Again thank you so much for your interest in my first H50 story and all your replies.
I went back to correct two minor oversights in Chapter 2, one of which was noticed by one of you (thanks for that) and the other is mine that was sort of gnawing at me after I posted the chapter. So if some of you received an alert for chapter 2, you know why.
I have no medical background whatsoever. What you read has happened in my own entourage and I decided to adapt it as a H50 story. If there are medical inaccuracies I apologize as I wrote the story on sheer memory of what happened some fifteen years ago and the rest is my own research off the Internet.
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"You all right there?" Danny asked worriedly. He cast a glimpse at his partner who sat deathly quiet with a faraway look on his face.
"Danny – something's wrong," Steve said with dread in his voice as he felt a numbing sensation creeping up on the left side of his face. "I can hardly see."
"You hold on. Hospital's just around the corner."
Steve's vision was becoming clouded and the headache worsened. He grabbed his head in excruciating pain and dry heaved a few times. "Danny, oh God!" Steve's agonizing cries tore at Danny's heart.
In a state of panic Danny put the pedal to the metal to shorten his ETA to the hospital.
He parked the car near the emergency entrance and rushed to help Steve out of the car. "Can you stand up?"
Steve tried to stand but the pain was too debilitating.
Danny hailed a nurse in green scrubs who was passing by. "Can I get a gurney here please? My friend's sick and can't get up."
She beckoned two paramedics over and together they lifted Steve onto the gurney. "What happened?"
"All over sudden he cried in pain and grabbed his head."
"Was he in an accident?"
"No. He's been having recurring headaches lately."
All three wheeled Steve through the emergency entrance doors with Danny running at his partner's side with a comforting hand on his shoulder. "Hold on, Steve. You're in the hospital. They'll take care of you."
"Dannnno," Steve slurred with a face scrunched up in pain. He reached out a weak hand toward the familiar voice.
Danny grabbed the hand and squeezed it tight. "I'm here. I'm not going anywhere. I've got you, babe."
Steve somewhat relaxed in Danny's presence.
"Sorry sir, this is as far as you can go," the nurse informed the frantic detective as the paramedics stopped short of the ER entrance.
"Steve, listen to me." Receiving no response from his agonizing partner, Danny nudged his hand to draw his attention. "Steve, buddy, listen to me. I'll be right here, waiting for you. Okay? Steve?" he received a weak nod in return. "Take care of him."
"We will. In the meantime, you might want to fill out some forms at the nurses' station."
"Yeah. Okay," he answered dazedly. He was still reeling from the shock.
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Danny contacted Mary, then Chin and Kono before taking on the dreary chore of filling the forms.
Chin and Kono both arrived at Honolulu Medical Center within minutes. Danny described Steve's symptoms and the ensuing race to reach the hospital in time.
"Governor Denning called barely a minute before you did. Says he'd made an appointment with Steve but that he never showed up. Guess now we know why." Chin said.
"I'll call him back and explain the situation," Danny offered.
"Don't bother. I already did."
"Is Mary Ann here?"
"Not yet. I called her at Steve's. She's on her way." Danny shook his head in anger. "I knew something was wrong with him. I just knew it!" he chided himself for not being more insistent in convincing Steve to see a doctor. "I should have put my foot down and dragged him to the doctor's."
"Be realistic, Danny," Kono scoffed. "Trying to get Steve to see a doctor is like pulling a tanker with a rope." She leaned into Danny and put an arm around his shoulders. "Don't blame yourself. We all saw that he wasn't feeling well but we dismissed it as mere strain. And perhaps that's all there is. He's reacting badly to an overload of stress"
"He's a former SEAL. Stress is part of the job. He can handle it."
"Depends on the circumstances," Chin chimed in. "It has been a whirlwind at the office lately. We are all a bit overwhelmed by everything that's happened and Steve has his sister's DUI to contend with."
"And early this morning he learned that Catherine was in critical condition in a Saudi Arabian hospital. Yeah, guess that does add weight in the balance," Danny admitted. "God I hope he was not having a stroke."
