Hello there, guys.
First of all, a thank you to those have read my story, especially to those who have left kind reviews.
Second, a disclaimer. I am not a doctor. If there are any mistakes, I apologize. I did research on this topic using Pubmed and guidelines on drowning as a ressource for information but I am not a medical professional. I tried to be as correct and accurate (without it being too much) as possible. Please keep that in mind when reading ...
Until further ado, here's the next chapter.
Thanks for reading and reviewing.
Boat Trouble and Dangerous Waters
Day 1, Tripler Army Medical Center, Waiting Room, 1950 Hours
Hours later, the rest of Five-0 and Grace had been waiting for hours, on an update on either Danny and Steve but until now no one had come to update them. Out of a sudden, the door opened, a man in scrubs walking into the room. He seemed tired but professional. A doctor. "I am looking for the family of Detective Daniel Williams?" The physician glanced at the waiting people sitting the chairs, waiting for news on their loved ones.
Steve.
And of course Danny.
If only there was an update, news they wanted to hear.
Not the kind of news you don't want to hear, ever.
Grace was still in her mother's arms, with Rachel trying to provide some sort of comfort. Just trying to deal with what was happening.
"That's us."
Both Kono and Chin got up from their chairs wanting to know how Danny was doing, Grace followed quickly thereafter. Occasionally small sobs escaped her throat.
Overall the wait had been quiet, the time had passed slowly.
"How's my dad?" Grace's voice was quiet, shaky.
She needed to know how her Danno is doing. The doctor threw her a gaze that she couldn't quite decipher but she knew it was unlikely to be good news at this point, especially when Danny's doctor looked at her that way. That glance just screamed bad news causing Grace's heart rate to accelerate, start beating hollowly in his chest.
The team and Grace needed some good news.
"Who is his POA?" The doctor asked, wanting to know who makes medical decisions for the detective if he isn't able to. Chin, Lou, and Kono exchanged worried glances. "That would be Commander McGarrett. But ..." Chin didn't end the sentence, Kono did. "We don't even know if he's still alive, so he can't make any decisions either. It's just us now. Please tell us how Danny is doing." In the end, Kono's voice grew quieter and more shivery.
Grace had grown increasingly more apprehensive and quieter.
She realized then that whatever condition her Danno was in wasn't good. That scared her.
Really scared her.
She didn't want to lose her Danno.
"Please." She said softly. "Is Danno alive?" She couldn't keep the shiver out of her voice.
"Tell me, please," Grace demanded.
Rachel stepped behind her daughter and put a supporting hand her shoulder. She could feel Grace tense up a bit. "Grace," Rachel called her name. Grace turned, her eyes flashing, "I need to know how my dad is, mom." She said quietly but with vehemence, the inner turmoil was out front and center.
Anyone was able to see that.
As soon as the young girl desperate for good news concerning Danny's state laid eyes on the exhausted, weary features of the physician who had entered the waiting area, she has to know how Danny is doing. But it was unlikely to be good news if the physician's face was any indication.
"Detective Williams is alive."
That was the first thing they were told.
Collective sighs of relief could be heard. However, the group realized soon that there was more than that, that it wasn't that simple.
Grace listened to the doctor, hoping against all odds that all would be alright.
The doctor looked at the group with a serious expression.
"Detective Danny Williams is currently in the cardiac intensive care unit. He's been treated for moderate hypothermia, dehydration, and exhaustion. He initially presented with moderate hypothermia due to being in the water for a significant amount of time. When he was admitted, he had a temperature of 91 °F. We have started active external rewarming since he did not really respond to passive and minimally active core rewarming."
Chin frowned when he heard that.
"What's that mean?" The native Hawaiian questioned. The others listened quietly, each on their toes. When Kono looked over at Grace, the girl had noticeably paled and even more frightened than before when the doctor told them about Danny's condition.
The demeanor of Danny's treating physician seemed serious. All of them saw that. "Active external rewarming is the application of heat directly to the skin. It's only effective in the presence of intact circulation that can return peripherally rewarmed blood to the core which is the case here. Danny's temperature is currently at 94 °F. We use a forced- air warming system to try and normalize Danny's core temperature. We are giving him warm IV solutions to combat his hypothermia. We have begun careful rehydration. We have placed him on a ventilator due to pulmonary edema, which was the reason for his respiratory symptoms." The physician started explaining Danny's medical condition.
Shocked gasps were the response to that.
Kono shook her head, not quite understanding how it comes that Danny's condition had deteriorated this much.
"But he was awake and talking in the helo."
Chin reached for her hand, pressing it in silent support.
"Now he's on a ventilator? I don't understand?" She questioned looking over to the doctor in the hope that he would be able to explain it, a bit confused and frustrated.
Shocked silence at first as the surgeon dropped a bombshell on them.
