Chapter 4: Breathless

The view from the helicopter was breathtaking but Lisbon didn't care. She was too busy keeping a frightened Patrick Jane calm. He said he could breathe a little better so she thought it might be because of the helicopter. She remembered he had said he enjoyed their last ride together, but he lied. When they got out she could tell that he hadn't liked it as much as he had claimed.

"Okay Patty," Ally yelled above the whupping noise of the blades and growl of the engine, "We're about to land. Everything is going to happen fast and you might feel a little disoriented. We're going to do this as quickly as possible to get you some relief. Lisbon, you won't be allowed into the treatment area but I'll come out and tell you everything as soon as I can."

As smoothly as clockwork and as inevitable as time, events hurtled along just as Ally described. They landed, the stretcher with Jane was unloaded, and he was rapidly wheeled away. Lisbon felt bereft. She knew it was irrational, but felt Jane would be okay so long as she was with him. Seeing him wheeled through the double doors into the treatment area recalled events from 30 years ago. After disappearing through the emergency room doors, Lisbon never saw her mother alive again. She took a few paces toward those doors, only to be gently guided away by an orderly who was clearing the path for another emergency patient being wheeled in.

Dazed, Lisbon made her way to the clerk's desk to answer insurance questions, medical history, next of kin. Finished, she sank into a chair in the waiting room. First, everything was happening too quickly. Now, time crawled. Several minutes later a nurse emerged. After verifying Lisbon's connection to Jane, she handed Lisbon a plastic bag - Jane's personal effects. Hospital policies were geared to getting wallets, clothes, and the like into the hands of the accompanying relatives, thus minimizing the chances they would be misplaced or stolen. Lisbon was about to go through Jane's things, to find his wallet and anything else she might need to deal the with administrivia of Jane's being hospitalized. Her phone rang, interrupting her, startling her after being out of the service for so long.

"Hello," she answered.

"Thank god, Boss. Wayne and I were following the fire on the news when we realized it was in the carny layover area. We worried when we couldn't get hold of you or Jane. Are you guys alright?"

"Everything happened so fast. We were having a barbeque and - can you believe it, all of this talk about Al and she's a she? A woman he grew up with. She was telling me stories about their childhood and it all went to hell fast," she rambled.

Slowly, deliberately. "The fire. Were you trapped in the fire? Are you okay? Is Jane okay?" Van Pelt asked intensely, alarmed. Normally, Lisbon was the last person who would be dazed, incoherent. What the hell happened to throw her so off balance?

Lisbon's focus was on watching those doors to the treatment area. Van Pelt got the remaining sliver of her attention. "It wasn't the flu. All last week I thought he was just being silly about the flu–"

Frustrated, "Who, Boss? Jane?"

"-It was pneumonia. They airlifted us here. I can't go back there with him. I can't do anything, damn it!" Frustrated, her voice rose in pitch and volume.

"Jane's being treated. Which hospital are you at?" she asked deliberately. It was an emergency and it was Jane. Van Pelt and Lisbon had become closer in the past few months. After Lisbon and Jane had publicly become a couple - public to the extent of the team - Van Pelt knew it would ease the work situation for her and Rigsby. The Lisbon who "didn't do personal" had become a lot more flexible over the years. This was the last step in blending and balancing work with the personal. Lisbon openly took Rigsby's obligations as a father into account in work assignments. Lisbon remained scrupulously even-handed about the workload, and assignments were always based on the team member best suited for the task. But life was easier now that Lisbon consciously factored the personal in as much as possible.

"Carson Springs General Hospital. He's with the doctor now. They just gave me his clothes and I'm waiting for Ally to come back out. She's a doctor, Grace. Thank God or he might not have made it this long."

Grateful for the first practical bit of information, Van Pelt realized Lisbon had to be working on no sleep and coping with a serious emergency with Jane. "Boss, do you need us there? I don't know how long it would take because of the fire detours."

More calmly, "No, just wait. I'll know more in a little while. By tomorrow maybe you can see him."

She was encouraged that Lisbon was calmer, finally sounding more like herself. She couldn't resist asking, "Did you guys get to talk? Wayne said there was a view Jane wanted to show you. Did you get to see it?"

"No." Her throat tightened and her voice rose remembering Jane's problems on the path. "We never got the chance. Listen, I'm going to go find out how he's doing. I'll call back when I know more."

"Sure, Boss. Let us know anything we can do and when you want us there."

"I will. Thanks."

