Jacob's Advocate - 7. Chapter 7 - That Dark Day After

Doctor Gavin Casey reached for the badge on the retractable lanyard and swiped it, the light on the reader turned green as it always did as the badge retracted back to the left side of his chest, on the white coat he rarely wore. He pushed the door open allowing him admittance to the Doctor’s entrance to the Emergency Room.

It was late in the evening when both his pager and phone went off at the same time, and the message had been short, ‘UH ER ASAP,’ these calls didn’t happen often but when they did it was under dire circumstances.

“Hi I’m Doctor Casey, I was paged?” He asked as he approached the nurses station, in the well appointed, yet pretty empty Emergency Room, at the cities University Hospital.

“Oh yes, Doctor.” A nurse dressed in pastel pink scrubs said as she looked up from a computer screen, pausing the entries she was making into the medical records system. “Nurse Ferguson, people call me Fergie, let me grab the chart and I’ll walk you over.”

Fergie picked up one of the few charts from the holder on the desk and flipped it open as she got up and stood next to him. “16 year old male, no physical injuries of any kind, he does have previous history of being admitted, but not for this. Vitals are stable but he’s absolutely catatonic. No responses to external stimuli except to reflex, no response to pain stimuli. Outwardly, his body is fine but it seems like the lights are on but nobodies home.”

“Patients name?” Gavin asked absently as Fergie led him away from the nurses station towards one of the more private areas of the Emergency Room.

“Last name Wells, First name Tyler.”

“Where’s Jacob Edwards.” Gavin asked quickly as he stopped dead in his tracks. Fergie looked at him with concern as his expression changed.

“Who is--”

“Were there any other 16 year old males brought into this hospital tonight?” Gavin asked again.

“Uh yeah, one. A 16 year old male was brought in via Care Flight from a high school football game. He’s in the ICU.” Fergie responded as she hugged the chart, “why what’s going on?”

“Both are my patients call the ICU tell them I’m coming up, I need to speak with the attending up there first before I see Tyler Wells.” Gavin said as he turned direction to head for a bank of elevators hidden from view.

Fergie headed back to the nurses station to make the call.

The elevator ride seemed like it took longer than it actually should, Gavin was no stranger to keeping his emotions from overriding medical judgment but somehow this felt different. It was almost personal. His training took over as the elevator doors opened and he stepped out onto the floor that held the hospital’s ICU department. Instead of regular rooms, bed’s had been placed in single’s doubles and groups of four along the walls, surrounded by glass panels that kept the outside world and outside air for the most part away from the most critically injured.

He walked along the glass until he found what he was looking for. In one of the single units there Jacob Edwards lay, hooked up to all the standard monitoring equipment plus a few extras with a bandage around his forehead. He appeared to be breathing on his own, and the monitor showed slightly lower than normal heart rate and blood pressure, and the oxygen monitor stayed at a steady 99.8 percent.

Gavin looked up as what he guessed was the attending physician for the ICU. The older Doctor was dressed in personal protection equipment that covered him from head to toe a mask hung under his chin and he gave a small smile as he approached.

“I’m Doctor Wilson, the attending.” The man said as he looked up to Gavin from his slightly shorter stature.

“Doctor Casey.” He nodded at the glass, “Jacob is one of my patients, there’s another down in the ER that’s in here in relation to this who is also a patient. I was hoping to get the details from this one before I saw the other if you could.” Gavin asked professionally, and as calmly as he could.

“I understand. This one took a hit to the chest that caused Commotio Cordis, it took two shocks from an AED, on site to restore cardiac function. However respiration didn’t return until the helicopter was halfway here. Respiration was supplemented by a resuscitation bag within moments of the incident so right now there doesn’t appear to be any permanent damage, according to the initial CT. The cardiac muscle appears to be strong and functions normally with no preexisting issues. However he is as you can see in a medically induced coma, to reduce intracranial pressure. It looks like despite wearing a helmet he fell pretty hard on the back of his head, which could explain the disruption to autonomic function in his lungs.”

“And the pressure now?” Gavin asked gently.