"Sometimes, in cases like this respiratory symptoms appear delayed, sometimes with a delay up to six hours, such a delay in presentation is what happened here. Danny is being cared for in intensive care unit right now until his respiratory symptoms resolve and his temperature returns to normal. He did suffer a respiratory arrest in the emergency department which is why we were forced to intubate. Right now, Danny is dependant on a mechanical ventilator to help him breathe. Pulmonary support will be necessary until Danny's pulmonary edema resolves which we are treating right now. There is a possibility that he can be extubated in twenty-four to forty-eight hours as soon as his pulmonary function improves."
Kono inhaled shakily.
Her gaze slid over to Grace. She felt for her, this must be traumatic for her, undoubtedly.
Why was this happening?!
Grace had shrunk in her seat, silent tears were running down her face.
The only thing keeping her grounded was her mom's tight embrace. "I can, however, say that the detective is in stable condition right now." The doctor, dressed in scrubs, paused to let his patient's relatives catch on, giving them time to process what they just heard.
Pulmonary edema?!
He'd seemed relatively okay on the helo, but then again, when Chin thought back, Danny had shown respiratory symptoms back then.
Shock painted on the faces of the remaining team members of Five-0 as they realized what they had just been told.
"Will he be okay?" Kono had to ask.
For Grace's sake, for all their sakes she hoped the doctor treating Danny would confirm Danny would survive.
But she also knew that there were no guarantees for anything, not with Danny currently on a ventilator due to pulmonary edema. And there was still no word on Steve's condition.
"Danny should be alright, barring any complications, if his pulmonary edema resolves and we are able to get his temperature back to normal. But he should be alright with time and rest." The physician told them.
"Can I see him?" Grace questioned, having worked up enough courage to ask.
"I'm sorry, but minors aren't allowed in the intensive care." The doctor responded. "The adults can visit for five minutes."
"Can't you make an exception?"
Grace's voice shook as she asked, she had to see Danno. But apparently, she could not visit him due to stupid hospital regulations.
And he wouldn't let her.
"I'm sorry but those are the regulations." The doctor threw Grace an apologetic look but she had enough to do not to start crying right here and now. She needed to see Danny, to know that he's alive, that he hasn't died.
She was angry.
In the world. At everyone.
It was just too unfair to put into words.
Tears glistened in her eyes.
Rachel wrapped her arms around her daughter, trying to comfort her.
"Can you try and find out about Steve McGarrett?" Kono questioned, a dark and concerned look in her eyes as she gazed at the doctor. "They both came in via medevac chopper and there is still no word on Steve. Can you find out about Commander McGarrett?"
A hopeful look was in Kono's eyes.
"I won't promise anything, but I'll try and make a few inquiries."
With that the doctor left, leaving a devastated Grace behind who was now openly crying, not caring if anyone saw her. Those who know and love her won't judge and she knew that. The stress and worry of the last hours now coming now together causing this understandable emotional outburst. Rachel tried her best to comfort her, but Grace was inconsolable.
H50 H50 H50 H50
Day 1, Tripler Army Medical Center, Operating Room
"Let's initiate minimally invasive ECMO." The implanting surgeon said to the assembled team.
One team performed conventional cardiopulmonary resuscitation to keep the blood flowing until the doctors can get Steve on extracorporal life support. The other team is in charge of the ECLS implantation and operates independently. However, interaction between these teams is required in the case of defibrillation and short interruptions of the manual chest compression at the time of puncturing the vessels.
There were two teams in the room, all medical personnel working together to get the patient on extracorporal circulation.
Ten minutes ago, the patient arrested again, out of nowhere, which was the result of pulseless electrical activity.
The team of doctors had decided that the best course of action would be to transfer the very sick patient straight to the operating room for placement of an extracorporal membrane oxygenation circuit for rewarming and to make sure the was adequate perfusion as long as there is no perfusing rhythm. The only beeping that that could be heard was the medical monitoring equipment.
The lead surgeon looked at the oxygenation of his patient, sighing.
The perfusonist asked, "Are we doing central ECMO or are we going for the femoral?" The cardiothoracic surgeon looked up from the surgical field before answering.
"We'll use the femoral artery. Central is too invasive. Prepare for veno- arterial ECMO."
Then he turned to his intern he is supposed to teach. "Preparing for ECMO for active rewarming."
"Are you ready?"
"Ok, now we have to connect the cannulas to the tubing." The surgeon announced.
The cannulas were connected to the tubing of the ECMO machine and bypass circulation began. The lead surgeon heaved a sigh.
ECMO was initiated in the operating room with femoro- femoral cannulation performed under sonographic and echocardiographic guidance, extracorporeal life support was initiated using a minimally invasive extracorporeal circulation system. Steve's surgeons decided that a minimally invasive extracorporeal rewarming method via the femoral artery was preferable because then it wouldn't be necessary to perform a sternotomy which would have been necessary when using cardiopulmonary bypass.
"Ready to release clamps." The lead surgeon announced, his eyes were on the cardiac monitor, looking for any changes in the oxygen levels.
"Release clamps."
Then shortly after, the younger surgeon said, slowly releasing the arterial clamp.
