Fusion

by Diana Kane

  Our silence is broken by my phone going off. I have a consult, a patient has fallen and has a cervical spine fracture. I curse inwardly and start to panic. Depending on the location of the fracture this could require emergency intervention. I release Alex’s hand so I can grab my laptop and pull up the patient’s CT. The fracture is a small chip of bone off of the C4 spinous process. Thankfully it has dislodged itself posteriorly and should cause no threat to the spinal cord. I could go down and remove the fragment, but it isn’t worth putting someone through surgery for that reason alone. I look through the scan one more time, double checking for missed fractures or any compression on the spinal cord. Everything else looks great.

  “We have something coming down?” I jump, having forgotten that Erin is here.

  “Nope just a consult. Small chip off of C4 posteriorly.”

  “Brace it is then.” Erin knows her stuff. It makes me appreciate her that much more. I return the call to the trauma resident informing him of my findings, instructing him to admit the patient and put him in a Miami J cervical collar. We will keep him for observation and pain management until he feels like he is ok to go home.

  “Erin, why was she out so late last night?” I’ve resumed my post, Alex’s hand back in mine.

  “What do you mean?”

  “I mean why was she out in that weather so late last night? Her shift ended hours before her accident. What was she thinking?”

  “Her shift should have ended. She volunteered to stay late when most of the evening staff had called in and we didn’t have enough techs to handle the cases we had going. We both did.”

  I shake my head in disbelief. She could have avoided this. If she had just been selfish for once and gone home, we wouldn’t be here. Hadn’t she told me Elena had said the same thing to her over and over again? Oh crap Elena! I have no idea what to do about Elena, no idea if they have even spoken since Alex moved out of her house. I will have to leave it with Abby.

  “So the two of you huh?” I am so focused on the Elena thing that Erin’s question fails to register.

  “Sorry?”

  Erin looks pointedly at my hand, the one locked around Alex’s. “The two of you. Are you the reason she has been miserable these past few months?” Erin isn’t known for mincing words, something that I admire. This however is dangerous territory. My observations have given me the impression that she isn’t one for gossip, but even this might be too much for her to keep quiet.

  “Erin, I—.”

  “Look I don’t care about some scandal or stirring up some new rumor for everyone to sink their teeth into. I just want to know if you’re the reason why Alex hasn’t been herself lately. If you’re why she has shut herself off, why she is running on autopilot, why she just wants to work and go home to be alone.”

  I had no idea that it had gotten that bad, no idea that Alex was suffering so much. Consumed by my own emotions I had failed to see how much she has been hurting. “It’s complicated.”

  “Not really. Pretty basic. You either care about her or you don’t.”

  “Still way more complicated than that. Look I will give you a brief summary but I need you to hold it in confidence. Can you do that?” Erin nods that she can. I give her a basic outline of events, keeping things as simplified as I can. When I finish Erin has no immediate response.

  “You know there isn’t a rule forbidding it.” I have reestablished my focus on Alex, so it takes a second for me to follow Erin’s intent. When I don’t answer she continues. “They won’t allow her to scrub your cases anymore just in case there is ever a lawsuit. That is it, the whole policy. People in a relationship can’t work in the same room.” A sacrifice worth making in my book. Hell, at this moment I’d give up operating all together if Alex would simply wake up and be ok.

  A few minutes later Erin rises from her seat and heads towards the door. She stops at the foot of the bed and looks at me, waiting for me to shift my focus to her. “When she wakes up, you don’t get to hurt her anymore. Time to either call or fold doc.” I had no idea Erin is a poker player. She doesn’t wait for my response, just makes her way out the door.

  *****

  I realize I’ve drifted off again as I wake up with my head resting on Alex’s thigh. It takes a second for me to sense that I’ve let go of her hand as well. I reclaim her hand and give it a gentle squeeze. “At least I didn’t drool in your lap.” Something stops me, real or imagined I’m unsure. Could my wishful thinking be playing tricks on me or did Alex just respond? It dawns on me that I forgot to reevaluate her GCS score earlier. Ok calm down Catherine, think with your head not with your heart. I take a moment to collect myself, steel myself for what I’m about to discover. I squeeze her hand, trying to replicate the pressure I used last time. Nothing. “Come on Alex, I need you to squeeze my hand,” I plead as I give hers another gentle squeeze. There! It takes a second but this time I’m sure. She is trying to respond. I keep hold of her hand, I can’t let it go now. “Alex I need you to open your eyes.” I wait patiently. “Alex open your eyes.” Movement, finally movement, even if it was just the slightest twitch. She can’t open them but she at least has movement. I let go of her hand only to recheck her other stimuli responses. Still good. I call respiratory. I want to take the tube out, but need to be sure they agree it is the right call.

  Abby returns while I’m consulting with respiratory. The look of concern is immediate as she enters the room and sees all the unfamiliar faces evaluating Alex, making their determination. Eventually Dr. Shaw turns to me. I can’t read him, maybe my personal attachment here is serving as a block. I know my anxiety is making me impatient. I want to grab him by the lab coat and shake the answer out of him.

