "The nurses are continually waking him for neurological checks and while he is very sluggish and incoherent, he finally responds to them."

"We tried getting him awake at 15 minute intervals, but found it took almost that long for him to respond. So for the next couple of hours, I want him awakened every half hour," Dr. Makani told them. "After that, we will go to hourly checks for four hours tonight. But I have a job for you, if you can help."

"Anything," Kono replied.

"He may respond better to you than the nurses, so if one of you could stay with him, at least for a while, it might help ground him when he does wake up."

"We can stay in ICU?" Danny asked.

Makani nodded. "You will find that I tend to do what is best for my patients, not what is dictated by hospital protocol."

Danny grinned and replied, "I think you and Steve would get along splendidly. And I'll stay the night. Although from here I had planned to go to his house to see if there were any clues as to what happened to him."

"You don't have to do it all, Danny," Kono told him. "I'll stay for a while and you can go to Steve's. Hopefully you can figure something out over there."

"And I can spell you later," Chin told them.

Kono grinned at her cousin. "How about right now, since we are here, you take 'Dr. Kelly' to dinner?"

Chin grinned at Malia. "If she's agreeable, I could do that. But, if possible, I would like to see Steve before I go."

"I can take you before we eat," Malia assured him. "But I need to stay nearby, so our special 'date' will have to be cafeteria food."

"Malia, any date with you is special," he told her with a grin and a chorus of "awws" from the group, which made both Malia and Chin blush.

"Before you leave, can I ask a question?" Kono asked the doctors after they finished laughing at Chin's cheesy comeback.

"Certainly," Dr. Makani replied. "Ask anything."

She blew out her breath and tried to choose her words. "Well, the last conversation I had with Steve wasn't very… positive. He said some things and I really didn't handle it very well. My question is, will he remember that and if so, how do I deal with it?"

"Good question. Was he belligerent, mean, cruel, what?"

"Um, yeah," she admitted. "Pretty much all of that. He said if he hadn't hired me that my only career would have been meter maid or traffic cop."

"Ouch."

"Doctor, what I want to know is if that is how he really feels?"

Makani held up both hands to stop her. "No. Please believe me when I say that I'm sure that isn't the case. Let me see if I can explain. And Malia, jump in anytime."

"Well, before you begin," Malia spoke, "I've only known Commander McGarrett for a few months, but it is obvious how much he values and respects each one of you. When he talks about his team, it is with nothing but pride." She reached over and put her hand on Kono's arm and squeezed it. "Kono, please don't believe those words he said. He is a very sick man right now. Much sicker than he really looks."

"But those words had to come from somewhere," Kono quietly spoke again.

"I agree with Malia," Makani said, nodding his head. "Think about this. Consider our brains as computers. You spill something in your hard drive and the motherboard is fried. While the computer won't work correctly, it may still operate to some extent. But you would probably get garbage from it. That's what happens to the brain with leaks such as this. It begins to shut down slowly and the information isn't computing in a rational manner.

"For instance, I saw one woman who had been in a car accident and was leaking CSF. She was a 70 year old granny and when she woke up, she started cussing like a sailor. She was using words that her family swore she never even knew before. And some people are afflicted so badly that they can only speak in gibberish or what I call 'word salad'; real words come out, but in an order that means nothing."

"I have one for you," Malia told them. "Several years ago, a young mom lost CSF after having an epidural during childbirth. About three weeks later, she was acting strange and her husband thought she had post-partum depression and took her out for a nice dinner to cheer her up. She went to the bathroom at the restaurant and came out wearing only her high heels… without a stitch of clothing. These patients have no boundaries, no knowledge of right from wrong…"

Makani picked up, "No inhibitions, no conscience. They feel invincible and have thoughts of grandeur, but on the other hand, they are paranoid and suffer from delusional thinking."

"Honestly, I think we've seen all of that in the last couple of days," Danny admitted.

"I'll take a stab at an explanation for your friend… and this is only my opinion," Makani offered. "The commander has been feeling continually worse, but he can't or won't step back and acknowledge that fact. He tells himself that he's fine, or that this will pass, but he won't admit that something is wrong. If you brought it up, I'm sure he went on the defensive, right?"

"Big time," Chin agreed. "Whenever we asked, he insisted that nothing was wrong."

"He is hurting, so he is going to subconsciously lash out and try to hurt everyone else. Not physically, thankfully, but with words. He wanted you to feel as badly as he does. Not—" he hastened to add, "because he wants to. But because his computer is scrambled right now and what he really wants to convey is jumbled up inside his brain. And what is most unfortunate is that he doesn't even realize any of it."

"Will he remember the conversation we had?" Kono asked.

The doctor sighed and shrugged one shoulder. "That's something I can't answer. Possibly once the fluid reaches a moderate level, his memory may return. Then again, he may never remember anything of this whole episode. There have been patients, after they recuperated, who have had no recollection of the days or weeks before the accident. The brain is such a complex organ that we are continually learning something new about it almost every day."

"Thank you, Doctor," Chin told him. "We appreciate your candor."

"Any time," he told them, beginning to gather his documents. "I will check on him tonight and I plan to schedule the puncture around six in the morning. So, I'll see you later. And thank you, Malia for your help."

"Glad to help," she replied. "Chin, if you want to see Steve, we can go now."

