At nine am the following morning Candy was slouched in her chair next to Gil's bed, having been kept awake for a second night running by nightmares and a pining Socks. She had arrived half an hour ago to learn Sara had been taken down to surgery at eight o'clock, and Gil had slept through the night with no complications.
She closed her eyes and shifted uncomfortably; idly wondering if the hospital was trying to drum up business by providing visitors with chairs that were so uncomfortable they were liable to cause permanent damage. Unable to doze off, she let her mind wander freely as she tried to relax until movement made her stir.
"What time is it?" groaned Gil as he shifted slightly in the bed, his eyes firmly screwed shut.
"A little after nine," yawned Candy, sliding upright as a spark of hope rolled through her veins.
"I'm not going to work today," Gil mumbled thickly. "I think I've been used as the ball in an elephant soccer match." A small smile twitched across her lips at his phrasing.
"You don't have work today," she promised him, moving to stand by the bed. "It's still summer vacation, but you're not at home Griss, you're at Dartmouth-Hitchcock Medical Center."
His eyes inched open slowly, protesting fiercely at the assault of the needling stabs of morning light on his senses.
"Candy?" he asked, confused. She nodded soothingly. "What day is it?" he frowned, trying to compute the evidence around him but struggling with pain, fatigue and confusion.
"Sunday morning" replied Candy softly. "You've been here since Friday." He was quiet for a few moments thinking.
"Sara's birthday," he said finally, a faraway look in his eyes. Candy nodded in agreement as his gaze moved over to her. "What happened?" he asked, gasping in pain as he tried to move and abruptly changed his mind. Candy waited for him to settle again, trying not to look at the expression of twisted apprehension and fear on his face.
"You were hit by a drunk driver on the way to Animal Ark," she said, truthfully, forcing herself to look him in the eye.
"Sara," he gasped, his hand clenching in the blankets despite the intense cramping of his muscles at the movement.
"She's here," soothed Candy, resting her hand gently over his. "She's improving too."
"Where?" he twisted his neck, ignoring the increased banging in his skull as he looked around frantically.
"She's in surgery at the moment." When he twisted his gaze back to her with such rapidity she feared he would do himself more damage, she held up a free hand in a gesture for him to relax. "It's ok," she assured him gently. "She's stable, but her leg has a complex break so she's with an orthopedic surgeon right now. Doctor Andrea Thistle, the same woman who fixed you up. She will come and talk with us when she's finished helping Sara, ok?" she fixed her gaze firmly on his and held it there. He blinked a few times as he struggled to reign in his floundering senses; his mind racing painfully as he tried to grip his fear and get his pounding head to organize the sudden information overload. Watching him try and relax it occurred to Candy that he was probably in need more pain medication. Mentally berating herself for not doing it earlier, she pressed the call button for a nurse.
"What can you tell me about my wife?" demanded Gil, as soon as Nurse Joan walked in. He seemed to have recovered a little strength and coordination, and was unsuccessfully trying to push himself into a sitting position. Soothingly, Candy and Joan moved him carefully until he was partially sitting. Joan offered him some water but he glared at her and refused to take a sip until she started speaking.
"Very little I'm afraid," she told him. "I haven't treated her, or seen her notes but Doctor Fielding asked me to page him when you woke up so he can come up and talk to you." Gil stared pointedly at her, ignoring the straw she was waving under his nose. Suppressing a smile, Candy winked and the nurse and took the cup from her hands, supporting it while Gil sipped slowly. Joan walked out, scribbling notations on his chart as she went.
Gil groaned and leaned back into his pillows, resting his head.
"I don't remember anything," he said to Candy, his voice having taken on more of its normal tones with the cleansing sips of water. "I made breakfast for Sara, and then nothing." Candy sighed and put the cup down on the table beside the bed. She sank carefully onto the mattress edge and linked her fingers in her lap.
"It was the corner of Main Street and Church Road. Eyewitnesses said you moved when the light changed green and a red van approached at speed. It hit the driver's side of Sara's car, spun it around and impacted the passenger front corner. The van hit the church yard wall and knocked down a huge chunk, crushing an elderly man on the other side. Your car wrapped around a lamp pole." Candy watched the little color in his face drain from his features as she spoke.
