“After what happened last night, we need to reassess his level of neurological function,” she’d told Nick. “It shouldn’t take too long.”
“Just promise me you won’t let that nurse Patrick anywhere near him,” he had muttered, still livid over the level of incompetence he had witnessed the previous night. If Patrick’s near-fatal mistake with the medication prevented Brian from getting better, Nick vowed to make him pay for it. He planned on calling his lawyer to explore his options as soon as he had access to a working phone.
“I know you’re upset about what happened to Brian,” Dani continued, setting her cards down on the bed, “and I understand. I would be, too. But it was an honest mistake. Patrick’s still pretty new to critical care nursing; he’s only been working on this floor for a few months.”
Nick frowned as he laid his own hand aside. “Well, I don’t understand why you’re defending him. If he doesn’t know what the hell he’s doing by now, he has no business being here. Sorry, but you guys don’t have the kind of job where you can afford to fuck up like that. It’s not like me missing a dance step or forgetting a lyric. His carelessness almost killed my best friend!”
Dani bit down on her bottom lip. “I know, and I’m sorry that happened. But we’re only human, Nick. None of us are perfect. Even more experienced nurses mess up sometimes, especially when we’re tired and overworked,” she replied, rubbing her temples. “When we volunteered to stay at the hospital through the hurricane, I don’t think any of us thought we’d be stuck here so long.”
“At least you can leave if you want to,” Nick pointed out.
She snorted. “And go where? My house was destroyed, remember? Even if I did have somewhere else to go, I don’t know how I’d get there. Half the island’s still underwater, and Rob took the boat.”
“Right… I’m sorry,” said Nick, feeling bad for bringing it up. He still blamed Patrick for what had happened to Brian, but he hadn’t intended to take his anger out on Dani. It wasn’t her fault. In fact, if she hadn’t been there the night before, Nick had no doubt that Brian would have died.
“It’s okay,” Dani said with a shrug. “I would never leave anyway - not right now, at least. I have patients here who need me.” One corner of her mouth curled into a coy smile as she slowly met his eyes.
Nick couldn’t help but grin back. “Yes you do. One in particular.”
Her smile grew. “Hm… I think I may know which one you’re talking about.”
“Tall guy? Blond hair? Kind of an asshole?” He smirked.
She raised her eyebrows. “Asshole? No. Not at all. He’s actually super passionate about protecting his friends.” Her eyes sparkled, and Nick nodded, knowing he was forgiven.
“Ah, yes,” he replied. “You’re right - he really does need you.”
“I know,” she said, a provocative little smile still playing on her lips. Some of her cards slipped off the bed and scattered across the floor as she leaned in and planted a tender kiss on his forehead. “I need him, too.”
“You missed,” he said as she pulled away, pointing to his mouth.
“Oh, did I? My bad.” Dani leaned back in and kissed his lips long and hard. Despite the guilt he felt for betraying Lauren, Nick couldn’t help but enjoy it. A guy in his condition had to have something to keep him going, and Dani was it - his only source of pleasure, entertainment, and comfort, all wrapped up into one pretty little package. He put his hands behind her head, letting his fingers tangle in her hair as he deepened the kiss. By the time they broke apart, he was out of breath. “Was my aim better that time?” she asked, wiggling her brows.
“Much better,” he murmured, lying back against the head of his bed. “Right on the mark.” He inhaled air through the tubes in his nose, letting the flow of fresh oxygen refill his lungs.
Dani’s flirtatious smile faded as she looked at him closely. “You okay?”
Nick nodded. He could feel his heart beating slightly harder than normal, but there was no pain or sense of impending doom accompanying it. A kiss like that could make any man’s pulse pound. “I’m all right,” he assured her. “How about you? How you been feeling?”
She smiled again, her face aglow. “Pretty good, actually. No morning sickness yet. My boobs are tender, though,” she added, scrunching up her face as she put both hands over her breasts and gave them a squeeze.
He chuckled. “Yeah, Lauren always complained about that, too.” The words came out of his mouth before he could stop them. “Sorry,” he said, looking awkwardly at Dani. He knew she didn’t want to hear about his wife, the mother of his other children.
She shrugged. “It’s okay.” But he could tell by the look on her face that she felt awkward about it, too. Their conversation came to an abrupt stop, as neither of them seemed to know what to say next. After a long pause, Dani finally asked, “What are you going to tell her? About us, I mean?”
Nick shook his head. “I honestly don’t know.” He had been rehearsing that conversation in his head, imagining all the different ways it could go. Even in his mind, it never went well. There was no good way to tell his wife he had gotten another woman pregnant. No matter how it went down, Lauren would be devastated when she found out. He was almost relieved the phone lines were still down; at least that gave him a good excuse to delay the inevitable.
