CHAPTER 24

Laura closed her eyes long enough to tighten her grip on Fenton's fingers and drape her free hand over his forearm. "Of course we want to talk about Frank."

"Mrs. Hardy, I want to answer all the questions you and your husband may have, but you must understand that your son is very ill. Some of the information I give you now is supposition and will turn out to be wrong in the next few days. Why don't we start with the facts and then go to the possibilities?"

Seeing a tight nod from the parents in front of him, Dr. Sianturi took a deep breath to continue. "Frank has four broken ribs on the right and two on left. Only the ones on the left are displaced and fortunately none of them punctured a lung. His right clavicle is broken. He also has pneumonia on the right, probably from being unable to draw a deep breath. He was having a lot of trouble breathing and the flight crew intubated him before he got to the hospital.

He has welts and bruises over his torso and thighs that appear to be from a bamboo cane. Most of them are superficial, but several broke the skin and are somewhat infected. In the greater scheme of things, I think these are a more minor issue.

The right arm is a major issue. He has an open humerus fracture that has been field set, but it was through the skin at some point and the shoulder has been recently dislocated based on the bruising pattern. The wrist was still dislocated when he arrived, and I've reduced that." The doctor paused, wondering exactly how to continue, but Fenton beat him to it.

"Biff said a village girl did something to his arm?"

"Yes." Sianturi swept a hand over his face. Having the procedure done in a village certainly explained the mangled appearance. "Sometimes with a severe injury the muscles begin to swell inside the fibrous tissue that covers them. It compresses the nerves and blood vessels and unless that pressure is released, the results can be dire. Even though this was field surgery done under poor conditions, it was right thing to do."

Biff had mentioned that Joe had to make that decision, so Laura thought she understood what he meant by dire. The thought slipped aloud. "Dire as in losing the arm?" She tried hard not to imagine how that decision felt for her younger son.

The doctor inclined his head fractionally. "Dire as in dying."

He'd said it. Fenton and Laura had known for hours that this was going to be a discussion about Frank dying, but as long as the doctor had danced around the term they could pretend to ignore that. Now the word hung out there, obscene, suspended for a moment before slamming home like a dagger.

Laura never made a sound, but Dr. Sianturi was well aware of the impact he'd had. As much as he wanted to be hopeful for this family, it wasn't fair to them to sugar coat anything. It would only make it that much harder when the boy died. He mentally corrected himself, there was still a small possibility that Frank Hardy's death remained in the realm of if. It just wasn't a very good one. He handed her a box of tissues from the table in the corner without mentioning the glistening in her eyes.

"Ready?" He waited until both parents looked at him again. "The arm itself is potentially fixable with surgery, but that isn't what concerns me now. I told you there were facts to deal with and then speculation and I think we're heading into the uncertainties. Frank's blood pressure is dangerously low and as I said, he's intubated in order to breathe. He also has a fever and we're suctioning blood out of his lungs. Taken collectively, those symptoms suggest two diagnoses to me."

Fenton's frown deepened as the doctor placed a hand on Laura's elbow, not out of any misplaced sense of jealousy, but due to the implication. If this relative stranger felt the need to offer comfort, then there was little hope.

"Either the arm fracture led to a blood clot that moved to his lungs, an embolism, and that's the source of his respiratory failure; or the pneumonia or infection from the arm has progressed into the sepsis we were talking about. Sepsis can produce clotting and bleeding problems on its own, but it's one of the later complications usually."

"But you said that low blood pressure was the hallmark of sepsis." Fenton forced his mind to stay with the medic's dissertation rather than the condition of his son.

"It is, but it could go with the clot, too. Right now, I'm treating him for both until we're sure. The pulmonary embolism is probably the better scenario at present." He didn't include that any time you could conclude that a pulmonary embolism was the lesser of two evils, you were so far up the creek there was no point in even looking for a paddle.

"How do find out which it is?" Laura's voiced seemed thin, less substantial than an hour ago.

"I've sent lab tests that will help with that, but the better way would be a CT scan to see if there are clots in his lung or not. Unfortunately, he's is too unstable to go downstairs for the test."

