Chapter Sixty-Nine
Lucky's tight, ashen face was bent downwards over his body as he sat on a soft tan chair in the recreation area. He hadn't had a hair cut since he'd been admitted to General Hospital, and now it hung in loose waves inches below his shoulders. With his bent over posture, it pooled onto his thighs and hid his face from the nurses and psych techs that kept watching him. Lucky really wanted to be alone right now, but the orders from Dr Collins were to keep him in sight 24/7. Give him as much privacy as possible, but if he escalates dangerously, call a code and do whatever necessary to keep him and the staff safe.
Lucky pulled his feet onto the chair, and they dangled half on and half off of the padded surface. He wiggled one up while he bent the other one down, and he moved his body frenetically and irregularly to some sort of inner beat. He talked to himself occasionally in tense, whispered phrases that moved his hair slightly. Two nurses moved out of his hearing range and discussed his behavior.
"He looks like a spring all wound up tight and ready to uncoil," said Sarah nervously. "Do we have the muscle power if he escalates out of control? Where are the men?"
"Rick and Craig are on the ward, and I've notified them that we might need assistance. Jim is somewhere around here, too. Don't worry about that," said Barb. "I know that killer cast on his arm makes you nervous, but don't approach him close enough so he can reach you. You can go after the meds. The rest of us will hold him down if necessary."
Sarah's face relaxed, and she looked relieved. "I know, I shouldn't be this way, but he hit me pretty good on the head a few weeks ago, and he still spooks me. I'll get over it."
"You'd better get over it," advised Barb with a concerned look on her face. "You can't afford to be afraid of the patients if you work in the psychiatric wards. You might want to consider another field if you don't feel confident. The patients need to feel like you're calm and in control."
Sarah shrugged. "I'll think about it," she said with resignation. "I like babies. I might switch to maternity." She looked over at Lucky again. "He hasn't eaten or drunk anything all day. Should we approach him about that?"
Barb shook her head. "Kevin Collins said to leave him alone. I'll put some dinner and milk on the table in an hour or so and invite him to eat. That's all. I'm more concerned that he's isolating himself and won't talk to the staff. I can usually get a word or two out of him, but not today."
Sarah jumped when Lucky suddenly sprang out of the chair and started pacing the length of the room with his right fist balled tightly, and his arms gripping his sides. He started talking louder, and the two nurses caught a few words that he spoke. "Her fault…I hate her!"
"Sounds like he's trying to process the trauma that he's working through with Dr. Collins," commented Barb. "He's not dissociating and hiding out. That's a good sign." Barb looked down at her watch and sighed. "He's due for his medications. I'd better go get them and some water. Sarah, you stay here and watch him until I get back. Then, go chart his activities for the afternoon and take a break." Sarah nodded and looked apprehensively over at Lucky who was still muttering, pacing, and occasionally kicking at invisible objects on the floor.
~*~*~*~
"Hi, Lucky," said Barb brightly as she stood by a table. "Will you come here and take your medications? I'll go away and leave you alone after that." Lucky flinched at the sound of her voice and muttered something under his breath, but he didn't loosen his grip on his sides or slow his frantic pacing.
"Lucky," said Barb with a slightly authoritative tone. "Come here, please."
Lucky looked over at her with a red, angry face framed by his hanging hair. "Fuck off," he sneered. He then walked quickly over to the chair and sat down on it with one leg on and one leg off. His crossed arms hung over the padded arm of the chair, and he lay his forehead down on them.
Barb walked over to the chair, and spoke calmly and matter-of-factly. "Lucky, you're not usually rude to staff. I thought we were friends. Will you please take your pills so I can do my job? It will only take a second."
Lucky very slowly raised his head and turned toward Barb. His hair hung in clumped strands that scattered across his face. She noted that his eyes were dangerously dark and had a glazed look about them. "Give them to me!" he shouted with his hand held out. Before she could hand them over, he harshly grabbed the pills from her open palm and accepted the plastic cup of water. After swallowing the pills, his upper lip curled, and he opened his mouth and stuck his tongue out in a slightly obscene gesture.
