s. p. o. l.
just one more piece
- - -
On November 2nd, a Friday, Jared was hit by a truck on his way from the grocery store.
He hasn't woken up yet.
With time, it gets quiet.
They shaved his head, back then.
The surgeons considered it important to remove anything that might obstruct their view or contaminate the surgical site with bacteria.
It was the sight of someone else.
Nightmare material. Bleeding, bald, breathless.
After the surgery, they made a decision.
A bridge built between loss and chance. Specified, a medically induced coma.
This is the best option, the Doctor explained. It will help bringing down the energy requirements and swelling of the brain.
Jensen researched that one. Frankly, he researches everything they say. Thoroughly.
Control freak? Possible. If that's the term you choose.
He prefers to cut the cake into 120º thirds.
Time, anxiety, semi-acceptable hospital wireless.
You don't want to taste that cake.
Due to the injuries, Jared's brain wasn't getting enough oxygen.
Therefore, a fluid collection began to form within the brain tissue, which led to increased pressure inside the skull.
Which is bad.
Nerd prob'ly could've explained it better. For now, the XS summary will do.
Obviously, the family couldn't do much.
They were to wait, wait, wait some more.
So they did.
Just tried to keep talking, and hoped for the best.
In a way.
Time is everyone's frenemy.
"Good morning. Good morning, hello. Good to see you."
Dr Chau's hand retracted again, joining the other firmly holding his clipboard.
He took a big step back, taking in expectant eyes.
It was the day after.
"I'll cut right to it", he spoke curtly. "As soon as the swelling has gone down and Mr Ackles' state has stabilized, we'll begin the process of gradually reducing the amount of anesthetic drugs. The evaluation for brain injury will be limited until the patient is ready to emerge from medications and mechanical ventilation*."
Jared's dad, Gerald, was cleaning his nose again. It was constipating his voice.
"Well", Doctor explained, maybe one tad too slowly, "TBI* is different from, say, a punctured lung. It doesn't heal like other injuries."
From the corner of his eye, Jensen saw Megan raise an eyebrow. Carry on.
"Recovery is a functional recovery, based on mechanisms that remain uncertain", he stressed. "No two brain injuries are alike, so the consequence of two similar injuries may be very different. The exact extent of the damage will be determined best with the conscious patient."
"How long?", Megan prodded, chin held high.
Unlike most of them, she hadn't cried a single tear that day.
Generally doesn't, as far as Jensen knows.
"Can you give us a picture?"
When he met her, about a year ago, she was fire-spitting intimidation.
Not the only 'Hurt him, I'll kill you' talk he received on that day, but hers sure made him sweat.
"Only a blurry one", was the honest reply. "Could be days, or even weeks. The earlier the better, of course."
Yeah, that was a month ago.
The leaves have fallen off, and their breaths are white as they step over the parking lot for the umpteenth time.
He's wearing the grey beanie and bags under his eyes.
Against his half-hearted speech of reassurance, Gen made him stay the night.
But beds are too comfortable now. Heaven for his back. Oh, definitely.
Equally definite, a torture for his head.
Somewhen in the A.M.'s, sleep found him on a kitchen chair. Left arm stretched far out over the table.
This hospital wing is a pastel yellow. Despite the hue, it looks trist against the white sky.
White skies and no rain, the freaking irony.
They don't stop outside anymore, because Chad quit smoking.
So there's that.
Bit by bit, Jared's hair has started to grow back.
The hair on top measures about two and a half inches. It almost covers the bold mark on the temple, not quite healed.
There used to be a deeper gash on the upper back of the head.
He saw it a few times, when the bandages got changed. He saw it, wanted to look away. Never did.
It's a wide, dark red scar now.
Jay will be pissed as fuck, says Chad. He'll sue them for ruining his dream career as, uh, hair product ad model. Or whatever it's called, yikes.
It's the closest Jensen gets to a smile.
Maybe he won't notice a difference, Gen mumbles.
'Cause there won't be.
She's standing where the ventilator used to be. The breathing tube has been gone for weeks. White nose uncovered, more room for silence.
Together now, they stare at a sunken profile.
Grey skin and blue veins.
Where are you buried?
One day, Jensen wakes up with the outside matching the walls.
Big, fat flakes; falling as fast as rain.
Just before they reach the ground, the wind pushes them to the side.
The cast on the arm will likely be coming off soon, one of the nurses comments absently; focused on trimming Jared's fingernails.
Her name tag says something with B.
She brings him coffee sometimes.