Fenton ground his teeth together, wishing the barrier would keep his question at bay, both needing and dreading an answer. Eventually the attempt at delay failed. "You expect our son to die, don't you?"

Sianturi huffed out a breath, vaguely ruffling his own hair. "Yes." They deserved an honest assessment. "His injuries are extensive, even if he'd had prompt treatment and avoided complications. As it is, the survival rate is very low."

"No. You don't know Frank. He'll make it through this." Laura's crying was more evident now, but remained soundless.

A weak smile crossed the doctor's face. If anything could help his patient, a determined family would be a must. "Perhaps. Two other physicians have seen your son since he arrived and I have to tell you they both recommended keeping him comfortable and letting him go. I can only give you a realistic opinion of the situation, but what I can give Frank is twenty-four hours. I don't like his chances, but he's young and he deserves twenty four hours of full treatment to prove us wrong."

"And this time tomorrow?" Fenton squared his shoulders to the extent sitting in a wheelchair allowed, direct gaze boring into the man before him.

"If Frank survives until this time tomorrow, we'll speak again. If he's made any improvement, we continue to treat. If not, we should consider withdrawing the ventilator." His hand left Laura's arm after a faint squeeze. "I'm sorry the news isn't better."

Laura dropped her forehead to Fenton's shoulder, blonde locks shielding her face. "Can we see him?"

"Frank? Not yet. If you'll wait here a nurse will come and take you to see Joe."

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The faintly grey ceiling tiles marked off regimented squares over his head, the pattern clarifying his dulled vision. Once the corners stopped wavering about he allowed his eyes to roam a bit more. The last thing he could clearly recall was the baying of hounds. Obviously something had changed after that.

The bed beneath him was reasonably comfortable and the walls seemed to be coated in a blue flecked paper. Not menacing and not what he expected. Something tickled at his nose and he attempted to raise a hand to swat at it, but pulled up short. Neither arm would move. The alarm bells he'd just suppressed chimed again at full volume. He could feel someone beside him, just out of his line of sight. Forcing himself to calm down enough to listen to the tiny sounds, he realized whoever it was, they were asleep. Hearing the soft even breaths he came to another conclusion. They were also blessedly familiar.

"Mom?"

He heard a stirring and craned his neck as far as he could, spotting a slim ankle. "Mom?"

The reclining chair beside the bed snapped upright, bringing her tired face into view. "Joe? You awake baby?" Her fingers moved to the edge of his hair, sweeping a few strands aside.

Joe wasn't sure whether to smile or groan. It had been longer than he could remember since she'd called him baby. "Yeah, Mom." He nodded his chin toward his restrained wrists, confusion and a little betrayal on his face. "I'm stuck."

"Oh, Joe honey, I'm sorry." Laura pressed the call button, summoning the nurse. "The doctor said those could come off as soon as you were alert."

"Is Frank here? Dad?" Joe didn't miss the fear that crossed her face at Frank's name in spite of her nod.

A petite nurse entered the room, smiling warmly at Joe and forestalling any further conversation. "Hi there. Ready to get out of these?" She began to unwrap the padded cotton strap encircling his wrist before he answered.

"Definitely. Why?"

"You were a little rowdy the first time you started to come around. We couldn't get you to leave the IV alone; seemed to think someone was trying to drug you." She freed his other hand and watched as he rubbed his wrist, then fingered the oxygen tubing beneath his nose.

"Someone did drug me." The memories of the cave were hazy, but that he recalled. He hadn't expected to wake up. He plucked again at the tubing. "Do I need this?"

"Probably not, but leave it on until the doctor checks you over again, ok?" She recorded his blood pressure and temperature, a second smile reassuring his mother. "I'll let you two talk."

Laura rose to stand beside the bed, permitting herself a better view of her younger child. The blacked eyes were fading, but a tiny bump remained in his nose. "Your dad's here; he's fine. He's up in the ICU waiting room. Biff's there, too." She paused, sitting lightly on the edge of the mattress. Sadly her son was too perceptive to be lied to. "Frank's really sick, Joe. Dr. Sianturi thinks he might, might…"

"He won't, Mom. Frank's not dying, not now."

