Chapter 2

“Yes, excuse me,” the doctor apologized. “Your ex-husband. Ryan,” he said, turning to him. “I was just beginning to explain what was going on with Mr. Thompson to his ex-wife and their sons, Connor and Todd.”

The young men came forward and shook hands with Ryan. Ryan judged them to be in their early to mid teens. Both were handsome. Both were clearly concerned about their father.

Facing the family again, Dr. Newman said, “Arteriovenous Anomalies are not highly unusual. They occur when an artery and vein join with few or no capillaries between them. Many people have them and live their whole life without knowing it. In some cases, as with your…ah…Mr. Thompson, they rupture and can cause damage to the surrounding tissue. Unfortunately, in his case, the anomaly was in the area of the brain that controls language and motor function.”

He paused, seeming to want to make sure Mrs. Thompson and the boys were following him. They appeared to be, so he continued.

“We went in surgically to tie off the artery to stop any further bleeding. We cauterized the vein. We did this to prevent as much damage to the brain as we could. The surgery was successful in that we accomplished this.”

“It sounds like there’s a ‘but’ in there somewhere,” said the young man Ryan thought was named Connor.

“Well, yes there is,” the doctor continued. “Whenever these ruptures occur in this area, there’s always the possibility of language and motor function loss. Right now he is in a state of post-operative trauma. His brain and the surrounding tissue are swollen. As the swelling goes down, we will monitor his condition and determine how much function can be regained.”

“Are you saying he may not recover completely?” the ex-wife asked.

“Yes. But I’m not saying he won’t recover fully, either. In cases such as these, there is a wide range of prognosis. We will be better able to assess the eventual outcome in a few days.”

“How long will he be hospitalized? And will he need long-term care if the recovery isn’t complete?”

Something about the way the ex-wife asked these questions raised a pink flag in Ryan’s mind. He had a brief inkling of why they might have divorced.

“Both of those questions will be better answered in a day or so. That’s one of the reasons I asked Mr. Phillips to come down and make an initial assessment. By comparing assessments over a period of time, we can ascertain the rapidity of recovery and project a more accurate outcome. I’ve asked someone from physical therapy to do the same later today.”

Dr. Newman looked from one family member to another. Ryan knew he was waiting to see if there were further questions. When none were forthcoming, the doctor turned to the therapist.

“Ryan, Mr. Thompson regained consciousness an hour ago. At that time he seemed disoriented and non responsive to verbal and tactile stimuli. He is asleep at the moment. I think it would be all right to try to wake him and see what you find.”

Ryan nodded. Dr. Newman turned again to the family. “If you have questions or concerns, please let me know.”

He shook hands with each of them and left the room. Ryan smiled at the family, who now looked to him for instructions.

“If you would step out of the room for a few minutes, I can start my evaluation. There is a family lounge down the hall.”

“And just why is it you want us to leave?” the ex-wife asked in a rather confrontational voice.

Ryan’s less than positive opinion of the woman deepened. “At this time, as the patient is just beginning to recover, the presence of family or friends can cause a patient to feel pressure to communicate. That sometimes makes it harder to accurately assess their current level of ability.”

“I see,” the woman said coldly.

“Come on, Mom. Let’s get out of the way and let the man do his job,” the taller of the two sons, whom Ryan remembered as Todd, said, taking her arm and steering her to the door.

The three Thompsons walked to the door. The two sons turned back and looked at their father. The ex-wife did not.

After they had left the room, Ryan stepped to the side of the bed. He carefully lowered the guard rail and looked at the man lying there. Once more, he thought him to be nice looking. But he had a professional reason for studying the man’s face. He wanted to see if there was any asymmetry as he lay relaxed and asleep. There was none. A good sign, he thought. Less chance of dysarthria.

He then took a tongue depressor from his lab coat pocket, peeled back the paper and lightly touched the corners of Mr. Thompson’s mouth. There was a slight twitch in response to the stimulation. He repeated the tactile probe in various places on the man’s face. Each time there was a response. Ryan nodded his approval: an improvement from Dr. Newman’s earlier assessment.

Ryan then placed his hand on Mr. Thompson’s shoulder. He gently shook him. “Mr. Thompson can you hear me? Mr. Thompson?” Ryan could feel a solid, well- developed muscle beneath the fabric of the hospital gown.

The man’s eyes fluttered; there was an increase in the steady beeping of the heart monitor. Ryan shook him gently again. This time he opened his eyes. At first they looked unfocused, but after a few seconds he blinked and began to look around the room. He found Ryan’s face and he looked up into his eyes.

God, he has beautiful eyes.