Chapter Text
There’s absolutely no time to spare.
When the consultant neurologist arrives, she confirms that Ellie’s right pupil is fixed and dilated, and tells Bernie and Serena they’re going to skip the CT and get Ellie prepped for theatre.
“We know what side it’s on, so we know where to drill the burr hole,” she says. “And we’ll just get the rest of it cleared out when we do the craniotomy.”
Serena’s eyes are flashing but she doesn’t argue. The neurologist, Ms. Jindal, is a locum and as far as Bernie knows Serena has no opinion on her. And the only thing she's heard Serena say about the consulting neurosurgeon who’ll be doing the surgery is that his coffee order is needlessly complicated and he’s not Guy Self.
It’s not quite trust, but it’s better than the alternative.
“All right,” Bernie says. “Where is she on the Glasgow Coma Scale?”
“Six as of last evaluation, which was five minutes ago,” Ms. Jindal responds, clear and even. She’s remaining professional even though she’s treating the daughter of one of the most respected consultant surgeons in the whole hospital. Bernie decides that she likes her.
“Officially a coma, then,” says Serena. Her voice cracks.
Bernie runs a hand between Serena’s shoulder blades. She’s hyper-aware of how tense Serena’s body is, and she knows that even this gesture will do nothing to ease it. Still, she sets a rhythm on her upper back. Tries to ground her.
It’s no use. Serena’s shaking, and she feels so very far away.
“Nothing to do but operate,” Bernie says. “Ms. Campbell and I will observe.”
A craniotomy is a messy procedure. They cut off large swaths of Ellie’s hair so they can peel away a portion of her skull. The surgeon then scrapes the bleed off the brain and into a metal bowl.
There’s so much blood. She’s used to seeing blood, she’s hands deep in it on any given shift, but this makes her stomach turn. It’s just... when you think of terrible things happening to your kids, or at least when Bernie does, it’s always gruesome, immediate. A car wreck. A bomb detonated on a public transport system in another country. When Cam used drugs, Bernie was plagued with pictures of him overdosing, drowning in his own vomit.
You don’t think it could be something insidious like this. Ellie was perfectly conscious for hours, while this bleed was slowly killing her. And they had absolutely no idea. It’s not a danger you can prepare yourself for, not until it’s too late.
Not until you’re completely defenseless against it.
They keep their eyes trained on the neurosurgeon as he works. They see that the bleed is at the back of Ellie’s head, close to the brainstem, and they know that’s not a good sign. Bernie reaches for Serena’s hand, and Serena squeezes their fingers together tight.
The surgeon has started sewing Ellie’s head back up when Morven bursts into observational suite. She’s winded, she’s been running.
She has Ellie’s bag draped over her shoulder.
Serena lets go of Bernie’s hand. “Morven, is now really the time?” she asks, quiet and raspy.
Morven nods vigorously. “It’s the only time.” She hoists Ellie’s bag off her shoulder and pulls out a few of its contents, which she gives to Bernie to hold. A wallet, a tube of lipstick, a small hairbrush.
A plastic bag of white powder. A bottle of pills.
Serena snatches the drugs from Bernie. She doesn’t open them; she just turns them over and over again in her hands.
Morven acknowledges Serena with a quick glance, and then she turns to Bernie. “You get a tox screen?”
Bernie shakes her head. “We didn’t even get a CT. There was no time.”
“Right, that’s what I thought.” Morven says. “So the label on the pill bottle is diazepam, but there’s more than one type of pill in there. Most people who mix benzos with something else mix them with opioids, like oxy or methadone. I’m thinking if she just crashed her car, and maybe had taken whatever’s in that plastic bag earlier and then had to talk to the police, she’d probably want to calm down. Benzos and opioids are both good for that. And if you have both…”
“You’d take both,” Bernie finishes. Serena drops the pill bottle and its contents spill out over the floor. She curses softly and scrambles to pick them all up.
“No, Serena, let me,” Bernie says, and she immediately drops to the floor. She gathers the pills, two kinds, just as Morven said, into the bottle. She reaches for Serena’s hand and covers it with her own.
Serena narrows her eyes. Bernie can see she doesn’t want to be coddled.
She meets Serena’s gaze, and laces their fingers together. You don’t have to be strong for this, she tries to say with her eyes. It’s okay.
“I’m thinking the drugs might be interfering with her GCS Score,” Morven says from somewhere above them. Bernie reminds herself to focus. “Can’t really tell what’s from the injury and what’s from the drugs if they’re both a factor.”
