Chapter 268

All visitors in the room were forced out an hour ago. They were standing around in the waiting room. Nobody really knew what was going on. Everybody looked anxious.

"Something big is wrong… I could hear it in her voice" said Sonia pacing up and down.

Lindsey looked pale and worried. Her leg was bouncing up and down nervously.

Sax and another doctor entered the room. Sax looked rattled.

"What's going on?" asked Sonia, emotions threatening to spill over.

"It's Sara… we just did another CT of the brain and an MRI. That and a LOT of other tests. I have bad news… She's in a coma" said Sax fiddling with her stethoscope in her hands.

"What do you mean… a coma? She was awake… she…" said Stephen suddenly looking pale and clammy.

"Meaning right now, we can't wake her. This is very serious. The coma is caused by a fat embolism. It's a common but very serious complication after trauma" said Sax.

"Oh my god" said John and put his hands in front of his face. He shook his head with his eyes closed. This scared the shit out of everyone because he obviously knew a hell of a lot more about these things than they did.

"I don't understand" said Sonia, she sat down shakily.

"I'll explain as well as I can. A fat embolism is process by which fat tissue passes into the bloodstream and lodges within a blood vessel. In general, an embolus is something that travels through the bloodstream, lodges in a blood vessel, and blocks it. A fat embolus is a fat particle or droplet that travels through the circulation and eventually blocks a blood vessel. Fat emboli tend to be small and multiple, causing numerous signs and symptoms. Up to 90% of cases are associated with trauma, such as a fracture of one of the large bones in the leg. As a result of the broken bone, the bone marrow fat escapes into the bloodstream.

Typically, fat embolism occurs suddenly 12-36 hours after an injury. Symptoms and signs depend on the specific location of the blocked arteries. Signs and symptoms of fat embolus include central nervous system dysfunction that may progress to coma which in Sara's case it already has, irregularities in the heartbeat, respiratory distress, and fever. Anemia and low platelet count are common. Commonly, small hemorrhages are seen on the neck, shoulders, armpits, and conjunctiva, we're already seeing these on Sara" said Sax.

"You can fix this right? You're going to fix this?" said Sonia in tears. Sax sighed.

"Treatment of FES is supportive and consists of ensuring good arterial oxygenation. High flow rate oxygen is given to maintain the arterial oxygen tension in the normal range. Additionally, maintenance of intravascular volume is important, because shock can exacerbate the lung injury caused by FES. Albumin has been recommended for volume resuscitation in addition to balanced electrolyte solution, because it not only restores blood volume but also binds with the fatty acids and may thus decrease the extent of lung injury. Mechanical ventilation and PEEP will be required to maintain arterial oxygenation. Medications, including steroids, heparin, alcohol, and dextran, have been found to be ineffective and we are in the process of devising a treatment plan with the intensivist and the orthopaedic surgeon"

"You didn't answer me… can you fix this or am I saying goodbye to my daughter?" said Sonia biting back her tears.

"I can't give you an answer Sonia… We're doing everything we can for her. I'm hoping we caught this in time" said Sax.

"Is… um… Tegan… she has broken bones too… is this… can she get this too?" asked Lindsey. She felt as if somebody had punched her in the gut. Something had sucked her breath out.

"No, not necessarily, but there's always a risk after a significant fracture. We are aware of those risks just like we were aware of them in Sara's case. Tegan is on some prophylactic medication already. It could help avoid it. Then again, Sara was on it too so it's not always effective"

Lindsey started sobbing.

-0-

Another hour later Sonia sat down next to her daughter's bed. Sara looked ill… very ill. She was back on the ventilator. Sonia glanced up at the heart monitor. It was beeping about at 40 beeps per minute faster than the last time she saw her. Sara had sweat beads on her forehead and upper lip and what looked like a red rash on her chest, arms and neck. She was under a cooling blanket and a fan blew over her. A red light on the monitor was flashing continuously indicating that Sara's temperature was still not in an acceptable range. Sara was now on a 12 lead EKG and had a few more IV lines running into her.

"I'm so sorry Sonia. I'm… there's… there's no way of catching this. We're managing this aggressively. She has a good chance" said Sax stumbling over her words.

Sonia nodded.

"Can't they just all get better" she sobbed.

"I know it's hard… I know" said Sax and took Sonia in her arms.

"We're here Sara sweetie… we're here. We love you so much. Amelia sends her love. She misses her mommies… she needs you. You get better now okay" said Sonia and kissed Sara's fingers.

-0-

"Any idea when you'll wake Tegan up?" asked Lindsey a couple of hours later. She purposefully moved away from the bed. She didn't know what Tegan could or could not hear.

"Maybe in the morning Lindsey. She's not strong enough yet and I don't want to put her to unnecessary trauma. Right now I would prefer if she was just left to heal now" said Sax.

"Dr Sinclair..." said Lindsey staring at the floor.

"Yes Lindsey..."

"Is Sara going to die?" asked Lindsey and looked up. "Because if she dies… Tegan… Tegan's going to die too… I know it. They… Sara is… look they have a very special connection… Tegan won't make it through this without Sara" said Lindsey through tears.

"We'll know soon if she's responding. She could get through this really well and relatively fast or… or she could… it could go either way although the odds are mostly in her favour at the moment. I'm positive. We need to keep supporting her vitals, monitor her very closely. She got through so much already. She's very critical right now but she has a good chance" said Sax.

"Is she… going… to die?" asked Lindsey slowly through clenched teeth.

Sax stayed quiet for a few seconds. "Not on my watch Lindsey" she said softly.

"And Tegan? And Kate?"

"They're both stable. Still critical but they're doing as well as we could hope for right now" said Sax.

"I just wish I could wake up… and find out it was all a nightmare" said Lindsey.

"Me too" Sax sighed.

A/N: :( This isn't good. Hope they all hang on.