"Good news first. The swelling has gone down", is Dr. Chau's report on on a Tuesday morning.
They blink back.
"As you know, we regularly do GCS* tests. He's been struggling to follow hardly any commands. The recovery... is taking longer than we thought."
His voice cushions the air. "We simply don't believe he is ready."
Gerald starts mumbling a prayer.
I'm ready, Jensen thinks, staring at a gray stain on the wall.
Egocentric, bitter stain.
It's a fairly small one, you know. Small enough to go unnoticed for weeks.
See, he doesn't care how it got there. He doesn't give two shits. Not now, not ever.
Yesterday he determined his top five theories.
Every hidden corner in this room has been perceived.
You can see Jeff's heart sinking. You can see Sharon hiding her face.
Greed is what sits on his own shoulders.
Nothing new until December 13th.
"We're taking it slow, but we've started the process. Judging by our previous experiences, patients may react sooner under withdrawal. It's worth a try."
Chris is here today.
He plays the guitar and sings.
First a few slow songs from his band. A funny one, a nostalgic one.
Then others. Classics.
Dirty Laundry. The Gambler. Bad Moon Rising. American Pie.
All the good stuff.
Sing with me, Jen. He likes your voice.
Says the friend and sings alone, for Jensen is - he can't open his damn mouth, there's a thing in his windpipe as big as a planet, and he just. He can't.
After the sixth one, he excuses himself.
When it was clear that Jared would be staying in the coma for longer than a week, they moved from short acting sedatives to a longer acting sedative.
Not to forget painkillers. Morphine, Fentanyl.
Long story short, Jared's getting addicted.
Therefore, pulling him out will bring withdrawal symptoms, while and after.
Might slow down the waking up process, too.
Greed doesn't leave; it transforms.
Say hello to desperation.
The aching kind.
Danneel, of all people, is coming more and more often. Often means three to four times a week.
She usually just sits on the opposite, watching the snowflakes through the window, slightly bobbing her head to the beat coming from her earplugs.
Other times, she tries for small talk.
Stuff like You okay?, or Doesn't the constant beeping make you crazy? -, until he excuses himself to the bathroom again.
No, he really is.
He'd rather be alone with restless boy and the snowflakes.
Heartrate monitor and the tick of the clock are part of the quiet now.
They'll end, is what makes him crazy.
They'll end. One way or another.
The length of time spent in coma is used to label the severity of a person’s brain injury.
Once two months are passed, there will be much less to hope for.
Or so the statistics say.
A rewind. Jared's face.
It wasn't just his face. There was blood spilling from the temple wound, streaming down the side of his face to the chin.
The other one, bigger one, was coloring the pavement.
Jensen was at the parking lot, frozen.
He waved. He saw the truck coming from the left, and he couldn't do anything.
He waved, waved. Yelled. Jared. Watch out. Don't jaywalk. There's a. No, don't. Watch out.
Unfreezing, he moved. Everything did.
His knees hit the ground, hands hovering in the air above the mess. He didn't want to make it worse. His voice was left behind somehow - screaming at a shocked passenger having trouble scrambling out their phone.
He half expected Jared to sit up and bellow Sike!, wild jazz hands in the air.
So Jensen stares-swears-'don't you dare's,
and gears up hope's last dirt.
Not gonna lose this one, you hear me.
You hear me.
Night and day, he flinches like a rabbit with every new noise coming from the bed.
No surprises. No jazz hands.
Just a fever.
It's normal, they tell him. The cold sweat, the frown, the shaking. Even the small kicks.
They tell him three times a day.
It's okay. It's all part of the process. These are all symptoms of withdrawal.
Means that it's working. All smooth.
There's a fuck ton of studies and explanations for everything.
Saturn floats on water, rainbows can't be touched.
It is normal that sometimes, Jared's eyes suddenly rip open, gaze through him into another dimension, then flutter closed again.
No reason to.
Weep into your fist at the bathroom sink.
With the first piece o' cake thrumming on his nerves, it gets hard to breathe. And nowadays, it's worse.
Sometimes he gets stupid.
Sometimes he notices something out of the blue - something like, hey, the heartbeats now are much quicker than the ones two minutes ago.
Guess what he does then.
What he does then is think too much.
Shit, why is this happening. Is it just me. What if this. What if that. While the heartrate is still picking up.
Before he knows, he's completely in distress, already rising from the chair to call the nurse, pronto.
'S how it goes.
She never calls him stupid.
She checks the monitor, checks the bandages and the tubes.
