Chapter 3: Spine Juice and Comfort Cake
"Hi." Andy greeted as he watched Ephram slowly regain consciousness.
"Mmmm." Ephram moaned stiffly. His current recollection of what happened and how he got to his present location was fuzzy and partial. He remembered going to the fair and the gripping pain in his body but hardly anything else. However intense that pain had been, it was gone for the moment or so it seemed. Not fully aware of his whereabouts, he pondered at his father's concerned but smiling face to make sure it wasn't all a dream. When he finally accepted that he was indeed awake and not dead, he attempted to rise out of bed.
"No Ephram. You mustn't move." Andy said touching his son's shoulders to prevent him from exerting himself. "Lie back down."
Fatigued, Ephram had no choice but to obey. The sudden activity made him realize how achy his whole body felt. He blinked curiously at his father. For the first time, Ephram noticed his father was wearing a white lab coat with cream colored surgical gloves sticking out of his breast pocket. Ephram always thought his father looked smart and professional in that 'doctor get-up.' Ephram gazed down at himself and saw he was stripped of the clothes he had on that morning. His top was now a white cambric sheet with a bare back and two holes cut out for the arms to pass through. His bottom was a heather gray cotton drawstring pant.
The shallow breath he took to test his out his lungs caused a burning itch to develop in his throat and he coughed vigorously until his face turned beet red. Andy brought a cup of water to Ephram's lips when the coughing ceased. The cold and soothing water trickled down Ephram's dry throat and quenched his thirst. He observed his father's every move for any signs of disappointment or anger towards him for all the trouble he's caused. But the lingering throb in his temples made it difficult for him to concentrate on any particular subject for too long. His joints were stiff but he was able to move. He slowly made a fist with his fingers. He felt something itchy on his wrist and absentmindedly proceeded to scratch it with his free hand until he recognized the infamous tube sticking into his soft flesh.
"Don't touch that." Andy pulled Ephram's hand away from the tube and adjusted the IV drip. Ephram was annoyed at his father for continuously bossing him around by telling him what he could and could not do.
Ephram looked straight ahead and realized a thick piece of foam underneath his knees elevating both his legs. He stared at his toes. It finally registered in his brain the cause of this ordeal. His legs. It was obvious something was wrong with his left leg. It didn't take a team of astrophysicists to figure that out. Even though he wore long loose pants, he saw that his left leg was almost twice the size of his right leg. There was a reason why his father put pants on him instead of leaving him with just the usual hospital gown. His father didn't want him to wake up to something alarming like a vision of a swelled up leg resembling a giant link of sausage. Ephram knew his leg had swelled up. He saw the redness and puffiness of his left foot and ankle. A spark of panic flickered in his mind as he tried to see if he could feel his legs. His knees and thighs were numb and felt like they were two tons of concrete anchoring his efforts at movement. However, he was able to slightly wiggle his big toe on his right foot. Nonetheless, he sighed a breath of relief at the semi- successful try - every little bit counts.
"How ya doing?" A voice came from his from his bedside. The voice startled him because he was unaware of anyone else being in the room aside from his father. He relaxed when he saw it was Nina.
"I don't feel so good." Ephram croaked. And that was the truth. Honestly, he felt like he had just been ran over by a herd of cattle. He didn't need to strike sympathy in Nina because she had already done her motherly duty and took him under her wing.
"That's because you've got a bit of a fever going." Andy said caringly as he fiddled with a collection of medical utensils on a tray by the bed.
"God, this place looks awfully familiar." Ephram groaned after speculating his surroundings wearily.
"The boy still has a sense of humor." Andy snickered.
"When can I leave?" Ephram inquired weakly. He hated being hospitalized. It was like an automatic prison sentence. You're limited to movement - the wires and tubes resembled shackles or the good old ball and chain. You're restricted to venturing out your room without supervision and permission - doctors get to determine whether you're allowed to go anywhere and in the event that they do grant your wish, they assign a nurse to chaperone you. It's like they don't trust you to be by yourself. Nasty rations of barely edible gunk called food were served, which aside from the Jell-o, the smell made him want to vomit. Then the worst part was the uniform - the backless thin sheet of cotton gossamer that showed your entire derriere. One unlucky gust of wind and you would be doing the famous Marilyn Monroe scene only you'd be flashing your privates to everyone in the entire room. How embarrassing. All they needed to complete the process was a mug shot and fingerprinting.
"Leave? You're not leaving for a while son." Andy said amiably. "Just take it easy, ok? You're very sick right now and we need to keep you here for observations."
"Why? What's wrong with me? Why are my legs numb?" Ephram's voice came out in a scared whisper.
"We're still waiting on some test results but from what we gather so far, you had a deep vein thrombosis in your leg, which lead to a pulmonary embolism." Andy stated.
"What's that mean?" He sighed. Ephram was exhausted but he fought with every ounce of vitality left in his body to stay awake long enough to find out how bad the damage was.
