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Casey seized again in the ambulance, his body spasmed and strained against the thick black restraints. Big dark bruises would soon form where they lay. He struggled to breathe. As his body convulsed he couldn't take a breath. The constant straining burst a blood vessel in his left eye. He was completely unaware of his surroundings and soon left the conscious world entirely.
"Matt Casey, 33 year old male, known seizure disorder, he's been seizing on and off for at least half an hour with no return to consciousness. Given midazolam before we arrived and diazepam at the scene but seized again on route," the paramedic announced as Casey was rushed into the emergency room with Shay by his side. Severide arrived moments later having sped along behind them but they were both ushered away by the nurse.
They administrated more diazepam when Casey seized again but the convulsions continued for another four minutes until there was just a slight tremor in his right hand, at the rate he was going they were worried about oxygen deprivation, dying neurons and further brain damage. The monitors screamed and warned them of his racing heart and low oxygen level. The EEG showed the unusual electrical activity in his brain.
"He's still seizing," the junior doctor said as he looked up at the monitor.
"Get a central line in," the doctor ordered.
"His pupils are fixed," a nurse stated as she checked his reactions.
"Get me some lorazepam and phenytoin."
The nurse passed the doctor the syringe with a questioning look.
"He's dead if we don't." The doctor would rather overload Casey with benzodiazepines and risk respiratory failure than let him continue seizing. The EEG activity normalised, she checked his O2 stats. "Can I get an arterial line in," she asked the junior doctor by her side. She leant over Casey to check his pupils. "Pupils are reactive," she stated with a satisfied sigh. "Matt? Matt, can you hear me?"
Casey's eyes flickered open and closed but the doctor was happy with that reaction.
"Has he got family here?" she asked as she took off her gloves.
One of the nurses nodded. "Waiting room."
The doctor went to inform them of Casey's condition. The change in medication had set the seizure off. Switching from one medication to the other had caused a neurotoxic reaction, it was rare but it happened and when Casey discovered this he would laugh, his doctor would become concerned at the reaction but Severide would know he was laughing at the absurdity of the situation, of course something rare would have to happen to him after everything he'd already been through.
The ER doctor barely got his name out before Severide and Shay rushed over to her. "How is he?" Severide asked urgently.
"It's a dangerous situation for his body to be in, especially with the damage his brain has already sustained, his doctor is in surgery at the moment but will see him as soon as he's out, all signs indicate that he should be ok but…" she explained.
"But brain injuries are tricky," Severide supplied, "Yeah... we know."
"We're transferring him up to the ICU, the drug's he's been given put him at a high risk for respiratory failure," she said.
"The drugs you've given to help him might stop him breathing? How is that…" Severide began with annoyance.
"Kelly..." Shay warned. "They know what they're doing. Can we see him?"
Casey had started to hide his limitations well but now he was stripped bare, in pain, exhausted and nauseous, he couldn't even think about disguising any of his inabilities. His eyes were unfocused from all the medication they had given him, he could barely think at the moment and would likely lose this brief moment of lucidity but he was glad Severide was with him. His body ached. There were already vivid bruises on his pale skin from the restraints in the ambulance.
"Hey," Severide spoke softly, "You're ok."
Casey felt a gentle squeeze to his hand as Severide reassured him, he didn't know what had happened, why he was here, or exactly where here was, Severide must have understood his expression, although Severide insisted he always had a slightly puzzled look about him nowadays.
"We're in the hospital but you're ok." Severide watched as Casey's eyes drifted close, the oxygen mask and EEG electrodes obscured most of his face but Severide was happy that he didn't seem to be in any pain, his expression had been laced with confusion but that wasn't surprising.
"How is he?" Severide asked when the nurse checked Casey's vitals.
"His O2 stats are low but they're holding where they are, his…" she stopped, "He should be ok."
"He was awake, sort of, he looked… confused…" Severide began.
"We won't know if there's any further damage until the drugs are out of his system; he's had a lot of nerve depressants and AEDs," she explained. The aftereffects of Casey's seizures, the disorientation and tiredness, tended to last about a day; he would sleep it off and would spend the next day doing very little. The aftereffects of the status epilepticus would be much more severe, if the doctors had been unable to stop the seizures they would have been forced to put him an induced coma, fortunately for his already damaged brain that had not been the case. The threat of respiratory failure was high, Severide knew the doctor wouldn't have put him in the ICU for no reason, he needed the critical care of all the staff, his brain couldn't afford to be oxygen deprived for long and he was still at risk for further seizures. Casey was still attached to the EEG monitor and he had a rebreather mask feeding him a fresh supply of oxygen. The central line had been inserted so they could provide medication to his body as quickly as possible whilst the arterial line and pulse oximeter assessed his O2 levels. All the medication he had been given had depressed his nervous system so a catheter had also been inserted.