Then comes the part where she says it's fine; and has the patience to explain in detail why it's fine, and Jensen pretends to understand and calm down and stop freaking out and be rational for once. Okay. But. Okay. Alright. Thanks. Yeah, I know. Sorry.
They never say it, but they watch him with it.
That unguarded, disgusting pity-and-sorrow mix.
There's just nothing to interpret. It's hanging out in the open.
Jensen ends up spending Christmas Eve at the hospital, with the only things he knows.
A body in construction; its loosely attached soul.
Presents he shouldn't have brought.
Guitar strings he doesn't touch.
No, time doesn't exist for now.
He picks up the guitar.
Puts it down.
A nudge to his shoulder wakes him too gently.
Briana's green scrubs have been replaced with jeans and a reindeer sweater. 'S neither comforting nor unsettling.
"Hey. Merry Christmas."
His eyes dart to - nope, just a dream - , then to the clock, letting him know it's 7 in the morning.
Lastly, down his phone. 7:01, December 25th.
Time flies, but it couldn't fly slower.
"You wanna grab coffee? Some breakfast?", nurse asks somewhere in the background. "It'll be good for you."
He turns his head, and just looks at her.
He knows very well he resembles a mess. He also knows very well that nobody's judging him.
This mess is okay. Relatable. Some called it romantic, even.
There's a whole darker mess in his head.
Sarcastic obscenities, meaningless insults, meaningful insults, fists of anger - plenty, plenty.
All to throw at her, at God, Satan, humanity, all of our deaths lurking somewhere at the end of the cosmos.
He wants to throw. He wants to throw a sharp one.
After a moment, she gives a curt nod. Accompanied by that same sympathetic smile (stop, stop). And walks away, cafeteria's direction. He snorts.
It'll be good for her.
The day is long.
Megan and Jeff stop by at noon. Jensen pulls two more chairs from the waiting room.
They read to Jared.
The Ghosts of Christmas Eve.
And then Megan pulls out a thin, faded book.
From Mom, Jeff murmurs under his breath. Richard Siken. She couldn't book a flight today, but she highlighted her favourites.
Rustling of paper. Megan clears her throat.
"The eye stretches to the horizon and then must continue up", she begins. Soft and careful.
"Anything past the horizon
is invisible, it can only be imagined.
You want to see the future but
you only see the sky."
Jensen peers at the floor, unable to look up.
He doesn't belong.
This is family. He is part of the family, he knows.
Still. Right now, his part doesn't belong.
No muscle moves.
"You wonder what he's thinking when he shivers like that." She clears her throat, again. "What can you tell me, what could you possibly tell me?"
"People get hurt here. People fall down and
stay down and I don't like
the way the song goes.
You, the moon. You, the road. You, the little flowers
by the side of the road. You keep singing along to that
song I hate. Stop singing", - .
She gets up. Need water, she says, blinking furiously.
After the short break, she raises her chin and, because she's Megan, reads four more poems.
Somewhere inbetween, Jeff opens the window.
Jared's heartbeats are even and steady.
They hug Jensen and pat his back, though he hasn't had a proper wash all week.
He's all alone with the stain on the wall. Long after they're gone.
Counts the hours.
Replays every scenario he's already created; the good, the bad.
The ones that don't make sense.
He didn't get what was on his wishlist.
At least he's not the only one.
On the Second Day of Christmas, Dan strides into the room wearing a Santa hat with LED stars.
He takes one look at Jensen's state, and takes a breath.
I'll say this once, buddy. Go home, take a shower. No, a bath. And shave, maybe.
Get at least five hours of sleep, then come back.
I'll keep an eye on him.
He doesn't put up much of a fight.
None at all, in fact.
The exhaustion is hanging from his bones.
He's been sitting too long, too deep in loud silences.
Jensen sets one foot out from the hospital's exit, and a muffled guitar starts playing softly.
His phone rings once. Once, Sundown's opening chords.
It seems to ring forever.
Something like nausea crawls up his spine.
Punches, drumming punches against his ribcage from the inside.
Ten seconds later he's taking several stairs at once, phone lost, cursing blood and gore up the sky as he stumbles, lungs stuck in his throat.
The nurse is there, the doctor is there, Dan is there, the lights are on, another nurse, open tubes, Jared's wide white eyes.
His heavy breath and guttural noises are heard all over the frantic heartbeat monitor, the nurses trying to keep his arms down, the doctor giving instructions, telling the someone to stay back.
"Jared", he says. And louder, "Jared."
Jared doesn't look at him.
