Chapter 3
Sleep was elusive. Most of the night, Ashley had tossed and turned in the worn waiting room recliner.
Her cell phone timer alerted her that visiting hours were open.
Sitting next to her husband’s ICU bed, she scrutinized his body, bruised and battered beyond recognition.
Memories of their Christmas Eve reunion the evening before seemed like ancient history.
Noah lay motionless on life support. Bleary-eyed, she looked at his lean, muscular torso.
Only twelve hours ago his strong arms had held her, and their lips entwined as they breathed promises of new beginnings.
Tears stung her eyes and clung to her lashes.
She cried out in agony, “Noah, Come back to me—to us. The girls and I need you desperately. I can’t live without you. Please God. Please.”
Wiping her tears with her palms, she glanced up at him through blurry eyes, praying that a miracle could somehow have occurred, but found only the rhythmic huffs of the ventilator and the flash of the life-sustaining machines attached to him.
There were no signs of the man, the spirit of her husband.
Sobs escaped her as reality struck. This might be the end.
She leaned forward and placed a tender kiss on his forehead, the only place on his body not connected to some type of equipment.
His skin was cool and clammy. Ashley crumpled down in the chair next to him, folded her arms around her body, and prayed.
Unable to stop her mind from endlessly swirling, Ashley wandered down the hallway to the visitors’ lounge while the nurses’ exchanged reports at the shift change.
She poured a cup of black coffee and sank down on a beige vinyl couch.
Landscape photographs decorated the soothing room, which was full of artificial plants and resting areas, but stress and sadness hung in the air like sodden clouds.
She shrugged her shoulders and let out a heavy sigh to lift tension before she called Noah’s parents.
His mom answered on the first ring. “He made it through the night. It’s still touch and go, but he’s stable for now.
He hasn’t woken up yet, but I think it would be good for him to hear your voices. ”
They confirmed they were on their way and would arrive in the early afternoon. They had wanted to jump in their car last night, but Ashley insisted they wait until this morning after the fog burned off.
Her next call was to her best friend and fellow NICU nurse Laurie.
She needed the comfort and stability Laurie provided.
Ashley knew she didn’t have to spend any time on pleasantries and just spoke nurse-to nurse.
“No spinal cord injury, but he has a major head injury with brain swelling.” She rubbed her tired, blood-shot eyes.
“The night shift nurse, Matt, was excellent and gave me as much information as possible, but I’m waiting for the intensivist to give the CT results. ”
“I’ve been praying non-stop. Thanks for the update. Everything is fine here. The girls had a hard time settling down but are finally asleep now.”
“Laurie, I appreciate so much you stepping in to take care of the girls. This has been so hard on everyone. I’m so sorry to disrupt Christmas with your family.
“Please. Don’t even go there. The boys are being spoiled rotten by my parents. My priority is you, Noah, and the girls.”
Ashley chewed her lip. “I have been thinking of them non-stop too. How are they doing today?”
“They are shaken up and asking how soon they can visit. They are asking a lot of questions that I don’t have the answers to. All the unknowns are hard for them. They kept asking when they could visit.”
Ashley chewed her lip. “It’s pretty bad, Laurie. His face isn’t even recognizable.” She held back a sob. Her voice tightened and constricted. “I don’t want them to be traumatized.”
“Your call, of course, but I wonder if it would be more traumatic for them not to see him.” Laurie took a deep breath. “I mean, what if?”
“I thought about that, too.” A tear slipped out as Ashley tried to push that thought out of her mind.
She started to speak again, but a rasp of sorrow blocked her throat.
After a few seconds of battling what-ifs, she sipped her coffee and cleared her throat.
“Maybe the girls can come with Noah’s parents when they get to town.
They’ll want to come to the hospital right away. ”
“Of course. That’s a good idea.”
Ashley leaned her head back on the couch. Fatigue enveloped her as her mind tried to sort out her ‘what’s next’ list. But it was useless. Her brain only wanted one thing. Sleep. “Listen, let’s talk later. I want to go back and check on him.”
“Honey, you must be exhausted. Rest. I’m going to check in on the girls. David was out all night on calls.”
“Poor guy. Thank you,” she whispered. “For everything.” Her face crumpled as she pressed two forefingers into her eyebrows and massaged the tight knots.
“You bet. Stay in touch. I love you, Ash.”
“I love you too. What would I every do without you?”
Ashley ended the call and shuffled like a zombie back down the hall to Noah’s room. She scanned the monitors. Satisfied that there were no changes, she sank into the recliner, leaned back, and closed her eyes.
Exhaustion won out, and the lull of the steady beeping monitors finally sent her into a light doze.
Several fitful hours later, Ashley jarred awake when a hand tapped her shoulder gently.
“Mrs. Smith? Sorry to disturb you.”
“What?” She rubbed the sleep from her eyes and looked up into the boyish, yet intelligent, face of a tall, athletic man in green scrubs and a white coat.
A young woman in scrubs with a stethoscope around her neck and a name tag that said Simone RN stood next to him.
“I’m Dr. Fisher, your husband’s intensivist. The CT scan results just came back.
” He glanced at Noah and lowered his voice.
“Let’s go into the conference room and talk. ”
The slender woman stepped forward. “Good morning Mrs. Smith. I am Simone, your husband’s day shift nurse. Let me do a quick assessment and vital signs and then I’ll join you in the conference room.”