Serena sighs. Bernie searches her face and guesses at what she’s thinking: that Morven’s theory really only works if Elinor had taken a large amount of the drugs.
They have no way of knowing how much or how little Ellie took, not until they do a tox screen. They have no idea of her drug habits at all.
Bernie looks up at Morven. “You’re thinking of giving her Naloxone?”
“It could make a difference,” Morven says. “It could make a huge difference drug use notwithstanding. There was a study done in 2014 that concluded Naloxone decreased mortality in traumatic brain injury patients in a statistically significant way.”
“Just the one study?” Serena’s voice is so pointed that Morven flinches. It was the word mortality, Bernie thinks. Everyone knows that there is a good chance Elinor will die, but Morven’s been the first one to say it out loud.
Bernie knows she should prepare herself for the possibility of Elinor’s death. But she finds that she can’t. There is no part of her that can fathom something that terrible happening to Serena.
She pushes herself off the floor and offers her hand to Serena. Serena takes it.
“Ms. Jindal is the presiding neurologist,” Bernie says. Serena’s standing now, the pill bottle clutched in her hand. “Page her and tell her everything you just told us. She’ll make the call about the Naloxone.”
“Yes, Ms. Wolfe,” Morven says with a nod. She goes to leave the observation suite, but she stops just at the door. She turns around abruptly.
“If either of you need anything, I’m just a page away. Doesn’t matter how little.”
Serena doesn’t even seem to register Morven’s words. She’s gone back to turning the pill bottle in her hand. The bag of powder, Bernie notices, is nowhere to be seen. Serena must have pocketed it at some point.
They both will need to be confiscated, but for now that can wait.
“That’s very kind of you, Morven,” Bernie says. “Thank you. Do let us know what Ms. Jindal says.”
Morven rushes out. Serena lets out a loud huff of frustration and shoves the pill bottle into Bernie’s hand.
“Read the prescribing doctor,” Serena says.
Bernie glances down at the bottle. Edward Campbell.
“I’m going to fucking kill him,” Serena grits out. “I’m going to… fucking…”
And then she breaks down.
Bernie puts her arm around Serena, and she burrows her head into Bernie’s shoulder. She wails, and Bernie’s thin cotton scrubs do nothing to muffle the sound.
She holds Serena for the rest of the procedure. Serena doesn’t look up, can’t look up, can’t bear to. So it’s Bernie who watches over Elinor through the glass.
After the operation, they do a full work-up on Ellie. They get a CT, a tox screen, they set up machines to monitor the intracranial pressure along with the ventilator and the feeding tube.
When they’re done, there are tubes coming out of Elinor from every which way. She looks like something out of a nightmare.
The tox screen comes back positive for both benzodiazepine and oxycodone. Ms. Jindal has a nurse administer the Naloxone before they get the results of the second screen, which will tell them just how much of the drugs are in Ellie’s bloodstream.
“Your F2 was bang on,” Ms. Jindal says. “The Naloxone can only help.”
Her GCS is reevaluated, and it’s still six, with no pupillary response to light. Serena turns white at that news, but Ms. Jindal is there with a few gentle reminders: her intracranial pressure is dropping steadily, and her eyes are responding to pain, which means the corneal reflex is present. She’s not brain dead. At this juncture, she is just as likely to improve as she is to deteriorate.
It’s a practical optimism. Serena’s curt nod betrays little, but Bernie can tell she appreciates it.
Serena excuses herself; she needs to call Edward. Bernie sits in the chair opposite Ellie and eyes her stats. No change.
“I’ll tell you what I think of the Chilcot report if you wake up,” she tries.
The ventilator hums.
Bernie knows so little about Elinor. Only what Serena has told her, really. That she’s talented, stubborn, has a selfish streak but cares deeply about justice on a large scale. That she spent so much time and energy canvassing for the Remain campaign that Serena felt compelled to remind her, via text, to eat, sleep, and shower.
“I wouldn’t be surprised if you two butt heads,” Serena had said, not long before Christmas. “She’s very opinionated. But I think she’ll grow to respect you, in time.”
So Bernie was shocked to hear that Ellie had taken the news of her relationship with Serena badly. And she was dismayed when the Ellie she met at Christmas was sulky, standoffish, and just downright rude to her and her children.
