sealie: made for me by tardis80 (seal_two)
[personal profile] sealie
Hawaii 5-0 fic: The Co-operative Prequel – HALO
Rating: h/c – shit loads of h/c, actually.
Word count: ~6,700
Warning: skip deals with the aftermath of Steve’s serious injuries in Afghanistan; medical details; physical and emotional trauma
Advisory: If you wish more details before reading, please email me: sealie1@hotmail.com
Disclaimer: writing for fun not for profit.
Comments: British English spelling.
Spoilers: none, it’s an AU.
Betas: Mischief and Springwoof. Thank you, Mischief, for putting up with my über finicky questions as I navigated the maze of US Naval assistance to the family of injured sailors, and your betaing, checking what I had written was correct and the extraneous comma or two! Springwoof, my Springwoof, patient and detailed, and so good at catching all those bleeping commas -- thank you.

This is Kristen999’s fic Typhoon Haiyan charitable donation fic. Thank you, Babe. When she won me (by which I mean I write fic based on a prompt *g*), I waited for my prompt. And there was pondering and considering. Eventually, I asked "when I was getting my prompt to do a Co-operative timestamp of the early days of Steve's recovery?” Apparently, I am a mindreader.


The Co-operative: High Altitude Low Opening (HALO)
By Sealie


Steve’s thoughts fractured and repaired, and then they fractured all over again. One moment, he was definitely in a C-130 Hercules; the roaring winds before a HALO parachute jump known and explicable. The next moment, he was sick to his stomach, falling through a white room with strobing lights above his head.

~*~

“Chin!” Mamo yelled, straight into the face of the uniformed officer standing on the stoop of their House. For one millisecond, he had thought that Stevie was unexpectedly home, but he wouldn’t have rung the doorbell. “Chin!”

“Hey, Mamo, you all right --” Toast came out of the kitchen as if fired from a cannon. Racing down the corridor, he came to a complete stop by the door and swore loudly and rudely, “Oh, fuckity fuck.”

Mamo found a travesty of a smile as Toast twisted on his heel and clattered up the staircase hollering for Chin.

“You better come in, son,” Mamo said to the dour naval officer. “Just tell me one thing first: is my grandson dead?”

~*~

“So you can’t actually tell us anything?” Frustrated, Kono almost came over the top of the kitchen table.

“Kono,” Chin said calmly, grabbing the seat of her shorts and tugging her back down on her chair. “Let Commander Tobin speak.”

They were ranged around the table. The US Navy officer sat at the head of the table with the cup of coffee (black, one sugar, ma’am) that Mrs. Keawe insisted on serving him.

It was disconcerting. Commander Tobin was tall, dark-haired and pale; out of the corner of your eye, you could mistake him for Steve like headache-inducing déjà vu.

“The personal casualty report is brief by necessity. Commander McGarrett was injured three days ago while on duty. He is currently being transferred to the Landstuhl Regional Medical Centre in Germany for treatment.”

“What’s the prognosis?” Chin asked.

“I don’t have that information. But he is listed as critical.” Tobin set his clasped hands on the work worn tabletop and regarded them levelly. “Commander McGarrett suffered significant blast trauma and needed emergency surgery to remove his spleen.”

“What’s a spleen?” Mrs. Keawe asked. “Chin?”

“It’s --” Chin thought hard; he was an artist, not a medical doctor, “-- got something to do with your blood. You can live without one, though?”

“I believe so. Yes,” Commander Tobin said seriously.

“So. So. So.” Kono held up her hands. “What happens next?”

“Commander McGarrett will receive further treatment at the Landstuhl Regional Medical Centre. I’ve been assigned to you. I’m your assigned casualty assistance officer. I’m here to help you and keep you informed.”

“Can we go to Land --” Mamo stumbled over the pronunciation.

“Should it be necessary, I will arrange your transport.” There was a weight of should the prognosis be bleak we will get you there to say goodbye.

“We should go,” Kono interrupted. “We should be there for Steve.”

“I will keep you updated, that is my job, and, yes, arrange transport for Mr. Kahike, as next of kin, and a companion.”