Van Pelt sat in her kitchen and worried. Lisbon was exhausted and so frightened for Jane she wasn't able to set aside her emotions like she usually did. Crap. Just when they're getting somewhere, just when Jane had plans. God, I hope he's gonna be all right.

Flashback

They were having lunch in the park. It was something they did every third Saturday of the month. Much to her surprise, Van Pelt and Jane had become close friends over time. He intrigued her and she amused him. Their relationship was based on and informed by years as colleagues. Van Pelt was less naive than she was when she started. Since then her intelligence, guts, and computer expertise earned her the respect of the team and especially Jane.

In turn, Van Pelt thought Jane had changed a lot. Or, perhaps she had changed, forcing a different understanding of Jane. She gradually saw beyond the smart-ass cockiness to his unending pain and guilt over his family's murder. And, despite his best efforts, he failed to completely hide his generosity and loyalty to the team and – especially – Lisbon. When they first met, Van Pelt was inclined to buy into his belief that he was responsible for the murder of his family by Red John. Her own tragedy with the aforementioned monster tempered that judgment. Red John was responsible for Red John's crimes - no one else. Meanwhile, to her mind, the good Jane did by solving innumerable crimes and preventing new murders overwhelmingly offset any slight responsibility for triggering the actions of an evil psychopath. She was now proud to call Patrick Jane a friend.

"Okay so what's the topic of the day? And why are we at the park instead of your place or the bistro you know I love so much?" Van Pelt asked innocently.

"Because those are places Teresa might pop up unexpectedly. I didn't want her around when I showed you this," Jane answered, taking a velvet box from his pocket.

The ring inside was stunning. Where Van Pelt had expected a diamond of some kind was a brilliant emerald. Beautiful for itself, it would bring out the flecks in Teresa's eyes. Some people might think Jane was rushing since he and Lisbon had only started dating a few weeks ago. Van Pelt wondered what took him so damned long.

"Oh, Jane, I'm flattered but Wayne and I–" she joked. She dropped the act and laughed when he nudged her shoulder.

"Do you think she'll like it?" he asked. By nature and training, Jane's total orientation was toward people – understanding them, reading them, manipulating them. It was a gift to again have trusted friends, friends close enough to share important moments in his life. Van Pelt was the perfect mirror, reflecting and augmenting his joy in anticipating this step with Lisbon. Her unqualified enthusiasm and youthful - but no longer callow - romanticism perfectly complemented his mood.

"Jane, no, she won't like it. She'll love it. I can't wait to hear from her afterward. She's going to flip."

Van Pelt just hoped to God that her friend had healed enough from the murders to go through with it, to slip that ring on Lisbon's finger. They were finally finding happiness. They just couldn't delay it, couldn't lose it now.

Returning to the present, she called, "Wayne, we need to pack a few things. We're going for a drive. Lisbon needs us." Rigsby woke from his nap in the living room and stretched. He wasn't surprised there was a problem after his boss and Jane had been out of contact the last two days, longer than expected.

Carson Springs

Ally Turner was exhausted but Patty was doing better. She looked through the window to the treatment room. He still looked pretty alarmed at the contraption helping him breathe, but it was better than the alternative. He didn't want to be intubated. She understand that but worried that soon he might not have that choice. If it came to that, he wouldn't be making that decision - Lisbon would.

Ally knew it was time to update Lisbon on what was going on. All things considered, Ally was happy Jane was brought here. She grew up in Carson Springs and knew the hospital well. Though old and in a bad part of town, she knew it was well equipped for his condition and the staff was good. He would get good care here.

Lisbon was about to go through Jane's effects when Ally came from the treatment area where she had disappeared seemingly a lifetime ago.

"How is he?"

"He's not in critical condition but he's not stable. The pneumonia was viral as I suspected, and he's on antiviral medication to help overcome the infection. There are other drugs to suppress the inflamation, thin the secretions, and a mild sedative to keep him calm. Once the infection is tamed, he will gradually recover. So far, I don't think a drainage tube is necessary for pleural effusion or abscess."

"So it was pneumonia?"

"Teresa, I don't know how he made it to the barbeque. It's bilateral pneumonia - both lungs. His arterial oxygen level was dangerously low. His breathing is still labored and we put him on a BiPAP machine." She frowned then thought to ask, "Do you know what that is?"

"Actually I do. It's used for sleep apnea. Right?"

