The Diagnosis

Archibald followed the army doctor into his office, only a small cubicle really, with a desk and bookcases. It had windows on both sides which looked in on the ward. The doctor gestured for Archibald to sit, although the doctor himself remained standing. He took out a file and added several papers from his clipboard, he flipped through the pages, gathering his thoughts.

"From what we can gather from the field hospital's report, your son was protecting another soldier in the field when both were thrown by an explosion into a nearby shell hole and were later hit by some debris. He and a Private Sowerby were found by an ambulance crew some hours later once the barrage subsided. The other boy was injured as well, though not nearly as badly. It seems your son took the brunt of it. He saved that boy's life. I wouldn't be surprised if his commanding officer puts him in for a distinguished service cross. Do you know if they knew each other well?" Lord Craven rubbed his forehead "yes, they have been friends since they were children, Dickon is slated to be head gardener once our current one retires." The doctor frowned slightly and continued pursuing his papers. "He was quite brave, they would both have been killed if he hadn't acted as quickly as he did." Archibald stood, his eyes pleading "please Doctor, just tell me."

The doctor sighed and put the folder on his desk. "Let me be clear, I do think your son has a good chance of survival, better than most spinal patients I see, but his injuries were quite severe. One leg suffered nerve damage, and is broken badly, the other leg is damaged as well, though not as badly. The impact also caused muscle damage, and he lost a lot of blood, he's lucky they didn't amputate in the field. Either injury alone would probs have put him out of the service. What I am more worried about is his spine, he sustained blunt force trauma to the lower back. An X-ray showed damage to the spinal column around the tenth thoracic vertebrae and a significant amount of swelling around the spinal cord. The vertebrae have been crushed and dislocated, causing pressure on the nerves. This pressure cuts off the blood supply which caused what I believe to be significant nerve damage. This had caused swelling which I believe had contributed to your son's current illness. Although I couldn't see a clear break of spinal column or specific transaction of the cord itself, unfortunately the spinal cord is notoriously hard to examine, even in an x-ray. This means that as the spine heals the swelling may recede and he may regain feeling and possibly some movement. I suspect that even after the spine heals he may remain paralyzed due to the nerve damage in the legs themselves. It is my opinion that with the combined damage to his legs and spine, that your son will never walk again."

Archibald collapsed into the chair, his head in his hands, he made no sound. His son hadn't walked until he was ten years old, he had been weak and sickly, everyone, including Archibald, had thought he would die young. He had never thought his son would be healthy enough to be a soldier. Then by some miracle a child called Mary Lennox had come into their lives, hit them over the head and made them see that Colin's infirmities were all imagined. But now, now he would have to tell his only son that everything he had gained in the past years was gone. That it had been destroyed in the blink of an eye. His son would never walk again, never run across the moors again. Never again stand proudly next to Archie as they surveyed the gardens. His voice broke as he thought aloud "I'll have to tell him. When he wakes up. God, how do I tell him? My boy didn't walk until he was ten years old, how on earth can I tell him this? It will kill him." Dr. Hawthorne sighed, he looked confused by Archie's revelations, but he didn't pry, he put his hand slightly gruffly on Archibald's shoulder. "I have specialized in neurology for 15 years and I have yet to find an easy way to break news like this. Just be there for him, encourage him, keep him learning and doing. Make him feel useful. When he cries, hold him. When he lashes out at the world be there to take his pain. And be honest with him, treat him like a man. Don't patronize him or infantilize him, he's a soldier, and a brave man. He isn't a child anymore, and you cannot let him remain one forever. Find a way for him to both accept help and remain strong. He must be his own man, despite his paralysis. I don't have a perfect way of doing all that, but you will find a way in time. And Mr. Craven, he does deserve to hear it as soon as possible, and he deserves to hear it from you. He should wake within a few days and I suggest you discuss it with him as soon as he is coherent and I am able to perform a more complete neurological assessment." Archibald had composed himself and stood, "thank you doctor, I think I shall go and see my son now." Dr. Hawthorne nodded and went back to surveying Colin's papers.

Archibald breathed in sharply as he left Dr. Hawthorne's office, he had promised Colin that he would remain strong no matter what happened and he intended to keep that promise. He remembers hugging Colin as they saw him off at the train station in Richmond. He had been so tall and strong, black hair perfectly set beneath his cap, the army issue pack swung jauntily over his shoulder. He wore his uniform with such pride, standing tall with his chest puffed out with pride. He had smiled at Archie, telling him not to worry, that he would be fine, that he'd be home before they knew it. He had jumped onto the train with a skip in his step and had smiled and waved as Archie's heart broke, watching his only son march off to war. He had begun to feel the void inside himself again the moment Colin had announced that he was joining up. Now there was a great fear inside him that both he and his son would sink back into the pit of despair in which they had lived before the summer of the secret garden and the Magic. He felt the black pit inside him still, threatening to escape and swallow him whole, he fought it down like bile.

