A/N Sorry about the wait, it was due to a combination of technical issues and a touch of writer's block. Still, at least this is a long chapter to make up for it.

Cottonwood House III

The Hand You're Dealt

Disclaimer: No, CSI: still isn't mine. *sigh*

Chapter 4

Lucy

I put a pan on to heat some milk and then prepare two mugs; Gil's, with an extra large handle, gets malted milk powder and cocoa powder goes into mine. Gil has gone through to prepare himself for bed. I'm pleased that he's chosen to get ready by himself, just as he'd do on a normal night, but I know he's tired, so I'm not going to change out of the clothes I wore to Lindsey's party just yet. While I prepare our drinks I'm keeping an ear open in case I'm needed urgently and I've made sure that he has his alert button around his neck, the receiver for which is now back in its regular place, clipped to my waistband.

I'm pleased with how well things have gone today, but now it's my job to make sure things continue to run smoothly and no unpleasant after-effects spoil the memory of success, discouraging Gil from doing something similar again in the future. Luckily it's Saturday, so he has no formal therapy sessions tomorrow and, because I knew he'd be in a swimming pool today, I've arranged with his physical therapist Daniel that Monday morning's session won't be in the pool as normal, but will be a massage therapy session instead.

Even the hot drink is part of my master plan. Gil certainly won't need any help to get to sleep tonight, but this will help settle any stomach discomfort that might arise from the unaccustomed party nibbles and I'm hoping he'll sleep late in the morning, so something that might stop hunger waking him up seems like a good idea.

While the milk continues to warm I potter around the living room straightening a few things and clearing away the remnants of the day. There's not much to tidy up really, Gil seems to be a naturally organised person and, with him using a wheelchair so much, anything that falls on the floor has to be retrieved quickly before it gets run over.

The latest addition to the living area is a drawing board. Drawing is right brain based, so it should be possible for Gil but his partial paralysis won't make it easy and that's why the activity has only just been introduced to his program. Gil and his occupational therapist are still trying to work out what works better, for Gil to try and hold a pen or pencil in his left hand or to strap the drawing tool to his right hand instead. I hope they manage to work something out. Being able to draw will add an important additional string to Gil's communication options, allowing him to include things in his 'conversation' which aren't physically present to be pointed at and without the delay and frustration of seeking the right image from a picture source book like the one currently lying on the couch where Gil half threw it in disgust this morning.

I gather together a couple of magazines of my own. Even though this purpose built apartment includes a bathroom and a spacious bed-sitting room of my own I spend so much time with Gil that my possessions have developed a tendency to wander into the main living area. As well as being a 'translator' when Gil needs to interact with other people I try to spend about an hour a day in concentrated communication with him. Normally Gil chooses a topic, something he'd like me to know, something he'd like me to help me with, or maybe just something he's read about or seen on TV, and then we 'discuss' it using as many techniques as necessary for Gil to get his side across. Sometimes we just dive in but if Gil thinks the topic might be difficult or complex then he'll try and let me know in advance so that I can get together appropriate material. Normally I arrange this in the form of a communication sheet, a large piece of paper with words and pictures that might be useful for Gil to point at while we 'talk'. But that's just the formal stuff, any opportunity that can allow Gil the chance to express himself needs to be grabbed and made use of, so the more time I spend with him the better, especially as the more I get to know him, the easier communication is. That's not just a case of familiarity with his body language, something as simple as learning that Gil likes to drink Mountain Spring or Dr. Pepper's more often than some other sodas means that I can offer him those first, when otherwise it might take several questions to work out which soda he wants. Not that I need to as if Gil wants a cold drink much anymore, he usually gets his own now he's mobile enough to go and reach into the fridge. However, for safety reasons, I still need to be around if Gil wants to make himself a hot drink.

Speaking of hot fluids, I catch the pan just before it's too late and add the hot milk to the mugs. Gil probably isn't finished getting ready yet so there's time for them to cool before I add just a sprinkling of cinnamon to Gil's drink, a small preference of his that it took him a long time to work out how to ask for, an example of just how frustrating aphasia can be when it can block even the simplest of requests.

All this interaction has ended up with us becoming as good friends as it's possible to be in the context of caretaker and client. I used to retreat to my own room once Gil was settled for the evening, coming back only to make sure he could get to bed OK, but now he asks me to stay and keep him company and I enjoy our quiet companionship whenever I do. We're a good partnership now, but I can't be sure why Gil chose me over the other caregiver/communication partners he was introduced to when he first arrived at Cottonwood House, although I have my suspicions. Shortly before I was told that Gil had expressed a preference for me it was my turn to visit him in his room in the main building which is where new arrivals and those with the most severe disabilities are accommodated, and when I went in I found him crying. It was early days then, Grissom, as I knew him at the time, was still largely paralysed on his right side and what little movement he had there was weak. More importantly, from my point of view, was that he was completely withdrawn and barely even trying to communicate. Although it was important to find the right helper for Gil, it was even more important for him to start one to one communication work soon, before he fell into deep depression.

