Sharon had been able to arrange the meeting with Dr. Reilly for the next afternoon, when everyone would have been able to get a bit of sleep and Emmet and Keith had been able to get home to pack. Ryan had done very well with the recordings the previous day, so they were used again to allow everyone, Kellys and CT family, to attend the meeting.
Dr. Reilly started out by telling them that, while he'd been reluctant to have the boys in initially, it had turned out far better than he'd hoped, and that some of the staff had been asking if they could have Celtic Thunder music played in the ICU on a regular basis, as they found it helped their concentration and stress levels. That brought grins and slight blushes all around. He then got down to business.
"As you know, we've started reducing Ryan's medications to allow him to wake out of the coma naturally. Now, we don't know for sure that he WILL wake up when all of the medications are out of his system, but given the responsiveness he's shown recently even on them, I'm optimistic that he will. I must tell you that even the level of awareness he's shown, of your voices and presence, is unusual at the level he is medicated to, and that gives me encouragement. I know it's been easy to read into some of his responses and believe they are voluntary, but that is unlikely at the level of medication he is at. The responses are reflexive or emotional at best rather than purposeful right now. That should change as the medications are lowered.
"People refer to coming out of a coma as 'waking up', but a coma isn't completely analogous to sleeping, and the process of coming out of one isn't exactly like waking up. What we'll see first is what's referred to as a 'lightening' of his coma state - he'll become more reactive and more responsive although he won't technically be awake. We may see him turn his head towards familiar voices, begin moving on his own assuming there is no paralysis, change in facial expression with pleasant as well as uncomfortable things. We may even see the ability to respond to simple commands such as the classic 'squeeze my hand if you can hear me'. Eventually, he'll begin to open his eyes, but he may not be completely awake even then and may have limited awareness of what's going on around him.
"Now, when he does wake up, you must not expect him to be completely back to normal. He'll have no memory of the accident, nor the last several weeks, and it's likely he'll have lost some memory of the time immediately before the accident, possibly several weeks before. He will not know where he is, or why he is here. You'll tell him, but he may ask you again and again, as it will be hard for him to form new memories immediately. It's possible that he may have some trouble remembering who he is, or who his family members and friends are." He saw the downcast faces at these words and smiled gently. "With luck, all these effects will be temporary, except for not remembering the accident or the last few weeks. Those memories never got a chance to be formed. Over time, either the other memories will come back or he will relearn the information he's lost. It is possible, even likely, that there might be some long-term difficulty with memory; we'll simply have to see.
"The one thing you need to be aware of is that Ryan's personality is likely to be different when he first wakes up. Almost all coma patients go through a period of intense agitation when they first wake up. Some go through it in one screaming tantrum; others get stuck in it for months, but most go through several weeks where they are easily irritated and are likely to get angry and even aggressive. It's similar to how you might feel if you'd been under intense stress for a long time; the least demand will throw you over the edge into anger or rage or tears. It's not voluntary or under his control in any way; it's best just to be supportive and calm and let it pass. I understand from speaking with you all that Ryan is ordinarily a very gentle person, and over time that should return as his brain continues to heal and processes information better.
"Once he's awake, we can begin to determine what, if any, permanent brain damage might have been caused. As I said, given his current unusual responsiveness, I'm optimistic that he'll make a much better recovery than I initially feared. But we are still looking at a likely time frame of months before he is close to anything resembling normal. There is always the possibility of damage to his ability to speak or understand speech. In addition to the continued healing of the brain injury, he'll need to regain the strength and muscle mass he's lost through being in bed for such a prolonged time. As soon as he is able, his physical and occupational therapies will transition to more active tasks, and other therapies may be added. It's likely he'll need some time in specialized brain injury rehabilitation as well."
Dr. Reilly stopped there, knowing he'd given them a tremendous amount of information to process and adjust to. He assured them that he would be available to answer any questions, including any that arose after the other singers had left for America, and that Sharon would have his contact information. He asked, but no one had any questions at that point, they were too overwhelmed with the information they'd been given, and a bit down-hearted that things weren't quite as far along as they'd thought. Never having dealt with anyone with a brain injury before, they'd had no clue that it would cause so many issues in so many areas of Ryan's life. They had to readjust their thinking to realize that they would be helping Ryan for many more weeks. They spent most of the rest of that day and the next day talking things over.
The next day brought a welcome break in Damian's arrival. Sharon had let them all know when he was coming, so that everyone was in the waiting room and practically dogpiled him to the floor. They made so much noise that Nadine came out to see what all the ruckus was about. She was introduced to Damian as being yet another brother, but she kept looking at him in puzzlement and finally pulled Sharon aside.
"Look," she said. "I know that you told me he's another 'brother', but we've got a pretty strict policy regarding minors visiting in the ICU. I honestly can't tell whether he's older than he looks or younger than he acts. How old is he?"
Sharon laughed. "You don't need to worry, he's 19," she said. "Older than he looks and younger than he acts is probably the most accurate description of Damian I've ever heard, from the first day I met him when he was 14."
"Fourteen?" Nadine said in surprise. "How did you meet him when he was fourteen?"
Sharon smiled in remembrance. "Damian, along with Keith, Ryan, and George, was one of the original members of Celtic Thunder when we formed the group in 2007. They've been through a lot together. And yes, that's awfully young for a touring musical group, and yes, he absolutely belonged there. I've never met another young man with the voice and the stage presence he had at that age. It still boggles my mind when I remember that first show we did and how he - and all of them really, with no professional stage experience at all - just took off and flew with it. I couldn't be more proud of any of them."
"Wow," Nadine said. "I can't wait to hear him sing, now! His voice is so deep anyway, it takes you off guard."
"It took us all off guard," Sharon said. "His voice hadn't broken yet when we did the first show, but by the time we got round to touring it, it was breaking and seemed like it was getting deeper every day. And he kept getting taller! He started out below Keith's shoulder, and now look at him! Keeping him in clothes and adjusting his vocal parts was a constant job for several years."
"I'm sure!" Nadine laughed. "Not to mention keeping him fed, I'll bet!"
"Well, that's been a problem right along with all of them," Sharon said, shaking her head. "They all eat constantly when we're touring, and the amount they put away is amazing. We literally restock the tour bus daily."
Nadine got her chance to hear Damian sing pretty quickly, because he wasn't about to be kept out of Ryan's room very long. He'd heard, of course, in detail from everyone, but it was still a shock to him to see Ryan so still and quiet. When he started singing, though, there was no doubt in the mind of anyone present that Ryan actually did smile at the deep rich voice rolling through the room. It was gone too quickly for anyone to get a picture of it, but they all knew it had happened.