"Okay Tony we're almost done, you did well." Dr Pitt spoke to his unconscious patient, his hands sliding the scope out of the endotracheal tube.
The nurse took the tube and placed it to the side, Dr Pitt came around to listen to his patient's breath sounds, they sounded better than before, but knew they still needed to improve quite a bit before he was out of danger.
"Watch him for any bleeding, a small amount is of course normal, but if you have anything that is more than a small amount call me right away." it was a precaution,bleeding could be a risk of the procedure.
"Where's Mr Gibbs? I was consulted on him also." Dr Pitt asked , as the staff noticed for the first time that he was missing from the room.
Ducky too, was also hit by the realization that Gibbs had left, a very unusual action given his propensity to always be there for his team especially Tony.
He looked around to see the other team members glued to the isolation glass, a look of terror on their faces, he needed to talk to them, to reassure them of what their plan was for Tony, getting him off the vent.
Outside the isolation room, Gibbs walked back in, his team still standing at the glass quietly, he was no longer wearing the gown but a sweat shirt, sweat pants and a pair of socks and snickers
Abby turned to see her boss, she ran over, "It's over, he's okay Gibbs." she spoke it low into his ear, grabbing him around the neck, doubt evident in her voice, she was scared. She held on tight for several seconds before finally letting him go.
Gibbs nodded, glad to see that his agent was doing better than he had been when he had left but he knew that Tony wasn't out of the woods yet, he was still on the ventilator, he knew the risks for Tony, Dr Pitt had explained them when Tony had the plague, the man's words still resonating in his head, 'If Tony is ever placed on a mechanical breathing apparatus he might not come off due to the damage done to his lungs.'
Ducky was now outside the isolation room, standing beside the AWOL patient. "Jethro, the doctor is looking for you. Do I need to remind you that you have not been discharged yet?" the look of concern on his face.
"No Ducky, you don't have to remind me." he continued to stand there,holding onto Abby's hand,"How is he?"
Ducky looked at the others who were looking at him with great anticipation of what was happening with their friend, "He is doing better, but he was and will continue to have difficulty clearing his lungs, they have been damaged by the Y Pestis and getting out the phlegm is difficult, and will be more difficult when they take out the tube. He will need all of us to help him get through this difficult time."
Ziva looked over at her friend, again the nurse was having to suction his tube, his body reacting even under sedation, his restrained hands continued to attempt to reach up to remove the tube. She was overwhelmed again at the prospect that her partner could possibly die, her friend.
"I need to check on something." her excuse sounding flimsy, even to her own ears, but she had to get away, to the waiting room, she could not stand to see Tony suffer anymore.
Tim watched as Ziva exited the isolation area, knowing that he wouldn't be far behind but wanting to give Tony some of his strength, wanting him to get past this and get better, even call him Probie or Elf Lord, he just wanted his friend back to normal.
After several minutes he too followed the Israeli out the door, he too felt helpless as he watched his friend struggle. As he walked by Abby he took her hand, she was in tears, she was struggling the most, her relationship had been the longest with this man, other than Gibbs and Ducky's, there was a bond, and she didn't feel right walking away.
She was Abby, Tony's little surrogate sister, he had saved her, had loved her and had always treated her with love and respect. He was her big brother and right now her big brother was very sick, and she knew what he had gone through last time, she knew how he had suffered when the others were not around. Guilt overwhelmed her as she was lead out of the room, feeling that she too should have the strength to stay but unable to find it.
Ducky was watching Tony struggle again, Dr Pitt and the nurse at his side, "It is very unlike you to abandon Tony. What is wrong with you Jethro?" Ducky asked wanting to hurry and get back inside but wanting Gibbs to also enter with him.
"I made a mistake but it won't happen again." his voice low but determined. he pulled together the courage to walk back in and stood and took his place at his agent's bed. He then reached down and picked up Tony's hand, he bent over as close as his body would allow and whispered into Tony's ear,"Tony, I'm here. I won't leave you again"
It was as if Tony heard him through his drugged and panicked haze, his body visibly relaxed, his breathing evening out.
Dr Pitt walked over, "Mr Gibbs, I hear that you are a patient too but it's a little hard to tell without your IV and gown."
"If you want to examine me, this will have to do, I'm not leaving my agent again." his words spoken in seriousness, he could not leave Tony until he was off the machine, he had to have Tony fighting, the way Kate made him fight, he would have that obligation now.
"I won't argue with a marine." he pulled out a new stethoscope and placed it under the sweat shirt and started listening to his patient's lungs, after a few minutes he smiled, "I am officially discharging you. You have great, healthy lungs, Tony would appreciate that statement. Tony told me you had never had allergies or even the flu during his last visit."
Gibbs laughed to himself, not even a cold, he thought to himself. "Can I stay?"
"He seems to do better when you're here, I have no problems as long as you rest too. You are a drowning victim too." Dr Pitt gave his patient his stern look, wanting him to realize that he needed to rest as much as Tony.
"What do you mean, too?" Gibbs asked,needing an answer, his own guilt resurfacing.
"It's called dry drowning. Even though didn't take in as much of the water he must have inhaled something during the rescue, and with his damaged lungs he quickly went into laryngospasms, he was lucky to have been intubated so quickly or he would have died, I've seen it happen to ten year olds. We are going to have to get him off this machine though, hopefully in the next couple of hours, I don't want him on it any longer than necessary."
He started to walk out to the desk when he turned, "I'll write your discharge but remember, you need to get some rest, that bed is still yours if you need it."
