Chapter Text
The thing they don't tell you about the ICU is the quiet. The ongoing quiet, only fractured by the steady bleep bleep bleep of the heart monitor and the expanding of the pump and the compression of the pump and the expanding of the pump and the compression of the pump forcing air through the pipe and into his lungs.
It's so quiet, and you don't want that to change because when it wasn't quiet it was filled with alarms and nurses and doctors and shouts and screams and tears. But the quiet, fuck, the quiet got to you sometimes. Sometimes Josh'd pray that Tyler would suddenly wake up screaming from a nightmare like normal, it was horrible but the noise would be better than quiet. Him being awake and screaming was better than not knowing when or even if he was going to wake up again.
They wouldn't put a date on it, they said they couldn't. They said once the swelling had gone down enough, once the pressure on his brain had decreased enough. They said a lot of things. Josh didn't believe most of it. He didn't believe they were optimistic he would make a full recovery. He didn't believe that it wasn't his fault. He didn't believe there was nothing they could do but wait.
Josh was sick of waiting. It wasn't okay anymore. It wasn't terrifying, wasn't hopeful, wasn't nauseating, wasn't anything. He was numb. Numb and fixated on the rise and fall of his best friend's chest, dictated by a machine.
That was one of the reasons he didn't trust the doctor when he said Tyler would wake up soon. To start with they had the ventilator in his mouth, but after a week they moved it so the tube stuck out of a hole in his throat. Tracheostomy they called it. Google called it a long term procedure. Long term, as in the doctor lying, as in Tyler not waking up soon.
"Sir, general visiting hours are over, I'm going to have to ask you to leave," the nurse told him, but Josh didn't break eye contact with Tyler's chest. "Sir,"
"I'm not leaving," he croaked.
"It's 8 o clock, only immediate family members can stay I'm afraid,"
"I'm not leaving,"
"I have to insist,"
"Are you deaf? Or just stupid?! I'm not leaving," he snapped, and the timid woman hurried away quickly.
Josh's brow relaxed again as he focused on the rise and fall, rise and fall. Everyday all day it would rise and fall. Nothing else, no head roll, no finger twitch, no sign of life except the rise and fall. The rise and fall, orchestrated entirely by the ventilator.
"Josh," the ward manager said, arriving at the foot of Tyler's bed. He didn't need to look up to recognise the old man's deep voice. "Please don't be aggressive towards my staff, I understand this is a difficult situation but that doesn't make it acceptable."
"You're not getting rid of me,"
"We've let you stay for the last few nights because Tyler's wife gave her consent, but that's not the case anymore,"
"Jenna can fuck right off, what right does she have to control me," He muttered, still not looking up.
"A legal one, she's his next of kin. Look, Josh, I just so happen to agree with her. You need to go home, get some sleep, freshen up and sort yourself out a bit. Come back tomorrow morning,"
"I'm not leaving,"
"What would Tyler want if he could see you now? Would he want you to carry on sitting here day in day out? Or would he want you to look after yourself,"
"I'm not leaving. Call security to drag me out again, but I'm not leaving,"
"I'm not calling security, but you should know that Jenna has called your parents."
"Bitch,"
"Josh let them take you home, let them help you,"
"Who the Hell are you to talk about helping people?! Your one job is to look after Tyler and you've done fuck all. 19 days and you've done nothing. Why don't you fucking help him rather than me?!"
"I'm going to grab you a glass of water whilst you wait for your parents to arrive."
Josh hated the polystyrene cups almost as much as he hated the slightly acidic water that always left his mouth feeling dryer than before. Once he had thrown the lukewarm liquid down his hoarse throat, he began passively breaking the cup in time with Tyler's mechanical breaths. He pushed its rim with his bloody chewed thumb, snapping little segments into the increasingly smaller cup.
Josh couldn't remember the last time he had been home, 3 4 days? He hadn't totally shut down, at least that's what he told himself, because he left to go to the toilet and to the cafeteria and to smoke. He wasn't leaving the hospital, but he left the room sometimes so that was fine.
And Tyler would no doubt yell at him for picking up his old bad habit again, although first he'd have to wake up. But as each day blended to another and each cig break used up more of a packet, Josh convinced himself that Tyler would never be able to call him a cancer enthusiast again.
If Josh let himself think about all the things that Tyler would never do again then his vision would go all misty and his chest would go all tight and his breath would get all caught. So he didn't. Instead he would sit with him, sit with him and wait for something to happen. Anything at all.
"Josh sweetheart, hey," Laura said, opening the door to Tyler's room. "You ready to go? Dad's waiting in the car,"
"No,"
"How is he?" She sighed, walking over to Tyler's bed and carefully running her hand through his long combed hair. He never combed it himself. This time Jenna had combed it, but Josh hated it, he really hated it. All he could think of was Tyler as a corpse being prepared for display at his funeral, being primed by the undertaker. He wasn't dead yet, the bleep bleep bleeps told Josh that he wasn't dead yet.
"No change," Josh murmured, hand covering half his mouth.
"That's better than deteriorating," the mother attempted to comfort him with a fake smile. Fucking sick of fake smiles.
"Is it?" He replied doubtfully.
"Come on sweetie, let's get you home," she sighed sympathetically.
"Not leaving him,"
"Afraid you're gonna have to J, hospital policy says you can't stay unless Jenna says okay, and Jenna wants you home for tonight."
"Don't care,"
"Have you been here since I dropped you off on Monday?"
"Yeah," he admitted.
"Right, come on you, bed time. You're 28, let's not play the stubborn 6 year old game. It's 9pm, I'll have you back in that chair by 9am I guarantee, as long as you hop in the shower, have a decent meal and get some shuteye. He'll still be here in the morning I promise."
Josh gave up tossing and turning in the bed that now felt foreign to him at 1am and rolled out of it, staggering out the window of his apartment and onto the fire escape.
The scattered half hours of sleep on the crappy plastic chairs in the ICU had done nothing to stifle his exhaustion, and yet he couldn't sleep in his own home. Every time his eyes shut he relived it over and over again, and every moment his eyes spent looking up at the white ceiling was invaded by the desire to be next to his best friend. He needed to be there, to be with him, just in case - just in case what? Josh didn't know. All he knew was that he couldn't sleep.
With a shaking hand he sparked the lighter once, then twice, then a third time before it finally caught. He sheltered the flame from the wind and brought it up to the cigarette gripped between his chapped lips, rolling his head back once its tip began to glow.
Josh didn't even feel the cold of the mid November weather despite only being dressed in the shirt and shorts his mother had forced him into. She slept on his couch, despite his protests, but she hadn't even stirred as he heaved the heavy window open and clanged his feet against the loud metal steps.
Josh knew she meant well, but it didn't stop him from wishing she would disappear off the face of the planet Earth.
He had come to the recent conclusion that other people sucked. They sucked real bad. Not a single one of Tyler's so called friends had payed him a visit, and his parents only swung by for the occasional half hour inspection when it was convenient for them.
Jenna joined Josh for a few hours every day, but she was really starting to piss him off. She always wanted to read to Tyler, incessantly doling out paragraph after paragraph of meaningless sound, even pausing at certain points to ask him questions. As if he gave a damn about why whoever the protagonist was did whatever the protagonist did, he had a 9.6mm diameter tube shoved through a hole in his throat. And the crying. Once she started she'd never stop, soaking Josh's shirt and blocking out the sound of the bleep bleep bleeps.
No, people sucked. They all sucked par one, and that one just so happened to be comatose. So Josh flicked the first complete cigarette to the ground and lit a second, already anxious that his remaining 11 wouldn't be enough to get him through till morning.
•• •• •• •• •• ••
Day 28 was the same as day 27, and the same as day 5 and the same as day 11 and the same as every other bloody day. Josh paced and Josh sat and Josh smoked and Tyler did nothing.
And yet day 28 was significant because Tyler had gone into the coma on the 28th. It was significant because Josh was 28 and Tyler would be 28 in a matter of days. It was significant because 28 meant 4 weeks which meant 1 month which meant a certain statistic kept ringing around Josh's head.
