Thank you for sticking with this story. This was a weird chapter to write, after watching last night's CSI episode. I won't say any more than that, in case anyone hasn't watched it yet. Cathy.
Chapter 57
Art Fontaine jotted notes on a pad while Jim Brass sat in a chair across from him, recounting in a dull monotone everything that had progressed from the time Sheriff Mobley had suspended the detective, until the shootings at Sturney's. The agent was impressed with Brass' ingenuity, from his borrowing his neighbour's car to enable him to slip out undetected by the surveillance team, to his purchase of a fake badge in order to get staff at the pet shop to speak with him.
Fontaine was mildly irritated that Brass had kept two of the boxes of papers that had belonged to Beth Marchison, rather than turning them over to those actively involved in the investigation. But he could understand the other man's reasoning. And he had to wonder whether anyone else would have caught the similarity between a clerk's signature on a nine year old sales receipt, and the writing of a serial killer.
Sturney hadn't even tried to deny that he was responsible for the deaths of several women and three police officers. Listening to the detective explain Sturney's warped reasoning and justification for the killer's heinous acts, Fontaine realized that secretly he was pleased that Dean Sturney was dead. Now none of those involved in the investigation would need to waste additional years preparing for a trial that would suck huge sums of money from the system, and become a media circus that would only add to the pain of the families mourning loved ones. There was no chance of the serial killer getting off on a technicality. No one else would ever have to suffer at the hands of the madman. It was over.
Or it would be, soon, Fontaine knew. One way or another. When Brass had returned from the hospital's chapel, accompanied by Gil Grissom, the detective had seemed different. There was a calm resignation about him. The unbridled energy, the need to physically do something, seemed to have subsided. Brass' movements were slow now. He looked exhausted. Only his eyes, shining brightly in his waxen features, evidenced his worry and heartache.
Without prompting, the detective had begun to give his statement. He sat stiffly in the vinyl covered chair, hands on his knees, his dark eyes fixed solemnly on the agent. Occasionally his gaze would wander to the doorway of the waiting room, watching for the messenger who would bring them word on Cecilia, and Brass' words would falter for a moment. There was a mixture of both hopefulness and dread in that look, that made Fontaine ache for the other man.
Gil Grissom sat at a bank of chairs against the far wall, the only other occupant of the room. He waited quietly, his blue eyes watchful, as Jim Brass related the series of events that had brought them here. Other than a brief smile, when the detective spoke about borrowing his neighbour's car, first to run out to Laughlin to question the elderly neighbour of Elliott Keeth, and later to slip out to Sturney's, the scientist's face was impassive. Fontaine had observed a strange detachment in Grissom from their first meeting. He assumed the criminalist was there now to lend moral support to the detective, but there was a distance, both emotional and physical, that Fontaine found striking.
Before Jim Brass had headed down to the chapel earlier, Fontaine had asked him about who Cecilia's next-of-kin might be. It was imperative that her family be notified of her accident. The detective had told him that Cecilia's parents were living in Pennsylvania, but he didn't have their contact information. A quick call to O'Reilly, still at the Prospect Street scene, and an ensuing search by officers there, had not turned up a purse or wallet that might help them.
The detective had finally suggested getting in touch with Janice Kellerman, the wife of Las Vegas' mayor, who was friends with the writer's literary agent. Fontaine had called the Sheriff and asked him to do so. While Brass was in the chapel, Mobley had called back. Janice Kellerman had been unable to reach Sally Long, Cecilia's agent, but she had left a message on her answering machine. It was unlikely that anyone would be able to reach Cecilia's family until morning. Fontaine felt better about bringing the detective to the hospital. Someone should be there for the novelist.
Brass had finished chronicling events, and the three men sat silently, while the black hands of the plain, utilitarian clock on the wall continued their sweep. Finally, a middle-aged nurse with a wide lock of silver in her dark hair, came to stand in the doorway of the room. The detective sprang to his feet.
Jim's heart thumped painfully against his chest. He tried to read the woman's tired features, to glean a sense of what kind of news she might have for them, but his normally adept skills at reading people failed him. Jim was is agony, waiting for her to speak.
"The surgery has been completed," she announced matter-of-factly. "Ms. Laval has been taken to the ICU. Dr. Kasey will come and speak to you shortly."
"I want to see Cecilia," Jim said huskily.
The nurse shook her head. "They're still monitoring her while the anaesthesia wears off," she explained.
"How is...did everything go okay?" Brass asked, his voice catching.
"I'll have to let Dr. Kasey answer your questions," the nurse insisted. She read his despair and her tone softened. "She should be here momentarily."
