Avengers: Search for the Winter Soldier

Chapter 44

Title: "Steve"

Summary: As Sam takes care of Barnes, Dr. Banner retrieves Steve from his brief respite and informs him of his friend's altered condition.

"Barnes is awake."

That was as far as Banner got. Steve scrambled up from the table and headed out with a quick stride. Bruce sighed and spun on his heel, moving rapidly to try to catch Steve at the elevator.

Over Nat's shoulder Emily saw the commotion and watched as Steve rose and headed out with a determined stride. Nat saw Emily's eyes tracking movement behind her and she turned to look over her shoulder. They watched Steve and Bruce leaving quickly and Nat turned back around. She and Dr. Golden just looked at each other.

Bruce caught up to Steve at the elevator where he was repeatedly pushing the call button in rapid succession as if the more he hit it the faster the lift would appear.

"Steve -," Bruce said as he came up alongside him; reaching out to take his arm gently. "Slow down. I need to talk to you."

"He's awake?" Steve asked and hit the button again.

"Yes, he's awake. Sam's tending to him."

"Is he talking? Did he ask for me?" he slammed his hand on the wall. "I should have been there for him when he woke up!"

"Steve… he's awake, but he's not talking. He's… not focused. He's in an altered mental state," Bruce told him as the elevator arrived and the door hissed open. He stepped inside right behind Steve and watched him hit the button to the sub-basement floor.

"What does that mean?" Steve asked, turning to face Bruce. "He's been in an altered mental state for seventy years."

"That's true, but this is quite different," Bruce explained. "He's showing signs of neurological damage – severe brain trauma. Remember how he was when you put him to bed? He was weak, unable to walk or move his legs properly, he had no balance -"

"Yeah," Steve nodded.

"He's still like that but even more depressed now," Bruce told him.

"Depressed?"

"Not emotionally depressed, but physically. I think what we're seeing - what you're going to see – is Barnes, I believe, in the condition he was probably in… right before he lost his fight against all the odds. He's showing signs of extreme neurological damage… his movements are jerky and his muscles are twitchy. He's having a lot of trouble visually focusing. He's tracking sounds with his head, but not his eyes. It's taking him a lot of time and a lot of energy to manage successfully focusing on anything. We're going to have to help him regain that ability, if it's at all possible. When we're interacting with him, we can each engage in vision therapy with him. His condition resembles Parkinson's," Bruce told him, trying to brace Steve for what he's going to see. Steve stared at him but didn't say anything. "You know what Parkinson's is, right?"

Steve blinked and nodded. He had been hoping Bucky wouldn't be severely altered once they got him back but he had to be realistic. He straightened and took a deep breath to calm himself. They knew already that Hydra had targeted Bucky's brain trying to destroy his free will, to crush the fight in him and gain control over him; his thoughts, his actions, his autonomy as a person. He shouldn't be shocked by this… and he wasn't.

"Sam was talking to him. He's not responding, much at all to direct questions but -," he paused, remembering one positive thing he could share. "When Sam mentioned you by name, telling me 'Steve should be here'… Sgt. Barnes did respond to your name, he recognized it and repeated it. He said your name."

Steve tried to smile but all he could manage was a nod of acknowledgement. He looked up at the floor indicator above the door wondering why it was taking so long and the door suddenly opened. He nearly shot out of the elevator and Bruce grabbed onto his arm.

"Easy, Steve," he instructed. Steve stopped and looked at him. "Remember, he has difficulty tracking voices and movement. You're moving at a hundred miles an hour right now and he can barely track us in slow motion. Okay? Slow... and calm…"

"Okay," Steve said nodding. He took a slow deep breath to steady himself and turned to walk to the room. He could hear Sam's voice talking to Bucky as he got closer and then he was standing in the doorway. Bucky was sitting up, his head was held forward and Steve could see his head rocking back and forth and his body twitching with involuntary movements. Sam looked up at him and was about to tell Barnes that Steve was there when Steve stepped back out of the doorway.

He turned toward Banner and brought his hand up to his mouth. Bruce watched him as he fell deep into thought. "Steve?"

Long seconds passed and then Steve looked at him, dropping his hand. He took a deep breath and nodded, standing up straighter. "Okay," he said.

"He needs you," Bruce told him, reminding Steve of the commitment he started.

"I'm good," Steve told him and turned back toward the door. He stepped up to the threshold and paused only slightly before walking calmly into the room.

He pulled another chair up close to the bed opposite Sam and sat down. Bucky still didn't know he was there as his head was turned toward Sam. Sam made eye contact with Steve and Rogers smiled and nodded. Sam then turned to Bucky.