90% of brain injured patients who are vegetative for one month or longer will fail to improve to a state better than severe disability.
"Josh," Jenna said as she walked back into the room after getting herself a paper cup of crappy tea.
"Mm?"
"I think you should head home, I'll stay with him and call you if anything happens,"
"I'm good,"
"Go shower and brush your teeth, you stink like a human ashtray."
"Thanks,"
"I'm serious Josh, how many are you up to now?"
"Like a pack and half a day," he murmured, not making eye contact as he watched Tyler's chest rise and fall.
"What's that? 18?"
"30," he told her and she exclaimed under her breath, "but I don't get what that has to do with you. It's literally none of your fucking business,"
"Don't cuss, you know he doesn't like cussing. He doesn't want you smoking either,"
"Well he should fucking wake up and do something about it then," Josh snapped, standing up from the grossly uncomfortable chair he now called home and striding over to the window.
The view was bad. The buildings were half derelict, the litter atrocious, the weather abysmal. Fucking pathetic fallacy.
"Josh, you know I don't blame you don't you?" Jenna said softly, but his mouth was too busy ripping the skin off from around his thumb to answer. He didn't want Jenna's empty forgiveness. Didn't deserve anyone's forgiveness. Didn't need anyone's forgiveness.
"When Ty wakes up he'll tell you the same,"
"If,"
"When," Jenna insisted.
"It's been a month, 9-" Josh began to mutter quietly.
"I swear if you say that 90% stat again then I'm going to call your mom to take you home."
"You're living in your own fucking fantasy world you realise, fairy land where everything is fine and works out in the end and has a fucking happy ending; meanwhile back in shitty reality Tyler can't fucking breathe. If I were to flick that switch then he would die."
"Josh we're not flicking any switches, never,"
"Why the fuck not?! He's fucking gone Jenna, we're both just sat here watching an empty vessel - and for what?! This is hopeless,"
"I know you don't believe that Josh,"
"You know jack shit about me."
"I know that you're angry, and you're angry because you're scared. I know that Tyler is your best friend and that imagining life with him perhaps being a little different is terrifying, but I know that you haven't lost hope. If you had then you wouldn't be here. Josh he can do this, I know he can, we just need to work together to make sure that we can do this too. He loves us and that's never going to change, and we need to show him that goes the other way too. I know you're scared, but I also know you're brave and Tyler needs that. No matter what happens, he needs us. Please Josh, work with me on this, I'm not the enemy."
"I'm going for a smoke." Josh informed her, pacing away from the window and heading towards the door, scratching the back of his head.
"Josh please don't,"
"You're welcome to join me," he mutters bitterly.
"You know I can't,"
"You know I didn't mean it." He spat back as he walked out of the the room, the door bouncing shut behind him.
Josh sighed, looking at his unconscious best friend through the small window in the door from the corridor. After a second he had to look away, averting his attention to the whiteboard to the side.
Room Number 4
Name: Tyler Joseph
Medical condition: Traumatic Brain Injury
Admitted: 28/10/16
Discharge date:
Today's target(s):
Treatment plan: Observations
And suddenly Josh had enough of fucking observations. Enough of standing around and enough of watching and enough of no fucking plan and no fucking targets and no sort of acknowledgement that this was wrong. How could there be literally nothing they could do? It was wrong and it was fucking bull and Josh decided that the trash next to him deserved to pay. In a fit of frustration he kicked the plastic container over before storming down the corridor to calm his nerves with a cig.
•• •• •• •• •• ••
As far as Josh was concerned, day 34 was just day 34. As far as Jenna was concerned, day 34 was Tyler's birthday and for some reason that required a massive fanfare. She brought in a whole bunch of helium filled balloons and made two dozen cupcakes and iced every single one, offering them out to all the staff and family members on the ward. Jenna even brought in bunting and wrapped it around the rails of Tyler's bed. She thought it was marvellous, Josh thought it was obscene and an obvious display of a breakdown.
"Come on Joshie, have a cupcake," she grinned, standing next to Tyler with all the remaining cakes on his over-bed table, balloons bobbing behind her. Josh remained slouched in his chair on the other side of the room and scoffed.
"I'll pass,"
"They're Ty's favourite, red velvet, and look! This one's got a little basketball on it," Jenna smiled, holding one up proudly. Josh stared back blankly. "Or there's tiny music note ones too, the treble clef took me like 20 minutes and 3 YouTube videos to perfect, but voila! Pretty good huh?"
"Why? Why are you doing this?"
"It's my boy's birthday,"
"Yes I am aware." He sighed bitterly.
"Do you think we should sing to him? Yeah, aw he'll love that, we could get all the nurses in and-" she babbled excitedly but was interrupted as the door opened and Tyler's lead doctor entered.
"Good morning,"
"Hi Doc," Jenna welcomed him warmly, "Want a cupcake?"
"Oh I heard from Katie about these, sound delicious, I think I'll take one a bit later if that's alright,"
"Of course,"
"So how's our birthday boy doing this morning?" He asked, walking over to Tyler's bedside carrying a clipboard.
"Isn't that your job? Not ours?" Josh remarked sourly.
"Indeed it is," he laughed deeply, but Josh wanted to rip his face off. Instead he bit the remains of his nail and watched as the older man checked several monitors surrounding the head end of Tyler's bed.
"Alright we're looking good here," he concluded.
"What exactly does that mean?!" Josh snapped, his skin crawling with resent as the doctor helped himself to a cupcake.
"Yeah everything is within normal parameters, he's remaining very consistent across the board."
"How the fuck is that good then?! Fucking make him better, don't shove your mouth full with cupcakes and accept comatose as good enough,"
"Josh," Jenna warned him.
"No, this has to be some sort of joke - am I the only person in this fucking hospital who even wants him to wake up?!"
"Josh, my office now,"
"I'm not 14 years old, piss off,"
"If you want to have this conversation then I highly recommend you follow me to my office, otherwise I have the rest of my ward round to complete." Dr Hansen told him in a matter of fact way, convincing Josh to begrudgingly stand on his shaky feet and trudge after him.
"Josh, I must have mentioned this to you before but I'll repeat anyway, if you have any concerns you wish to raise then please feel free to find me and we can discuss them rationally. This is hard, today especially, but we can't have Jenna under anymore stress than she already is because it's bad for the baby. Please, I ask you come to me privately rather than in front of her,"
"Totally fucking forgot that this whole thing revolved around her,"
"She's pregnant Josh, at least try to fake a little empathy," the doctor smiled. Fucking smiles.
"It's that baby's fault Tyler's fucking comatose,"
"It's nobody's fault, but I'm glad you're not blaming yourself anymore."
"Fuck you," Josh spat back.
"Josh," the doctor sighed, "Do you have any questions?"
"Well for a starters why are you sat here trying to give me some sort of therapy when my best mate has been comatose for 5 weeks tomorrow?"
"As we've discussed, the best treatment plan is observing him and taking his vitals' variations into account when thinking long term."
"Bullshit."
"There's very little that will be beneficial for him beyond that,"
"Shunt, he's got increased intercranial pressure so insert a shunt to drain fluid," Josh recited blankly.
"The problem with Google searches Josh are that they can't take into account individual cases. In Tyler's case, the increased pressure wouldn't be significantly decreased with a shunt and the risk of infection is far too high."
"Take risks! Jesus Christ take risks! I'm sick and tired of watching him being kept alive as a vegetable."
"Here on the ICU our patients are not 'vegetables', they're sick people in need of extra assistance. Sometimes surgical options are available but often we just need to be patient whilst the body repairs itself."
"I'd rather he fucking bled out on the operating table than sit there and watch that for the next 60 years,"
"You know who wouldn't prefer him dead? Jenna, who would be made a widow aged 23, and their son or daughter who will never get to meet their daddy."
"Stop mentioning that thing," Josh growled.
"It's a baby Josh, I know you need somewhere to direct your anger but an unborn child is not the right target." Dr Hansen told him.
"I don't care, this is its fault." He snapped, standing up and walking out.
