A/N: On request a third chapter of the storyline 'Crashed', hope it doesn't disappoint. Could stand alone but makes more sense if you read these chapters first. Tried to keep this one a little more light hearted but with enough HC to keep me happy. Enjoy. Medical notes at the bottom. And I'm afraid I don't know what the average time is waking from a coma I'm pretty certain it is dependant on the type of brain injury, age etc, so the statement in there is purely made up.
Chapter 10 - Crashed (part 3)
When John Watson finally cracked his eyes open, the only thing he could concentrate on was the immense pressure he could feel in his chest. He throat was tight and uncomfortable and mouth dry like cotton wool. The doctor picked up echoes of familiar voices around him, but his brain could not make out their words. Suddenly clearly a voice told him to cough, and after a pause it felt like his throat was being torn apart. He gagged violently and lost himself to blackness.
When he finally came to again everything seemed a little more clear, he cracked his eyes open, the world was lit dimly and the room around him was less bright and hectic. The great pressure in his thorax had dulled to a low thrum and the only sound he could hear was the gentle beeping of a familiar ECG monitor. John sat up slightly, immediately regretting the movement and stifling a moan.
"Easy mate." Lestrade said and the doctor cocked his head to the side. The inspector was sat next to his bed in what looked like the most uncomfortable chair a man could possible make. "You gave us all quite a scare."
John swallowed thickly, his throat protested. "Water." He finally managed to form words.
"Sure." Greg pulled up a cup of water with a straw and held it to his friend's mouth. John eagerly gulped down half the contents, throat soothing in seconds. He took a slow inhale, feeling his chest burn with pain, clearly dulled with drugs. He soon located the morphine drip and a chest drain on both sides of his body. Christ, he must have been bad. "Sherlock?" He asked.
Lestrade pulled a sad smile, one which the doctor could not read. "He's just the other side of the curtain." The inspector pointed to the other side of John and the doctor's head whipped around to face the plain blue hospital curtain. His face paled several shades and he swallowed past the rising bile in his throat.
"He's alive." Lestrade quickly shot, seeing the spikes in heart rate on the monitor and look of horror on his friends face. "Please don't panic."
"Then why?" John's words caught in his voice box and they made it out barely a whisper.
"He's a little out of sorts." The inspector murmured. "They think it's probably the head trauma. He had a bleed to the brain, had to induce a coma initially. They said it was to protect his brain from further trauma."
John nodded slowly, he was familiar with the treatment for traumatic brain injuries. "Exactly how long have we been here?" He furrowed his brows and looked to a clock on the wall reading it at 3.36pm. Ok, so he knew the time, what about the date.
"Five days." Lestrade added. "You've been pretty poorly yourself you know."
"I kind of worked that out, at least." The doctor tested a deeper breath, thankful for every free breath now making its way into his re-inflated albeit damaged lungs. The extra oxygen through his nasal cannula whooshed into his nostrils, and seemed to calm him somewhat, his next question did the opposite.
"How out of sorts?" John braced himself for the coming storm. Sherlock never made life easy did he.
"He woke up well, he was in a coma for a couple of days initially. The doctors say he was fighting through the drugs they had him under with."
John sniggered. "Doesn't surprise me."
"Well the moment he was more lucid he started asking after you. But the doctors wouldn't tell him, after a while he just went a bit nuts. I don't even know how to explain it."
A stab of pain shot through the doctor, this time not a physical but emotional hurt. "Why the hell didn't they let him see me? He probably thought I was dead!" Voice raising, yet his chest refused to allow his usual volume of speech.
Lestrade threw him a disgruntled look. "They told him you were ok, but even so. Letting him in here in the state he was in would have been dangerous. He almost re-broke his foot. I've never seen him like it John, not even on the drugs."
"It's no unusual for someone with a brain injury to be confused and even aggressive." The doctor ran through the symptoms, he was no neurologist.
"Mycroft stepped in. He found you both a private room together."
"So why is he behind the curtain?" John could not take his eyes of the blue flimsy material.