When he didn’t elaborate, Dani opened her mouth and then closed it again, as if reconsidering what she’d been about to say. Nick knew she must have had more questions she wanted to ask, but she decided to change the subject instead. “We should start a new game, now that you’ve seen half my hand,” she said, ducking down to pick up her playing cards from the floor.
“Sure,” said Nick with a shrug. “I’m kinda tired of Crazy Eights, though. Can we play a different game?”
“Of course. What did you have in mind?”
“I dunno. Strip Poker?”
She laughed. “You’d lose. You’re wearing a lot less than I am, mister,” she said, looking at his skimpy gown.
He smirked. “You underestimate my mad poker skills.”
“Ha! Well, in that case… it might be a little awkward if Elizabeth were to come back and find me in my bra and panties, so let’s take a rain check on Strip Poker.”
“I’d pay to see that,” said Nick, smiling at the visual of her in sexy underwear. “So what do you wanna play?”
“Hm… how about Hearts?” she suggested with an impish grin, adjusting the stethoscope around her neck.
Snorting, Nick shook his head. “Has anyone ever told you you have a sick sense of humor?”
She laughed. “All the time. It’s so true.”
“You’ll have to remind me how to play Hearts; it’s been awhile.” He and the guys used to play cards together on the tour bus, back when they all shared the same one. That was before they had wives and children to bring with them when they went on the road. Now they each had their own bus and barely saw each other between tour stops. Glancing at the space where Brian’s bed had been, Nick found himself missing those good old days.
“No problem,” replied Dani. “I can teach you all kinds of card games. We nurses have so much extra time on our hands to play cards, you know.” She rolled her eyes, and he smiled, noting her sarcasm.
Dani had just started to deal when Dr. Elizabeth poked her head through the doorway. “Can you help me transport Brian back to the room?” she asked.
“Of course,” said Dani, setting down the deck of cards.
“How did his tests go?” Nick asked.
Elizabeth’s impressive poker face gave away nothing. “We’ll talk about it later,” she promised, leaving Nick with the nervous feeling that he wouldn’t like hearing what she had to tell him. He waited anxiously while they went to get Brian.
When the two women wheeled Brian’s bed across the room, Nick was disappointed to see that he was still unconscious, as he had been ever since Patrick’s disastrous attempt to sedate him. He watched Dani and Elizabeth put Brian’s equipment back into position, making sure all the machines and monitors were properly connected and plugged in. He waited until they were finished to ask, “When do you think he’ll wake up again?”
Elizabeth and Dani exchanged glances. Nick got the impression Dani knew something he didn’t, and his anxiety grew.
“Let me grab his test results, and we’ll go over them together,” said Elizabeth, holding up her index finger in a “wait one minute” gesture. “I’ll be right back.”
While she was out of the room, Nick looked at Dani, wanting to know what Elizabeth had told her. His apprehension kept him from asking.
When Dr. Elizabeth came back, she pulled a stool up next to Nick’s bed and sat down, resting a manila folder across her knees. “I’m afraid it’s not good news,” she began, confirming Nick’s fears. “As you know, Brian suffered a severe closed head injury that caused swelling and contusions in his brain. He’s been in a coma ever since.”
“Until last night,” Nick interjected. “He woke up last night.”
Elizabeth gave him a look of sympathy. “What you witnessed last night was most likely a seizure caused by Brian’s traumatic brain injury. We’ve been keeping him on a constant drip of anticonvulsant drugs to prevent them, but Patrick admitted that he was late in changing Brian’s IV bag and accidentally let it run dry. This may have contributed to any muscle spasms or eye movements you observed.”
Nick had been shaking his head in denial the whole time she was talking. “He wasn’t having a seizure; he was awake!” he insisted. “He squeezed my hand when I asked him to. He opened his eyes and looked right at me! He was trying to breathe by himself; that’s why Patrick gave him the sedative in the first place - to stop Brian from fighting against the ventilator.”
“I’m sorry,” said Elizabeth, shifting her weight awkwardly. “I didn’t mean to discount your version of events. It’s just that no one else has ever noticed Brian exhibiting any signs of emerging from his coma.”
“Just because no one else noticed doesn’t mean it didn’t happen,” Nick snapped back, glaring at her. “So why isn’t he waking up now?”
Dr. Elizabeth took a deep breath. “In addition to the trauma, Brian’s brain was also deprived of oxygen during his cardiac arrest last night.”
“You mean the cardiac arrest caused by the overdose Patrick gave him,” growled Nick, his blood pressure spiking as his heart began to pound.