"Thank you, Lucky," said Barb respectfully.
"Piss off," replied Lucky loudly as he lowered his head back onto his arms and repeatedly kicked the chair with his heel. "You can all go to hell," he growled.
~*~*~*~
Barb set Lucky's dinner and a carton of milk on the table and walked over to Lucky. He was still seated on the chair holding a furious conversation with himself and grasping his bent legs with a death grip. His head was placed on his raised knees, and his startled face reluctantly looked up when he heard her approach.
"Dinner's here," said Barb happily. "It looks like a real nice sandwich and chips."
Lucky let go of his legs, and they slid to the floor. He got up from the chair and stumbled clumsily as one of his legs wouldn't cooperate since it had gone to sleep. Rubbing his tingling leg, Lucky walked to the table and looked down at the paper plate. He reached out his hand and poked one finger at the sandwich. He quickly grew enraged when he saw the milk. Picking up the carton, he drew back his arm and let the beverage fly. It sailed through the air and smashed soggily onto the far wall, sliding down and trickling white liquid onto the floor. Lucky grimaced angrily and raised his arms, then jerked them down in fury. "NO MILK!" he screamed at Barb, his eyes betraying his emotional pain and disorientation. "NOOOOOO!!" he cried out, holding onto his stomach as if in pain as he stalked away from the recreation room.
Barb looked up at the ceiling and rolled her eyes. What a day this has been, she thought. What next? "Don't let him out of your sight," Barb ordered the nearby psych tech. The tech followed Lucky back to his room and adjusted the door until it was halfway open. "Get OUT of here!" yelled Lucky. "Leave me ALONE!"
"Regulations," stated the tech calmly. "You need to be in sight at all times. The door stays open or I sit in there with you. Which is it?"
"Fuck you!" screamed Lucky as he jettisoned himself angrily onto his bed and turned his back to the tech. Shrugging, the tech stepped out of the room and remained stationed by the open door.
~*~*~*~
Lucky moved restlessly on the bed for over an hour. His muscles were tight, and he couldn't settle. The anger kept rising into his chest and set his entire body on fire. He punched his pillow repeatedly and thrashed around. She let him do that to me. She didn't care about dad or me. I hate her! Lucky accented his thoughts with punches to the pillow and bed.
The psych tech poked his head around the door when he heard the ruckus, and raised his eyebrows, but gave Lucky his privacy since he wasn't hurting himself.
Lucky sat up and panted as his eyes grew sad and pensive. An unwelcome wave of new thoughts invaded his mind and heart. Dad should have been there. He should have known that something happened to me. Why didn't he stop her? Why didn't he do something? Fear mixed with anger as Lucky tried to emotionally process his father's betrayal. Lucky was blindly stepping into dangerous territory when he started doubting the man who was always his protector, the man of the house and main object of Lucky's admiration and affection.
Grief swiftly took over for fear, and Lucky let out a howl of outrage and pain as he hopped up from the bed and began trashing his room. He viciously pulled the sheets and blankets from the bed and started ripping and shredding the pillows with his teeth and fingers. He growled ferociously as he banged his plaster cast repeatedly on the metal frame of his bed. The psych tech ran into the room as Lucky was frantically beating his cast on the bed, and tried to grab hold of Lucky's arms from behind.
Lucky spun around so quickly that the tech lost his grip and fell back onto the bed. Lucky let out an extremely loud roar full of pain, fear, terror and grief as he raced for the doorway.