She shook her head, wishing she could have the youthful innocence that allowed her son to believe that. Then a wave of sadness and resignation replaced that absurd thought. Youthful her sons were, but after the last two weeks, any innocence that might have eked out an existence in their hearts was surely gone.

"I pray you're right, honey, I pray you're right." Laura dipped her head, hand clasping his, struggling to regain her composure. It was her job to be steady for him, not the other way around. It worked briefly, then the waterworks she'd been fighting for days trickled again.

"You ok?" Joe found the button to raise the head of the bed.

Laura fought down her sniffles, an out of place nervous chuckle slipping through. "Shouldn't I ask you that?"

"Yeah, but why stick with the script?" He started to say it wasn't important, that she didn't need anything else to worry about. "I'm fine."

"I need an honest answer, Joe." She'd been in his room fourteen hours, the first half of which had consisted of his feverish thrashing and mumbling. 'Fine' wasn't the word that had come to the forefront.

"I really am fine." He stopped for a quick mental inventory. "My foot hurts a little, I'm a little achy, a little dizzy, and I could go for some water. That's about it. So, how long am I marooned here?"

She handed him the water with a shrug. "Why don't we at least get through the first day before you start campaigning to get out?"

He filed the suggestion in the mental round file and changed the subject. "What does the doctor say about Frank?"

"Why don't we talk about you instead?" Sianturi entered the room, conjuring up a stilted smile for the younger Hardy. "I heard you were back among us."

Joe snorted. "You mean the nurse ratted me out."

"Something like that." He turned to Laura. "Mrs. Hardy, do you mind giving me some privacy with Joe? Mr. Hardy's waiting for you upstairs so you can see Frank together."

"Any chance of me going?" Joe started to climb out of bed, but four hands guided him back to the mattress when he swayed sideways.

"Hey, take it easy. You're sick too, you know." Laura tousled his hair, her frayed nerves one strand thinner at the near fall.

Joe clamped his eyes shut against the vertigo, waging a battle with his stomach. It was a near thing, but eventually he decided he'd won. The voice that emerged was much subdued. "I'm guessing that's a no, then."

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Fenton sat in the doorway to Frank's room, staring. He'd thought he was prepared to see his son, but there was no way to be ready for this. A dozen plastic bags of liquid festooned two metal stands behind the bed like a macabre Christmas tree, the trailing tubes snaking their way into a large bore IV that seemed to tunnel below his collar bone. Banked monitor screens winked an ever changing series of numbers, the meanings evasive. Plastic invaded his child's throat, the corrugated piping attached to a ventilator at his side. A smaller tube from his nose made its way to a canister on the wall half full of what looked alarmingly like blood.

He jumped slightly when small hands lit upon on his shoulders, then tipped his head back to acknowledge his wife, covering her wrists with his hands. She took her own moment to absorb the contents of the room before pushing the wheelchair to the bed.

Laura traced her fingertips along her son's face, finally brushing a kiss on his forehead. "Frank? It's Mom, honey. Dad's here, too. You're going to be fine, baby, okay? It's safe here and everything's going to be fine. We'll be right here; all you have to do is get better. Joe's downstairs. He wants to come up, but that might take a few days. He's doing well, though, don't worry about that. Biff's got the lobby staked out; everyone's waiting for you. I love you, Frank; you're going to be okay.

Joe said you'd been awake off and on since he found you, but not here, huh? Can't blame you for that, hospitals just aren't all that interesting. I'd love to see those big brown eyes though. No? Okay, I can wait. Not too long. You always had the biggest eyes as a kid. Fenton joked it was because you were too curious to risk missing anything. I had to stop pointing them out to people when you were about six; it started embarrassing the dickens out of you. They saw them anyway. If it embarrasses you now, you can always wake up and tell me to knock it off. I would, at least when you're around to hear me."

