Reviews are my wraith enzyme… :D
It's over now, I'm cold alone
I'm just a person on my own
Nothing means a thing to me
No, nothing means a thing to me
Not An Addict – K's Choice
In an instant, Carson's world was narrowed down to one single, overriding concern; his patient. Everything else was peripheral, his focus entirely on the need for immediate action, adrenalin making his pulse race as he grabbed the bed railing and roughly hauled the wheeled bed out from the wall, sliding himself quickly between the array of monitoring equipment to stand at the head of the bed, looking up impatiently to snatch the proffered intubation kit as Klare fumbled it from the nearest supply cabinet.
His movements were urgent, precise, yet oddly gentle as he carefully raised Colonel Sheppard's head, pushing the pillow down to support his neck in the correct position and pushing firmly on his chin to open his mouth. Sheppard was limp and still, unresisting, as Carson ripped open the sterile packaging and laid the kit down within easy reach. He snapped open the laryngoscope with a practised flick of his wrist and inserted the cold metal instrument into Sheppard's mouth.
Time seemed to drag, Carson painfully aware of the passing of each second that Sheppard's body was deprived of oxygen as he struggled to visualise the glottis, muttering in frustration, "Dammit. There's too much swelling.." He was oblivious to Klare's hovering, anxious presence, to the nurses who had run to assist in the crisis. Time raced by far, far too damn quickly and yet, at the same time, each moment seemed to last a lifetime.
"Nearly there, nearly… got it!" He let out a triumphant shout as he reached for the endotracheal tube, sliding it carefully into place before quickly removing the laryngoscope and pulling the stylet from the tube, a well-trained nurse handing him an ambu-bag before he could even open his mouth to ask. Momentary relief flooded warmly through his veins as he connected the bag, the nurse stepping up immediately to take control of pushing air into Sheppard's lungs as Carson moved around the bed to throw back the sheets and lean anxiously over his patient, settling the stethoscope into his ears, pressing the cool metal bell first to Sheppard's stomach and then to his chest.
He felt the awful knot of tension in his shoulders begin to ease a little and realised belatedly that he had been unconsciously holding his own breath as he listened to Sheppard's chest. "Breath sounds equal," he murmured thankfully to himself as he continued to move the stethoscope over Sheppard's lungs. The Colonel's chest rose and fell gently under his touch as air was forced rhythmically into his lungs. Finally, Carson straightened, breathing out a slow, deliberate exhalation as he accepted that the crisis was past; his patient was stable. He scrubbed a hand across his face, feeling suddenly exhausted as the short-lived burst of adrenalin-fuelled energy deserted him, and smiled gratefully at his team.
"Good work, everyone. Let's get the Colonel on the ventilator please, Siobhan." His voice sounded a lot stronger, a lot more calm and confident than he felt. Grateful that the immediate danger was over, he took a moment to just stand and breathe and gather himself, trying to consciously relax the tension from his body, looking on as his team went to work taking care of Sheppard, disconnecting the ambu-bag as they hooked the ET tube up to a ventilator. Confident that Colonel Sheppard was in good hands, he firmly pushed aside the cold knot of worry that lodged in his throat and turned his attention back to the serious issue of the Colonel's long-term prognosis. Dr Klare was still hovering nearby, looking a little shell-shocked and nervous, his attention still drawn to Colonel Sheppard's battered body and the sudden drama that had unfolded before him. Carson was forcibly reminded that the young doctor had very little trauma experience; he'd done a rotation in emergency medicine as part of his training but his specialist area was laboratory analysis, specifically haematology and clinical pharmacology, and Carson had chosen Dr Klare for his staff primarily for the man's unparalleled knowledge and experience in his chosen arena.
Carson made a mental note to schedule some refresher training for all medical personnel, including the laboratory staff, on trauma procedures. It was a sad fact of life here in the Pegasus galaxy that he couldn't afford for any of his medical team to be hesitant in a trauma situation. He kept his voice calm and business-like, drawing Dr Klare away from the bed with a gentle hand on his shoulder.
"Dieter. You had something to show me, son?"