"Arterial clamp off."
"Venous clamp off. Pump on." The lead surgeon said, hoping there would be an increase in oxygen saturation, and the rewarming process was started. The machine started whirr. All personnel looked at the monitor. After a seemingly very long minute, the pulse ox went up to 95%. That was good. As the mobile circuit began rewarming the patient at a slower rate to avoid a potential mismatch between oxygen requirements of the warming tissue and oxygen delivery as this may be preferable in this particular case, even though extracorporal membrane oxygenation and cardiopulmonary bypass can rewarm up to eight to ten degrees Celsius per hour.
"Starting to close up." He informed as he threw a glance at the multitude of monitors and devices his patient was connected to, now that he was connected to femoro- femoral cannulation in veno- arterial ECMO. Now that the group of surgeons had dealt with the immediate ramifications of the hypothermia and the persisting bouts of life- threatening arrhythmias as, importantly, extracorporal membrane oxygenation alleviates the need for continuous chest compressions until return of spontaneous circulation during rewarming; the medical team turned their attention to the man's remaining injuries that needed treatment.
But the main concern had been the hypothermia and the resulting cardiac problems.
"Let's page general surgery." The lead surgeon ordered, knowing that his patient had internal injuries that needed to be addressed. The circulating nurse complied, minutes later the general surgeon arrived and was scrubbing up for surgery. They were also aware that the hypothermia has had an impact on coagulation as well as the heparin, reducing the blood's ability to clot even more. "We got the patient's lab reports back. His hematocrit is normal."
"It should be high. The fact that it's normal indicates blood loss."
The surgery to remove the bullet and the subsequent repair of the patient's abdomen took another few hours, all while the patient remained on ECMO.
H50 H50 H50 H50
Day 1, Cardiac Intensive Care Unit
After having completed the patient's procedure, he was transferred to the cardiac intensive care unit.
Steve was still on ECMO by the time he was moved to intensive care unit.
There was a dedicated team caring for him after surgery and urgent implantation of extracorporal life support. Upon arrival, an echocardiogram was performed to observe cardiac function and volume loading of the left ventricle to make sure that there are no cardiac abnormalities present. "His temp's at 92 °F which means it has risen a few degrees. We will continue with rewarming using extracorporal membrane oxygenation. Also, we need to watch out for arrhythmias." Dr. Kalani warned his colleagues. But now that Steve's temperature was above thirty degrees Celsius, they could actually use defibrillation. The medical team would do continuous blood gas monitoring as well as continuous transcutaneous oxygen saturation to make sure the extracorporal membrane oxygenation is working properly.
Steve was on a ventilator, using conventional ventilation with positive end-expiratory pressure.
"The patient needs repeated endobronchial administration of surfactant administered." A serious face expression was firmly planted on his face. The doctor rechecked the multitude of medical devices, perfusor pumps and the mechanical ventilator before addressing his colleague.
"I'll go update the family now. Page me if there are any changes in his condition."
"I will."
The physician assistant nodded, taking the doctor's place and controlling the cardiac monitor and the extracorporal circuit once more.
"I want a repeat echo in one hour."
H50 H50 H50 H50
Day 1, Rachel Edwards' Residence, Grace's Room, 2010 Hours
Grace lies on her bed, on her side staring against the walls. She could hear her mom rummaging in the kitchen but she could not care less at this moment. Grace's shoulders shook harshly as she let her tears fall. Sobs occasionally erupted from her throat. Her eyes were red from crying. She hides her face in her pillows, tries to hold back her tears but she was not able to.
Why did this happen, to her Danno?
To her Uncle Steve?
Still, in tears Grace continued to cry softly into her pillow, occasional deep breaths interrupted the breathing pattern. That is how Rachel found her when she came upstairs to inform Grace that dinner was ready. "Grace, sweetie. Dinner is ready." Unsure if how to interact with her saddened and devastated daughter. Life has really thrown them a curveball and now they to deal with repercussions whether they like it or not.
When Grace lifted her head Rachel was shocked to see her eyes lined red, traces if tears on her cheeks. Dried tears caking her face. "You wanna come down?"
No response.
"Try to eat something light?" She suggested. "I am not hungry." Grace's voice shook, lacked strength and hope. "I just wanna see Danno." She added, tears streaming down her face. In an angry motion, Grace wiped them away before turning away from Rachel. She just wanted to be alone. Carefully, Rachel sat down on her daughter's bed, as she runs her hand up and down Grace's back.
"I am here for you, Grace," Rachel whispered, her voice quiet, soothing.
Rachel tucked a strand of her hair back behind her ears. Rachel was at a loss at how to help her and it pained her that she had to watch her child suffer like this. God, she hoped Danny would make it, for the kids' sakes. Rachel sat on the edge of the bed, a hand on her daughter's shoulder, yet she did not say anything. Grace would start to talk when she is ready. And Rachel was right about that. "This isn't fair." Grace ground out, her voice shook with emotion clashing together.