•• •• •• •• •• ••
Day 40 started the same as any other. Josh rubbing his cramped neck as he repositioned on the plastic chair. Ignoring the nurses as they said good morning and washed Tyler with damp cloths. Turning down Jenna's offer of a hot drink.
The mechanical breaths were the same. The mechanical buzzes of the lights were the same. The mechanical beeps were the same. The only thing different was Jenna.
She sat down and opened a book, but didn't begin to read it aloud. Instead she stared at Tyler with wide eyes for a minute before shutting it again, watching with tears rolling down her cheeks.
"Jen," Josh said, voice cracking, "Let me do it today," he continued, prising the book from between her fingers. He glanced at the cover before opening it on the first page and clearing his throat.
"Tyler, it's uh, it's Josh. Jenna's chosen the book for today, it's called Lolita. If you have any questions then feel free to ask and she'll answer." He began, feeling horrifically uncomfortable but indescribably obliged to take Jenna's place. With another sigh, he began reading. "Lolita, light of my life, fire of my loins. My sin, my soul. Lo-lee-ta: the tip of the tongue taking a trip of three steps down the palate to tap, at three, on the teeth. Lo. Lee. Ta."
Josh read 11 chapters before excusing himself for a smoke. Despite it being a week into December, he didn't bother with a coat. The cold snow falling on his face contrasting, conflicting, with the hot smoke filling his lungs was the closest he came to actually feeling anything at all.
There was a nurse, not from Tyler's ward, not Tyler's nurse, but a nurse who stood with Josh in the morning. It was an unspoken relationship, not so much as an introduction, but they always stood outside the ambulance loading bay at 11 o clock and smoked. She smoked 1. He smoked a pack.
On day 40 the black middle aged woman arrived first, her cigarette half gone as Josh unwrapped the new pack he had shoved in his pocket.
He turned the closed box upside down, rapped it 6 times, turned it back. Tradition. Routine. Ritual. Whatever, but he always did it. Just like he always took the first cigarette and turned it upside down before putting it back in. That would be the last one he smoked. The first, next first, was removed using his teeth and immediately lit with the spark of the woman's green lighter.
He rolled his head back and allowed the smoke to fill his mouth before breathing it into his lungs. Even the first drag of the first cigarette didn't give him a buzz anymore.
He lazily let the smoke wander out from between his lips before finally forcing the last remains into a horizontal stream. The nurse stubbed her's out and gave him a nod before heading back inside, and Josh lifted his cigarette in a weird goodbye dismissal.
With the glowing tobacco clutched between his lips, he used both his raw chewed hands to clear the snow from a low wall behind him, then sat on it.
Barely a minute passed alone before Jenna appeared beside him.
"Hey," she said softly, clearing her own space.
"Hi."
"Thanks for upstairs,"
"S'nothing,"
"He loves that book."
"Never mentioned it." Josh replied, before softening the blow by adding, "But uh, seems like him, I mean it was deep and made no sense,"
Jenna breathed out a short laugh, accompanied with a smile that stayed fixed to her face whilst her nose crinkled and tears swelled.
"Do you think I should buy him children's books? Read him something simple? Something easy he'll be able to understand if uh, if he's, you know, if, if he can't uh,"
"If he has impaired cognitive function," Josh finished for her, and she nodded tearfully. "Buy kids books for the kid, carry on with the classical shit for Ty. Either he'll understand it or he won't, but I don't think I can take 8 hours of Thomas the bloody tank engine everyday." He said light heartedly. Josh didn't do lighthearted. Or at least he didn't anymore.
"Does, does it help?" Jenna asked, picking up his box of cigarettes and pulling one out, letting it roll between her fingers, glide across her knuckles, slip between her nails.
"No not at all." Josh answered honestly, watching as she examined it.
"Could I maybe try one?" She sniffed.
"No," he told her, "In fact I don't even think you should be sat here whilst I've got one going. Second hand smoke for the baby and all."
"Since when did you give a damn about her?" The blonde asked, running a hand across her slowly showing belly.
"I don't, but uh, but Ty would kill me."
"True," she nodded, putting the cigarette down and wiping her face.
"Her? She's a girl?"
"Maybe, I think so,"
"We're going to go and read Daddy the rest of Lolita, do you want to come listen?" She said, sliding off the wall.
"Nah, still got 19 to go." Josh replied, putting her play cig back in the box.
"Okay, but Josh?"
"Yeah?"
"I think you're doing better today, well done."
•• •• •• •• •• ••
Of course taking one step forward on day 40 meant Josh took two steps back on day 41.
His pathetic excuse of a night's sleep turned out to actually be a 2 hour loop of Tyler's incident. Incident. Not accident. Accident implied there was no one to blame.
He saw it, then he saw it again, and then he saw it again. Tyler stepped off, no he jumped, no he failed to fly.
"Morning Josh, want a coffee?" Jenna said as she arrived.
"No,"
"You wanna read to him whilst I buy my tea?" She asked, holding out a new book.
"Waste of time," he snarled into his palm.
"Oh, okay, well I'll be 5 minutes."
"You were gone 8 hours, what difference does 5 minutes make?!"
"Alright J," she sighed, putting the book down on the table and leaving the room.
Josh glanced at the book briefly before rolling his eyes, not in the fucking mood for a rendition of The Scarlett fucking Letter. Tyler loved that crap, words that made him think, but it was completely pointless now that Tyler was completely useless. Because honestly, what's the use of a body that can't even breathe?
Josh bit at the side of his thumb until metallic liquid coated his tongue, then switched to pulling at his hair with his other hand, legs bouncing restlessly.
He watched Tyler's body be inflated then deflated then inflated then deflated, like some sick balloon. Josh desperately wanted to cut the balloon's string and let him fly away. That or stab him.
"I'm back, morning Ty, did you sleep well baby?" Jenna said as she walked back in carrying a paper cup full of tea. She put it down on the table next to her husband, then lent down and kissed him on the forehead. Josh watched with a grimace as she began smoothing his hair down then caressing his cheek with her thumb, having to avoid knocking the ventilator sticking out his throat with her forearm.
"Oh Josh, I got you a little present to say thank you for reading to my man yesterday." She told him, walking round the bed and reaching into her back pocket, then holding out a pack of cigarettes.
Josh looked down at the extended box. Menthols. Fucking Menthols.
"Are you fucking stupid or something?!" Josh yelled, snatching them from her hand whilst standing up confrontationally.
"I'm sorry," she cowered.
"Can you do anything?! I mean it's not fucking hard! How fucking dumb do you have to be to fuck up buying cigarettes?!" He shouted, taking a step closer to her.
"I'm sorry,"
"You can't do anything right!" He screamed in her face, throwing the cigarettes at the wall behind her, making her jump and burst into tears.
"You can't even keep your own fucking husband safe! Jesus Christ you knew this was going to happen! You fucking knew! And what did you do to stop it?! Fucking nothing! Waste of fucking space!" He yelled, spitting in her face at the cusp of each word, her having to stumble backwards as he stepped closer and closer until she was backed against the wall, sobbing terrified.
"Josh, get out." Dr Hansen entered the room and jogged over, pushing his way in between them and turning Josh away with two hands on his shoulders.
"Don't fucking touch me," he spat bitterly as he shook the doctor's grip off and Jenna slid to floor.
Two nurses walked in, one going to Jenna's aid and the other standing beside Dr Hansen to form a barrier between Josh and the pregnant woman.
"Do you need security?" She asked.
"Josh do we need security or are you going to leave the building of your own free will?" The doctor asked Josh calmly as he paced fuming.
"Shut the fuck up, everyone shut the fuck up!" He screamed at the room. The nurse knew the answer to her question and rushed out.
"Josh, listen to me, you have to leave. Let's go." Dr Hansen said and tried to usher him towards the door, but Josh lashed out and shoved the older man away from him aggressively. He staggered back a step, but remained as a guard to Jenna hyperventilating on the floor.
The other nurse rejoined them in the room, also protecting the two women on the floor.
"On their way," she nodded to the doctor.
"Mr Dun, you're going to be escorted off the premises and will not be allowed to return until we deem it to be safe." Dr Hansen said matter of fact, then 3 beefy security guards entered the small hospital room and dragged Josh out kicking and swearing.