Mary sat in a chair beside Colin's bed holding one of his hands in her lap. Archibald closed his eyes and sighed, then he walked over to Mary placing his hand on her shoulder. Mary turned, her eyes asked the question she could not. 'Will he be alright?' Archibald's voice wavered and he spoke quite softly. "He won't be able to walk again, he'll live, but he'll never walk."

"What? Uncle Archie, that can't be true!" There were tears in her eyes and she spoke too loudly for the quiet ward. Archibald took Mary in his arms and held her.

"I'm so sorry, Mary. I should have stopped him." Archie whispered as he held her while she wept softly into his shoulder.

"How can we ever tell him? After everything? He's come so far, to have it taken from him again! It will kill him!" Archie sighed, he couldn't handle this, not again, the pain of it clutched at his stomach and became a stabbing pain, a deep sadness in his chest.

"I don't know Mary, I don't know how we will go on, it seems, beyond understanding, how cruel this world can be." Mary lifted her head and saw his grey, drawn face. She saw his pain, and she feared it. It took all her strength to take on the mantle of bravery, but she grasped at it, and her tears dissipated, replaced with hard conviction.

"No, Uncle Archie, don't you dare. We will get through this, I don't know how but we will. Colin is strong, we won't let him disappear again, no matter what." Archibald smiled sadly, his eyes failing to smile with him, but the darkness in them receding a little.

"You keep me alive my girl, you really do." Mary smiled. It was a warm and wonderful feeling, for a girl who had spent most of her childhood so unloved, to feel loved as if by a father. A nurse had brought a second chair for Archibald and both sat down beside Colin's bed. Archie took his son's hand and kissed it. "It won't be like last time, I promise." They watched Colin sleep, his face contorting in dreams and in pain. He murmured unintelligibly, delirious with fever and with the trauma his body had received. Mary stroked his cheek, warming his clammy skin beneath her soft palm.

"It's alright Colin, we're here now. We won't be going anywhere I promise. We're going to bring you home soon. You will get well and come home with us, you're not going to leave us again, not ever, I promise." Colin groaned, his head turning slightly towards Mary. Archie felt Colin's hand twitch slightly in his own.

"Mary," Archie whispered. "I think he might be waking up."

Mary studied Colin's face but shook her head sadly.

"I don't think so Uncle Archie. He's just dreaming I think, his eyes are moving. Besides, he's probably still full of morphine." For several minutes they sat silently, holding Colin in the small ways they could without hurting him. Then Mary whispered.

"Do you think he knows we're here? Dr. Craven says that sometimes people can hear you or feel the presence of those they love, even if they are unconscious." Archie studied Colin's face closely, rubbing his fingers over the back of Colin's hand.

"I hope so Mary, I hope so."

A few hours later Nurse Anderson once again summoned Archie to speak with Dr. Hawthorne. He rose quickly, worried what new bad news this second meeting would bring. He patted Mary on her shoulder, forcing a smile.

"I'll be back presently, then I must go to the flat and make sure it's ready for you." Mary turned around, concerned.

"But Uncle Archie, won't you be staying there too?" Archie nodded.

"Yes, of course, but I would like to stay here tonight if possible, I don't like the idea of leaving him alone tonight. Not just yet." Before Mary could retort, he added "and don't argue with me about staying, you need food and rest, this is no place for a young lady to spend the night."

"But Uncle Archie!" Mary replied, ever obstinate, Archie might be alright pushing himself to the brink of collapse but that didn't mean she couldn't try to stop him. But then she saw his eyes, he needed this, she saw, he needed to be near Colin. He physically could not let him out of his sight, even for the night. She sighed.

"Alright, Uncle. But I'm staying until the hospital closes." Mary had noticed that it seemed the rules of the spinal unit were somewhat less strict than was common in most hospitals, even less strict than the rules in the officers convalescent home where Mary and many of the other young women of the area were volunteers.

Archie nodded and turned towards Dr. Hawthorne's office. When he entered Dr. Hawthorne looked quite uncomfortable, as though not sure of what he was about to say. Archie waited with bated breath, unsure what this could mean.

"Dr. Hawthorne, what seems to be the trouble?" Archie said, sitting across from Dr. Hawthorne once again.