"It isn't." Rachel agreed. "But Danny's strong. He'll make it."
Grace scoffed.
"You heard the doctor, mom. This is ... this is serious. I know that. I am not a little child anymore."
She ignored the tear running down her cheek. "I just want Danno to come home." She added, now vulnerable and unlike the teen girl, she had been before this had happened. "I know, sweetie, I know." Rachel couldn't think of anything to say, words wouldn't make this any better. The only thing that would help is knowing Danny would recover and come home again but right now there were no guarantees about that.
"Mommy." A small voice came from behind them causing Rachel to look up. Charlie stood in the doorway wearing his Superman PJs, confused he stared at his mom and sister. Grace was clearly upset. About what he didn't know. "Charlie." Rachel threw another view over to Grace who continued to stare at the wall. It was obvious that she wanted to be alone.
Rachel got up from the edge of Grace's bed, in slow-moving steps she walked over to her youngest.
Also Danny's son.
Without any words, the British woman picked him up and carried him out of Grace's room.
Seconds after that she heard the door slam closed. Rachel couldn't imagine how hard this must be for Grace. Sighing, Rachel carried Charlie down the stairs and into the kitchen. Trying to resemble some kind of normalcy she asked: "You want a juice?", as she rummaged in the cupboard to find some cups to fill with juice. But Charlie, being Danny's son, picked up on the fact that something was not as it should be.
"Mommy, why is Gracie sad?" The blonde boy wanted to know, his blue, innocent eyes bore into hers.
Rachel swallowed thickly.
This is when she realized that she had to tell Charlie too. She had hoped to shield him from all this but she had lied once before. To Danny. To Charlie and Stanley. Had denied Charlie to get to know his real daddy. She learned her lesson and that she had screwed up massively. She kneeled down to Charlie's height. Rachel drew in a deep breath. "I need you to be strong for me, Charlie." Rachel started. "I need to tell you something." Charlie merely stared at her, unsure of where this would go.
"Danno is hurt, Charlie."
"Hurt?" Charlie's voice sounded genuinely scared.
Rachel nodded, feeling slightly overwhelmed by the situation. In a quiet, calming voice she continued: "Danno's in the hospital so that the doctors can make him feel all better."
Rachel hoped she had made the right decision in telling Charlie. This was the child-friendly version of what happened to Danny, leaving out all the scary details of Danny's current condition. But maybe this was the wrong one. Charlie's eyes widened, he took a few hasty breaths as his brain tried to understand what his mom just told him.
"Is that what made Grace cry?"
Sure enough, the little guy had noticed Grace crying. "Grace is sad because Danno got hurt, yes."
The young boy bit his lip.
"Maybe a hug makes her feel better? We could paint pictures for Danno."
Charlie's suggestion made sense in his seven-year-old head. Rachel smiled softly at her youngest. She was so proud of them. They had grown into amazing human beings. "That's a great idea, Charlie. But we should let Grace have some alone time." Rachel surmised that her daughter wanted some time for herself, to come to terms with what happened to her Danno.
Charlie nodded.
"I'm gonna get my crayons to paint a picture for Danno."
If only it were that simple, Rachel thought to herself.
With that the young boy sprinted out of the kitchen, minutes later returning with paper and crayons.
H50 H50 H50 H50
Day 1, Cardiac Intensive Care Unit, 2100 Hours
The first thing that greeted Chin and Kono upon entering Danny's room in intensive care unit was the monotone whirring of the mechanical ventilator standing next to his bedside and the loud, continuous beeping of the cardiac monitor.
Danny had a tube down his throat to ensure adequate oxygenation.
"He's on a ventilator?" Kono whispered with a shudder in her voice. Chin gazed at her for a moment. "The doctor said he would be, Kono." Her cousin gently reminded her, his eyes focusing on the machine standing in the corner. Chin surmised that it was the forced- air thing that the doctor talked about. That 'Bair Hugger' Temperature Management Unit to regulate Danny's temperature so that it would return to a normal value.
Chin gripped Kono's hand in silent support.
They watched as the ventilator breathed for Danny because he wasn't able to do it on his own at this moment. "The doctors had to put him on a ventilator because his respiratory system was impaired due to pulmonary edema," Chin uttered, relaying the words the doctor had told them to Kono who seemed to be only half listening.
"His hands are so cold, Chin," Kono said in a shivering voice, her voice shaking slightly when she touched Danny's cold, clammy skin, careful of the intravenous access in his hand. Swallowing slightly, Kono sat down next to Danny's bed, the persistent whirring of the mechanical vent and the regular beeps from the cardiac monitor in the background. The regular beeping was at least comforting to some extent as it told them that there was still living inside the unmoving frame on the bed. There were several bags of IV bags suspended over the hospital bed, hanging on the IV pole. There was a steady drip, drip sound coming from the IV bag. The bed was in an upright position. Danny's doctor had told them that he was receiving medication to help treat his pulmonary edema.