“Reduced but still not out of danger. We will keep him in the induced state until it goes back to normal, then wake him up and see what damage persists.” Doctor Wilson said as he glanced at the chart. “He’s very lucky, the response on the field to restart his heart saved his life. This condition is so rare it’s almost un measurable but they had three minutes at most to do what they did and from this old Doctor I’m glad to see the right decisions were made.

“Thank you Doctor. Has the family been here yet?”

“Yes, I believe his mother has, and a few others as well. I believe they stepped away to make some calls.”

“Okay, again thank you. I have exactly what I need for the other problem down in the ER.”

Doctor Wilson cast him an inquisitive glance and he filled him in on Tyler downstairs. The two talked for a moment before Gavin departed, he retraced his path back downstairs and stopped at the nurses station to grab Tyler’s chart from Fergie before making his actual appearance at the curtained off area in the back of the ER where Tyler had been placed.

“Gavin!” Joanne said as he cleared the curtain.

“Mrs. Wells, Mister Wells.” He greeted as the two approached him.

“Please, Joanne, and this is my husband Dan.” She said introducing her husband and they shook hands.

“I didn’t expect to see you.” Joanne said as she crossed her arms against her chest and looked with worry at her only son who sat at the edge of the bed staring off into space.

“I have an M.D. in pediatrics, as well as my degree in psychology. I’m on call for both here because I have privileges at this Hospital.” Gavin explained. “First off, Jacob is stable but not out of the woods. I was just up there.”

Gavin moved in front of Tyler, who looked deathly pale. Instinctively he reached for and donned his stethoscope to listen to Tyler’s heart beat which was strong and true, and his respiration which yielded the same results. He then pulled out a pen light and flashed it against Tyler’s left and right iris, noted the slowed pupil reaction and the fact Tyler didn’t even flinch at the brightness of the light.

“That’s good to hear.” Joanne said, “what about him?”

“He’s in a catatonic state. Usually we don’t see this outside of schizophrenia, but I’ve spent enough time with him to rule that one out. He has none of the other signs except this one and I don’t believe that’s what this is.” Gavin said as he continued doing the basic vitals check including blood pressure.

“His friends say he’s been like this since Jacob went into the helicopter.” Joanne commenting leaning against Dan for support who held her gently.

“Psychological shock most likely.” Gavin said as he finished his tests. “Sometimes the brain, sends itself into this kind of protection mode when it receives severe emotional trauma. It’s my belief that the emotional pain of what he saw happen to Jacob and it’s aftermath was so great, his brain could not physically process it, so to protect itself from permanent damage, it did this.”

“Can he be pulled out of it?” Dan asked quietly.

“I believe so, if he does it may not happen until Jacob’s awake or until he himself has slept. But this can turn serious if it goes malignant. He won’t eat nor drink while he’s in this state and without basic care it could effect other organs such as his kidneys for example.”

“So what do we do?” Joanne asked slightly exasperated at the information Gavin just relayed.

“For now I’m going to admit him for at least 24 hours. I also need to get a benzodiazepine based drug, into his system. Basically Valium or Xanax. It’ll be an injection since I don’t think we can get him to swallow anything. This will make him sleep. When he wakes up and can at least react and communicate he will be fine. If not we may have to try a more drastic measure I really don’t want to get into right now.”

“I just need you to sign this permission form to get the ball rolling, “Gavin said as he held out the chart. Dan took it and signed it without question and handed it back.

“This is a serious situation, but he’s here, and I’m here. I’m going to do whatever I can to help Tyler.” Gavin said gently as he took the chart back.

Joanne and Dan didn’t say anything as Gavin stuck his head out of the curtain and called, “Fergie I need you when you get a minute.” She appeared as he was writing orders into Tyler’s chart.

“Yes Doctor?” Fergie said as she made her appearance.

“This one needs to be admitted upstairs. I want him on the monitors, as well as an IV with saline, and a benzodiazepine based injection. The details are here.” He said as he finished writing it up and handed her the chart.

“I’ll get right on it Doctor.”

She disappeared quickly and Gavin grabbed Tyler’s hand. “Tyler, if you can hear me, Jacob is still alive, but he’s still in danger. I’m going to do what I can to help you both.” And for a moment, Gavin could have sworn he saw a flash of something in Tyler’s eyes as he spoke, but it was gone in an instant.