A nurse walked over to the threesome. "Detective Williams?"
Danny sprung to his feet. "That's me."
"Would you come with me, please?"
He looked at both Chin and Kono, not sure if he should go alone. "Go on, Danny," Kono encouraged. "We'll wait for you here."
With a lump in his throat and a racing heart, Danny followed the green-scrub-clad woman to the ICU.
"How's Commander McGarrett?"
"The doctor will tell you," she answered with a professional smile as she led him to an outer room where Doctor Prentiss was studying Steve's CT scan on a X-Ray film holder.
"Doctor Prentiss?" she waited for him to acknowledge her before turning to Danny. "This is Commander McGarrett's medical proxy, Detective Daniel Williams."
"Detective Williams," he greeted. He extended his arm to shake Danny's hand. "I'm Doctor James Prentiss." He dismissed the nurse while Danny walked over to the glass window behind which Steve was resting in bed in a semi-sitting position. "How is he?"
"Right now he's resting. We gave him some morphine to alleviate the pain."
"What's wrong with him?" Danny asked fearfully. He held his breath bracing for the answer that he suspected would not be uplifting.
"There it is." The doctor pointed to a dark dot on the X-ray.
Danny walked up to the film holder and squinted. "What is it?"
"It's a brain aneurysm."
"It's huge," Danny remarked qualmishly.
"It's nearly the size of a golf ball and it's pressing down on his left optic nerve over here," he explained with the tip of his pen.
"That would explain why he complained of blurry vision."
"One of the symptoms of an unruptured aneurysm is recurring headaches with a pain usually located behind one eye in particular where the aneurysm is."
"Yeah, he's had throbbing headaches in the past few days and always seemed to favor his left side when massaging his scalp," Danny stated.
"What were the other symptoms he exhibited?"
"To my knowledge it was mostly headaches, some more severe than others. He said they came and went, no big deal and to be honest, we didn't put much stock in it until recently when they worsened. I grew a bit concerned but he kept saying that it would pass. But then I suspected something was definitely wrong when he started retching his guts out."
"He vomited?" The doctor sounded alarmed.
"Yeah, once he threw up his breakfast and a couple of minutes later when that excruciating headache hit, he dry heaved. God, why didn't I see this coming?" Danny ran his hands through his hair, upbraiding himself for failing to notice the signs.
"Unfortunately most people confuse the symptoms with tension headaches or migraines. In Commander McGarrett's case he was experiencing what's called sentinel headaches. That along with the vomiting, blurry vision, unequal pupils and a numbness in the face are strong warning signs that an aneurysm is leaking and is about to burst. Right now we are titrating his blood pressure, meaning we are controlling it to reduce the risk of a rupture."
"He would also draw sudden memory blanks."
"Transient global amnesia. It's a sudden, temporary episode of memory loss that can occur before an epilepsy attack or stroke or in this case, an aneurysm.
"I've scheduled an MRA , that's a magnetic resonance angiogram, to see what exactly we're dealing with but in all likelihood we'll need to operate to fix the problem before it's too late to reverse the damage, especially if there's a leak, which from the symptoms you've described is a high probability. The blood will collect into the space around the brain and create a subarachnoid hemorrhage or worse, a hemorrhagic stroke that can lead to serious brain damage and even death.
"If he'd come to us sooner when he first exhibited the symptoms, we might have been able to treat it with drugs but now, surgery is the option I recommend to save his life. Unfortunately he doesn't want to consent to it."
"What? Why not?"
"Says he has his reasons."
"Which are?"
"I was hoping you could tell me."
"What is the procedure?"
"There are two, one being a bypass. We take a vein from the leg to build a detour around the aneurysm. The second option is called microvascular decompression, which is the insertion of a small clip at the base of the aneurysm to cut off its blood flow."
"Both of which requires that you crack open his skull."
"To put it midly, yes."
