Chapter 13

The rest of the family arrives

They all arrive on the floor and Eric goes to the desk and asks where Brian's room is, because there was so many of them they were led to the conference room/family waiting area. The head Nurse asks if for Brian's parents only but since Nicole was there too they allowed her to go with them.

They walked into the room the curtain was closed, but Matt could see them come in from where he was standing. He motioned for them to stop.

He walked over to them hugged them and said quietly. "Be prepared he doesn't look good and he is kind of out of it that's why we have to sign the consent form for the surgery."

They walked around the curtain Bridget was half laying on the bed holding Brian She moved to let the Eric, Annie and Nicole get close to him. They all took turns hugging him but they really couldn't have a conversation with him he really was too out of it.

The nurse came in and told them that she needed to finish prepping him for surgery she needed to get the area on his head ready for surgery and she needed to insert a Foley catheter so he wouldn't be incontinent during the surgery. So they needed to step out while she did it.

They went to the conference room where everyone else was. Matt explained to everyone all the information that Dr. Fitzpatrick had given him. Eric led them in a prayer. It was ultimately up Bridget and Matt to sign the consent form because it was their names on the proxy that Brian signed when he first got there, but every one discussed it and when they all finally made the decision, they agreed that the surgery needed to be done.

Bridget and Matt signed the forms and gave it to the Doctor. Brian was wheeled out of his room towards them heading to the OR. A portion of the left side of his head had been shaved to prep the area for surgery. He had been given more mediation to sedate him and he was completely out of it, but not because of the medication, that was given to him just to relax him.

It was the pressure in his brain that was causing him to be incoherent Everyone shocked at the sight of him he was wheeled to the OR and all they could do watch him as he went through the doors that led to the operating suite everyone seemed to lose it and Bridget who had kept it together for Brian's sake just fell apart.

She turned to Matt, she started to shake and cry. He held her trying to console her "Shhh Bridget" Matt said "God will be with him, we have to believe he will be ok." Annie and Nicole held on to each other and cried to, they all went back to the family waiting area. Matt knew if all went well they would be waiting 4-5 hours so this would be a long wait.

Brian has Surgery

Brian was given general anesthesia that was administered through the IV that had already been placed in his arm when he was being prepped, before the surgery to put him to sleep completely. Since sometimes there could be breathing issues during surgery after he was asleep he was intubated and put him on oxygen. Dr. Fitzpatrick was the lead surgeon He was going to start with the Ventriculostomy to relieve the pressure.

He worked on him quite a while He had to drill a small hole in his skull, then surgically a catheter tube was inserted in his brain ventricles to drain some of the fluid. It was connected to an external collection device.

Then Dr. Fitzpatrick said, "There is still massive swelling at the trauma site and he is still continuing to have swelling and intracranial pressure and his blood pressure is dropping,"

He consulted the assisting surgeon; they made the decision to do more they had to perform a craniotomy with a bone flap. The assistant had to shave the rest of his head. Then the doctors proceeded. They worked on him for hours, they had a very hard time to get him stabilized the finally had to hook him up to a respirator. They finally seemed to get everything under control and had him stabile and he put the bone flap loosely back in place and held together with soft wires, plates and mesh. Doctor left the drain in he then proceeded to stitch him up. Then the bandage was put over the area. And he was taken to recovery.

After the surgery

In the waiting area it was getting tense. It was after 2 am over 6 1/2 hours had passed and they still had not heard anything, No one had left. The kids were all asleep on the couches. All of Brian's family and friends were there, even Mary and Carlos and the kids had gotten there by this time. When Eric had called them right after the ambulance had left for the hospital to tell them what had happened they got on the first plane which was a direct flight, to get there.

Annie got up and went over to Matt she knelt beside him and whispered to him, "You're a doctor what could be taking so long?"

"I don't know Mom, this isn't my field of expertise, but I will go see what I can find out what is taking so long. Just as Matt got up , Dr. Fitzpatrick came in the room. He only had written permission to speak with Bridget and Matt on the consent forms so he asked to speak with them first and then they could relay any information to the rest of the family.

He took them into another room. He told them. "The surgery obviously took a lot longer than we thought. The original drain I put in only relieved some of the pressure. There was so much edema "(Matt whispered "He means Swelling") the doctor continued, "There was much more trauma to the impact area than we originally thought. So a craniotomy with a bone flap had to be done to relieve the pressure and allow the brain more room to expand at least until the swelling goes down. He is has been stabilized for now and in recovery and is being closely monitored. If all goes well he may be back in his room around 7am. We have to wait and see how he responds when the anesthesia wears off."

After explaining to them everything he added. "I will be going to recovery in about 10 minutes to check on him, Dr. Camden after you and Bridget explain things to you family, if you would like, since you are a Doctor and his brother listed on the proxy, you can come with me and then you can stay with him while he is in recovery ."

"Yes I will do that and Thanks." Matt replied.

