6. Sick and Injured
His body was on fire, sirens and shouts and flashes of bright light overwhelming him. Everything merging into just too much. He couldn't do it, couldn't hold on, so he let go, the sudden snap of relief just welcome blackness. There was no fight against whatever was holding him down, forcing each breath down his throat. He was dying, he was sure of it, and he was just so exhausted. It wasn't giving up. or giving in, it would just be a rest, just a break.
"Everyone ready? Yeah, Okay. This is Finn, he's 22 and has quite the extensive medical history. He was found by a member of the public on the side of the road, confused and combative. When we arrived, he was in and out but very agitated. Apparently witnessed falling over a few times, initially query intox, but has a medic-alert bracelet on his backpack - He's known epileptic from a TBI, with EDS, POTS, chronic pain, fatigue and a few other mental health conditions.
"When he's fallen, he seems to have hit his head multiple times, he's got two reasonable sized lacs to the left side of his head, and one across his eyebrow. No boggy masses, but cheekbone feels deformed. Obvious dislocation, possible break to left shoulder / collar bone, looks pretty unstable at the minute.
"He is cannulated and tolerating an OP at the moment. He had a possible 30 second seizure as we moved to the ambulance, and he's gone a lot more vacant in the last three minutes or so.
"He's got a temp of 38.6, tachy at 126, hypotensive 98/76. bm of 6.2. Sats have been 92 on air, came up to 96 on 15L. Reduced air entry globally, nothing being shifted on the right base, sounds very congested and crackly there. We've got NOK details from his alert card, so can give them a call while you guys get him sorted, if there's nothing else you need from us?"
When Sheila had called Fao in the middle of the night to say his brother had disappeared, he had to admit it hadn’t quite been what he’d expected. He’d known Finn was struggling with a chest infection of some description, and they’d been worried about seizures, and so he expected the call to be from his mum saying they’d had to go to A&E.
He’d been sitting up with a cup of tea, just in case Finn turned up at his place, when his phone rang again, showing as No Caller ID. He snatched it up, immediately hitting answer.
“Hello?”
"Hi, is that, uh, Faolan?"
He winced. “Yeah, that’s me.”
"In just ringing about your brother, a Finn Daniels?"
He sighed. “What’s happened?”
"He's been brought into the ED, he's…he's quite unwell at the moment. It might be best if you were able to come in?"
“Has he had a seizure?” Fao asked, glad he was already dressed. “I’m on my way in.”
"I think it's best if we explain in person."
Oh, fuck. That didn’t bode well, and Fao felt a cold fear run through him. “George’s? I’ll be there in ten.”
"Yeah. Did you want to let the family know? Or would you rather I called them?"
“I’ll call them.”
"Thank you."
“Thanks for calling me.” Fao murmured.
"I'm sorry it's not good news. Be safe getting in."
“Mm, thanks.” Fao said softly, before he put the phone down. He drained his mug, shoved his shoes on and grabbed his stuff before he woke Ollie to tell him he was going and he didn’t know when he’d be back. The drive to hospital was quick, Fao definitely not speeding. He called Sheila on the way, explaining what little knew, and soon he’d found somewhere to park and rushed into the hospital.
Finn had continued to swing between agitated and not, the staff only growing more concerned. He'd been sedated slightly, mainly just to get him through CT, but they'd still yet to get a coherent response from him. Even the mention of Fao coming to see him didn’t seem to break through, Finn staring blankly through them.
When Fao finally got to the reception desk, he felt like he was going to lose his mind. He hated not knowing anything, whoever he’d spoken to on the phone so vague and unhelpful. Yes, he appreciated things were best discussed in person, but an idea was helpful. He didn’t even know if this was a seizure, though with what Sheila had told him it was somewhat likely.
They took him through, but he wasn’t allowed straight into resus, instead shown the relatives room to wait. He paced up and down like a caged tiger, his hair a mess from how many times he’d run his fingers through it, though it fell in his face all the same.
There was a sharp knock on the door, all too clinical and harsh for the situation. "Hi, is it Fao?"
Fao stopped pacing. “Yeah. What’s going on? Nobody’s told me anything.”
"Sorry about that, do you want to have a seat?"
“Is he alive?” Fao barely dared to ask the question.
They softened, giving him a small smile. "He is, he's currently in our resus bit. He's very not well at the minute, and we're waiting to get him stable enough to take up to ICU."