"To keep him settled and also so you don't freak out the moment you wake up." Greg looked to his feet.
"What?" John didn't understand, his head was fuzzy, what an earth were they pumping into him besides opioids, he looked to his IV line and huffed.
"Too much stimulation and he starts to fight through the drugs." The inspector explained, "that and they had to restrain him otherwise he was going to do himself or someone else some real harm."
"Let me see him." John pushed up on his arms, this time groaning audibly.
"Whoa, hang on mate" The inspector looked sadly at him. "Your hooked up like a Christmas tree right now."
John quickly surveyed himself to confirm his friends observations. Only then did he notice the heavy strapping around his left shoulder, a small jolt of pain from the joint made him inhale sharply. He looked down, two chest drains, an IV line, central jugular catheter, 12 lead ECG, pulse oxymeter, oxygen nasal cannula, blood pressure cuff and a urinary catheter, he cringed, why did they always have to place those. "Ergh." He tugged uselessly at the blood pressure cuff and gave in, resting his head back against the pillows. "Is this all really necessary?"
"You nearly died John." Lestrade cried.
Silence fell over the room and the doctor could do nothing but look at the end of the bed and the two small mounts were his feet were clearly hiding. "Sorry." He said finally.
"No apologising." Greg held a hand out, "but really John," his voice turned a little more serious, "you really do need to take it easy this time. They said both of your lungs collapsed, by the time they wheeled you through the accident department doors you'd stopped breathing. You two caused quite a stir you know, sounds like half the hospital were on yours and Sherlock's case."
John smiled to himself sadly, trust Sherlock to pull him into all this drama, to be fair he crashed the damn car initially, he'd regret that later. His smile fades, if there is a later and the detective is still the same man he was five days ago. Head injuries can do all sorts to the brain and personality.
"Let me see him." The doctor asked again.
"You sure?" Lestrade stood, "I mean you've only just woken up."
"He clearly needs me otherwise Mycroft wouldn't have put us in the same room." John turned back to face the ominous blue curtain and Lestrade did the honours by standing and then finally carefully pushing the screen back to reveal John's best friend.
"Jesus." Was all John could muster for a moment, he took in his friend. Sherlock was flat on his back, his head was propped up on an array of cushions and his head bound tightly with bandaging. John could see these were dressings from surgery not just the annoying scalp wound from the accident. His eyes were half open, semi circles, staring lifelessly into nothing but the bare ceiling. His right foot and ankle was strapped lightly, the appendage was blackened from bruising and a neat external fixator poked out his angry skin in several places, holding the shattered bones in place. What concerned John the most though was the soft restraints around the detective's wrists and one good leg. He was strapped to the sides of his gurney, and not just lightly either, how bad had his really got?
"Good to see you back with us Doctor Watson." John did not turn to look at the older Holmes enter the room. "I see you have been aquatinted with my brothers current state of health."
"I have." The doctors jaw clenched tightly, "and I would prefer it if you would kindly remove the restrains. Christ, he's not a bloody animal Mycroft!" He inhaled a little too deeply and the pain in his chest made him groan reflexively.
"I think many of the staff here may disagree with your statement." The man finally came into John's view, his usual dapper outfit, yet John could see the edge of something in his eye, concern perhaps. "I have had to use my position on a couple of occasions already considering Sherlock has broken the nose and arm of at least one member of the nursing team here."
"What?"
"They tell me a period of confusion and agitation is often normal when ones recovering from a minor brain haemorrhage, sometimes coupled with aggression and anxiety. It would happen, as usual, that my brother has taken this to the extreme."
"Jesus." John echoed again.
"All he seems to ask about is you though. He seems to have latched onto you, not exactly sure why." Mycroft looked somewhat annoyed now, obviously the fact his brother had not asked after him had hit a nerve. "Now that your conscious we can perhaps consider weaning him down off this ridiculous concoction of chemicals."