"Josh sweetheart, are you ready to talk about it yet?" His mom asked him, sitting down next to him on his couch.
"Fuck off,"
"I've heard Dr Hansen's interpretation of the events over the phone, and Jenna texted me to say she doesn't feel safe with you visiting anymore. What happened baby? Why did you scare her?"
"If you call me baby one more time then I am actually going to slap you." He growled quietly.
"You most certainly will not Joshua. You may be 28 years old but I will still send you to your room if you think that's an appropriate way to talk to your mother."
"Bite me."
"Josh I know you darling, I know what you're like. When you are scared you get angry, and when you're angry you bottle it up until you lash out. I take it that's what happened today?"
"You gonna give me my keys back?" Josh retorted.
"No J, because you're in no fit state to drive. I mean not only are you emotional, but you've also barely eaten or drunk or slept in the past month and a half - I'm surprised you've haven't passed out yet. Plus where are you gonna go?"
"Hospital."
"You're not allowed in the hospital for the next 48 hours at least sweetheart,"
"What they gonna do." He murmured intimidatingly.
"They're gonna call the police J, and you're going to get arrested." She told him, and suddenly he sobered up to the reality that he wasn't going to be able to see Tyler for 2 days. It had been, well, he couldn't remember how long, but at least 6 months since they had gone a day without seeing each other. And now he had fucked everything up. Again. As per usual. Fuck up after fuck up after fuck up.
"Oh Josh, sweetheart," Laura cuddled up against him as he broke down into sobs.
"It's, not, fair,"
"I know J, he's your best friend, it's not fair at all," she supported him whilst rubbing his shoulder.
"I tried, to stop, him,"
"I know baby, we all know,"
"I tried Mom, I tried," he broke down.
"Shhh, Josh, it's not your fault okay, this is not your fault,"
"He was right there, I should've grabbed him, should've stopped him,"
"Baby you can't torture yourself like this,"
"And it's not fair, because, he's just my best friend,"
"What to you mean J? It's okay,"
"Jenna, he's her, husband, he's the, the, father of her child. I'm just, I'm just a friend. I've got nothing," Josh sobbed.
"Josh, darling listen to me, best friend still means a lot. Everyone understands this is just as hard for you as it is for her,"
"I've got nothing, and I, I miss him Mom,"
•• •• •• •• •• ••
Josh hadn't cried since 'The Incident', so once the flood doors opened there was no stopping them. Day 42 consisted of tears. Silent ones, sobbing ones, screaming ones.
Also, the reappearance of an old friend. Panic attacks.
He hadn't suffered any since high school, but the combination of paranoid concern and the knowledge that he was not allowed to contact Jenna or the hospital meant he was dissolved to a hyperventilating wreck on multiple occasions.
Laura held him tight and whispered comforting words, but told Josh that it was good he was finally letting himself deal with all the emotions he'd been holding in. As if it were his choice.
Well Josh could tell you that if it were up to him, there's not a cat's chance in Hell that he would have chosen to spend his day crying on the bathroom floor opposed to sitting with his best friend. Tyler needed him. He needed Tyler.
He tried to tell his mom that, begged her to take him to the hospital, but she insisted that he actually needed a shower and a meal and a rest.
It took Josh holding a knife to his own abdomen along with the threat of stabbing himself so that he'd be taken to the hospital for Josh to realise that he was a mess. He'd gone too far. He was a mess.
Laura helped him into the shower, sat him down in the bath and washed his hair with the shower head. She commented how he needed to get it cut, needed the sides shaved, needed the roots doing, needed the colour refreshing. Josh just let her massage the shampoo into his head and swayed like a rag doll, silent tears blending in with the warm water.
After she helped him into clean clothes and towel-dried his hair, she shaved his stubble then sat him down on the couch in the living room again.
"Josh sweetheart, are you safe for me to go and get blankets and food or do you need me to stay with you?"
"I'm safe," he whispered hoarsely, and she rubbed his shoulder and kissed him on the top of his head then left the room.
Josh was exhausted, his eyes were half open as he stared blankly at the black screen of his TV. He was all cried out. His eyes flicked down in their tear-swollen sockets and glanced at his hands, which were exposed from his hoodie. The bones protruded more than ever, and they shook too. The bottom half of every finger was chewed pink or bloody, and his nails were so small they bled too. Tar and nicotine stained the inner sides of two fingers, and he began to wonder how soon until his remaining nails would turn yellow.
He blinked away his watery eyes as he heard his mother's footsteps.
"Sweetheart, lift up your arms a little," she told him, then wrapped his comforter around him, tucking it comfortably. His hands rested back down in his lap, then a bowl of cereal was placed in them and 4 bottles of water put to the side. The spoon slid until it rested against this thumb, but Josh didn't pick it up.
Laura walked over to his DVD player and inserted Fight Club, then sat down on the couch next to him.
"I'm not going to make you eat a lot, but I do need you to eat that bowl at least. Then with all your tears and you not drinking enough anyway, you're bound to be dehydrated so all that water too please." She told him and he just nodded.
"Once the movie gets going, do you want me to pop to the chemist and get you some of those non prescription anxiety meds you used to take? Or I can look for something to help you sleep?"
"It's fine, but uh, thank you," Josh whispered.
"Okay sweetheart, but if you change your mind then let me know."
"Thank you,"
"Josh darling, are you going to be okay watching this?" Laura asked a moment later as the character of Tyler Durden was introduced.
"Yeh,"
"Sure? They say Tyler a lot, I don't want you getting worked up again. I can change it to something else,"
"It's, uh, it's my favourite, I'll be fine Mom,"
"Alright handsome, but again let me know," she told him and he nodded again. "Eat your cereal," she prompted him, and he slowly did.
Josh wasn't effected by the repetition of the word Tyler, because he fell asleep just moments after he finished his cereal. Laura stood up and moved the milky bowl so he wouldn't spill it, then repositioned the blanket fondly and turned both the lights and the film off.
•• •• •• •• •• ••
By the time Josh woke up from his 14 hour sleep, his hospital ban was over. Despite his urge to be at Tyler's bedside as soon as possible, he knew he had to start slowing himself down. Start taking back control. He couldn't control what was going on with Tyler, but he could at least dictate his own actions.
At his request, Laura drove him to the building that had served as both his home and his downfall for the past 6 weeks, but not before he forced himself to eat breakfast.
Laura walked alongside him as he lead the way down the overfamiliar corridors until they reached ICU room number 4.
"Please can you ask Jenna to come out here?" Josh asked his mother nervously.
"Don't you want to go in sweetheart?"
"I do, but uh, she might not want me to."
"Yeah okay, best to be polite, I'll get her,"
"Oh and Mom, will you offer to stay and read to Tyler whilst she's talking to me?"
"Read to him?"
"Yeah, she'll have a book on the go, she'd like it if you did." Josh explained.
"Okay darling, give me a minute." Laura said, putting a hand on the back of his neck and kissing him on the forehead, then entering Tyler's room.
Josh breathed out a sigh, then sat down on the bench in the corridor, leaning back against the wall. As his legs bounced and he prepared himself for the profuse apology he was about to make, Dr Hansen walked past.
"Ah, Mr Dun, you're back," he said, stopping and standing opposite him.
"Yes, and I am so sorry about what happened and about how I've been the last couple of weeks, I just, urgh, all over the place."
"I'm the clinical lead of an intensive care unit, trust me when I say you're not the first angry loved one I've dealt with."
"I'm so sorry,"
"You on your best behaviour now?"
"Absolutely," Josh nodded.
"Good. Listen, I've got to go see another patient but then I want to talk to you and Jenna about something,"
"Is everything okay?" He panicked.
"You'll be happy, we have a plan Josh," the doctor smiled as he walked away. Josh didn't know whether to smile or cry, so instead focused on trying to regulate his breathing as he waited for Jenna.
"Josh, please stand." Jenna said formally but quietly as she came out of the room and shut the door behind her. Josh obeyed immediately.
"Jenna, I am so sorry-" he began, but she raised her hand and stopped him.
