Hey everyone, here is the next chapter. A small argument with a red back spider (read relative of the black widow in America) has put my dominant arm out of action for a few days. But I am back and hopefully pumping out the good stuff! Anyway I hope you enjoy. Your reactions to this story so far have been amazing. To reassure… this is not a deathfic and any whompage of Tony will be resolved by the end!
*NCIS*NCIS*
Gibbs learned to like Ronnie. This short plainspoken woman, who recorded everything about Tony's progress on the giant desk, exuded a calm assertiveness that was very comforting to the former marine. In this windowless semi lit room time had no real meaning to the Lead Agent. It was only by the almost military precision of Ronnie's observations of Tony every thirty minutes that provided any sense of passage of time. On the quarter hour Ronnie would rise from her chair and take readings and plot the outcomes on Tony's chart. From the oxygen saturation in his blood, to its pressure; his heart rate; and general observations, nothing was overlooked.
Gibbs looked on as Ronnie performed the required tests to gauge Tony's reaction to outside stimuli.
"Tony, I want you to open your eyes." Ronnie asked, her voice gentle but commanding. When Tony failed to respond Ronnie placed her index fingers in the palms of his hands. "I want you to try and squeeze my fingers Tony." Gibbs watched his agent's hands silently commanding the younger man to curl his fingers. Still nothing. "That's okay Tony, next time… Can you try and wiggle your toes for me?" She reached down and carefully folded back the blanket and sheet of the bed, watching for any response. Gibbs heart sank as the pale white foot failed to react. "Perhaps you're the ticklish kind?" Ronnie mused taking her penlight out of her pocket and running the head of the device from the heel to the toes of Tony's exposed foot. Gibbs liked to think that he saw a minute spasm of muscles in Tony's calf, but he couldn't be sure.
Moving up to stand at the head of the bed opposite Gibbs, Ronnie looked down at her patient. "Okay Tony, this is the bit where you're not going to like me. I have to cause you a bit of pain." As she reached forward towards Tony's face, her penlight still in her grasp, Gibbs own hand flew out and grabbed her wrist.
"What do you mean, pain?" Gibbs asked, his eyes narrowing to dangerous slits.
Ronnie arched an eyebrow and looked pointedly at her wrist until Gibbs released it. "It's a standard response protocol we follow with comatose patients Agent Gibbs. It helps gauge what if any level of consciousness he has and helps bring him out of it. All I will be doing is applying pressure to the pressure point between his eyebrows and see if I get a response. Now are you going to let me do my job or are you going stand there and glower at me?"
Gibbs crossed his arms and stepped back, chastened by the nurse's response, but respectful of her conviction. It wasn't his place to stop her doing her job… it was just the idea of someone causing DiNozzo more pain than he was already in was unpalatable.
"Okay Tony, here we go… just let me know if this hurts." Ronnie leaned forward and placed the butt of the penlight firmly between the agent's eyebrows and the top of his nose.
As Ronnie started pushing and twisting the pen deeper into the spot, Gibbs had to internally stand himself down, as every instinct in him fought to end her actions.
It was clear she was hurting him at some level, but the response he gave wasn't great. Gibbs watched immobile as Tony managed to flicker his eyelids ever so slightly, hope bloomed in Gibbs chest at the reaction until it died again as Ronnie peeled back Tony's eye lids and shone the business end of the penlight straight into flat unseeing eyes. He didn't react or resist as the bright light played across his corneas.
Ronnie straightened up and pursed he lips. "Not the best response we could have got," she stated flatly before twitching the corner of her mouth, "But not the worst I've seen either." Lowering herself into the chair at the foot of the bed, Ronnie began annotating Tony's charts. "You gonna just stand all day there all day, or are you gonna be a normal person and pull up that chair… depending how stubborn your boy is, we could be here a while.
Gibbs snorted. "DiNozzo… stubborn… I should've bought my bivy with me." With a wry grin to Ronnie, Gibb slid the hospital issue padded armchair over next to the bed and sat down, carding his fingers through his silver hair.
Six sets of obs later showed no discernable improvement in DiNozzo's responses. Ronnie had been unable to get anything past a brief flicker in reaction to her grinding her penlight into his forehead. Gibbs thoughts had absently turned how Tony would be horrified at the divot beginning to form in his brow and that he didn't seem to remember being told if the doctors at Portsmouth had attempted to rouse him from his own coma two years before by similar tactics. Gibbs was so lost in thought that he didn't hear when he name was being called.