Barb had been alerted to the noises coming from Lucky's room and had already called a code. Hurry up guys, she thought nervously. The kid is going wild. Even with her years of experience in psych wards, she was startled to see Lucky running toward her with the strength and determination of a disoriented battering ram holding out a dangling arm cast almost broken in half. She jumped out of the way to avoid a head-on collision and saw the muscular psych tech running full force behind Lucky. The tech leaped and tackled Lucky by his legs. Lucky landed hard on his stomach with an angry yelp, and a swift whoosh of air knocked out of him. In a millisecond, he turned before the tech could maintain a good grip on his legs and kicked viciously and efficiently toward the tech's head. His sneakers softened the blows, but the fierce force of his actions met their mark, and the tech fell away and rolled onto his side, gripping his bleeding head with his hands.
Lucky scrambled to his feet before Barb could react, and ran as fast as he could for the strong metal door that secured the locked ward. He didn't lessen his pace at all as he neared the door, and unfortunately, Rick and Craig were just placing their access cards into the locking mechanism as Lucky stretched out his arms for the door and freedom. As Rick began opening the heavy metal door, Lucky's head, face and arms connected solidly with the door at a running speed of nearly five miles per hour.
Rick jumped back in surprise when the door slammed shut in his face with a muffled rustling, banging sound. The door was relocked, and he quickly stuck his access card in again to gain entrance.
Lucky never had the time to cry out as his forehead smashed against metal. His teeth promptly bit deeply into his cheek, and his world quickly faded to black.
Barb cried out and ran toward the door. Rick pushed hard against the door with a frown and was confused as to what was going on.
"Stop! Be careful," shouted Barb as Rick continued to move the door against Lucky's unconscious body. "He might have a neck injury, don't move him," she instructed tensely.
Rick and Craig slid through the partially opened door and both looked down in amazement at the crumpled body beside the door. "What the hell is going on here?" asked Craig. "We came here to assist with the code that was called."
Barb pointed to Lucky. "He's your code," she said. "He hit the door as you were opening it. Rick, go down to ER and bring up a backboard and a neckbrace. If there are any paramedics down there, bring one up. This is an emergency. He might have broken his neck or fractured his skull. "Hurry!" she said with an edge to her voice.
~*~*~*~
Frank Scanlon had never been asked to go to the psychiatric area of GH to assist and transport a patient, but there were first times for everything. He frowned when he saw Lucky lying curled up on his side on the floor. Barb was sitting beside the kid, and looked up with relief. Frank lay the backboard beside Lucky and quickly knelt to assess him. Lucky looked like a mess. Half of his face and hair were covered with thick blood. He was bleeding profusely from his mouth and nose.
Frank looked over at Barb as he pulled on some latex gloves. "What happened to him?" he asked as he held Lucky's wrist to take his pulse. "The kid ran headlong into the door as Rick and Craig here were entering. He was running quite fast and immediately lost consciousness when he hit the door. I was worried about a potential neck injury, so I asked for a paramedic."
Frank nodded with approval. "Quick thinking," he said. "Help me place him on the board," he instructed Craig after he fitted a c-collar onto Lucky's neck. Frank finished his preliminary examination. "Respirations 30, BP 110/100, pulse 120. Pupils equal and reactive. How long has he been unconscious?" Frank asked.
"About fifteen minutes," said Barb worriedly.
Lucky made gasping, gurgling noises, and Frank quickly reached for his large bag of supplies. "Help me stabilize his neck," he instructed Barb as he carefully positioned Lucky.
"What's the kid's name?" he asked Barb. "Lucky Spencer," she replied quickly. "Lucky!" said Frank loudly. "What happened to you? Can you hear me?" Lucky's eyelids fluttered weakly, opened briefly, then closed. Frank pressed hard on Lucky's thumbnail, and the kid pulled back as he moaned and spoke some garbled, incoherent words.
"I need to clear an airway and intubate him. He has a facial injury and is starting to aspirate blood." Frank started an isotonic crystalloid solution IV and injected Propofol 2mg to sedate him for intubation. Next, he attached a pulsimeter to measure Lucky's blood oxygenation.