Typically for someone in the 'emerging communicator' phase Grissom turned his head when I greeted him, only not towards me. He clearly didn't want me to see him crying, but with so few messages getting out of his mind and into the outside world, I had to work with what I could. Seeing a magazine discarded on the bed in much the same way as Gil tossed his communication book today I guessed the tears might be something to do with that. It took a lot of effort, Gil wasn't feeling very co-operative and didn't always want to even try giving a yes or no response, even though I knew he could, but in the end, having ruled out physical frustration with holding the magazine or turning the pages and the content of an article making him sad, I eventually established that he was upset because there was a crossword in the magazine and he had found it indecipherable. Having the impact of his aphasia on something he used to love doing thrown into focus that way had deeply upset him.

I don't know if it was the discovery of a shared interest in puzzles; the sense of achievement at finally completing a successful communication, one that showed to me he wasn't far from moving up to the next level of communication ability if he could be persuaded that he wanted to try; or because I suggested that, given time it may be possible to find other challenging puzzles that he could enjoy, even if crosswords might remain beyond him; but the next day, when offered a selection of photographs of his choice of potential aphasia specialist caregivers, he picked mine. I've been working with him ever since, and while jigsaws are the only puzzles Gil has yet managed I have one or two ideas stored up, I'm just waiting to see how well my friend can manage to use a pen or pencil before I introduce them. Gil's basic math skills appear intact, so number puzzles are a possibility if we can work out a way for him to fill them in, logic problems may be good for him because they'll challenge his language abilities but only need boxes to be marked to represent either 'yes' or 'no' and Sudoku can work with any symbols or even colours, provided Gil can distinguish and use nine variations. I'm looking forward to helping him try.

It's time to check on Gil. Leaving our drinks to cool a little longer I grab Gil's regular meds and a glass of water and then go and knock on his bedroom door. I wait a minute and when there's no response I enter. If Gil actively wanted me to keep out he'd have made some noise, because he may not have heard me or, worse, may not be in a position to respond because he's fallen or hurt himself some other way, it makes more sense to have Gil signal if he wants me to go away than to wait for him to invite me in.

I enter to see Gil safely seated on his bed wearing his skull print pyjama pants and in the process of putting on one of the loose t-shirts he likes to sleep in. His left arm is already through one sleeve and, as I put down the pills on his bedside locker, he manages to guide is other hand through its own armhole. After that's done his head appears quickly, wearing an 'I did it' grin.

I smile back. "I was making myself cocoa and thought I'd make malted milk for you while I was at it. Is that OK?"

The response is positive so I offer the option of drinking it here or in the living area and a pointing finger indicates Gil would like his while he's in bed. When I turn to go and fetch it I hear a call of "'Ucy," from behind me and Gil manages to put together a 'sentence', pointing at me, making a drinking motion and then pointing at the only chair in the room. I confirm that he's asking me to keep him company and then go and fetch both mugs. When we first met Gil could indicate 'yes' or 'no' and point to things, but only in response to questions and he was unable to initiate communication for himself. The fact that he just managed to say my name as a sign he wanted to say something and then use multiple gestures to clearly show me what he wanted is great, especially after such a tiring day. Even though his intent was so clear I still needed to double check with him, it's important not to assume and risk leaving Gil frustrated because of my lack of understanding. I also try not to make decisions on Gil's behalf, even small ones, and the only reason I didn't ask him if he wanted hot milk before I made it was because Gil was in the bathroom and I don't disturb him there if I can avoid it. Hopefully he would still have indicated 'no' if he didn't want it, especially as he knows by now that I wouldn't be offended if he did.

Thinking about making decisions for Gil, I remember something I need to say to him so, once we're both settled, I begin.

"I have a confession to make, Gil. I was by the bar when Jim Brass came to order beer for you both and I suggested a low alcohol brew might be a better idea. You should really have been given the choice, but Jim saw Ray Langston sit down beside you and wanted to get back so he just grabbed the bottles and you ended up with the LA version without being consulted." Gil shakes his head slowly in disapproval, but there's a smile on his face. His brow furrows briefly and I know he's trying to figure out how to say something. I wait patiently, letting him work the problem through for himself. I don't offer to help; he'll let me know if he wants it from me.