Cam was able to laugh through the worst of Ellie’s snickering and eye-rolling, but it got under Charlotte’s skin, Bernie could tell. Charlotte never talks about what bothers her, she just lets it happen until she decides she can tolerate no more of it.
That’s what she had done with Bernie, anyway.
Charlotte had been very polite at Christmas. She’d complimented Serena’s cooking and swapped Doctor Who theories with Jason. But Bernie could feel Charlotte’s anger radiate from every tight smile and forced laugh. And she knew, as soon as her daughter’s car drove away from Serena’s house, that the effort she’d made over the past few weeks had been lost.
It was hard, after that, to not resent Ellie a little.
She absolutely wants Ellie to be all right. But what if she doesn’t want it enough? What if she feels the wrong things, reacts the wrong way? What if Serena tries to depend on her and she’s not up to the task?
God, what if she lets Serena down?
A nurse comes in to change Ellie’s catheter, so Bernie gives them some privacy, and maybe take a moment to gather her thoughts. But soon she steps out into the hall, she hears Serena bellowing from some unknown place in the ITU.
“THEN SEND HER TO A PSYCHIATRIST, FOR FUCK’S SAKE!”
Bernie follows the sound of Serena’s voice and finds her pacing frantically outside the ITU’s public restrooms. She’s screaming into the phone and her whole body is shaking.
“OF COURSE IT MATTERS WHERE SHE GOT IT FROM! A PSYCHIATRIST KNOWS THE SIGNS OF RECREATIONAL USE! YOU JUST WRITE HER A BLANK CHECK AND SWAN OFF!”
She doesn’t dare touch Serena because she’s not sure how she will react. She does step into her line of sight and mouth I’m here so Serena knows. Serena reaches for Bernie’s hand and grips it so tightly that her fingers start to go numb.
“I would get here as soon as you can, if I were you.” Serena hisses into the phone. “Because we’ll be evaluating her for brain death soon enough, and if it comes to it, I’d imagine you’d want to be there when we turn off the machines. To say goodbye to your daughter.”
That must have shut Edward up, because she hangs up the phone soon after. Bernie takes the phone and sets it down on a nearby plastic chair. She opens her arms for Serena.
Serena collapses into them.
Bernie kisses Serena’s forehead, over and over again. Serena smells good, and she feels silly for breathing her in, for taking some comfort in that. It’s backwards, it’s not the way it’s supposed to go.
None of this is the way it’s supposed to go.
Bernie has no idea how much time passes. They stand in the middle of the hall, embracing, until Serena’s pager goes off.
It’s Ms. Jindal. There’s news.
“Pupillary response,” Ms. Jindal says. She’s tapping a small torch excitedly in her hand. “Nurse Cox noticed it. Her pupils are both the same size now, and they both react to light. It’s very subtle, but it’s measurable. Here, take a look.”
She guides them both to Elinor’s bedside and opens one of Elinor’s eyes. Shines the light right in. Ellie’s pupil retracts in a way that’s slight but absolutely noticeable.
“Do it again,” Serena says.
The result is the same the second time.
Serena sets her mouth on a thin, hard line. She is trying, as hard as she can, to be inscrutable. She is trying not to have too much hope.
“Other eye,” Serena says.
Ms. Jindal shines the light in Ellie’s other eye, and it, too, retracts. Bernie picks up a folder with Ellie’s name and sees that someone has recorded the exact measurements of Ellie’s eye dilations. She hands the folder to Serena.
“It’s good news,” Bernie says.
Ms. Jindal smiles awkwardly at the two of them and then pockets her torch. “Nurse Cox mentioned that it’s possible there was pupillary response immediately after surgery but we weren’t using a strong enough light.”
“That’s quite a long shot,” Serena mutters.
“That’s fair,” Ms. Jindal concedes. “But it’s undeniable now. And we still have a corneal reflex. We’ll send her in for another CT as soon as possible. Obviously we will keep a close eye on her and keep evaluating that pupillary reflex. I’ll page you when we’re done with the CT.”
Bernie thanks Ms. Jindal and starts to lead Serena from the room, but Serena doesn’t want to go. Bernie rubs her back and reminds her that Ellie needs to go for a CT and it might be a good time to catch a very small nap in the on-call room.
But it’s less than twenty minutes before the pager goes off again. They go Ellie’s room to find that Ms. Jindal is absolutely ecstatic.
Bernie shakes her head in confusion. “What’s this?”
“Eye opening to sound,” Ms. Jindal says, just barely able to get the words out. “Twice, just now. I thought, Ms. Campbell, that you might like to talk to her to see if you can replicate the response.”
