Hey everyone, so I'm a little late this week - but better late than never right? So now that everyone knows that Ponyboy has meningitis...what do you all think?
I've never had meninigits...or known anyone that has had it...but I'm trying to write this story as authentically as possible, with a lot of research.
Remember, it's the 60s...though I did take the liberty of inserting a medicine or a medical machine from a future year here and there.
You will notice, however, that Ponyboy does not get a CT scan - something that is common in today's world, as meningitis affects the brain. CT scanners were invented in 1967, and this story takes place when Pony is 14, in what is likely 1965.
Another example, I mentioned the Glasgow coma score/scale (GCS), the neurological scale that gives a way of rercording the state of a person's consciousness. This scale was not invented until 1974, but it would have been difficult to portray Pony's symptoms in a way that makes logical sense to the reader (and where the readers can see the progression/regression the doctor is seeing. Doctors before 1974 were looking for the same symptoms as what is assessed with GCS, but the actual scale wasn't put into practice until the 70s .
The scale isn't just used for meningitis, but many forms of altered mental state or injury.
There will be other medical terms. I can only hope I used them accurately.
I am not a doctor or in the medical field, but I had a lot of help from online videos and from Indianagreaser, who happens to work in the medical field and has been there every step of the way. Without her insight, I'm not sure if the authenticity of this chapter (and story) would even be possible.
If anyone here in the medical field wants to offer their insights as the story continues, I'm all ears. And thank you so much to everyone reviewing, favoriting, and following the story.
- Simona
XX
"Well..I suspect it's more than just the flu," Dr. Roberts told them, " The fever, vomiting, neck pain, aversion to light...all signs point to something called meningitis. But we need to do more tests to confirm it. And we need to see the results of the tests Ponyboy did with Dr. Reed."
"Meanwhile, I asked Nurse Julie to get masks for everyone," he added.
"It's contagious?" Darry said at the same time that Soda asked, "Meningitis? What's that?"
Dr. Roberts answered Soda's question. "It's an infection of the brain and spinal cord," he said. Soda's eyes went wide.
"How serious are we talking here?" Darry said, though he tried to remain calm.
"Meningitis is serious, but it is something we have the ability to treat, especially the earlier we ," Dr. Roberts answered.
"How'd he catch that?" Soda asked.
"There's no way to know, unless you know for certain that Ponyboy was in direct contact with someone who had it. Otherwise, it can be spread through saliva or coughing, sneezing, like a virus or through bacteria.
Before they had a chance to ask any more questions, Dr. Reed - Ron - hurried into the room. He stopped when he saw Darry and held out his hand.
"Darrel! How are you?" he said shaking Darry's hand warmly.
"You remember my name?" Darry asked in a surprised voice.
"Well, we only saw each other a few hours ago. I'm good with faces. And you can't forget a name like Ponyboy,"
Darry grinned, even though he was dazed by the news he had just heard from Dr. Roberts.
Ron gave Darry a half-grin in return but quickly turned serious. He looked over Darry's shoulder at Ponyboy dozing on the examination table. "Ponyboy's here," he said stoically.
Ron exchanged pleasantries with Dr. Roberts and the nurses. Dr. Roberts then went over to the nurses who were standing near the table where Pony lay, and talked to them about the various medications that were hanging above him.
"Listen, I've been trying to call your house -" Ron said to Darry.
"Yea," Darry scratched the back of his head, "My truck sort of got stuck in the snow. It wasn't pretty. If it wasn't for my brother rescuing us…" he acknowledged Sodapop next to him.
"Ahh so that's why I couldn't reach anybody. No one was home," Ron said, his face a bit drawn. "I was calling because I got results for the flu and strep tests - both were negative. Paul, you're going to want to hear this," Ron called out to Dr. Roberts, making sure he was listening. He turned back to Darry. "Pony's blood work shows a white blood cell count that is extremely high. It indicates that there's a severe infection."
"Aha, just as I suspected," Dr. Roberts said. "I think it's meningitis."
"Really," Ron replied, "How did you come to that conclusion?"