"Which side?"
"Sara's side."
"The driver?"
"He's fine. He got out of the van and went to sleep in the roses."
"Does Sara know?" he asked, his voice and eyes full of disgust.
"No," Candy hesitated, not sure she wanted to tell him anymore until there was a doctor to give him all the facts. She knew Gil well enough now to know that he would question everything to the nth degree, just like his wife. It was the expression in his eyes that made her give in. "She's in an induced coma," she admitted. The alarm and terror that swamped him was palpable, pressing on Candy and making her feel sick.
"She lost too much blood," she said, struggling to find the right place to begin and the way to tell it. She was saved by the arrival of Doctor Fielding.
"I was on my way back downstairs and wanted to check in on you," he explained to Gil, after introducing himself.
"Thank you," replied Gil, "what can you tell me about my wife?"
"She was rushed into my trauma room almost as soon as she arrived. She was hemorrhaging severely and contracting." Candy thought Gil was going to be sick as realization that the baby would have been affected dawned on him. In his hazy state, it hadn't occurred to him that their little girl could be harmed. He heaved a wheezy breath and Joan reached to resettle his nasal cannula, altering the oxygen flow and then administering another dose of pain medication to help him relax a little.
"Baby," he gasped.
"I delivered your daughter and she was transferred to the neonatal intensive care unit immediately. She is now stable, but there are issues that the attending specialist will talk to you about soon." Gil lifted his good hand shakily to his face, pressing his palm over his eyes in an effort to hold himself together. Jacob continued,
"Sara had a uterine rupture that could not be repaired; I had no choice but to remove the uterus. I'm sorry," he apologized, his eyes showing his regret that he had needed to resort to such drastic measures. "We tried, but she had internal bleeding from the spleen as well and she arrested twice." Gil forced himself to pull in a breath that sat in his lungs like lead; he nodded his understanding at the doctor and gripped the blankets to try and maintain his compose and sense of reality.
"The hysterectomy and spleen repairs were successful," said Jacob, his tone encouraging. "Because of the blood loss, and the shock to her system it was really too dangerous to fix her other injuries then, so we put her in an induced coma to let her body rest while her blood pressure, ph. levels and body temperature leveled out again. She responded well, and so Doctor Thistle took her down for surgery on her broken leg earlier this morning. She'll come and speak to you later, not just about your wife, but about your injuries as well."
"What else can you tell me?" asked Gil. Jacob sighed and ran a hand through his hair.
"Sara has a linear skull fracture and a serious concussion, not unlike yourself. We've been monitoring her for any sign of bleeding in the brain, but there has been nothing so far, and I expect the fracture to heal fully. She also has a penetrating wound to the left shoulder caused by a large shard of glass; there may be some initial impairment as the tissues heal, but physiotherapy will fix that. My concerns at the moment are the reconstruction of her leg, which, as I said, Doctor Thistle will guide you through, and recovery from the combination of blood loss, internal damage, hypothermia, and hysterectomy. I won't lie to you Doctor Grissom, her condition is serious, but so far she has been doing as well as can be expected."
Gil asked a few question, clarifying points, and obtaining treatment details. As they talked, Jacob walked him through the standard post head trauma checks and went over his injuries, satisfying himself that Gil was healing as he should be, despite the fact that Gil was no longer directly under his care.
"Your lungs have improved," he told his patient, "But you'll have difficulty breathing for some time while your ribs heal."
"I want to see my daughter," said Gil, his voice raw and his lungs sore with the effort of so much talking.
"You need to rest," said Joan firmly, tucking in his blankets securely. Candy winced at her tone, and looked at Jacob as Joan launched into a lecture on recovery. The doctor winked slightly at her, and backed out of the room quietly. Candy spent a tense five minutes trying to mediate between the adamant nurse and the increasingly irate patient. When Jacob reappeared five minutes later with Doctor Ian MacAndrew, the teenager unconsciously let a breath of relief whistle softly out of her lips.