Over the next forty-eight hours they became increasingly satisfied that Casey hadn't suffered further neurological damage. He had been tested and prodded by his doctors, he hated the invasive setting of the ICU but he was too tired and disorientated to complain or become agitated. Severide and Shay spent most of the visiting hours by Casey's side. James and popped by as well. His whole body ached, he could barely lift his arms when asked but the doctors weren't worried, his body had been put through a lot of stress and was still quite heavily medicated. The rebreather mask had been replaced with a nasal cannula. He spent most his time unconscious and his brief moments awake were spent listening to voices and sounds, he could hear but he didn't understand, the drugs, mixed with his postictal state left him unable to make sense of his surroundings and unaware of what had happened; it was as if he was wrapped up in a blanket of darkness and stuffed full of cotton wool, it wasn't unpleasant, but it would be when he truly woke up to discover the aches and pain his body felt, the nausea that would spread through him in waves, the headaches and confusion.
"Shay…" Casey's eyes were opened and he looked at her blearily, his voice was barely above the sound of a whisper.
"Hey, Matt," she smiled and pushed the stool closer to the bed so she could take his hand. "Kelly and James are here too, they're just getting coffee."
"Coffee..." he repeated slowly. "I miss... coffee." He smiled tiredly and let his eyes close.
Shay smiled at his admission. "Tired?" she questioned when he didn't open his eyes again.
"Bright..." he muttered.
"Yeah," she said, briefly looking round the ICU at all the beds and monitors. "You're being moved to a private room later. Do you have a headache?" she asked when he scrunched his eyes up.
"Mmm..." he mumbled.
"Feel sick?" she questioned, knowing how nauseous he usually felt following a seizure.
He took a deep breath. "Not so... so bad," he responded.
"Ok, I'm going to see if they can give you something for the headache." She squeezed his hand as she stood up. "I'll be back."
Casey was curled up on his side in the private hospital room when Severide informed him; "You can go home tomorrow if you eat dinner and breakfast." Casey had been up and about in the last twenty-four hours; the catheter had him removed along with the arterial line and EEG monitor. He'd completed more of the necessary neurological tests once again and they were satisfied with the results. He was stiff and unsteady on his feet but he had joked it off by saying he was always unsteady on his feet now. More physical therapy sessions had been suggested and Severide was going to urge him to go, at least for the next few weeks.
The pain of his tired and aching body diminished any hunger that Casey should have felt after days with no food, only IV nutrition, but he ate dinner and kept it down despite the fact he could feel his stomach lurching with every bite. Severide saw the nausea Casey felt across his face, before breakfast they gave him some antiemetic's to prevent the constant feeling that he was going to be sick, it worked and Casey actually enjoyed his food and was soon discharged into Severide's care.
"Into bed," Severide said as he led Casey into the house.
Severide helped Casey out of his joggers and change his top before pulling the covers up over his friend. Casey lay on his side appreciating the familiar smell of the fabric conditioner on his pillow, thankful to be out of the hospital away from the scratchy sheets and unfamiliar sterile smells.
Severide copied Casey's smile and explained, "I've put the electric blanket on for an hour, hopefully you won't feel so sore when you wake up; I'm at home all day today and tomorrow. You don't need to be anywhere tomorrow so you can stay in bed if you want." He wasn't sure how much Casey had heard as he'd fallen asleep. Severide watched as the bed covers rose and fell in time with his steady breathing before leaving him be for the night.
Casey did spend the whole day in bed; he slept most of it, wrapped up in the safe cocoon of his duvet. Severide checked in on him, he made sure he drank and wasn't too hot or too cold but Casey wouldn't remember any of Severide's administrations when he woke up the next day.
"You're awake," Severide said with a little surprise when Casey appeared out of his bedroom. "And up," he frowned.
Slowly Casey walked over to the couch where Severide was sitting. I'm ok," he spoke, shrugging, "Might fall over and forget things but I'm not going to shatter."
"Ok," Severide nodded.
"I'm starving," he smiled, "Is it breakfast time?"
Severide grinned, "It's 1pm."
"Oh," he mouthed.