"Deep Vein Thrombosis is just a big fancy term for blood clot forming in a large vein in the body. In your case, it was in your left leg. This blood clot in the vein blocks the normal flow of blood back to your heart. Basically, your circulation was cut off hence, causing the pain, swelling, redness and warm feeling in your left calf and thigh. To make things even more complicated, a fragment of that blood clot broke off and traveled through your blood stream. The clot lodged in your lungs and eventually blocked the blood flow in your blood vessels. This is called a pulmonary embolism. It would explain the pain in your chest and rapid heart rate." Andy described slowly in his doctoral tone of voice.
"It's caused by the spinal injury?" Ephram asked in a small, weak voice.
"Yes. But you're stabilizing now. We're giving you heparin to thin the blood in your system to help dissolve the clot. Your medicine is dripping thru your IV right now."
"Will I be able to walk?" Afraid of the answer to that question, tears instantly filled Ephram's eyes. Andy saw the fear in his son's eyes and thought it best not to tell him at the moment.
"Most people recover from DVT. Why don't we just concentrate on getting thru today first?" Andy kept a strong face but his heart was chipping off little by little each time he saw his son on the verge of tears. Ephram turned his head and looked at Nina with glassy eyes. Somehow, he knew the answer to his question.
"Oh baby. No, don't cry. Things will be alright." Nina tried to alleviate Ephram's anxiety. "We're gonna get thru this together, ok?" Ephram watched Nina stroke his cheek and brush his hair back. He was too tired to have the energy to shed a tear.
"Ephram, there's one more test that needs to be done. Normally, Doctor Monroe would be the one to conduct this procedure, but given the circumstances, I volunteered thinking you'd be more comfortable if I did it." Andy said softly. "We're gonna do a spinal tap."
Ephram had never heard of the term 'spinal tap' or even knew what it was or what it involved. But it sounded painful. He tensed up and looked at Nina again for support. His eyes shook and lips quivered.
"Tired." Ephram mumbled hoping to discourage his father from doing this spinal tap thing. "Want to sleep."
"I know. But this procedure won't hurt and will only take ten minutes. The reason we need to do this is because your injury is initially spinal related so we want to make sure there's no infection due to your recent complication. All I'm going to do is extract some cerebrospinal fluid from your spinal cord and run some tests on it." Andy said brushing his son's cheek affectionately. "It's kinda like drawing blood - no big deal. You do trust me, don't you?" Andy smiled warmly. Ephram nodded gingerly.
"And I'll be right here next to you the whole time. So you don't have to be afraid." Nina added.
"OK then, are we ready to begin?" Andy clapped his hands together. "Ephram, I'm going to need you to lie on your side in fetal position, which we will help you do." Ephram stared at his father too weak to move a muscle. "You didn't think we would make you do it by yourself, did you?" He forced a smile.
Andy removed the thick foam block under the boy's knees gently and went over to Nina's side. He slipped one hand under Ephram's lower back and the other over Ephram's hip. Nina slid one hand behind Ephram's neck and the other over his armpit. On a count of three, they rolled Ephram onto his side. Ephram's legs and hips were pulled up towards his chest and his neck bent slightly forward.
Ephram's backless top was raised a few inches above his waist and the back of his drawstring pant was pushed down exposing the lower portion of his back.
"Ephram, you let me know if you experience any pain at any time, ok?" Andy said snapping the surgical gloves tightly on his hands.
"Ok." Ephram murmured and stared at Nina.
"Sweetheart, want to hold my hand?" Nina offered as she took the boy's trembling hand. She stroked his cheek with the back of her fingers. "My gosh!" She blurted.
"What?!" Andy looked up.
"Nothing. It's just that he's so warm." Nina replied. "I wish I can take some of the aches and pains away." She continued stroking Ephram's face.
'You already have mom. More than you know.' Ephram wanted to say to Nina but kept the thought to himself.
Andy felt for Ephram's pelvic bone in order to locate the corresponding area between the third and fourth lumbar space in the lower region of the back. The needle will be inserted between these two vertebrae to enter the space where the fluid is to be drawn. Andy then proceeded to inject a dose of lidocaine into Ephram's lower back to numb the area completely.
Ephram flinched at the prick of the syringe. A few tears found its way onto the mattress and soaked thru the bed sheet. He heaved a small sigh.
"It's ok baby. It's ok." Nina soothed.
"Is everything cool?" Andy looked at Nina.
"He's scared as hell. Poor kid." Nina replied wiping the tears off Ephram's pale face.
Once the numbing medication was in effect, Andy draped a blue sheet with a pre-cut hole onto the region where the puncture is to be made. He then continued to insert a special wide needle into place. Andy patiently watched the spinal fluid drip into the tiny, transparent narrow glass vial he held steadily in his hand. Unlike extracting blood, collecting spinal fluid was not something that could be rushed. When drawing blood, the liquid is sucked out using a syringe making the whole process fast and simple. When drawing spinal fluid, once the special needle is inserted, the liquid drips out passively. Andy was almost done with his second vial when he heard a soft moan from Ephram.
"It's almost over Buddy. Just hang in there." Andy said in a tranquil voice. "I just need one more vial."
"Can't you give him something for his fever?" Nina asked worriedly.
"I'll get him a cold compress in a while. I don't want to administer additional medication that might conflict with the heparin." Andy answered.
"He's such a sweet kid, why is this happening to him?" Nina shook her head in pity. She rubbed Ephram's fingers.
