"Officially, he's gone to a seven on the scale guys. He withdraws and has a reaction to painful stimuli. This is good news. Unfortunately there's still no eye movement or opening and still no verbal responses but this sign is hopeful. Very good job Aaron. Your doing okay, but we were hoping for better. Dr Winters will examine your right leg whilst I, Dr Peters and Dr White talk to Dave, Sean and Jess outside okay? Sean, Jess, Dave?"
"We'll be right back Aaron and we'll only be right outside."
The 3 of them followed the 2 doctors and one of the nurses outside of the room.
"He's doing okay and the improvement on the GCS scale is a good sign. Physically he's doing okay. We'll keep him on the antibiotics, fluids, morphine and IV nutrition to help support him. Dr Smith will talk to you about keeping him moving as much as possible, moving his limbs, except his right leg of course, moving him to avoid bedsores, that kind of thing. Sean, we'll need you to consent to a couple of long term coma care options. First we'd like to put a nasal gastric tube into his stomach. This is a tube that goes up his nose and down the back of his throat and directly into his stomach. Once we place it, it can stay in and will means Aaron can be syringe fed liquid food. He'll need to be sat upright but it's a way of feeding comatose patients. Right now we need to look after his body and by syringe feeding him, we can help give him as much strength as possible to pull through and wake up. The tube wouldn't hurt him. We'd make sure of it. Once it's in, he won't really feel it. When he wakes up and can eat orally and normally, we'll take it out. It'll just be whilst he's in the coma. But to put the tube in, we'd need you to consent."
"Sure, sounds good and if you think it's best for my brother then it's fine with me." Sean signed the consent form Dr Simpson held out. I'll even help feed him. I'm sure some of the guys can help hold him up to."
"Sure, that's fine. Thanks Sean. Can you also sign the form underneath, consenting to syringe feeding your brother liquid food?"
"Course."
Sean signed the second form before handing the clipboard back to Dr Simpson
When Dr Smith comes down, you'll need to consent to him starting physical therapy. He'll not only do physical therapy on your brother now but after Aaron wakes up, he'll still need physical therapy and when his cast comes off his leg, Dr Smith will continue physical therapy on his right leg to help your brother's leg heal up and so Aaron can walk on it again. There's another long term care need we need to discuss for your brother. Whilst he's got the catheter in, which can stay in fine and his urine can and will simply continue draining into the urine bags, his other bathroom need is another matter. You see coma patients can't control anything, including their bowels and bladder. So whilst Aaron's in the coma, not only can he not control his urine, but he can't control his bowels, so when his body gets an urge, they'll simply let go. For now your brother is doubly incontinent. To keep him as clean as possible and to ensure he doesn't have to lie in any mess, the nurses would like to put your brother in adult diapers. The catheter will ensure all urine drains into the bags so the diapers would only be for his bowels. The nurses will check them regularly and clean him up and change him at the first sign he's had any movement and needs cleaning up. He'll be kept as clean as possible. The catheter will ensure he stays dry. Once Aaron wakes up, he'll be able to control his bowels and bladder again but whilst he's in a coma, if he needs to go, his body will just let go."
"Jess, what do you think? Aaron in diapers? He'd hate that so much."
"Either he wears diapers or the nurses have another option. Manual disimpaction. Or they can simply wait and if he does have a movement, he'll soil the bed. But diapers will ensure any faeces stays clear of his right leg and that he stays as clean as possible."
"Can I ask what that manual thing is? Or should I just imagine?" Sean visibly cringed.
"Simply put, we help your brother have a bowel movement, Sean, clean his bowels out regularly. Sometimes we use enemas and let the patient empty their bowels into bedpans, other times we literally have to go in manually and help encourage the bowels to move. It's up to you though, what option you choose for your brother. If he wears diapers, we'll keep him clean and dry and at the first sign he's had a movement, we'll be in to clean him up and change him into a clean diaper. He can keep the catheter in which would keep the diapers dry of urine. As he's lying in bed under covers, he's covered up anyway so no one will see them and we can do our best to make sure his son never knows his dad is having to wear a diaper. We are used to doing our best to prevent young visitors or children from finding out anything about the patient being in a diaper. The manual option would be more uncomfortable for your brother and not the best option considering his badly broken right leg, but it's up to you. You can think about it for now and take time to decide. Or you can choose to not go with either and leave your brother as he is but then he'd risk soiling the bed. Whilst we don't mind cleaning him up and changing his bed, it part of our job, it would risk his right leg, both having to move him and any faecal matter getting on his cast or near any wound on the leg."
"Jess what do you think? You are a nurse. Dave? What do you think?"
"Whilst he'd hate it and the idea of it Sean, I do think, as a nurse, diapers would be the best option for Aaron. But you're the one who has to decide and consent to anything."
