It was heartbreaking to see Ryan lying there so still, his face badly bruised and all the tubes and wires attached to him. Mrs. Kelly was holding his left hand, and they vaguely noticed that Ryan's right hand was in an odd position, his elbow bent, hand palm up, but with the wrist bent and the hand in a loose fist. Mrs. Kelly got up to give Neil and George hugs, and when they looked back at Ryan, they saw his left hand had moved into the same position as his right.
"Why are his hands like that?" Keith wondered, not realizing he'd spoken aloud.
Mrs. Kelly looked at Ryan sadly. "It's because of the brain injury, they tell us. Somehow the pressure in his brain is telling some muscles to pull tighter than others, and it moves his hands into that position. His toes are pointing down, too, like he's standing on his tiptoes. It's a little more obvious than it was when we left last night, and a little harder to pull his hands out of it. Dr. Reilly said that therapists will be up today to make splints for his hands and feet to keep them stretched out - apparently they could get stuck like this if they don't."
Neil shook his head. "I hope it doesn't hurt him," he said. "But getting his hands and feet stuck like that and not being able to move them when he wakes up would be worse, I guess." The boys were realizing that this injury was more than just Ryan being unconscious; it was affecting his whole body.
"We're not going to be able to stay long," George said. "Emmet, you've had the most sleep, and I got some before I got on the plane. Why don't you stay in here for now, and I'll stay in the waiting room; then Neil and Keith can go back to the hotel and get some sleep, and take over later." They all agreed that this sounded like a good plan. Then George suggested they pray for Ryan. Joining hands, Keith holding one of Ryan's hands and Mrs. Kelly the other, George said a brief prayer. Somehow the "Amen" at the end turned into a sung chord. Mrs. Kelly was watching Ryan's face, and she was sure she saw his face shift slightly, and felt his hand relax just a bit as the familiar harmony surrounded them.
"I think he heard you," she whispered, tears slowly running down her face. "He seemed to relax just a bit when you were singing." This prompted sad smiles from the boys, all hoping she was right and not seeing what she wanted to see.
Nadine, Ryan's day nurse, came in then. "That chord was beautiful," she said. "Everyone in the ICU just stopped and listened to it. Unfortunately I have to ask most of you to go out now." With the exception of Emmet, the boys filed out, George going back to the waiting room to stay with Mr. Kelly, while Neil and Keith headed to the hotel.
On the way back to the hotel, Neil said, "Do you really think he heard us? I hope so, but it seems so unlikely from what they've told us before." His voice sounded very depressed, almost hopeless.
"I don't know," Keith said slowly. "I didn't feel anything change, but Mrs. Kelly's been holding his hand longer, she'd be more likely to notice a change. To me his hand just felt stiff, I had to pull a little to get his fingers open."
While Emmet was sitting with Mrs. Kelly, two physical therapists came in holding a box of what looked like supplies for making casts. They introduced themselves, and explained that they were going to make the splints for Ryan's feet.
"It looks like you're putting casts on him," Mrs. Kelly said, puzzled.
"We are, but then we'll take them right off, cover the rough edges, and put straps on them, so they can be taken on and off easily. By doing them this way, we know they will fit him exactly and not cause pressure sores. We'll just need one of the nurse's aides to help hold his leg up, this is a multi-hand process to get everything in the right position."
"Can I help?" Emmet asked. "That way you won't have to tie up one of the aides."
"Certainly, if you'd like. Just be careful not to let the casting material touch your clothes, it'll stick and the fiberglass will never come out. You'll need gloves to make sure it doesn't get on your skin, either."
The two therapists showed Emmet how to support Ryan's leg, with his knee bent. Then one therapist held his foot in position, as if it were flat on the floor. Over a piece of fabric tubing, they wrapped layers of cotton padding, then several layers of fiberglass. Once the fiberglass had dried hard, they used a special saw to cut the cast off, then repeated the process with Ryan's other leg. Once that one was off, one therapist left. The other began pulling the fabric liner in each cast piece tight and taping it down overlapping the edges of the cast, making a smooth edge, then added velcro straps and marked each set for right and left leg. In about an hour, they had made two custom fitted splints. Placing them on Ryan's feet, the therapist smiled and said, "Thanks, that was a huge help. You did a great job. These will be on for two hours and off for two hours throughout the day and night. The nurses will let us know if he gets any red areas from them, then we might have to add more padding or redo them, but I think we got good molds. We'll be coming up every day to stretch his muscles, too."
Emmet said gratefully, "I'm glad I could help, it feels like I can do something for Ryan. That was fascinating, watching you do that." The therapist smiled and left.
Nadine was in regularly to check on Ryan's machines and to shift his position, sometimes on his back, or partially on one side or the other, using pillows to prop him in position and to keep his elbows and knees in the positions they wanted. Since he couldn't move himself, they needed to keep changing his position so he didn't always have pressure on the same areas of his body, which would cause bedsores.
Around lunchtime, George and Mr. Kelly switched places with them, and Emmet took Mrs. Kelly down to eat lunch. George and Mr. Kelly were there when two occupational therapists came in to make hand splints. Rather than the casting material, they used a special plastic which they could soften in a hot water bath and mold around Ryan's arms and hands. George was able to help this time by supporting Ryan's arms. These splints too would be used two hours on and two hours off, alternating with the foot splints, and these therapists, too, would be coming every day to keep Ryan's muscles stretched out.