John looked at the IV line heavily taped into Sherlock's left foot. This must have been the place where he was less likely to pull the catheter out, the doctor could see the dorsal aspect of his hands and forearms were littered with bruising from previous failed and pulled IV's. There were two syringe drivers and a fluid pump whirring away beside the bed pumping what looked like several sedation drugs and one white filled syringe of propofol which John recognised instantly, the drug commonly used to knock out patients for surgery.
"I have called the doctor and he should be here any minute now." Mycroft looked at his pocket watch impatiently.
"Are you sure this is a good idea?" Greg piped up, he had moved to stand at the end of the detective's bed. "John's only just woken up, do you really think waking Sherlock up in the state he's in is fair?"
"The quicker we can get him over this state the better. My brothers brain is his hard drive as he so commonly likes to remind me. If doctor Watson is the answer to bringing him back from the coma then so be it."
"But..."
"It's alright Greg I can handle it." John pushed himself up a little, immediately regretted it. Instead he located the bed controls and allowed the back to rise so he was now in a more comfortable position.
A short Afro-Caribbean lady then appeared at the doorway. She smiled widely, her white teeth showing starkly against her dark skin. "Good to see you awake sir." She bumbled into the room. "My name is Julie Gayle, senior nurse, have been looking after your both since your arrival last week." She came to John's bedside and gently shook his hand, "been a pleasure to meet you, I read your blogs all the time." Her Jamaican accent was strong.
"Thanks." Was all the doctor managed. She let go of his hand and quickly retrieved his file from the end of the bed, noting down his parameters and setting the blood pressure cuff off on a cycle. "You and Mr Holmes here have caused quite a stir here."
John wanted to ask which one, but kept his mouth closed, he could see Mycroft's patience waning.
"There's been all sorts of goings on, the press have had a field day outside. And a small array of visitors to you both."
"That's enough Julie." An older man entered the room, his glasses perched on the end of his nose as he looked down, hair greying at the sides, "you don't need to talk our patients to death now do you?"
John smirked and for a second time in as many minutes he received a hand shake.
"Anthony Dean." The doctor said, "consultant neurologist."
John heard Mycroft sigh loudly, and knew if it had been Sherlock standing there the exact words being said right now. Somewhere along the lines of 'must we waste time with small talk'.
"I see you are inpatient to get started." Clearly Mycroft's audible sigh had not gone unnoticed. "Just let me check your brothers vitals and we'll sort out turning down these infusions."
John watched closely as the neurologist spent the next couple of minutes assessing his friend's vitals and level of consciousness. He noticed he detective's arm muscles flexing lightly in his bonds and his eyes flicked gently. Sherlock was unbelievable, any other man would have been stone dead out cold with the infusions he was on.
"I think we're all ok to give it a go again." The doctor pushed his glasses back up the bridge of his nose and collected Sherlock's file. "Bring Mr Watson closer Julie." He beckoned but did not look up from his scribbling.
John felt sorry for the nurse, she hurried around his bedside, connecting and disconnecting monitors so the bed could be moved merely a couple of meters to the right so he could actually reach out to his friend. "Thank you." He said as he finally put he breaks on the trolly and stood back.
"No problem." She disappeared from the room.
"So we'll start by weaning off the propofol I think, probably the one we least want him on right now." The doctor pressed the syringe driver buttons and the machine beeped annoyingly. He reduced the flow down. "It can take up to a few minutes for he affects to start appearing but considering Mr Holmes's current reputation I would assume he will wake much quicker."
John watched closely as his friends body twitched occasionally, the muscles in his hand contracted and extended and John put his hand over it. "Hey Sherlock, it's alright, I'm right here. It's time to start waking up." The syringe driver beeped again as the flow rate dipped even lower.
The detective inhaled deeply, his eyes closed and reopened but were still glazed and listless.
"Sherlock?" John tried, a small noise, something close to a squeak sounded from his flat mates throat. A few minutes passed.
"Okay, let's try this off shall we?" The syringe driver beeped again and the doctor turned the machine off, clamping the line to the detective to stop anymore flow of the drug.