"I'd have to agree with Jess, Sean, even though I know Aaron would hate it and hate even the thought he was wearing diapers or needing them at all."
"In that case, I think the diapers option is best for bro. You promise you'll do your best to make sure Jack doesn't find out his dad is in a diaper?"
"We promise Sean, as far as we're concerned, he'll never know."
"In that caseā¦" Sean signed the third consent form before he, Jess and Dave went back into Aaron's room where Dr Winters was just finishing checking Aaron's broken and casted right leg and was writing on Aaron's chart. "His leg looks okay, I'll check it again tomorrow. But you arTe doing okay Aaron."
"Tina, can you get us the supplies for a nasal gastric tube? Aaron we're going to put a tube up your nose and down into your stomach. It'll stay in place whilst your comatose and allow us to syringe feed you liquid food directly into your stomach. The tube won't hurt you and you should barely feel it once it's in place. It's only whilst your in this coma. Once you wake up, we'll take it out and you can eat normally, I promise. Actually are there any strong guys next door who might be willing to help hold Aaron upright and help us insert the tube into his stomach, Dave?"
"Sure, I can think of at least 2 or more guys. How many do you need?"
"If you 3 help, maybe 3 more?"
"Be right back."
Dave hurried to the room next door.
"Hey Morgan, Jack, Sam, you guys help the docs and us whilst the doctors put a tube into Aaron's stomach so he can start being syringe fed? He needs to be held upright."
"Sure."
"Need any more than 3 guys, Dave?"
"Not right now, Stephen, but maybe all the guys can help with giving him a quick wash after the docs have finished. For now, Morgan, Jack, Sam? Come with me?"
The four men hurried back to Aaron's room next door and, as they talked to Aaron throughout, they helped Sean, Jess and Dr Peters support and hold Aaron sitting upright, Aaron limp and heavy in their arms, as Dr Simpson, Dr White and Dr Winters inserted the tube up Aaron's nose and down the back of his throat into his stomach. After the tube was in, Sean and Jess helped give Aaron his first syringe feed and syringed liquid food down the tube and into his stomach. Aaron was kept sitting upright, supported by all the others whilst they ensured the food settled and stayed in his stomach. After several minutes, they carefully laid him back down and settled him so he was comfortable again.
"Thanks guys. Tina, best get that diaper on, just in case. Sometimes after the first feed and all the moving of the patient can stimulate the bowels."
Morgan, Jack and Sam, who didn't know about Aaron being put in diapers, stood there looking completely confused and in a little shock.
"I had to consent to him being put in adult diapers guys. Sorry. But apparently whilst he's in the coma, Aaron's doubly incontinent and can't control both his bladder and his bowels. It really is the best thing for him right now. Bro, I am sorry. I know you'll hate it and probably hate me forever, but you do need to be put into diapers, bro, at least for backend business. You'll keep the catheter in for your pee and any urine will keep draining into the bags. But you need diapers bro for backend. It'll only be whilst your in this coma, so it's another incentive to wake up. The sooner you wake up, the sooner you no longer have to be put in the diapers, bro."
"That's a good point Sean. Very good incentive for Aaron that. Aaron, you'll definitely want to wake up soon. I know you will. Derek, Sam, Jack, thank you, for your help. You might want to wait outside now."
"We have to make sure Jack doesn't ever find out, Derek, about the diapers and his dad needing them and wearing them."
"Definitely Sean. We promise little man won't find out from us. We'll wait outside. Besides being put in diapers and having the tube up his nose, how's Hotch doing Sean?"
"Not too bad, Derek. Hey Dave, how about we go next door, tell the others how Aaron's doing whilst the nurses put him in a diaper?"
"I'll stay here, with him Sean, and help put him in a diaper. Sorry Aaron, but you do need it, I'm afraid."
Whilst Jess stayed in the room, Sean, Morgan, Jack and Sam followed Dave to the room next door. By this time, Will, J.J, Spencer, Kate and Chris had arrived.
"How's Hotch doing? Any better? We heard the doctors were in with him, so we came straight here."
"He's about the same. Oh but you know how yesterday his coma score on the Glasgow Coma Scale, was five? It's up to seven. He physically withdrew from painful stimuli and had some response to the painful stimuli, which is good news. But he hasn't made any movement, hasn't opened his eyes, hasn't made a sound or anything. He's got a nasal gastric tube up his nose and in his stomach now and he's just had his first syringe feeding of liquid food being syringed down the tube into his stomach. Oh but, you all have to promise not to say a word to Jack, Henry, Meg or anyone under 18. Jack can never know this about his dad. But whilst Aaron's in this coma, he's doubly incontinent. He's got the catheter in and any urine drains into the urine bag. But until he wakes up, he's having to be put in adult diapers."
"Oh man, Hotch is so gonna hate that, Sean!"
