Thanks for following my story! We're still in the flashback scene where Darry is remembering what the doctors told him after Ponyboy's surgery. This is a bit of a filler chapter, but it's necessary to understand what's going on with Pony. Thanks to Indianagreaser (and the good 'ol internet) for help with the medical jargon.
XX
"I'm not gonna sugar coat things and they won't either," Ron told the boys, " It's been a tough surgery. All cranial ones are. But it's going well. Pony is doing ok. All his vital signs are good." Darry watched as Soda's face light up for a brief moment before getting serious again. "They had to drill a hole into his skull and put a tube there to suck out some of the excess fluid," Now Soda's face was tight and his hands were over his eyes.
"It's good news but - it's not over yet. The infection is still there. We can't really know how he will react to the whole thing until he comes out of it. And we're still going to have to give him some strong antibiotics. But so far so good…" he paused, placing a hand on Soda's shoulder. "It won't be much longer now - then you'll be able to see him. He's in good hands," Ron said looking pointedly at Darry. "Carl is an excellent surgeon. One of the best. I'd trust him with my own family."
Ron paused. "We have a little bit until they come out. Do you guys have any questions that maybe I can answer?"
Darry rubbed his chin, reliving the entire day's events in the back of his mind like they were bits and pieces of an insufferable silent movie. The mounds of snow, the swab scraping the back of Pony's throat, the squealing of the tires...
More black and white moments flashed through his head. Four-year-old Ponyboy calling Darry into his bedroom because only big brothers could get rid of monsters under the bed. Six-year old Pony latching on tightly to big brother's wrist, not wanting to admit the first day of school was scary.
Ponyboy burying his face in Darry's shoulders when he first undrestood his parents had died. Ponyboy crumpling under the streetlight like Dallas Winston, no one yet realizing just how bad he was.
This was so much bigger than that.
"Can you tell us more about this thing he has? This illness? I've never even heard of it before. How bad is it?" Darry asked.
Ron paused, put a hand on Darry's upper back and led him over to one of the uncomfortable chairs in the waiting room. They both sat down and Soda sunk into a seat on Ron's other side, his foot tapping restlessly. Steve stood in front of them, a bit off to the side so he wouldn't get in the way. A cigarette dangled from his mouth - he had been planning to go for a smoke but he wanted to hear this.
"I'll explain it again," Ron started, "We're pretty confident that Ponyboy has meningitis - we can't say for sure yet because we don't have the results of the lab work, but all the symptoms point to it. The fever, the vomiting, the aversion to light, the neck pain. And I think that they noticed that the fluid that came out of his back during the lumbar puncture was cloudy. Also a big indicator."
"In English, doc," Steve growled, crossing his arms in front of himself. "I wasn't inside the room while you were doing your tests, remember? What's a lumbar puncture?"
"That's where they put the needle in Pony's back to take out fluid from the spine," Darry answered for him.
"Sounds like it hurt," Steve retorted with a grimace.
"It wasn't supposed to hurt," Soda said, his eyes shining, "But Pony was really strong." He was really proud of his tough little brother..
Ron nodded, then continued, "Meningitis is an inflammation of the inner two membranes that surround and protect the brain and the spinal cord. It's serious - usually it means some kind of foreign substance has entered the area. The immune system responds by releasing white blood cells, which is what I saw in the lab results I did earlier today. Signs of a serious infection."
He continued. "We don't know if it's bacterial or viral yet. We're waiting for the test results. Thing is, viral meningitis isn't life-threatening and doesn't respond to medication. There's no treatment really. But if it's bacterial - the only thing that works is really strong antibiotics. Bacterial is more serious - and it can get really bad really fast if we didn't take care of it right away. That's why they rushed Pony out of the room. It's extremely deadly and if not caught fast enough could result in -"
"Death," Darry finished for him, sitting back in the chair in shock.
"Well, I can tell you that you guys brought him in early enough that he has a strong chance. And it sounds like Pony is a fighter. I checked his file - he's already been here once before right? For a concussion, among other things...and he got through that ok,"
"Yeah, Pony's one tough kid," Soda repeated.
"So he'll get through this too. You just gotta keep him fighting, ok? He's not out of the woods yet, and it's gonna be a hard road, but he can pull through this."
"But we got him here in time right?" Soda jumped in.
"Looks like it," Ron answered, with a small smile.
"What's he gonna be like when he wakes up?" Soda asked.
"Well, right now he's got a tube breathing for him. He's sedated, so he probably won't wake up for a while yet," Ron answered, "The doctors will tell you more about that. We can't really know how he will react to the medicine until he wakes up. Everyone is different. But we did get his fever down quite a bit…."
"Hey, that's good news," Darry smiled tiredly.
"It may be going up and down for a little bit, but hopefully the antibiotics will be strong enough."
"He going to be out of it, doc?" Soda asked. "Like he was in the ER?"
"Could be. It might be from the infection, or the medicine even. Again, no way to know how he will react. The other doctors can tell you more."