Fenton spotted Dr. Sianturi at the doorway, beckoning him into the hall. He wheeled himself out, leaving Laura talking to their eldest. It was the voice she'd read storybooks in years ago, the one every mother reserved for cuddling her child. One she hadn't used for Frank in a decade and a half.

"Do you think he hears her?" Fenton spoke to the doctor as soon as they returned to the waiting area.

"No one really knows the answer to that question, but she should keep talking. It will help her, whether Frank hears it or not." The medic sat, grateful this half of the waiting room was vacant. "I just came from Joe's room. The delirium appears to have been a transient issue, he'll be fine. I cleaned his foot up a little more and I'll probably need to do that the day after tomorrow as well, but it actually looks better than I expected. He's lightheaded, so I want him in bed today, but he can try some crutches tomorrow if he feels up to it."

"Thanks. Helps to have one of them on solid ground. What about Frank?"

"I've been going through his test results and I'm convinced this is sepsis at this point. It's kind of a bleak picture, I'm afraid. He's developing something called DIC; it can be part of the sepsis syndrome. The body makes tiny blood clots throughout the system and eventually uses up all the clotting factors and cells. When that happens, then there's nothing in the bloodstream to use to stop normal bleeding, like the bleeding from a blood test puncture or scratch, and sooner or later hemorrhages start." Of all things to try to make comprehensible to a nonmedical family, disseminated intravascular coagulation as a complication of sepsis or muscle injury, or in this case both, had to top his least favorite list. The fact that he could hear his medical school professor's voice from twenty years ago announcing that the letters ought to stand for death is coming didn't help matters any. Same guy joked that the only place you found DIC was at autopsy. A regular Mr. Sunshine. Fortunately, Sianturi had a few modern treatment options that gloomy-gus hadn't.

Fenton raised his eyebrows as a piece of paper landed in his lap. "What's this?"

"It's a consent form. I want…"

Fenton interrupted the sentence. "I respect your view, but Laura and I talked about this all night. We're not ready to consider withdrawing treatment."

"Actually, Mr. Hardy, neither am I. Frank's status is alarming, but there's something I'd like to try. There's no direct cure for DIC, the management is to treat whatever caused it in the first place. In Frank's case, that's the infection and sepsis. There's a drug called xigris that might help."

The detective skimmed the paper on his knees, uneasy about a medication that required a signed form. "I take it there's a downside to this medicine?"

"A substantial one. Xigris can actually cause hemorrhages, sometimes ones that can't be stopped. Since bleeding is also part of the DIC itself, it's a calculated risk to use it. The open injuries in the arm will almost certainly be a problem. The drug isn't recommended in patients with an open site."

"So this may make Frank bleed to death?" Fenton needed to be certain what he was agreeing to.

"Yes. Unfortunately, I don't see another option. He's showing early signs of kidney failure and I've already got him on all the medication and IV fluid I can to raise his blood pressure plus a wide range of antibiotics. In spite of that, he's getting worse. Only the lung function has shown any improvement, and that's the reason we're having this conversation. With even that minimal change, I want to try. Xigris is a miracle drug when it works. It can be a disaster when it doesn't."

"Does he have any chance without it?" Fenton couldn't quite look up from the crisp form clasped in his fingers.

The doctor felt a dam of explanation about acidosis, metabolic encephalopathy, thrombocytopenia, hemolysis and circulatory collapse about to burst in his chest. He choked it all back down, another long diatribe wouldn't help the frightened father in front of him. "Realistically, no."

"Then we try." Fenton accepted the offered pen and signed the line at the bottom.

The next twenty four hours were horrible, the flurry of traffic swirling around Frank's room resulting in his parents being banned for hours at a time. The nurses came with the first of a series of consents to sign for blood transfusions about six hours into the process, grim expressions doing nothing to reassure them. Fenton and Laura alternated sitting in the waiting area and visiting with Joe, deflecting his increasingly urgent demands to see his brother as best they could.

Dr Sianturi summoned them both to the conference room late the next afternoon, arriving after they did. As always, his expression could have been carved in stone, no information to be gleaned in the shadowed eyes.