  “I agree the tube can come out. She’ll need close monitoring though, just to be safe.” I look to Abby, the relief visible on her face.

  “Neither of us are going anywhere.” Satisfied he and his staff get organized, their suction at the ready, a replacement tube on hand just in case. Neither Abby or I can sit, our anxiety is too high. We’ve clasped hands again as we stand and wait.

  “Ok, all good.” I don’t realize I’ve been holding my own breath until Dr. Shaw makes the announcement. The exhalation taking a small bit of the weight off my shoulders with it. As the respiratory team takes their leave I can feel Abby looking at me expectantly.

  “Tell me what happened!” We take our seats as I fill her in.

  “We still have a lot of hurdles to clear, but she is moving in the right direction. When they brought her in she had good reaction to painful stimuli but she was unconscious. Her response to stimuli is still good, now she is starting to respond to verbal commands as well. By taking the tube out we can get a true measure of where she is at.”

  “So right now?”

  “I’m cautiously optimistic.”

  *****

  Abby left her daughter with her mother so she would be free to stay with Alex. I am grateful for the company and that she will be here if I have to operate. We set up my laptop and find a few movies to watch, the rule being they have to be movies that Alex loves. Abby makes a quick trip to the cafeteria and gift shop to procure caffeine and snacks. We settle in for a long movie night, neither of us wanting to miss it if Alex shows any improvement. I choose first and select Carol. Abby hasn’t seen it yet and I know Alex has been waiting for the digital release so she can own it. I remember when Alex and I saw it over Thanksgiving, how I identified with Therese and couldn’t understand how Carol could lead her along that path, knowing what her situation was. Now I know how big of a fool I was for feeling that way, I’ve now seen it from a new perspective.

  We finish Carol and take a break to stretch our legs. I use the time to check Alex’s drains. They are still nearly empty so I elect to take them out and put an order in for another CT tomorrow afternoon, just to be sure the the bleed is still under control and her pressure is still good. I am being overly cautious, I know and I don’t care. Abby isn’t back yet so I talk to Alex
. I remind her how I feel about her and plead with her to wake up. Abby eventually returns and we start up her choice, Sliding Doors.

  Although I’ve seen Sliding Doors before and enjoyed it, I can’t help but start playing out all the what if’s that could have altered Alex’s outcome in my head. I know it is pointless but I cannot stop it, they play endlessly on. I finally get to the question that I still don’t know the answer to. It doesn’t matter that the movie is on, I have to ask the one person who might know. “Abby, why did Alex leave?” Abby looks at me and it is clear that she is not following what I’m asking. “Why did she move out? I never asked her to, never wanted her to. So why?”

  Abby sighs and looks at Alex as if she is waiting for her approval. “I’m not sure I should be telling you this. It really is pretty obvious if you think about it, although I doubt she would ever admit to it if you confronted her with it. She ran because she is scared.” I don’t follow, the pieces of the puzzle I have aren’t lining up the way Abby suggests they should. I look at Alex then back to Abby. “Think about it. Everyone who should have been there for her no matter what has abandoned her at some point. Her father never cared or took a real interest in her, her mother was cordial at best when Alex lived by her rules and standards. As soon as Alex fought against those her mother tossed her aside. The people she is closest to have all proven that they aren’t going anywhere in some way. When you told her you weren’t sure how you felt it set off the alarms. She couldn’t allow herself to continue to develop deeper feelings for you thinking you would abandon her. So she protected herself the one way she knew how to, she left.”

  I’ve forgotten about the movie, Abby’s information playing on a loop in my head. I squeeze Alex’s hand, willing her to understand that I’m here, that I’m not going anywhere. A small twitch is her response, not huge but more movement than earlier in the day.

  *****

  Sunday morning arrives without any change. Abby agrees to hang around so I can complete my rounds, shower and eat. I complete my rounds and discharge one of Dr. Hasting’s patients. Rounds and charting complete I quickly make my way to the cafeteria where I grab a bacon, egg and cheese sandwich on a biscuit. I practically inhale it as I make my way to the locker room for a quick shower and change of scrubs. I just want to get back upstairs to the ICU, to Alex’s side. I realize that my impatient nature is not helping, but I really hoped to see some more improvement by now. I am starting to become paranoid that I elected to remove her drains too soon and the bleed is not under control, increasing the pressure on her brain. Constant reminders to myself that her progress is normal are not helping to alleviate my anxiety.

  I get back to the room as quickly as possible. I try to tell myself it is so that Abby can take her own leave, go home, shower, eat and check in with friends to update them, but selfishly I know it is because it is where I want to be. I tell her to take her time, that I will send a text if someone comes in that I need to operate on. I know I have been quite lucky so far this weekend, luck that will surely run out.