Bridget and Matt went back to the waiting area they were visibly upset even though they tried to hide it. Bridget sat next down in between Annie and Nicole. Annie put her arm around her shoulder, and then looked at Matt.

"So what did the surgeon say?" Matt explained in detail what the surgeon told them. (they already knew the explanation of what the possible surgeries were so he didn't need to go over them again) and then said "we just have to wait and see it's in God's hands now"

He told them he was going to be allowed to stay with Brian in recovery because he was a Doctor.

He advised "Maybe some of you should go home at least take the kids home. You will be called when we know anything. So everyone except for Eric, Annie Bridget and Nicole and of course Matt, went home. Mary and Carlos and the kids went back to her parents, Sarah took her boys and Sam and David as well back there Lucy and Kevin went to her parent's house and took Ruthie and Simon there. As for Brian's friends, everyone went back to Dave and Deena's.

Dr. Fitzpatrick came and got Matt to take him to the recovery room. When they entered Brian was hooked up to all kinds of monitors, that were keeping track of his vitals, he saw the drain from his head, and the fact that now, his whole head had been shaved, and there was a dressing covering the area where the craniotomy had been done, But nothing could have prepared him for how bad Brian looked, he was also shocked to see that Brian was still intubated and on a respirator.

"You didn't tell me he was intubated still and on a respirator" He said to Dr. Fitzpatrick.

"It's a precaution we had a hard time keeping him stabile during the surgery." he responded. "If in a few hours he is more alert we will unhook the respirator and if his respirations are good we will take out the intubation tube from his throat."

Matt pulled up a chair beside the stretcher he was on. Matt looked at his brother and thought to himself "He looks so awful, if I were just looking at the left side of his head and face I wouldn't even recognize him."

He said a prayer for him and asked God to help Brian. Matt thought some more to himself. "He saved my Noah and Jacob's lives. He ran to them to get them out of the way without thinking of the risk to his own life. Yet, the way he talks about himself he worries that he isn't good enough for us or that he isn't Camden material. If this doesn't prove it to him that he is then nothing will."

Matt shakes his head and puts his head in his he finally let himself cry. He finally pulled himself together. He helped the nursing staff monitor his vital signs and every one in a while they tried to see if he would wake up. The last time they checked at 5:30 Brian was still unarousable and unresponsive.

That really concerned him even if they couldn't fully wake him because the anesthesia might not have fully worn off, there should be some sort of response by now. It was now 6:00 am Dr. Fitzpatrick stayed all night to monitor Brian to and he could tell by the look on his face he was concerned too.

He walked over to Brian and said to Matt, "Why don't we try to arouse him again let's see what his response to painful stimuli is."

He performed standard procedures to check his responses. Finally, Brian looked like he groaned but no sound came out because he was intubated,

Matt held his hand and got up very close to his face and spoke to him "Brian can you hear me", nothing he said it again "Brian, it's me Matt, if you can hear me squeeze my hand."

Brian was able to weakly squeeze Matt's hand.

"Good job buddy" Matt said

He then said to him. "Now Brian I want you to try to open your eyes and look at me" Brian was able to open his eyes barely the left one was harder because that side of his face was swollen.

He couldn't talk yet because he was intubated, but since he was somewhat awake Dr. Fitzpatrick felt he could remove the respirator and breathing tube so it was removed,

The first thing Brian said was "Too Bright it hurts"

They figured he was talking about the lights being so bright it caused him head pain. Dr. Fitzpatrick dimmed the lights,

"Is that better for you?" he asked

"Yeah" Brian responded in a raspy voice.

Dr. Fitzpatrick pulled Matt aside and told him Matt, "This is a good sign, try to see if you can keep him awake. See if you can assess his short term memory by having casual conversation with him"

"Ok" he replied, Matt sat down again next to Brian. Brian had closed his eyes again.

"Hey Bri, you still with me?" Matt asked. Brian sort of just groaned in response.

"Come on Brian I need you to stay awake I know it's hard buddy"

Brian was only able to say in response, "I AM IN SO MUCH PAIN"

"Ok Brian I will talk to your doctor to see what they can give you, but they can't give you anything that will put you to sleep."

Brian lay there trying to figure out what was going on "I can't think straight, I am in so much pain." He thought to himself. "I can't move it hurts too much and my shoulder is strapped or something I can't move it, God it hurts like hell! My head is going to split in two" he raised his right arm to touch his head.

Matt saw him and quickly stopped him." No you can't touch your head Brian you just had surgery on it" Matt grabbed his hand "You're going to get something for the pain in a minute," He sat back next to Brian again on his right side, "I know you are still groggy but what do you remember about where you are and why you are here?"

Brian hard a hard time thinking past the pain all he wanted was to go back to sleep. "I just want to go to sleep"

"Brian you need to stay awake" Matt said, "Now think, it's important so I can help assess what's going on with you."

Then one of the nurses came over to put some pain medication in his IV port,

"This should make you feel better" she told him. Within a few minutes the medicine seemed to kick in. It didn't make the pain completely go away but it made it more tolerable.