A warm gentle pressure on his shoulder had the former Marine jump. Looking back over his shoulder Gibbs was relived to see Dr Donald Mallard smiling down at him, a younger clean-cut young man in a doctors coat standing behind him.
"Duck!" Gibbs jumped to his feet.
"Jethro." The Scottish ME nodded. "How is the boy?"
"You tell me Duck?" Gibbs growled, unable to hide the frustration in his voice.
"Indeed. This is Dr Isaac Freidman. He is the head neurologist here at GW. He has been assigned Tony's case."
"Doc." Gibbs nodded studying the younger man. In his early forties, probably about DiNozzo's age his tousled sandy blonde hair seemingly giving him a teenaged quality, a look not helped by the fact the man only stood about five foot four in height. But size was not a determining factor in a person's skills. "What can you tell us?"
"A great number of things Agent Gibbs." Freidman nodded grimly. "Agent DiNozzo was brought in from the…"
"Actually Doc, can we do this someplace else?" Gibbs asked looking back towards Tony.
"Of course, we can go back to my rooms." Dr Freidman gestured out into the hall.
"If McGee and Ziva are still in that waiting room, I want them to hear too."
A glance passed between The neurologist and the ME. "aaah…welll…"
Ducky came to the specialists aid before Gibbs had the opportunity to open his mouth and say something foolish. "Isaac, Jethro is Agent DiNozzo's medical power of attorney and next of kin. He is also his team leader and head of a… rather inseparable group of individuals, of which I am a member. It is inevitable that what ever you tell Jethro will be passed on to them." The ME smiled. "Might I suggest that we just move into the waiting room and fill everyone in all at the same time?" He shot a faintly wicked grin in his friend's direction. "Quite frankly you'll be doing me a monumental favour as Gibbs doesn't do 'technical' very well and would have gotten me to repeat everything you said to him dear boy!"
Isaac remained judiciously silent, instead opting to gesture for the two older men to move out into the hallway. "Ronnie we'll be back shortly."
"Not going anywhere." The ICU nurse murmured as she continued watching over Tony.
When Ducky and Gibbs walked through the doors into the waiting area, the reaction was predictable yet surprising. Predictable by virtue of the fact that a cacophony of questions launched at them from several angles of the room; surprising because the number of voices asking had increased. When Gibbs had left to go and see DiNozzo, only McGee and Ziva had been left behind waiting in the room. A suddenly blur of sylphlike proportion in black streaked from the far side of the room and barrelled into Gibbs.
"He's not dead Gibbs! He's not dead!" Abby's arms snaked around Gibbs neck, her emphatic mantra being muffled as she repeated it over and over into the crook of his neck.
Hugging the overwrought scientist closer to him Gibbs murmured reassurances in her ear. "Abs, I've seen him… he's not dead."
Pulling back she looked at him, the anxiousness and worry clearly apparent in her moss green eyes. "Really?"
Gibbs ran a hand down the side of her head and cheek and smiled. How and when the young forensics expert had arrived at the hospital Gibbs couldn't tell, but he was glad to see her all the same.
"Abigail. Dr Freidman is here to fill us all in, how about we take a seat shall we?"
With Ducky guiding her on one side and her other arm wrapped securely around Gibbs upper arm, Abby let the two men direct her over to a couch where all three could sit.
Gibbs took the moment to look at his other two agents, the news that Tony wasn't 'dead' clearly a relief to Ziva and McGee.
"Timothy why don't you come and take my spot and sit down next to Abby? I would like to look at young Anthony's reports as Dr Freidman fills us in."
McGee blinked momentarily. "Um… sure Ducky," he replied, quickly replacing on the couch next to Abby.
Ziva lowered herself gracefully into an over stuffed armchair to Gibbs immediate right, her jaw firm, chin raised, dark eyes intently watching the neurologist.
With his audience settled Dr Freidman began.
"On their arrival, EMT's found Agent DiNozzo completely unconscious. Both EMT's commented that they were surprised that Tony was alive at all given the severity of the crash. They began to stabilise him and proceeded to administer best response procedures to assess his condition."
"GCS?" Ducky interrupted looking up from the report in his hand.
"Yes, Agent DiNozzo scored four." Freidman replied sombrely.
"Oh my." There was no mistaking the tone of Ducky's response.