"Well, it's not conclusive just yet, but he has neck pain and aversion to light," Dr. Roberts said. Darry watched as Ron nodded in agreement. "We looked for Brudzinski's sign and Kernig's sign - he had both," he explained, referring to the two tests he had done to diagnose meningitis, including touching Pony's chin to his chest, which made his knees flex and Pony's inability to straighten his leg.
As Dr. Roberts went to talk to one of the nurses. Ron took that as an opportunity to introduce himself to Sodapop.
"Hi, I'm Ron," he said shaking his hand, "You must be Ponyboy's cooler older brother," he quipped, then looked at Darry, "Besides Darrel here, of course. I see the family resemblance."
They all laughed and Soda cocked his movie star eyebrow. "I also have a cool name," he said smoothly, "It's Sodapop."
"Another amazing name!" Ron exclaimed, "Your parents must have been something."
"They were," Darry said wistfully.
Soda grew silent for a moment. Then he looked at Darry, "I like this guy!" he said.
Ron laughed.
"So you got stuck in the snow, huh?" he asked
"Yea, well it was more than that," Darry explained and for some reason, he felt like he could tell Ron everything, "We almost got into a car accident and then we ran out of gas. We were sitting there for a while and Ponyboy was sick - apparently more sick than I realized," he paused, the concern evident. "I went to look for help and luckily Sodapop and his friend Steve found us. If they hadn't been looking for us and if we hadn't been close to home...well, I'd hate to think what could have happened…"
"I wish I had known," Ron said sympathetically, "Maybe I could have helped. But really, I don't know how I made it to the hospital myself. This weather is insane. We're all probably staying here for a good, long while." He paused.
"It's that bad, huh?" Darry asked, and Ron was sure he was talking about Ponyboy and not the snow. Ron gave him a look, pulling his lips into a tight line, but didn't say anything.
After a few moments of silence, he asked, "Steve's the guy outside right? The one with the big scowl on his face."
Darry grinned, "Yeah that's him."
"Hey! I didn't know you almost got into an accident," Sodapop blurted out.
Darry looked at him. "The highway was icy," he said, cursing himself for having so many things go wrong, "Nothing happened. We're fine."
Nurse Julie, who had been out of the room for a few moments, came back in. She had in her hands a tray filled with medical supplies, which freaked Darry and Soda out a bit. It included a flat paper sheet with a hole in it, some disposable swabs, a vial of liquid, two needles (one fairly small and the other thin and large), a syringe, a specimen tube, and a pile of medical masks.
"If you boys are going to stay in the room, you're going to have to wear the masks, too," she told Darry and Soda.
Ron saw the look on Soda's face and answered the question before he had to ask.
"Meningitis is contagious," he said, "Some are more contagious than others. We don't know what kind he has yet, but for now, we should all be wearing masks."
Darry and Soda took masks and put them on, as did Ron, Dr. Roberts, and all the nurses. Darry and Soda eyed the tray of needles worriedly, but Ron spoke first.
"So you're going to do a lumbar puncture?" Ron asked.
"I'm going to start him on a stacked dose of antibiotics," Dr. Roberts told Ron, "If he does have meningitis, he's going to need to be on antibiotics right away, before we do anything else. And yes, we'll do a lumbar puncture."
Sodapop turned to Ron. "What's a lumbar puncture?"
"It's a procedure to take out fluid from the spine with a needle. It's not supposed to hurt," he said quickly, when he saw Soda and Darry's mouths hang open and their eyes go wide, "It's the best way to diagnose meningitis," he said.
"Pony doesn't like needles…" Soda said anxiously.
"I know. I remember when I had to take his blood at the clinic," Ron said, "But he did great," he said and thought for a moment. "He won't see the needle, it will be in his back. And now that you have the masks, you guys can stay in the room. It will be fine," he said.
As if he had just heard their conversation, Pony began moaning again. "Soda…" his brothers who heard him wail.
Pony had rolled over onto his right side, like he knew what was coming. This time both Soda and Darry went up to him. He was shivering, so Soda put a gentle hand on his back as if that would make him warmer. He was careful, as Pony had complained previously of neck pain.
Pony's eyes were open, but not very wide.
"Soda…" Pony said thickly, running his tongue over his cracked lips, "Take me home, Soda…Where's Darry?" he asked.
