“How’s Jakey doing?” Paul asks. My jaw tightens in irritation. Jacob hates when Paul calls him that. He’s only told him about fifty times.
“Let me take a look,” Dr. K says.
She steps up to the bed and begins her exam. There’s something in her manner that makes me trust her implicitly, but watching her examine Jacob is profoundly unsettling. She lifts his eyelids up and flashes a light in his pupils, listens to his heart and lungs with her stethoscope, and lifts up his hospital gown to examine some terrifying bruising all over his stomach and sides. I get my first look at the tube in his chest, stuck in between two ribs and secured with a bunch of white gauze and paper tape. She peers at the machine his breathing tube is connected to, looks at his catheter, examines his legs. The whole time, I want to step in and stop her. I want to wrap Jacob up in blankets and tell them all to leave him the hell alone.
Finally, she steps back and moves to stand at the end of his bed. She gestures for me to sit on the other side of the bed, opposite Paul, and I sink gratefully into the chair.
“As we discussed the other night,” she tells Paul in her gentle accent, “Jacob has suffered an extreme traumatic injury. There are the obvious issues—his broken leg and hip, broken ribs and punctured lung. Those will heal with time. But it is the injuries we cannot see as easily that are causing the most trouble.”
She moves to the side of the bed again and lifts up his gown to show us the bruises. “These bruises are not from impact, they are from internal bleeding. Jacob had a bad laceration to his spleen. The surgeons removed his spleen yesterday. He does not need it to live, though its absence will make him more vulnerable to certain infections. Down the road, he will need extra immunizations to prevent against those types of infections. He also had a deep liver laceration, which is more difficult to fix. The surgeons think they’ve stopped the bleeding for now, but his blood pressure is still too low, and his blood counts are not good. He will need another blood transfusion this morning.”
All the color is draining from Paul’s face. “Another one? But... didn’t you say it could be bad for his lungs to give him more blood?”
Dr. K nods. “You’ve pinpointed the problem exactly,” she says. “We need to have Jacob on this medicine”—she points to one IV bag—“to keep his blood pressure up. He needs this one”—she taps another bag—“to prevent infection, and this one to keep him sedated. Unfortunately, all of this means pushing fluid into his body. When you have a pulmonary contusion—bruising to the lungs,” she adds, seeing my confusion, “fluid can leak out of the tissues and cause pulmonary edema—fluid on the lungs. Adding a transfusion on top of these three means more fluid, and more risk of respiratory failure.”
“But—can’t we do the transfusion tomorrow, then?” Paul asks.
Dr. K shakes her head. “Jacob’s blood count today is sixty-eight. It should be around one hundred and forty. Without enough red blood cells, he can’t get enough oxygen to his organs.”
Paul catches my eye—he’s forgotten, in his fear and grief, to be suspicious of me—and we share a helpless glance.
“We will give him a medication through his IV to help push off fluid, before and after the transfusion,” Dr. K continues. “This may help protect his lungs.”
She sighs heavily, her eyes on Jacob’s face. This is probably an awful case for her. People in the ICU should be eighty-year-olds with cancer and heart disease and diabetes, not twenty-three-year-olds who were previously in perfect health.
“His situation remains very critical,” Dr. K finishes quietly. “Do either of you have any questions for me?”
Paul hesitates, so I jump in. This may be the only chance I have to get any information.
“You said—” My voice is thin and hoarse. I clear my throat and try again. “You said one of these medicines is to keep his blood pressure up?” I wave a hand at the IV bag she pointed out.
She nods. “Yes. It’s called a pressor.”
“But...” I lick my lips. “That machine says his blood pressure is ninety-two over fifty, doesn’t it?” I Googled “heart rate monitors” last night, and I know a normal blood pressure is something like one-twenty over eighty. “That’s still low, isn’t it?”
“It is,” she confirms. “Quite low.”
“So... can’t you increase the medicine to make it better?”
Her mouth tightens. “Unfortunately, that medicine is already maxed out.”
I swallow this news down. The urge to reach out and grab Jacob’s hand again is almost overwhelming. “And do you think—is there a chance he has a brain injury?”
Paul flinches. Like me, I’m guessing he hadn’t thought about brain injuries yet.
Dr. K considers her words carefully before speaking. “Unfortunately, we won’t know until he wakes up. We did a scan of his brain when he came in, and another yesterday when his heart rate dipped, and neither showed any sign of swelling or bleeding within the brain. But we won’t know for sure until he wakes up.”
“You said one of these medicines is a sedative, too?” I press. “It’s... keeping him out of it?”
She nods.
I swallow hard. “So he’s not—in pain?”
As soon as the question leaves my lips, I realize it sounds too personal, too intimate, not at all the type of question an acquaintance would ask. But Dr. K’s expression doesn’t waver.
“There’s no reason to believe he’s in any pain right now, no.”
She waits patiently while I frown at the bed, trying to think what else I can ask. My eyes catch on the bare skin above his casted leg, and another question slips out. “Should he have a blanket over him? He’s usually—he’s always cold.”