Ms. Jindal extends her hand, inviting Serena to stand next to Ellie. She walks to her bedside and leans in close to Ellie’s ear.
“Elinor, it’s mum.” It’s just a whisper. Nothing happens. Serena clears her throat and tries again, much louder. “Ellie? It’s mum.”
Elinor opens her eyes, and then closes them.
Ms. Jindal beams. Bernie leans in and kisses Serena on the cheek, and then turns her head so she can kiss her on the lips. She doesn’t care at all that Ms. Jindal is watching, and Ms. Jindal, to her credit, doesn’t react.
“We still have to get the CT,” Ms. Jindal says. “But it’s good, good news.”
Ms. Jindal and one of her nurses roll Ellie away. Serena watches, stunned.
“It could change her prognosis,” Bernie says quietly.
Serena sniffs, lowers her head. Speaks to the floor. “Recovery can stop at any time. She could be in limbo for months. Or indefinitely.”
“She could,” Bernie agrees. “But she’s not yet.”
Bernie can’t tell if it helps, but she supposes it’s better than nothing.
After the CT, Ms. Jindal informs them that Ellie has been officially upgraded from coma to vegetative state.
“If you want to go home, this might be a good time,” Ms. Jindal starts carefully. “It’s unlikely she’ll deteriorate so soon after such a marked improvement.”
“What, and leave her alone?” Serena snaps.
Ms. Jindal steps back, chastised. Serena pulls a plastic chair very close to Ellie’s bed, entangles her fingers with her daughter’s.
She is trying to project strength, but Bernie can see that Serena is so, so tired. She steals Serena’s phone from her purse and texts Edward for an updated ETA. He says he won’t be long now. Bernie rolls her eyes and puts the phone back.
It’s an hour later when Edward and Liberty do arrive. Serena doesn’t have the energy to argue with him, so she just says be there for her this time and lets Bernie lead her to the on call room.
They brush their teeth in silence. Getting clean scrubs feels like too much effort, so they collapse into bed in what they’re wearing.
They face each other in the narrow bed. Bernie holds Serena as close as she can and says, “I’m here whatever happens. You know that, right?”
Serena’s breath hitches. “I do.”
“I love you so much.”
It’s not the first time Bernie’s said it. But it never comes as easily to her as it does to Serena, who says it when she leaves in the morning, and when she comes home at night, before sex and during and after and right before they go to sleep.
Just as easy as breathing.
Serena moves her hand away from Bernie’s hip and runs her fingers over the buttons on her pager. It’s quiet. No news.
“I know,” Serena says. “I know.”
The next few days are surreal. Bernie tends to the ward and checks in on Jason (recovering nicely, will be able to come home soon) while Serena spends long hours at Ellie’s bedside. She talks to her, reads her websites, magazines, books. She has Bernie fetch several Eloise at the Plaza books from Ellie’s bedroom, since they were Ellie’s favourite growing up.
They determine that it’s safe to take Ellie off the ventilator. When they do, she starts groaning intermittently. Serena knows it’s not in reaction to anything, but she talks back to Ellie’s noises anyway.
Ellie will groan, and Serena will say yes, darling, quite without missing a beat.
Bernie finds it endearing, until she realizes that it may never get any better than this.
Bernie tries not to spend time around Serena and Ellie when she’s on shift. She mans the red phone. She overschedules herself in theatre. She keeps herself focused.
Morven, however, makes it difficult.
“D’you reckon the Naloxone helped, then?” she asks, lingering in the door of Bernie and Serena’s shared office. “It sounds like if her intracranial pressure didn’t decrease as quickly as it did, there would have been damage to the brainstem.”
“I don’t know, Dr. Digby,” Bernie says, and sighs. “I, for one, wouldn’t discount the craniotomy’s role in decreasing the intracranial pressure.”
“Fair dos. But the timing with the pupillary response was a bit suspect, don’t you think? Usually fixed pupils or a fixed pupil right after surgery predicts mortality in extradural haemorrhage patients, so to have it clear up some time after the surgery…”
“Morven,” Bernie cuts in. “I doubt we’ll ever know exactly how Ellie got out of that coma. It could be the surgery, could be the Naloxone, could be that Ms. Jindal didn’t waste time with a CT when she knew the situation was dire. Truth is she’s not out of the woods yet, so unless you have a thought that can actively help her current care, probably best to keep your theories to yourself.”
