Six Days After Christmas
(Or how we wrote a story with the sole purpose of which was to kick Ryan's ass.)
Part 7
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Sandy planned to track Seth down and put him in his place.
No holds barred, gloves off.
All out can of parental whoop-ass.
Like hell he had any intention of allowing Seth to storm off in a temper-tantrum after accusing him and Kirsten of somehow being responsible for Ryan's…situation. That attitude was not what the Cohen family needed right now. It needed to ban together, not manufacture ways to shred apart. Caleb provided enough of that drama lately, thank you very much.
Sandy gathered his momentum and went in search of his son, found him in the ICU men's room, kicking the hell out of an innocent trashcan.
One sharp "Seth!" ceased the outburst.
Seth didn't need to be put in his place. He needed his dad.
Sandy sat with him, on the floor of the bathroom until finally he asked his son, "Are you ready to go back?"
"This is so hard," Seth admitted, his voice barely above a whisper. "It's too hard, seeing him like that. I can't cope with it."
"I'm going to help you Seth," Sandy promised. "Because if you don't go back in that room son, you'll regret it for the rest of your life."
He didn't need to elaborate.
Seth understood.
Go back in the room, and be a man and stay with Ryan.
Just in case.
Go back and be thankful that you have an opportunity to help him through the hurt and help him heal. Go back now, in case there isn't another chance, in case the doctor is wrong and things aren't ok.
Sandy patted his son's knee.
"We're going to do this together Seth, as a family. We're going to help Ryan make it through this."
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Kirsten found Lindsay crying outside of Ryan's room. She walked her half-sister back to the ER waiting room, told her to go home, get some sleep, come back tomorrow and take the day shift.
Jimmy was still there, offering to help her with anything she and Sandy might need.
When he asked if he could bring Marissa in the morning, Kirsten told him to hold off on that, give her a call first.
Ryan was unconscious.
Kirsten felt uncomfortable making the decision concerning who was and was not allowed in to see him. Ryan was a very proud, private person. She doubted, given a choice, that he would even want her or Sandy or Seth seeing him incapacitated like he was.
She stopped off at the bathroom and splashed water on her face, studied her reflection in the mirror, steadied her nerves, reminded herself of what to do. This wasn't about her and how sick to her stomach she felt. This was about a seventeen-year old boy in intensive care who needed her to be his mother.
When Kirsten returned to the ICU, Sandy had sweet-talked the nurse into allowing all three of them to stay. He and Seth were already in the room, sitting in chairs, looking mutually miserable.
She kissed Ryan on the cheek, careful to avoid the breathing tube and his many bruises. Pushed the hair back from his forehead, kissed him there too.
Let her lips linger.
He felt warm and that surprised her. For some reason she expected him to be cold.
The nurse came in, asked them to leave while she completed the first neuro-check.
"Is he going to wake up Linda?" Sandy asked, hopeful.
"Not really," the nurse shook her head. "I'm just checking to see if he responds to a few, very basic commands. We don't want Ryan conscious right now. The ventilator is very uncomfortable, he'd be confused, agitated. I should only be about ten minutes."
Sandy leaned over Ryan, told him, "We're right outside the door Ryan. All of us. Me and Kirsten and Seth. We're not leaving you kid."
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Linda reviewed her notes pertaining to the young man lying in front of her.
Ryan Atwood, seventeen.
Suspected victim of a carjacking.
Only seventeen.
He'd probably been driving for less than a year.
She should be immune to this, the after affects of useless violence. After all, she'd been working in the critical care setting for many years now, and she'd seen much worse. But the young ones generally wound up in Pediatric ICU, not on her floor, and it was hard to completely remove yourself from the instant panic that swirled around nervous parents as they found themselves dealing with a critically injured child. Linda hated to play favorites, but something about this kid and his family struck her as special. She had already bent the visitor limit rule for them.
