Alternative Route Taken
by Castlefan6
Authors Note: Another What If based on the episode, A Deadly Game, what happened if Rick didn't return to the precinct after leaving and this was really their last case. What would each other's lives have looked like? The story starts with Canon dialog, courtesy of Dust Jackets Dot Com, then goes quickly and completely AU. The journey continues with a new Kate and Rick, hope you enjoy!
I don't own Castle; I use the characters for amusement purposes only, except the ones I create.
Previously
She then heard the voice, "Hello Katherine Darling, thank you for coming, I hope the trip wasn't too hard" Martha stood with open arms, and Kate was in them in a flash, as Martha hugged her as a mother would know how to do. She quietly comforted her, then when Kate regained her composure, she asked,
"Has there been any change? When can I see him, without hurting his recovery?" she asked shyly,
"We just came down Kate, so it'll be two more hours, then they let two of us see him for 15 minutes, we were going to get something to eat. If the stories Rick told of you, then you probably haven't eaten in a while" Gina said gently,
"I guess it has been a while, so yeah, let's go I mean if you want me to come"
"Kate, one thing, if we didn't want you here, if we knew Rick TRULY didn't want you here when he woke up, you wouldn't be here, so please stop walking on eggshells with us, it'll work out, it just has to," Gina said softly as she wrapped her arm around Alexis's waist,
*********************************************************************************/
Chapter 20
Same Time Frame
Walter Reid Hospital
Kate's POV
Kate had gone along with the cafeteria, only because she had no choice, if she wanted to see Rick, she had to play by the rules, and not put up a fuss. She thanked her lucky stars that she had been received with such kindness by the family, after all the man lying in the ICU, near death, was only there because he went to extreme choices to rid himself of her memory.
She picked at her food, although the coffee was welcomed, and she finally got down a piece of toast, along with the three cups of coffee. She took two aspirin and her headache began to improve, but the damn clock had only moved 15 minutes since they sat down.
"Kate, when you see Daddy, please control yourself, we think he can hear us, his eyes blink and the doctors are still running tests to determine the brain activity. I know it's going to be hard, but I bit down on a handkerchief to keep from crying when I first saw him, we all had problems, he doesn't look like himself."
"Alexis is right Kate, it's going to be hard, but please for Rick's sake, don't let out any crying or despair. The doctors told us if we talk to him, to keep it short, simple, and not too detailed. If you want to touch him, his left hand isn't hooked up to the IV, but be careful of the feeding tube on that side" Gina said with tears in her eyes,
"He has a feeding tube, Gina? How long will that be in, or never mind it's a stupid question, it'll be there until it's not needed." Kate said, her tears falling from her eyes,
"It's all right Katherine, we're talking out here so you will be at least a little prepared, he doesn't look like Richard, he doesn't look like my son, but he's in there. I know he's fighting to wake up, I know it. The doctors told us that if the field medic hadn't taken the steps he did, he would have been gone.
"I know they are worried about the brain swelling, and want him to remain as quiet and still as possible. They repaired his shoulder, and arm, and removed the 4 bullets that were in him, including the one that had lodged against his spine.
"They're hoping this was the trauma that caused him to go into the coma, but the official report said they had to give him two units of blood before they could move him." Martha remained calm as she described facts that she knew Gina or Alexis could never be able to when she finished, she dabbed her eye and just said,
"Richard's a lot tougher than people think, he's fighting hard, and he'll be back to us." As she looked out the window.
"Well, speaking of that Grams, we should be heading back, we don't want to miss Doctor Jardine's visit, and update," Alexis said gently,
Kate saw for the first time she had met this family Martha actually showed just a hint of her age, her eyes were sad, and she looked so sad as she said, "Of course Darling, we should be on our way back up to the waiting area."
They made their way through a maze of hallways, and finally a private elevator, where Alexis punched in a code and hit 7 for the top floor.
"Kate, the code for the elevators, at least as long as we are staying in the hotel is 8068, some students did research and it's the least common numerical password." She rolled her eyes,
"Thanks, Alexis, I'll put in a note on my phone, and secure it, I would never have picked those numbers," she said just to break the silence.
As the stepped off the elevators they were greeted with a security guard, who nodded at them until he saw Kate, Alexis quickly spoke up, "Justin, this is Detective Kate Beckett, NYPD and a close friend of Dad's and the family, you better add her to the list of allowed guests please."
Justin quickly glanced at Martha and Gina, both who were nodding yes, "Certainly Miss Alexis, is it spelled with one or two T's Miss Beckett?"
"Two, and thank you, I appreciate your help," Kate said sincerely,
The door buzzed and they walked into what appeared to be a huge Airport VIP club, various types of seating, including recliners, a bar, snacks, and what Kate needed most, an endless supply of coffee. The private restrooms were just off the hall, and soft gentle music played lowly in the background, just to break the barrier of silence.