"I ask myself the same question. I hate seeing him in this much pain. I'd do anything to trade places with him. At least I would be able to handle it." Andy said as he started collecting the third vial of fluid. "Maybe I should've seen this coming. I wasn't paying enough attention."
'You should never say such a thing. None of this is your fault. If only I opened my dumb mouth and told you I wasn't feeling well maybe all this could've been avoided.' Ephram wanted to say but was too debilitated to speak up.
"Andy, you're doing fine. Don't go blaming yourself for everything. Ephram's a brave and strong kid. He will overcome any obstacle." Nina rationalized.
Ephram's drowsiness and lethargy forced his weighty eyelids to close. He wanted to hear the continued conversation between his father and Nina but his brain wouldn't allow it. His brain told him he needed sleep and he denied it by blinking awake. The refusal only made his eyelids bounce back twice as heavy. He did this several times and finally gave in and drifted off into a deep sleep.
"I guess it's only natural for a parent to worry about all the should've, could've, would've's to prevent things from happening to their children." Andy said. "Ephram and Delia are all I have. When something bad happens to either of them, I get this way. I blame myself. Some of it's true."
"This was nothing anyone could predict. You've been a very hardworking and dedicated father to your children. If only I can say the same for Sam's father. Now, there's a real jerk." Nina smirked. "Don't blame yourself for Ephram's suffering. He wouldn't want you to."
"He's an ok kid. Maybe sometimes a little too head-strong and stubborn, but he's a good kid." Andy admitted.
"Well, the apple doesn't fall far from the tree." Nina hinted with a smile. Andy laughed.
"I'm just about done. How's the young prince doing?" Andy said as he removed the needle from Ephram's back and applied a sterile bandage to where the puncture had been made.
"He's asleep." Nina noticed. "He must be exhausted."
"Good. He needs sleep. Let's straighten him out." Andy fixed Ephram's clothing.
With Nina's assistance, Andy extended Ephram's legs. They rolled him flat on his back. Ephram caught his father's attention when he grumbled something incoherently. Andy gently set Ephram's head onto the pillow. Before Andy could say a word, the boy let out a sigh and fell back into his peaceful slumber. The thick block of foam was placed back under Ephram's knees to keep the legs elevated. Nina pulled the thin sheet up and tucked him in.
"I've got to bring these samples to the lab for evaluation." Andy said unwilling to leave his son alone.
"Go. I'll sit with him while you're gone." Nina offered without hesitation. She pulled a chair next to Ephram's bed while Andy arranged the specimens and medical paraphernalia neatly.
"I'll bring back a compress for the fever." Andy said and quietly left the room with the tray.
Nina fixed her gaze at the unconscious boy lying motionless on the bed. There was only silence in the room except for a slight wheeze coming from Ephram's breathing. She watched him sleep. It was frightening how lively he had been earlier that morning only to become so sapped of strength and run down in just a few short hours - sort of like he's lived two lifetimes. Other than a hint of flush on his cheekbones stemming from the fever, his facial complexion was as white as the pillow he laid his head against. Nina reached over and fixed his dark ruffled hair. Ephram stirred in his slumber and Nina was afraid she'd waken him, but his eyes didn't open. Her heart flickered when she saw his face wince as he attempted to stretch. It wasn't fair. Nina thought tenderly how such a strong and free-spirited boy like Ephram could end up so confined and fragile. She wanted to caress him and make all his pain go away. With an elbow on the mattress, she rested her chin in the palm of her hand.
"Ephram." She whispered. "You have to get well. For your father's sake. And for Delia." She paused. "But most of all, for me." She peered around the room suspiciously as if someone might've heard her. When she realized how silly she was for being so paranoid, she shrugged it off.
"I haven't known you for a very long time. But for the time that I have known you, I've grown rather attached to you. I didn't think any one's kid could have this affect on me. Boy was I wrong." She whispered feeling more relaxed. "Maybe I don't show it enough for you to realize it. But truth is, you are like a son to me. I will always treat you like one of my own - no matter how unaware you are to my affections. And it's so easy for me to say these things to you right now. Coward as I am, I wouldn't have the nerve to tell you when you're conscious and certainly never display these feelings in front of your father. My heart bleeds when I see you like this."
"Your mother must've been so lucky to have a son like you. She would've been so proud. Sam's only five but he looks up to you. Hell, everyone looks up to you. You just don't know it." She watched Ephram breathe thru his mouth. His lips parted slightly.
"Why didn't you tell someone you were hurting? Why did you deny your pain? You are only a boy Ephram. You shouldn't have to mask your physical and emotional feelings like this. We don't expect you to be almighty, powerful, and unbreakable. You think you always have to put up this brave front because you're afraid others might see thru you. It's ok to show your weakness." Nina confided. She was getting comfortable talking to the unconscious boy. "I know the situation with your father before your mother died. I also know you think you have to fend for yourself and take after Delia since you thought there was no one left to care for either of you. That is an awfully big burden for a fifteen year old. I wish you would let someone take care of you. Let me take care of you."