"Would you prefer breakfast to lunch?" Severide asked, standing up from the couch.
Casey nodded. "How long was I in bed?" he frowned, "How long was I in... hospital? Hospital right? … Don't really remember it…"
"You got home from the hospital yesterday lunchtime," Severide explained, "You were there for four days."
He frowned. "Didn't feel that long."
"You were pretty out of it most the time," Severide said.
He scoffed. "I'm always pretty out of it," he grinned.
Severide laughed and nodded in agreement, happy Casey seemed to be unaffected by everything that had happened, which surprised him a little as his previous seizure had left him unable to leave the house out of fear but Severide supposed if he had little memory of the events that took place it was a blessing; it had been petrifying seeing him in the ICU again, he could only think how terrifying it had been the previous time when they didn't know if he would wake. He shook his head of his morbid thoughts and smiled at Casey. "Let's go make some breakfast."
James and Casey were in the kitchen getting ready for dinner, it was Severide's first shift back at work since Casey had returned home from the hospital. "Can you pass me a fork please, Matt?" James asked as he cracked the eggs into the measuring jug.
"Uh huh," Casey put down the recipe book he had been holding and opened the cutlery draw.
"Matt?" James turned around to see Casey staring down into the open draw.
"I… I..." he stuttered, his eyes not leaving the vast arrangement of cutlery.
"It's ok, Matt," James reassured him, "You've had a rough week, don't worry about it."
But Casey did worry about it and he was preoccupied for the rest of the night, but fortunately the incident seemed to be forgotten by the time Severide arrived home in the morning, James mentioned it to him as they all needed to be on the lookout for any changes with Casey especially after his recent seizure.
Casey's words fail him not only when he's tired but when he was surprised. One afternoon a few weeks after his hospital stay he opened the door to find his mom and sister standing before him. He opened his mouth only to find no words came after his mother greeted him. "Matthew," she'd smiled warmly as if she'd not been uncontactable over five months ago.
His sister smiled. "Are you going to let us in?"
He frowned, he didn't want to invite them into his home but still lost for words he moved aside and allowed them to enter, as they walked further into the house he finally found his words. "Kelly's out," he said. This was important to him, he was currently on his own, trusted to look after himself for a couple of hours whilst Severide was out running, his sister and mother dismissed this important act of independence, they didn't know he was rarely by himself, they didn't know much about him anymore, but they hadn't before either.
It was strange seeing the two of them sitting together opposite him as he sat down in the chair without offering drinks or snacks, the thought never even crossed his mind, they had been at odds for what seemed like the best part of Casey's life and here they were together. They even sat the same way. Casey didn't say anything; he didn't know what to say.
His mother broke the silence. "How are you?" she asked. She eyed the silver medic-alert bracelet on her son's wrist, the wrist itself was thinner than she could ever remember.
"Fine," he replied stiffly, uncertain why they were here.
"You're not working?" she asked, a sore subject on Casey's part at the moment as he spent most of his waking hours feeling rather useless, he just shook his head. "Are you doing all right for money?"
"Yes," he said, agitation evident in his tone.
"Are you sure?" she questioned as she looked round at the house as if she was assessing the cost of its upkeep.
"I don't need your help," he stated.
"Will you be going back to work? I thought you loved your job? And what about your business? I was always so proud of you, Matthew," she spoke softly.
Casey's heart was racing and he had to take a moment to order his words. "I can't go back to work."
"What are you going to do? Christie says you've come on a lot since the accident," she said.
"Did… did... did she say she wanted to put me in... in... in a home?" he stuttered.
"She was doing what she thought was best," she stated, "Could you think about going to work now you're better?"
"Better?" he frowned, "I can't… I'm not allowed… I'm epileptic, I have seizures," he said, he didn't explain about his diminished cognitive skills and motor functions, why should he explain himself to his mother when she had seemingly disappeared, he shook his head, "Why are you here?" he asked scathingly, there were no floodgates to hold back his true thoughts and feelings so it was perfect timing when the front door opened.
"Case, I'm back!" Severide called into the lounge as he took off his shoes. "I'm gonna have a shower and then we can make…" he trailed off when he saw that Casey had visitors and after taking one quick look at his friend realised they weren't welcome. "Hello..." he announced slowly, "Christie, Casey's mom…"
"Hello, Kelly," Christie replied.
"Nancy," Casey's mom supplied.
"Yeah… We've met," Severide said.
"Right, at the firehouse," she replied, "Do you leave my son on his own often?"