She snapped out of her thoughts and got back to the task at hand, checking out the status of the patient. Ryan's sedation should be wearing off. She'd deliberately withheld that last dose to allow him to surface a bit.
His skin color was still a bit pale, but he was slightly pinker and no longer clammy to the touch, all indications that his respiratory and circulatory statuses were improving. Linda disabled the ventilator alarms, disconnected the accompanying tubing, removed the condensation that had accumulated, and then quickly replaced the plastic tubing leading to the endotracheal tube. She glanced at the various monitors to see how well Ryan was tolerating her ministrations. The pulse ox showed an acceptable sat of 95. The cardiac monitor displayed a steady sinus tach with a rate of 135. There was minimal drainage from the chest tube, good urine output, and good bilateral pedal pulses.
All in all, considering what he'd been through tonight, he wasn't doing that badly.
Unraveling her stethoscope from around her neck, Linda auscultated Ryan's lungs. They were clear and a good exchange could be heard, with slightly diminished sounds to the right lower lobe. But there was some air moving. His lung was re-expanding.
Now, to see if the teenager would respond.
"Ryan, I'm Linda. I'm your nurse. You've been injured; you're in the hospital. If you can hear me, I want you to squeeze my hand."
"Ryan, squeeze my hand…"
"Ryan?"
After no response, Linda moved on. She shook the teen's arm. Ryan moved his head slightly - good sign. She tried one more time, "Ryan, can you hear me? Squeeze my hand Ryan".
Linda was rewarded with a slight feeling of pressure. "That's great Ryan. You're in the hospital. My name's Linda and I'm going to take very good care of you. You have a tube in your throat to help you breathe, so you can't talk right now. I know it's uncomfortable, but you're doing really well Ryan and I'm going to make sure you stay as comfortable as possible."
Picking up her penlight, she warned, "Ryan, I'm going to shine a bright light in your eyes," and proceeded with the neuro checks.
Finally, Linda assessed Ryan's abdomen, continuing her narration, talking to him in hopes that her voice would be calming. The bruising on his stomach continued to deepen and his abdomen was feeling a bit tight to the touch. She measured the circumference and noted all of her findings on the flowsheet at the foot of the bed.
Something didn't feel right, but Linda couldn't quite put her finger on any one thing in particular. All the readings look good. She wondered if it was simply the patient's age that had her feeling slightly uneasy, slightly uncertain.
Ryan's head shifted again and he started straining against the ventilator. His left hand reflexively rose up, pulling against the soft restraint on his wrist. Linda murmured soothing words while she administered the much-needed sedation that would return Ryan to an unconscious state. Once she was finished, the nurse freshened up his linens, straightened up the bedside, and then stepped out to invite the teenager's anxious family back in.
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Seth leaned against the waiting room wall face first, gently thumping his forehead against the wall.
One thump for each word.
"This… is… taking… a… long… time," he announced, turned to his father, "Do you think this is taking too long?"
Sandy blew air out of his cheeks, held out a hand to answer, "Well I'm sure…."
"So you think so too, huh?" Seth interrupted. "Mom. Dad and I think it's taking too long."
"I'm sure everything is fine Seth," Kirsten answered wearily.
Seth manically nodded up and down, folded his arms around his midsection, "So it's unanimous. We all agree it's taking too long and therefore something horrible must be happening."
The nurse, Linda, entered the waiting room and Seth immediately jumped at her, "How'd he do? Did he pass?"
"Ryan did fine," Linda smiled. "He's resting again. It wasn't really a test."
"Did he wake up?" Sandy inquired. "Does he know where he is? Did you tell him we were here?"
"Ryan was able to follow a few verbal requests Mr. Cohen, just enough to let us know that the head injury doesn't appear to be complicating things. Everything went well. I told him his family was here. In most likelihood, your son really won't start comprehending or remembering what is happening to him until after the ventilator is removed. The sedative we are administering causes most patients to have a foggy recollection at best."
