Emily Prentiss was a quick learner and one of the many things she had learned in law enforcement was that pissed off doctors did not happen easily. They possessed a patience to rival Aaron Hotchner's - at least when it came to the family of patients, but this doctor was PISSED!
Dr. Lawrence Wilson met the gaze of each team member, all 6 of them crowded in his small office.
"How does this happen, Doctor?" she asked, breaking the awkward silence. "When Garcia called me, she said Reid was fine - he was playing a game. How -?" She still couldn't believe that Reid was in a coma - medically induced or not. She wasn't even sure which it was.
"When I checked Dr. Reid's vitals an hour before the event, he was medicated with his pulse at 130."
"What does that mean?" Garcia spoke up from the door. "I don't -"
"A normal reading would be 60-100. What this means, is that while he was lying in bed, his heart was racing as if he was at the gym. Now that number is not dangerous, you can go to the gym, have a 130 pulse and have no need to fear. But this was without external stimulation. His breathing was difficult and shallow, hence the need for the breath mask on the bed rail. His vitals were undesirable, but STABLE!"
"Why was it so high?"
"The drugs," Hotch answered.
"That can't be right, Hotch!"
"It is!" Dr. Wilson spoke up. "Agent Hotchner is right."
"No, it. It can't be. Look, man, I was a beat cop in Chicago, I've seen what Dilaudid can do. It lasts six hours max, it had been 14 since we found him...there's no way."
"Well, then, man," the pissed off doctor retorted "- you must be are aware that most addicts -"
"Reid's not - ."
"-start with taking a drug in pill form." The doctor chose to ignore the interruption. "As they get desperate, they look for a quicker high - they go for the injections. The kidnapper - Hankel, you said it was? - he gave Dr. Reid an addict's dose via injection and based on the numbers in his tox screen, we estimate he was drugged with a high dose each day of his abduction. If he only had one small dose of the drug, you'd be right, but you're not. This to a man who had a perfect chem panel a month ago, suggesting - as you stated - that he had not used drugs prior to this week. Just help me understand something. What happened before I was paged?"
"We were just playing a game," Garcia answered, when it was obvious that J.J. could hardly say a coherent word between her tears. "Monopoly. He was even telling us how many communist countries had banned it. He was just in full Ried lecture mode." It had been so refreshing and comforting to know that he would be...but he wasn't fine was he? "Then J.J. started asking him about -"
"I just wanted to help! I needed to know so I could help him!"
Emily couldn't decide if Dr. Wilson's face looked homicidal or compassionate. His facial muscles were in a war all of their own. "You wanted to help him?" the man asked slowly. "So you thought that forcing him to relieve his worst nightmares would help him how? How could you be so selfish?"
J.J. looked like she'd been slapped in the face. "I was trying to help! I wasn't being selfish."
"Did he want your help?"
"No," Garcia answered for her. "He just wanted her to give him the dice so he could keep playing."
"Did either of you notice anything unusual when you were playing the game?"
J.J. nodded. "When I hugged him, I noticed he was sweating despite the cold from where the ice had been. A couple of times I handed him the dice and he dropped them instead of rolling them. It was like he couldn't hold them properly..."
"You mean he was sweating and his hands were shaking from the drugs."
"I thought it was hunger and dehydration. We gave him tea and snacks. He held the cup with both hands. He never does that, he likes to keep a hand free. I just thought he wanted to warm up."
"Did the tea have caffeine in it?" Please say 'no', please say 'no'!
"No, it was chamomile."
Oh good. At least they hadn't been stupid enough to give him coffee, even decaf still had more caffeine than his patient could handle at the moment - and he had made sure to tell Dr. Reid as much at breakfast time. "So instead of letting sleeping dogs lie, you keep pressing him for information he didn't want to think about, when the signs of drug withdrawal were staring you in the face? And here I thought FBI agents knew how to handle trauma victims!"
"But he's..."
"An agent, yes he is. But he stopped being that the moment that Hankel guy got to him. Look your job puts you in the line of fire all the time, but most law enforcement injuries are bullets. Painful and potentialy lethal yes, but nothing compared to the days of torture endured by most victims. You're still seeing him as an agent first and a victim second, you need to switch your brains around and treat him like you would any other victim. So, he's getting upset and didn't want to talk, then what happened?"
"I dismissed them."
"One point to Agent Hotchner. Good call. So, you girls weren't in the room when it happened?"
"No we had gone to the cafeteria and gift shop, we ran back when we heard the page."
"So who was with him?"
"I had gone back to sleep when he decided to call his mom."
Morgan raised his hand. "I was."
Dr. Wilson nodded at him. "Go on."