The younger man tore his gaze from the flurry of activity around the Colonel's bed and nodded, holding out the datapad almost reluctantly; Carson accepted it with a frown, his heart sinking as he skimmed through the data.
He looked up at the specialist with a grimace. "You're sure about this?"
Dr Klare nodded unhappily. "Yes, sir. I've identified at least three different drugs in the Colonel's bloodwork, one of which definitely seems to be opiod in nature, as you suspected, but much stronger than any such drug I've come across before. His system has already metabolised most of it.. and yet what little remains is still having a profound physiological effect."
Carson looked back at the test results, his frown deepening as he read through Klare's observations. The Colonel's electrolytes were all over the place, his body showing widespread systemic reactions to the cocktail of drugs he'd been injected with – drugs whose nature they had only partially identified, whose purpose or eventual effect they could only make an educated guess at. The only piece of good news that could be gleaned from the results so far was that the opiate drug was almost certainly responsible for Sheppard's current respiratory difficulties.. meaning that his respiratory function should recover spontaneously as the drug was slowly metabolised from his system.
Carson's gaze wandered back to the pale, bruised body surrounded by wires and tubing and machinery and he found himself weighing the datapad thoughtfully in his hands as his eyes lingered sombrely on the angry track marks marring Sheppard's arms. The Colonel's face was already partially obscured by the mass of tubing connecting him to the ventilator, his eyes closed, his chest rising and falling to the rhythm of the steady hiss-click of the machine that was keeping his airway open, keeping his blood oxygenated. The twitches and fine muscle tremors that had ceased as Sheppard's body had shut down when he stopped breathing had begun to return and, even as he watched, the Colonel's body shivered briefly and his fingers flexed spasmodically.
Dr Klare was continuing to elaborate on his findings and Carson listened carefully to the specialist's words as he scrolled through the readouts on the datapad, Klare's voice becoming animated as he discussed the results, reaching over to point things out on the screen.
"This drug seems to be some kind of anti-convulsant or paralytic. I can't be sure, but it's possible that the Colonel's tremors and muscle contractions are related to the breakdown of this drug, perhaps a symptom of withdrawal?"
The young doctor's face twisted as he pointed to the data on the third and final drug on the list. "This is the one that I am most concerned about," he admitted hesitantly. "I've never come across a drug quite like this before and I can only guess at its purpose. All I can tell you for certain is that it seems to be acting on the Colonel's nervous system. Quite what its effects are…"
He trailed off, his manner uncertain as Carson looked up at him enquiringly.
"What is it, son?" Carson pushed.
Dieter's swallowed, his eyes dark as he regarded Carson earnestly. "If my suspicions are correct…"
He broke off, a sick expression on his face as his gaze slipped to the side, skittering across the pale and bruised figure twitching and jerking in the infirmary bed. "The drug is targeting the nervous system, specifically the sensory nerves and the areas of the brain that process physical sensation. If I had to hazard a guess… I would say that this drug was intended specifically to attack those areas in order to… cause pain." His eyes were hollow as he met Carson's eyes.
For a long moment Carson couldn't think of an answer to that, couldn't trust himself to speak. He felt the anger at the people who had done this coalesce into a hard, cold lump in his chest, making his breath shorten and his heart ache fiercely. He forced himself to breathe around the block of pain, to push the anger aside and think rationally, proactively.
"Okay. Okay.." He spoke carefully and quietly, surprised at how normal he sounded. He felt like there was an icy layer of calm coating his throat and if he moved too quickly, spoke too harshly, it would shatter and fragment, driving shards of pain and anger deep into his flesh. He stared at the datapad, considering the information before him, assessing it, applying it to treatment protocols. When he raised his head to look at Dr Klare, his face was tight, his emotion carefully controlled and focused, his energy devoted entirely towards finding a way to help his patient, his friend. "What are your recommendations?"
"There's little we can do about the opiate other than wait for the Colonel's body to metabolise it. I wouldn't recommend using an opiate antagonist at this point, it would be too stressful on the Colonel's systems in his current condition."