"Pone, I'm right here," Darry said, coming around to the head of the table, so Pony could see him in his line of vision.
"Pony," Soda said, looking down at his feverish baby brother, almost at his level, a hand in his hair, "Darry's here, too."
The mask was suffocating and it muffled Soda's speech just a bit, but there was no choice.
Pony didn't seem to answer (or care.)
"Don't leave me here, Darry," he said, like he was talking to open air and not his oldest brother in particular. "I wanna go home," he mumbled, "When can we go home?"
Soda responded. "Soon, baby. We'll go home real soon."
Sodapop knew that likely wouldn't be the case, but it seemed to make Ponyboy a lot calmer. He took Pony's hand again and rolled his thumb over the knuckles, rubbing gently. Pony quieted down.
"He's a bit confused," Darry said worriedly. Ron came over and stood next to Soda and Darry. Pony's eyes were glazed and unfocused, but he looked at Ron curiously. Darry saw this and decided he would say something.
"Pony, you remember Ron? The doctor from the clinic? He's here, too," Darry said.
"Hi Ponyboy," Ron said. "I was in the hospital already when you came in. Not feelin' too good, eh? We're working on that."
It looked like Pony was going to try to say something, but he was so tired. Instead he closed his eyes for a brief moment, and then opened them again.
"Don't talk if it's hard for you, ok, honey? We're not going anywhere." Soda answered for him, always knowing the right thing to say.
"Ok," Dr. Roberts said from a corner of the room where Nurse Julie had set the tray, "I think we're about ready to do the lumbar puncture now."
He came up to explain the procedure to Darry and Soda in further detail. "Now boys, this might look like it's going to be terrifying, but I can assure that your brother is going to feel nothing more than some minor pinches. We're going to numb the area. He may feel some pressure when I insert the needle." Dr. Roberts explained.
"I'm going to have Ponyboy curl up on his right side. It's good that he's already laying that way," Dr. Roberts said coming over. He helped Nurse Julie curl up Pony's legs and draw them up towards his torso, in a fetal position.
Pony whimpered.
Dr. Roberts said, "You need to keep him absolutely still. Julie will hold his legs down here. Once I sterilize and numb the area, I'm going to insert a very long needle into his spine. The position needs to be exact so I can collect fluid. He can't move."
"Ponyboy," Soda said, looking into his brother's eyes, as he got down on his level. "The doctors need to do a test, to see what's making you sick. You have to stay still, ok?" Soda was bent low but his fingers were carding through Pony's hair. "It's not going to hurt. It's not going to hurt, but you can't move," he continued with words of comfort, "Darry's here, too, Pone. We're with you."
Darry looked down, making sure Pony's eyes reached his so that he could know he was there. He came around and took Pony's right hand, rubbing his thumbs over it as Soda had before, "We're right here, but you need to stay with us, ok?"
Soda thought he saw Pony nod, but it was faint. Still, he could see that as he kept his glassy eyes on him, Pony's breathing slowed, his body relaxed and he became a lot calmer.
Darry looked up and gave Dr. Roberts a slight nod to continue.
"Ok Ponyboy," Dr. Roberts said from behind Pony's head, "I'm going to use iodine to clean the area now," he said, taking a swabstick to rub iodine across the middle of Pony's back in a circular motion. Dr. Roberts saw Ponyboy tense up.
"Yea, it's going to feel a bit cold," he said.
Dr. Roberts draped the flat sheet over Pony's lower back, with the hole visible around the point where the needle was going to go.
"I'm finding the spot where I'm going to numb the area," the doctor explained. He used the hip bone to help direct himself to the spot where he was going to apply the local anaesthetic, deciding on the space right above it as the appropriate place. The first needle, which included a syringe and a vial of 1% lidocaine was inserted. Pony felt a pinch.
"Alright, you're doing great, Ponyboy," Dr. Roberts said, "We're going to do the procedure now," he said, not wanting to scare his patient by telling him he was going to insert a spinal needle between the vertebrae.