That wasn’t unusual for Finn, as awful as that was. His shoulders slumped with relief that his brother was still alive, and he scanned the doctor’s face to try and work out what was going on. “Was it a seizure? He’s had an infection brewing and that always sets him off, are we talking status? If you’re waiting on ICU I’m assuming he’s been tubed? Have you spoken with his consultant? I think he was looking at trying to arrange an admission anyway.”
"We're not entirely sure what's been going on. He was picked up at the roadside, by the sounds of it he'd fallen quite a few times. He's got some pretty significant head injuries at the moment. We've not intubated him yet, no, but it's looking likely that's the way it's heading. He's currently just about managing with some extra support, but it's…he's got a significant chest infection, pneumonia, and we're not sure if the falls he's had has made it worse, but his lungs aren't working as they should be." He sighed. "We've not been able to really have a chat with him at all, he's been very agitated and quite combative, so we've sedated him a little bit, for his safety. He currently has a little piece of plastic in his mouth, just to help him keep his airways open. It's not the most comfortable for him, but he needs it with the medications and the stuff going on."
Evidently this was going to be a long conversation, and Fao was sore from the sheer amount of pacing he’d been doing. He sat down, nodding. “Alright. I got a call off my mum about an hour ago saying he’d gone missing and was he at mine.” He murmured. “Has he had a CT for the head injuries? He can be really agitated and combative especially when he’s feeling overwhelmed. He doesn’t like to be touched, he doesn’t like a lot of people around him, especially after a seizure. I’m happy to give you any social or medical history that would help you out. He really hates things on his face, it’s a struggle to keep oxygen on him when he’s postictal, he’s a nightmare. He doesn’t always tolerate the OP well as he comes around so you’re best keeping him sedated a bit. He’s well known to ICU, his seizures unfortunately often lead to him in status and needing to be intubated.” He wasn’t trying to tell this doctor how to do their job, but it was hard when this was his little brother.
"That's very helpful to know, thank you." They said, and meant it. "We're just currently waiting on the CT report, so we'll be able to give you a bit more insight then. Unfortunately his agitation has been pretty constant, even when left alone. And, with the infection, he needs to be on the oxygen, he's not managing without it at the moment."
“Yeah, I appreciate that.” Fao said. “He’s epileptic from a tbi as a ten year old, he always really struggles with his seizures when he picks up infections, and he’s been through some difficult personal stress in the last six months or so as well as some meds changes which have also made his seizures more difficult to control.”
"Of course. You can come and sit with him, if you'd like? I will warn you he does have quite a few injuries, he might not look quite like himself.
“Nothing I can’t handle, I’m sure. I was with him when he had his initial TBI.” Fao said, standing up. “I’d like to see him.”
"I can't imagine how difficult that must have been."
“Makes Afghanistan look like a walk in the park.”
"Did you serve?"
He nodded. “Four tours, medical corps.”
"Wow, that's a lot."
“Yeah. Can I see my brother now?”
"Of course. Can i get you a cup of tea? Coffee?"
“I’m fine, thanks.”
"Alright, just let me know. I'll let you though."
“Thanks.” Fao said, following him through into Resus. It was busy as always, though it was familiar to him now. His eyes flicked over to the bays, trying to find his brother’s. He hated this, being on the back foot with him. As much as moving out had been so much better for his mental health, it had its challenges too.
Finn was crowded with doctors and nurses, poking and prodding at him. Unlike normal, he was too still, too quiet. While they'd obviously tried to clean the blood from his head injuries, each period of agitation had quickly opened them back up. His shoulder was almost in a sling, though it was clear he'd fought against that not so long ago.
Fao’s eyes flicked critically over the monitors, trying to gauge where Finn was at. Not great. He took a moment at the foot of the bed, watching them work. Finn really didn’t seem like Finn, though at least he wasn’t fighting them in that moment. He fiddled with the lighter in his pocket,something to keep his hands busy. He’d instinctively reached for his tags, but they weren’t there any more, and he needed something to do.
One of the nurses caught sight of Fao in her peripheral. "Hi, you must be Finn’s brother?"
Fao nodded. “Yeah. Sorry to linger, I didn’t want to interrupt you all.”
"No, no, of course not. Come on, you can come say hi to him."
