Manny Needs a Nanny - 11. Progress? Or Surgery, Round Two

Saturday

Bass waited until after dinner to take Rocky to see Manny. Since the nurse said he'd be sleeping most of the day, he felt waiting until the evening visiting hours would make the most sense. Rocky wasn't happy, but understood. By then, Manny was in the ICU's step-down unit. They were apparently keeping a closer eye on him than Bass expected would be the case. Seeing his left shoulder bandaged, Rocky went around to Manny's right side and gave him a hug.

"I'm glad, you're okay, Manny. I was really scared until Bass woke up and gave us details."

Manny seemed sad, and nodded. Bass asked him, "So, how is it going for you?"

Manny looked at Rocky, then decided, he'd find out sooner or later, "It could be better. The doctor's worried about my left hand."

Manny lifted his hand just a bit—all he was able to do at this point. Three fingers and the outside of his forearm were discolored, showing a bluish tint. The middle finger, not quite as blue as the other two.

Rocky stammered, "What's … wrong … with it?"

"The doctor thinks, my fingers and part of my forearm were deprived of blood for too long."

Bass read the hidden message behind Manny's words and raised his eyebrows in question. Manny shook his head slightly.

Rocky continued, "But it'll be okay, right? It's getting blood now."

"Maybe. Another day or so will tell us more."

"What happens if it doesn't get better? It just stays blue?"

"Sit here with me, Rocky."

Rocky climbed up on the bed to sit next to Manny, the fear already showing on his face.

"I'm not going to lie to you, or sugar coat anything. If it doesn't get better soon, they'll have to amputate fingers, or maybe even my arm, possibly up to the elbow."

"No-ooo. Can't they just leave it like it is?"

"No. If they do that, the dead flesh will spread. I could lose the whole arm," Manny gave a quick glance at Bass, "Or worse."

"What could be worse than losing your arm?"

"Rocky, if the circulation doesn't improve and it starts spreading, I could die. Amputation would be the only choice."

"So, if they amputate your arm, you won't die?"

"Well, not from this. Everybody dies sooner or later. But it will allow me to live as long as I'm supposed to."

"Can they do, like a transplant or something? I've read stories about fingers or hands being reattached."

"I suspect, those are rarely completely successful, and an entire arm? I don't know if it's ever been done."

Rocky already had his cell phone out and was tapping away, "Johns Hopkins says, there have been over a hundred and thirty hand and arm transplants. Even the first one performed is still surviving after eleven years."

Manny almost smiled, "Can I see that?"

Sure enough, Rocky was right. And it wasn't some fake Internet site reporting this.

"Well, I guess, I can ask Doctor Ko about it. But it probably costs a fortune and my medical insurance from the bar isn't much."

"We have money. I'll pay for it."

"Let's not get too excited yet. We'll look into it with my surgeon and take it a step at a time. Who knows, my arm may still recover."

"I hope it does. But if not, I'll convince Mr. James to pay for the transplant."

Rocky was fired up about the transplant possibility. Manny and Bass let him have his optimism. Manny's concern was if there were one hundred and thirty successful transplants, how many failures were there?

Sunday

Rocky wasn't very motivated to do a lot. He spent the whole morning in his room, researching arm transplants. If Manny had to have his arm amputated, Rocky wanted to have all the arguments, he could throw at Mr. James to convince him to pay for it.

Rocky came down for lunch, "Can we go see Manny this afternoon, Bass?"

"Sure, I don't see why not. Let's all go see him. It may cheer him up to know that everybody's concerned about him."

Bass would soon learn that 'everybody' was a lot more people than he thought. Rocky and the rest of the staff showed up a few minutes after visiting hours began. They were surprised when the woman at the information desk gave them a different room number than last night.

They walked into room four-oh-two just as the surgeon was finishing checking Manny out, overhearing his final words.

"Otherwise, this is excellent progress. I'll check back with you later. Oh, excuse me—Mr. Blank, wasn't it?"

"Yes, these are the other folks that live in the house with Manny and Rocky."

"Right. Manny has spoken quite a bit about you, young man. Let me be the first to tell you that the prognosis for his arm looks very good. The discoloration on his forearm is lightening, and the surface area of that discoloration is shrinking. I'm hopeful that Manny's arm will have a full recovery."

The doctor didn't mention the lack of progress in his hand and fingers to this group as he did with Manny. No reason to scare a young boy. Fortunately, Rocky didn't notice the omission. Bass, however, did.

"Awesome!"

"Yes. Well, I'll leave you all to visit. He still needs his rest, so please don't stay too long."

Rocky was beaming, "We won't. Thank you doctor."

"You're welcome, son."

After quietly celebrating the good news for a while, they took the doctor's advice and were preparing to leave, when Priscilla and Danny walked in. Bass told them that Manny had good news to tell them, and they left, so Manny's other friends could spend some time with him. Before the visiting hours were over, the rest of the Charlie's team, and Charles, all made visits.

Rocky begged Bass to take him back to see Manny after dinner. He had to know if Manny's arm was still getting better.

"Please, Bass. I know, I won't sleep tonight if I don't know if he's still getting better or not."

Bass had every intention of visiting Manny again, although he would have preferred to do it alone, but he relented. Perhaps he could have Rocky go to the waiting area to give Bass some time alone with Manny.

When they entered Manny's room, he was sitting more upright and seemed to be in better spirits.