"I'm sorry to bring you in again so soon, but... you see, I have only just learned of your station, Lord Craven, and of Colin's position as your only heir. Given that information there is something else about his injury that you must know."

"Yes, Dr. Hawthorne, what is the matter?"

"As you are already aware he received a blow to his spine which occurred in the middle of his back which means everything below is almost certainly affected to some degree. This means that unfortunately your son will likely be unable to father children, to produce an heir."

"What are you talking about? You said it was his legs which were effected."

"The spinal cord controls all the functions of the body, it allows information to reach the brain. The nerves which control the legs are above the nerves which control the sexual organs, when the former is affected, so is the later."

"You are sure of this? And there is nothing you can do?"

"I'm afraid I am quite sure. Outside of the miraculous, all we can do is wait and see what he regains."

"So there is still hope for him in that regard?"

"Yes, but mainly because we cannot be entirely sure of the extent of his injuries until we have completed a neurological exam and have waited a few weeks for the shock to wear off. It is highly unlikely that he will be entirely unaffected. I would prepare for the worst." Archibald began to get up and leave, but then stopped, turning again to Dr. Hawthorne.

"What do you really think will happen to Colin. Will he recover at all? My cousin is a doctor in Yorkshire, he has only seen a handful of spinal injuries but from what he has said, there are dismal survival statistics for these injuries. Doctor, is my son going to die from this?" Dr. Hawthorne folded his hands on his desk.

"I certainly hope not. I work in conjunction with a Dr. Monroe in Philadelphia and a Dr. Jones in Manchester and we have begun to have great success treating incomplete spinal injuries like your son's. Dr. Jones will in fact be consulting on his case once he has gotten stronger. There are several things we can put hope in. Do you mind if I am rather blunt, medically?" Lord Craven indicated he was. "The main cause of the eventual death of spinal patients is infection; particularly of the skin and urinary tract. Another is kidney damage, generally caused repeated, aggressive urinary tract infections and by urine backing up into the kidneys. We are doing everything we know to do to prevent bed sores. When an infection has taken hold aggressively there is little which will reliably stop it, we must focus, therefore on prevention. So far, our main problem has been the infection in his feet left over from the conditions in the trenches but the wounds are not deep and the infection seems to be healing well. There is only so much we can do, but if you keep him active he has a good chance of keeping those at bay. Particularly if we get him mobile as quickly as possible. One of the indicators we have gotten with Colin that his injury is incomplete is that he is voiding his bladder completely. Unfortunately I don't think he feels the need to do it or even knows when he voids but we have determined that urine isn't staying in the bladder after it is emptied or backing up into the kidneys. We have the nurses keeping track of his output and it looks remarkably good particularly considering that he hasn't even fully regained consciousness yet. I have had some patients with similar injuries to your son who regain bladder and bowel control along with partial use of their limbs over the course of the first year post injury. I hope that this will happen for your son and I've had some good indications that this is the likely course of his recovery. But even those patients who regain movement and sensation have never recovered enough movement to walk independently, and frankly I don't have any evidence that they have fathered children since their injuries. Truthfully, we know very little about injuries like these. Until recently the initial injury was simply not survivable, we still lose many patients now. Unlike some other doctors I do not believe that injuries like this are not to be treated, or that death from them is inevitable or in the case of your son, even likely. I don't however have any indication that injuries like this are recoverable. His life is going to be different, you will both have to accept that."

Archibald stood outside Dr. Hawthorne's office, out of sight of Mary and the rest of the ward. He slumped against the wall with his head in his hands. He didn't know how he could cope. He hated seeing his son in such pain. He was angry at the restrictions so cruelly placed on his son. He had believed Colin's health to be a miracle, surely God could not be so cruel as to take even the prospect of fatherhood away from his son. How would he even tell this news to Colin. He couldn't remember ever speaking to Colin about the intimacies of marriage, he simply figured whatever gaps boarding school had left him with would be filled either by medical texts or university friends. He didn't even know if Colin had ever even kissed a girl. His prospects for marriage had never been a topic of discussion between the two of them. He couldn't begin to fathom that his now handsome, vibrant, son would never marry. When Colin was a child Archie had hardly given a thought to his son's marriage prospects, his health had never been good enough for him to imagine his son would even survive childhood. There was part of him which simply did not believe it. His own doctors and even his parents had insinuated for years that no woman would ever want a hunchback like him. That it would be cruel for him to have children who could inherit his condition. But he had never had to grapple with the question of his capability, but rather his prospects. Colin had grown to be a healthy, handsome young man, his prospects had looked promising. But now...it all seemed quite a mess.