"Well, that's probably for the better," Sandy muttered, ran his fingers through his hair. "I mean who in the hell would want to remember any of this?"
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"We're back," Kirsten told Ryan as she pulled a chair close to his bed. "The nurse said you're doing really good. I sent Lindsay home. She's fine. You protected her Ryan. You kept her safe. I'm so grateful to you."
Seth grabbed another chair, a little further from the bed.
Sandy stayed on his feet.
Listened to his wife softly talking to Ryan, thankful that for once he didn't have to be the strong one.
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Seth glanced at his watch. An hour and a half had passed. He must have fallen asleep. He stretched his neck, leaning side to side. The hospital chair wasn't bad but it was no bed.
His stomach growled.
He was a horrible friend, a horrible brother. Ryan was laying here with a tube shoved down his throat and all Seth could think about was food.
Shouldn't he be telling people he wasn't hungry? Shouldn't food be inconsequential? People on TV were always skipping meals when catastrophe struck.
His dad had set up camp next to his mom who remained resolutely next to Ryan's bedside. They were holding hands, his mom's head on his dad's shoulder. He spent a second watching them, not remembering the last time he had seen them like this, this close. Seth stood up, joined his parents, nodded toward Ryan, asked his father, "How's he doing?"
"Sleeping," Sandy answered. "Soundly."
"Yes, thank you Father. Let's not allow this current, tragic set of circumstances to derail your acerbic wit."
"Sorry," Sandy apologized. "But honest to God, he hasn't even twitched."
Seth's stomach groaned louder, causing his father to inquire, "Hungry there sport?"
Seth scratched unconsciously at his cheek, grimaced, "Yeah maybe a little bit. Does that make me a bad person?"
"No," Sandy shook his head, "Just a hungry one."
He handed Seth several ones, "Go grab something, I'm sure there are vending machines around. Get your mother a bottle of water."
Seth started to leave the room but hesitated.
Sure, he was in Ryan's room, instead of running as far away from the hospital as humanly possible.
That was a start.
But he was letting his parents do all the talking, as if Ryan was a museum piece that Seth was being informed of while he stood a few feet away, detached, examining it.
He walked slowly to the other side of Ryan's bed. He preferred the left side, no bandage. No hideous bald spot. Fewer tubes.
Seth cleared his throat. Leaned down.
"Hey man, I'm uh, just gonna' step out and grab something to munch," he clumsily told his friend. "So…yeah, so, I'll be right back."
His dad gave him a quick bob and a small smile as he exited.
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Linda entered Ryan's room, noting that his parents were the only ones in it. Both their heads snapped up, looking at her, watching her with wariness. She hated the way her presence always shifted the mood of a room, from calm to awkward.
She'd learned not to take it personally.
"Mr. and Mrs. Cohen, it's time for Ryan's next neuro-check. The coffee cart on the third floor should be open by now, if you want to stretch your legs."
"It's a little early, isn't it?" Mr. Cohen asked, glanced at his watch, "for another check?"
"There's no set time," Linda maintained a cheerful veneer. "It shouldn't take too long. I'll come and find you in the lounge as soon as I am done."
The couple stood up, said goodbye to their son, politely excused themselves.
Not son, Linda reminded herself.
The paperwork noted that Ryan was their foster son, not biological. That explained the differences in the last names. But earlier, in the waiting room, she had referred to Ryan as their son and no one had even blinked, let alone made an attempt to correct her. He must have been living with them a long time.
Linda pulled the blinds in the hospital room shut in case one of the Cohens came back early. She was concerned about Ryan's recent blood pressure reading. It wasn't a significant drop, but when combined by her earlier misgivings, Linda's radar was at full alert.
She began the exam in the usual fashion.
"Ryan…"
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Seth returned from his vending machine safari chewing on a Snickers. He would have preferred a Twix, which for some reason he considered more of a food group, but it was best for beggars not to be choosers at five in the morning.
Noticing that Ryan's blinds and door were shut, he detoured straight for the small ICU waiting room.