Travis paced the emergency room waiting room with worry as they awaited news. So far no one had hold them anything, they didn’t even know if Jacob was still alive.

“Sit down Travis.” Matt said for the fourth time, from his seated position with Amanda leaning into him totally exhausted.

“I can’t.” Travis said. He fidgeted with his hands that were shaking lightly.

“Yes you can. Sit down.” Matt said again.

“Dude I can’t!” Travis said as he visibly broke down, “dude you saw Tyler. It’s bad enough if we lose Jacob but if we lose them both I don’t know how…” He never finished his sentence as he completely broke. Travis had been holding this in the entire time trying to will it away but giving those words a voice, his voice caused it all to come rushing out.

Matt immediately jumped to his feet and caught Travis in a tight embrace as his legs tried to give out, Amanda followed and grabbed him from behind, finally breaking as well.

“We are NOT, going to lose them man. We won’t, we can’t.” Matt said as his eyes watered.

A voice interrupted their moment, “any news?” They looked up and wiped the tears away as they separated. Coach Steven’s stood a mere few feet away, his own anguish apparent. His hands wringing his signature ball cap in his hands.

“No, we don’t know Jacob’s condition yet,” Matt said as he cleared his eyes. “And Tyler is being looked at by the ER doctors.”

“What’s wrong with Tyler?” Steven’s asked as his eyebrows went up with a new sense of concern.

“He’s out of it coach.” Travis said his face scrunching up to keep the tears at bay, “he was awake but completely out of his mind. He was like a walking dead body.”

Coach Steven’s immediately turned around for a moment, his hand going to the bridge of his nose holding it for a moment.

The doors to the ER opened and Joanne stepped out alone. Everyone turned to look at her with hope and fear clearly etched on each of their faces.

“How is--” Amanda tried, Joanne held up a hand to stop her.

“Jacob, is alive. He’s breathing and his heart is beating on it’s own. He’s in an induced coma due to a head injury, he’s stable but still in danger.”

Travis sucked in an audible breath as his hand clapped over his mouth, Matt held onto Amanda as she did the same.

“Tyler is another story. Physically he’s fine, but he’s basically catatonic right now, almost like a waking coma. They called Doctor Gavin Casey to the hospital and he’s with Tyler now getting him admitted. Gavin said what he saw was too much for him to handle and he basically shut down on the inside. They’re giving him something to sleep and to help relieve what’s going on inside his head but we won’t know till he wakes up if other actions need to be taken to help him.”

“But is he going to be okay?” Travis asked his eyes pleading for an answer.

“Right now we don’t know, and that goes for both of them. Right now they’re in the best of care and they’re both alive.” Joanne said soothingly attempting to calm Travis’s nerves.

Travis nodded and everyone was silent for a moment.

“Matthew, you still have the keys to Tyler’s car correct?” Joanne asked looking at Matt.

“Yeah, here.” He said producing both Tyler’s keys and his phone.

Joanne took the phone but handed the keys back, “I want you to keep Tyler’s car for the moment. I want you to get everyone home. I know you guys want to stay but there is literally nothing you can do here right now. Come back in the morning I’ll leave instructions so you can see Tyler tomorrow.”

Matt nodded as he took the keys back wordlessly.

“Matt,” she continued very softly. “Drive safely, enough tragedy has happened tonight okay?”

He nodded again sniffing and wiping his nose with his sleeve.

“Mrs. Wells, I’m Coach Stevens.” The Coach said as he extended a hand which she shook.

“Yes Coach I remember.”

“I just wanted to say the thoughts and prayers of everyone on the football team and myself are with you and Jacob’s family. I’ll make calls as soon as I get home to let everyone know what’s going on. Jacob and Tyler’s team mates are pretty shaken up right now and they’re worried about them both and I think the school is going to end up bringing in grief counselors on Monday.”

“I’ll make sure Matt and Travis stay informed of everything that happens. Diane, Jacob’s mom is beside herself right now and can’t really talk to anyone but I’ll make sure she gets your message.” Joanne said in reply.

Stevens turned to look at Matt, Travis and Amanda, “call me as soon as you know anything. Please I’m just as worried as you three are.”

“We will Coach.” Matt said with an affirming nod.

“I’ll see you guys later.” He gave them a look of sympathy before patting them on the shoulders and disappeared quickly out the main entrance.