"He was leaving her a message when I walked in. Baby Girl...Garcia," he corrected seeing the doctor's look of confusion, "she was crying. Reid had made her upset...and no one makes my Baby Girl cry."
"Okay, I don't know what kind of team you guys have here, but what do her tears have to do with this?"
"I told Reid when he hung up the phone that talking to her that way was unacceptable."
"Let me get this straight. After Agent Hotchner dismisses the ladies, you walk in and pick up the same conversation he had put an end to?"
Morgan nodded. "Yes."
"And what did Dr. Reid have to say to that?"
"He told me to leave him alone."
Dr. Wilson was no longer making even the slightest attempt at hiding his annoyance, more like anger at this team of the finest idiots the FBI had to offer. "So no one is taking the hint that he doesn't want to talk about it?" Why hadn't his patient called the nurses to remove the unwanted guests? Why?
"I did take a hint!" Morgan defended himself. "He didn't want to talk, I dropped the subject."
"Then why did the detective tell me that the two of you were arguing when he came in the room?"
"Reid brought up the topic again..."
"I highly doubt that."
"He didn't want to talk about his memories. You see, he's a genius - like a certifiable one. He's got a photographic - no, Eidetic, memory. He remembers everything, but he couldn't remember anything. It was driving him crazy. He wanted to know how we found him, what we were doing last night. He..." Morgan rubbed his face. "Oh God!" It was all making sense now. "He hadn't seen the injury, he didn't know what it was. He was probably trying to get me to tell him so he could hear a truth that was less traumatizing than whatever his imagination was telling him."
"He was thinking that the fact couldn't be as crazy as the fiction in his head."
"Probably. He kept pressing the issue. I told him he didn't want to know...he got angry, told me not to tell him what he wanted. He said he was fine, he wanted answers. So when the detective came in, Reid asked for, and got, his answers."
Dr. Wilson put his head in his hands. "Answers that he couldn't handle." He flipped through the chart and noted the timing of the medicine. He'd been due for another dose, no wonder. He could only imagine his patient's terror as his panic attack caused his pulse to skyrocket and with the medicine worn off, it must have felt like his heart was about jump out of his rib cage. By then it had been too late for the second dose to work in time. He had been scared to death - literally. He checked the times again, he had scheduled the nurses to return in half an hour. Half an hour longer and he may have been fine, panic attack or not. "Okay, from now on, Dr. Reid can not handle any stress. ZERO stress! He needs three things: calm, happy thoughts, and comfort. If you can't give him that, then get out of the ICU. Understood?"
"Understood," seven voices echoed around him.
"It is VITAL that his temperature stay between 90 and 92 degrees. You can hold his hand, that's fine, but don't hold anything hot. If you need your caffeine, iced coffee or soda will have to suffice. The machines will regulate his temperature, but the less fluctuation the better. Talk to him, coma patients can often hear what's going on around them even if they can't respond to it. Yes, Agent Garcia, you have a question?"
Garcia didn't even bother correcting him as a horrible thought had filled her head. She had to get it out. "Sir, if he can feel our hands, does that mean...is he in pain?" This whole time she had been imagining him getting the sleep he so desperately needed.
"We don't know," the doctor answered, his tone compassionate for the first time. "Holding his hand, gentle touches, it can't hurt and might help. If he can feel the pain, then the knowing that someone is by his side, should give him some solace and peace. He needs that right now. We've restarted the epidural, but the pain has spread now. Due to the extensive CPR his chest will be hurting as well as his back, but the epidural was placed based on the original injury."
"Can he get two of them?"
The doctor shook his head. "Any higher up on the spinal cord and it would affect his breathing, its too dangerous. The drugs are still in his system, the same pain management protocols apply. We really can't afford a seizure on top of all of this. I'll be honest, most doctors wouldn't have done this given the drugs in his system."
"Why not?"
"Because most drug addicts have such extensive heart damage from abuse that they wouldn't be able to tolerate it. Based on the records I got from his primary doctor this morning, I'm taking a gamble on the assumption that he has no prior drug abuse history and therefore none of the usual damage. The hypothermia can also cause platelet dysfunction which the drugs were already doing, but he's had two bags of transfusion since admission so that should offset some of the risk. The head injury could also be an exclusion criteria to some doctors, except that it wasn't severe enough to contribute to the cause of the cardiac arrest. This is a gamble, I'll need Agent Hotchner's consent to continue the therapy."
"You'll get it. So what's the goal here, what can we expect?"
"Well there is some good news. Less than 10% of heart attack victims even survive, less than half of those survive with comparable brain function."
"This is good, how?"
"The hypothermia treatment increases the survival rate to 50% and of those many of them retain vital brain function."
"So if this is a gamble, then his odds went from 5% to -?"