"Everything cool?" he asked, more as an introduction to his return than an actual question.
"Yes," he mother answered quickly.
"No," his dad countered.
"Sandy, come on," Kirsten urged, "Stop it, you'll worry Seth."
"Worry Seth about what?" Seth asked, eyeballing both his parents.
"Nothing," Sandy said quietly, turned his head away from his son.
Seth avoided his mother, went straight for his father. "Worry Seth about what?" he repeated.
"Your father's being paranoid honey."
"I'm pretty sure I wasn't talking to you Mom."
Silence.
"Hey," Seth complained, "If this is what it's going to be like every time I go for a candy bar or a soda or a pee, I'm not leaving the room anymore. If something's going on, I have a right to know."
Sandy stood up, "Your mother's right, it's probably nothing. I'm probably overreacting."
"See, Dad, it's the overreacting to what that has me so confused and feeling left out."
"It's just," Sandy hesitated, "The nurse came in to Ryan's room early for that check and now it's taking longer than before."
"They're just being thorough," Kirsten offered. "The doctor told us he's doing fine."
"That was hours ago, Kirsten," Sandy reminded her. "He also warned us that something could go wrong."
"Well how long has it been?" Seth asked, his anxiety growing. How long had he been away, searching for food? How long had he left Ryan alone, in this place, in that room? He observed his father pacing, his face serious. "Dad, how long has it been?"
"Thirty-five minutes," Sandy rapid-fired. "It only took ten minutes last time."
Kirsten bit her bottom lip, avoided Seth's stare.
"I'm going to go find out what's taking so long," Sandy declared.
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Linda reviewed the lab results again, compared them to the previous ones. Between Ryan's most-recent exam and the new findings, she knew something wasn't right. The kid had to be bleeding out from somewhere and her money was on the belly. His abdomen had felt a bit tight and he had jerked slightly when she was examining his right side.
It was time to call in the troops for a more thorough check.
She gathered her notes and paged the Surgery Resident. Linda needed to get someone to take a look at this kid quickly, either to confirm her suspicions or put them to rest.
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Dr. Morrison was in his third year and almost finished with his residency. He couldn't wait to get off of the ridiculous 36-hour shift rotations. How the medical profession could consider sleep deprivation ideal training ground was beyond him. He was counting the days until this forced servitude was over, and he could begin to practice medicine in a more civilized manner, during more civilized hours.
The beeper woke him from a light sleep.
More like a light nap.
Morrison hadn't been lying down for more than thirty minutes since his last call. He considered for a nano-second ignoring the page, but that thought was absurd and definitely the lack of meaningful sleep talking. He sighed, glimpsed at the callback number on the pager's display, then quickly got up and placed a return call to ICU.
There were plenty of nurses who paged him for no good reason.
Linda wasn't one of them.
So, when he returned the page and listened to Linda describing the condition of her patient, he didn't hesitate to haul ass to the ICU and assess the situation for himself.
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Sandy peeked into Ryan's room, saw the nurse hanging up the room phone, withdrew his head, waited by the door.
Counted to ten.
Told himself to stay calm and rational.
He was the amateur investigator, the one that never jumped to conclusions without analyzing the leads.
The nurse came out, almost running into him, surprised by his presence.
"Oh, Mr. Cohen," she said briskly, " I'm not done with Ryan's exam. You need to go into the waiting room sir. I'll be there as soon as I can to give you an update."
Sandy tried to keep his voice steady, tried to ignore the nurse's change in tone and body language. "Is everything all right Linda?"
Use her first name, force her to treat you like a human being, don't allow her to blow you off.
"Sir, you really need to return to the waiting room. One of the rules we discussed earlier this evening is how important it is to Ryan's recovery that you and your family follow every and all instructions presented to you by the ICU staff."
Ouch.
Nurse one, him nothing.