Kate had just finished her second cup of coffee, Alexis sat with her drinking a hot chocolate, when a dark-skinned man, jet black hair, perhaps in his early 40's walked through the doors and greeted Martha and Gina.
"Dr. Jardine, this is Kate Beckett, Detective for NYPD and a close friend of Rick's and the family, we thought if he heard her voice it might help." Gina spoke up
"Hi Doctor Jardine, Kate Beckett" Kate said she extended her hand,
"Pleased to meet you, Detective Beckett, I've heard a lot about you and your experiences with Mr. Castle, I'm Doctor Donald Jardine, and I'll be treating Mr. Castle until we get him well, or well enough to be transferred to a local hospital in New York. I know this is not how or where you want to spend your time.
"First of all, Miss Rogers, Miss Gina, I need your approval to discuss Mr. Castle's case in the presence of Miss Beckett, if so, please sign these forms, and we can proceed to the update for today." He said as he laid two forms on the table in front of the two ladies
Without bothering to read both signed their names and Dr. Jardine, filed them away in the case notes he was carrying. He then opened his tablet and began to speak.
"I'm going to start at the beginning, to give Miss Beckett some background of where we're at, if I may", as the three ladies nodded,
"As you know Mr. Castle was involved in a crash landing, we also had to treat gunshot wounds, one which was applying pressure to the spinal column, until he is awake, we can't be positive, BUT we don't believe there will be any long-term disabilities from that wound.
"The broken arm and shoulder were reset, our chief of Orthopedics and team physician for multiple major league teams performed the operation, and is confident Mr. Castle will have at a minimum of 93-96% full range of both right arm and shoulder.
"Mr. Castle suffered severe blood loss, as well as a trauma to the left side of his head, reports we received, as he turned just in time to deflect a larger impact, but we're not clear YET how severe the damage is. We ran some tests, one which is an EEG, or electroencephalogram. In its commonest form, it is a measurement of the electrical activity of the brain measured from an array of electrodes on the scalp. There are other tests we will be conducting as well, but the EEG does reveal activity.
"Electrical activity in the brain appears in an EEG as a pattern of waves. Different levels of consciousness, like sleeping and waking, have a specific range of frequencies of waves per second that are considered normal. For example, the wave patterns move faster when you're awake than when you're asleep.
"The EEG will show if the frequency of waves or patterns are normal. Normal activity typically means you don't have a brain disorder, of course with Mr. Castle we used this to ensure the brain is still responding. Although the tests reveal abnormal results, it's still a good sign, that the electronic wave transmissions are continuing, even though we may not be aware of them just looking at him as a patient."
Kate began to cry, her tears falling from her eyes, Doctor Jardine quietly handed her a box of tissue as he continued the update.
"When Mr. Castle was first found, a very smart and attentive Medic realized that he was suffering from brain swelling and took steps to relieve the pressure, this has been followed up here and we've seen a decrease in the swelling, but I have to warn you all, we can't put a time table of how fast the swelling will leave entirely, one reason we are continuing the sedation medication to allow his body and brain to heal before he wakes and faces if he remembers the trauma."
"What do you mean if he remembers Doctor?" Gina asked,
"Gina, I wish we could give you definitive answers but the truth is we really don't know how much or if Mr. Castle will retain any of his memory when, and we're confident he will wake up, so please don't go to the worst-case scenario."
Kate who had sat next to Gina noticed her tears falling now, and quietly held the tissue box for her to pull some out to wipe her eyes.
"Remember that a coma is a state of unconsciousness when a person cannot be wakened with touch or noise. The inability to waken makes coma different from sleep. The length of time that a person remains in a coma is one factor we use to determine the extent of Mr. Castle's severity of brain injury. We are keeping him sedated now, and as I mentioned early test show a reduction, although minimal, we are headed in the right direction."
"Doctor, what caused my Dad to go into the coma, to begin with, I know he was hurt bad, was it the pain from his wounds, or the hit on his head?" Alexis asked, fighting tears
"That's really a good question Alexis, I'll try to explain it in plain speak, I know a lot of this is confusing since you don't have to deal with it on a daily basis. We aren't always sure the causes a coma, sometimes brain stem is often injured. The brain stem processes automatic, unconscious controls, and if you are Googling any information, I would ask you not too, it will only scare the hell out of you.
"As I was saying the brain stem is the control center of the body including heart rate, blood pressure, body temperature, and breathing. The reticular activating system (RAS) is located within the brain stem and is the important "on/off" switch for consciousness and sleep.
"There are several reasons why this stop working, but when it does, either the RAS has stopped working, or both cerebral hemispheres have shut down. When there is swelling in the brain, as in your fathers' case, it causes compression of the brain tissue against the skull bones. This swelling can affect other parts of the brain.