Frank waited until Lucky was under, completed the endotracheal intubatuon and oxygenation and phoned the ER. "This is Frank Scanlon, EMT," he stated. "I was called up to the psychiatric ward to package and transport a head trauma patient. He's male, about 17-18 years old." Frank paused. "Yes, that's him. How did you know his name?" he asked in a puzzled tone of voice. Frank finished his conversation and said, "Yeah, ETA five minutes."
Barb wheeled over a gurney, and the board with Lucky lying on top was lifted by the three men and strapped on. "You need to inform ER that he was very agitated and violent when the accident occurred," she said.
"Thanks for the heads up," replied Frank. "Let's get him to the ER quickly," he nodded to Craig. "Lift up the board at about a 30 degree angle," said Frank as he loosened the chest strap slightly. "It helps to prevent further damage to the brain."
"I'm going to call Jim and Dr. Collins," said Barb. Oh, God, let him be okay, she thought. The wounded psych tech slowly creaked along behind Frank and crew and held a hand to his throbbing head.
~*~*~*~
Dr. Ian Thornhart walked quickly up to Frank when he exited off of the elevator with Lucky's gurney. "Let's take him to the Trauma Center," he directed Frank, pointing down the hall to the specialized emergency facilities. "What do we have here?" Ian asked as he walked beside the gurney and helped to steer it down the hall.
"GCS is E3V3M5 equals 11," said Frank. "His BP has been stable during the trip. Systolic pressure hasn't fallen below 100."
"Good," said Ian. "His GCS indicates moderate brain injury, but we need a CT scan to see what's going on. Thanks for the heads up on the facial injury. We have an oral-maxillofacial surgeon on his way down here. You used Propofol for intubation?"
Frank nodded and said, "Yes, he displayed some level of consciousness, so I had to put him under."
Ian pointed to a room when they reached the Trauma Center. "Good choice," agreed Ian. "We'll bring him out of it quickly when the neurologist examines him. For now, the sedation will allow us to do the diagnostics." Ian shook Frank's hand. "Thanks, man," he said appreciatively.
Frank replied, "Sure thing. Hope the kid does well," and walked off.
"Clean him off," Ian instructed one nurse as he pulled on his latex gloves. "I can't see what his injuries are with all that blood. Alert radiology that we'll be arriving in a few minutes for a CT scan."
Ian picked up Lucky's left arm and pulled off the hanging, battered cast. "You sure do go to extremes to avoid paying your poker debts, don't you Mr. Spencer," he snickered. "Bring a splint for this arm," he ordered. Ian moved away Lucky's stiff, blood soaked hair to the side of his battered face. "He has a nasty laceration on his scalp," he said. "That's where a lot of this blood is coming from. We'll suture that before sending him to radiology. And we might as well repair this torn side as well." Ian turned toward a nurse and ordered, "Morphine 5 mg IV push."
~*~*~*~
"Dr. Thornhart." Ian looked up. "Jim-bo!" he said heartily. "Can't you keep your patients on the psych ward? They keep ending up in my department," he laughed. "You have good timing. Come here and fix the sutures that your patient ripped out."
Jim blanched when he approached Lucky. "I still feel queasy whenever I see that much blood," he said. "Psychiatry is starting to look awfully good."
Ian made a face as he bent over Lucky's scalp and sewed small, careful stitches. "Ah, blood and guts are the stuff of medicine," he snorted. "I like emergency medicine because it's always something new. It's a great challenge. However, I'm getting tired of Lucky Spencer here. He's becoming a regular bore, aren't ya kid?" Ian gave his unconscious patient a quick smile.
"Kevin sent me down to check on him. He's tied up with another patient at the moment," said Jim as he threaded a needle. "How's he doing?"
"We'll see when the diagnostics come back," stated Ian. "He's presenting with moderate brain injury, but we won't know until we see the films. His facial injuries are worrisome. He's still bleeding like a stuck pig. I'm sure he's broken his nose at least. I'm going to have to pack that nose before we send him to radiology. We're still waiting for the oral-maxillofacial man. They tend to be real primadonnas," sighed Ian. "Do you know why Mr. Spencer was in such an uproar?" he asked conversationally. "They said he ran into a door face first, full force."