There was silence for a few more minutes, the air of the room grew thick from some sort of anticipation. John watched closely as his friends chest rose and fell in rhythm, steady and deep, the numbers on the monitors were happy green and it seemed his friend was coming too well.
All of a sudden as if on cue Sherlock's body tensed, he sucked in a great gulp of air and groaned, pulling against his bonds. "John!" He cried, eyes opening wide in panic.
"I'm right here mate, it's ok." The blogger tried to remain calm but the panic in his friends demeanour sent shots of worry through him, his heart started to race and concurrently his ECG monitor started to whale in response. John could see his friend tense further at the noise.
"Will you turn that bloody racket off!" He shot. The doctor obliged quickly, returning the room to near silence.
"John." Sherlock's voice was weak and quiet and his breathing was now hitched into short sharp intakes.
"I'm right here Sherlock, just calm down ok." John squeezed his friends hand and then pulled it into his own. The detective's hand clamped down and the doctor had to stifle a cry from the pain of his crushing grip. "Sherlock?" He tried again.
"Leave me alone!"
With renewed vigour the detective pulled again at his bonds, the leather biting into his skin but not breaking it.
"I want John!"
"I'm right here you imbecile." John tried to pull his second hand across the touch his friend but his shoulder told him otherwise. "It's me you clot, I'm right beside you. You've been in an accident. You banged your head up a bit."
"John?" The pained desperate cry made the doctors heart lurch with worry. Sherlock pulled forwards uselessly again, this time, his fractured foot kicking out against the rails, the metal work clanged together.
"For god sake just get rid of this bloody cuffs." John was losing patience. "And turn whatever else he is on down."
"That's not advisable doctor Watson." The neurologist answered, "last time it took us two hours to get him sedated and back to bed. In the process he broke one of my colleagues arms and required an X-ray of his own foot as he displaced the ex-fix."
"Well that won't be happening this time." John watched as Sherlock seemed to becoming increasing agitated, his eyes were flicking wildly, unfocused and panicked stricken.
"I'm afraid I can't."
"Just do as he says doctor." Mycroft stepped closer to the bed. "I have every faith in doctor Watson's judgement, he is my brothers private physician and whatever he says goes, so I suggest you do as he proposes."
The man simply shook his head, he pulled at the cuffs releasing them quickly and then turned to the second syringe driver, pressing the buttons to turn down the flow rate of the next sedative. "I cannot take responsibility for what may happen." The man stood back a few steps.
"Sherlock?" John pulled his trembling hand free of the restraint and he visibly saw his friend relax a little, his flicking eyes slowed somewhat and finally came to rest on his own. "It's me. I'm here. Please don't worry."
"John?" Finally some sort of recognition in the detective's voice could be heard.
"Yes it's me. Come on now, time to wake up."
"We're am I?" Sherlock pulled his hand up to his face and patted at the dressings. He frowned deeply then took in the room of people who all seemed to have eyes on him. "What is this a spectators sport?" He snarled.
"Sherlock look at me." John edged his fingers out of the iron grip. The detective's eyes drooped a little. "You were in a car accident, do you remember?"
"No." Sherlock sat up quickly, bracing his arms agains the bed. "Let's go home, I don't like it here." He shuffled on the bed and Mycroft stepped forwards along with Lestrade, ready for a fight to keep the man in his bed.
"Alright, alright, calm down." John leaned towards, stifling the moan threatening as his chest tightened and thrummed with agony. "Just. Please. Don't get out of bed." He huffed a couple of pained breaths
"Your hurt?" The detective's face scrunched in confusion yet again, he picked at the edges of his dressing thoughtfully. "What's happening?"
"It's ok." The doctor squeezed his friends hand, "just lay back down?"
"Why?"
"Because your hurt too." John sighed.
"Oh."
