Chapter 14:
Mid-Day Day 4
Sherlock had slept quietly through the morning, even sleeping through most of Dr. Hillcrest's exam. John was relieved to know that things were looking up for his ill friend. It was around noon when Sherlock began to stir.
John rose from his chair and placed his hand on Sherlock's shoulder. He spoke quietly to Sherlock.
"I'm here. Easy."
Sherlock blinked his eyes to clear his vision. John smiled at him.
"Hello." Their eyes met. John then pressed the nurse call button. Sherlock's brows furrowed in question.
"Dr. Hillcrest wanted to know when you were awake. You slept through his visit this morning." John nodded to the nurse that had appeared at the door. She nodded back before returning to the Nursing Station.
"He's going to take out some of those tubes."
Sherlock closed his eyes and sighed, slightly nodding in agreement. John knew he had to be relieved that he would be freed from some of the restraining tubes. John helped Sherlock straighten himself up in the bed when he noticed Sherlock briefly grimacing and holding his stomach. John stood beside the bed with his hands clutching the bed rail. He didn't know how he could help his friend. He closed his eyes for a moment, pausing to gather his thoughts about how to ask Sherlock about his stomach. He knew he was tired of being asked questions about his health status.
He felt a cool hand over his and looked to see a distressed Sherlock looking to him, tears in his eyes. His other hand was still clutching at his stomach. He grasped Sherlock's hand between his.
"Sherlock, is your stomach hurting?"
A nod and more tears. John pulled a tissue from the bedside table and wiped away the tears streaming down Sherlock's face. Quietly, he soothed him, "Nothing we can't fix..hmm? Dr. Hillcrest will be here in a few minutes. Let's have a look see, hmm?"
John knew that Sherlock had been having some bouts with diarrhea since he was started on the tube feedings. Gently, John pulled down the blanket and raised Sherlock's gown a bit to uncover his belly only to find it slightly distended. "I'm going to feel okay?" John gently pressed on Sherlock's stomach.
"Hmm...you are a bit distended. Nauseated any at all?"
Sherlock nodded again.
A new voice spoke from the doorway. "Not tolerating the tube feeds?" It was Dr. Hillcrest. He approached the opposite side of the bed from John.
"Hello Mr. Holmes. It's good to see you are recovering well."
Sherlock nodded.
John stepped back as Dr. Hillcrest took out his stethoscope to listen to Sherlock's abdomen, heart and lungs. "Pain in your belly, Mr. Holmes?" Gentle palpation again.
Sherlock nodded.
He pulled down the gown to cover Sherlock's exposed stomach. "I'm here to take out that breathing tube and probably your chest tube." He looked at the IV pumps and settings before going to the door and calling for his nurse. John was relieved to see Chrystal. Sherlock was more at ease when she cared for him. Dr. Hillcrest instructed her on some new orders and she jotted them down on a notepad.
Chrystal is going to discontinue that tube feed and I am going to get respiratory up here to help with your extubation, okay Mr. Holmes."
Sherlock nodded and gripped John's hand.
"That's good, Sherlock. I'm glad to see you are getting better." Chrystal smiled her best while attending to the pump that gave Sherlock his feeding. She turned off the feed. "I'm going for supplies, I will be right back."
John smiled at Sherlock, who still seemed fretful about the whole event.
"Sherlock, I know you are uncomfortable. That tube will come out and you'll feel much better. We still have to work on the breathing." Sherlock's eyes rolled. John laughed. "I know, breathing's boring."
Chrystal returned and disconnected the tubing from the pump and flushed Sherlock's nasogastric tube with bottled water until it was clear again. "Sherlock, your tummy don't like the feeding very well. You've been so sick, it's common to have that happen. This will help with that sick feeling and distention." Then she turned on the wall suction and connected the tube to it to clear his stomach of the last feeding. Slowly the pinkish fluid began to fill the suction canister. Sherlock tried to watch but Chrystal warned him. "You don't want to watch that with your tum already sick." She then hung a small bag of IV medicine to the already impressive array that he already had. "Now this medicine will help with that yucky feeling." She glanced back at the suction canister then to Sherlock.
"Are you okay? You seem afraid."
He nodded a small bit. She smiled, placing a hand on his cheek.
"There's nothing to be afraid of. No one to hurt you here. I'll get Dr. Hillcrest to order you something to help you relax before he pulls any tubes, okay?"