"Good. Danny, I'll talk to you later. In fact, I'll meet you at Steve's after we eat. Two sets of eyes may be better than one."

Danny nodded. "Sounds good. Hey, Doc, one more question."

"Certainly," he turned from the doorway.

"Um, how long do you think it will be before his attitude changes?"

"It may take a few days, so don't be surprised if he's cantankerous for a while. It will take time to build up the fluid to a more normal level."

The team grinned as Danny replied, "Cantankerous doesn't begin to cover it, Doc. But as long as there is light at the end of the tunnel, we can manage."

~~~H50~~~

Queens Medical Center ICU

2000 hours

Danny entered the ICU to find Kono and a nurse leaning over the bed, talking to Steve. Kono looked up at him and smiled.

"Hey, Danny. This is hard work, Brah. He really doesn't want to wake up."

The nurse glanced up and added, "You have a very stubborn friend."

"Tell me about it," Danny agreed. He stepped next to Kono and grabbed Steve's hand. "Yo, McGarrett, wake up," he called to him. "Come on, open those eyes." He turned to Kono and asked, "Does he talk to you when he wakes?"

"Yeah, he can answer questions. He's not the most pleasant person, I'll tell you that."

"And that's different… how?" he asked with a grin.

She elbowed him in the ribs. "That's mean," she said. "Especially when he can't defend himself."

Danny traded places with Kono and leaned over the bed. "Then, Steven, you'll just have to wake up, won't you? Hey! McGarrett! Up and at 'em."

"Hunnnhh?"

"Well… wonders never cease," Danny muttered. "Come on, wakey, wakey."

The nurse leaned over him from the other side of the bed. "Son, can you tell me your name?"

Steve frowned, "You-you keep askin' me that…" he paused and licked his lips, then continued. "wr-write it down."

The nurse smiled at her patient. "I'll do that. But first you need to open your eyes."

He gave them a put-upon sigh but eventually got his eyes open, blinking in the dim light above the bed.

"One more time," she asked. "What's your name?"

"Steve."

"Good. Do you have a middle name?"

"Yeah."

Danny huffed and shook his head. "She wants you to tell her what it is."

Steve rolled his head on the pillow and stared at his partner, blinking as his vision focused. "Dan-?"

"Hey, partner. So tell the nice nurse what your middle name is."

"Um… J-John."

"That's good," she said. "Do you know where you are?"

He turned to look at her and started to raise his head off the pillow before she quickly put her hand on his forehead. "Lay still, you can't raise your head. Remember?"

"Hmm?"

"Keep your head on the pillow." She glanced up at Danny and said, "You need to make sure he stays like this. He can move his head from side to side as long as he doesn't raise it."

"Got it."

She turned back to her patient. "OK, Steve, one more time. Do you know where you are?"

"Hospital. W-why?"

"You hurt your head, so you need to rest and take care of yourself."

The eyes slowly closed. "'K." He breathed the sound, asleep before he finished speaking.

Another nurse entered the room. "Hey, Joan. Looks like Mr. McGarrett is my patient for the night."

Joan turned and smiled at her relief. "Hi, Kari. He just fell back asleep, but let me tell you, he's a stubborn one. You've got another check at 8:30 and thereafter you can just wake him hourly for four hours. He's scheduled for lumbar puncture at 6 a.m."

Kari turned to Kono and Danny. "I understand someone will stay with him tonight?"

"Me," Danny replied, and held out his hand. "Danny Williams and this is Kono Kalakaua."

Kari accepted Danny's hand while looking at the two of them. "Hey, Kono, didn't you graduate from Kokui?"

"Yeah, hi, Kari. I think I was the year ahead of you."

"Good to see you again. Are you…" She pointed to Steve and then Kono.

"Oh, no," Kono replied. "He's my boss."

"Got it. Let me go through his chart and then I'll be back to check him over," Kari told them as she and Joan prepared to leave the room.

"Kono, why don't you get out of here, too," Danny told her. "You've got to be hungry. I grabbed something earlier."

"You want to go get coffee or something before I leave?"

"Nah, I'm good for now. Chin and I just had a cup before I came over here."

"Did you find anything at the house?" she asked.

Danny blew out his breath and shook his head. "Nada. But honestly, if something happened last weekend or Monday or Tuesday, what would we find now? We checked outside, thinking maybe he fell or something, but there's no sign of anything. The truck isn't damaged so we ruled out a fender-bender." He ran his hand through his hair. "We really have no clue. Chin and I did start writing down the things we remembered that have been out of the ordinary, but we didn't remember anything out of character until Wednesday. How about you?"

She shook her head. "Me, either. Tuesday everything was fine… or so I thought. I don't even remember if he said what he did last weekend."

"He said he spent six frustrating hours working on the Marquis on Sunday," Danny told her. "We checked the garage and didn't find anything out of the ordinary in there. Except that honkin-big metal death trap that he likes to call a car." Danny turned to stare at his sleeping partner. "Maybe he can tell us when his head gets normal again."

"Yeah, Brah, I sure hope so." She hugged Danny and then reached over the bed rail and squeezed Steve's hand. "Good luck getting him awake. It takes a while."

"Want me to smack him around a bit?"

She laughed. "Yeah, you try that. And tomorrow I'll count how many broken fingers you have."

~~~H50~~~