"I, uh, I might lose my husband, Josh," she said slowly, tears falling as she looked anywhere but in his eyes. "And because, because of you I, I, I could have lost my child too," she continued, breathing out through tight lips whilst stroking her small bump and ignoring the tears dripping from her face. "We, w-we could have lost our baby,"
"I know I can never apologise enough-"
"No, no you can't Josh." Jenna interrupted him again. "And you will never pull a stunt like that again."
"Never,"
"Because I will press charges."
"I understand." He nodded, watching as she bit her lip and looked up to the ceiling.
"Is the baby okay?" Josh asked cautiously.
"I have to take medication Josh," she cried. Josh didn't know what to do or say, but Jenna took a step forwards and Josh pulled her into a hug.
"It's okay, she's going to be okay, the meds will make sure of it."
"For my blood pressure, they say I'm too stressed, well what do they expect?!" She sobbed.
"I'm so sorry Jenna, it's okay, come on it's okay. I'm going to be a better friend to all three of you now, I promise I'm going to stop adding to the stress and start helping,"
"You're going to leave as soon as I tell you,"
"Okay,"
"And you're never allowed to be in there without me."
"Okay,"
"No sleeping overnight anymore,"
"I won't,"
"If I tell you to do something then you have to do it,"
"I will,"
"And you have to start taking some responsibility for looking after yourself, I've already got myself and Ty and the baby, I can't look after you as well, I can't."
"Of course you can't, I'm sorry,"
"Okay come on, come on, come in," she said, releasing the hug and holding his hand, pulling him into Tyler's room.
As they entered, Josh saw his mom reading Wuthering Heights to Tyler. She stopped at their arrival and smiled at them holding hands, but Josh simply nodded to her once.
"Say good morning," Jenna instructed.
"Morning Tyler, it's Josh," he said to his unconscious friend.
"Every morning and evening, hello and goodbye. Minimum." Jenna said, and he nodded. "Sit down,"
"Sit next to me darling," Laura told him, picking up her jacket to clear a seat. He sat in it and she patted his arm fondly as Jenna crouched down to her bag on the floor a rummaged around before finding what she wanted.
She held out a box of nicotine patches, and Josh took them off her solemnly.
"Tyler is going to get better and he is going to wake up soon, so you need to start cutting down and stop smoking soon too. You know he hates it. I hate it. So you need to quit, and you need to be off them by the time he wakes up, understand?"
"Okay,"
As Josh and Jenna waited for Dr Hansen to finish talking to another patient, they sat in his office holding hands.
"Whatever he says, we can deal with it," Josh told her in a deep voice.
"Yeh," she nodded but didn't seem convinced, tears rolling down her cheeks once again.
"You said you could tell he was enjoying The Scarlett Letter yesterday, and remember what the doc told me, they've got a plan; it's going to be good news I promise," he continued to comfort the clearly terrified woman.
"It's going to be good news," she whispered, as if she was trying to convince herself.
"Hello, sorry to keep you both waiting," Dr Hansen apologised as he entered the room, a large file of notes tucked under his arm which he placed on the desk before shaking both of their hands.
"Not a problem," Josh replied.
"Now Tyler Tyler Tyler, what are we gonna do about Tyler," he muttered under his breath whilst flicking through the file. "Ah yes, so he's had a GCS of 3 for 6 weeks now,"
"6 weeks 1 day," Josh couldn't resist correcting.
"Yes, and 1 day, and I take it you've both familiarised yourself with GCS? Glasgow Coma Scale? It's the way we measure consciousness, and right now Tyler has the lowest score."
"Right," Josh said whilst squeezing Jenna's hand.
"If he were to move up, that would be because either he opened his eyes in response to pain, he made a sound, or he's decerebate which means he holds his body in an abnormal position, for example pointing his toes or arching his back."
"And do you think he's going to do one of those soon?" Jenna asked, wiping her face.
"It's hard to tell, near impossible to predict I'm afraid. However, I do at least have some good news, hence why I asked you here,"
"Good news," Josh whispered to Jenna, her nails digging into his hand.
"Indeed," Dr Hansen agreed whilst getting out a spreadsheet of paper covered in numbers and putting it on the desk for them to see.
"Okay you see this column here? This is his ICP, intercranial pressure, so it's how much pressure is inside his skull and therefore in his brain and cerebrospinal fluid." He explained, running the tip of his pen along a row of numbers that still meant nothing to Josh.
"Okay,"
"It's measured in mmHg, millimetres of mercury, and your average healthy adult will be between 0 and 10, and over 20 is seen as abnormal. 40 is the point where everyone would suffer some sort of neurological dysfunction, for example impairment of consciousness, problems breathing, pupil dilation etcetera. Then 60 is widely considered as fatal."
"Right," Josh said, beginning to understand what he was reading.
The doctor moved his pen to point out the extremely high numbers from Tyler's first three days unconscious.
"If you look here, he's fluctuating around the 55 56 mark, which was very worrying. That was back before the surgery when he was having seizures, but thankfully the surgery successfully lowered his ICP to 49, see here?"
"Yeah," Jenna whispered.
"Since the brain has had time to calm down effectively, had time to relax after being jabbed and prodded in surgery, some of the swelling has gone down and it became less aggravated and that means we're down to 42 43," he said, pointing out to them yet another figure.
"Right,"
"Now at this point I have to bring up the disclaimer that any sustained ICP values above 40 are considered severe and life threatening,"
"But 42 is better than 56," Jenna concluded for him.
"Precisely," the doctor smiled.
"So what does that mean for Ty?" She asked, sniffing.
"Exciting stuff. If you look back to week 3 he was mostly 44 with the odd 43, then week 4 was spilt fairly evenly between 43 and 42, and week 5 was mostly 42 with the occasional 43. We were hoping that for week 6 and 7 he would continue this trend of slipping down until he went sub 40, but he's being quite stubborn and sticking at 42 43,"
"Stubborn, sounds like Tyler," Josh joked quietly, and Jenna laughed once through the tears.
"I'll have to take your word for it," Dr Hansen smiled. "So we were going to wait until he was averaging 39 before moving forwards, but he seems fairly settled and stable at 42, therefore we've decided to go full steam ahead and trial him on ventilation weaning,"
"He's coming off the ventilator," Jenna gasped, covering her face with once hand as she sobbed with a smile. Josh felt himself tear up as he grinned. He'd always hated that damn machine.
"Jenna I need you to keep your expectations realistic okay, his ICP is very high and we still don't know the true extent of the damage he did to his brain when he jumped in the first place. There's a very real chance that this could fail and we will have to try again at a later date."
"I know I know, please, just explain how it's going to work?"
"Of course. We'll start out doing SBTs, spontaneous breathing trials, 2 to 4 times a day depending on how well he responds to them. It involves basically testing to see whether he can breathe independently for a short period of time. We'll begin with 5 minutes and work up to 15."
"So you just switch the machine off and see if he breathes?" Josh asked doubtfully.
"Yes the machine will be off, but there will be a whole team of specialist nurses on hand who will monitor his blood pressure, respiratory rate, pulse, and ECG for signs of trouble. If they see him struggling then it will only take a couple of seconds to restart the vent."
"Okay, that's okay, we trust you," Jenna nodded.
"If he's able to support his own breathing for 15 minutes 4 times a day for 3 consecutive days then we'll remove the mechanical ventilator,"
"It's coming out?" Jenna smiled tearfully.
"We'll keep the collar in, that's the little circle entrance of the internal tube, but it'll be closed. Then overnight we'll reattach the ventilator so he doesn't get too fatigued."
"And during the day he's just free to breathe for himself?" Josh asked.
"Almost, there's an intermediate step where we'll use a pressure support ventilator. That's gonna go through his mouth rather than his trachea, and it works basically by Tyler initiating a breath and the ventilator extending it. So once Tyler starts to breathe in by himself, the pressure kicks in and fills his lungs for him, then he'll exhale it. That way he gets practice using those muscles again, but he'll be able to build up his endurance rather than getting too fatigued."