“Chin?” Mamo asked, all his hopes and fears in a single name.

“Of course.” Chin nodded.

Mamo pushed up from the table. “I need to speak to Mother. And pack a bag, just in case.”

Chin watched Mamo go, his face too grey under his normal warmly tanned skin. He lumbered heavily instead of moving with his normal solid grace.

“Oh, god.” Kono put her head down on the table.

“Shush. Shush.” Chin curled over her back, arms around her shoulders. “Steve is strong, you know that. He’ll pull through.” He regarded Commander Tobin’s neutral expression as he tried to comfort his cousin and found no reassurance.

~*~

“Lieutenant Commander Steven J. McGarrett, US Navy, thirty five years of age. New patient. Arrived Monday a.m. from Afghanistan.” Dr. Randolph Warring stood next to the monitor display presenting his patient’s statistics for the assessment committee. “Traumatic Blast Injury due to an IED. Commander McGarrett suffered primary associated pressure wave injuries, and secondary penetrating trauma to the chest and abdomen requiring an immediate splenectomy, plus repairs to the lung structure by the Forward Surgical Team at Kandahar Air Field before transfer to LRMC. While being airlifted, the patient presented with hyperthermia, dyspnea, and hemoptysis with rust coloured phlegm. On arrival, he was immediately transferred to the critical care unit. By twenty two hundred hours on Monday, he showed signs of tachypnea -- respiratory rate of thirty two breaths per minute -- with tachycardia and central cyanosis.”

The head of surgery and medicine, Colonel Sophia DiFiore, waited patiently for her young colleague to present the whole of his patient’s history. This was scene setting, but would be relevant to the whole story.

“Get on with it, Randy,” Doctor Tyler O’Briain prodded from the front of the group.

“The patient continued to decompensate,” Warring said, “and as of zero-six hundred hours Tuesday, he was moved to ICU and ventilated in a medically induced coma to support breathing function.”

Warring flicked his fingers across the screen, changing the display to show basic metabolic panel details. As one, the committee leaned forward to scrutinise the results. Arterial pH 7.20, PO2 42 torr, PCO2 32 torr -- and his serum electrolytes -- sodium 130 mEq/L. chloride 96 mEq/L, bicarbonate 13 mEq/L, potassium 4.2 mEq/L. Uremia (BUN 23 mg/dL). White blood cell count less than 4000 cells/µL. Platelet count less than 100,000/µL. It all boiled down to an infection in a seriously weakened individual.

“Chest x-ray?” Dr. Nomakhosi Evers prompted, as ever enthusiastic, flicking her long fingers as if she had control of the computer monitors.

Warring tapped the screen again -- posteroanterior and lateral view images of the patient’s chest were presented. The gross trauma to the ribcage was evident and the staples securing the flail chest were bright white points on the negative image.

“This is the first set taken on Monday,” Warring said, stubbornly presenting his storyline of diagnosis, as was his wont.

“It’s early days to see any infiltrates,” Doctor O’Briain volunteered from the floor.

DiFiore could clearly see the faint lower lobe opacity with pleural effusion developing in the left lung around a chest tube. Kids, she thought, shaking her head inwardly.

Warring brought up a second set of x-rays and the distinctive lobal pattern of infection was evident in the lower lobes of both lungs.

“Causative agent?” DiFiore asked.

“Based on sputum type, we suspected Streptococcus pneumoniae. Cultures confirmed our inference. Due to the rapid decline and lack of response to administered broad-spectrum antibiotics, we suspected that we’re dealing with penicillin-resistant Streptococcus pneumoniae pneumonia. Cefotaxime and ceftriaxone are not working. Cultures have shown that treatment with gentamicin combined with β-lactam antibiotic imipenem is likely the best option at this point.”

“Correct me if I’m wrong.” Dr. DiFiore pushed her glasses up her nose with her ring finger, a precursor usually to her staff wincing. “While I appreciate your focus on the immediate and direct issues presented, Commander McGarrett has also presented with a traumatic brain injury, and evidence of auditory and vestibular dysfunction.”