“Calm down, Nick,” Dani said softly, reaching for his hand. He shook her off, not in the mood to be comforted or coddled.
“Don’t tell me to calm down! I’m pissed off, as I have every right to be.” He looked directly at Elizabeth. “I heard you tell Patrick he gave him too much, so don’t even try to deny it. If Brian dies, this hospital’s gonna be hearing from our lawyers.”
“I understand,” said Elizabeth, speaking in the cool, composed voice she had been using the entire conversation. Nick didn’t know how she could stay so calm when she was being threatened with a lawsuit. He could feel a warm flush creeping up his face, as it always did when he was upset. “Unfortunately,” Elizabeth continued, “the oxygen deprivation, coupled with the diffuse axonal injury Brian sustained in the car accident, seems to have caused catastrophic, irreversible damage to his brain.”
Nick blinked in confusion, overwhelmed by what he had just heard. “What exactly are you trying to tell me? Can you ditch the fancy words and just fucking say it?”
“Nick, Brian’s brain dead.” It was Dani who finally spoke the words he had been dreading, simply and directly. Nick felt his stomach drop and his heart skip a beat as he stared at her in disbelief. She bit down on her bottom lip, her brow creased with concern as she looked back at him, reaching again for his hand. “I’m so sorry.”
Nick barely felt his hand on hers. His whole body seemed to have gone numb. “I still don’t understand,” he said, shaking his head. “You guys were giving him oxygen and doing CPR the whole time. How could he be brain dead?”
“Even the most effective CPR isn’t the same as a beating heart,” said Dr. Elizabeth sadly. “High-quality chest compressions only produce about twenty-five percent of normal blood flow to the brain and other organs. In Brian’s case, it may not have been enough to preserve what brain function he had left.”
Nick didn’t know what to say to that. He just kept shaking his head, struggling to process what she had told him, refusing to accept the grim prognosis. Brian couldn’t be brain dead. He couldn’t be.
“Let me show you something.” Elizabeth pulled several pieces of paper out of the folder in her lap. “One of the tests I ran was an EEG, which measures the electrical activity in the brain. This is what a normal EEG looks like.” She flipped over the first page, tracing her finger along one of the series of jagged lines that spiked across the front of the paper.
“This is the first EEG we did on Brian to assess his brain activity the day after his accident,” she added, setting the second page down next to the first so Nick could see the difference. “Do you notice how the waves are not as varied or pronounced as in the example?”
Wordlessly, Nick nodded. He already knew where this was going.
“And finally, this one,” Elizabeth went on, turning over the last page, “is from today.”
Nick swallowed hard, his eyes filling with tears as he looked at the evidence in front of him. All of the lines were flat.
“As you can see, Brian has no neurological function left,” said Elizabeth. “For all intents and purposes, he’s already dead. The only thing keeping the rest of his body ‘alive’ at this point is the ventilator. If we were to turn that off, he wouldn’t be able to breathe on his own. Without oxygen, his heart would stop beating in a matter of minutes, and the rest of his organs would shut down.”
Nick didn’t want to believe her. “But this is only one test. What if it’s wrong? Can’t you run it again?” he asked desperately.
Elizabeth offered a grim smile. “You bring up a good point. It’s only one test. But it’s not the only test I ran. I also did an echocardiogram to make sure Brian’s heart hadn’t been damaged during CPR. While I was monitoring his heart, I gave him a dose of a drug called atropine to see how it responded. In patients whose parasympathetic nervous system is intact, atropine dramatically increases the heart rate, similar to the dobutamine you received during your stress test a couple of weeks ago.”
Nick shuddered, remembering the medication that had made his heart race out of control.
“But,” Elizabeth continued, “the atropine didn’t have any effect on Brian’s heart. That means his heartbeat is being controlled only by his heart’s built-in pacemaker and not by the part of his brainstem that normally regulates the heart rate. In other words, his heart is working, but his brain is not.”
“Okay, so maybe his brain is damaged, but that doesn’t mean it can’t still get better,” Nick argued, as Dani tightened her grip on his hand. “How do you know he won’t wake up again?”
Elizabeth looked at him with sympathy. “This is different,” she said gently. “I do need to examine him to confirm the diagnosis of brain death before we make any decisions. You can watch if you want, and I’ll explain what I’m doing.”
Nick gave a brief nod. His body still felt numb, and his mouth was very dry. He hardly noticed when Dani let go of his hand and got up to help the doctor.
Elizabeth walked over to Brian’s bed and pulled back his blanket. “First I’ll call his name and see if he responds to commands.” Leaning over Brian, she said in a loud voice, “Brian, can you open your eyes for me?”