"Thank you," Jim told her. Once she had left, he began to pace the room. Cecilia had pulled through the surgery! The nurse had told him that they were monitoring Cecilia. That meant that she was still alive. Surely that was a good sign, if she had survived so far. It was just a matter of time now, time for her to heal and regain her strength. He clung to the hope.
As the nurse had promised, Dr. Eileen Kasey appeared no more than five minutes later. She entered the waiting room and came towards the men. Fontaine and Grissom stood at her arrival, and Brass moved past them, closing the distance between himself and the surgeon.
"I'm Dr. Kasey," she introduced herself with a brief smile. "Are any of you family of the patient?"
There was a moment's silence and then Jim cleared his throat. "Cecilia's family is in Pennsylvania. We're working on reaching them. I'm Jim Brass. Dectective Brass. I'm...she's my..." he floundered for words.
Dr. Kasey assessed the sick worry in his eyes. There was dried blood on the man's white shirt. Possibly the woman's. The surgeon wondered if the detective was even aware of it. During the course of the surgery she had learned a brief history of the patient. Apparantly she had been shot while police were trying to take a serial killer into custody. The woman wasn't a police officer, from what Eileen had gathered, but an innocent bystander. She had heard that the killer had in turn been shot dead by another officer.
Dr. Kasey gauged that Detective Brass had been at the scene of the shooting, and that his concern for Cecilia Laval extended way beyond the professional. In the abscence of a true family member, she decided to allow the policeman to adopt the role for now. Clearly, he was desperate to do so, and the surgeon assumed the woman was probably his girlfriend.
"Ms. Laval's situation is very serious," Dr. Kasey began. "She remains in critical condition. Did someone explain to you why it was necessary for Dr. Van Dyke to do the emergency thoracotomy, and what that involved?"
"Yeah," Brass nodded.
"I fully support Dr. Van Dyke's decision, without the thoracotomy Ms. Laval would have died. There were clear signs of vascular trauma; a pulse deficit and persistent hemmorhage. But conditions in the ER are not as ideal as those of an operating room, of course. The preferred course of action, had the patient been stable and not in danger of exsanguinating, would have been to get her upstairs for angiography, an x-ray of the blood vessels, to assess the damage.
"Penetrating subclavian arterial injuries are relatively uncommon and often difficult to treat. My first choice for repair would have been to do a stented graph. In that scenario a polytetrafluoroethylene graft is sutured over a balloon-expandable stent. The advantage to this type of surgery would have been that it is only minimally invasive. Remote access can be gained through one of the brachial arteries in the upper arm.
"With that technique, we can try to stop hemmorhaging, and repair damage without having to do direct surgical repair of the vessels. There is an added element of difficulty with direct surgical repair because of the exposure required and the surrounding structures which are traumatized when we have to open a patient up. As necessary as the thoracotomy was, it carries its own risks and complications."
Dr. Kasey watched the detective's eyes shift to the man with salt and pepper hair. The other man gave an almost imperceptible nod. She had a sense that the second man had some understanding of anatomy, and perhaps medical jargon and techniques, and that the detective's silent communication was to determine that the silver-haired man understood fully what she was saying and would clarify later if necessary.
"Since the chest was already opened, I did a manual repair of the subclavian artery with suturing. There were other, smaller vessels that sustained damage during the thoracotomy that needed to be repaired as well. The surgery was as successful as I might have hoped under the circumstances," the surgeon said guardedly, "but even following a successful vascular repair, there are other factors such as brachial plexus injuries, pulmonary contusions, and bony fractures which add to morbidity."
"What does that mean exactly?" Brass queried, his brows knitting together.
"The brachial plexus is a system of nerves that transmits signals from the spine to the shoulder, arm and hand. Brachial plexus injuries are caused by damage to those nerves, and symptoms may present as paralysis of the arm, lack of muscle control in the arm, hand or wrist, or a lack of sensation in the arm or hand.
"Pulmonary contusion is an injury to lung larenchyma which can lead to respiratory distress. Even if an injury was not sustained during the original trauma, there is a chance is could result from the invasiveness of the surgery.
"And of course there is an increased risk of infection, since such a large area of internal organs was exposed. Dr. Van Dyke did a textbook perfect thoracotomy, and it was the only option in this case. I just want you to understand however that while it was a literal life-saving technique, it means that the actual underlying cause, the damaged artery, was consequently more difficult to repair."
"I understand," Jim said quietly.
"I repaired the subclavian first, and that went well. There were some partial lacerations of other internal veins that I closed primarily with vein patches. That will help prevent subsequent stenosis, a potential narrowing of one of the valves of the heart. Because it was a high velocity, penetrating wound, the bullet produced a surrounding area of contusion that was thrombogenic in nature. That means there was the formation of a clot inside a blood vessel, obstructing the flow of blood to the circulatory system.
