Chapter 4 - After Twelve Hours

Alex is still in a serious condition but is at least conscious and holding his own but Luka's injuries are extensive and severe and have caused complications and he might die. Abby joins her and is sorry for what happened earlier between them.

It was 10:15 am; twelve hours since Sam, Alex and Luka were airlifted to County. Luka was in surgery for almost nine hours. There were setbacks in the OR but the team kept addressing them one after another and, by a miracle, he survived surgery.

Elizabeth Corday slumped into the armchair in the surgeons lounge. She dragged the cap from her head and wiped the tears that she allowed to flowfrom her eyes, now that it was all over. She reflected on the last nine unbelievable hours. Luka had arrested just as she had finished repairing his liver.

"What's going on Henry?"

"V-fib!" he shouted.

"Okay, paddles ... charge 200! ... clear! Alright push the Epi!" For 10 minutes they shocked his heart, and he had been pumped with Epi and Lidocane. Once he had been stabilized, they continued to repair his body. But extreme blood loss dropped his blood pressure and once again they had to stop their procedures to work on his vitals.

"Dr. Anspaugh, his blood pressure is falling fast," said the anesthetist.

"Dr. Dean, you might have some blood pooling somewhere in that leg," he suggested to his colleague.

"Christ, not just some, a lot! Here under the skin,"

"Well, come on let's find where it's coming from!" she had said.

She remembered the alarms going off yet again, indicating his heart had arrested once more. The aura of the OR was frantic. Elizabeth's eye briefly caught Deb Chen's pained expression as she stood in the observation area. She had been in disbelief. As she sat in the armchair, she tried to make sense of the past events. He was fine yesterday. Walking around doing his job and in just hours, it all changed. She rubbed her eyes and tried to get the images out of her head. Images of Luka, mere hours ago, nearly dying on an operating table in the hospital where he worked.

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The consulting neurosurgeon spoke with Sam about Alex's condition.

"We intubated him using RSI and we pre-medicated him with lidocaine, etomidate and a neuromuscular blockade. We're using mannitol with him now to help reduce inter-cranial pressure and blood viscosity because we want to increase blood flow and oxygen delivery to his brain,"

"Are there any side effects to the mannitol? It's just that he's diabetic ... and ... I worry ...,"

"Don't," the doctor re-assured her. "We used mannitol and we administer it according to his weight. It's safer to use on diabetics than phenytoin that has been known to raise blood sugar levels. But, as with any drug, we'll monitor him for any pulmonary congestion, or dehydration, fever or intracranial bleeding. He's in good hands up here and Alex's recovery looks very promising,"

"Thank you, Dr. Stewart,"

"Just have me paged if you have any questions and try and get some rest. I've heard you're pulling double duty up here,"

"I'll try. Thanks," said Sam and she looked at her son who was still asleep with a tube down his throat and all sorts of electrodes and wires leading from his bandaged head. At least everyone was hopeful about Alex. It was different for the man who saved his life. The doctors felt Luka was more likely to die of his injuries. Powerless. Helpless. Afraid. She had felt these before but not with such overwhelming intensity. If Luka died, it would burden her forever. She was so grateful to him yet he might never be able to hear her express her feelings to him. It would just be she and her son. Alone – as they had always been.

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Alex started showing signs of consciousness around noon. His eyelids fluttered at first, and then he moved his fingers and turned his head a bit. He drifted in and out of sleep, happy to see his mom at his side.

"Hey, kiddo? ... You're feeling pretty rough, huh? You banged your head pretty hard last night. Do you remember what happened?"

Alex blinked and a tear rolled down his cheek. He reached for her hand. He managed a little smile but then looked worried again. He tried to whisper something but Sam gently explained that he shouldn't try to talk because he had a tube down his throat to help him breathe. The boy blinked several times and Sam realized that his vision, though returned, was still blurry.

"I know you're in a lot of pain sweetie, and everything is blurry but you're going to be fine and you'll be able to see again in no time. I'll be right here with you, so I want you to go back to sleep now. You need to rest so that you can get better real fast, okay?" Alex continued to blink to clear his vision but soon the simple task became too difficult and his eyelids grew heavy. Sam watch as he drifted off, thankful that he was still with her and was going to fully recover.

"How's he doing?" said a voice as a hand gently rested on Sam's shoulder. It was Abby.

"He's waking up slowly. There's been quite a bit of movement. He recognizes me. So far so good,"

"He's going to be fine. How are you?" Abby said, pointing to Sam's arms. Sam said they felt better and Abby turned to face her.

"Listen, Sam, I want to apologize for my behavior earlier. I had no right and I'm sorry. I know none of this was your fault and you were trying to protect Alex,"

"Hey, no worries. I know you and Luka are good friends. You can't shut out someone like him ... he's a good guy. I mean, look at what he's done for me. He came to get us and he saved Alex's life," sniffed Sam. Abby put an arm around her.

"So here's what's going to happen. Luka's in recovery and Kerry has made arrangements for him to take up that parking space right over there," Abby pointed the next room over through the glass window. "That way, if you're here with Alex you can see Luka and if Alex is asleep you could sit at Luka's bedside,"

"I don't know what to say," said Sam, wiping her tears.

"Don't say a word. We wouldn't have it any other way. Now, they're bringing Luka in about half an hour so go grab something to eat, a coffee, splash some water on your face and I'll sit with Alex,"

Sam hugged Abby. She rose to leave then said, "You know, we've got no family here and neither does Luka. It's nice to have people like you around,"

"You do have family Sam and not just us. Luka's your family and you and Alex are his," replied Abby.