Sandy recognized a verbal slap down when he was administered one. He considered arguing, but so far she had been lenient with him. If everything was all right, he didn't want to risk falling out of her good graces. He began a reluctant retreat back to the waiting room.
"Linda."
"Dr. Morrison."
Sandy heard the nurse's name called. He glanced over his shoulder just in time to see a large, well-built guy in a white lab coat and blue scrubs hustle his way into Ryan's room.
Sandy turned around and stared at the nurse, his eyes willing her to tell him what in the hell was going.
"Just a few more minutes Mr. Cohen," was all she said before joining the doctor in the hospital room.
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After a hasty, but complete exam of Ryan, Dr. Morrison put into motion a flurry of activity.
First, he called Dr. Caulard to report his findings and plot a plan of action.
Next, he contacted the OR to secure a surgical suite and to begin the on-call process for assembling the required members of a surgical staff.
That was the easy part, the resident told himself. Linda had warned him about the hovering family. If medicine were all cutting and drilling, it'd be a piece of cake. It was the damn PR that was going to be the death of him. Morrison practiced his speech as he walked slowly to the waiting room to locate the Cohens and discuss the most recent development in their son's case.
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Linda prepped Ryan for an immediate transport to surgery. Dr. Morrison had toyed with ordering another CT Scan but Ryan's condition was deteriorating too quickly to risk the time it would take to run the test. He wanted the teenager in surgery now.
"Ryan, it's Linda. I'm not sure how much of this you're following but we're taking a little ride down to surgery. I'm going to be doing a few things to help get you ready."
She attached Ryan to a portable cardiac monitoring device, hung two new bags of IV fluids, including a piggyback of antibiotics, and paged Respiratory to assist with the transport, all the while talking to Ryan, explaining to him what was going on, assuring him he would be fine.
Always assume the patient can hear you; always assume they might be aware of something.
Linda worked quickly, focusing on what needed to be done, fueled by the sense of urgency created by Ryan's declining stats. His heart rate was racing, blood pressure dropping.
The respiratory specialist arrived and Linda let out a silent sigh of relief, unconsciously patting Ryan on the head as he was whisked away.
Thank god she had called Morrison without delay, instead of wasting time second-guessing herself.
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"How can this just now be happening?" Sandy questioned. "How can you just now be finding this? We were told by the other doctor that Ryan was stable."
"He is stable," Morrison answered. "We need to locate the bleed and eliminate it to keep him that way. I understand that this is a little bit disappointing but we've caught the bleeding early and I don't anticipate any further complications."
"Disappointing?" Sandy blinked disbelievingly at the doctor. "Disappointing? How about scary or terrifying? How about explaining to me why we shouldn't be panicking that Ryan is bleeding internally and has most likely been doing so since the moment he was admitted into this hospital?"
Morrison held out his hands. "Look, Mr. Cohen, we ran every single test possible. Sometimes these things just take their time presenting. It's fortunate that Ryan displayed classic, easy to recognize indicators and didn't experience a sudden drop in blood pressure. If we have to cross this bridge, believe me Sir, this is the way we want to do it."
"I'm pretty damn uncomfortable that it's taken you and your staff this long to find 'the bridge'," Sandy snipped. "All that damn machinery you have Ryan hooked up to and this is the best you people can do?"
"Sandy," Kirsten put a hand on his shoulder, "This isn't helping honey. This isn't what Ryan needs right now." She turned to the doctor. "How long…will the surgery take?"
Morrison nodded, happy to be back on familiar ground. "A few hours, maybe a little less, depending on what we find."
Sandy started to open his mouth again, but Kirsten applied pressure to his clavicle, effectively silencing him.
"Thank you," she said quietly.
Morrison quickly explained the consent forms, obtained the Cohens' signatures, and high-tailed it out of the waiting room.
Sandy slunk into a chair, putting his head into his hands.
Kirsten knelt down on one knee, put her hands over his, whispering to him.
Seth stood numb in the middle of the room.
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End of part 7