“Thank you for talking to us Joanne.” Matt said.

“You bet, get some sleep please. Tyler’s going to need all of you in the morning.” She said in a motherly as she turned around and headed back towards the ER area.

“Come on guys, I’ll drive you home.” Matt said as he moved in between Amanda and Travis, and they all walked out with arms around each other into that dark good night.

Somehow the three managed to sleep through the night. Amanda wasn’t available the next morning but she said she would show up later that afternoon, and left Matt strict orders to call her if anything happened immediately. Matt and Travis rode in silence together until they got to the Hospital, and made their way up to Tyler’s room first.

Joanne and Dan were nowhere to be seen, when they arrived, perhaps they had gone home to try to sleep as well. The curtains on the windows were still drawn shut, on Gavin’s orders to let him sleep. Tyler lay on his back, with a dim light over his head casting shadows in the room. Dark circles appeared under Tyler’s eyes, and his skin was still deathly pale and almost cold and clammy to the touch. Tyler simply looked worse than he had before.

The medical monitors he was hooked up too, beeped with his pulse, and an IV had been set into his right arm with a bag of saline slowly dripping down the line.

“I’m going to go see if Diane’s here and check on Jacob if they’ll let me.” Matt said softly as Travis approached Tyler’s bed alone.

“I need to talk to Ty for a minute if you don’t mind Matt.” Travis said quietly as he took in Tyler’s drawn features.

“Okay, I’ll be back.” Then quietly disappeared and pulled the door closed with a soft click.

Travis took one of the empty chairs and pulled it next to Tyler’s bed and sat in it for a moment as he rested his head in both of his hands. With a sniff he exposed his eyes, which watered slightly as he gazed at Tyler who continued to lay still.

“Ty,” Travis said softly as he took Tyler’s almost too cold hand into his own. “I need you to wake up man.”

He paused for a moment as he collected his thoughts and what to say next. “You’re my first love dude, and no matter who either of us end up with in the long term that will never change. But I need you to wake up because I’m scared if you don’t I’m going to end up like you are now. I can’t stand seeing you like this man, please wake up.”

“I need you Ty, I need you to live, even if the worst happens and you seem broken beyond repair I’ll always be there to help you pick up the pieces. I just don’t want you to die. Please don’t die. It would kill me if you did, so please. Please God wake up.”

Travis wiped away the tears with his free hand as his eyes went red and his eye lids puffed with irritation. He didn’t let go of Tyler’s hand, instead he squeezed it and while Tyler didn’t open his eyes or make any other movement, Travis shook with relief, his heart skipping a beat as Tyler’s hand squeezed his back.

Matt stepped off the elevator on the ICU floor. He wasn’t sure how his presence would play out or if visitors were even allowed up here. He didn’t wait to find out as he quickly found Diane sitting in a seat along a wall across from Jacob’s ICU room.

“Matthew,” she said as she embraced him as he sat down.

“How’s Jacob?” He asked in almost a whisper, looking at her intently.

“Almost the same as last night. The Doctor told me the pressure in his head went down a little more but it’s still not there. He’s still in danger. They just did another scan on his head but they haven’t told me anything yet.” She said painfully as she dabbed her eyes with a tissue.

“Is there anything I can do for you?” Matt asked sincerely.

“Oh no Matthew, thank you though. And thank you for being here.”

“It’s not a problem, Travis is here too but he’s downstairs with Tyler.” Matt replied with a sigh.

“Is Tyler still out?” Diane asked gripping his hand.

Matt nodded, “yeah. Travis stayed to talk to him. If there was anyone other than Jacob that could talk Tyler out of this it would be Trav.”

“I sat with him a little while, when Joanne and Dan left for the night. I tried telling him nothing was his fault, it wasn’t anyone's fault.” She explained with an exasperated sigh.

“Matt?” A new voice called out gently. Matt and Diane turned to see Preston Foster standing in the corridor with two guys, a pair of identical twins about their age he didn’t know.

“Preston.” Matt said, and explained who Preston was to Diane and she nodded in recognition.

“Matt, Mrs. Edwards, this is Derek and Eric. They played on the team against us last night.” Preston said quickly looking down. The twins looked down as well, with lines of guilt and sadness etched clearly into their faces.