Matt could see Brian relax he said to him, "Are you feeling any better?"

"A little bit but I am really fuzzy. What is going on with me? I am obviously in the hospital. My head really hurts and there is a weird I don't know pulling sensation on my head."

He again started to reach to touch his head he touched the right side and to his horror he felt that his head was shaved. He started to reach over to the left side.

Matt stopped him again" You have to leave the left side alone Bri, you had surgery and the pulling you feel is a drain that was put into your brain to relieve the pressure you will be ok it will just take time to heal"

Brian started to have a panic attack this really freaked him out. His heart rate and B/P started to go way up and he was rapidly breathing he was almost hyperventilating.

"You need to slow your breathing down Brian concentrate on just slowly breathing in through your nose out through your mouth" Matt coached him.

He didn't want Brian to get any more medication because anything they would end up giving him would sedate him which really wasn't a good idea. With Matt's support Brian was able to get the panic attack under control without medication.

"Just lay there and relax Brian, in a while we will bring you back to your room."

"Matt help me remember what happened"

"Ok, what's the last thing you remember? Then we will go from there." Matt said.

Brian had to think really hard, then he remembered, "Getting to the park and getting out of the car, Oh God Noah and Jacob, the car was heading straight for them are they OK were they hit"

"No they are ok thanks to your quick reaction you saw it coming and dived for the boys getting them out of the way that's how you got hurt. The boys landed on top of you bore the brunt of the fall you landed hard on your left side you hit your head very hard and your shoulder was hurt."

"I kind of remember" Brian said. "I didn't want to go to the hospital did I?"

"No you didn't "Matt replied

Then Brian added, "I kind of remember being in the ambulance I threw up I think?"

"What do you remember about being in the Emergency room?" Matt asked him

"That's a little fuzzier," Brian replied. "They did something to my shoulder and it hurt like hell! What did they do to it why is it strapped so it can't move?"

"Well Brian" Matt told him, "When you fell in the parking lot you dislocated your shoulder. It had to be popped back into place and it is now immobilized because the muscles surrounding it are weak and this will keep it from popping back out until the shoulder area is healed."

Then Brian told him, "I remember my head started to really hurt. I was taken somewhere for a scan or something. I don't really remember anything after that."

Dr. Fitzpatrick was listening to the conversation trying to make his own assessment of Brian's memory and thinking (the injured part of the his brain was the part that controlled thinking and speech) It seems he doesn't remember anything after the seizure He noted in Brian's chart,

"But that's to be expected that also that's when I think a lot of the major intracranial pressure started "He thought.

"I will be right back" Matt told Brian, "I just want to talk to your Doctor ok?"

"Ok" Brian replied.

Matt went to talk to the Dr. Fitzpatrick "I am assuming you were listening? It's a very good sign I would think that he has most of his short term memory. I am debating on whether or not to give him the details of the surgery I don't think he will remember anything you tried to tell him when he was in the room"

No I don't think he will either Dr. Fitzpatrick answered. "Well it is up to you, If you think he can handle it go ahead and tell him , Oh and I think he is stabile enough so in about 15 minutes he will be taken back to his room"

"Ok thanks" Matt says and walks back and sits down next to Brian again

"What did he say?" Brian asked?

"He was just saying you will be going back to your room soon and that it is a good sign that you have retained most of your memory. So are do you think you can handle me explaining your surgery to you or is it too much? I don't want you to have another panic attack." Matt asked him.

"You mean there is more than just the drain thing they did to my head? Oh God Well I think I will be ok tell me, I need to know."

Matt explained the exactly what the drain was the Ventriculostomy and how that was done and then he paused …. And they said to Brian, "that only took care of some of the problem but more pressure was building and they needed to give your brain more space"…Matt paused.

"What did they do for that?" Asked Brian? Matt explained the craniotomy with a bone flap and what that procedure they did. "

"I guess I am a real mess." Brian said, "I must look a mess too. Do you have a mirror?"

"No you really don't want to do that Brian" Matt said.

"Yes I need to see," replied Brian. There was an over bed bedside table in the room that had a mirror. Matt moved it over to Brian and positioned it so he could see himself. Brian looked at his reflection, he didn't even recognize himself. He has never seen himself with a shaved head before he looked like he was beaten up or something. He closed the table it really bothered him. He knew it would be upsetting to everyone to see him look like that. Especially Bridget, Mom and Nicole not to mention he would scare all the kids." I am pretty scary looking" he tried to make light of it

Matt knew it really bothered him but there wasn't much he could say Brian did look horrible" You will heal Brian that's the important thing" Matt reassured him.

Just then an orderly came with Dr. Fitzpatrick. "Are you ready to go back to your room?" He asked

"I think so, Hey Matt who will still be here? I don't think I can deal with a crowd right now.

"Well" Matt replied "I sent most everyone home but I am guessing Bridget, Nicole and mom and dad will still be on the floor"

one of the nurses came over to disconnect the monitors and get the external ventricular drain set up to move with the stretcher. They proceeded to move him back to his room.