"Hey, Buck?" Sam said and Steve had to smile at the gentle tone of his voice. Steve watched as it took Barnes a few moments to turn his head more toward Sam's voice. "Steve's here," he told him.

Bucky's head jerked involuntarily and settled into the soft back and forth motion Steve had been warned about. Steve could tell he wasn't looking directly at Sam in fact he wasn't looking at Sam at all. His eyes were directed to Sam's left and not focused on anything in the room. As Steve watched him though, Bucky's mouth turned up slightly as if he attempted a smile and he said softly, "Steve."

Sam smiled and then looked at Steve. "It's the only word he says, but he's said it a few times." Steve smiled at Sam and nodded then redirected his attention to Bucky.

"Hey, buddy," he started off keeping his voice soft and calm and Bucky's head jerked up. Steve could tell he was trying to turn toward him but was having difficulty getting his muscles to do what he wanted them to. Steve watched as it took nearly half a minute for Bucky to get his head to turn to the right. His motion was jerky and his muscles twitched sometimes with force, knocking him backward in his efforts. Steve also noticed that he was breathing heavily as if he was over-exerting himself. Finally he got himself turned to face Steve but his eyes didn't look directly at him nor did they focus on anything, they just seemed to be focused inward. "Hey, Buck… it's Steve."

"Steve." Bucky repeated the name and the corners of his mouth turned up in a soft smile and then it disappeared again.

"Can you look at me?" Steve asked and waited a few seconds to see if Bucky understood the question. He remained looking blindly beyond Steve and he waited another few seconds before trying to get his attention again. "Buck?"

"Huh?" Barnes answered, jerking his head up but he still had the dull expression on his face. His jaw was slack and he made no attempt to blink or swallow.

"Can you look at me?" Steve asked again. He watched as Bucky very slowly dragged his eyes in his direction and then seemed to stare through Steve's chest. Steve raised his hand and waved it slowly to give him something to track. "Right here… can you focus on me, hmm?" As Bucky raised his eyes trying to track the movement, he held his hand still and wiggled his fingers to make an easier target on which to focus.

Bucky's eyes moved in the direction of Steve's hand which was held up in front of his face. When his eyes stopped on the hand, Steve dropped it slowly and leaned forward to put his face there. He watched as Bucky's eyes shifted and finally focused on his face. Bucky flashed a smile and then it disappeared. "Steve," he said, acknowledging his friend.

"Hey, buddy… it's so good to see you," Steve told him. An involuntary movement pulled Bucky's eyes off Steve as his head jerked to the left.

Steve watched him and swallowed thickly, fighting back emotions. His eyes raked down his friend's body, noting the almost constant twitching as his muscles jumped involuntarily. As he looked back at Bucky's face he noticed the oxygen mask resting on his shoulder where Sam had placed it. Sam noticed Steve looking at it and then his eyes shifted to look at Sam in question.

"He was having a little trouble catching his breath when he woke up," Sam explained, "Bruce tried to put it on him and he… panicked. He couldn't handle having the mask placed over his face." Bucky's head jerked to the right, paused and jerked left again. Both Sam and Steve looked at him, wondering if that was his attempt to tell them 'no' – no mask. Steve rubbed his forehead as he realized that innocent and well-meaning action would be traumatic for Barnes. Sam gestured behind Steve's left shoulder and he turned to look. "He didn't have a swallow reflex so Banner had to suction him. We're going to have to be aware of that issue and help him to keep his airway clear so he doesn't aspirate his own saliva," Sam told him and Steve nodded. "But... so far it appears if we just touch his mouth he automatically responds to the touch. It doesn't always trigger him to swallow, but sometimes is better than not at all."

Steve noticed that Bucky's mouth hung open as if he didn't have the ability or muscle control to close it. He wore a dull expression as if his facial muscles had no tone – the only time he managed any expression at all was when he was told Steve was there and then he was able to smile briefly but he couldn't hold it longer than a few seconds. Steve reached out and gripped Bucky's right hand. The contact drew Barnes' attention and he turned his head jerkily in that direction. Steve watched as he tried to locate the hand touching his but his eyes wouldn't focus. The 'blind' expression in Bucky's eyes disturbed Steve more than his jerky movements. He squeezed his friend's hand but Bucky didn't squeeze back.

Twenty minutes had passed as Sam and Steve talked to each other and attempted to get Barnes to focus on them or on an object when Dr. Golden walked into the room with Natasha. Dr. Golden slowed her approach as she saw her patient's condition. Natasha saw him and abruptly halted.

Emily saw her response and touched her arm in support. Natasha stared at him from near the doorway and covered her mouth with her hand to keep from verbalizing her surprise and dismay. She couldn't handle what she was seeing; she turned on her heel and left abruptly. Sam was the only one who saw her reaction and he frowned, concerned.