As if on cue, two men stepped out in blue scrubs. They had on the works - gloves, a blue cap, and medical masks covering their faces. They began walking towards the group in the waiting area. At the same time, other orderlies wheeled a gurney out of the room the surgeons had been in. It was Pony! Darry realized...He was desperate to see him. But the gurney was too far back and he couldn't see anything. The orderlies took the gurney in the opposite direction, down the hallway, and disappeared.
It was after midnight by now and Darry felt the weight on his shoulders. It had been a long, exhausting, and scary day, and he knew it was going to be a long and exhausting night, too, even though Ron had tried to make them feel better. But he hadn't been one of the surgeons in the operating room.
The Curtis brothers stood up when the doctors arrived as did Ron. Steve gave some serious side eye.
"Family of Ponyboy Curtis?" One of the doctors questioned, even though he knew. Ron was standing right there. "Hey Ron," he nodded in acknowledgment.
"I'm Dr. Wexler," he told the group.
"How is he?" Darry asked.
"Ponyboy is in critical but stable condition. We had to perform an EVD - an External Ventricular Drain. In the brain, there are these fluid spaces called the ventricles. The ventricles make cerebrospinal fluid. There are certain circumstances where that fluid that is made in the brain and circulates around the brain can be blocked. Typically this happens in a variety of cases. Meningitis is one of them. If that fluid builds up and it can't circulate or get out, that pressure builds and the pressure can be extremely high, to the point where it can actually damage the brain," The doctor explained.
Soda's face went white and he looked to Darry for answers, but Darry was just as scared.
"So we did this procedure, EVD, to relieve that pressure," the doctor said, "Since we saw there was a lot of buildup. We gave the patient general anesthesia and made a small, about inch-long incision just behind the hairline. A very small hole was drilled into the skull and a small rubber catheter was placed down into the brain into the fluid space. The fluid could escape through that tube. We drained the fluid into a small bag at the patient's bedside. The drainage does a couple of things. It decreases the pressure in the brain, bypassing the blockage and getting the fluid out of the brain. It also tends to drain some of the blood in the fluid spaces so that blood clears up fast," the doctor said.
"Once the blood reabsorbs and the brain circulation can start up, we do this thing called an EVD weaning. What that means is that we slowly raise the pressure on that drain to see if the patient can absorb their own spinal fluid. Ponyboy was able to do that and so we were quickly able to get the drain out of his head."
"Is he ok then?" Soda asked warily. "What happens now?"
"Pony is doing very well, for now. There is a small chance that there will be some fluid buildup later on, but we won't know that for some time. Meanwhile, his vitals look good and we'll check them again once we get him up to ICU."
"He has to go to the ICU?" Darry asked worriedly. "So things are still pretty bad then?"
"Not bad, necessarily," Ron spoke up. "But serious."
"I'm Dr. Thomas," the other doctor cut in, speaking up for the first time. "Ponyboy has meningitis. It's a serious infection that doesn't just go away because we've relieved the pressure in his brain and got the fluid moving. We already have him on corticosteroids - dexamethasone to be specific - which has been known to have some side effects. So we need to watch for them. If we learn that Ponyboy has viral meningitis and not bacterial, we'll take him off the medication right away - there's no need to give antibiotics for a virus."
"Wait, wait," Soda said shaking his head, "Steroids? The drugs that athletes use to build up their muscles? Why would he need those?"
"They're not the same kind of steroids, Soda," Ron said kindly, "These steroids are for decreasing inflammation, which is what meningitis is."
"To answer your question," Dr. Wexler said, turning to look at Darry, "He's going into the ICU because his condition is still serious and until the inflammation has cleared up and his fever is down - which it isn't yet - we need to keep him there to ensure that his condition doesn't deteriorate. Meningitis has been known to become life-threatening quite quickly -"
"There are also a number of complications we need to watch out for," Dr. Thomas added, "And not merely because he just got out of surgery. Seizures, kidney failure, sepsis, those are also possible complications of meningitis." he said.
"What is his temperature now?" Darry asked. "How high?"
"It's down to around 101," Dr. Thomas said, but until he is over this, don't be surprised if it continues to go up and down. That's just his body fighting the infection. And also responding to the medication."
"Can we see him? What floor is the ICU?"
"Pediatric Intensive Care is on the third floor. Right under us," Dr. Thomas said, "Just know that we wanted him to rest for the night so we sedated him. It will help his body rest and deal with any pain that might come up. Oh, and as with all surgeries that require anesthesia, we had to put in a breathing tube to help him breathe during the EVD. And because we sedated him, we decided to keep it in for now. If he's doing well in the morning, it's likely that the doctor will decide to take it out."
"What about going to see him?" Soda asked impatiently.
"Yes, that's not a problem," Dr. Thomas said, "They just need a few more minutes downstairs to get him settled and I'll have a nurse come and get you to take you to him. Oh, and one more thing. Meningitis is contagious. You're going to have to wear a mask in the room for a good 24 hours. After he's on antibiotics for that amount of time, you can take them off. He shouldn't be contagious any longer."
"Immediate family only," he added before shaking Darry's and Soda's hands and walking away with Dr. Wexler.
"Guess that means all of you will be going to see him," Ron said, winking, when the doctors were out of earshot.