After a moment Gil looks at me and raises his hand to tap himself on the forehead.

"You knew?"

A nod comes in response, followed by a mime of him holding something in his hand and looking at it.

"You saw the label?" He gives another nod. "I should have remembered that nothing much gets past you." Gil grins and shakes his head. I know him well enough not to have to ask if he agreed that the LA was a good idea. If he hadn't then he'd have found a way to let Jim know he wanted the same as the detective was drinking, either by pointing or just sneaking Jim's own bottle when he wasn't looking. Gil's not afraid of arguing or taking liberties with Jim because there's a relaxed, half-teasing comradeship between those two which, as far as I can tell, existed before Gil's brain damage and has survived relatively unaffected. I'm glad of that, because Jim holds full power of Attorney for his friend now that Gil can't always express his wishes clearly enough for legal purposes and having such an embarrassment free friendship helps them both deal with that necessity and the possible awkwardness associated with it. It's also good for Gil not to feel he's being treated with kid gloves all the time.

After our exchange Gil and I don't try and make any further 'conversation', he's tired and needs to relax so he can sleep and making the effort required to communicate isn't a good idea for him right now.

His drink finished, Gil hands his mug over to me and grabs a tissue to clean away the froth of foam that has gathered endearingly on his moustache. I notice him glance towards the bathroom door and I reassure him that, as he's brushed his teeth already it won't do much harm not to go and do it again, just for once.

"Get some sleep Gil, you've earned it. I'll be up and about for another couple of hours at least so don't worry about letting me know if you need anything. I suggest you don't set your alarm tonight either, let's just see what time you wake up tomorrow and you can decide what you want to do with the rest of the day then."

Gil nods his acceptance, looking at me wearily. I often tell people to look into Gil's eyes and see the acute intelligence that's there if they are concerned that the cause of his disabilities has also affected his intellect, but when the irises appear softened and darkened by sadness, pain, fear or tiredness I find it hard to resist the urge to mother him. I do though, because Gil's a grown man and there's no way I would embarrass or humiliate him by treating him as anything other than an adult.

Well, not most of the time anyway.

When caring for someone with a brain injury you soon learn that there's an exception to pretty much every rule. While Gil is highly sensitive to any hint that he is being patronised or babied because of his disabilities the changes caused to his personality have left him emotionally exposed. Sometimes he finds himself in a situation when that exposure leaves him desperately seeking comfort. I suspect that he likes that comfort in physical form as a result of his brush with total paralysis, when he had almost no physical sensations at all. There are many times when I've soothed him while he's cried on my shoulder. I try and keep track of Gil's motivations when seeking this kind of support, it should never become an opportunity to manipulate me to do something for him that he's capable of doing himself, or be allowed to become a method of avoidance. Those things are unlikely though because one thing I know for sure about Gil is that he is very uncomfortable about demonstrating what I think he believes to be a weakness, so when he seeks comfort it's usually because he has no idea how else to cope. Quashing the brief flash of maternalism I rise to leave and let Gil settle for the night, but just as I do I hear Gil's voice.

"'Ucy? 'Ug?" Gil's request is almost plaintive.

When Gil asks for a hug it's always interesting, I would never initiate that kind of contact because of the 'mothering' issues, but when Gil asks for a hug I always oblige. It's a form of communication for him and it's my job to facilitate that, not ignore it. When Gil does it on first meeting his friends he's saying much the same as anyone else in that situation, 'hello', 'I love you' or, if he's feeling insecure, 'do you still love me?' At times like this though he may be using his hug to say 'thank you' or he may want reassurance for some reason. I'll need to read his face and the way he performs the hug to work out which.

With my arms around Gil it's good to feel the muscle tone and body mass that he has gained since arriving at Cottonwood House. It's not the bulk he might have achieved if he was a manual wheelchair user, but it's appropriate for a man of Gil's age and build and a vast improvement on when we first met. I interpret this hug as mostly 'thanks', although some of the nuances combined with the tone he used in his request say he needs just a little more reassurance. I respond accordingly.

"I'm glad I was able to take you today, Gil, I think it went well for everyone."

It's a pleasure to see a smile spread across Gil's face. He reaches over to his bedside table and there's a whirring noise as his bed slowly flattens, clearly Gil doesn't need to read himself to sleep tonight. My offer to get the light receives a nod in reply so I watch from the doorway while the weary man settles himself into his usual sleeping position, on his right side, deaf ear up, right arm positioned so that his paralysed hand is protectively placed on the pillow beside his head where it won't accidentally get squashed and have the blood supply reduced. When we first met he hated having his good ear blocked and it's a positive sign that he's now more relaxed and less afraid of his deafness, he appreciates being able to make things quiet while he sleeps instead of fearing he'll be caught out by something he cannot hear.