Doctor MacAndrew gave Gil a thorough check over and battery of tests in the presence of the crotchety Joan, before declaring that, under the circumstances, a short trip to the NICU was not out of the question, and would Joan please be kind enough to assist in getting Mr. Grissom ready to go. The woman pursed her lips tightly and glared at the blankets, but with the help of another nurse, gently bound Gil's arm in a sling to stop it from moving, cocooned him in blankets and transferred him to a wheelchair with a high back to help support his head, neck and torso in order to avoid aggravating the broken ribs and concussion associated whiplash. With the IV's disconnected temporarily and the safety belt fastened snugly over his hips Joan reluctantly wheeled him out of the room, Candy trailing behind with a grateful look to the two doctors.
If the Intensive Care ward was quiet, then the NICU was eerily so; machines still hummed and beeped, and the pneumatic hiss of air still escaped into the atmosphere around them, but the sounds of the patients was far less. Every so often a baby would cry softly, but the sound didn't linger long after an attentive nurse or doctor soothed away the pain. The stillness unnerved Candy, and she followed Joan closely as she looked around with a mixture of awe, dread and horror.
Baby Girl Grissom was at the far end of the room; when Joan parked the wheelchair next to the incubator and set the brake, Gil felt his heartbeat increase rapidly in shock and was fleetingly grateful he wasn't hooked up to the monitor for Joan to see. Even in the small box designed to help her, his daughter looked terribly small. Small, but perfectly formed. He could see tiny eyelashes resting against her cheeks as she slumbered, and fingernails so miniscule he had to squint to make them out clearly.
A purple beanie hat kept her head warm as she lay flat and limp on her back. IV's ran into her arms, and a tube fed into her nose while another snaked down her throat. Wires in every color imaginable flowed over her body like a living spider web, monitoring her every function and output. Gil pressed his lips tightly together in an effort to reign in his emotions. A woman in a white medical coat came to stand next to him.
"Gil Grissom?" she asked softly. He nodded, still not quite able to summon words to his lips. He had been expecting the worst, but this somehow didn't even come close. His child looked like she was made of wafer thin spun sugar, and would crack under the faintest puff of air. "My name is Shawna, Doctor Shawna Feather and I'm a neonatal specialist. I've been treating your daughter since she was born." He nodded, his eyes still glued to the tiny life before him; watching intently as the ventilator made her chest move up and down with the movement of oxygen in and out of her lungs. She was so tiny his wedding ring would have slipped over her fist to act as a bracelet. His eyes were drawn to a tag secured around her ankle; Sara's name was printed there, along with dates, times and other information. He realized Sara would have a similar symbol attached to her wrist, marking her as a mother and connecting her to the right baby.
The right baby; his heart clenched as he stared at this tiny, perfect creation. He loved her so much, had wanted her for so long, but not now, not like this. She should still be wrapped safely inside her mother's belly, waiting for her body to strengthen enough to take on the world. Abruptly he was angry; angrier than he ever had been in his life before. His little girl was lying here in front of him in box instead of his or her mother's arms because of a single idiotic decision. He didn't even realize he was crying until Shawna knelt beside him and pressed a tissue into his fingers.
"She's doing alright so far," she said quietly, resting a hand on his knee. She pointed to the monitors on the side of the incubator. "Her brain functioning is good; you can see here on the screen. It's better than most preemies at this gestation." Shawna paused and looked carefully into his face, searching for understanding and overwhelming anguish. Finding only deep sadness and not sensory or emotional overload that would put him at risk in his own recovery she decided to press on.
"She has what's called Infant Respiratory Distress Syndrome because her lungs aren't fully developed yet, which means she can't breathe by herself yet. We see it quiet commonly in premature babies, and while it is very serious, it's something we have a great deal of experience treating. On the positive side, her blood sugar and salt levels are pretty good and we haven't had to give her much of a boost, which is also common in conjunction with IRDS."
"What else?" he asked, voice barely audible as he spoke for the first time since entering the room. Shawna looked at him, surprised. "What haven't you told me?" he wanted to know. The woman sighed and then pointed to the heart monitor.