Carson nodded shortly. "I'm with you on that one, son. Colonel Sheppard has been through more than enough. We want to be looking to ease his suffering, not prolong it."
Klare frowned as he moved onto the next drug on the list, talking almost to himself as he considered the best direction to take. "The paralytic is more problematic. If his physical symptoms are related to withdrawal from the drug then they will only worsen as the drug clears from his system. I'd like to look at starting the Colonel on some medication to control the symptoms, possibly a similar anti-convulsant which we can then wean him off slowly."
Carson swallowed against the sudden lump in his throat as he asked, "And the third drug?"
Frustration was evident in Klare's face as he admitted, "We know so little about this drug, about what it is doing to the Colonel's body.." He gestured helplessly at the bed where Sheppard lay twitching sporadically. Carson's gaze was drawn back to Sheppard's battered body, to the dreadful bruises and scrapes, ugly against pale flesh, the angry track marks, the evidence of treatment on a level of barbarism the doctor had thought never to see. What kind of people developed a drug whose sole intention was to cause a subject pain? Anger burned hotly and he took that fire, that heat, and funnelled it into fierce determination; a determination to undo the vile work that had been done here and to bring his friend back to health.
His voice was still calm but there was a layer of steel to it now, a decisiveness that had Dieter almost snapping to attention before racing back to his lab.
"Okay then. I want you test for interactions for the paralytic, give me some options for medications we can give the Colonel to ease the withdrawal symptoms, and I want you to continue to analyse the third drug. If its purpose is what you think then we need to do something about that – and my options for pain relief are limited with the Colonel already having opiates in his system. Check for interactions, check for contraindications and find out exactly what this drug is doing to him."
Carson turned back to the bed, taking the time to check the readouts on the heart and pulse-ox monitors, the flow of the respirator and Sheppard's vitals before pulling up a chair and lowering himself slowly into it. His body shuddered in relief as he settled into the chair and he realised suddenly how utterly exhausted he felt. There was little more he could do for Colonel Sheppard for the moment, until Dieter's further tests offered them some concrete treatment options, but for now he would do what he could; he would be here for Sheppard. The Colonel had yet to reawaken following his respiratory crisis and, given his obvious state of confusion when he had previously awoken, Carson wanted to make sure that there was someone to hand when Sheppard came to and found himself unable to breathe independently. It was a good, medical reason for him to sit at the Colonel's bedside and watch him sleep. It was a sound, reasonable, clinical decision. And it had the benefit of being true; he would have done the same for any patient in the Colonel's condition. Yes in his heart Carson knew that there was more to it than that, that he would have chosen to sit at the Colonel's bedside even had he not been on the ventilator. For reasons he couldn't quite name, couldn't quite find a way to articulate, it was important to Carson that, unconscious or not, Colonel Sheppard know that he was not alone.
He didn't notice at first when the Colonel did begin to awake. It had been an hour or more that he had been sitting at the bedside, passing the time by reading through in detail Dr Klare's preliminary report on Sheppard's bloodwork, unconsciously chewing at his lip as he frowned in concentration. Sheppard's intermittent tremors and twitches had been slowly worsening as time went on and, at first, he had taken the jerky movements of Sheppard's hands as just more random muscles spasms, more symptoms of withdrawal from the drugs. It wasn't until Sheppard tried to lift his hand from the mattress that Carson belatedly realised that the motion was conscious and intentional. He was on his feet in an instant, the datapad tossed carelessly onto his vacant seat, and leaning over the bed, checking vitals and readouts.
A faint frown had creased Sheppard's brow and, even as Carson watched, his eyelids fluttered briefly. His throat worked spasmodically and the regular beep of the heart monitor quickened its pace as Carson watched Sheppard gag on the invasive tube, his hands flailing jerkily as he tried to turn his head and found he couldn't.
"Colonel Sheppard?"
The eyelids fluttered again, the frown deepening, and then Sheppard's face suddenly creased in what looked like pain and his eyes shot open.
"Colonel?"
There was no response. No reaction.
"John?"