"I had to resect using vein grafts from the saphenous. Saphenous veins are principal veins of the leg. The vein is used as a conduit for coronary artery bypass grafting. That part of the surgery went very well.
"All things considered, the bullet's path was probably the least destructive we could have hoped for. But that's not to negate the severity of the existing damage."
The surgeon continued. "Injury to major neck vessels is the largest cause of mortality from penetrating neck injury. While repairing the artery we also had to attempt to preserve blood flow to the brain. I was fortunate to be assisted by Dr. Whang, our vascular surgeon on staff.
"I closed any mucosal lacerations with absorbing sutures. There were a couple of small, cartilaginous fractures that were fixed with wire. The patient received blood transfusions to replace the loss. There was no time to type, so she received O Rhesus negative. Five units."
"Uh, I think that is her blood type," Jim inserted. "She mentioned one time about being a universal donor."
Dr. Kasey inclined her head and nodded. "One of the things we'll be watching for now is PNP...phrenic nerve paralysis. Bascially, the phrenic nerve is responsible for the act of breathing. Sepsis is another possible complication. Sepsis is caused by an acute infection of the bloodstream, due to the prescence of toxin-producing bacteria.
"At this stage there is no evidence of neurological compromise, but we'll be continuing to monitor. We'll also be repeating angiography to ensure intact vascular repair."
"To be honest," Brass told her, his gaze frank, "some of that I get and some of it I'm not too sure of. What I need to know Doctor is...will she be okay? Is Cecilia going to make it?"
Dr. Kasey stared back at him. She knew the the odds of the patient not surviving the post operative period of the next few days could vary between thirty to eighty percent. She didn't like to quote statistics though. She had lost patients to what was routine surgery with seemingly no complications and an overwhelming statistical chance of complete recovery. Conversely, she had seen patients who she had not expected to survive even an hour following emergency surgery walk out of the hospital a week or two later with no lasting ill effects and who went on to live normal lives afterwards.
She had learned from incredible highs and lows that it was impossible to predict a patient's outcome, and she didn't like to give loved ones either a false sense of hope or to devestate them and make them lose faith by announcing a dire prognosis. Still...she knew that she owed the detective some kind of answer to what was a natural, valid question.
"I can't say either way," she admitted. "She has alot of fighting to do still. She's in the right place and we've got good people and good equipment here."
"I don't want cost to be an issue," Brass remarked passionately. "I don't know if she has insurance, or what your policies here are, but I want her to have the very best of everything. I want you to run every test you think can help you make decisions about her care. And I want every specialist you need to assist with her recovery. She gets the best medications and whatever amount and variety you feel you need to prescribe. I want to her to have every chance to get better, and I don't want a single person involved in Cecilia's recovery and stay to ever hesitate even a moment before ordering something they think she needs.
"I'll sign whatever you want, assuming full financial responsibility, and if you need some kind of confirmation from the bank regarding my ability to pay, then you'll have it. I don't want her to go without a single thing. And I want only the very best." Jim stood with his feet slightly apart, his arms straight at his sides, his fists clenched. His chin jutted determinedly.
"Certainly," Dr. Kasey replied.
"Can I see her now?" the detective asked.
The ICU was supposed to be restricted to family, but Eileen Kasey knew that if she was laying in a hospital, in critical condition, she wouldn't like to imagine herself alone. Whether or not she was conscious and aware. As much as she had devoted her life to science, Dr. Kasey could not discount the idea that there were things even the most well-educated and experienced men and women in her profession did not fully understand when it came to the power of the mind and heart to heal.
Even in the most unresponsive patient, where it seemed that brain activity was at a minimum, and where the textbooks and medical papers assured her a patient could not process sensory information, there had been times where she had seen things that science could not explain. It wasn't going to hurt her patient to have a single visitor sit quietly at her bedside. And if there was even the slightest chance it could help...Eileen Kasey could think of no good reason to forbid it.
"Not just yet," she replied. "I'll send someone to get you in half an hour or so though. You have to understand that she won't be responsive. And there will be alot of tubes and monitors, so be prepared. Also, there was some swelling of the neck and facial areas, which will have subsided somewhat, but it could alter her appearance."
Half an hour. Jim knew it would seem an eternity. He wanted to be with Cecilia now. She was in ICU in critical condition. For the time being, she was alive. There were no guarantees, however, of what another half hour might bring. He agonized over that reality.
CSICSICSICSICSICSICSICSI
The man raised his arm then, and the woman's head came up. Where her eyes had been, were dark sockets, crawling with fat, white maggots. More of them wriggled through her nostrils, spilling out onto the pavement, and Jim's lips curled in disgust. When she opened her mouth, further clumps of larvae tumbled from the cavern within. Like the rustle of old parchment, lips as dry as dust formed around whispered words.