Gibbs nodded his appreciation and placed his focus on Tony, who seemed to be resting better now.
Waiting Area
Abby and Tim sat together, their hands still intertwined, still giving each other emotional support, watching Ziva as she paced the floor.
"Ziva, you're making us nervous." Abby finally commented on the nervous movements of the trained assassin, it looked as if she was stalking her prey.
"I can not help it. Tony is in trouble and I do not know what to do." her words very telling of her state of mind.
"Tony has very good doctors and nurses Ziva, he made it through the plague and he was a lot worse." Tim tried to be encouraging, but if fell flat on the pacing ninja skilled woman who seemed more agitated by the statement.
"I have read about the pneumonic plague, the y pestis can go dormant and when a patient is stressed the effects can become evident again. Tony can die from complications, Gibbs knows it too, I could see it in his eyes. Why else would he abandon Tony unless he knew more than us?" she stopped speaking, her movements halted by the presence of Dr Pitt standing in the room with them.
Tim stood and shook hands with the man whom they had become very well acquainted with when Tony was in here the last time, "This is Tony's new partner, Ziva David." Tim introduced her to the man, who shook her extended hand.
"How is Tony?" she asked worriedly.
"Tony is in some trouble I'm afraid but we are going to attempt to get him off that machine this morning. He is a fighter, and he is definitely fighting that machine, which is actually a good sign, so we are going to take him off as soon as he can breathe on his own."
"What about the y pestis? Will it effect him? I have read that it can cause problems later, if a patient is having other health issues." her voice matter of fact now, wanting details not platitudes.
"I don't think it will have any effect on him if we can get him off the machine and get him working on getting that junk out of his lungs, he is still a healthy man otherwise, much to my surprise but from what I hear, Ducky keeps him straight." he smiled, wanting to negate any fears that they might have regarding the plague.
"So Tony is going to be okay?" Abby asked, feeling a sense of excitement.
"When I get him off the machine I will know more but right now his lungs are not that bad, but they are damaged lungs from the y pestis and damaged lungs are harder to diagnose because they can incur problems quickly. So right now I am going to get him off the breathing machine and see how he does, which doesn't mean he will stay off but I feel Tony will try harder if he is awake and alert than if he would if he was kept sedated, he tends to fight the machine." he stood to leave, " I have to get back inside but I will keep you updated and Dr Mallard will also help keep you guys in the loop. He smiled and walked back inside of the isolation area.
They all sat down except Ziva who restarted her pacing, the doctor's words were comforting but she knew Tony, he never did things the easy way.
Isolation Area
Dr Mallard and Gibbs stood at the top of the bed as the nurse and Dr Pitt were preparing to remove the tube, Tony able to take breaths on his own, the machine not assisting as much now.
Tony's sedation had been stopped, he was opening his eyes now, his hands still restrained though, not wanting him to reach up and remove the tube. The fear on his face, a panic that patients tended to get when the tube was about to be removed, Dr Pitt knew he had to cut through Tony's panicked state and he needed his friends to assist.
"Tony, listen, we are going to get this tube out of your throat but I need you to calm down, and I need you to cough so I can pull out the you understand?" Dr Pitt's hand reached up and disconnected the tube from the ventilator, the respiratory therapist there if the patient got into distress,
"Tony, this won't take long at all, all you have to do is cough." Ducky reiterated the doctor's words, holding onto his hand, wanting him to be able to listen to their instructions.
Tony was feeling more panicked, he wanted the tube out, it was making his throat hurt, he felt as if he were smothering.
Dr Pitt shook his head, he didn't want to medicate Tony but was not seeing another way,"Give him a half milligram of Ativan IV."
"Wait!" Gibbs interrupted,not wanting Tony unable to respond again, knowing how Tony did on medications. "Tony!" his gravelly voice seemed stronger. "Tony I need you to listen, I need for you to calm down so Brad can take that tube out. Do you hear me?"
Tony visibly calmed, his eyes shooting up and to the left to see his boss. He nodded, and then looked over to the man who had once broken his leg, his hands were still moving, but quieted, as Ducky and Gibbs both grabbed one and held onto to them.
"Okay, just cough and we will do the rest, you can breathe on your own but it will be a little difficult at first until after the coughing spell passes, then you will be fine." he explained as he reached over and deflated the balloon, then instructed Tony,"Cough!" Tony complied, the tube quickly removed.
Tony was wanting to sit up as he coughed and the phlegm came up into the pink sputum bowl.
"Take a deep breath Tony." Dr Pitt instructed as he kept his voice calm, wanting Tony to do as he was instructing, not wanting to replace the tube if he couldn't calm down.
Tony again nodded and attempted to comply but his throat and chest were not cooperating."Can't ...stop ...coughing!' his voice ragged, his lips taking on a tint of blue.
The respiratory therapist replaced the tube with a nasal cannula, turning on the oxygen, wanting his patient to just calm down so he could get air to his lungs.
"You want me to place him on bipap?" the therapist asked as he started to prepare the machine.
Gibbs had given Tony enough time to calm down on his own, his hand reaching up and given Tony a slight tap to the head,"Tony you need to breathe!"
"Yes boss. Sorry boss." he was calming down, the order recieved, Gibb's words had reached his ears.
He laid back down onto the bed and looked down at his restrained hands, his voice gravely, almost a whisper, "This reminds me of the movie 'One flew Over the Cuckoos Nest' a 1975 classic starring Jack Nicholson, Louise Fletcher and by directed by Milos Forman." his reference more to the restraints on his hands.
They all smiled, Tony was acting like Tony.
TBC