"Yeah well, when he wakes up, he doesn't have to wear them any longer. Plus if anything, he'll hate me. I had to consent to it and okay them putting him in diapers. But it's in his best interest right now. Even Jess said so. And, cos she's a nurse and knows Aaron so well, I trust her opinion and judgement more than my own. I know it's in his best interest, even if he hates it and, when he wakes up, wants to kill me. Plus, it's another incentive for him to wake up quicker."
"That is so true Sean."
"Did Jack go to school okay and is he okay Will, J.J? He seemed okay when me and Jess spoke to him.
"He was okay. We still had to convince him that his dad would want him to be in school and that it was best for him to go to school, but he's okay. He did have a broken night. After he spent over an hour worried before he finally fell asleep out of tiredness, the poor little guy was exhausted, he woke up at midnight and was so worried about his dad and worried his dad would die. I spent about an hour sitting with him enjoying hot cocoa and talking to him before I convinced him to at least try and go back to sleep. But I had to sit with him til he fell asleep but he was exhausted and it was 1 in the morning but it didn't matter to me. He was awake by six, worried so much about his dad again. Me and J.J found the little guy sitting dressed in the kitchen waiting for us to get up so he could call you Dave. Only then was he happy. But I made him and Henry chocolate chip pancakes and bacon for breakfast to try and cheer him up and he at least ate a good breakfast. He didn't want to go to school and wanted to come here but after talking to you and Jess, Sean, he agreed to go to school but even after that, me and J.J had to convince him again before we left for school. But he's so worried about his dad and we can't blame the little guy. It has to be tough on him but we're trying to be there as much as we can for him. He really can't wait til school finishes and he comes here to see his dad again."
"I'll bet he can't. Thanks though Will. Listen, me, Dave, Morgan and some of the others are gonna go by Aaron's apartment later today. We're gonna bring photos, books, CD's, photo albums, stuff like that for Aaron and to put up around the room, make it more homely for him."
"Sounds like a brilliant idea, Sean. Want me to come help?"
"Yeah and if you came to help, you could maybe pack another go bag or two for Jack if you wanted, so he's got plenty of stuff. Plus maybe if you wanted, take a few action figures or toys, maybe even a photo or two that Jack could keep and look at whilst he's at yours if he wanted to. Maybe a picture of his mom, of him and his dad, of them as a family, or of Jess or me, or at least a photo of each. Whatever you think might be worth having to make him feel better and that he can look at if he needs to. I'm sure Aaron won't mind and would think the same."
"Sure, thanks Sean. Might be a good idea, actually so thanks. Oh, got the day's papers for you on our way up here." Will handed Sean a couple of newspapers "Sorry, this is all they had but their the main papers."
"That's fine, Will. Thanks. How much do I owe you?"
"Nothing, don't worry about it, really."
"Appreciate that. I was gonna read them to bro, so he can be kept to up to date, but thanks, man. Appreciate it."
"No problem."
Just then, Jess came in the room.
"Everything okay Jess? Whose with Aaron?"
"Two of the nurses. He's fine, don't worry Sean. Just came to tell you, you guys might want to wait a few minutes. They'd just put the diaper on and were tidying up when the results of the feeding and moving Aaron around had the effect they'd suspected it would have. Their cleaning him up now and changing his diaper. They'll spray of air freshener in the room too. Hey Will, J.J. Thanks for looking after Jack. He get off to school okay?"
"You mean bro actually had a movement?" Sean and everyone else's faces looked disgusted.
"Hotch, soiled the diaper Jess?"
"Yeah, but we thought he might given he'd had his first syringe feeding and been moved around. Often happens especially on a coma patient's first feeding. Just well he had the diaper on and shows he needs it."
"Talking of syringe feeding Jess, I forgot to ask the doctors, would it be like us, eating 3 times a day or is it less or more we'd have to syringe feed him? I'm happy to do it for my brother, no matter how many times a day."
"It is just three times a day, Sean, breakfast, lunch and dinner like we have. If he needs it, he can have another feeding before bed like if one of us gets peckish and has a snack before bed. But it's good that you've already done it once and now you know what to do, there's no reason you can't do it and feed Aaron whenever you want. I'm sure if we showed him what to do, Jack would want to feed his dad, too, and I'm sure he'd be careful and good at it. We'd help him of course."
"Yeah, he'd really want to help his dad however and whenever he can and your right, he would be good and careful, especially if we were helping him."
"Oh they said they've found a couple of tables and a CD play so, after they've finished with Aaron, maybe you, you Derek, being the big tough muscle guy, Jack, Matthew, Will, and any other strong guys can go with the nurses so they'll show you where the tables are and you guys can carry them to Aaron's room and set them up? Dave, go with them and make sure Sean here doesn't try to chat up Aaron's nurses, will you? Penelope, until Sean and the others bring Aaron and Jack's CD's later, maybe you could use your laptop and play some music? You don't by any chance have Aaron's favourite album do you?"