Seeing Gil's eyes drifting peacefully shut I turn off the light and retreat, touching the button that will close the automatic sliding door softly behind me.

With Gil in bed early I can put aside the immediate challenges of working with him and use the time to consider what I learned while watching what happened at the party today. Is there anything that I can learn from it that needs to be explored with Gil later, whether it's something positive or negative?

Today is the first time since I've been working with him that Gil has been part of such a large group. He doesn't often have more than a couple of visitors at once and on the few occasions, like his birthdays, when there have been more it has been on home ground here at Cottonwood House. Gil was very keen to attend the party and with Lindsey there to be a focus of attention instead of him it seemed worth trying. We did have a fast exit strategy in place, but I'm pleased to say it wasn't needed.

In fact the party was a real success for him, it showed just how well Gil can manage simple exchanges with people he knows well, helped by the fact that those friends have put in the effort to learn some basic strategies to help their friend communicate. With so much water around we decided that Gil would try to manage without his speech computer and it wasn't a major problem. Gil has been a fast learner with the device but he does far better when he can pre-plan what he's going to say and creating ad hoc speech can be quite hit and miss; so it's never going to be a miracle solution for him. I don't think he really missed it and I also got the chance to observe how Gil dealt with challenges when he couldn't give himself space by pretending to hunt around his touch screen looking for an appropriate word.

Gil's immediate circle all interacted with him in much the way I'd expected; Greg and Jim treated him just as they always do; Catherine, Nick and Warrick can all be a little too protective of Gil at times, but the men seemed to relax once they saw how confident he was about moving in the water; and Catherine, once I'd reassured her a little, just included Gil in her general anxiety about being a good hostess to everyone. In fact, once she saw that Gil was happy and taken care of by the others, Catherine became focussed on getting me to take time out and be a guest instead of concentrating on my responsibilities.

Although I don't know Lindsey as well as I know the others because she has to find a ride before she can come out here and see Gil, I'd already gathered that as far as her love and concern for her 'Uncle' Gil is concerned, she's a very remarkable young woman. Our 'phone conversations before the party showed her mature attitude to Gil's needs, but I admit I was a little anxious about how she would receive his gift to her. As it turned out I think I was almost as pleased with her reaction as Gil himself was. She must have worked out how much effort it took him to put the puzzle together, even if she didn't include factors like the effort required to select and order the right jigsaw in the first place or to explain to me that he wanted it framed, because she seemed as proud of him as I believe he is of her.

Of the two guests who were strangers to him, Gil seemed to do much better with the young woman, Riley. Although she made the mistake of not giving Gil the time and space necessary to formulate a response to what she was saying, Riley was clearly tailoring her conversation to him. I noticed that Gil was laughing a lot even when Lindsey, who was also listening, wasn't. I know the laughter was genuine too, because if Gil was ever the kind to laugh just out of politeness he doesn't have those kinds of social graces now, he can't convincingly fake what he doesn't feel and finds it almost impossible to mask what he does.

Doctor Langston was a different matter. I noticed that Gil was avoiding him, probably quite subconsciously, from early on. It wasn't unusual or surprising to me; Gil is uncomfortable with strangers, due to a combination of concern about how he might be perceived and frustration at his inability to oppose any conclusions they might draw. Gil would probably have treated Riley the same way, except she didn't give him the chance. Today was about fun, not making Gil work, so I just tried to keep an eye on the situation although I'd noticed that Gil's friends were shielding him from Langston, whether they were aware of doing that or not.

Letting things ride worked during the afternoon but as evening drew in I was persuaded to take a break while Gil napped. Some of the guys volunteered to sit beside him while I had a fruit juice with Catherine and Jim Brass was there when Gil woke up. Shortly afterwards Jim came over to the bar to fetch them both drinks. While Jim was waiting to be served, Langston, who I thought had left, approached Gil. Jim moved quickly to rejoin his old friend, a bit too fast, I thought at first because I wanted to give Gil the chance to at least try and deal with the stranger on his own, but Jim had the advantage of knowing them both and in the end, I think he made the right decision. I'm not sure if it was anything specific about Langston, the fact that Gil was just waking up, or the blow that Gil had to his confidence when things went wrong at the restaurant a few weeks back, but I could see Gil's anxiety surge rapidly to the point where he was probably beyond even considering which strategy might help him cope, let alone managing to apply it. Fortunately Jim's rapid response meant he was able to get to the two men, find an amicable way to get Langston to leave without the additional stress of a confrontation and was kicking back beside his rapidly relaxing friend before I'd gotten much further than getting out of the pool.

