"Oh Wam, I'm so thankful you're here. Wanda is in surgery, getting her leg set. They said tib-fib fracture, if that means anything to you? Kara will be okay, she was in her car seat, but Halian here is in rough shape. Please Wam, save him."
I enveloped my youngest sister in an embrace and tried to reassure her, "I'll do my best Mona."
Dr. Yankton came walking through the curtain with ipad in hand, ready to update me on my nephew. I listened briefly as he explained Hal had been thrown backward through the front windshield, hitting the back of his head on the mangled hood of the car. Looking at my nephew, lying on the cot in the trauma bay, the usually energetic young man seemed lifeless. His head was swollen with dried blood turning his normally black hair, a reddish color. A once white C-collar remained around his neck but was marred with browns and reds. An endotracheal tube had been placed in his small mouth, a ventilator whirring and hissing with each breath to help keep young Hal alive. His usually dark tan skin was much too pale along with a much too elevated pulse, and a barely normal oxygen rate. No doubt, the swelling was putting pressure on his brain and pushing against the skull. I needed to see imaging to know if he could survive with burr holes, or if a piece of his skull would need to be temporarily removed.
I did a quick neuro assessment before looking closely at the imaging and ordering Hal be prepared for surgery. Dr. Yankton said he would call in the third on-call team. Team one was on the other pediatric surgery, and team two was fixing Wanda's leg due to the compound fracture, bleeding, and chance for developing an infection.
I couldn't think of Wanda, sweet Kara, or even of Mona's sad emotional state right now. I had to push all my emotions to the back of my mind and focus on what I did best... save lives.
Initial assessment of the closed head injury showed profuse swelling and hematomas. Hal's pupils were uneven, response was sluggish, and he was unresponsive. All ominous signs. Within an hour of my arrival, we were in the OR (operating room) with Hal's head shaved and presented for easy to access. My main concern was the acute subdural hematoma that was worsening and increasing pressure by the moment. As expected, there was little blood outside the skull, but upon removing a piece of the skull and placing it in preserving fluid, we began to suction blood and clots from the surface of the brain, inside the skull. I was able to stop a small but active bleed with cautery. Once the pressure was relieved and bleeding stopped, I did another neurological assessment, with a slight improvement in findings. Hal would be kept in a coma for several days to allow his brain to heal. We would discuss replacing the skull piece, if he improved. Hal was young, and children usually heal better than adults from things like this. Time would tell and be the true test.
It had been a long and much busier day than I anticipated, but I wouldn't want anyone else caring for Hal. It was nearing five in the evening when I stopped and checked on Wanda. I found my mother there. I could immediately tell she'd been crying as she sat at Wanda's bedside. I knelt down in front of her and gave Mom a huge embrace. She hugged me back like her life depended on it. "I'm so glad to see you my son." Mom pulled back slightly to meet my eyes, but did not release me. "They said Wanda's surgery was a success. She just looks so small in this big bed. I won't even talk about that ugly contraption on her lower leg." Mom's hand flew to her mouth, the tears started again, and I could see her bottom lip quiver slightly around her hand.
"Momma, the external fixation device allows them to better stabilize the fractures. I know it looks bad, but it's only temporary. Hopefully within three or four months, Wanda will be up chasing Kara again. Where is Kara? I heard she was in the car too."
"Yes, but Kara is okay and went home with Alec, thank goodness. How is Halian?" She asked in a serious tone.
"Well, we had to remove part of the skull to relieve pressure. We stopped bleeding and removed numerous clots. I already saw a slight improvement in his neurological exam, so that's promising. I'm not gonna lie though momma, his injuries are serious. It's not going to be an easy recovery for any of them." I ran my hand through my hair, took a deep breath, and stood. "Do you need anything Momma?" Mom simply shook her head, a true sign of how shaken up she was. "I should go update Mona. Hal should be in recovery by now. I'll check back with you and Wanda before I leave okay?" Mom nodded. I patted her shoulder and made for the surgery waiting room.
Mona was sitting in a vinyl covered chair, her head in her hands, elbows resting on her knees, and her shoulders shaking slightly. I sat in the chair next to her and pulled her into a side hug. What had been slight shaking, became wracking sobs as her whole body shook with her head against my chest. We remained like this until the shaking subsided and I could hear her breaths become longer and deeper. She sat up and thanked me, "thanks Wambleeska. I needed to let that out."