"- greater than 70%. Most patients are found at home and brought here later, there's often a few hours delay in starting the ice therapy. His body was cooled prior to that, we started the treatment right away and got his temp down to 92 within 2 hours. Usually it takes 3-4 hours to cool the patient."
"So Reid got the treatment in less than half the normal time frame?"
"Yes, timing is everything. The major problem will be that he was without a pulse for six minutes and 15 seconds. On a room temp patient, we would call time of death after 5 minutes."
"But you kept going. Thank you!" Garcia, scurried up to the young doctor, grabbing him in a bear hug. "Thank you, thank you! You got his odds up from 5 to 70! Thank you!" She'd have to write those numbers down for Reid, he loved numbers. "Can we see him now?"
"Yes. I'll have the nurses take you to see him. Like I said, if you can't handle this...leave. If my nurses even THINK you are upsetting my patient, they won't hesitate to remove you from the ICU, am I clear?"
A room full of nods was all he needed.
"Uh-huh, hold up! Nurse!" Dr. Wilson interrupted as the group filed down the hall to the ICU. "Two at a time for now, you two -" he pointed to Prentiss and Gideon - "did not upset my patient, you may see him first. And remember I don't care how many titles or badges you have, upset him in the slightest if you want security to kick your asses to the curb. You three -" he rounded on Garcia, Morgan and J.J. - "will get kicked to the curb for setting foot in the ICU without my consent. You got that, Nurse Davis?"
"Yes, Doctor."
"Good, now please take these two agents here to see Spencer Reid. Agent Hotchner, a word."
Sparing a warning glance to the fuming Derek Morgan, Hotch followed Dr. Wilson back to the office. The door shut behind them, Dr. Wilson sat down at his desk with his head in his hands as he stared wide-eyed at the open chart in front of him. "Okay, I gave your agents my highest hopes, but you need to know everything. Despite the prior cooling and quick response time, the fact of the matter is this could end very badly. I'm actually being rather careful and conservative with this treatment. I've chosen the cooling blanket and ice packet approach due to the damage the drugs have done to his platelets. The more aggressive treatment would include inserting catheters into his groin via the femoral veins, which would deliver the cold saline directly to his vascular system but with all of the additional trauma he's endured recently, less invasive is safest, less chance of a bleeding risk during the warming process. My main concern right now is infection from the knife wound. He absolutely can not handle a fever right now. He could end up paralyzed, in a vegetative state, anything can still happen - statistics aren't promises."
"I'm aware of that." Hotch swallowed the lump in his throat.
"With Dr. Reid unresponsive, I'm going to need to notify next of kin."
"You have his mother's number -"
"Yeah, about that." He pulled something out of his lab coat pocket. "Your phone and water didn't mix very well." He handed back the drenched and ruined cell phone. "I'm going to need that number again. Dr. Cheng was turning to you for consent last night out of emergency and I will continue to do the same for the time being, but I'm going to need family who can make decisions -"
"In that case, Doctor, you should know that his mother is institutionalized."
"What?" Oh this couldn't be good.
"Her son is her Power of Attorney. So.."
"She can't make her own medical choices, much less his," the doctor finished with a sigh, tapping his pen on the file. "Well then I'll talk to his father," the doctor decided, wondering as he said it, why the woman's son had Power of Attorney and not her husband.
"That might be a problem."
"Problem?" How many problems could one patient have? "In what way?"
"When Dr. Reid thought his family might be on a hit list a few months ago, he had his mother brought into protective custody, but not his dad. I've never heard him mention his dad once in three years. I have no idea if the man's even alive, and he's an only child," Hotch added before the doctor could ask the question.
"Well you're the FBI, find him! I need someone who can take Power of Attorney, in case-" he didn't want to think about it, but he had to. "Do you know if he has an Advance Directive on file with the Bureau?"
"Yes, he does."
"I'll need to see it."
"Of course."
"And get me any other family you can find. If his father is deceased, I'll still need a next of kin. You also need to know that in this protocol, the patient is kept at the cooling temperature for 24 hours, then we start the very slow warming process which can take several hours. If there is a DNR on file in the Directive, it would not be acknowledged until after the patient has been warmed for 72 hours. That is usually enough time for the patient to wake up and to get an accurate neurological assessment. If that doesn't happen - well let's hope it doesn't come to that. But we do need to prepare for it."
"Agreed."
Well there's your medical information overload. If you want more information on medical hypothermia, I got the name wrong. Its technically called Mild Therapeutic Hypothermia and you can begin by looking at the sites I linked on my profile page. One link would not save to my profile page, so I'm adding it here
resuscitationcentral dot com / hypothermia/ post-resusitation-overview/