"I can get it. Easy to download. Sure Jess, love to. Be my pleasure."
"Thank you Penelope. Then after you guys have moved the tables to Aaron's room, could you men maybe give him that quick shave and bed wash? He's wearing the diaper so that area doesn't need worrying about. You can't touch and wash his right leg of course but wash his left leg, his torso, arms, neck, face? I'll help with any tubes and such but he'll need strong guys to help manipulate and move him a bit. Plus I think Aaron would prefer it if guys he knew washed him and cleaned his body.2
"Absolutely Jess."
"How many guys do you need? We're all up for helping."
"Well all you guys can help."
Just then Alex Blake, who used to be on Aaron's BAU team but who'd left to move to be with her husband in Boston, came in the room with her husband James, who was a M.D. Both were looking so worried.
"How's Hotch guys? We heard the nurses were busy with him and everyone was in here. Dave thanks for the jet by the way."
"No problem, Alex, good to see you. You too James. Thanks for coming. Sean, this is Alex Blake and her husband, Dr James Blake. Alex, James, this is Aaron's brother Sean. You know Jess here."
"Hi Alex, James. Thanks for coming here. You only just get here?"
"Yeah, but when we heard about Hotch, we so had to be here, Jess. How you holding up? And how is he? We heard he'd been hit by a car, broken his right leg in two places and been knocked unconscious. That he'd had surgery on his leg but that he was in a coma and on a ventilator. Nice to meet you finally Sean. We've heard a lot about you."
"All good I hope?"
"Yeah, so how is Hotch?"
"What's his GCS?"
"Seven. He's got no verbal responses, no eye movement and no response to commands. He did manage to move a finger on his left hand for Jack last night. But when the doctors assessed him just now, he just lay there. He does have a pretty strong reaction and withdrawal from painful stimuli and the doctors are hopeful and say he's doing okay and it's a good sign. He was only a five yesterday when he came in so he's already up to a seven. He was breathing on his own when he came in. He's only on the ventilator as they had to put him on it for his leg surgery and decided it was safest and best to leave him on it for now. They weren't sure if they could bring him off it without trouble and plus they want to make sure he keeps breathing for now. But he's in a deep coma and is lying there. He hasn't moved all night. He's just had a nasal gastric tube put in and has had his first syringe feed which went okay and he seemed to take to. The nurses right now are in there changing and cleaning him up."
"I take it that means he's been put in adult diapers right?"
"Yeah as of this morning. He's got a catheter in and all his urine is draining into a bag so the diapers are only for backend. The feeding and moving him apparently stimulated him and they'd only just put the diaper on bro before, you know. Anyway, their cleaning him up and changing his diaper now. After that we'll be able to go back in."
"Hotch, in diapers?" Alex looked a little shocked.
"Yeah, but he obviously needs them, Alex, as he's proven. Whilst he's comatose, he's doubly incontinent and has no control whatsoever. Once he wakes up, he shouldn't need them and should have full control again. What did his CAT scan show? Dave said he'd had one when he came in."
"It was clear. They couldn't see any damage or anything which is good. He also had a full body CT and apart from his right leg, he's got no other injuries."
"That's good. Dave said he'd had surgery on his leg and had it pinned. Whose his doctor here?"
"Dr Simpson, head of the ICU. He's also got Dr White, the chief of the ER, Dr Peters, head of neurology, Dr Winters, a Dr Smith, the head of physical therapy, who we should meet soon. He's going to start physical therapy to keep Aaron moving and mobile as much as possible and then after his cast comes off after he goes home, he'll do physical therapy with Aaron on his leg to get it fully healed."
"Dr Simpson, as in Andy Simpson?"
"You know him?"
"Yeah, an old med school buddy of mine. Whenever I've been in town, we've caught up and we've stayed good friends over the years. He's a great guy and an excellent doctor. He's clear got the best of the best. I actually know them all. Dr Simpson is the best ICU doctor in the country. Dr Peters is the top neurologist in the state and the best in comatose patients in the country. Dr Smith is the top physical therapist in the state. Aaron's clearly got the best care. Dr White is one of the most renowned doctors and the leading ER chief in the state. Dr Winters is the best and top surgeon in the country. Jess, Sean, would you mind and would it be okay with you both if I collaborated with his doctors and was involved in Aaron's care? I could help explain anything medical and make sure he gets the best of everything, though clearly he already is. Plus all his doctors I know and trust."
"Of course, James, that would be amazing. Sean?"
"Definitely. You could even help in explaining anything medical to me that, due to medical jargon and my lack of medical knowledge, I wouldn't understand."
"Course Sean."
"Thanks James. Be awesome to have you involved in bro's care."