Another nod.
Chrystal smiled at John while Sherlock closed his eyes, trying not to panic. His breathing was a bit more ragged and fast. John knew Sherlock had a long recovery before him.
Chrystal left them for a few moments before returning to give him something for his anxiety in his IV port. John held onto Sherlock's hand to reassure him and tried to distract him with talk of the day's news. John felt Sherlock relax a little each minute until Dr. Hillcrest returned with the respiratory therapist. The RT was carrying a bag with supplies in it.
"Sherlock, I'm going to set you up a bit." John adjusted the head of the bed while the Doctor and RT laid out supplies. John noticed Sherlock watching them as they laid out a bag mask and oxygen mask on the bedside table. The RT turned on the wall oxygen and attached it to the bag mask as Dr. Hillcrest listened to Sherlock's chest again.
John coached him, "Sherlock, don't look at them, look at me." Wide aqua eyes focused on his dark blue ones. "That's it. Only me. Deep breaths. In and out. Just like that."
They disconnected the tubing from the ventilator.
John refocused Sherlock, "No no me. Look at me." Suctioning made him cough and gag and then he felt the tube pull free and more suctioning. John held his head still while the RT cleared out his mouth and throat before giving him some breaths from the bag mask. John then held his hands while the RT finished his work and fixed a tight fitting oxygen mask around Sherlock's head. Sherlock's wide eyes caught every movement. He clung to John's hands.
Dr. Hillcrest removed the soft restraints holding Sherlock's wrists while explaining the oxygen treatment he was receiving. The respiratory therapist gathered the dirty equipment and left the room to dispose of it.
"This mask is a continuous positive airway pressure mask. CPAP for short. A little more uncomfortable than an oxygen mask but it will help you breathe better and clear that pneumonia from your lungs. Better oxygen perfusion will help you heal faster too. Try to tolerate it for a few days okay?"
Sherlock felt around the mask and made a small humming sound. He looked tired and pale now. Dr. Hillcrest felt his abdomen once more before checking the suction from his stomach. John noticed a few red streaks in the tubing that wasn't there before. The canister contained a few dark red blobs or clots from his stomach. No wonder his stomach was hurting, his stomach was bleeding. Dr. Hillcrest pulled the mask loose and pulled the tape holding the tube in Sherlock's nose and advanced it a bit further into his stomach. Bright red blood then filled the tube and splashed into the canister. He looked at John.
Sherlock could not see what they were looking at but knew something was wrong. Dr. Hillcrest re-taped the tube and fixed his mask. Sherlock's arms flailed to John as he tried to sit up further. John pushed him back on the bed.
"John...what's...wrong?" came Sherlock's voice, rough and whispery.
"Now, Sherlock...don't panic. Lie still...and... don't panic. You have a GI bleed.", John tried to explain fighting back the pain he felt for his best friend.
"Where?"
"Your stomach probably. It looks like it is actively bleeding and you can lose a lot of blood volume that way. I need to get you into endoscopy to take a look right away. I'm going to make immediate arrangements." Dr. Hillcrest rushed from the room to secure an operating room.
Sherlock clung to John's arms and John lowered the bedrail to sit on the bed facing him. Sherlock looked so tiny in the stark whiteness of the hospital bed. His dark hair a mess of unruly curls and eyes still wide with pain and fear. He tried to talk but that ended in a gagging dry cough.
John wrapped his arms around his skinny frame and pulled him in close. Sherlock laid his head over John's shoulder while John rubbed his back. "Sssh. Don't try to talk just yet. Just breathe and rest." John felt Sherlock slightly tremble and choke back a few sobs. He mumbled a faint whisper, "What's wrong... with ...me, John?"
John held him. "You've been very sick, Sherlock. You can't help it. Just let it all out. You are still very sick. Let me take care of you." He stroked Sherlock's hair, now damp from emotion and exertion of being moved around. John supposed he needed Sherlock to hold him just as much as Sherlock needed John. After a few minutes of silent comfort, Sherlock weakly pulled away and John helped him lay back down, adjusting the mask on his face and generally fussing over the tangle of wires and tubing. He smoothed back Sherlock's hair from his face and wiped his face with a cool flannel. Sherlock closed his eyes and he and John waited for the OR team to arrive.