As Dr. Roberts began to insert the spinal needle, Pony felt the pressure increasing, wrapping around his lower back like squeezing hands that drove their thumbs into his spine. If he hadn't been looking up at Sodapop and Darry, he probably would have tried to get away, but instead his face contorted into an expression that looked scared, but also confused.
Pony didn't cry out, but his brothers saw it right away, "Pony...Pony…" Soda said, bending down so that he was right in front of his brother's face, on his level, hand on his head and gliding his hair back. "Look at me, Pone. Stay with us...Don't move…" his hand pushed Pony's hair out of his eyes. Pony's face paled somewhat, but he found solace in the fact that he was still able to look at his brothers.
Even Darry's voice was oddly gentle. "You're doing great, Pone," he said, mimicking the doctor but in a more comforting manner, as he rubbed Pony's upper arm and then kept it there for a while to hold him still before reaching down and taking his hand again
"Hold him. He can't move for this part," the doctor said as he performed the procedure, The stylet was removed from the needle and cerebrospinal fluid began to drip out. The liquid that dripped out was a strange cloudy color and it was immediately collected in the appropriate tube.
As the needle came out, Darry felt Pony's grip loosen on his hand. He was so involved in making his baby brother feel comfortable (without moving) he hadn't even realized Pony was squeezing his hand so tight.
"Ok, we're done here," Dr. Roberts said, capping the container. He wiped off all of the iodine and put a sterile dressing on the area where the needle had been.. "Pony was excellent. He needs to stay laying down for a bit, it will help him avoid a headache that could come later because of the procedure," he told Soda and Darry.
Ponyboy felt the nurse loosen her grip on his legs.
"That wasn't too bad, was it?" Ron said, suddenly appearing next to Darry and looking over at Pony. "Pony, you did great," he said. Pony looked at him but didn't say anything. "You can turn him to lay on his back now," he said.
As Soda and Darry gently helped Pony turn over, Dr. Roberts said, "Ok, we have everything we need. We're going to get those test results soon. Darrel, can you join me over here for a moment?"
Darry gave Pony a quick smile and squeezed his arm before he went off to the side.
Pony looked up, blinking at Soda. He felt woozy.
"Hear that, Pone?" Soda said, trying to keep him occupied while Darry went to talk to the doctor. "We're going to find out what's wrong with you soon. You did real good, kiddo," he said, a thumb smoothing Pony's hair.
Pony didn't REALLY hear him. He couldn't really focus on anything at all.
"Darrel," Dr. Roberts said in a low voice, as the two spoke in a corner of the room. "I need to tell you that I noticed the liquid that we collected was turbid."
"Turbid?"
"Cloudy. Opaque. It's a fairly clear indication that Ponyboy does, in fact, have meningitis. We'll still need to look at the full lab work, but since we won't get that for a little while, we need to act fast as this is very serious."
"Doctor, I'll sign off on anything you recommend," Darry said, his heart thumping in his chest.
"We'll need to start him on an aggressive course of antibiotics right away. Probably corticosteroids to prevent complications -"
Over on the other side of the room, Pony was wondering why the world was looking all fuzzy.
"Soda?" he mumbled, and his mouth felt like it was stuffed with cotton. "What's wrong with me?" he whimpered and watched as Soda gave him a funny look. Soda didn't know if Pony was just confused or he was asking based on what Soda had just said.
Pony was feeling lightheaded and his vision was blurry. The lamps above him suddenly had halos around them.
Suddenly Soda's face was replaced by Darry's, Ron's, and Dr. Roberts. "Pony, you ok?" Darry asked, wearing the same funny look.
"What's wrong w-"
He didn't have time to finish his own sentence. The colors around him blurred and collided and then, his eyes rolled back into his head.
"Pony?" Soda called out as he watched his brother's eyes roll back into his head. "Pony!" he cried out as his brother lost consciousness.
He wanted to keep calling out to him, to get him to wake up but the room became chaotic just then as Ron and Dr. Roberts pushed him and Darry out of the way to tend to the boy.
Pony began to convulse violently on the bed, his eyes still rolled back into his head. His hands went up to his chest, balled into fists involuntarily.
"Hey! What's happening?!" Darry shouted, the fear evident in his voice.
"He's having a seizure," Ron said.
Soda lurched forward in a panic.