"Very good. Yes it is. A mask completely covers his nose and mouth. There is no tube or anything down his throat, so you two will be able to talk when you see him. In fact, if he's willing, it would be helpful to get him to talk. If not conversation, see if he'll watch TV. The distraction will get his mind off of what's happening."

"What is the machine doing?"

"Well in long intervals air is literally blown in his face at high speed. It is forced down his airway to open up his chest so he can breathe. This helps in many cases. The more successful we are at opening up his airway, the more effective the vaporized medications and other breathing treatments will be. Of course, the positive air pressure helps him breathe, as well. We'll try this for the next 2 to 3 hours."

"So this might not be enough? If this doesn't work, then what?" she asked nervously.

"Dr. Jameson is a pulmonary specialist who's also working on his case. If this doesn't work, she thinks he'll need a ventilator."

Lisbon stiffened, resisting the information, the lack of certainty. And she didn't care for this version of Ally Turner. This Ally wasn't the woman she had by her side all night helping Jane. This Ally was giving her doctor-speak, what Jane called "that creepy, cold doctor vibe." With calm detachment, Ally was telling her Jane might have to go on a ventilator, a form of life support. Her rational part realized the professional detachment was necessary, just the same as it is for cops. Emotions were a handicap when cold logic was best for dealing with a crisis. The warm, in-love-with-Patrick part, however, was scared by the detachment. Irrational or not, she couldn't help but want Jane's doctor to be passionately committed to his recovery. Lisbon swallowed with difficulty and tried to set aside the tsunami of emotion that was drowning her ability to think. She shook her head, realizing she needed to focus on the doctor's assessment and recommendations rather than indulge in useless emotional reactions.

"-I really hope the current treatment will be effective. I don't want to put him on a ventilator." Ally looked away for a moment. Contrary to Lisbon's silent rant, Lisbon realized Ally was struggling to maintain that calm detachment needed for her job. "Of course, intubation and a ventilator can have undesirable side effects that aren't a risk with a simple BiPAP. Let's both hope this works." She took Lisbon by the elbow, "Come on, he's asking for you. Things look a lot scarier than they are so you'll need your game face."

Spine straight and shoulders back, Lisbon walked into the room with Ally. She was still taken aback despite the warning.

Sacramento

"Are you sure we should be going there?" Rigsby asked his wife from the passenger side.

"You didn't hear her, Rigs. This is Lisbon and yet she's going crazy. I don't think Jane is doing well. We have to be there for her. For the both of them," she told him punching the gas. Lisbon told her to wait till the next day, but it sounded to her like Lisbon needed them now. And with Jane helpless in a hospital, they still couldn't afford to assume away any Red John risk.

Carson Springs

Lisbon was laughing. Jane was doing better, which helped her ignore the cumbersome face mask, tube, and machine. From the part of his face she could see, he was getting some color back. Jane had drunk half a cola and they were waiting on some pie. He tried the tea but made a face after one sip. She asked him if his breathing was better. He assured her it was, although he seemed a bit out of it.

The door opened. Lisbon smiled, thinking it was the helpful nurse who had scrounged tea and then pie for Jane. Her smile faded as she saw it was Ally with several other people.

"What's going on?" She wasn't surprised when Jane took her hand, his familiar response when scared or hurt.

"The monitors show that the BiPAP machine isn't helping. Well, it isn't helping enough." Ally turned and spoke directly to Jane. "Patty, your blood oxygen levels aren't rising enough. Unless we take more effective measures, you risk a heart attack and, eventually, other organ failure. Dr. Jameson and I agree a ventilator is necessary."

"No!" came the muffled protest from the bed. Jane tried to rise, but was gently restrained by two of the people who accompanied Ally.

Lisbon stroked his arm. "Jane, take it easy. Let me talk for you." He relaxed against the bed, still tense and frowning. The medical personnel stepped back and tension in the room eased.

Lisbon turned to face the doctor. "Ally, I've been talking with Patrick for the last two hours. He feels better. How can he need a ventilator?"

"Lisbon – Teresa, I'm sure he is feeling better than he was at the cabin. But that's not the right basis for this decision. The monitoring shows he is gradually losing ground. The strain on his heart is of increasing concern as well. I told you I don't want to do this unless necessary. But it is necessary. This literally can save his life."

'But he's refusing that treatment."

Ally took a deep breath. "His blood oxygen levels are so low that the patient's – Patty's – decisions are not deemed fully competent. As his medical proxy, the decision is yours to make."