Steve looked at him strangely and Darry realized that he didn't know who Ron was.
"Steve, this is Ron. He was the doctor at the clinic that Pony and I saw today at our appointment," Darry said.
Ron reached out to shake his hand as Steve's eyes went wide."No shit!" he said in surprise.
"Steve!" Darry said curtly, because of the language. Ron just smiled.
"Nice to meet you," he said to Steve, "You're a close friend?"
"More like family," Soda said, trying to smile, as he looped his arm around his friend. "Steve and I work together. And we're best friends."
Steve nodded.
"Listen, I better get going," Ron said, "I'm planning to sleep at the hospital tonight, along with a lot of the other staff that can't go home because of this crazy snowstorm. It's just too dangerous to drive right now," he said. "I have an early shift. How about I stop by tomorrow afterwards? It will probably be late morning. I'd like to see how Ponyboy is doing," he said.
"Sure thing," Darry nodded, "Thanks again, Ron. It's nice to have someone here to answer our questions."
"No problem," he said, "I'm not the doctor on the case but you can still ask me anything. I'll answer as best I can."
Soda had been staring at the floor, eyes bleary. He looked up, "When are they gonna come get us?" he asked innocently and sadly, biting his lip.
"Soon," Ron said, putting a hand on his shoulder gently, "Pony is going to be FINE," he reassured, though both Soda and Darry looked unconvinced.
"Come on, Soda, let's go get some air," Steve said, as he took out two cigarettes, handed one to Soda, then put his arms around Soda's shoulders like Darry had just moments earlier.
He steered him away to a door that happened to be unlocked. Soda quickly whipped his head around. "Darry, you're going to get me when the nurse comes, right?" he asked tentatively.
"Of course," Darry answered, and they disappeared out the door. A gust of icy wind blew in, and Darry shook his head, realizing too late that it was freezing outside and Soda's coat was mediocre.
"Jesus, I'm going to have to deal with two sick kids real soon when my other little brother gets pneumonia," he said under his breath. "They could have smoked inside."
"The nurse will be here soon,"Ron said confidently. "Alright Darry, I'll check in tomorrow. Pony will be fine," he added again with emphasis. "We have the best doctors here at Tulsa General, especially in the ICU."
Darry nodded, wishing he could fully believe him. "Thanks, Ron, we appreciate everything you've done for us so far," he said, holding out his hand to shake the one of the good doctor. With that, Ron headed out and Darry sighed deeply and took his seat by the cold, frosty window to watch the pitter patter of snowflakes that were still falling.
With that, Ron headed out and Darry sighed deeply and took his seat by the cold, frosty window to watch the pitter patter of snowflakes that were still falling.
It was almost 1 in the morning by now and Darry was trying to blank his mind, to no avail. Having thought of what had just happened in the past few hours, he tried not to let the guilt eat at him. Too late.
And then a kind older woman with gray-streaked hair hidden under a nurse's cap walked up to him. "Mr. Curtis?" she called gently. "Come with me. I'll take you to your brother," she said.
Darry shook himself out of his reverie. "One minute, ma'am," he said, using the manners his mama taught him. "Please just let me get my brothe - my brothers - they're standing outside," he said.
"My, my, outside in this frightful weather," she said, but she smiled kindly.
Darry brought Soda and Steve inside. He noticed right away that Soda's face was covered with tear tracks, but he didn't have time to ask him about it now. He could only hope that Steve had been supporting his best friend.
They followed the nurse to the elevator and down to the third floor. And then it was down strange corridors and empty hallways that left Darry so confused, he wondered if he was going to be able to find this ward himself next time. Suddenly they came to colorful doors, which were surrounded by brightly painted, color streaked walls with cartoonish looking animals on them - bears, lions, dogs, even birds that flew next to a canary yellow sun shining high in the sky.
It was at that moment that Darry remembered Pony was still just a child. Just 14 years old. Too young and innocent to be dealing with such a horrible illness.
The nurse pushed a button and was buzzed in by a nurse on the other side.
"You're all family?" a nurse at the desk asked in a tone that said she didn't believe them. But she didn't stop them either after Darry said yes.
The nurse that was leading them to Pony's room wore a medical mask and held other medical masks in her hand, which she passed out to the boys. "Remember to keep the mask on," she told them, "It's very important. You don't want to catch what he has," she said matter-of-factly. "It's also why he has a private room," she told them
They three boys put on their masks. They stopped in front of Ponyboy's room.
"Before you go in, understand that we had to shave one side of his head. And one side of his face could get black and blue. It's not like that just yet, but it probably will be over time. It's a common side effect of this particular surgery, just the body's way of healing itself, but it's still a little bit jarring."
Soda nodded, for fear of bursting into tears right there.
"Yeah, the doctors told us," Darry answered quietly.
"You can sit with him, and maybe even talk to him," the nurse continued, "But don't expect him to wake up tonight. That's ok, though, it doesn't look like any of us are going anywhere in this inclement weather so maybe you can all rest a bit. The doctor should be in early tomorrow morning," she said.
And with that she opened the door. Darry heard Soda's sharp intake of breath.
Another cliffie! Sort of. Review please!