Emily approached the foot of the bed and Banner looked up at her. She nodded to him and he turned his chair to observe. "Well, I wish I could say this is unexpected," she told them.

Steve looked up at her. "You expected him to be like this?" he asked.

"Well, I was hoping he wouldn't be affected to this degree, but - with all that he's had done to him…" she explained. "He's been showing signs of damage to his hypothalamus and issues with the thalamus since we first started his detoxification. Those parts of the brain are in close proximity to the pre-frontal cortex and are strongly inter-connected with the area known as the basal ganglia."

Steve looked confused and shook his head indicating he didn't understand.

"It's clearly recorded in the journals of his… of the experimentation the Hydra scientists had performed on him…" she tried to explain carefully, but there really was no way to sugarcoat any of the crimes committed against Barnes. "They were using the Winter Soldier project to dissect and de-construct the human brain in order to learn how to unlock free will," she told them.

"They specifically targeted the basal ganglia, which controls motor function along with other abilities," she explained. "Damage to the basal ganglia cells is known to cause problems in controlling speech, posture and voluntary movement. The combination of those issues is referred to as parkinsonism," Dr. Golden explained.

"Difficulties in starting, stopping or sustaining movement are well-known issues with basal ganglia dysfunction. The very function of that part of the brain is to fine-tune voluntary movements.

"Disruption of, or damage to, the basal ganglia network causes several movement disorders that we know of," she explained as clearly as she could, hoping it was enough for them to be able to follow.

Sam listened to her explanation and had a thought. "Would the damage to that part of his brain cause difficulty in breathing and swallowing? - he's having those issues too."

"Yes," Dr. Golden affirmed. "The electrical stimulation of the basal ganglia can cause changes in the tidal volume and the rate of respiration. So yes, his efforts to complete the respiratory movement can appear to be labored at times or difficult for him to perform properly, so we'll have to be attentive to that. The difficulty in swallowing is related to the hypothalamus. The issue stems from the same basis that causes an inability to absorb fluids or will cause him to vomit and seem to come out of nowhere. It's all dependent on the types of signals being transmitted at any given time and if they're able to relay and be interpreted properly.

"We've already seen signs in both Soldat and the Soldier that relate to ongoing issues with this section of the brain. Memory function and retrieval has been clearly interfered with and just like explicit memories, implicit memories are stored in multiple areas of the brain… two areas of the brain to be exact and both of those areas are connected by a neural "bridge" and are called basal ganglia.

"In order for the basal ganglia to function properly it requires dopamine to be released at the right time. Dopamine dysfunction is known to be associated with several movement disorders such as Parkinson's Disease," she told them and then gestured toward Barnes. "These jerky movements are indicative of dopamine dysfunction."

"We also know that the basal ganglia have a direct role in learning processes and memory retention, both of which Soldat had difficulty with. The basal ganglia are in direct contact with the pre-frontal cortex," she explained raising her hand to touch the frontal curve of her skull, "which is like the control center for the brain," she told them. "It helps to guide our actions and is involved in regulating emotions. The prefrontal cortex also plays an important part in memory, intelligence, concentration, temper and personality."

"Man, they knew what they were doing, didn't they?" Sam asked, confounded.

"It would seem so," Emily agreed, "and I would put money on the fact that what they didn't know up front, they had no issue with finding out by experimenting on his brain to discover what would work.

"In the scientific journals that Hydra and the KGB kept… there are detailed accounts of specific surgeries conducted to dissect and map the workings of the human brain to specifically remove free will and implant the ability to control a person remotely… using their own brain functions against them."

"They dissected his brain?" Steve asked, repulsed.

"Well, not his directly," Emily told him. "I don't believe they would've been able to dissect the brain of a living person in that manner and have that person survive. I believe the brains they would have dissected were those of previous subjects in the Winter Soldier program…possibly not even actual Winter Soldiers, just in conjunction with the program itself, but their findings allowed them to use their theories on Sgt. Barnes with great success."

"But not fully," Sam mentioned, "since he's apparently had the ability to reverse a lot of their control on him over the decades."

"That's true," Emily nodded. "It's clearly recorded how often they had to subject him to their memory wipes and brainwashing techniques to get him back under their control. I believe that ability to heal and recover from those injuries is related to his being a super soldier. In time, I hope to see a full recovery, or at least close enough to be called fully recovered."

"So you think this is reversible?" Steve asked to be sure he understood.

Emily nodded. "I believe it is. I believe that's what we're actually seeing. He's been slowly reverting... moving away from the Winter Soldier programming. Each time he starts a new level of reversion we see a different stage of his construction or destruction, however you want to label it."