"This is why I said the young Medic who treated your Dad saved his life, If the intracranial pressure continues to increase without being treated, the brain will continue to swell until it pushes down through the opening at the base of the skull. This damages the brain stem where the reticular activating system is located. This also damages the breathing and blood pressure control centers of the brain and can be the reason for death in the hours or days after injury.
"So, what is the treatment plan for my son now?" Martha asked in a very sad voice,
"We, his medical trauma team are concerned about swelling of the brain, so an intracranial pressure monitor was placed inside the skull to read the pressure inside. As we monitor the pressure it allows us to adjust the medications to "induce" the coma state, until the swelling has reduced below the critical threshold.
"I don't think anyone here in the hospital has explained WHY we ask family members and friends to be very quiet when visiting when there is a concern about high-pressure spikes in the brain. The lighting of the room is also monitored and kept low as well as the room temperature kept cool. This is called "keeping the stimulation low" so that the brain can rest and recover.
"Doctor, how soon will you know if your treatments are working, I mean is there a range, not that we're holding anyone to a date or time, we just need to know, we need to be strong to face what is coming, good or bad" Kate got out through her tears,
"Kate, I really hate to put timetables on recovery, every patient is different" the Doctor tried to sidestep the question,
"That's true Doctor, but here sits Rick's Mother, Daughter, Wife, and Best Friend, we have the right to know what to expect, do we have hours with him, or is it days? Please I know it's not exact but please give us something to hold on to, or to start preparing for the worse, please." Kate dabbed her eyes, as she finished, and Martha reached over and squeezed her hand,
"Thanks, Darling, I wanted to ask that, but was too afraid."
"OK, but remember as you said everyone is different and this is a general range. A coma usually evolves into the vegetative state or a higher level of consciousness within two to four weeks, (LONG PAUSE) for those who survive was said quietly, and sadly by Doctor Jardine.
"Doctor, I'm sure you have some data backing up that estimate, would you share it, please? I know I'm the new one here, but his family needs to know what his chances are to be more than someone they visit, who may or may not even know they were here. Please, this family is resilient, and together we can get through this, but please don't hold back the facts." Kate was half pleading with, half interrogating the doctor.
The doctor looked very uncomfortable, but finally, with four pairs of eyes staring at him, he relented. "OK, again, these are clinical numbers, based on averages, and clinical trials. Rick scored a 9 on the scale as of this morning, patients with a Glasgow Coma Scale of 8 to 10, 27% will die or remain in a coma, while 68% will have a moderate disability and/or good recovery." He said very quietly,
"OK, so we have an almost 70% chance that Daddy will come out of this with some mild disability, I know you don't know what or even if he will be one of those, but at least we have a better than 50-50 chance we had walking in here Doctor. NOW what can we do to help in the recovery, other than remain calm, no crying, keep the room cool and dark, is there anything else?" Alexis asked, with hope in her voice.
Doctor Jardine replied, "like everything else involved with coma's this is what we know, or how some people responded. When people are in comas, they are unconscious and cannot communicate with their environment, meaning they can't speak and their eyes are closed. They look as if they are asleep. However, the brain of a coma patient may continue to work. It might "hear" the sounds around them. Some patients recall the sound of the footsteps of someone approaching or the voice of a person speaking.
"You can talk to him, only happy stories, if he has a favorite book, reading to him is also great. Let him hear each of your voices, we've lifted the 2 people max rule starting today. Just include him in conversations, I or other doctors can't prove it if has any clinical value, but we do know it sure as hell can't hurt. You all will be able to see him once he is set up in his new private room, give the nurses at least 45 minutes, please." The Doctor said,
"Well if there are no more questions, please have a snack or beverage and relax, Rick will be able to pick up on any tensions, and it could cause his blood pressure to spike. If that happens, we will have to revert back to the more stringent visitation policy, OK?"
"Sure Doctor, and Thank You," Gina said, as the patient man in the white coat turned to leave,
"Does anyone know any of Dad's favorite poets besides Edgar Allen Poe?" Alexis asked,
"He loved Tennyson, almost as much as Poe," Gina said, tears falling,
"Well if you want your father to wake up, start reading him one of James Patterson's books, he'll wake up in a minute and snatch it from you" as Martha smiled, trying to inject some humor.
"He loved to tell stories, he and Captain Montgomery would sit for hours spinning tales from their youth, so any stories about him growing up or Alexis he would really love" Kate offered,
"That's a good suggestion Kate, you could tell him what's going on at the precinct, he always talked about the gang there, just please keep it positive."
"I will, and thanks Gina," as Kate looked out the huge window, so many memories, so many lost moments that could have been, "If Only"
A/N This chapter is full of many medical details, the topic has been researched as much as possible, and I apologize for any errors, BUT it was not meant to be a Medical Journal Entry, please forgive any errors and move on with the story. Thanks