Jim squinted as he concentrated on repairing Lucky's torn stitches. "He's been working hard with Kevin on some trauma issues. He was hypnotized today, and it's hard to face the truth sometimes. Most patients have to learn new, healthier coping mechanisms in order to deal with what has happened to them."
A nurse entered the room. "They're ready in radiology," she said. "Fine," said Ian. "Jim, would you mind going with him to make sure they don't extend his neck while they take their x-rays. We need to keep his head and neck immobile until we rule out any problems with his cervical spine."
~*~*~*~
The thin, emotionless oral-maxillofacial surgeon stood before Ian as he explained his diagnosis. "He has an isolated fracture of the anterior nasal spine. It will heal on its own, no treatment necessary. I'm not sure about this amateur nose packing job that you did," sniffed Dr. Richards.
Ian rolled his eyes and crossed his arms. "He was bleeding out all over the place," he said defensively.
"He has another fracture here," continued Dr. Richards as he manipulated the bones in Lucky's nose and fixed it with a splint. There should be no disfigurement, but there will be lots of swelling and bruising. He won't be able to breathe through this nose for awhile." Dr. Richards looked up at the x-rays again. "Let me show you this," he said plainly. "See that short, hint of a line there?" Dr. Richards pointed to an area above Lucky's eye. "That's a hairline fracture over the sinus," he noted. "No treatment for that either. It will heal on its own over time." Dr. Richards sighed. "Most of his injuries are deep contusions in the soft tissues," he said. "He'll look like hell for awhile, but no permanent damage. He was lucky."
Ian nodded. "That's his name," he said vigorously as he glanced over at his patient. Ah, get a personality, man, he thought as he watched Dr. Richards depart from the room.
~*~*~*~
"He's been on Propofol, and we discontinued 30 minutes ago to bring him up," explained Ian. "Are you sure you want to handle this?"
"It's not a problem," said Tony Jones. "If he requires surgery, I'll hand over the case to Dr. Watanabe. I can do the diagnostics." Tony walked with Ian into the room where Lucky lay still on a table, immobilized by drugs and a neckbrace. "I wish I could say that I'm surprised that this happened," said Tony sadly. "But I've learned to roll with the punches where Lucky is concerned. I just hope he hasn't sustained any serious, permanent injuries."
Tony's heart sank when he looked down at Lucky. Most of the blood had been washed away from his face and neck, but there were still traces of dried blood clinging to his tangled hair. The entire left side of his face was severely bruised and very swollen, and his nose looked twice its normal size with the splint on it. Lucky had two black eyes, with the worse one located under the massive, four-inch long red bump on his forehead.
Tony walked over to the CT films that were displayed on a backlit viewer. "He has some contusions on his left temporal lobe and left anterior. But, I don't see evidence of intercranial pressure or any hematomas or active bleeding. Nothing unusual." stated Tony. "That's good. Let's see how he does with his neurological exam."
"Lucky!" said Tony loudly "Lucky, it's Tony. Can you hear me?" Lucky groggily opened his eyes and made a sound like he recognized Tony. "Don't try to talk," said Tony. "You have a tube in your throat to help you breathe," he explained. "I need to do a neurological exam to determine if you hurt yourself when you ran into a door. Do you understand?" Lucky blinked his eyes and made a noise.
~*~*~*~
"You can take off his c-collar," stated Tony as he walked with Ian from Lucky's room. "He hasn't sustained any spinal cord injuries other than what appears to be some mild whiplash. His motor reflexes are good. His GCS has improved from 11 to 13 over the last hour. We'll have to test his verbal responses again after he's off the tube, but everything looks good so far. Are you going to keep him in CCU for a few days for monitoring?"
"A room is being set up as we speak," replied Ian.
Tony shook his head. "Now I need to talk to Kevin," he said tiredly.
.