Steve turned to look at his friend. It broke his heart to see all that Bucky had to go through to be broken down so far to allow evil people to take control of his mind and body… and now he had to endure those same processes in reverse as his body tried to heal itself.

Dr. Golden followed Steve's gaze. She looked at Barnes and smiled softly. "There's definitely something in there that either escaped destruction or has already recovered itself, since he clearly seems to know Steve, whom he hasn't seen in seventy years. So, yes, I believe there's hope," she told them with a smile.

"He still has fight left in him as well," Bruce mentioned and they all turned to look at him. "When I tried to put the oxygen mask on him – not realizing how he would take it – he rejected it forcefully. He wasn't able to actually punch me or push me away, but his intentions were clear. He wanted nothing to do with a mask on his face." Sam nodded his agreement to that statement and Steve gave them a small grin.

"Is there anything we can do to try to speed up the process?" Steve asked Dr. Golden.

"There may be," Emily told him. "Talking to him, telling him stories… either made up stories to try to get his imagination moving or true stories that would be memorable for him. Try to trigger his memories of the two of you together, perhaps things you did together when you were younger," she instructed and Steve nodded.

"You can read books to him, listen to music, show him pictures… try to get him to perform small tasks. Maybe have him try to pick up a pen or take it from your hand; either way it would focus his attention and direct specific movement that he'd have to try to control.

"I can bring down that box of blocks that I use for evaluations. See if he can match the shapes to the cutouts and let him practice putting the blocks into the proper holes. It will help with focus and concentration as well as give us an idea of his motor ability and where we should go from here with physical and psychological therapy.

"I also have coloring pages he can do as well... he won't be able to stay within the lines at this point but coloring pages are very useful in keeping track of any progress. By doing any of these activities with him we'll be able to gauge any progress in his ability to control his movements."

Steve nodded. He liked the idea of being able to do these activities with Bucky and having an active part in his recovery. He'd waited so long to have him back in his life and he'd do anything for him; whatever it takes.

"We should probably also discuss collecting our own images of his brain to see where the damage truly is and to what extent," Golden mentioned.

Steve looked up at her with a frown. "You want to x-ray his brain?"

"Yes, well it would be magnetic resonance imaging actually," she corrected him. "We'd need to do an MRI."

Steve frowned and looked at Sam. Sam was also frowning and took the lead from Steve.

"You want to put him in an MRI machine – am I reading you correctly?" Sam asked.

"Yes," Emily confirmed.

"You want to take this man," he said, gesturing at Barnes "… who has had to endure electro-shock torture, has been repeatedly strapped into a chair and had to withstand machines that wiped out his memories, causing him horrific pain… you want him… you expect him to just let you strap him to a table and then roll him into a giant circular machine that would take pictures of his brain?"

"It's a painless procedure, Sam," Bruce interjected.

"I know it's a painless procedure," Sam assured him, "but he doesn't know that. Do you realize the terror you would put him through by introducing him to a machine like that?"

"Oh… good point," Bruce agreed thoughtfully.

"Well, we would have to sedate him," Dr. Golden decided.

"Again-" Steve pointed out.

"Yes, well, he would have to be sedated anyway," she told him. "He would need to lie completely still for the MRI to obtain clear pictures and at this time he can't hold himself still while awake," she pointed out and tilted her head at Barnes to indicate his involuntary movements. "The only time he can hold completely still at this point is when he's asleep or sedated… and sedation would also allow us to do what's required without traumatizing him further."

"When do you think you could do that?" Steve asked the two doctors.

Dr. Golden looked to Bruce for his opinion as he would be the one operating the machine.

"Oh, well, I can set it up for after dinner," he told them. "Then he can sleep it off through the night. That way we don't interrupt half an afternoon again with him sedated. Give Steve a chance to interact with him tomorrow without disruption."

Emily and Bruce looked to Steve. They waited for him to make a decision as Sgt. Barnes' guardian.

Steve raised his eyes to them. "How long will it take to get the pictures you need?" he asked. Emily looked to Bruce again.

"Umm, I think an hour… maybe an hour and a half. It'll take a while to be sure we get every angle that we need," he told them.

Steve thought about it for a moment and then nodded his consent. "Okay. Tonight then," he agreed.

"Wait," Sam interjected. "Can he get an MRI? He has a metal arm."

"Well…" Bruce thought about it. "Since we only need to image his head, we can drape a lead apron over his left arm and shoulder," Bruce stated. "That should be sufficient in providing a barrier between the magnets and the metal."

"Okay then, tonight," Steve nodded and turned his full attention back to Bucky. He laid his hand on his friend's shoulder and the contact caused Barnes to lift up his head in response. Steve gave the shoulder a light squeeze and it caused Bucky to flash another smile as he realized who it was.

"Steve," Bucky said softly, making Steve smile.