"I'll tell you another thing. Your father - he may be wet behind the ears on how to raise his kids and you think he wouldn't know how to even if it ran right smack in his face, but he's trying so hard. If only you knew how much he wants to have that special bond with you again. There are so many things you don't see. Your father is a different and better person now than what he may have been in the past. You just have to realize that." Nina's eyes began to tear. She touched Ephram's hand. The tears were uncontrollable. She held in her sobs.
"Don't give up, baby." She whispered. "I love you son."
The sound of a creaking door startled Nina. With her back against the door, she stood up, quickly brushed the remaining tears away from her face and wiped it on her jeans.
"Everything ok?" Andy questioned standing by the door holding a small towel and a basin of water.
"Yep. Fine." She said abruptly. She wondered how much of her rambling had he actually heard. "Here, let me help."
She extended her hands for the basin meanwhile avoiding any eye contact to hide the fact that she'd been crying. She did that well by keeping busy and distracted with soaking, wringing, and applying the cool cloth to Ephram's toasty forehead. There was no conversation for a good half hour.
"Do you think he's going to be ok?" Nina finally broke the silence.
"From a doctor's stand point, it doesn't look too promising. Apparently, that fall did more harm than the blood clot. Worse case scenario, he may never be able to walk on his own." Andy answered grimly.
"You said 'may.' So there's a chance he might still be able to fully recover. Right?" Nina inquired.
"Chances are slim. At this rate, he's able to wiggle his right toe and that's always a good sign. If the spinal contusion was severely complicated with the fall, even if he regains the function of his legs, he wouldn't be able to walk without crutches. I'm hoping the CT and X-ray results will tell me something good." Andy replied. Strong and stoic as he was, a tear rolled down his cheek and blended in his thick beard. He bit his lip and turned away to hide his vulnerability from Nina.
"Oh." Nina sighed with a broken heart. A soft moan passed thru Ephram's lips. The coldness of the cloth suppressed the burning flame under the boy's skin as Nina dabbed the boy's warm forehead and cheeks with care. Several droplets of water escaped the cloth and trickled down Ephram's neck and slid onto his chest where it evaporated in an instant. With eyes closed, he moved his head slowly.
"Ahhh." Ephram surprisingly cracked a weary smile.
"Is that better?" Nina asked.
"Mmm. That feels good." Ephram murmured feverishly.
"I'm glad it's helping." Nina said sounding more enthusiastic for the boy's sake.
"It's so hot in here." Ephram swallowed with eyes still shut.
"You've got a fever." Nina explained. She continued to apply the compress to his neck and chest.
"Where's dad?" Ephram raised his voice. He sounded like a little lost child.
"I'm right here buddy." Andy touched Ephram's hand. Andy wanted to hug the living daylights out of his son. Suddenly agitated, Ephram's eyes shot open and rapid breathing took over.
"Oh no, Delia. Delia. I didn't mean to scare her like that." Ephram slurred. "I have to - "
"Shhh. Delia is ok. She's with Nina's mom and Sam in the waiting room. I'll bring Delia by to see you later." Andy rubbed his son's arm to calm him down.
Achy and tired, Ephram didn't have the energy to rebut his father. He allowed his head to sink into the soft delicate pillow. It cushioned and cradled his feverish head in the most comfortable and relaxing way he ever thought possible. Never had a mattress been so tender under his aching body. It was like he was lying on a massive cloud of fluff. His shoulders were stiff and knotted with such tenseness that upon the touch of this very softness, he felt every muscle unwind. His lower back was sore from the spinal tap as well as from the fall. His legs were still numb and tingly as the heparin did its work in dissolving the blood clot. Andy watched his son's eyelids droop to a close with drowsiness. And the worry from Ephram's brow softened as he fell asleep again.
Andy and Nina looked at each other with heartfelt sorrow in their eyes. They swallowed the extensive tear shed they so badly wanted to let out. They would've never been able to stop crying. Andy reached over and gave Ephram a gentle kiss on the cheek. It was not something he normally did. He knew his son was touchy when it came to parents showing affection for their children in certain places. Ephram was at the ripe old age of eight when he decided it was inappropriate for his parents to advertise parental affection towards him. He refused to hold his parents hand when they went out because he didn't want people to think he was a baby. Kissing and hugging him in front of his friends, at school or anywhere was strictly forbidden. They were not allowed to yell out, "I love you, honey." Or anything remotely related when he was playing with his friends. He would go kicking and screaming if either parent showed any budding signs of smothering him with love at any given place aside from home. He wanted to be so independent and grown up. Andy was glad Delia was different. Delia was still very receptive to hugs and kisses. Andy couldn't even remember the last time he kissed Ephram. It had been too long. He didn't care what Ephram had to say about it now. Perhaps it was even now that Ephram needed that kiss the most. Andy watched Ephram sleep for a while.
The poor boy suffered excruciating pain in his back from falling, he survived the deep vein thrombosis and pulmonary embolism, and now he's running a fever of 101. Above all this, he was still thinking about Delia. He didn't seem worried about his own well being. Delia had always been a top priority. He cared so much for the little bugger. And Andy was thankful to have such a selfless and devoted son like Ephram.
The most difficult part was telling Ephram he might be relying on a wheelchair for the remainder of his life.