Nick propped himself up on his elbow to get a better view, watching his friend’s face hopefully. Come on, Frick, he thought. You can do it. Prove her wrong! But unlike the previous night, Brian’s eyes remained closed.
“Can you stick out your tongue, Brian?”
Brian had always made the best funny faces, but his mouth didn’t even move.
“Squeeze my hand, Brian,” said Elizabeth, wrapping her hand around his. She waited for a few seconds, then shook her head. “No response to commands.”
Nick refused to give up hope, reminding himself that Brian hadn’t responded to commands any of the other times Dani or Dr. Rob had tested him either. All they’d told Nick then was that Brian was in a deep coma - not that he was brain dead.
“Next I’ll check his extremities,” Elizabeth continued. Still holding Brian’s left hand, she lifted his arm a foot into the air and then let it fall. Nick frowned as Brian’s arm flopped limply back to the bed. Elizabeth followed the same procedure with his right arm and both legs before she stated, “His limbs are all flaccid and areflexic. They don’t move on their own or resist when I try to move them.”
“But couldn’t that be because of his spinal cord injury?” Nick argued.
She nodded. “Yes, it could. That’s why we won’t rely on one test alone.” She moved back to the head of the bed. “I’m also going to see if he responds to painful stimuli. I’ll try to make him just uncomfortable enough that he moves in some way.” She pinched Brian’s brow, pressing her thumb against the top of his eye socket. Just watching made Nick wince, but Brian didn’t move a muscle. “Most people would try to reach for my hand or at least roll away,” Elizabeth pointed out. “Brian didn’t react at all.”
Nick felt a sinking feeling in his stomach as he watched Dani write the results down on a clipboard. He remembered what she had told him the day he first saw her do a similar assessment on his friend: “Technically, even a dead body will score twenty percent.” Brian had failed every test so far.
“I’m going to examine his eyes now,” Elizabeth said, taking a penlight out of the pocket of her white coat. “I’m looking to see if his eyes react to light or move in any way.” She pried one of Brian’s eyelids open and shone the light into his eye, moving it from side to side as she observed the response. Then she swept a cotton swab across his eyeball. She repeated the same tests on the other eye. “Both pupils are fixed and dilated. His eyes don’t move or react to light,” she explained. “His corneal reflexes are also absent. He didn’t blink when I touched his eyeballs with the Q-tip.”
Nick knew that was a bad sign. He had only heard the phrase “fixed and dilated” used by doctors and detectives on TV when they were talking about dead bodies.
“Next I’ll test his gag reflex,” Elizabeth went on. “I’m going to use a tongue depressor to touch the back of his throat, which would make most people gag or cough.” She pulled down Brian’s lower jaw to open his mouth and inserted the flat, wooden popsicle stick.
Please, Nick prayed, but Brian didn’t move or make a sound.
“The last thing I need to check for is spontaneous respiration,” said Elizabeth. “That requires me to take him off the ventilator temporarily to see if he tries to take a breath on his own. If he doesn’t, I’ll reconnect the vent.”
Nick nodded, remembering how Brian had fought the ventilator the night before. There was still a chance he would do it again.
Dr. Elizabeth disconnected the ventilator hose from Brian’s trach tube. “During this test, I’ll keep an eye on his end-tidal CO2 - that’s the level of carbon dioxide in his blood. The normal range is between thirty-five and forty-five. When it rises above fifty-five, a functioning brain prompts the patient to breathe. A dead brain doesn’t.”
They waited, watching the number on the monitor move from forty to fifty. Nick held his breath as Brian’s carbon dioxide level continued to climb. Fifty-four… fifty-five… fifty-six. C’mon, man, he begged. Breathe. But nothing happened. The number blurred before Nick’s eyes as they welled with fresh tears.
An alarm went off on the monitor, as a blue light began to flash. Without a word, Elizabeth reattached the hose to Brian’s trach tube. The test was over, and the results were just as dismal as all the rest. It took a few forced breaths from the ventilator to make the number go back to normal, but Nick knew that was only because there was a machine breathing for Brian. He wasn’t doing any of the work himself. This time, he wasn’t even fighting with it.
Nick exhaled with a sigh of defeat. “So that’s it, huh?” he said hoarsely. The tears had started to trickle down his cheeks, but he didn’t bother to wipe them away. “He’s dead.”
Dr. Elizabeth nodded, her expression solemn. “I wish there was something else we could do for him, but there isn’t.”
Dani came back to Nick’s bedside. She sat down on the edge of the bed and wrapped her arm around him, rubbing his shoulder. “I’m so sorry, Nick,” she whispered.