"Yeah,"
"And I'm sure you both know how weaning works; we'll decrease the amount of time he uses the ventilators for until he's breathing independently."
"Okay,"
"So you're happy for us to start that tomorrow?"
"Absolutely," Jenna nodded.
•• •• •• •• •• ••
Josh arrived back at the hospital on day 44 at 9.25am, and Jenna was already in Tyler's room with a cup of tea and Wuthering Heights opened where they had finished it the night before. Usually she managed a whole novel a day, but after their meeting with Dr Hansen she spent a lot of time on the phone to her parents and to his.
Jenna seemed to be coping okay with the idea of the first spontaneous breathing trial looming, but Josh was on edge. He had done what his mother had instructed and eaten a full breakfast and just about managed 4 hours sleep, but still his breath caught in his throat as he entered the room.
"He shall never know I love him: and that, not because he's handsome, but because he's more myself than I am. Whatever our souls are made out of, his and mine are the same." Jenna read before looking up at Josh.
"Hey,"
"Hey, sorry, I already went on a tea and coffee run," she apologised.
"Not a problem, you reading Wuthering Heights still?"
"Yeah," she nodded, "he uh, he loves that bit."
"The souls bit?"
"Yeah, before he started getting sick again he used to say it about us, how I make him feel more like himself than anything else and that we were cut from the same cloth. Our souls the same." The pregnant woman recalled sadly.
"He loves you even when he's bad, you know that right?"
"Yeh, I know, it's just,"
"Just what?" Josh asked.
"It feels nice to hear him say it you know, like not many guys will quote Wuthering Heights and give a 10 minute analogy of how much they love you just because you passed them their shirt. That's just what makes my Tyler my Tyler,"
"Yeah,"
"And before it happened, he was getting really fixated on souls and it's just upsetting to see him upset."
"Course," Josh nodded understandingly.
"Like he wouldn't sleep in the same room as me, he kept saying how his soul was too dirty, it was too dirty and heavy and he had to stay away to protect me."
"See even when he's sick he cares about you, he wanted to protect you,"
"Yeah,"
"He'll wake up soon and shower you in love I'm sure," Josh smiled supportively.
"Yeah," she seemed slightly unconvinced.
"What happens next in the book then?"
"Do you two want to stay in here for this?" Dr Hansen asked quietly, sitting next to them on the seats as 4 other members of staff talked and set up equipment around Tyler.
"Yes," Jenna immediately nodded.
"Okay, any questions for me?" The older man asked.
"5 minutes yeah?" Josh said.
"5 minutes." He nodded.
"Come on Ty, you can do 5 minutes," he murmured whilst looking at his unconscious friend.
"Doc, we're ready when you are." One of the male junior doctors said.
"Alrighty," Dr Hansen replied, drumming his hands on his thighs then standing up. "Okay Tyler, let's see what you can do." He continued, nodding to a nurse.
"Mechanical vent off," she told him as she pressed a few buttons, and another nurse began a stopwatch. Jenna grabbed Josh's hand tightly, knuckles white, and they both held their breath until Tyler wheezed his first.
"Thank you God," Jenna burst into tears, and Josh wrapped an arm around her shoulders whilst watching Tyler breathe through blurred vision.
"Oxygen sats?" Dr Hansen asked.
"90%," a nurse replied.
"Good, good Tyler," he hummed, nodding slowly.
"Well done baby," Jenna called out to him tearfully.
"Yeah good job mate," Josh added as he wheezed sporadically.
"30 seconds," another nurse read from her stopwatch.
"Sats at 84%,"
"Okay watch that," the doctor instructed her. "James what's his partial pressure of oxygen in arterial blood?"
"53,"
"Hmm,"
"Is something wrong?" Jenna began to panic.
"We're okay for now, just need to watch he doesn't dip," he murmured whilst watching the monitors.
"Sats dropping, 78%,"
"Partial pressure down to 51,"
"Heart rate 141 and climbing, 158, 170, 187, 192,"
"Okay I'm calling time, put him back on the ventilator," Dr Hansen decided, and the nurse restarted that overfamiliar pump and Jenna sobbed harder.
"Back down to 150,"
"Sats are still low,"
"Heart rate 110, 100, 70,"
"Good," Dr Hansen nodded, "Sats?"
"Staying at 80%,"
"Increase the oxygen percentage," he told the nurse, who pressed a few buttons.
"Back up to 97%," she said a moment later.
"Okay good, back to baselines. Can I get a total time off vent?"
"He was off 52 seconds,"
"52 seconds, okay thank you everyone." Dr Hansen said and the nurses all left the room, leaving Jenna sobbing against Josh's chest whilst the doctor wrote rough notes.
"Jen come on, shhh, shh come on, calm down, it's bad for the baby," Josh murmured to the crying woman.
"He, can't, breathe," she broke down in hysterics.
"Jenna," the doctor began, crouching down in front of both of them, "He can breathe, he breathed for 30 35 seconds independently with no issues, and still managed another 20 on top of that. He can breathe. He just needs a rest now, okay? He's tired, hasn't used those muscles in a while, but he did fairly well."
"Jo-sh,"
"It's okay Jen, come on, he's okay, he's going to be okay isn't he Doc," Josh comforted her.
"He's not," she answered for him, "he's not,"
"We'll give him some more time and then we'll try again," Dr Hansen told them.
"Why? Why bother? You said, y-yesterday that his ICP is staying the same, he's staying the same and he's not going to get better," the pregnant woman sobbed desperately.
•• •• •• •• •• ••
Josh stayed at Jenna and Tyler's house after his failed breathing trial, not wanting to be alone but more importantly not wanting Jenna to be alone.
He had presumed he would sleep in the guest room, but upon arrival it quickly became apparent that Jenna had been using it. She said that it was too hard to sleep in Tyler's bed without him, and Josh understood straight away. He made sure she fell asleep, then settled down on the couch.
"Josh," Jenna tapped him on the shoulder, waking him up on day 45, "Josh, you up?"
"Morning," he groaned, rubbing his eyes and stretching. "You alright?"
"Yeah, how long do you need till we can go?"
"In a rush? Sit down and I'll make you some breakfast," Josh offered, sitting up on the couch slowly.
"We can grab something from the store on the way, come on, I wanna go. Tyler's gonna wake up today, I can just sense it." She beamed. Josh smiled at her, glad to see that she had somehow pulled herself back together after her breakdown the night before.
"You're his wife and his whole world, he's not gonna do it without you. He'll wait. Let me make you and your littleone something to eat." Josh insisted.
"Morning Ty," Josh said as he walked into room number 4, holding the door open for Jenna.
"Hey baby," she smiled, walking over to his bedside and kissing his forehead then perching on the edge of the mattress. "Did you miss me? I missed you lots and lots. We're a bit late because Josh made himself and the baby and me waffles for breakfast."
"I offered to make my legendary berry compote with lemon mint syrup, but she wanted chocolate." Josh told him as he sat on a chair.
"You know me babe, I'm a chocolate obsessed toddler when it comes to food."
"Need you to wake up Ty, then I'll have someone with a sophisticated palate to cook for," Josh told him playfully.
"Once our baby comes I'm just going to be eating lots of apple purée with her little baby spoon, you're gonna find me sat in her nursery in the evening, elbows deep in a jar of baby food." Jenna smiled, rubbing his arm fondly.
"When do pregnancy cravings start?" Josh asked Jenna.
"Should start any day," she replied, stroking her 14 week bump. She then picked up Tyler's limp hand and turned it before placing it against their child, holding it softly with both of hers.
"She's 3 and half months now Ty, second trimester." She told him quietly, looking at him. "And I've got my dating scan tomorrow, so we're finally going to get a due date. We don't know the gender till the next scan, but she's a little girl, I can just tell. Can you feel her darling? She's in there, our daughter,"
Josh watched the couple with a small smile, feeling a little choked up but also proud of her for being so strong.