With an exaggerated cringe, I said with horror, "Wam, please! Here are some kleenexes," I said as I sat the box on the end table next to her.
"Whatever would make you think I needed kleenexes? Haha," she jokingly but in a deadpan voice as she wiped her eyes with the tissues.
I gave her a sad smile and then filled her in, "Halian's surgery went well. We were able to relieve the pressure as well as stop the bleeding and remove clots from the surface of the brain. His neuro checks were already better after surgery. A positive sign for sure." Mona nodded in response. "I stopped and saw Momma and Wanda too. Wanda is still very sleepy from the anesthesia and pain medication. They put an external fixation device on her lower leg, but it should heal okay in time. Mom is taking this really hard though." I looked over at Mona and put my hand on her shoulder. "How are you holding up?"
"I'm okay. I just feel bad for them because Wanda was finally happy after marrying Alec and getting visitation set up for Hal with her jerk of an ex. Now everything is all in chaos again. It's like the spirits don't want her to be happy. It's just not fair Wam!" Mona had a determined look on her face.
"Life isn't fair sometimes Mona. You know that. What would Dad have said? 'Life isn't fair, and It isn't a circus either.'" We both laughed at the memory.
"All we can do is be there to love and support them as much as possible while they recover. You already do so much to help them. I know Wanda really appreciates it." I looked around as I spoke, but we were the only ones present on a Sunday evening in the surgical waiting room. "Hey, why don't you let me show you to Hal's room in the ICU. He will be there for several days at least, because we will keep him in a medically induced coma to allow his brain to heal itself. I guess I didn't think to ask, what happened to the driver of the other vehicle?"
Mona took a deep breath, "well, the cops said it was an elderly gentleman who pulled out in front of Wanda. The guy didn't believe in seatbelts, and he died at the scene. Pulling out in front of a car going 55mph and getting t-boned, doesn't usually have a good outcome. The guy was wearing a 'do not resuscitate' bracelet and had paperwork filed here at the hospital, so they did not attempt to bring him back. That's all I know." Mona blew out a deep breath as we walked.
"I hope for his sake that he went quickly." I glanced up at the board behind the nurse's station and saw Hal was in room 2, across the hall. I led the way for Mona and found Dr.Yankton checking Hal's pupils again. The oximeter showed Halian's vital signs were improved compared to prior to surgery. "Anything new Dr. Yankton?"
"It's just remarkable to me how quickly things can change in neurology." Dr. Yankton turned toward Mona before saying quietly, "you were right to convince me to call your brother. Hal may not have made it until 4pm when the other surgeon was available. Dr. Teton is a miracle worker." Turning back toward me, he said, "we needed a hero today and you came through for us Dr. Teton."
I shook Dr. Yankton's hand and tried to use this as a teachable moment. "You knew Dr. Yankton that something needed to be done. I think you'd have made the right call with or without my sister's persuasion. Don't be afraid to trust your gut."
"Yes sir," he responded.
"Okay, enough of this 'sir' stuff. I know you're trying to be respectful, but I'm not elderly yet. Please call me Wam."
Dr. Yankton's face flushed slightly, "okay Wam. Please, you can call me Yank. That's what all my friends call me."
I nodded and moved up next to Hal's bed. His skin color was already less pale. I heard my sister talking quietly behind me, "thank you Dr. Yankton for helping save my nephew. I'd like nothing more than to take you to dinner and thank you properly. Here is my number. Give me a call if you're interested... Yank."
I couldn't help but look back at the two. Mona had a flirty smile on her face and Yank looked like a deer caught in the headlights, but one that was blushing profusely. I'd bet the good doctor doesn't have much experience with dating. They'd be a cute couple.
"Well I've been awake since four this morning, everyone seems stable, so it's time for me to head home." I side hugged Mona, shook Yank's hand, and kissed Hal on the cheek.
After a quick shower and clothing change in the locker room, I stopped to say goodnight to Wanda and Mom. Unlike earlier, my main focus now was food and sleep. I opted for a sub with lots of fresh vegetables instead of unhealthier fast food options.
My cat greeted me as I entered the front door and then proceeded to follow me around complaining about leaving her with only the housekeeper to check on her for days. Once I gave her some of my meat from my sandwich, all was forgiven. I could hear her purring, she rubbed against my legs, and followed me to bed where I scratched her under the chin and stroked her fur until I fell asleep.