* end chapter 3 *
"Hi." Andy greeted as he watched Ephram slowly regain consciousness.
"Mmmm." Ephram moaned stiffly. His current recollection of what happened and how he got to his present location was fuzzy and partial. He remembered going to the fair and the gripping pain in his body but hardly anything else. However intense that pain had been, it was gone for the moment or so it seemed. Not fully aware of his whereabouts, he pondered at his father's concerned but smiling face to make sure it wasn't all a dream. When he finally accepted that he was indeed awake and not dead, he attempted to rise out of bed.
"No Ephram. You mustn't move." Andy said touching his son's shoulders to prevent him from exerting himself. "Lie back down."
Fatigued, Ephram had no choice but to obey. The sudden activity made him realize how achy his whole body felt. He blinked curiously at his father. For the first time, Ephram noticed his father was wearing a white lab coat with cream colored surgical gloves sticking out of his breast pocket. Ephram always thought his father looked smart and professional in that 'doctor get-up.' Ephram gazed down at himself and saw he was stripped of the clothes he had on that morning. His top was now a white cambric sheet with a bare back and two holes cut out for the arms to pass through. His bottom was a heather gray cotton drawstring pant.
The shallow breath he took to test his out his lungs caused a burning itch to develop in his throat and he coughed vigorously until his face turned beet red. Andy brought a cup of water to Ephram's lips when the coughing ceased. The cold and soothing water trickled down Ephram's dry throat and quenched his thirst. He observed his father's every move for any signs of disappointment or anger towards him for all the trouble he's caused. But the lingering throb in his temples made it difficult for him to concentrate on any particular subject for too long. His joints were stiff but he was able to move. He slowly made a fist with his fingers. He felt something itchy on his wrist and absentmindedly proceeded to scratch it with his free hand until he recognized the infamous tube sticking into his soft flesh.
"Don't touch that." Andy pulled Ephram's hand away from the tube and adjusted the IV drip. Ephram was annoyed at his father for continuously bossing him around by telling him what he could and could not do.
Ephram looked straight ahead and realized a thick piece of foam underneath his knees elevating both his legs. He stared at his toes. It finally registered in his brain the cause of this ordeal. His legs. It was obvious something was wrong with his left leg. It didn't take a team of astrophysicists to figure that out. Even though he wore long loose pants, he saw that his left leg was almost twice the size of his right leg. There was a reason why his father put pants on him instead of leaving him with just the usual hospital gown. His father didn't want him to wake up to something alarming like a vision of a swelled up leg resembling a giant link of sausage. Ephram knew his leg had swelled up. He saw the redness and puffiness of his left foot and ankle. A spark of panic flickered in his mind as he tried to see if he could feel his legs. His knees and thighs were numb and felt like they were two tons of concrete anchoring his efforts at movement. However, he was able to slightly wiggle his big toe on his right foot. Nonetheless, he sighed a breath of relief at the semi- successful try - every little bit counts.
"How ya doing?" A voice came from his from his bedside. The voice startled him because he was unaware of anyone else being in the room aside from his father. He relaxed when he saw it was Nina.
"I don't feel so good." Ephram croaked. And that was the truth. Honestly, he felt like he had just been ran over by a herd of cattle. He didn't need to strike sympathy in Nina because she had already done her motherly duty and took him under her wing.
"That's because you've got a bit of a fever going." Andy said caringly as he fiddled with a collection of medical utensils on a tray by the bed.
"God, this place looks awfully familiar." Ephram groaned after speculating his surroundings wearily.
"The boy still has a sense of humor." Andy snickered.
"When can I leave?" Ephram inquired weakly. He hated being hospitalized. It was like an automatic prison sentence. You're limited to movement - the wires and tubes resembled shackles or the good old ball and chain. You're restricted to venturing out your room without supervision and permission - doctors get to determine whether you're allowed to go anywhere and in the event that they do grant your wish, they assign a nurse to chaperone you. It's like they don't trust you to be by yourself. Nasty rations of barely edible gunk called food were served, which aside from the Jell-o, the smell made him want to vomit. Then the worst part was the uniform - the backless thin sheet of cotton gossamer that showed your entire derriere. One unlucky gust of wind and you would be doing the famous Marilyn Monroe scene only you'd be flashing your privates to everyone in the entire room. How embarrassing. All they needed to complete the process was a mug shot and fingerprinting.
"Leave? You're not leaving for a while son." Andy said amiably. "Just take it easy, ok? You're very sick right now and we need to keep you here for observations."
"Why? What's wrong with me? Why are my legs numb?" Ephram's voice came out in a scared whisper.
"We're still waiting on some test results but from what we gather so far, you had a deep vein thrombosis in your leg, which lead to a pulmonary embolism." Andy stated.
"What's that mean?" He sighed. Ephram was exhausted but he fought with every ounce of vitality left in his body to stay awake long enough to find out how bad the damage was.