“Yes,” Warring said succinctly.

DiFiore raised an eyebrow indicating that he should expand on the topic.

“He’s slated for surgery to repair the damage to the tympanic membranes of both ears, and ossicles in his left ear --” Warring touched his own ear, “-- when stable.”

“Oh, dear,” Evers said.

“Yes, gentamicin is ototoxic.” Warring clenched his jaw. “But I’m afraid at this time there may be little choice. Due to the blast to which Commander McGarrett has clearly been exposed there is a significantly increased likelihood of the gentamicin antibiotic causing permanent sensorineural hearing loss, in addition to the direct trauma to the ear architecture from the intense pressure wave.”

Warring regarded the committee, heavy eyebrows coming together, daring them to disagree. DiFiore knew her staff, and knew that they knew the harsh reality of benefits outweighing risks. Commander McGarrett’s hearing was likely already compromised.

“Better deaf than dead,” Warring finished his presentation.

~*~

Midnight. Randolph splashed water over his face and then scrubbed his skin dry with a rough paper towel. He caught a glimpse of his reflection in the mirror over the sink. ‘Tired’ was his diagnosis, in the face of bleached skin and dark wedges under his eyes. He was well into his second shift -- departmental resources stretched thin by a bout of flu decimating the staff coupled with an influx of injured warriors.

“Onward.” Randolph left the men’s bathroom.

He had to oversee five patients in the ICU. Commander McGarrett was the most seriously ill; his splenectomy coupled with the antibiotic resistant strain of bacteria resulted in a nasty combination. The nurse assigned to deliver one-on-one care to Commander McGarrett gestured him over. He didn’t know the nurse other than politely passing the time of day because she was new to the unit, and generally preferred the nightshift.

“Alima? What’s up?” A quick scan of the monitors revealed a higher temperature than he liked to see.

She had McGarrett stripped to the waist as she replaced the large dressing over the weeping surgical incisions -- repairs and chest tube. It was large to cover the expanse of secondary burns and penetrating shrapnel trauma over his left side.

“Temperature’s gone up again,” Alima said, tone abrupt.

“Let’s see how he responds to cooling packs under his armpits and groin.”

“Good, I’ve already sent Charlie to get some.”

She was kind of abrasive, Randolph noted, but exuded competence and aloof professionalism. He really didn’t want to get on her bad side. Feeling a little like he was being marked on performance under her judging dark brown gaze, Randolph unfurled his stethoscope and bent over his patient, setting the bell over his vulnerable ribs to listen closely. There were definitely reduced breath sounds and the distinctive whoop of crackling in both lungs, which was not even remotely surprising.

“We’re going to have to suction again,” Randolph decided.

“Irrigation?”

“Yes,” Randolph said slowly. The mucous previously had been thick and tenacious as they had attempted to draw the material out of his lungs via the Ballard catheter.

“I’ll get the 0.9% saline.” Alima marched off.

Randolph straightened, rubbing out the kinks in his back. He took a moment as he stretched to actually look at his patient. His father, Dr. Randolph A. Warring II, had always impressed on him that he remember that he was treating a person, not a disparate set of interesting quandaries. Commander McGarrett was young, otherwise healthy until injured while on duty. McGarrett had his whole life ahead of him as long as he could make it through this hurdle.

As long as he could make it over this hurdle.

They had a battle before them.

Randolph was determined to make sure that McGarrett won.

~*~

Steve could feel the vibration running up his arm, making the IV in his wrist pinch, as he tapped the rail in front of his nose. If he lifted his head a fraction of an inch, the roaring threatened to drown him in a sea of dizziness. The tapping kept it at bay. Something to focus on, he thought. Over the curve of the transparent mask wrapped around his face, the world outside the confines of his high tech nest was very confusing.

A bright pink blob leaned over him, and dull notes -- pop, popping, pop -- bled over the air. Warm fingers curled around his hand, stopping him finding his comforting rhythm.

He knew that he should be concerned that he didn’t know what was happening, but he couldn’t find the energy to care.