"I'll get you a copy I promise, yeah, get you a scan and we'll stick it up with all your get well soon cards so she's near your head. And she might start kicking in the next couple of weeks, so we can sit like this and you can feel her,"
"That'll be nice for you Ty,"
"Yeah," Jenna agreed. "But babe listen okay, once we get a due date, that's a target date for you too, yeah? 5 months, I need you home and I need you better. I know you Ty, I know you can do this. The doctors are going to come in soon and they're going to let you breathe by yourself again for a couple of minutes. Yesterday was 30 seconds perfectly and I am so-" she stopped to lift his hand from her belly and kiss it, "so proud of you baby, but let's see if we can beat that today,"
"Remember what you told me Tyler? If you're not competing then why did you get up this morning? Show us some of that competitive spirit, beat your personal record." Josh smiled.
"Your little girl is going to be watching you sweetie, make her proud," Jenna told him, then began playing with his hair affectionately.
"Jenna you can hold his hand, but make sure you don't block Casey's view of that monitor," Dr Hansen said as everyone prepared for Tyler's second breathing trial. Jenna stood at his bedside, one hand holding Josh's and the other Tyler's, and 3 nurses plus Dr Hansen stood ready to observe and intervene.
"So that you understand what's happening guys, the higher the oxygen saturation percentage the better, that's the blue number; then the closer the heart rate to 65 the better, that's the red number,"
"Thank you,"
Josh mouthed a silent prayer under his breath as the nurse switched the ventilator off whilst another began the stop watch.
"Oxygen sats and heart rate every 15 seconds please," Dr Hansen requested.
"That's it baby," Jenna whispered as he took his first wheezy gasp, gripping incredibly tightly on Josh's hand.
"96% and 64," a nurse announced, then shortly after, "95% and 64,"
"Great going Tyler," Josh told him as he remembered that was when it had all gone wrong the day before, and hoped it wouldn't again. A rush of relief ran through him as the nurse called out the 45 seconds measurements.
"95% and 68,"
"We love you baby," his wife told him, and Josh watched as she pressed Tyler's hand against her bump again.
"94% and 71,"
"That's one minute Dr," another nurse informed him.
"Absolutely smashing it Ty," Josh grinned.
"89% and 77,"
"That's a big change, is he okay?" Jenna panicked.
"It's way within normal parameters for a healthy adult." Dr Hansen calmed her down.
"89% and 78,"
"Come on Ty," she whispered.
"92% and 80,"
"Oh wow, he's increased his own oxygen saturation, that's incredible," the doctor seemed genuinely impressed, and Jenna turned to grin at Josh with tears filling her eyes.
"92% and 85,"
"That's two minutes,"
"91% and 85," then, "90% and 86,"
"You're half way done Tyler," Dr Hansen informed him.
"83% and 90,"
"That was a big dip," Jenna panicked again.
"Let's watch that please, if he goes sub 75 oxygen sats then I'm restarting ventilation," the older man announced to his team.
"83% and 91,"
"3 minutes,"
"Come on baby," Jenna whispered, holding his hand flat against her actual baby.
"85% and 90,"
"He's listening to you Jen," Josh noted, and she just quietly cried more.
"86% and 93,"
"Tyler I love you,"
"85% and 97,"
"His heart's racing, must hear the sound of someone he has a huge crush on," Josh smiled, skeptical that Tyler could hear at all but knowing that Jenna needed to think that he could.
"80% and 101,"
"4 minutes total Hansen," a nurse told the clinical lead.
"Come on Tyler, go for the home run," Josh willed him on.
"79% and 119,"
"Watch that pulse," the doctor said.
"74% and 129, begin to ventilate?"
"Hold out a second longer, let's see if he can safely do the whole 5."
"30 seconds baby, calm down," Jenna supported him.
"72% and 135,"
"Hold out," Dr Hansen instructed, Josh's heart pounding.
"69% and 142,"
"Ventilate," he nodded, and the switch was flicked back on.
"Congratulations Mr Joseph, you've officially passed your first spontaneous breathing trial." Dr Hansen told his unconscious patient as the pump began to sound again. Jenna wiped away her tears and planted a large kiss on her husband's forehead, then whispered something in his ear that Josh couldn't hear.
She then turned around and pulled Josh into a tight hug and held him for a moment before saying,
"He can hear us J, he heard us ask him, he did it for us, for the baby. He did it."
•• •• •• •• •• ••
Josh's legs bounced up and down and up and down and up and down. It was not supposed to be like this. Tyler was off the ventilator, he was supposed to be awake, things were supposed to be better. Josh wasn't supposed to spend Thanksgiving, Christmas and New Years in a hospital with his fucking comatose best friend. Jenna was supposed to hold Tyler's hand, not Josh's, when she had the scan to confirm she was having a girl. Everything was wrong. Everything was supposed to be better, and it wasn't.
Day 70 was the same as day 67, and the same as day 56 and the same as day 61 and the same as every other bloody day since he came off the ventilator. Josh paced and Josh sat and Josh smoked and Tyler did nothing.
When things seemed to be looking up, when Tyler was able to breathe for 5 then 10 then 15 minutes, when everyone was excited as he did his first hour, then his first whole day, then his first night, Josh had tried to quit smoking. He wore those stupid patches, chewed a pack of gum a day, set himself time limits, and sure enough he cut from 40 a day to 15. But now they were back in a rut of nothingness, he was back up to 30. Minimum.
He didn't even have the sound of the pump anymore.
"Ooh Ty, Ty feel baby, can you feel that?" Jenna whispered excitedly, holding her husband's hand against her kicking belly. "Do you feel her sweetheart? She's going be our little soccer star."
Josh watched the couple glumly, wondering when Jenna was finally going to catch on and realise that Tyler wasn't going to get any better. It was clear the staff had given up, and she needed to too. Face reality.
They claimed that they hadn't given up, but Josh wasn't an idiot, he had eyes. He saw how they changed his observations from every 2 hours to every 4 hours. He saw how Tyler's physiotherapist went from visiting 4 times a week to just once. He saw how the nurse didn't bother asking Tyler to squeeze her hand anymore, just wrote that he couldn't.
"Josh, do you want to come feel? She's kicking,"
"I'm going for a smoke,"
"Please don't,"
"Be back later," he told her whilst opening the door.
"At least say goodbye to him," she said but he walked away, door bouncing behind him.
"Diane," Josh began as he breathed in the familiar smoke. The nurse and he had began brief conversations when Josh shared his cigarettes with her whilst trying to quit.
"Yes sweetheart?"
"How long will a hospital keep a patient who isn't responding to treatment before they say enough is enough?"
"There's no set time limit, depends a lot on the case," she answered, taking another drag.
"If they're stable and won't deteriorate then we'll send them home as soon as we can. I mean I don't know what's going on with your friend, but it's been quite a while hasn't it."
"10 weeks,"
"And when was their last improvement?"
"2 weeks 3 days," Josh recalled when Tyler had been taken off the ventilator completely.
"If I were you then I'd talk to their lead doctor about taking them home."
"They can't come home,"
"Why not sweetheart?"
"Their partner won't be able look after them,"
"Well there's long term hospitals you can look into then, rehabilitation hospitals and nursing homes and hospices,"
"Hospice, Jesus," Josh whispered under his breath before taking another deep breath from the cig.
"That's usually for end of life care, have you been told whether your friend's condition is terminal?"
"It's not,"
"Talk to their doctor about moving them to a nursing home then I'd say, they'll be able to give you better advice and support than I can,"
After Diane went back inside, Josh picked at the scabs on the end of his fingers from all the skin he had chewed off anxiously. Some only stung whereas others bleed, dropping minute splashes of red down onto the white snow.
Josh sighed, fed up, frustrated, and bored. So fucking bored. Everyday was the same, even the books Jenna read were starting to be repeats. And yet Josh still turned up everyday, and he knew he would continue to until, well, who knows? Until something changed.
•• •• •• •• •• ••
Josh listened to Jenna read A Tale of Two Cities, trying to pluck up the courage to bring up moving Tyler to a nursing home. He'd spent the evening researching nearby brain injury care homes, found 2 that were under an hour away and seemed alright. He'd requested brochures for both, but knew he would have to talk to Dr Hansen before taking it any further, and he would have to talk to Jenna before Dr Hansen. He had to talk to Jenna. All he had to do was talk to Jenna. Talk to her.