"Deep Vein Thrombosis is just a big fancy term for blood clot forming in a large vein in the body. In your case, it was in your left leg. This blood clot in the vein blocks the normal flow of blood back to your heart. Basically, your circulation was cut off hence, causing the pain, swelling, redness and warm feeling in your left calf and thigh. To make things even more complicated, a fragment of that blood clot broke off and traveled through your blood stream. The clot lodged in your lungs and eventually blocked the blood flow in your blood vessels. This is called a pulmonary embolism. It would explain the pain in your chest and rapid heart rate." Andy described slowly in his doctoral tone of voice.
"It's caused by the spinal injury?" Ephram asked in a small, weak voice.
"Yes. But you're stabilizing now. We're giving you heparin to thin the blood in your system to help dissolve the clot. Your medicine is dripping thru your IV right now."
"Will I be able to walk?" Afraid of the answer to that question, tears instantly filled Ephram's eyes. Andy saw the fear in his son's eyes and thought it best not to tell him at the moment.
"Most people recover from DVT. Why don't we just concentrate on getting thru today first?" Andy kept a strong face but his heart was chipping off little by little each time he saw his son on the verge of tears. Ephram turned his head and looked at Nina with glassy eyes. Somehow, he knew the answer to his question.
"Oh baby. No, don't cry. Things will be alright." Nina tried to alleviate Ephram's anxiety. "We're gonna get thru this together, ok?" Ephram watched Nina stroke his cheek and brush his hair back. He was too tired to have the energy to shed a tear.
"Ephram, there's one more test that needs to be done. Normally, Doctor Monroe would be the one to conduct this procedure, but given the circumstances, I volunteered thinking you'd be more comfortable if I did it." Andy said softly. "We're gonna do a spinal tap."
Ephram had never heard of the term 'spinal tap' or even knew what it was or what it involved. But it sounded painful. He tensed up and looked at Nina again for support. His eyes shook and lips quivered.
"Tired." Ephram mumbled hoping to discourage his father from doing this spinal tap thing. "Want to sleep."
"I know. But this procedure won't hurt and will only take ten minutes. The reason we need to do this is because your injury is initially spinal related so we want to make sure there's no infection due to your recent complication. All I'm going to do is extract some cerebrospinal fluid from your spinal cord and run some tests on it." Andy said brushing his son's cheek affectionately. "It's kinda like drawing blood - no big deal. You do trust me, don't you?" Andy smiled warmly. Ephram nodded gingerly.
"And I'll be right here next to you the whole time. So you don't have to be afraid." Nina added.
"OK then, are we ready to begin?" Andy clapped his hands together. "Ephram, I'm going to need you to lie on your side in fetal position, which we will help you do." Ephram stared at his father too weak to move a muscle. "You didn't think we would make you do it by yourself, did you?" He forced a smile.
Andy removed the thick foam block under the boy's knees gently and went over to Nina's side. He slipped one hand under Ephram's lower back and the other over Ephram's hip. Nina slid one hand behind Ephram's neck and the other over his armpit. On a count of three, they rolled Ephram onto his side. Ephram's legs and hips were pulled up towards his chest and his neck bent slightly forward.
Ephram's backless top was raised a few inches above his waist and the back of his drawstring pant was pushed down exposing the lower portion of his back.
"Ephram, you let me know if you experience any pain at any time, ok?" Andy said snapping the surgical gloves tightly on his hands.
"Ok." Ephram murmured and stared at Nina.
"Sweetheart, want to hold my hand?" Nina offered as she took the boy's trembling hand. She stroked his cheek with the back of her fingers. "My gosh!" She blurted.
"What?!" Andy looked up.
"Nothing. It's just that he's so warm." Nina replied. "I wish I can take some of the aches and pains away." She continued stroking Ephram's face.
'You already have mom. More than you know.' Ephram wanted to say to Nina but kept the thought to himself.
Andy felt for Ephram's pelvic bone in order to locate the corresponding area between the third and fourth lumbar space in the lower region of the back. The needle will be inserted between these two vertebrae to enter the space where the fluid is to be drawn. Andy then proceeded to inject a dose of lidocaine into Ephram's lower back to numb the area completely.
Ephram flinched at the prick of the syringe. A few tears found its way onto the mattress and soaked thru the bed sheet. He heaved a small sigh.
"It's ok baby. It's ok." Nina soothed.
"Is everything cool?" Andy looked at Nina.
"He's scared as hell. Poor kid." Nina replied wiping the tears off Ephram's pale face.
Once the numbing medication was in effect, Andy draped a blue sheet with a pre-cut hole onto the region where the puncture is to be made. He then continued to insert a special wide needle into place. Andy patiently watched the spinal fluid drip into the tiny, transparent narrow glass vial he held steadily in his hand. Unlike extracting blood, collecting spinal fluid was not something that could be rushed. When drawing blood, the liquid is sucked out using a syringe making the whole process fast and simple. When drawing spinal fluid, once the special needle is inserted, the liquid drips out passively. Andy was almost done with his second vial when he heard a soft moan from Ephram.
"It's almost over Buddy. Just hang in there." Andy said in a tranquil voice. "I just need one more vial."
"Can't you give him something for his fever?" Nina asked worriedly.
"I'll get him a cold compress in a while. I don't want to administer additional medication that might conflict with the heparin." Andy answered.
"He's such a sweet kid, why is this happening to him?" Nina shook her head in pity. She rubbed Ephram's fingers.