"What?" he frowned.
"You heard me," she questioned.
"Yeah... I did," he frowned.
"I just found out that he's epileptic," she stated.
"Yeah… You'd have known that months ago if…" Severide began.
"Do you leave him on his own a lot?" she asked as if Casey weren't sat a few metres away from her.
"I can be on my own, I can even…" Casey trailed off, impressed with himself that he managed to stop the words that were about to leave his lips – I can even separate my washing into whites and colours now – a fact he'd been happy to tell the neuropsychologist in his session nearly a week ago.
"Honey, I'm not saying that," she replied softly, "But from what Christie's told…"
Casey shook his head. "I'm better now… What…" he stuttered again, "Wh... what do you want? I'm not... not... not going…" he stumbled over his words, he wanted to make it clear that he didn't want to be in an assisted living setting, or care home because that's what he thought when he thought of Christie now; she hadn't wanted him to be at home and the only reason he'd been able to come back here was because of Severide.
"We don't want anything, Matthew, I wanted to check on you, I am your mother," she replied.
"I'm sorry," Casey murmured.
Severide couldn't watch anymore of this, Casey was distressed and he too didn't fully understand why his friend's mother and sister were here after such a long time. "I think it's time for you both to go. We have plans," he announced, "Christie, you have my number; call me if you need anything."
They left. Severide closed the door behind them and walked back to find Casey deep in thought, unconsciously biting his lower lip, Severide leant down in front of him and quickly earned his attention. "What…" he stumbled, "… What did they want?"
"Don't worry about it, Case, they're gone and I don't think they'll be back soon," Severide replied.
"Don't… I don't get it," he frowned, "What…"
Severide sighed and place his hands on Casey's knees. "You know how you always forget stuff and laugh about it?" He smiled. "You should do that with this visit, forget about it, put it at the back of your mind, laugh at it."
He looked panicked now, he wasn't focusing on what Severide was saying. "I haven't seen her for… for what? Two years?" he questioned, "And Christie wanted…"
"Casey," Severide stated in order to draw him back away from his panic.
"Hmm?" he mumbled.
Severide continued now he had his attention. "They probably wanted to make themselves feel better by checking on you, something your mother should have done after all our missed calls," but Casey wasn't consoled, "And now their selfishness has made you feel like crap..." he said offhandedly. "It's Friday," he stated, a distraction technique.
"Movie night?" Casey questioned, a smile tugged at his lips, his distress had faded.
"Yeah," he smiled, "I'll go shower and then we'll have a whole movie day."
Casey woke up one morning to discover an empty dining room and an empty kitchen. He frowned as he checked the time, usually Severide was awake and up before him, he was out of bed the same time as usual so he immediately strolled into Severide's room without knocking wanting to know if his friend was ok. There was a startled yelp as he walked into the bedroom, a very feminine yelp.
"Oh…" Casey breathed, incapable of nothing more. It took his body a moment to comply with his brain but as soon as it did he turned on his heel and walked back out the room.
Severide stepped out the bathroom with a towel wrapped around his waist; there was no sign of Casey so he assumed he was still in bed so he slipped straight back into his room. "Your roommate walked in," the girl stated. He'd met her a few nights ago at a bar and she'd called last night, one thing led to another and she spent the night.
"Oh crap…" he muttered, "Was he ok?"
"What? Yeah..." she shrugged.
He sighed. "Erm… you can let yourself out… Jul…"
"Rebecca," she supplied.
"Rebecca," he smiled, "I'll call you."
"No you won't," she replied.
"No," he shook his head, "I won't."
Casey was sitting on his bed when Severide entered his room. "Who was she?" he asked.
"No one." Severide shrugged. He sat down next to Casey.
"Good to know you're getting back to your old ways," he smiled.
Severide scoffed. "Really?" he grinned.
"Thought you'd gone celibate," Casey laughed.
"Celibate, that's a fancy word for you," he mocked. "You don't mind that she came here?"
"Why would I?" Casey asked, "It's your house too, couldn't be here if you weren't… I'd probably burn the place down or starve or I dunno…" he shrugged.
"Useless without me," Severide joked.
Casey laughed. "Yup. Just keep bring the hot women home and I'm happy."
Severide watched as his laugh faded and glimmer of sadness appeared in Casey's bright eyes. "Hey," he touched his arm, bringing attention back to the present, "Looking forward to this afternoon?" he asked.
Casey nodded. "I am."
TBC