Chapter 26

Apologies for the delay!

His throat burned as a vicious, acidic wave was flung up from his stomach. His eyes were stinging, his nose was running, and his head felt strange.

'Nice deep breaths. There we go,' Dylan rubbed Ethan's back gently. 'Bad reaction, that's all. You're alright.'

He waited for Ethan swill his mouth out, then helped him lie back down. The younger medic looked sweaty and grey. 'Sorry.'

'Nothing to be sorry for. How are you feeing otherwise?'

'St-stomach hurts.'

'Do you mind if I examine you?'

Ethan nodded, closing his eyes. Having suffered multiple migraines since the surgery, he'd been put on Verapamil to try to reduce the episodes. His sensitivity to drugs seemed to be worsening, given he'd reacted badly minutes after the first dose. 'I just want to check your throat in case of anaphylaxis, although I can't see any other symptoms. Any itching, tightening in your throat?'

This time, he shook his head. He felt too out of it to try and operate his left hand just then, so made a clumsy pass over his forehead with his right to wipe back his hair which was damp with sweat. He was happy for Dylan to check him over. He was very gentle.

Hanging his stethoscope around his neck, he turned back to Ethan, looking sympathetic. 'Heartbeat is a little high, but you've just vomited. I'll suggest to Mikael that we delay physio for today, the last thing we want is you feeling unwell and trying to put pressure on yourself.'

Ethan shook his head. 'No… I want to go. Making good steps.'

Dylan sat down on the edge of the bed and helped Ethan take sips of water through a straw. 'You are making good progress. Taking an extra day to ensure you're ready is no bad thing.'

'When can I go home?'

It was one of his first full, clear sentences since the haemorrhage.

'You know I'm not a neurologist. You've still got a long journey. Guy wants you to be a week clear of migraines and seizures before you go to the rehab unit for 4 weeks,' Dylan was repeating what Ethan had already been told several times. It was tricky to fully judge how well he retained information, particularly about his recovery.

'Seizure yesterday.'

'Small seizure yesterday. I think it was linked to the stress from the migraine.'

'Stupid brain.'

'They can be, can't they? Mind you, we'd be stuffed without them. I had a brilliant lecturer when I was training- Dr Feliks, fantastic doctor and teacher. She used to drill it into us, there's no body without a brain.'

'Anencephaly.' Ethan replied, surprising himself.

Dylan looked at him with interest. 'Good memory. What does Anencephaly mean?'

Ethan closed his eyes, really thinking. 'Baby. Brain not whole. Skull too. Neural tube deficit. C-c-c-cephalic.'

Dylan wanted to jump, he felt so pleased. He gently clapped Ethan on the shoulder instead. 'Well done! That's more than I get from some final year students who've been spoon fed for weeks. Good job, Dr Hardy.'

'What's going on?' Connie said, clipping in. She'd been away at a conference for the last three days, and looked fresher because of it. 'How are we all?'

'Good.' Ethan said. 'Anencephaly.'

Connie looked confused. 'No, darling, you had a haemorrhage.'

'No. Not me. No brain.'

'Well done,' Dylan said again. 'We've been discussing how important brains are. Ethan recalled Anencephaly and a few facts.'

'Excellent,' Connie passed Dylan a coffee. 'How's things?'

They'd had a quick phone call last night, but in a case like Ethan's, things were always changing rapidly. 'He's reacted poorly to the Verapamil. Nausea, very slight temperature and stomach pain. I've given him a check over and I'm not too worried.'

As he was speaking, Ethan suddenly vomited. His eyes were streaming. He started retching again, and for round three, Dylan managed to get him a cardboard dish. Ethan gasped. His throat burned and his eyes stung. He could see a veil of grey spots starting to come down. 'Migraine,' Ethan groaned.

'Dim lights, please.' Dylan ordered. He managed to get Ethan to swill his mouth out and then spit into the bowl. He was an expert by now at helping this particular patient to lie back down, and lowered Ethan gently, still mindful of his back. 'Ethan, do you want a KoolPak?'

Ethan had his strong hand clamped firmly over his eyes, and tried to make a thumbs up with his weaker one. 'Yuuu.'

Connie was adjusting the monitors to try and stop any sudden beeping sounds from adding to Ethan's predicament. As carefully as she could, she clipped on an o2 reader. 'How much Verapamil has he had?'

'240mg.'

She sat down, trying to stay quiet. Ethan's legs were trembling, but she could tell he was trying to keep moving them to distract him from the sensation of the migraine.

'Do you think you'll be sick again?' Dylan asked, softly.

'No. Better now been sick.'

'That's something.' Dylan checked the finger monitor and gave Ethan's hand a quick squeeze. 'It'll stop, Ethan, it will.'

'So, migraines are the new thing to worry about?' Connie asked. The latest one had gone on for close to an hour, leaving Ethan feeling shattered. He was so deeply asleep that he was snoring softly, something that was rare. The hospital environment around him usually meant he slept fairly lightly compared to how he usually would at home.

'They're likely to be much more temporary than the risk of long-term seizures.' Dylan yawned, stretching his legs out. He was trying, but without as much ease as Connie, to stay quiet and still to allow Ethan to rest. 'They've improved. I think it's more of a result from the pressure changes after the surgery on his spine than another symptom of the haemorrhage. He's only had them significantly after.'

'Did he ever have migraines prior to this?'

'Not that I know of. Cal suffers quite badly from them. I saw a case when I was on orthopaedics where the patient was very ill with migraine headaches- far worse than Ethan is- post spinal surgery. This may well be the same.'

'I know,' Connie sighed. 'I do worry about the possibility for epilepsy. It's getting more likely that he'll meet the threshold for a diagnosis. I mean, the fact that he's on track to live independently and be able to work, even if he can't work as a medic, that's amazing. It was always going to be near-impossible for him to recover from Potts' Disease and a subarachnoid haemorrhage without any long-term impacts.'

'Some days, I just feel lucky we've got him at all.' Dylan said, sounding surprisingly affectionate. He cleared his throat. 'I doubt he'll drive again, or not for a significant period of time, and if he does come back to the ED, I'd advise a very long time before he does anything around patients that's delicate. He's a strong diagnostician, and he's got an excellent bedside manner. I'd feel confident enough having him in a crash team. It's more the worry of him having a seizure while doing something like suture work.'

'Tamponade.'

'Pardon?'

'Or a tamponade. The day he collapsed with his back- I was doing a cardiac tamponade. I was focused on getting Dr Munroe to observe me. Ethan had already seen me do it, I had full faith in him. I just assumed he didn't need the support, that he was so far ahead, that I didn't need him to still be learning. He was doing so well. I'd been so impressed with how well he'd been doing. And all the time, he must have been in agony with the TB going through him. I look back now…' she took a breath, 'I look back and think I should have seen it. Cal lived with him, it was harder for him to notice. But I didn't see him as often. The weight loss. How tired he looked. How stiff he'd become. Why didn't I see it?'

'Say you had. He'd have had the same treatment. Potentially, the series of events might have changed. He could have had a more peaceful stay, without the fall. He could have died on the table. He could have been paralysed. It could have been misdiagnosed, and the TB could have continued to eat away at him. Fever, weight loss, tiredness- he'd have been referred for cancer and then bounced back. I hate the phrase, but things happen for a reason. We can't change the past, we can't change the future, and to be honest, there's not a whole lot that we can do for the present. We can hope and we can try. And when we do both, that's going to make the best impact.'