Sheppard's eyes were open but Carson may as well have been talking to himself. The pupils were still oddly pin-pricked and Sheppard's glassy gaze roamed randomly, flitting from place to place with no real sign of comprehension. His face was pale and drawn with a tightness around the eyes that Carson found worrying. Sheppard had never exactly been a cooperative patient when it came to pain relief, preferring somehow to manage on his own as much as possible, claiming, if pressed, that he hated the woozy, medicated feeling of strong painkillers. Carson privately suspected that what the Colonel actually disliked was feeling out of control – particularly of his own body. A by-product of their constant skirmishes on the issue was that Carson had developed something of a knack for diagnosing Sheppard's pain levels – if his patient wouldn't tell him when and how much it hurt, then he would have to learn to read it for himself from the smallest of clues. And right now, everything about Sheppard's posture and behaviour was telling him that the man was hurting… and there wasn't a damn thing Carson could do about it.
It went against every instinct he had, both as a man and a doctor, to see a person suffering and not offer relief but until Klare's tests were completed, he simply could not risk giving Sheppard any medication.
"John? Can you hear me, son? It's Carson."
Sheppard's eyes flicked over him and moved on, staring blindly through him as though he were not there. The Colonel's frown deepened and his throat worked helplessly, a sheen of sweat beading his brow. A jerking, twitchy arm raised from the mattress and grabbed fumblingly for the tubing obscuring the lower part of Sheppard's face. With a grimace of reluctance, Carson was forced to push the Colonel's arm, gently but firmly, back down against the mattress. Sheppard's nostrils flared in uncomprehending panic and Carson tried again to break through the fog of confusion and reach him.
"It's alright, Colonel. You're in the infirmary on Atlantis. You're safe now."
Sheppard's arm tensed and jerked in his grip and Carson wasn't sure how much of the motion was involuntary muscle spasm and how much the Colonel trying to break free of his grasp. An cold weight in his stomach robbed Carson of breath as he realised how this situation must translate to the Colonel in his confused state.. he had gone from a prison dressed up as a hospital where he had been restrained, tortured and injected against his will.. and now he had awakened, confused, disoriented and in pain, his mind clouded by drugs, in a familiar hospital setting, with invasive tubes in his body, unable to fend for himself and being physically restrained when he tried to move.
There was a definite roughness to Carson's voice as he spoke again, trying hopelessly to project some kind of feeling of safety, of comfort, "No-one's going to hurt you here, John. I know you're confused and you're in pain but we're going to help you. You're home, son. You're safe at home…"
For a moment Sheppard's dull, glassy gaze met his and Carson thought perhaps he'd reached him, he'd gotten through. Then the Colonel's back arched, his body twisting up from the mattress, and Carson found himself leaning across the bed, using his body weight to try and hold Sheppard down as he struggled and jerked, his throat spasming as he gagged helplessly, fighting the ventilator.
"Siobhan!" Carson yelled over his shoulder, struggling to keep a grip on his thrashing patient, "I need you in here now!"
The senior doctor on duty responded in an instant but, even with two of them - three of them including the nurse who also ran to help - they couldn't get the Colonel to calm down, could barely keep a hold of him as he twisted and jerked in their grip. The heart monitor blared an alarm as Sheppard's heart rate raced and Carson could see that he was still fighting the ventilator, trying to breathe on his own, disrupting the steady flow of air into his lungs.
"We have to stop this," Siobhan gasped, her face flushing from the exertion of trying to contain Sheppard's violent struggles, "he's going to hurt himself." Carson was forced to agree. Sheppard was fighting them ferociously, struggling to free himself from their grasp and they couldn't let this continue. Carson cursed fluidly.
"Okay. Dammit." This wasn't going at all well. "We're going to have to extubate him."
He caught the look Siobhan threw him and acknowledged her concern with a grimace. "I know, I know. It's hardly ideal. But the ventilator is making him panic and the very fact that he's fighting it tells us he's breathing spontaneously. I'd far rather leave him on it a while longer until we're sure his respiratory function is sufficiently recovered but I don't have the option to sedate him and restraining him is only going to make him panic more, as well as aggravating his injuries from the previous restraints."