“Right,” Morven mutters. She scratches at the back of her neck. “Sorry.”
Bernie grabs a patient’s file and gets ready to head back into the ward. “It’s interesting research to pursue, in a more general sense. The effect of Naloxone on traumatic brain injury patients. If you want to talk to Ms. Jindal about pulling some records, for a start…”
Morven’s face breaks into a smile. “Okay, yeah. Maybe I will. Thanks.”
Bernie tries not to smirk as she watches Morven return to her patients. She lets herself imagine a future in which she and Serena pass on the keys to AAU to Morven and Cam, and the thought calms her. For a moment.
Then her pager goes off. It’s Serena.
Bernie tosses her patient file back on her desk and rushes to the ITU.
“She’s squeezed my hand,” Serena says, blinking back tears. “Look. Ellie, squeeze if you can hear me.”
Ellie’s hand tightens around Serena’s.
Serena gives Ellie more simple commands, and the results vary. But the hand squeeze remains mostly consistent, if limited to her left side. Ms. Jindal comes in and says that Ellie’s now minimally conscious and her GCS is 12 out of 15.
Bernie and Serena are at Ellie’s bedside all night. Serena has hope now; she’s not even pretending otherwise. And that, Bernie thinks, could be the most dangerous thing.
Jason comes home ten days after the accident. Serena is loathe to leave Elinor but Edward and Liberty have promised to cover the day between them. Bernie’s on shift and has no desire to have more contact with Edward than absolutely necessary, so she avoids the ITU.
But she does stop by at the end of the day. She’s surprised to find Ellie alone, even though Serena had said Liberty would be there in the evening. She quickly pulls up a chair.
“Hi, Ellie,” she says. “I’m sorry it just seems to be me right now.” She reaches out and folds her hand into Ellie’s. “Squeeze if you can hear.”
Ellie does.
Bernie withdraws her hand and slouches back in her chair. “I don’t have magazines or anything to read. And I know we didn’t quite get along so I’m not sure…”
“Mmmmmrggggghhhh,” Ellie groans.
Bernie chuckles. “I know, me too. But I want us to be able to, um…”
“Mmmmmmmmm,” Ellie groans again, or maybe it’s more of a hum. Bernie leans into the sound and sees that Ellie’s eyes are open and have started moving from side to side. Not like REM sleep eye movement but more like…
“Ellie?” Bernie prompts gently. She grabs a small torch from a drawer near Ellie’s bed and goes to shine it in Ellie’s eyes when Ellie suddenly jolts back.
“Mum?” Ellie croaks. Her mouth can only barely form the words. She’s agitated; she’s trying to move more than her body will allow. She jerks once, twice, and then she looks right at Bernie. “Mum?”
Bernie has no idea what Ellie remembers, or even if she knows where or who she is. She can ask her these questions. She can do a basic neurological examination, and she should.
“It’s all right, Ellie,” she says instead. “It’s all right.”
Ellie doesn’t react badly to hearing her name, so that’s a good sign. Bernie hits the room’s call button and a nurse is there within seconds to tend to Ellie and calm her down. And do that neurological examination.
Bernie leaves the room and immediately texts Serena: Ellie’s conscious. Get here now.
She’s making to dial Serena when she gets a text back. On my way. Tell her I’m on my way.
Serena’s there in ten minutes, half of her usual commute time.
“Nurse says she remembers who she is, but doesn’t remember the accident,” Bernie tells Serena just as Serena enters the building. Serena nods, but doesn’t so much as look at Bernie. She’s focused straight ahead.
She rushes into Ellie’s room and takes her daughter into her arms.
“Mum?” Ellie asks weakly.
“Shh, shhh,” Serena soothes. “I’m here now. It’s all right, darling. It’s going to be all right.”
Bernie watches from the corner of the room. Ellie looks so much like Serena: the cleft chin, the full cheeks, the shining eyes, that it hurts to look at them.
This isn’t her place. She can’t get between them.
Bernie goes to duck out of the room, but Serena turns her head at just the right moment and catches Bernie’s eye.
Thank you, Serena mouths.
Bernie can’t find anything to say to Serena that even starts to convey the gravity of what she’s feeling. There’s not a vocabulary for it. Even the word love doesn’t seem to contain it.
So Bernie just nods and runs out. And when she reaches the end of the hallway, she collapses against the wall. Sinks to the floor. Begins to weep, silently, into her hands.