Hand still on Jane's arm, Lisbon felt him tense at her words. She looked at his face. She knew he was scared. Jane hated hospitals, hated being out of control, hated not being able to speak. His mother had died of leukemia when he was ten, the start of his lifelong aversion to doctors and hospitals. His stay in the asylum after the murders transformed the aversion into acute fear of being hospitalized.

"Ally, give us a minute alone, please." She waited till she and Jane were alone.

"Jane – Patrick, I know you're afraid of this." She could feel him shudder under her hand. "I talked with Ally. And it's not just her, Dr. Jameson is a pulmonary specialist. You know that?"

He nodded but didn't say anything.

"What they say makes sense. If the current treatment isn't working, you have to let them do something that will work." He looked away. "Jane! You're risking a heart attack, and that certainly is life-threatening. Other organs can shut down without effective treatment." He shook his head. He didn't have any counter arguments, but clearly wasn't willing.

She bit her lip. "Jane, we're finally going to try to have that future together. I love you and want that. Don't you? Give yourself, give us, the best chance to have that." He swallowed, still unwilling to face her. After a moment, he nodded. His grip was painfully tight.

Lisbon stepped outside the room. "Do it." Ally looked at her, relief and gratitude plain in her eyes. So much for professional detachment, Lisbon thought, but was comforted anyway.

Ally told one of the respiratory therapists that they would be proceeding with the ventilator. "First we're going to give him a sedative. He'll go to sleep. The RT team will intubate him and put him on the ventilator. He'll probably sleep for the rest of the day and maybe some of the night, so don't be alarmed. It's normal to cough and try to get a foreign object out of the throat. He'll remain on sedatives to minimize that reaction, but he will be conscious. He won't be able to talk as long as the breathing tube is in place."

"Uh, how – how long will he have to remain on it?"

"That depends on how quickly he responds. Hopefully, no longer than a day or two. Patients ready to come off a ventilator must be stable with normal temperature and vital signs, and be capable of coughing up secretions. Because of the bilateral pneumonia, we'll take special care to be sure he's getting enough oxygen as we wean him from the machine. He may still need BiPAP or CPAP for awhile after. Believe me, we don't want a patient on a vent any longer than necessary because of the risk of side effects."

Acutely aware she was responsible for making the best decisions possible for Jane, Lisbon asked the obvious question. "Like what?"

Ally grimaced, clearly not wanting to raise her anxiety about problems that might not occur at all. "Ironically, the main ones are pneumonia and trauma. Elderly patients on a ventilator often acquire pneumonia. Also, a ventilator can cause lung damage, a pneumothorax - where air escapes into the chest cavity, and abrasions to the trachea or vocal cords. Patrick is young and in good health other than the pneumonia. There's every reason to be optimistic."

"Thank you," Lisbon said coolly.

Ally was working hard to maintain her professionalism but she couldn't do this to Lisbon. Ally had always promised herself she would balance professional detachment with treating patients and their families with empathy. She leaned in and offered Lisbon a hug. Lisbon accepted. Ally wasn't shocked when she hugged her back. Lisbon needed this comfort and Ally saw no reason not to give it to her.

Lisbon went back into the room with Ally. "it's going to be okay Patrick. I'm right here," Lisbon told him. She noted the sedative injected into his IV line was already taking effect.

Ally touched her arm. "When he wakes up he'll be on the ventilator. You'll be able to stay in here with him. But now I need you to wait in the hall while we do this procedure."

"No! I promised I'd stay." She glanced at Jane. His eyes were closed and he showed no signs of being conscious.

"You don't have to prove how strong you are. If I didn't have to be, I wouldn't be in here."

Lisbon looked back to the bed that the RT team was currently flattening. One person removed a long tube from its sealed packaging while another opened Jane's mouth and positioned his head back. Lisbon grabbed the bag of Jane's clothing and fled the room. Safely in the hallway, she leaned against the wall and tried to calm down. She still couldn't believe he was this sick. And she was falling apart! A pleasant holiday to a life-threatening emergency within one day. A sleepless night hoping they could get help in time. And now she was making life and death medical decisions for Jane. Crap. Based on this holiday, the relationship thing is certainly overrated. She shook her head. Jane's gonna be okay, she tried to convince herself.

She tried to stop her hands from shaking when his things spilled from the plastic bag. She picked up his shirt then noticed the small, velvet box underneath. She opened the box. Tears overflowed and spilled down her cheeks. Far from questioning the relationship, after seeing the ring she decided there was no way Jane wouldn't get better. He had to so she could be his wife.