“The defensive tackle that…” Matt said in realization as it clicked as to who these guys were.

“Ma’am we are so sorry for what happened, for what we did.” One spoke out as his face broke and he leaned against his brother.

“You gotta believe us, we didn’t mean to hurt him!” The other wailed as he too broke down.

Diane rushed up to both of them and hugged them tightly. “It was an accident boys.” She managed to get out as they returned the embrace.

Preston approached Matt and sat down next to him as the twins and Diane talked softly among themselves. “How’s Jacob.”

“Still out man, his heart is fine and he’s breathing but they’re worried about his head.” Matt explained simply.

“And Tyler? He didn’t look too good last night.” Preston commented after his question as he rubbed his hands against his jean clad thighs.

“Tyler’s here, downstairs. He was admitted last night too. Right now he’s asleep but he was in a catatonic state, the doctor said he’s pretty messed up in his mind right now.”

Preston nodded slowly, the Coach had called him the night before and relayed the news, he had hoped Tyler would have at least woken up or something by now. Diane had managed to get Derek and Eric calmed down enough to sit, and she explained under no uncertain terms that this truly was an accident and she blamed no one for what happened to Jacob, even though it didn’t make anyone present feel better.

A flurry of activity behind the glass suddenly got everyone’s attention as a group of medical staff dressed in personal protective equipment burst through the door into Jacob’s ICU room. Diane stood up with worry as they started unplugging Jacob from the monitors and were shifting him to a portable gurney.

Doors flew open from the end of the hall and a Doctor approached them quickly with a lab report in his hand. He stopped in front of Diane with a worried expression on his face.

“We’re taking your son to the OR. The Cat Scan we just took found a bulge in an artery in Jacob’s brain. We’re going to have to fix it surgically or else he may have a brain aneurysm.” The Doctor explained quickly as Jacob’s gurney disappeared through another set of doors.

“We are suiting up for surgery right now. I’ll have more as soon as it’s done.” He said just as quickly before he rushed in the direction the gurney disappeared too.

Everyone just sat in stunned silence.

Travis sat alone in Tyler’s room still holding his hand when Matt, and Preston and the twins showed up. He looked up with curiosity, and Matt explained the situation. Travis nodded in understanding. He noted the looks of surprise when they laid eyes on Tyler, no doubt anyone had thought he would look as bad as he did.

“There’s something else man.” Matt said as he started to pace in Tyler’s dark hospital room.

“What?” Travis said getting up reluctantly releasing Tyler’s hand and laying it back on the bed at his side.

“Jacob.” Matt replied as his lips started to tremble. “They just took him into the OR. One of the arteries in his brain is about to burst.” He finished with finality.

“What? No!” Travis said as he quickly approached Matt.

“This is all our fault.” Derek said to himself as he stood with an arm draped around his brother.

“If he dies, I’ll never forgive myself.” Eric said solemnly echoing his brother’s heart break.

“I’ll forgive you.” A quiet voice said from the bed behind them. Everyone turned to look to see an awake Tyler staring at them with those still dead looking eyes.

“What…” Eric asked.

“I forgive you.” Tyler’s voice repeated, his dead eyes changed from the dead look to sorrow, yet utter forgiveness.

“Tyler.” Travis said, quickly moving back to his chair grabbing Tyler by the hand.

Tyler looked at Travis with mournful eyes, “I heard what you said. I heard all of it Travis.” Tyler’s gaze then dipped down as his face became crushed with emotion.

“Jacob.” He said mournfully as he turned towards Travis and gripped his hand pulling it to his chest as he finally felt the pain his brain so desperately tried to lock out.

I wish I could say I remember everything that happened from the time the helicopter left and when I woke up with Matt, Travis, Preston and the twins but I don’t.

I vaguely remember seeing Gavin and what he told me. Images flicker in my memory of being admitted and falling asleep. What I do remember was the dreams. It was like the entirety of the last month played in my head. The good and the bad.

Jacob trying to tell me he was gay and the look of utter devastation on his face when he ran from my house. The angry looks, the pushing the shoving and everything else he did to me during that painful time we didn’t talk. And of course the fight that left me bloodied on the ground.