"Fight, Danny. Grace needs you." Kono whispered, Danny's slack hand in hers.
Steve too.
As do we, Danny.
Her mind was subconsciously remembering Grace's crushed face expression when Danny's doctor told them that she wasn't allowed in the intensive care unit.
"We all do."
Chin quietly paced across the room, their stoic silence only interrupted when a nurse came to check on Danny and the multitude of appliances he was attached to, to make sure everything was working accordingly. Suddenly, the glass doors slipped open and Danny's doctor walked into the room, a clipboard in his hands. Kono watched him closely, for any signs that might suggest that something was going on with their team member and family. After one or two minutes of silence, only the sound of a ballpoint pen scribbling on paper and the sounds from the medical devices could be heard; Kono broke the silence.
"Is he-"
Danny's doctor looked up.
"He's doing as well as he can under these circumstances. He's not better but he's also not worse."
Chin nodded from where he was sitting.
"Any news on Steve?" He questioned, sitting up straighter.
Danny's doctor shot them a serious look before answering the question. Almost instantly Chin and Kono became even more concerned about their friend's condition.
"It's bad, isn't it?" Kono couldn't help but ask, instinctively squeezing Danny's hand a little tighter.
"I did some inquiries about your friend. He's in good hands." He looked at them, quietly Kono willed him to continue, she wanted to know what was going on with Steve. "However, he's in surgery right now. That's all I can tell you for now." Kono deflated internally. She had hoped he would have had a bit more information on Steve's condition. The doctor rechecked Danny's vital signs and the ventilator settings before once again turning to the cousins.
"I'd have to ask you to step out for a moment."
"Why?"
Kono's voice rose, instinctively.
"It's nothing serious, I can assure you. But for now, visiting hours are restricted." The doctor was fairly insistent on that matter. Feeling somewhat disappointed at having to leave Danny again, Chin and Kono turned to leave, however reluctantly. Outside Danny's cubicle in intensive care, the cousins once again headed to the waiting room to continue waiting for a much-needed update on Steve's condition, who had yet to come out of surgery.
Come out alive ... A little optimism surely would not hurt, would it?
H50 H50 H50 H50
Day 1, Tripler Army Medical Center, Waiting Room, 2130 Hours
As more and more time passed, Chin, normally very patient, seemed to grow more and more impatient as there was still no news on Steve. After Danny's doctor had told them that they had to leave the cousins had gone down to the waiting room, and true to the promise Danny's doctor made he showed up a little while later to give them an update on Steve's condition.
"You know something about Steve?" Kono asked with hope in her voice.
She couldn't help the shiver in her voice, however, she was disappointed when there wasn't much that he could tell them. "I'm sure the surgeon will be down shortly to talk to you about Steve's condition. However, I am able to tell you that he's still alive and my colleagues are working on him. He's in good hands." Overall, the update was a bit ambiguous, a bit hazy on the details of the situation which led Kono and Chin to believe that the outlook for their commander, their friend, wasn't that good.
"At least we know Steve is still alive," Chin muttered to himself.
But the question each member had being, but for how long?
"Thanks."
The doctor nodded quietly, pressing his lips together before hurrying back towards intensive care to check on his patients, one of them being Danny, their friend, and teammate.
Chin stood there, lost in thoughts.
Kono dropped down on a vacant chair, hiding her face in her hands as she took a couple shivery breaths in an attempt to calm herself down.
"I can't believe this." She finally murmured, looking up, silent tears running down her face.
Where's Grace?" She suddenly wanted to know.
"Rachel took her and Charlie home," Chin responded, his eyes fixated on the wall as he drew in a deep breath.
"She seemed so ..."
Shaking her head in desperation, Kono choked up again when she remembered Grace's facial expression after Danny's doctor had updated them. "Rachel asked me to call her when there's news on either man's condition." Chin added, a somber expression on his face, "This is becoming unbearable." He then muttered as he gets up and starts pacing around, hands in his pockets. Nervousness and blatant worry were radiating off of him.
"They have to make it!"
Chin nodded.
For a while, it seemed like an eternity no one said anything. "Where's Lou? He was here before."
"He had to bring Will home. He'll be back."
Chin leaned forward, Kono nodded almost imperceptive.
Almost on cue, Grover rushed into the waiting room. "I am back." He got out, his breaths coming out quickly. "Are there any news?" He wanted to know. As he looked into Kono and Chin's faces, he knew almost instantly that there was no news of any sort. "All we know is that Steve's still alive and they're working on him. I am guessing that means his condition isn't good." Chin replied with a somber expression, Kono's face expression mirroring his.
"Oh, damn it." Lou cursed loudly.
"Danny and Steve truly can't do anything by halves, can they?"
"Danny?" He asked, great concern visible on his face.
"We were able to see him for a few minutes. He was so pale." It did not even look like Danny, the man who they knew and loved. Kono shook her head, not believing that this was their reality. "What did the doc say?" You asked, feeling the tension rising. "He's got pulmonary edema, they're keeping him on a ventilator for now." Chin retorted.