He swallowed hard. “So what happens now?” he wondered. He was thinking about Brian’s family and about the other guys. None of them had gotten the chance to say goodbye. He couldn’t even call them to let them know Brian was gone.
“Well… that depends,” said Dr. Elizabeth. “The life support machines will keep Brian’s body functioning for a little while, until you’re ready to let him go. But in the meantime, you have some important decisions to make.”
The tears were dripping from Nick’s chin and falling onto his chest, wetting his hospital gown. “What do you mean?” he asked dully.
Dr. Elizabeth sat back down on the stool next to Nick’s bed. “One way people are able to bring something positive out of a tragedy like this is by donating their loved one’s organs. Do you know if Brian wanted to be an organ donor?”
“I… I don’t know,” said Nick with a shrug. After twenty-six years, he’d assumed he knew everything about his Backstreet brothers, but suddenly, there was so much he wished he had thought to ask Brian. Now he would never get the chance.
“We could check his driver’s license,” Dani suggested. “There’s a bag of his personal possessions under his bed, everything he had on him when he was brought into the ER.”
Elizabeth got up and went back over to Brian’s bed. She reached underneath to retrieve a small bag and carefully emptied the contents onto the foot of the bed. Nick felt a pang of sorrow in his chest as she pulled out the clothes that had been cut from Brian’s body after the accident. It only got worse when he saw Brian’s wedding ring and the watch his wife had gotten blinged out as a gift last Christmas. What would Leighanne do without Brian? Nick wondered, a lump rising in his throat. He was her whole world.
“Here’s his license,” said Elizabeth, sliding a card out of Brian’s wallet. She brought it over to Nick’s bed so they could all look at it. Nick’s eyes focused first on Brian’s face, but Dani’s drifted down to the bottom right corner.
“He’s on the registry,” she replied, pointing out the word DONOR with a tiny heart beside it, both printed in red.
Nick nodded, not surprised. Donating his organs did sound like something Brian would do.
Elizabeth lifted her head slowly, a strange look in her eyes as they landed on Nick. “Did you know you and Brian have the same blood type?” she asked.
He raised his eyebrows. “No. Really?”
She nodded. “Really. That means his heart may be a match for you.”
Nick stared, his own heart thumping hard against his ribs. “No… no way,” he said, shaking his head as he realized what she was suggesting. “I can’t take Brian’s heart.”
“Why not? He won’t need it once we take him off life support. Don’t you think he would want it to go to you?”
Nick hesitated. “Well... yeah,” he admitted after a long pause, “but… I dunno.” His head was spinning; he felt dizzy and nauseous. “I don’t wanna think about this right now. It’s too weird. Too soon.”
“I understand,” said Elizabeth gently, “but if Brian is a suitable match, we’ll need to move fast. There is such a thing as directed donation, where the donor’s family can name a specific recipient they want their loved one’s organ to go to, but we would need to find a way to get in touch with Brian’s wife to make that happen. We would also have to bring in a special surgical team to perform the transplant.”
It sounded like an impossible task to Nick, who still wasn’t sure he even wanted it to happen. The thought of feeling his best friend’s heart beating inside his chest freaked him out. “You don’t even know if his heart would help me. I mean, he used to have a heart condition himself. Can it still be donated?”
Dr. Elizabeth nodded. “Actually, yes, it can. His heart looked perfectly healthy on the echo. The ventricular septal defect he had surgically repaired has healed well and shouldn’t have any effect on the heart after transplant. There’s nothing structurally wrong with his heart now. It’s in great shape.”
Nick’s own heart was fluttering like the wings of a moth, making him even more light-headed. He wanted to throw up. “I need some time to think about this,” he said faintly. “And I would want to talk to Brian’s wife before we do anything. It should be her making these decisions, not me.”
“Of course, Nick,” said Dani with a nod, giving him a reassuring squeeze. “We’ll do everything we can to get word to Leighanne and keep her in the loop. We can use the satellite phone to try to get in touch with her.”
Nick swallowed hard. “You need to do better than that. You need to get her and Baylee down here so they can see him before…” He shook his head, unable to bring himself to say the words out loud. What a nightmare. He wished he would wake up to find it had all been a bad dream. It seemed unbelievable that he and Dani had been talking about Strip Poker less than an hour ago. Now here they were making plans to transplant Brian’s heart into Nick’s body. It felt totally surreal.
“We’ll see what we can do,” said Dr. Elizabeth.
“I’m so sorry, Nick,” Dani added again.
Yeah, thought Nick, tears blurring his vision as he turned to look at Brian, who never would have come to Key West if it hadn’t been for him. I’m sorry, too.
***