Ashley watched as Simone competently checked Noah’s vitals and IV lines.
Satisfied that Noah was being monitored, she nodded and followed him down the hallway.
He gestured to a seat, and she sank into it.
He took two bottles of water from a small fridge and offered her one.
She took it, and after a long drink, looked at the man.
He capped his drained water bottle, set it on the table, and tented his fingers. “I understand you’re an RN, so I’m sure you know that even in a medically induced coma, the patient can still hear and understand things being said. That’s why I wanted to speak with you here.”
“I’m glad you did.”
The door opened. The day-shift nurse, Simone, entered, followed by a woman in her early thirties with a long raven ponytail and gold hoop earrings. She sat down next to Ashley with a kind expression and offered her hand.
“Hello, Mrs. Smith. I’m Sabrina, a social worker with the hospital. Dr. Fisher asked me to join the meeting to assist and support you in any way I can.”
Ashley cleared her parched throat and took another sip of water. “Please call me Ashley.”
“Okay, let’s begin.” Dr. Fisher swept his eyes around the table and focused on the group with a serious expression. “I’m afraid the news is not what we had hoped.”
Ashley took a deep breath and exhaled, wringing her hands in her lap.
“The CT results indicate massive brain swelling, and the monitors are showing his intracranial pressure is continuing to increase.”
Simone nodded, pursing her lips as she looked at Ashley. “I’ve noted that as well, even since I came on shift an hour ago.
Dr. Fisher continued. “We need to relieve the pressure. I think the best course of action is to take Noah to the OR and insert an internal shunt to drain the extra cerebrospinal fluid from his brain and spinal cord.”
“I’m very familiar with this procedure,” Ashley said. Her voice faltered as she continued. “But...my concern is that he’s not stable enough to survive it.”
Sabrina pushed the tissue box closer to Ashley, who grabbed a tissue and twisted it over and over into shreds, fragments billowing to the floor.
“I understand the pressure needs to be relieved, but I wonder, would it be easier on Noah to place an external shunt at the bedside first...until his status stabilizes? We often do this in the NICU.”
Dr. Fisher tapped his chin with his forefinger. “Hum, I hadn’t considered that option.” He turned to Simone. “I think it’s worth a try. Can we set up a consultation with the neurosurgeon STAT?”
Simone nodded. “Dr. Stuart is on call. He was walking down the hall as I entered the conference room.”
“Can you please see if he’s available to join us?” he asked.
“Sure.” Simone hurried from the room, and Ashley glanced at the clock on the wall.
It was 8:30 a.m. She swiped her cell, which had been on silent mode.
It was blowing up with texts and voicemails from concerned family and friends.
Too weary to answer calls, she left it on silent and dropped back into the chair. Spent.
Sabrina watched her, empathy shining in her hazel eyes. “The hospital does have a few family rooms with a bedroom and bathroom. We could arrange for you to stay there, if you’d like?”
Dr. Fisher nodded. “Great suggestion.”
“Thank you,” Ashley said, “but I want to stay by Noah’s side for now. He’s too unstable for me to leave.
Sabrina patted her hand with a gentle touch and a kind smile. “Totally understand. The offer stands if you change your mind.”
With a light knock, Simone entered the room, followed by a serious-looking doctor dressed in OR scrubs, with a surgical cap on his head and blue foot booties. He shook Ashley’s hand and introduced himself before sitting down next to Dr. Fisher.
For the next several minutes, they evaluated the CT results and conferred about the placement of the shunt.
“Mrs. Smith,” Dr. Stuart leaned toward her, hands clasped between his knees. “I understand that you’ve been told that your husband is in very critical condition.”
Ashley pressed her lips together and nodded. The sheen of unshed tears blurred her vision. She swabbed quickly with the shredded remains of the tissue.
“His intracranial pressure must be reduced to avoid further brain trauma.”
“Yes, I know that.” Her voice quivered as she twisted the tissue in her hands.
The tears spilled out and ran down her cheeks as she desperately tried to maintain control.
A tinny buzz filled her ears as the room started to fade.
She could hear and understand his next words, but her brain could not comprehend the meaning.
“An external VP shunt done at the bedside carries enormous risks.” He rubbed hand over his chin.
“However, I agree that transporting him to the OR in his current condition is far riskier and involves extensive logistics with his open femur fractures. So, I say, let’s do it.
” He rapped his knuckles on the table and gave a decisive nod.
“Once you sign the consent, we’ll move ahead. ”
Dr. Stuart stood and rolled his shoulders while Dr. Fisher leaned forward to shake Ashley’s hand. “We’re going to prepare for the procedure. We’ll give you an update as soon as possible.”
As they briskly walked out of the room. Ashley croaked out a thank you and laid her spinning head on the table.
Sabrina placed a cool hand on Ashley’s arm. “Are you okay? Do you need time to think about it? Or ask more questions?”
“No. It’s in Noah’s best interest.” Her voice broke as she swallowed back tears. “We need to do this as soon as possible. Every moment counts.”
“Can I get you anything? Some coffee or juice?” Ashley raised her throbbing head voice raw with emotion. “I just want Noah okay and home again.”
Sabrina nodded sympathetically. “I’ll collect the paperwork and be right back.”
Once she was alone, Ashley closed her eyes in prayer. Please God, in the name of Jesus, heal Noah. Be with him as he goes through this procedure. Give me peace to know that I made the right decision. Amen.