"Jersey's on a vent?"
Lou could only shake his head at that, clearly not expecting that.
"He'll be alright." Kono insisted stubbornly, trying to convince herself and the others. Trying to stay positive, but it was hard and getting harder with each minute passing.
This day really had turned to hell.
"We don't really know anything about Steve's condition." She bleakly added as she stared ahead, at the wall.
H50 H50 H50 H50
Day 2, Tripler Army Medical Center, Waiting Room, 0130 Hours
Dr. Kalani and his colleague walked to the waiting room to speak to their patient's family members. It was past midnight already when the surgery was completed. As soon as both doctors had entered the waiting room all eyes were on them, longing for good news. "Is this the family of Commander Steve McGarrett?" Dr. Kalani questioned, a neutral face expression covering his face. Instantaneously, Chin and Kono got up from their chairs. Now they would find out.
"That's us," Chin spoke up.
This was going to be an unsettling conversation he needed to have with the commander's family as there was a chance that he might not make it.
Maybe one they should rather have in his office to give them the privacy they deserve. "Let's head to my office." He tried but Kono interrupted him. They had waited long enough and any second longer was a second too long. "How's Steve doing?" Kono chimed in, them all having waited long enough.
"Just tell us!"
Dr. Kalani cleared his throat before responding.
"The commander is alive and situated in our cardiac intensive care unit. Commander McGarrett requires sedation and mechanical ventilation. We have started active core rewarming via extracorporeal membrane oxygenation to get his temperature back to normal." He explained, tried to put it in the simplest terms possible.
Confused silence.
Lou Grover, Chin, and Kono exchanged confused and horrified glances, their worries increasing.
That didn't sound good at all.
"What do you mean?"
Lou stared at the doctor, attempting to comprehend what they've been told.
Chin listened to the doctor, but he couldn't understand a thing of what he said. He gazed over to his cousin and Lou who seemed as lost and confused as he felt. But only Lou had voiced that thought. Both he and Kono were unable to form a thought, much less try to put into words.
Dr. Kalani realized that his patient's relatives couldn't comprehend so much medical talk right now, so he tried to rephrase it, using easier words.
"What I mean is that we have him on extracorporeal circulation until his temperature normalizes and he has got a stable heart rhythm. The machine supports his heart and lungs and slowly rewarms the patient. It is the preferred rewarming method for patients in cardiac arrest. When he came in he arrested again which is why we decided his best chance was extracorporeal membrane oxygenation which would assure adequate oxygenation and blood flow and also alleviate the need for cardiopulmonary resuscitation." Steve dependant on a machine? Not only a mechanical ventilator but a machine takes over heart and lung function as well as temperature regulation?
That seemed unimaginable.
But apparently, that was exactly what the doctor told them.
Lou stepped forward, his voice was kinda shaky when he questioned, "So that means you had to put him on a machine in order restore a normal temperature." The doctors both nodded, confirming Lou's question. "And to support his lungs and his heart, both of which are struggling right now."
The shock was visible on all their faces.
It was a lot to take in.
"Doesn't he have a normal heart rate?" Kono wanted to know. "What do you mean he arrested upon arrival? They got him back on the helo." Kono spoke, confused and worried about her boss and friend.
"Unfortunately, your friend still suffers from bouts of ventricular fibrillation which might be related to him having hyperkalemia, common in hypothermic drowning victims. Currently, we are treating the hyperkalemia."
"So, what now?"
Kono broke the disturbing silence.
"Right now, Commander McGarrett is still on extracorporeal life support and will remain so until his temperature reaches a specific core temperature and he has a stable cardiac rhythm and adequate native perfusion and oxygenation." The doctor responded in a calm, collected tone.
"What?" Kono's voice was deathly quiet, anxiety increasing tenfold.
"We will try to wean him off as soon as his condition, which is especially dependant on his pulmonary function, allows it. There's radiologic evidence of pulmonary edema which we are treating with supportive treatment to ensure adequate ventilation and oxygenation. However, there is a chance it will worsen while he's on ECMO. Our team has placed a chest tube to drain air that accumulates in the chest cavity. Chest tube placement was necessary due to pneumothorax caused by rib fractures that punctured his lung. For now, he's still critical." Dr. Kalani explained while throwing a glance at his colleague as a small 'pling' sounded from the pager the other physician was carrying on his waistband.
The other doctor threw a cautious glance at the pager.
The two men communicated with glances. 'I'll go deal with this if it's serious I'll have you paged.'
"Good.'
"I need to go, they're paging me." Dr. Kalani's colleague addressed him and hurrying away, obviously having been paged to someone experiencing a medical emergency.
A frown appeared on Kalani's face but he quickly schooled his features into a more neutral look. "I will let you know when the Commander is stable enough for visitors." He said, answering the question left unsaid. "His liver?" Chin questioned, toneless. "We are aware of his recent liver transplant. The commander's liver seems to be functioning, we'll periodically check his liver enzymes to make sure it is working. We'll also administer his prescribed regimen of immunosuppressants." Dr. Kalani paused as he glanced at the group consisting of his patient's family that obviously cared a lot for him, assuring them that they knew about Steve's liver transplant.
