MacGregor, this is Dr. Karen Olson. Dr. Olson is the neurologist I called. I’ll leave you with her. When you’re finished, please see someone in Patient Receiving. You’ll need to fill out some forms.”
Mac nodded his response and turned to Dr. Olson. “Is Richard badly injured?”
“It’s too soon to say. But I need to ask you several questions now. Does Richard use any medication, I.V. or recreational drugs, or alcohol?”
“No,” answered the Scot emphatically.
“Does Richard have a history of chronic liver, kidney, lung, heart, or other medical disease?”
“No, he’s always been very healthy.”
“That’s good. Now why don’t you go to the waiting room and try to relax. I’ll get back to you as soon as I review some tests. I’ve ordered a CAT scan and an MRI.”
Mac gave Patient Receiving the required information and found a seat in the waiting room. Paging aimlessly through a magazine, he tried to follow Dr. Olson’s advice and relax. Finally, he picked up a Gideon Bible and turned to Romans 8:28. He read the words several times: “And we know that in all things God works for the good of those who love him, who have been called according to his purpose.”
Then a voice beside him asked, “How are you getting along, Mr. MacGregor?”
Mac turned to see a nurse standing near him. “I’m awright. Thank ye for askin’.”
“Dr. Olson asked me to look in on you and see if you would like a cup of coffee or tea.”
“Aye nurse, a cup o’ tea would be nice. And could ye find out somethin’ aboot my nephew Richard and his friend Tony—I was so worried aboot Richard I neglected to ask after Tony.”
“I’m sorry, Mr. MacGregor. I thought you had been told. The man in the car with your nephew, identified as Anthony Kline, was dead on arrival. He died of internal injuries. His family has been informed. Was he a friend of yours?”
“No, not o’ mine. He was a gude friend o’ Richard’s.”
“I’ll get you that cup of tea,” said the nurse softly as she left Mac.
A little later, Dr. Olson appeared carrying Mac’s tea and placed it on a coffee table near him. “Nurse Ella sent this to you. I wanted to tell you what I know at this point about Richard’s condition.”
“Aye, whatever ye can tell me, Dr. Olson.”
“Richard remains comatose, Mr. MacGregor. This means he is in a state of extreme unresponsiveness; he shows no voluntary movement or behavior. He’s been unconscious now about four and a half hours, which is not unusual after severe head trauma. The assessment we’ve made is a concussion.”
“And the concussion,” Mac said thoughtfully, “causes the coma.”
“Well, yes. When a severe blunt force is applied to the skull,” replied Dr. Olson, touching the top of her head, “as in a car accident, communication pathways between parts of the brain are disrupted, resulting in loss of consciousness. The concussion causes bleeding and tissue damage, which, in Richard’s case, has produced a diffuse injury to the cerebral cortex.”
“A ‘diffuse injury,’ ye say, Dr. Olson.”
Noticing the confused look on Mac’s face, Dr. Olson explained, “This means that the injury was spread out rather than concentrated in one spot. Based on tests, structural damage appears limited. We’ve assessed basic reflexes, including his eye responses to light, eye movements, gag reflex, and his breathing drive. What we learned did not suggest primary or secondary brainstem damage, since there seemed to be control of those involuntary functions.”
“So, you’re sayin’, Richard’s condition could be much worse.”
“Yes, his injuries could be considerably more serious. But his head injury is serious. It’s true people who suffer head injuries generally do better than those who become comatose from other causes. However, Mr. MacGregor, only about 15 percent of patients who remain comatose for, say, 12 hours recover all of their physical and intellectual functions. And adults, whose coma lasts more than four weeks have little chance of coming out of it with their former abilities intact.” Wanting to sound more optimistic, she added, “On the other hand, I’ve had cases of children and young adults who’ve beaten the odds and have regained good functioning even after eight weeks in a coma.”
“When di’ ye think I might see my Richard again, Dr. Olson?”
“I’ve had Richard moved to the Intensive Care Unit. Nurse Ella is with him. I’m going there now. When I’m ready, I’ll have someone notify you that you can come up. He’s in room 507. Will you be here?”
“Aye, I won’t be movin’ from this spot.”
An hour later when he received word that he could see Richard, Mac found his way to the Intensive Care Unit. Opening the door of room 507 slowly and quietly, Mac peered in. He could see Richard in bed, lying motionless, Dr. Olson bending over him. On receiving her signal to enter, he moved close to the bed and watched her put a cotton wisp under Richard’s nostrils. Speaking to Richard as if he were awake, Dr. Olson said, “Richard I’m going to tickle your nose to see how you will respond, so that I’ll know more how to treat your problem.”
“Oh, he’s movin’ his head to get away from the tickle,” observed Mac.
“Would you step out into the hall with me a minute?” prompted Dr. Olson.
Mac followed her out of the room and stood by her, next to the closed door. “Is anythin’ wrong, Doctor?”
“No. I just wanted to explain, out of your nephew’s presence, why I spoke to him as if he weren’t comatose. You see, we can’t be sure of how much Richard is aware, so everyone giving care to him will tell him what is being done and why. We also do this because he deserves the same respect as a fully awake patient.”
“Aye, that’s gude. But Dr. Olson, would ye try that tickle test again on my Richard? He’s always been a wee bit stubborn.”
“Well, you understand, it’s not a matter of stubbornness,” replied Dr. Olson with a smile. “But I’ll try again and see how he responds.”
With Mac looking on, she performed the test again and, this time, he moved his hand to his nose and shifted his shoulders.
“Aha, as your uncle thought, Richard, you needed a little coaxing. Now, I’m taking your right hand in mine and I’m going to press hard on your knuckles for just a moment. I want you to respond to the pain.” Saying this, she pressed down on his knuckles, which elicited from Richard some unintelligible sounds. Pressing his knuckles a second time, she exerted more pressure. Richard responded with a few disconnected words. “That’s just fine,” she said, patting his arm.
“Excuse me a minute, Mr. MacGregor.” Dr. Olson said this, as she walked across the room and spoke quietly to Nurse Ella, who was observing machines monitoring Richard’s vital signs.
While Dr. Olson talked with the nurse, Mac leaned over to Richard, placed his hand gently on his forehead and quietly prayed, “Dear God, please heal my boy’s body. Protect his brain from any permanent damage, so