"That may be what he's afraid of." Danny assumed from Steve's refusal to go under the knife. "Is there any way we can avoid surgery?"
"We could wait and treat the aneurysm with medications, but he'll need to curtail his activities and avoid strenuous work and stress at all cost."
"That might be a bit difficult seeing how he's a former Navy SEAL who still keeps up his training. Plus which the work we do at Five-0 isn't a desk job. I hardly see him lounge around the house all day. He has too much energy for that."
"Another alternative would be to insert a catheter called a Pipeline stent into the artery in the leg, and navigate through the blood vessels up into the brain. Once in place, the stent expands against the walls of the artery and across the aneurysm, cutting off blood flow. The blood remaining in the blocked-off aneurysm forms a clot which reduces the chance for it to grow or rupture. However I wouldn't recommend it in his condition. The aneurysm's too big and possibly leaking."
"Look, can we get a second opinion before he makes a final decision?" Danny asked.
"Of course. I wouldn't have it any other way. I will bring two neurosurgeons in to consult on this case."
"Okay thanks. And if you and your colleagues unanimously agree that surgery's the only way to go, then I'll try to get him to consent."
"Fair enough."
"Can I go in and see him?"
"Yes, but try not to tire him. He needs his rest."
"I won't. Thank you Doctor Prentiss."
Danny made his way to the other room where his partner was resting with his eyes closed. He walked up to the bed with light steps to avoid waking the patient. He stood over him, cringing at the drawn features that stared back at him, evidence of the hardships and pain he's been through in the past few days.
Slowly the eyelids pried open behind which two bleary eyes peered at him. "Hey babe." Danny strained a smile.
"Danny," Steve croaked out and blinked heavily.
"You okay there? How's your head?" Danny asked with a caring hand on Steve's shoulder.
"It's a little sore but the heavy pounding has stopped," Steve mumbled out tiredly against a thick tongue.
"They have you on morphine to ease the pain."
"Did you speak to the doctor?" Steve asked with his eyelids drooping.
"Yeah. He told me everything. He also said that you're refusing surgery."
"That's right."
"You do realize that if this aneurysm bursts, you will die?"
"There are other ways around it."
"Sure, like living a plain staid life at home, desk-bound at work. You can kiss your military career and Five-0 field work goodbye" Danny's sarcasm was bordering on cynicism. "Why don't you want the surgery?"
"I just don't."
"Don't give me that stubborn hogwash. Talk to me, Steven."
Steve took a moment to steel himself but his quivering bottom lip was a dead giveaway of how frightened he was by the idea of surgery. "I'm scared, Danno. There are a very few things that terrify me and this is one of them."
"Hey, I know it's open brain surgery and the mere thought is enough to send you into a frenzy, but if this is the only way to save your life-"
"Danno you don't understand. I've had two Navy buddies of mine going in for the same operation and they never made it. They died on the table from bleeding out."
"There is a non surgical procedure. Did the doctor tell you about it?"
"Yeah, but he's not recommending it on account of the size of this thing. He says if it bursts once they're up there, they'll need to go in and stop the bleeding."
"It's a possibility but then again it might work and you'll be rid of this thing, whereas now it's a looming threat on your life." There was an uncomfortable pause. "Look, we'll wait for the results of your angiogram before you make a decision and -"
"My mind's made up. I'm not having the surgery," Steve cut in with a decisive edge.
"But Steve, if the aneurysm is already leaking blood into your brain you may not have a choice."
"Danny please - leave me alone." Steve averted his gaze from Danny and closed his eyes in despair.
"Steve listen -"
"Please Danny - go."
Danny heaved out a heavy sigh and patted Steve's shoulder before leaving the room. He felt a sickening helplessness invade him at the prospect of failing to sway his partner, his friend, his brother to make a sound choice that would ultimately save his life. He feared that the angiogram would confirm that surgery was imperative for having seen him nearly stroking out in the car. But what if Steve still doggedly refused to go under the knife? Would he be able to convince him otherwise?