  I find myself alone with Alex again. I check her incision sites and facial lacerations. Things still look good. Her lips are dry so I grab my chapstick from my bag. She has some facial twitches while I’m applying it, the sight reinvigorating the hope that was starting to fade. I take her hand once more and stroke her face as I talk to her. I tell her that I can’t wait for her to wake up, so we can see what this is between us. I tell her that I’m here and I’m not going anywhere. I tell her I need her to wake up so I can tell her all of these things when she will remember them. I take out a book and read aloud to her for a while. Probably not a book she would read under normal circumstances, but it is what I have with me. When I tire of the sound of my own voice I set up the laptop and start up Game of Thrones. Many people have told me over the years that I need to watch it and I know Alex loves it. I am halfway through the second episode when I realize that tomorrow is Monday and I have cases scheduled. I pull out my phone and look at my calendar to see what it is I am supposed to be doing. Three elective back cases, none of them urgent. I contact the on call PA and ask her to contact the patients to reschedule. It doesn’t matter to me that I will end up working late several nights to make up for it, I just need to be with Alex.

  I am a few episodes into the show when transport arrives to take Alex for her CT. I need to stretch my legs so I make the trip down to CT with them. I know it will be a little while so I head down the hall to the ER just to see if anything is happening.

  “Dr. Waters, I was just about to page you.” I turn to see one of the trauma residents, I am not sure what his name is.

  “Have something?”

  “23 year old male with a cervical fracture. I actually have the CT called up here if you’d like to take a look at it.”

  Shit! This might require surgery. I look over the scans a few times. The patient is young, too young for me to really want to do a fusion if it can be avoided. I look at the scans a final time before deciding to go with a halo application to see how his healing progresses. The fusion can happen later if he doesn’t show signs of healing properly, but with his age a conservative approach is better long term. I’ll have to take him downstairs, but it isn’t a lengthy procedure. I get the patient information and head over to see him. I’d like to get him downstairs and into the halo as soon as possible.

  Alex is back from CT when I return from the short procedure. “Sorry I was gone so long, had to put a halo on someone.” I’m not sure what possesses me to do it but as I take her hand I lean over and kiss her on the forehead. I pause in the middle of standing up, certain that I just heard her make a sound. “Alex can you hear me?” Nothing. “Alex can you open your eyes?” More movement than last night! I ache to see her beautiful green eyes staring back at me. I take my seat and look up her latest CT. Everything looks good.

  Abby returns late in the afternoon, carrying a grocery bag. “My mother made chicken noodle soup and bread. She wanted me to bring you some.”

  I smile, hopefully hiding how surprised I am. “You told your mother about me?”

  “Not in great detail, she knows you are essentially holding a permanent seat up here. She likes to make sure people are fed.”

  I chuckle as I picture an older version of Abby in a kitchen preparing far too much food. “Well tell her thank you for me. It smells delicious.”

  “I will. You know I can stay here with her if you want to go home and sleep in your own bed for a while.”

  “Thanks but I’m fine. I’ve already cancelled my scheduled cases tomorrow. I’m still on call until the morning as well. I’ve been sleeping on and off here. We’ve been watching Game of Thrones.”

  “Great show. If you are going to stay would you mind if I went home tonight, see my kid and sleep in my own bed?”

  “Not at all Abby. I will call you if something major happens.”

  “Thanks. I’ll check in tomorrow before we start our first case. Want to continue Thrones?”

  “Sure.” I start up the next episode and take my soup from Abby. It is good, but not as good as it Alex’s. Abby heads home after two episodes leaving Alex and I to continue the marathon on our own.

  I wake up with my head in Alex’s lap once again, only this time I have drooled. I wipe the side of my face as I stand up to stretch, glad that Alex won’t remember this when she wakes up. I use the bathroom and walk around the limited space in the room a few times. I grab the chapstick to keep her lips moist. As I am applying it I know I hear her try to make a sound, this time I have zero doubt. It is brief and incomprehensible but it was there. “Alex, it’s Catherine, can you hear me?” Another grunt. “Alex can you open your eyes?” It takes a second but she manages to open them just slightly! I kiss her on the forehead and run my fingers down her right cheek. She twitches and grunts. I kiss her forehead one more time and whisper, “Keep fighting baby.” I resume my seat and squeeze her hand. This time there is a soft attempt to squeeze mine back. Knowing I won’t be sle
eping anytime soon I restart the last episode of the show and continue on.

  *****

  I don’t bother to fight it this time when I start to feel tired. I simply lay my head on Alex’s thigh and give into sleep. I’m pulled from my stupor by the sense that something is off, something has changed. In a matter of seconds I realize that Alex’s hand is gone. My eyes fly open as I bolt to an upright position. I must be dreaming, I am not seeing what I’m seeing. Alex is awake, eyes half open, a look of extreme confusion on her face. “Alex?” She looks at me, her confusion still thick like a fog. Tears start to form and I fight to hold them back. I need to stay calm for her. “Alex you were in an accident. You are currently in the ICU.” Her confusion seems to lessen a little as she takes in what little the room has to offer. Her hazy eyes slowly make their way around the room before landing back on me. She tries to speak to me but there is nothing. My heart drops, panic at the idea that she might have lost some speaking ability setting in. Stay calm Catherine!