He practiced what he had to say in his head over and over again. Jenna, Tyler's not making any improvements, I think he would be happier in a more caring and less clinical environment. Yes, make it about Tyler as though he had any sort of emotions or opinions on anything - which of course he didn't. How could he? All he did was lay there.
Nothing was going to change.
"Jenna-" he began, but then something did change. Tyler's whole body began to violently shake and jerk, alarms sounding as he involuntarily bucked and convulsed on the bed.
Jenna ran out of the room crying and returned a moment later with several nurses, and Josh just stood helpless, watching Tyler fit.
"Okay he's having a seizure, Jenna, Josh, out," Dr Hansen said as he joined the busy room. Jenna stayed at Tyler's bedside crying as he jerked erratically, but Josh put a hand on her arm and pulled her out and into the corridor.
She tried to barge her way back in but he stood in the way and she soon collapsed against him, ugly snotty sobs breaking against his shoulder as she cried terrified. Josh glanced briefly through the door window and saw Tyler continuing to seize.
"Jenna, come on, it's okay, change is good, change is what we need, this is good," he told her emptily, having no idea what he truly believed.
"I'mm s-scared,"
"He'll stop soon, they're looking after him, shhh, he's okay,"
"I don't want him to die," she cried.
"He's not going to die Jenna, he's not, and you know why? Because he's a stubborn so-and-so, yeah? And also because you told him not to. You always tell him: Tyler I need you home with our daughter by the 2nd of June, so you better be better by then. He listens, remember? He listened to you and he's going to do what you told him to, because you're the only person he obeys."
"Yeh," she whimpered.
"He's not going anywhere I promise."
"Has he stopped?" She asked quietly between sobs, unable to look. Josh peered across again and briefly caught site of Tyler's flailing arm.
"Not just yet, but it won't be much longer I promise," he answered and she continued to break down in his arms.
As the pair sat in Dr Hansen's office, Josh could barely concentrate on what the old man was saying as he kept zoning out or getting distracted. Rather than focusing on the news about Tyler's seizure, instead Josh was focused on reading the certificates on the wall behind the doctor. But he metaphorically shook himself and tried to pay attention again.
"-so the fact he had a seizure is just evidence that there are electrical signals being transmitted by his brain. All a seizure is is an abnormal discharge of an electrical signal. If he's having seizures then he must have brain activity which is very promising,"
"Yeah," Jenna whispered, and Josh guessed it to be an appropriate time to squeeze her hand reassuringly.
"Now, you should prepare yourself for the reality that there is quite a high likelihood of Tyler developing epilepsy as a result of his brain injury,"
"Even once he wakes up?"
"It's a life long condition." Dr Hansen nodded. "But don't be discouraged, many people find the right balance of medications and go long periods of time between seizures, years sometimes."
"Yeah,"
"And I'll be looking through the details of the seizure in terms of what was picked up on his monitors later today and we'll begin to give him anti seizure meds as soon as possible."
"Thank you," Josh finally chimed in.
"Are there any questions?"
"Um, I was uh, I was wondering whether, well, when he had his first seizure you took him into surgery, are you going to do that again?" Jenna asked nervously.
"Okay so remember what I was telling you the other week about his ICP, the pressure in his head. When he was having seizures last time it was because his ICP was peaking around 56 which was potentially fatal. We took him into surgery to lower the pressure which then stopped the seizures, whereas these seizures are not caused by high pressure. As I'm sure you're aware, brain surgery is very very risky. We performed it last time because it was necessary and his condition was life threatening, but surgery for epilepsy is not vital so I don't feel it a big enough issue to put him through surgery again. If he regains consciousness and later down the road he is having a big problem with epilepsy then we'll revisit surgical options, but because he is quite vulnerable at the moment we won't be performing any operations no."
"Okay," Jenna sniffed, and Josh looked across to see her crying again.
"I am going to take him for a CT scan later so I can see what's going on inside his head. My main goal is to try and identify what part of the brain caused the seizure-"
"Surely it's the bit he hit when he landed." Josh interrupted.
"Not necessarily. Because brain cells can't repair themselves, his brain will have started to rewire itself so that the damaged synapses aren't used anymore. There's a high chance that one of the new links is wrong and causing seizures, so hopefully I'll be able identify that."
"Okay,"
"Whilst I'm looking for that, I'll also be able to check up on the damage originally done. Now that the swellings gone down I'll get a clearer look at how extensive it is."
"Does that mean you'll know what he's going to be like when he wakes up?" Jenna asked quietly.
"Only very very vaguely, and from what I've heard about him, Tyler doesn't exactly always do what he's told."
"True," Josh smiled at Jenna, squeezing her hand again.
"It will only be an approximation of a prognosis, and Tyler could still do what he did with his breathing and take us by surprise."
"I'm sure he will," Josh lied through a smile.
•• •• •• •• •• ••
On day 72 Jenna asked and was given permission to sit in on a meeting about Tyler with Dr Hansen and a whole army of neurosurgeons and physical therapists and intensive care nurses and everyone else involved in his care, but Josh chose to stay with Tyler. He knew they would be talking in words that he didn't understand and everything they would conclude would simply be speculation as there was no way they could possibly predict the future. So he sat with Ty, and read him the book that Jenna had chosen that day.
He sighed, eyes tired from scanning over the small print. Jenna and Tyler were both far more interested in literature than him, and the daily doses were yet to inspire Josh to follow in their footsteps.
"I'm gonna stop Ty, give my eyes a little break." He told his friend as he closed the book and put it to one side, then rubbed his face with his painfully gnawed hands.
"Happy 8th of January," he sighed, slouching in the crappy plastic chair. "Fun fact for you, both Galileo and Stephen Hawking were born on the 8th of January, exactly 300 years apart. There we go, you've got your literature and I've got my random useless crap."
Josh bounced his legs for a minute, craving a cigarette and feeling awkward talking to him. He turned his wrist and checked his watch. 11am. Diane would be on her break, and nobody would know if he slipped out for a couple of minutes. But he sighed, he had made a promise to Jenna and intended to stick to it.
"You're lucky I love you Ty, otherwise I'd be downstairs chain smoking a pack rather that watching you sleep. Oh and by the way you owe me like a thousand dollars for all these cigarettes, they're not cheap." He said lightheartedly, still bouncing his legs.
"You know if it were up to me Ty, I'd buy a shit ton of German novels and read those to you instead, then that way you could learn a whole new language which would actually be a productive use of your time. I mean I know you used to like these classical classic things, but you've read them all before. German would be cooler." Josh babbled, knowing Jenna would want him to fill the silence with something.
"I guess this is good for you, getting a bit of rest. You can finally catch up on all the sleep you've missed recently." He continued, picking at a loose thread on his jeans. "Well I say recently, I mean 3 4 months ago."
"You gave us quite the scare yesterday mate." Josh told him. "I know Hansen said it was a good thing, but you freaked Jenna right out, so do me a favour? Don't go having lots of those seizures."
"Jenna says I have to remind you as often as possible. 2nd of June is her due date, she needs you better by 2nd of June. That's your target Tyler, and that's your daughter's birthday."
"She's getting big Tyler, you can definitely tell she's pregnant. And she throws up a looot, so I'm jealous of you getting to miss out on all those pleasant smells and sounds. I wouldn't be surprised if she used up the intensive care unit's entire stock of vomit bowls."
"Oh and she's been thinking of baby names, uhmm, I think her favourite is Amélia at the moment, then she's also liking Talia and, damn, what was the other one, oh yeah, Darcy. If you want an input then you know what you gotta do Ty."
Josh sighed and lent back against the chair, glancing over at the dozen cards pinned to the board behind Tyler's bed. Most were get well soon cards he had received immediately after his admission, then there was a Christmas card from the staff on the ward and a Christmas card from his family. It actually made Josh quite angry when he thought about how infrequently they bothered to visit their son in intensive care. In the middle of all of the cards was a printout of Jenna's ultrasound - Tyler's daughter.
He looked back over to his unconscious friend, and that was when he saw it.
Tyler's eyes were open.