John knew, no matter how confused his friend may be right now, there was one thing that could potentially help. Data. "We were in a car accident, five days ago. You fractured your foot and ankle which has been fixed. You suffered a nasty head wound and a bleed to your brain. You've been in a coma for two days and sedated for another three because you kicked off so much coming round. I injured my shoulder and chest but I'm alright now."
Sherlock paused for a moment, and anyone who was watching him could practically see the cogs turning in his muddled brain. "So can we go home yet?"
"Not yet Sherlock but soon." The doctor looked to Mycroft for confirmation but found none.
"John?"
"Yes?" The use of his name was beginning to become annoying, he had to admit it.
"My head hurts." A small stray tear made its way down the detective's cheek. "I don't remember what happened."
Pain forgotten in a instant John threw himself forwards and pulled his best friend into an embrace. His chest and shoulder protested against the movement but he ignored it all, holding his best friend as tears flowed silently from him.
"Of course your bloody head hurts." John choked back a tear of his own, "that's kind of what happens when you've had surgery on it. And memory loss especially of the accident is normal don't worry. You remember your name right?"
Sherlock snorted and push his friend back. "What a stupid question, of course I know my name."
"There we go then." John let himself ease back to his own bed with a light moan. "Not completely brain dead then."
"If I was completely brain stem dead I would be on a ventilator because my medulla oblongata, pons and midbrain were clearly damaged beyond return. And hopefully by now one of you idiots would have realised this and pulled the plug by now. John really, I thought you trained in medical school."
John smiled and it grew into a grin. "He's back." He glanced to the other two still perched by the end of the detective's bed.
"It would seem so yes." Mycroft looked to his watch again, "only took you 4,698 minutes to come round from a coma, still far longer than anticipated."
"I was hindered by drugs, my prediction of 1,579 minutes is somewhat more accurate. Your bet has no standing as they apparently re-sedated me."
"You made a bet?" John's mouth fell open.
"Of course I made a bet. Clearly it was only a matter of time before it happened." Sherlock smirked, "the average time it takes to come round for a short induced coma from a head injury is two and a half days if your not sedated further, which I clearly was."
"Still, your prediction was way out." Mycroft replied.
"So was yours." Sherlock spat. "In fact, what are you still doing here, shouldn't you be off getting me transport home already?"
Mycroft frowned, pursing his lips tightly in anger. "That's not why I'm here brother mine and you know it."
Sherlock faked a laugh, "here because you care?"
"Now boys that's enough." Greg butted in, the older Holmes simply sent him a death glare that could have killed.
"Okay." Finally the neurologist spoke up. "I suggest we all take a break. I need to assess Mr Holmes, perhaps you could take a quick coffee break so I can speak with my patient. I'm going to have to ask a few questions."
Lestrade and Mycroft decided it best to take this as a good time to exit. Mycroft was already on his phone before he even left the room.
John gave the doctor a weathering look. "I really wouldn't bother, you won't get anything constructive out of him."
"The year is 2016." The detective droned. "My name is Sherlock Holmes and my address is 221B Baker Street London."
The doctor opened his mouth to speak but John spoke first. "Don't even try asking him who the prime minister is right now, he won't be able to tell you. Or if the sun goes round the moon, apparently he deleted all of that."
"Oh not that again." Sherlock groaned. "Could you all kindly shut up, I'm awake aren't I?"
John smiled. Yes, he was definitely back.
External fixator - a type of bone fracture fixation, usually pins are inserted into the site from the outside and a cage is built around the limb to stabilise the bones while they heal.
Propofol - an induction agent for anaesthesia but can be used to heavily sedate/anaesthetise someone on a constant rate infusion (CRI)
Fluid pump/infusion pump and syringe driver - used to administer fluids and/or drugs into a patient at a set rate
Central jugular catheter - an intravenous catheter inserted into the jugular (neck) vein, it usually is long and sits in the cranial vena cava (the first part of the main vessel to the heart) and is placed in critical patients in hospital.
Pulse oxymeter - measures the amount of oxygen the blood is carrying around the body to ensure the patient is receiving enough oxygen to their tissues and organs.