"GCS Duck?" Gibbs prompted.
"Glasgow Coma Scale. It's a scale that aims to give reliable and objective recordings of a persons state of consciousness at a crash scene and in subsequent assessments." Ducky's eyes lit up as a remembered bit of medical information came to mind. "It was first published in 1974 by Sir Graham Teasdale and Professor Bryan Jennett from the University in Glasgow. Actually I had a rather interesting interaction with Sir Graham back in…"
"DUCKY!" The outburst from Ziva, Abby and McGee, pulled the ME up short.
"Oh… my apologies."
"Is four good Doc?" Gibbs asked directing his question to the neurologist.
Freidman fixed the Lead Agent with a solemn gaze. "GCS works like this Agent Gibbs, it's composed of three parameters, best eye response, best verbal response, best motor response. A coma score of thirteen or higher is indicative of a mild brain injury, nine to twelve is considered moderate, and eight or less in considered severe."
The silence in the room was all pervading.
Beside him, Gibbs could feel Abby begin to tremble. "What's the lowest score you can get?" He asked his cool blue eyes boring into the young Doctor.
To his credit, the Neurologist held his ground. "Three." Allowing the team a moment to assess what he had just informed them, Isaac took the opportunity to collect a small cup of water and handed it to the now shaking Abby before continuing. "EMT's advised that he did regain consciousness while they were trying to get him out of the car, in fact it appears that Agent DiNozzo was quite animated. He kept complaining that he had to get back to the Yard."
"So he is going to be okay then? He was talking right?" McGee asked hopefully, squeezing Abby's hand between his in hope.
"It's not that easy Agent…?"
"McGee."
"…Agent McGee. Injuries of this magnitude are oddly predictable. When the impact happens initially the brain doesn't recognise that there is anything wrong. To all intents and purposes the patient seems to be acting on a normal cognitive level. It's when the brain starts swelling that problems develop." Isaac consulted his notes. "It appears that Agent DiNozzo started to become aggressive in the back of the wagon and required a second unit to be called in to assist in sedating him."
"Tony's NOT aggressive!" Abby cried. "He's the sweetest guy around. How dare you say that!"
"I'm not implying that he is. Agent DiNozzo's…"
"TONY!" Abby yelled shaking off McGee's now restraining hand.
"Okay… Tony." Isaac placated. "Tony's brain had started to swell by the time the EMT's got him out of the wreck. It's normal for people to become disorientated and aggressive under those circumstances. As I was saying, the EMT's administered a sedative that was upgraded to full anaesthesia when he was brought here. We turned the anaesthetic off as soon within an hour of him being admitted, but by that stage the brain injury had taken effect."
"What's the prognosis Isaac?" Ducky asked.
"Uncertain. There is no clear boundary between the conscious and unconscious. MRI's show that his brain is haemorrhaging, has suffered bruising and some bleeding…" the neurologist turned his focus and addressed Gibbs. "That's what's causing the lump you saw on Tony's forehead. Most of the damage we have assessed so far has been to his right frontal lobe."
"What could this mean to Tony?" Ziva asked intently concern for her partner clearly apparent in her mannerisms and posture.
"The frontal lobe is the part of the brain that deals with things like the ability to judge distances, decision-making and problem-solving." Ducky replied solemnly.
Ziva tilted her head slightly to one side. "You mean everything that Tony requires to do his job." It was not a question.
"Precisely." Ducky answered flatly.
"In addition to the quantifiable injuries Tony has sustained we also need to consider the ones that aren't so cut and dry the injuries that the CT scans won't pick up that might affect him. The impact of the accident has damaged the nerve cells in his brain. It caused some of them to over stretch and break. This type of trauma can be extremely debilitating."
"Worst case scenario Doc?" Gibbs asked, a small hard knot forming in the pit of his gut.
Dr Freidman shrugged. "Damage can range from things like paralysis, blindness or deafness in varying degrees on the physical side, to depression, anger or seizures. It's not uncommon for people to recover but never be the person they were before. Some people come through but don't recognise their loved ones, or they decide to completely change their whole lives. I've seen people walk away from family and friends their whole personality changed forever"
Isaac paused as the gravity of his words began to sink into the closely knit group. He watched as dispassionately as he could as the news affected each member in its own way. "We simply don't know. The next forty-eight hours are going to be critical. I'm afraid it's now a watch and wait to see how he recovers… and what permanent damage, if any, there might be."