Siobhan's expression said clearly that she was no happier about the situation than he but nonetheless she nodded firmly, unable to fault the reasoning behind his decision.
It took three extra nurses to restrain the Colonel enough for Carson to be able to disconnect him from the ventilator. His limbs continued to tremble and jerk as he fought against the hands holding him down and his pin-pricked, unfocused eyes rolled in fear and panic as Carson leant over him. Even in his confused, uncomprehending state, Sheppard's instinct, his natural reaction, was to fight, to resist, and Carson's stomach twisted as he wondered if this was why the Colonel had been given the second drug, the paralytic. From the abrasions on Sheppard's wrists and ankles, it was clear that he had been restrained – and had tried to free himself from those restraints. Carson could only surmise, his lips thinning with bitter distaste, that the Drethans had tired of Sheppard's continued resistance and had chosen to add chemical restraints to their abuse of the Colonel.
He kept up a soothing, murmured monologue as he worked to extubate Colonel Sheppard, trying to appear non-threatening, reassuring.
"It's okay, son. I know you don't like the tube. We're removing it for you now." The plastic tubing was smooth and cold in his hands, disconnecting from the ET tube with an audible click.
"No-one's going to hurt you here. You're safe on Atlantis…." Sheppard's eyes were wide, staring, the tension visible in his neck muscles as he fought against the firm hands on either side of his head as a nurse struggled to hold his head still long enough for Carson to safely remove the endotracheal tube.
"Just a moment more, John. All over soon…" Carson gripped the neck of the ETT firmly and, in a smooth motion, pulled the length of tubing from the Colonel's throat, watching carefully as Sheppard coughed and gagged as the tube pulled free and then, thankfully, sucked in a deep breath. He continued to cough weakly, his chest heaving, but he was breathing spontaneously, to Carson's relief. A nurse handed him a cup of ice chips and he leaned over the bed to carefully slide a piece of the soothing ice between Sheppard's parted lips. The shrill alarm from the heart monitor abruptly stilled as Sheppard instinctively sucked on the cool sliver of ice, his racing heart beat beginning to slow as his breathing settled and the trickle of melted ice eased the ache in his throat.
He was frowning, his gaze uncomprehending as Carson stayed with him, keeping up his soothing litany as he slipped another couple of ice chips into Sheppard's mouth. "There now. That's better, isn't it?"
Sheppard's eyes seemed to meet his and for a second Carson thought he saw a glimmer of reaction there, the merest hint of recognition. It was gone so quickly that he couldn't be sure he'd ever really seen it but, nonetheless, the Colonel's gaze stayed locked on his, the disconcerting, pin-pricked eyes staring blankly into his own. He couldn't be sure Sheppard was even focusing properly, even really seeing anything, but he was loathe to break this first hint of awareness, of contact with the confused, frightened man. Without looking away, Carson gestured at his team with a vague wave of his hand, the Colonel's struggles already beginning to slow. Picking up on Dr Beckett's meaning, Siobhan and the team of nurses carefully, very slowly, eased their grips on Sheppard's trembling body; moving carefully, so as not to spook him, they gently let go and stepped back from the bed.
Sheppard's limbs continued to tremble and jerk, muscle spasms flexing and tensing throughout his body, but his breathing calmed and his eyes stayed locked on Carson's.
"That's right, John. You're safe now. You're home on Atlantis. We're going to take care of you. No-one will hurt you here, John…"
Sheppard's brown furrowed, struggling for comprehension, and Carson's chest tightened in sympathy as Sheppard suddenly tensed, a soft, pained exhalation escaping him.
"I know you're in pain, John. I know, son. We're doing all we can to help. You're going to be fine, son…"
A shudder ran through the pale, bruised body and Sheppard's glassy, unfocused gaze seemed to momentarily sharpen. Carson swallowed, his stomach twisting at the fear and pain and anger he saw contained in that hollow gaze.
Sheppard's throat worked soundlessly for a moment, his eyes still locked on Carson's. He swallowed and, in a dry, rasping voice, barely loud enough to hear, he croaked out a single word.
"Carson?"
TBC…