"I ask myself the same question. I hate seeing him in this much pain. I'd do anything to trade places with him. At least I would be able to handle it." Andy said as he started collecting the third vial of fluid. "Maybe I should've seen this coming. I wasn't paying enough attention."
'You should never say such a thing. None of this is your fault. If only I opened my dumb mouth and told you I wasn't feeling well maybe all this could've been avoided.' Ephram wanted to say but was too debilitated to speak up.
"Andy, you're doing fine. Don't go blaming yourself for everything. Ephram's a brave and strong kid. He will overcome any obstacle." Nina rationalized.
Ephram's drowsiness and lethargy forced his weighty eyelids to close. He wanted to hear the continued conversation between his father and Nina but his brain wouldn't allow it. His brain told him he needed sleep and he denied it by blinking awake. The refusal only made his eyelids bounce back twice as heavy. He did this several times and finally gave in and drifted off into a deep sleep.
"I guess it's only natural for a parent to worry about all the should've, could've, would've's to prevent things from happening to their children." Andy said. "Ephram and Delia are all I have. When something bad happens to either of them, I get this way. I blame myself. Some of it's true."
"This was nothing anyone could predict. You've been a very hardworking and dedicated father to your children. If only I can say the same for Sam's father. Now, there's a real jerk." Nina smirked. "Don't blame yourself for Ephram's suffering. He wouldn't want you to."
"He's an ok kid. Maybe sometimes a little too head-strong and stubborn, but he's a good kid." Andy admitted.
"Well, the apple doesn't fall far from the tree." Nina hinted with a smile. Andy laughed.
"I'm just about done. How's the young prince doing?" Andy said as he removed the needle from Ephram's back and applied a sterile bandage to where the puncture had been made.
"He's asleep." Nina noticed. "He must be exhausted."
"Good. He needs sleep. Let's straighten him out." Andy fixed Ephram's clothing.
With Nina's assistance, Andy extended Ephram's legs. They rolled him flat on his back. Ephram caught his father's attention when he grumbled something incoherently. Andy gently set Ephram's head onto the pillow. Before Andy could say a word, the boy let out a sigh and fell back into his peaceful slumber. The thick block of foam was placed back under Ephram's knees to keep the legs elevated. Nina pulled the thin sheet up and tucked him in.
"I've got to bring these samples to the lab for evaluation." Andy said unwilling to leave his son alone.
"Go. I'll sit with him while you're gone." Nina offered without hesitation. She pulled a chair next to Ephram's bed while Andy arranged the specimens and medical paraphernalia neatly.
"I'll bring back a compress for the fever." Andy said and quietly left the room with the tray.
Nina fixed her gaze at the unconscious boy lying motionless on the bed. There was only silence in the room except for a slight wheeze coming from Ephram's breathing. She watched him sleep. It was frightening how lively he had been earlier that morning only to become so sapped of strength and run down in just a few short hours - sort of like he's lived two lifetimes. Other than a hint of flush on his cheekbones stemming from the fever, his facial complexion was as white as the pillow he laid his head against. Nina reached over and fixed his dark ruffled hair. Ephram stirred in his slumber and Nina was afraid she'd waken him, but his eyes didn't open. Her heart flickered when she saw his face wince as he attempted to stretch. It wasn't fair. Nina thought tenderly how such a strong and free-spirited boy like Ephram could end up so confined and fragile. She wanted to caress him and make all his pain go away. With an elbow on the mattress, she rested her chin in the palm of her hand.
"Ephram." She whispered. "You have to get well. For your father's sake. And for Delia." She paused. "But most of all, for me." She peered around the room suspiciously as if someone might've heard her. When she realized how silly she was for being so paranoid, she shrugged it off.
"I haven't known you for a very long time. But for the time that I have known you, I've grown rather attached to you. I didn't think any one's kid could have this affect on me. Boy was I wrong." She whispered feeling more relaxed. "Maybe I don't show it enough for you to realize it. But truth is, you are like a son to me. I will always treat you like one of my own - no matter how unaware you are to my affections. And it's so easy for me to say these things to you right now. Coward as I am, I wouldn't have the nerve to tell you when you're conscious and certainly never display these feelings in front of your father. My heart bleeds when I see you like this."
"Your mother must've been so lucky to have a son like you. She would've been so proud. Sam's only five but he looks up to you. Hell, everyone looks up to you. You just don't know it." She watched Ephram breathe thru his mouth. His lips parted slightly.
"Why didn't you tell someone you were hurting? Why did you deny your pain? You are only a boy Ephram. You shouldn't have to mask your physical and emotional feelings like this. We don't expect you to be almighty, powerful, and unbreakable. You think you always have to put up this brave front because you're afraid others might see thru you. It's ok to show your weakness." Nina confided. She was getting comfortable talking to the unconscious boy. "I know the situation with your father before your mother died. I also know you think you have to fend for yourself and take after Delia since you thought there was no one left to care for either of you. That is an awfully big burden for a fifteen year old. I wish you would let someone take care of you. Let me take care of you."