Sam wiped her tears and smiled and headed for the ladies room.

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In recovery, Elizabeth checked on Luka. He showed some brief signs of waking; opening his eyes for about a minute but seemed too fatigued to try again. Though she was happy he was stable, Elizabeth was concerned. He certainly could have died right there on the table on two occasions. Elizabeth didn't know how much fight he had left in him. His lost a great deal of blood and was physically depleted.

"Dr. Corday, we'd like to move Dr. Kovac to the ICU now," said the OR nurse.

"He's good to go to, Debbie, thank you," Elizabeth took Luka's right hand firmly in hers and accompanied him all the way to intensive care. In his condition she felt it was vital for him to feel the presence of someone who cared about him. As they made their way down, all the memories of Mark's illness that cut short their time together came flooding back. She felt the tears well up in her eyes and she quickly blinked and wiped them away. "No", she thought, "I mustn't let Sam see me like this. She has to stay strong to help him pull through this ordeal,"

The elevators opened and Elizabeth pulled herself together. As Luka was wheeled into the ICU a hush came over Sam, Abby, Susan and Kerry who were waiting there. They had seen patients in this state a hundred times before but this was Luka and it was hard to watch him connected to all the machines with all IV bags, the bags of blood and tubes and wires taped all over his body. Elizabeth examined Luka again; spoke briefly with Kerry before turning to Sam. Kerry went over to the ICU nursing station to deal with some paperwork while Susan went for a coffee and Abby sat with Alex's until Elizabeth and Sam were through.

"He woke up for a bit in recovery but he's very weak and I'm concerned recovery's going to be an uphill struggle for him. I thought you'd like to see the chart," said Elizabeth, "But I'm going to go through his injuries and what we've done to repair the damage,"

Sam gulped as she heard about Luka's condition. Steve had crushed Luka with the impact of the truck. His right leg was broken in two places. He had a compound tib/fib fracture that caused posterior tibial hemorrhage, a clean, closed, transverse fracture of the femur, an impacted fracture of the left humerus and a comminuted fracture of the left radius with a greenstick fracture of the left clavicle. He had five broken ribs; one had lacerated his liver, one had collapsed his lung, one had made a small puncture in his small intestine and one had ruptured his spleen and the other had punctured his right renal vein.

"Sam, we nearly lost him twice in surgery. His heart stopped and his blood pressure fell dangerously low. I repaired his liver and removed his spleen and managed to control all the bleeders,"

"What are your gut feelings?" asked Sam, tearfully. "I'd like you to tell me he's going to ... to live ... but I know how weak he is and the seriousness of his condition,"

"And I have to be honest, Sam. I'm surprised and very grateful he made it out of surgery alive. I'm worried now about pneumonia, and infection and of course, his level of consciousness,"

"I know, he needs to wake up," Sam sighed and dried her eyes. "But ... Dr. Corday ... do you think he can survive this? Or ... Or will he ... die?"

"The odds he was given after we closed were 70:30 that he won't make it to morning but we haven't given up hope, Sam. We haven't given up on him and you mustn't either. He needs your strength and support to survive," Thank you, Dr. Corday . I'm not going to give up on him but I'm glad you were honest with me. I needed to get everything straight before I called his family,"

Sam glanced over the pages of the chart then put it down and walked to the head of the bed. She gently stroked his cheek. Luka did not respond. She had never imagined he could be that pale. His face was bruised and cut, a huge bandage covering the gash that stretched from his forehead to his temple. His left arm was in a cast and his right leg in a rigid splint. Sam shuddered when she saw long the stitched incisions on his leg. Dr. Corday explained that because of the massive injuries to his leg, Luka might need another operation. Sam was concerned about the use of his left arm but no nerve or muscle damage was indicated and they expected it to heal well. Sam fixed her gaze on him again. Luka's torso was bandaged and he was still intubated. Dr. Corday had recommended that he should be kept on the ventilator indefinitely because of his depleted physical state.

"Sam, if you need anything or have any questions ..."said Elizabeth sympathetically.

"Yes, I know. I appreciate what you've done for him Dr. Corday,"

Susan returned and joined Abby in Alex's room.

"Hey,"

"Hey, Susan," Abby was flipping through Alex's chart. "He's doing well,"

"Yeah, looks good," said Susan, looking at the chart over Abby's shoulder. "I wish I could say the same for Luka,"

"Why? What do you know?" Abby's voice was shaky.

"I spoke to Elizabeth up in recovery earlier on this morning. Luka's unresponsive. He's so weak she's afraid he could slip into a coma. She's also worried about infection and pneumonia,"

"Shit!" Abby mumbled.

"She's worked him up on drugs and they're gonna watch him like a hawk. He's in good hands," she squeezed Abby on the shoulder and tried to re-assure her. "Look, I'm here with kiddo. Go in there and say hello. The more voices he hears the more comforting and encouraging it would be for him,"

Abby made her way to Luka's bedside.

"Strange isn't it? We deal with this everyday but they're all strangers. When it's someone you know it all seems so unbelievable," Sam whispered. "Now I've got to call his father and tell him what's happened. Damnit. This shouldn't have happened,"

Abby reached out her hand as she took her place beside Sam. Sam took it. There they were, his past lover and his present gazing at him in disbelief, holding on to each other praying for his survival.