Fao pushed through to come along side his brother, a stark contrast to how he usually was at work. They’d not recognised him yet, but he hadn’t been there long, and he was likely just another faceless surgeon when he was down there. He gently reached out to take Finn’s hand, cautious of a reaction from him.
“Hey, Finn. It’s me, it’s Fao.”
Fao's voice, as it always seemed to, managed to break through to Finn. He blinked at Fao, his gaze dropping to their hands.
“Hi. Got yourself into a bit of a mess, eh?”
"Oh, he definitely recognised you there." The nurse smiled, fussing over Finn. "Bet you're glad he's here, yeah? You'll have had him worried sick."
Fao squeezed his hand. “You’re a nightmare, you know that? Causing all this lot trouble, too. Look at you.”
The recognition he'd had quickly vanished, Finn looking straight through the lot of them. He pulled his hand from Fao's to rub at his face, his hand coming back red.
“It’s okay.” Fao soothed. “Do you think I could try and clean these wounds for him? I’m a doctor, I’ve got ID somewhere.” He asked, digging around in his pockets.
"We shouldn't…" She hesitated. It was the most settled Finn had been, and the closest any of them had gotten to him. "I'll grab you some supplies."
He finally found his ID, the lanyard jangling. “Here, and I can give you my GMC if you want to document it.” He said, offering it to her. “Thank you.”
"Ah, brill. You know what the paperwork is like. Do you want a seat?"
“That would be great, thank you.”
"Won't be long." She said softly, resting her hand on his arm before disappearing off.
“Thanks.” He murmured, leaning on the rails of the bed whilst he waited, watching his brother carefully.
Finn seemed to fade back in, catching his brother’s eye and holding his gaze. A frown flickered across his face and he shoved his arm in Fao's general direction with a groan.
Fao took his hand. “Hey. Bet you feel shit right now, eh?”
He spat the plastic from his mouth, dislodging the mask on his face. "My chest hurts."
“Mask needs to stay on, Finn.” Fao told him, but didn’t move to adjust it. “It’s going to hurt, you’re not well.”
"Then help." He narrowed his eyes, his chest crackling with each breath. The cough didn't take long to follow, but Finn didn't move to cover his mouth or turn his head.
“Here, let’s get this back on.” Fao said, adjusting the mask. “I know it’s horrid, but it will help you out.” He was definitely out of it, though seemed more coherent than before - coherent enough to complain, anyway.
Finn scowled as Fao got close, but whatever argument he had planned was quickly lost. His arms stretched out, his shoulder dislocating once more, and his back arched in a seizure. His eyes were fixed in the corner as he groaned, his body contorted and stuck. It finished as quickly as it had started, the extra exertion making Finn struggle and cough.
Shit.
Fao winced as Finn’s shoulder slipped out of place again, as his back arched and the seizure took him. He was about to hit the emergency bell when it stopped, Finn struggling with his breathing again as his body tried to catch up. He considered going to find someone as the nurse reappeared, chair in hand.
“He’s just had a seizure, all of about two seconds long, and that shoulder’s gone again.”
She winced. "Ah, bless him. I'll get some more diazepam for him. The anaesthetists are on their way down, they'll probably have a chat with you. You probably know them, at least better than you know us."
“Maybe, yeah. I’ve not been here long. He needs his neuro really.”
"I think it's Dr Cunningham on this evening."
“Perfect.” Fao said, unable to stop the smile. “He’s Finn’s main consultant.”
"Oh, that's worked out well then." She said gently, moving to check on Finn.
The younger man had returned to his vacant staring, though still struggled to catch his breath. His saturations hovered just under acceptable, and the doctor sighed from behind them.
"We'd hoped to wait, but I think we should go ahead and get that chest drain in now."
Fao hummed. “Worth doing whilst he’s a bit more settled than he has been.” He took a seat gladly in the chair the nurse had brought him, stroking gently through Finn’s hair.
"Right, let's get an airway dump, just in case, and then give him a little more sedation. No point making it worse for him."
“Can I stay with him?”
"He's fine to stay." The nurse told the doctor. "He's fine."
Fao glanced at the doctor, relieved the nurse seemed to be on his side. He couldn’t leave Finn again, he just couldn’t. Besides, clearly he was doing something right, because his brother was settled.
"We'll get you to sit on his other side, yeah? We might have to move you, so just bear with." The doctor happily listened to the nurse. "How are we getting on with that sedation? Got it? Brilliant. Let's get this done for him."