Everything else that followed was in those medically induced dreams as well. My resolve to save Jacob from himself. The meeting at the DA’s office, talking to my parents, the letter we wrote the judge, the school board meeting and Jacob’s first day. It played out in my dreams like a movie without interruption as if I relived all those event’s in the space of the 14 hours I had been asleep.

Every tender moment me and Jacob shared were in there too. The scene outside the court room, the day at the park when we finally talked, our first kiss and every hug, cuddle, nuzzle and look we ever shared stayed at the fore front of my mind as it tried to make sense of the crushing emotional pain I felt on the football field.

Then there was Travis, his gallantry and steadfast presence, in the background giving me the strength silently to do all the things I had done. At first I thought it was all me, but the reality of it is simply, it was never all just me. It was the strength from all of them, my friends, my parents, Dee and especially Travis that gave me the will power to do everything I did to save Jacob.

In the end it was Travis falling on the sword that pulled me out from the prison my mind had created, and I knew that only he and Jacob had the power that would have brought me back from the brink. It was his self sacrificing love that woke me up. His inner strength that supported me and Jacob more than anyone else ever could. It wasn’t until that moment I truly recognized how special Travis’s soul really was and I always made sure he knew it. Our bond went beyond friendship, beyond family, beyond even that of lovers. And it would be a bond that lasted a life time.

The news of Jacob’s development absolutely crushed me, but I didn’t return to that dark place.

Preston along with Derek and Eric left after I too explained to the twins that this was just a horrible accident that could have just happened to anybody. A literal one in a million chance, and somehow fate had chosen Jacob of all people.

“Will you guys stay with me tonight.” I asked both of them, several hours after I woke up.

“Of course Ty.” Matt said with Travis in quick agreement.

“How are you feeling?” Travis asked as he stood next to my bedside.

“Just worried about Jacob. And a little groggy still from whatever it was they gave me.” I said.

At that point the door opened and Gavin stepped in complete in a white coat I’d never seen him wear before.

“You’re awake!” He exclaimed, “thank God. I was worried I was going to have to shock your synapses.” He said approaching my bedside opposite from where Matt and Travis were standing.

“How are you feeling?” He asked repeating Travis’s words from a moment before.

“Groggy, exhausted, you name it I feel it.” I replied honestly.

“Do you feel like eating? You’re parents are here.” He said quickly as he continued his examination.

“Yes, and yes. Gavin what’s going on with Jacob.” I asked seriously.

Gavin let out a breath and looked at me a moment, “he’s out of surgery, they where able to fix the problem and the pressure in his head is almost back to normal. In fact he’s in a recovery room right now still knocked out.”

My parents chose that moment to walk in, “oh thank God you’re awake!” My mother gushed as she shoved Gavin aside to hug me.

“Good to see you Ty.” My dad said as he watched my mom mother me to death.

“Guys, please. Gavin, I need to see Jacob right now. If I don’t see him I’m going to refuse to comply to anything until I do. Please I have to at least see him now.” I said over the din of excitement from those crammed into my room.

“You bet. Let’s go.” He replied.

Gavin emptied the room for a moment, while he unhooked the IV, and the monitors and switched them off temporarily. He found a pair of sweats and a loose shirt my parents had brought and escorted me barefoot through the hospital with my entourage in tow.

Finally, he pushed open the recovery room, to show a relieved Dee, and of course Jacob laying in a recovery bed. She gently hugged me and silently moved aside to give me the moment I needed. Slowly I gripped his hand and intertwined his fingers in mine.

“Jake…” I said as my throat swallowed.

“I love you with everything I am, with everything I’ll ever be. I knew I was right in my choice, you are worth saving, and now by some quirk of fate the universe agrees with me because here you are.” I kissed his hand and held it tightly.

“When you finally get out of here we’re finally going on that date so I can show you how much I do love you. Nothing can stop the two of us. You and me, we’re forever, and well Travis too if he doesn’t manage to find anybody.” I said with a chuckle.

“I’m lost without you man. I want to be with you for life, and that will never change. Please come back to me soon.”

I laid a gentle kiss on a small part of his exposed forehead, and I felt his hand weakly tighten against mine.

'Yes Jacob. I’m here. And I’m yours forever.'