Bass asked the first question, "Did you see the doctor again?"

Manny was obviously feeling better. He toyed with Bass a little, "Yes."

Bass waited a few seconds to see if Manny would continue, then, frustrated, "Welllll?"

Manny laughed, "He said, the arm was still improving but he was still concerned about the hand and fingers. They'll do some tests tomorrow to gauge the blood flow all the way to the hand."

Rocky saw only the positives, "So you probably won't need the amputation?"

"It's still possible, but the odds of needing it are going down."

"That's awesome!"

"Well, it's not all good news. It's going to take a lot of physical therapy to get the muscles that were blood-starved functioning again, primarily the forearm extensor."

"Which one is that?"

"If you hold your arm straight out, palm down and facing out a little, it's the one on top. Open and close your fist and watch your forearm."

"Oh, cool. I can see it tensing."

(LRW: OK, be honest, how many of you just did exactly that?)

"Right now, I couldn't make a fist. The rest of the arm is looking better, but that muscle isn't working at all. If we were fighting, you’d have the advantage because you can punch, I could only slap."

“But you wouldn’t hit a kid, anyway. And I wouldn’t hit a gimp.”

Bass glared at Rocky.

"Sorry. But you can keep the arm, even if that muscle is weaker?"

"Yes."

They spoke for a little while longer, then Bass wanted some alone time with Manny.

Bass asked Rocky, “Can you run to the cafeteria and get me a coffee? The vending machine coffees are horrible. Get yourself a snack first.”

Bass winked at Rocky, who nodded, realizing Bass wanted some time alone with Manny.

Rocky said, “See you in a bit,” to Manny and left.

Waiting a few moments to ensure Rocky was gone, Bass queried, "So, really, how are things going?"

"Honestly, the way I said. Like I told Rocky yesterday, I wasn't going to lie to him about any of this."

"But you were holding back, at least a little, right?"

"Well, yes. Dr. Ko said, I may never regain the use of that muscle, even with PT. He also thinks I still may lose one or two fingers. The tests tomorrow will let him know if there's any return of the circulation to that half of the hand beyond the wrist."

"Well, it started out terrible, possibly losing the whole forearm, so while the news isn't great, it's at least a little better."

"Yes. And there's still hope for the fingers. I'll know more tomorrow."

"Well, get a lot of rest, and do everything the doctor tells you to."

"Sure thing, dad."

"Ha ha. Why don't you give daddy a kiss goodnight?"

"I knew, you didn't chase Rocky away just to get the whole story. You'll have to lean down."

Bass leaned. They kissed. Rocky knocked about five minutes later.

"I knew it, that's why you wanted me to leave."

"Um, yeah. Well, goodnight, Manny. I, um, we'll see you tomorrow."

"Goodnight, you two."

Monday

Dr. Ko was there at eight o'clock, as Manny's roommate was finishing his breakfast. He didn't get one, due to the reason Dr. Ko was about to tell him.

"We'll be running the MRI on your arm at nine. We'll know right away what the status is. I'll warn you ahead of time: I'll want to amputate any permanently damaged fingers right away, so I've scheduled the O-R and a full surgical team for ten."

"Do you think, amputating the fingers will be necessary?"

Dr. Ko lifted Manny's hand so he could see. The ring finger and pinky were almost completely black. As was that side of his hand between the ring finger and wrist.

"Unfortunately, yes. The MRI will probably show no blood flow to that area. I'm also afraid of what may not be getting to the other two fingers."

Manny looked closer, the middle finger was obviously blue, and the pointer looked slightly blue.

"Shit. So, all four?"

"I can't say either way for sure until we get in there. Almost for sure two, the MRI will tell me definitively. But I'd say, the middle finger is fifty-fifty right now. I'll leave it if there's even close to sufficient blood flow, but we may have to do more at a later date. Obviously, I'd like to leave you with as much of a functioning hand as I can. But in the long run, that may not be possible. I'll have the nurse bring you the paperwork to sign, so we can move fast if we have to."

"Alright. I suppose, I don't really have a choice."

"Unfortunately, no. The longer dead flesh stays, the higher the risk of more dying."

Manny signed the papers approving the 'procedure,' up to and including the potential amputation above the wrist and below the elbow. 'Procedure. Great name for it,' he thought. Manny was more frightened than he'd ever been before.

At five to nine, he was wheeled to the radiology department for the MRI.

At twenty after, Dr. Ko told him the two fingers needed to be removed, along with that portion of the hand that was affected.

At just after ten, he was in the O-R, counting down from one hundred, being put under anesthesia for the second time in three days.

When the one PM visiting hours opened, Bass walked into an empty room four-oh-two. He quickly went to the nurse's station to ask what was going on. He was able to convince Rocky that Manny may not be very awake and came alone. Good thing.

"Mr. Talbot is in surgery. He should be in recovery soon."

"What surgery?"

The nurse checked the on-line record, "A proximal amputation of two or more digits, including adjacent necrotic area."

"In English?"

"He's having at least two fingers and part of the hand amputated."

"Thank you. Any idea when he'll be back?"

"Surgery started at ten, three to four hours expected. Probably not until around three. Later if there are complications."

"Thank you. I suppose, I'll just come back."

'There's no way I'm going back to the house without more news. Maybe, I'll go hang out at Charlie's for an hour or so.'

Next up - "The Wait, and Results"