Not at anything, really. He's blinking like he can't help it, glassy pupils turning in circles. Jaw hanging lax, hands balled to fists.
Don't belong to him just yet.
And Jensen, he read all about it, heard it all, all, all. All, maybe. Maybe, shit - maybe, he let his expectations break through the roof.
Thing is, thing is, internet said something - aftermath of heavy drugs, might drop out of character, a while, do, say things he normally wouldn't do, say.
He didn't prepare - he did prepare for emotions, in a sense.
Tears, yeah. Sure, sure, out with it, by all means. Immediate recognition? Maybe.
Not this. Not panic. Not, no, no - fear?
Not his ribcage almost bursting.
Someone blocks the view. Someone tells him to take a seat in the waiting room.
Go outside. Take a seat. In the waiting room.
One more time.
Grabs his arm. Not someone, but Dan.
Jensen steps in far enough to close the door, hands immediately fleeing into jean pockets.
Unsure. Awkward. Where to look. How to behave.
How do you possibly behave?
State the obvious, brain suggests.
Stupid brain. He won't do that.
Surprisingly, the face cracks a smile.
Just like that.
It looks too easy.
Four hours ago, it was distorted.
Did Jensen expect to be screamed at?
Before she let him in, Briana had looked at him firmly.
He's still very unstable, and very tired. He should be able to acknowledge you, but you might not get recognized at first. If that happens, don't panic. Stay friendly, stay calm, leave the room if you need to.
He supposes he did.
His nostrils release an unsteady breath.
It still hurts to look.
Dark scars. Hollowed out cheeks.
Drained skin. Pale and dry.
And sitting up doesn't magically make him look bigger. Not really.
It could be the oversized gown. Makes everyone look kinda cute.
Or maybe the hair.
It's similar to the style he was sporting in his early 20s, hazel strands falling down his forehead to greet the brows. Jensen never met that guy - he saw pictures and heard stories, all concluding that baby Jay was a pretty wild cat. When he voiced that thought, his fiancé at that time smacked him upside the head and called him a stupid donkey.
He's lost pounds. Didn't have much to begin with, always been lanky, only growing upwards.
Less to do with the liquid formula, more to do with decreased muscle and bone mass.
Long-term comas will do that to you.
Jensen is proceeding too much, he knows he is, maybe he should. He doesn't know. Leaving now would be a mistake. Cleary. He doesn't want to leave, not if. Well, he is going to cry, if this, and that, he knows he'll break and break down, knows that can't be a good mix with the patient's general confusion, maybe should call Briana, tell her that he's not sure if this is the right time because a quick smile doesn't mean recognition and he's always one to overinterprete things into signs from whatever reality is the most extreme, especially because this is his fre-a chuckle, faint movement from the bed.
His eyes refocus.
Jared is tilting his head, curved mouth never gone.
"Com'ere", he rasps.
He sounds wrecked. You sound wrecked.
But alright. Jensen can do that. Okay. He com'eres.
One, two. Three.
Can't count lashes, arms stretch out, four.
Here feels a little safer.
Long, shaking fingers pull him close.
He lets brain and muscles relax for three seconds.
Throat starts closing up.
Fuck, Jared's grip is tight. As thin as they are, these are Jared's knuckles pressing into his sides. And they're pretty damn strong.
Y'ain't getting rid of me.
A wet laugh. More throat pain.
Soon, soon after that, the family is let in. One by one. All of them with different faces.
When it's Megan's turn for a hug, her expression closes up.
Near her brother's ear, she mumbles.
The words are few, her arms on him like on porcelain.
Jensen interrupts a daymare to catch his mimic.
He seems thrown off.
Just one of a thousand missing pieces.
No memory of that round.
While they part, Jared sucks his teeth.
"Guess I did."
let's sew, heal
wake up in new ways, stay awake, grow
until it's time
to break again
+ + +
[Glasgow Coma Scale]
The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury. The test is simple, reliable, and correlates well with outcome following severe brain injury.
The GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sports injury, for example, and in the emergency department and intensive care units.
[Traumatic Brain Injury]
Traumatic brain injury (TBI) is a nondegenerative, noncongenital (not relating to a condition present at birth) insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.
The definition of TBI has not been consistent and tends to vary according to specialties and circumstances.
A medical ventilator (or simply ventilator in context) is a mechanical ventilator, a machine designed to move breathable air into and out of the lungs, to provide breathing for a patient who is physically unable to breathe, or breathing insufficiently.
[definitions collected from internet pages and edited by me for a better understanding in relation to my work]