'And the wicked go free...'
It was Cecilia's voice this time. Riddled with pain and hopelessness, but still undeniably hers. It was Cecilia's once luxuriant, dark hair that framed an olive complexioned visage made unidentifiable by the squirming masses of infant blowflies. It was Cecilia's battered and desecrated body that splayed out behind the killer, and which had been dragged ignobly across the dirty tarmac.
Jim had fallen to his knees, his arms outstretched beseechingly, trying to will away the complete and utter horror of the moment before his psyche imploded. Surely someone had just cut the heart from his chest, and his own body must be on the verge of collapsing in its final death throes, because no man could endure this kind of pain and live to rise from it. The keening that exploded from his throat rang with loss and grief. With rage and guilt.
He had failed her.
"Jim. Jim, wake up."
He heard the woman's soft voice, winging across the chasm of his subconscious, gently pulling him from the horror-filled landscape of his dreams. He hovered for a moment between sleep and waking.
Cecilia!
Jim's lids blinked heavily, as the detective raised his head from where it had rested on his crossed arms. For a second his heart soared, as he wondered if it had all just been a terrible nightmare. He would wake now in his own bed, with Cecilia snuggled beside him. But as his eyes adjusted to the artificial light, and he heard the soft whooshing of machinery, and drew into his nostrils the pungent medicinal smell, Jim's hopes were dashed.
His body, which had stiffened in sleep, protested now as Brass straightened in the chair. At some point before dawn, after he had lain his head against the side of the bed in prayer, clasping one of Cecilia's cool hands in his own, emotional exhaustion had claimed him.
It was not Cecilia's voice then that had brought him out of his slumber. Rubbing a hand tiredly across his face, feeling the grizzled stubble on his cheeks, Jim noticed for the first time the reddish brown stains that stiffened the fabric of his white shirt. Cecilia's blood.
Who then, had woken him? Jim shifted in his seat, and saw Catherine Willows standing just an arm's length away.
Once she had finished with O'Reilly, with Internal Affairs, and with Sophia Curtis and Warrick who had been sent to collect evidence of what had transpired at Dean Sturney's residence, Catherine had gone home to shower. To wash the ugliness of the night from her pores.
The criminalist had gone from there to the hospital, driving through the still darkened city streets, while her stomache spasmed and a second wave of shock manifested in the shaking of her hands on the wheel. She had managed to get hold of Agent Fontaine on his cell phone. All he could tell her was that Cecilia was out of surgery, but still critical and under observation in the ICU.
Catherine had arrived as Fontaine and Grissom were leaving. Both men were clearly preoccupied and had little to say to her, though both had expressed gratitude that Catherine was unharmed. Gil had given her a searching look that she hadn't been able to read. She had learned that Jim was in the ICU with Cecilia, and had gone there.
They hadn't let her in, because visitation was limited. Catherine had asked for an update on Cecilia and had been told nothing more than what she had heard from Fontaine. She had stood for a while, looking through the glass window into the room beyond. She could see Jim's back, and the bottom portion of Cecilia's bed. Eventually, the criminalist had settled onto a chair outside the unit, battling back the guilt, while frenetic images of those last moments at Sturney's flashed across her inner eye.
She had heard Jim moaning in his sleep, and then he was making strangled gasps and short, heart-rending cries. The nurses were at their station, initiating a shift change. Catherine had slipped unseen into the ICU, seeking to wake the detective and to put an end to his nocturnal torment.
She stood there now, looking back at Jim Brass. It seemed to her that he had aged overnight. Her sapphire gaze moved to the still, pale form on the bed, her heart constricting as she observed the tubes that entered Cecilia's body at various points, delivering antibiotics and fluids, draining her bladder and assisting her breathing. Catherine struggled against the nausea.
When Catherine looked at Jim again, she realized that she didn't know what to say to him. They stared at one another. Catherine felt her eyes well with tears. She could see his pain...could feel it, heavy in the air. She had only wanted to help him. Would he blame her, for what had happened to Cecilia? How could he not? Catherine blamed herself. She never should have allowed the writer to go with her.
Even killing Sturney, even ensuring that he had not been able to fire a second round, was not atonement enough, Catherine knew. Even if that quick action might have saved a second bullet from ending Cecilia's life then and there, or prevented Jim from being shot himself.
"Jim," Catherine whispered, her throat tight, "I'm so, so sorry..."
The detective couldn't hold her gaze, she saw. Couldn't say the words that she was desperate to hear. That he didn't blame her. That nothing had changed between them.
When Jim could no longer look at her, when he glanced away, over her shoulder and at an imaginary point of interest on the far wall, lips pressed in an unyielding line, the tears squeezed out from the corners of Catherine's eyes and made salty rivulets down her perfectly sculpted cheeks.