Fenton leaned forward, cursing the wheelchair that had become his constant companion. He'd adjusted to the doctor's long winded style, deciding the man utilized the familiar jargon of his field to distance himself from uncomfortable information he didn't really want to relay. He fully expected another introduction to critical care medicine lecture would ensue before he could find out anything about his son.

Instead the physician planted his palms on the table, his face nearly as haggard as the Hardys' as he scrutinized his knuckles. He uttered only one sentence before raising his eyes to meet theirs. "I think… it may be working."

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Three days later, Frank looked about the same. The ventilator support had been reduced by almost half once the xigris was completed, and although he remained on all the same medications, the dosages weren't as high. While Laura continued to express alarm that her son's appearance wasn't any better, Sianturi was thrilled. Lost in his world of graphed laboratory trends and mean arterial pressure mapping, he saw a world of difference in the boy. The question now was how much of the young man that existed a month ago was still in there. His body was healing. His mind, that remained to be seen.

Half way through a very detailed explanation on what those numbers all indicated he abruptly stopped, gazing at the woman seated across the table, fingers as always maintaining contact with her spouse. It had been a long time since anyone had offered that sort of wordless support in his life and it reminded him there was more here than a set of graphs. "Does all of this mean anything to you?"

Fenton fielded the question with a wry smile, oddly liking the egg head oriented doctor. "More than it did last week, but it's still medical-ese to an extent. Maybe your gut reaction to how Frank is doing would be better."

Sianturi nodded. "I can do that. When your son got here, I was almost certain he would die. Now I'm almost certain he won't."

Another day passed before the door to Joe's room flung wide open, light feminine footsteps hurrying in. Fenton slammed his cell phone shut and pocketed it in a single motion, not really caring how Elias felt about being hung up on, while motioning to Joe to shovel a stack of pictures below his blanket. Getting into hot water with Laura for working with Dahl he could handle. Getting into hot water for involving Joe was a whole other ballgame.

As it turned out, the footsteps belonged to the dayshift nurse, not his wife. "Joe upstairs."

Joe's head spun to face her, the breathless note in her voice unmistakable. Surely if something was wrong she would have asked for his dad? "I've been trying to go upstairs for days, no one would let me." He stood on one leg, opposite toes barely tapping the floor, grabbing for the crutches he'd only been allowed to use within his own room.

"Frank's okay?" The query came from Fenton and Joe at the same time, but her limited English didn't permit an answer. Instead she produced a second wheelchair, pointing at Joe. "Ride. Faster."

"I'll ride in a bloody donkey wagon if it'll get me in to see my brother."

Fenton would have followed Joe into the room, but a rending sound blocked his path. Laura. Laura was sobbing. Not the muted tears that had made sporadic appearances throughout the week, much to her frustration. This was a hiccuppy affair interspersed with a strange little sound he couldn't place. He fought his way out of the mound of pillows and plopped into the chair beside her, pulling her tight into his chest while his hand stroked at her hair. Surely nothing else had gone wrong. His family had been through too much for the fates to be that cruel.

"D-don't know wh-why I'm… cry-ing now. I j-just… I… He's alright. He's final-ly g-going to be alright."

The sound made sense to him then. It was laughter.

Joe stood as soon as she parked him beside Frank's bed, immediately searching his sibling's face. For the first time in days, the brown eyes were open.

"Hey, bro. You still lazing around in bed?" Joe waited, fearful of the once again wandering blank gaze. "Can you hear me, Frank? 'Cause I have to tell you, we've done this whole waking up scene already. Next time you want to scare the crap out of me, rent some monster movies or buy us roller coaster tickets or something, ok? …Frank? …Please?"

The walk clock ticking was incredibly loud. Joe had time to work his way through the various hard objects in the room, weighing their relative merit as a means to smash it to smithereens before Frank's shoulder trembled under his palm.

"Frank?"

The noiseless stream of words mouthed around the tube in his brother's throat was incomprehensible except for one. "Joe."

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to be continued...