I left Jim and Gil to get on with it then. I shouldn't have let Catherine talk me into that drink, but I think it probably worked out OK for Gil. Over all he probably felt better being rescued by his old friend than having his caregiver come swooping in. With Jim Gil calmed down quickly and took the time to share a beer and enjoy some sense of normality before we came home. If I had been involved then, however good a job I might have done, Gil would have been rudely reminded that his life is no longer 'normal' and would probably have asked me to take him home straight away. We should still take some time to work on Gil's stress management and coping strategies though, whether I was right to leave Gil's side on this occasion or not, neither of us want him to feel that he needs my constant presence as some kind of protective shield whenever he's out.

Gil's reaction to Dr. Langston was probably the most dramatic event of the evening, but there was something else that caught my attention too, something I'm not sure if Gil noticed.

Gil wasn't the only party guest to be showing signs of avoidance and, unlike him, I think Sara was somewhat aware of what she was doing. She made sure that she was among the first to greet Gil when we arrived and I saw her say something to him so he'd remember that, but once Gil was distracted by Greg and Lindsey, Sara retreated. She was never conspicuously distant from Gil, but always far enough away that they couldn't catch each other's eyes. Other than when Gil was hugging people goodbye, the only time I saw the two of them together was while Gil was trying to sleep. If I hadn't seen the tenderness between them then, I would have seen Sara's avoidance in the context of their previous engagement and her very recent discovery of what has happened to her former fiancé and decided that she is preparing to withdraw from their relationship but just hasn't worked out how to tell Gil yet.

My first concern on seeing what was happening was that Sara may not have wanted to approach Gil while I was watching. Sara could easily have problems with me because my role in Gil's life means I am in such close contact with him. I share a home with Gil, I spend most of the day with him, I communicate with him better than she can right now and there are even times when I see him naked, although that's much less likely these days. If Sara tries to cope with that by reminding herself that I'm a professional caretaker then, in doing so, she has to accept her former fiancé's need for such a person, and that will bring its own kind of pain. It may actually be easier for her to consider me a rival. If that's the case I need to find a way to persuade her that I'm no threat.

Helping someone in Gil's situation explore the possibilities of a romance is always a challenge. In most other life situations it's not completely unusual to have a friend along for support and having me around is accepted as an extension of that. But, with the possible exception of a first date, this doesn't apply to romantic liaisons. How do you navigate the line between enabler and gooseberry?

I knew from Gil that he and Sara had been engaged in the past so I decided to err on the side of discretion and I've left them pretty much alone when they've been together. The first time she came to Cottonwood House I gave Sara some basic pointers on communicating with an expressive aphasic, hoping that her familiarity with him would help her spot at least a few of the non-verbal cues that can enhance understanding of Gil. I also made it clear to them both that they could come to me if they needed any help in future. Now I'm concerned about why Sara hasn't come to me for further information or advice. Perhaps I'm right and she doesn't want to talk about this with me, or maybe she feels they're managing well enough for now and that further recovery from Gil will make more effort on her part unnecessary, but if that's what she's thinking she needs to be told that that just isn't true.

Gil's communication skills are now at a stage referred to as 'stored message communicator', although he is rather less independent in his communication than many in that category. It's hard work and his incredible intelligence that's got him here, there has been no spontaneous improvement since he started to use people's names well over a year ago and his neurologist and I agree that this time span, coupled with the level of permanent damage to the actual material of Gil's brain, means there is unlikely to be any further improvement of this type. Even the progress from Gil's efforts has pretty much stalled over the last few months and while I'm hopeful that he'll gain a useful tool in learning to draw again it won't make much difference to how well he can communicate over all. While many couples do cope with similar situations, when someone with such a severe condition is involved then at least some formal training can be extremely useful. I would be willing to work with the two of them as a couple or there are charity run courses if they prefer.

Whatever the issues, I need to find out more if I'm going to be able to help. Talking to Sara will be a problem if she has issues with me, and doing so without Gil's permission would be a breach of trust anyway. I'm definitely going to have to try and persuade him to communicate with me about this first. I know he'll find it difficult because, no matter how well we get to know each other, Gil's a very private person. I can't change that so, with the extra barrier of reticence to overcome, I'll need to do everything I can to help get around his aphasia.

I consider the various possible elements of the problem while I shower and change into comfortable clothes. This will be a very important communication sheet and, even if Gil can't or won't use it with me, he may want to use it with Sara next time she visits. Grabbing a large sheet of paper and a handful of marker pens I head back into the main area where I can use the larger table there. After a few more moments of thought I begin to draw and write.