"I'll tell you another thing. Your father - he may be wet behind the ears on how to raise his kids and you think he wouldn't know how to even if it ran right smack in his face, but he's trying so hard. If only you knew how much he wants to have that special bond with you again. There are so many things you don't see. Your father is a different and better person now than what he may have been in the past. You just have to realize that." Nina's eyes began to tear. She touched Ephram's hand. The tears were uncontrollable. She held in her sobs.
"Don't give up, baby." She whispered. "I love you son."
The sound of a creaking door startled Nina. With her back against the door, she stood up, quickly brushed the remaining tears away from her face and wiped it on her jeans.
"Everything ok?" Andy questioned standing by the door holding a small towel and a basin of water.
"Yep. Fine." She said abruptly. She wondered how much of her rambling had he actually heard. "Here, let me help."
She extended her hands for the basin meanwhile avoiding any eye contact to hide the fact that she'd been crying. She did that well by keeping busy and distracted with soaking, wringing, and applying the cool cloth to Ephram's toasty forehead. There was no conversation for a good half hour.
"Do you think he's going to be ok?" Nina finally broke the silence.
"From a doctor's stand point, it doesn't look too promising. Apparently, that fall did more harm than the blood clot. Worse case scenario, he may never be able to walk on his own." Andy answered grimly.
"You said 'may.' So there's a chance he might still be able to fully recover. Right?" Nina inquired.
"Chances are slim. At this rate, he's able to wiggle his right toe and that's always a good sign. If the spinal contusion was severely complicated with the fall, even if he regains the function of his legs, he wouldn't be able to walk without crutches. I'm hoping the CT and X-ray results will tell me something good." Andy replied. Strong and stoic as he was, a tear rolled down his cheek and blended in his thick beard. He bit his lip and turned away to hide his vulnerability from Nina.
"Oh." Nina sighed with a broken heart. A soft moan passed thru Ephram's lips. The coldness of the cloth suppressed the burning flame under the boy's skin as Nina dabbed the boy's warm forehead and cheeks with care. Several droplets of water escaped the cloth and trickled down Ephram's neck and slid onto his chest where it evaporated in an instant. With eyes closed, he moved his head slowly.
"Ahhh." Ephram surprisingly cracked a weary smile.
"Is that better?" Nina asked.
"Mmm. That feels good." Ephram murmured feverishly.
"I'm glad it's helping." Nina said sounding more enthusiastic for the boy's sake.
"It's so hot in here." Ephram swallowed with eyes still shut.
"You've got a fever." Nina explained. She continued to apply the compress to his neck and chest.
"Where's dad?" Ephram raised his voice. He sounded like a little lost child.
"I'm right here buddy." Andy touched Ephram's hand. Andy wanted to hug the living daylights out of his son. Suddenly agitated, Ephram's eyes shot open and rapid breathing took over.
"Oh no, Delia. Delia. I didn't mean to scare her like that." Ephram slurred. "I have to - "
"Shhh. Delia is ok. She's with Nina's mom and Sam in the waiting room. I'll bring Delia by to see you later." Andy rubbed his son's arm to calm him down.
Achy and tired, Ephram didn't have the energy to rebut his father. He allowed his head to sink into the soft delicate pillow. It cushioned and cradled his feverish head in the most comfortable and relaxing way he ever thought possible. Never had a mattress been so tender under his aching body. It was like he was lying on a massive cloud of fluff. His shoulders were stiff and knotted with such tenseness that upon the touch of this very softness, he felt every muscle unwind. His lower back was sore from the spinal tap as well as from the fall. His legs were still numb and tingly as the heparin did its work in dissolving the blood clot. Andy watched his son's eyelids droop to a close with drowsiness. And the worry from Ephram's brow softened as he fell asleep again.
Andy and Nina looked at each other with heartfelt sorrow in their eyes. They swallowed the extensive tear shed they so badly wanted to let out. They would've never been able to stop crying. Andy reached over and gave Ephram a gentle kiss on the cheek. It was not something he normally did. He knew his son was touchy when it came to parents showing affection for their children in certain places. Ephram was at the ripe old age of eight when he decided it was inappropriate for his parents to advertise parental affection towards him. He refused to hold his parents hand when they went out because he didn't want people to think he was a baby. Kissing and hugging him in front of his friends, at school or anywhere was strictly forbidden. They were not allowed to yell out, "I love you, honey." Or anything remotely related when he was playing with his friends. He would go kicking and screaming if either parent showed any budding signs of smothering him with love at any given place aside from home. He wanted to be so independent and grown up. Andy was glad Delia was different. Delia was still very receptive to hugs and kisses. Andy couldn't even remember the last time he kissed Ephram. It had been too long. He didn't care what Ephram had to say about it now. Perhaps it was even now that Ephram needed that kiss the most. Andy watched Ephram sleep for a while.
The poor boy suffered excruciating pain in his back from falling, he survived the deep vein thrombosis and pulmonary embolism, and now he's running a fever of 101. Above all this, he was still thinking about Delia. He didn't seem worried about his own well being. Delia had always been a top priority. He cared so much for the little bugger. And Andy was thankful to have such a selfless and devoted son like Ephram.
The most difficult part was telling Ephram he might be relying on a wheelchair for the remainder of his life.
* end chapter 3 *