Kono had dropped down into the chair and took a deep breath before refocusing her attention on the doctor.
"But I will keep you updated on the Commander's condition." Dr. Kalani concluded.
"Any questions?"
When he looked at the group there only stunned head shakes. Shocked faces, too shocked to ask questions right now." The only response he got was a nod from Chin, the rest of the Commander's family were too shocked to answer or say anything. Dr. Kalani left the waiting room and walked past the nurses' station, leaving the devastated relatives in his wake, his pager suddenly started beeping. In a hasty motion, the physician grabbed it from his waistband and glanced at the flickering screen. Immediately alarmed he turned around, rushing back to ICU.
H50 H50 H50 H50
Day 2, Tripler Army Medical Center, Waiting Room, 0140 Hours
Kono, Chin, and Lou were left in the waiting room, not knowing what the rest of the night would bring.
"I am staying," Kono said, staring straight ahead, trying to comprehend what she had just heard about Steve's condition.
"Me too." Chin agreed.
"Renée watches the kids, she will understand the gravity of the situation," Lou muttered to himself, having made a decision, the one decision that felt right. It wouldn't feel right to just up and leave while there was someone's life in the balance, someone he knew rather well. Two lives were. "I'll message her, tell her I'm staying." He wouldn't be able to sleep anyways, not with two of his close friends hanging onto life by a mere thread. "Who's gonna tell Joe? Where is he anyway?" Kono wondered, utterly confused by the military man's disappearance.
Chin glanced at her before replying.
"Perhaps Joe already launched an investigation into what happened, and is going after the people who did this to Steve and Danny, coz," Chin suggested, not sure where the former Navy man was, as he was not at the hospital. "And make those bastards pay for all they have done to Danny and Steve," Chin said, his eyes never leaving Kono. They would find whoever was behind it and put them behind bars, where they belonged.
Absentmindedly, Kono merely nodded.
Kono's thoughts reverted to Steve- dependant on a machine? Not only a mechanical ventilator but a machine takes over heart and lung function as well as temperature regulation?
That seemed unimaginable. Unthinkable.
She couldn't even begin to think of how to put it into words.
But apparently, that was exactly what the doctor told them. and Steve.
"That would be my guess. In the morning, I will head to HQ and tell him about Steve. Maybe he will show up before." Chin retorted, sighing with a heavy heart before he hugged Kono, they both desperate for some comfort. He heard her sigh into his shoulder. "I can't believe this is happening." She tightened her hold on Chin, thankful for the comforting hug that they both needed. Shortly before Chin left the waiting room, he turned around.
"Kono?" He called his cousin's name.
A fine frown crossed Kono's face as she glanced up, at Chin.
"Yeah?"
"Are you going to be okay, coz?" Chin couldn't help but feel like it was wrong to leave now.
Kono grimaced slightly. "I-" Kono inhaled sharply.
"I don't know in all honesty."
When I know Steve and Danny will be alright, then maybe but for now? Chin walked back into the waiting room, sat down next to Kono.
"Chin, I am as okay as I can be." Kono paused, wiping away a lone tear threatening to fall.
"I called Adam, he's on his way over. He will be here in a few minutes. I won't be alone."
Chin nodded, relief in his eyes. "Go talk to Joe. He needs to know about Steve." Kono's voice caught in her throat when she said Steve's name. "Now?" Chin hesitated, not wanting to leave his cousin alone. Not after what happened. To underline Kono's words, Adam hastened into the waiting room, he knew instantly that the situation was as bad as it seemed.
"Kono?!"
Adam rushed into the room.
"Adam."
Kono launched herself into his arms and hugged him tightly.
"I am so glad you're here," Kono uttered.
"Of course, there is no way I leave you to deal with this alone. We're in this together." Adam's reply came instantaneously.
Kono let out a forced smile.
Chin looked the other way as he slowly stepped into the hallway and slides down the wall. Out of a sudden, he felt a presence next to him, now they were sitting against the wall, shoulder by shoulder.
Without turning his head he realized that Lou had followed him outside.
Just waiting for the time to pass.
Each team member was settling in for a long, uncomfortable night at the hospital, filled with dread and fear of possible bad news. Worse news than those they had previously received.
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Day 2, Tripler Army Medical Center, Waiting Room, 0550 Hours
It was now break of dawn. Small rays of sunshine lit up the waiting room, making it seem a bit friendlier. Chin suppressed a tired yawn. He saw Kono and Adam occupying two chairs in what could only be described as uncomfortable. His cousin, however, seemed to be able to sleep despite the awkward position her body was in.