"She has a congenital heart condition called Mitral Regurgitation. It's quiet rare to see it at birth; normally the condition develops over time and shows itself in more elderly patients."
"The Mitral valve leaks blood back into the left ventricle from the left atrium because it doesn't close fully when the heart pumps out the blood," he said automatically. Shawna nodded, surprised.
"Yes."
"Is it acute or chronic?"
"Acute. The tachycardia was the only clue we had in trying to diagnose the condition. How much do you know about the MR?"
"Not a great deal," he replied, truthfully. "I was a coroner in Los Angeles before I went to grad school, but not much of a cardiac specialist."
"Right, well because the valve leaks, when the heart contracts to pump blood out into the aorta from the atrium, it works twice as hard because it's also pumping the blood that went back into the ventricle. Over time, the left ventricle deteriorates and becomes less functional. The volume of blood that flows back into the ventricle creates pressure on the atrium which in turn puts makes it difficult for the pulmonary veins to properly drain blood from the lungs, which then leads to pulmonary congestion. Pulmonary congestion is,"
"Heart failure," supplied Gil, his face bleak.
"Yes," agreed Shawna.
"What are the options?" he wanted to know, his fingertips grazing the plastic as he reached out to touch his daughter, only to be stopped short by the protective barriers around her.
"Repairing the valve, or replacing it. In her case, the backward flow of blood is classified as moderate to severe, the parameters of which are forty to sixty percent. Your daughter has presented with fifty percent since we discovered the condition."
"Repairing it would be a better option," he noted, "if it's feasible. If she had a mechanical valve it would wear out eventually and she'd need it replacing. And a lifelong dependency on warfarin or other blood thinners is something to avoid if possible."
"I agree, but a cardiac surgeon will have to make a decision about the best way forward. Repairing the valve is a controversial topic, and many surgeons prefer simply to replace it. I have spoken with Alice Kelvin, a pediatric cardiac specialist, and she's going to take over your daughter's cardiac care this afternoon. I know she prefers repair to replacement, but again, it all depends on what is possible and what is not."
"When is all this likely to happen?" he asked, feeling old and strained. His head was throbbing again, and his ribs and shoulder were white hot with the effort of sitting upright for so long.
"I don't know," admitted Shawna. "Right now, she's as stable as we can get her, considering the level of prematurity and complications. Obviously we would like her to improve and grow as much as possible before surgery, but the risks of waiting might be too great. Alice will be here around four o'clock; do you want me to ask her to come and speak with you, or ask if you can come back up here?"
"I'd like to come back up here," he said immediately, leaning back as far as he could into the chair to take the pressure off his protesting bones. "My wife is in surgery. I don't know when she'll be awake," he sighed and wiped his eyes again with the tissue. He remembered waking Sara up and making love to her on her birthday; they had laughed together over breakfast as their baby danced around inside her stomach, her feet connecting with their palms. How had such a wonderful morning come to this?
Joan reappeared and pushed the chair back toward his room as exhaustion caught up with him rapidly, he wavered unsteadily on the brink of sleep, barely coherent as Joan scolded him for overreaching himself. In the hallway Candy caught up with them; not more than ten feet inside the NICU she had had to turn around and leave. It was not fair that Sara was downstairs in the operating room, three days after her child's birth and had not even had the chance to meet her. Despite her fears, and need for reassurance, Candy couldn't make herself meet the baby before her friend had a chance to get to know her own daughter. The haunted look in Gil's eyes as the doctors spoke had convinced her that he needed the time alone to adjust to and take in the situation. She felt an odd mixture of guilt, and the calm understanding of knowing she was doing the right thing as she stood in the hallway and offered silent prayers to whoever was listening.
Joan reinstalled Gil in his bed, reconnecting the monitors and IV's. She tucked the blankets and grumbled over his stress altered vital signs. He didn't notice; half asleep, he stared at the wall through heavy eyes, seeing not the mass produced Monet print, but his baby girl in her purple cap and net of wires.
"I need Sara," he mumbled, eyes closed and voice slurred. "We both need her."