The clock on the wall told them it was about five or six hours past midnight, and the team was still camped out in the waiting room, not wanting to leave until knowing that Danny and Steve will be alright. Chin suddenly felt the need to move around a bit, stretch his legs. The Hawaiian man was optimistic that they would get to visit Danny today, if only for a few minutes. But that would be something at least. However, they were aware that it won't be a fast, miracle- like recovery. All of them were spent and fatigued, their energy levels depleted, both mentally and physically yet Steve's and Danny's 'ohana refused to leave. They had taken short naps on the uncomfortable chairs.
Ultimately, Chin had tried to get Kono to go home, saying it wouldn't do any good if they all go on like this.
But Kono had been fairly insisting on staying. Now the woman was half asleep, her head on Adam's shoulder. Chin had tried to sleep on several occasions during the night but couldn't. There was so much running through his mind, making it hard for him to relax, let alone sleep. Instead, he continued to stare at the clock, time slowly ticking away.
"Chin."
Lou's deep voice brought him back.
He saw the big guy holding out a cup of hot beverage to him.
"Here, you look like you might need it." A trace of a sad smile covered Chin's face. "Thanks, Lou." Chin appreciated the thoughtful gesture and took a sip. For a long time, both men sat there in silence, each lost in their own thoughts. Lou was the one to interrupt the deafening quiet.
"I can't believe we're in this position again." He shook his head.
Chin turned to look at him.
The Hawaiian merely responded with a nod.
At some point during the morning hours, Steve's physician made another appearance, probably for the promised update on Steve's condition. "What is it?" Chin got up in an instant as he sees the doctor approach.
"Did something happen?"
"We're having a bit of trouble getting his recurring cardiac dysrhythmias under control." He doesn't mention the scary details of how close a call it had been, the rhythm disturbances had been the reason he was paged soon after speaking to the commander's family. Steve's doctor glanced at the room, discerning that they seemed plainly shocked, startled facial expressions covering their faces. Chin, Kono, and Lou exchanged confused glances, not quite understanding what he meant by that.
Three sets of frightened eyes stared at him.
"Cardiac dysrhythmias?" Lou muttered under his breath, "What do you mean by that?" The former Chicago man questioned as he furrowed his brows. "Doc, what does that mean?"
We are no, absolutely no condition to understand complex medical issues, he thought.
Lou Grover was pretty sure that his teammates and friends felt the same way about this. "What that means is that because of the elevated levels of potassium in the commander's bloodstream his heart is affected. The elevated levels of potassium cause the cardiac dysrhythmias. We are trying to normalize the commander's potassium levels but it's going slow. For now, all we can do is treat the complications as they arise."
A shocked silence fell over the group.
No positive news except that he was alive, around four in the night, Steve's primary doctor had come out, to inform them about Steve's progress. Or not progress, the persisting arrhythmias due to hyperkalemia. "We've commenced hemolysis treatment to filter out the excess potassium. We're hoping that the cardiac dysrhythmias will stop sometime after completing the treatment." He had told them that they managed to stabilize his condition so far but not so far that the team of physicians were able to perform decannulation from femoro- femoral extracorporeal circulation, basically, the machine is taking over heart and lung function as well as temperature regulation as he is not haemodynamically stable right now.
"So that means what exactly?" Kono wanted to know as she looked at the doctor.
Chin reached for her hand and pressed it, gentle.
The doctor continued in a firm voice, a somber look crossed his features, "The Commander is still on extracorporeal membrane oxygenation. He will remain on that machine until his condition allows decannulation."
"But that's not happening in the near future, is it?"
Lou dreaded the answer.
"Is there any way of knowing if Steve-" Her voice broke. "- if he makes it."
A penetrant voice in the back of her head told her, 'This is Steve, he's a fighter, of course, he is gonna make it through this' but a body can only take so much and after all the physical trauma Steve's body had sustained in the last hours there is a possibility that he might not make it through this, no matter how unimaginable it seemed.
Dr. Kalani responded to Kono's question.
"Steve's condition is still listed as critical. If the Commander makes it through the next twenty- four to thirty- six hours, then he's got a chance."
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That was not easy to digest for any of them. Chin plopped down on a plastic chair, burying his hands in his face.
"Damn." The Hawaiian muttered as he attempted to process what he'd just been told.
More bad news.
They should have expected that, probably. But that did not make it hurt any less.
"This position feels oddly familiar." Chin was thinking back to the crash landing on the beach after Steve and Danny's plane had been hit by a hail of bullets, resulting in Danny donating part of his liver to give to Steve. Kono absentmindedly nodded, definitely agreeing with him, both lost in their own worlds, trying to cope with the fate they'd been handed.
Kono sat down as well to lean her head against Chin's shoulder, seeking comfort.
Something they needed in this mess.
Adam Noshimuri had volunteered to go on a coffee run and get coffee and sandwiches for them. He should be back any minute now. Chin glanced up when he saw Kono's husband reenter the waiting room, carrying coffee cups and sandwiches. He handed them out without words. None were necessary.
In the wee hours of the morning, Chin headed out the door, and towards the harbor to tell Joe the news about Steve.