~*~

Captain Kirsten Schreiber gently held her patient’s large hand between her own two as she checked the positioning of the arterial line at his wrist. He certainly didn’t want to knock the arterial cannula because it would be very painful. Lieutenant Commander McGarrett had only just been weaned off his vent. After two hard weeks, he was understandably exhausted and a little disorientated.

“Shush, it’s okay, Commander McGarrett. You’re in ICU at Landstuhl Regional Medical Centre in Germany. We’re looking after you.”

He gazed up at her through clumped eyelashes, a dip of furrowed confusion between his eyebrows. Poor thing.

“Kirsten? Everything okay?” Dr. Randy Warring asked as he picked up the day’s carefully annotated sheet of recorded observational data off the podium at the end of Commander McGarrett’s ICU bed.

“Yes,” Kirsten said, cocking her head to the side. Dr. Warring was one of the better members of a truly dedicated staff. “O2 sats have improved. White count is down. I am concerned at the degree of confusion that I’m seeing.” Carefully, Kirsten set his hand down on the blankets. The commander’s eyes were mere slits, as he slipped into sleep -- succumbing to the prescribed sedative she had just administered.

“I’ve organised a neuro-consult. The MRI showed a coup-contrecoup injury -- a moderate brain injury -- was sustained during the blast. And, to be fair, I don’t know what he can hear, if at all,” Warring said clinically.

“Will the surgery on his ears be scheduled here or Stateside?” Kirsten asked.

“Audiology is yet to chime in; they’re waiting until the pneumonia is resolved, until he’s stable.” Warring scrubbed a hand over his scruffy seven o’clock beard to tug at his chin. “The ossicular chain reconstruction can be carried out later; it’s not time dependent. It might be better to carry out the surgery at home, after a long, high altitude flight rather than before a flight. He’s from Hawaii; there’s a good audiology department at Tripler.”

“Hawaii?” Kirsten considered the treatment options. Transfer straight to Tripler rather than to Walter Reed was unusual, PACCOM rather than CENTCOM, but if he had family in Hawaii, it might be for the best. “You’re being transferred to Tripler, aren’t you?”

“Next week. Yes, we’ll see how the Commander does. It might be that I’ll be able to accompany him all the way home.”

~*~

Mamo put the old-fashioned phone down in its cradle with a clunk. He had to sit for a little while in the plush office chair as his heart thrummed against his ribs. It was good news: Stevie had woken up. Commander Tobin had said something about ‘ex-tubing’, which was a good sign. Mamo had been very, very concerned for a moment when he saw that the commander was calling, and more so when he couldn’t understand what Tobin said, but could only make out the words hospital and Steve. Mamo always struggled with his Nokia cell phone, and waiting for Commander Tobin to call him back on the Seolh landline had been terrifying.

Chin had to be out of cell phone range, because their casualty assistance officer had pretty much been contacting Chin directly with Mamo’s permission, since Chin could translate what he said, and then explain things to the family.

“Uncle?” Kono popped her head into the office. “What happened? Is Steve okay?”

Mamo lifted his hand, begging for a second’s pause, so he could speak.

“Commander Tobin rang. He said Steve’s doing better.”

“Oh.” Kono sagged against the doorframe. “Good.”

“I think… I want… I think we should go to the hospital in Germany.” Mamo felt chilled at the thought. It would be a very long trip but he had travelled further during the Korean War. He could do it for Stevie.

Kono slid across the room. She knelt at Mamo’s side.

“I know that you want to.” Her dabbling fingers were warm against his palms. “If Steve’s getting better, he could be on his way back before we got there.”

“Really?”

Kono bit her bottom lip. “I honestly don’t know. But Commander Tobin said he would tell us if we had to get there fast, and he would make it happen.”

“I don’t know, keiki. Maybe we should be heading out there at any rate. I’ve got savings, and we could afford the plane tickets, Mother and I.”

“Seolh would pay, you know that, Mamo.” Kono squeezed his fingers. “If we have to go, we’ll all go together.”

~*~

Chin glared at his phone. He had missed two calls from Commander Tobin and one from Mamo. He was just about to check his voice mail when his phone cackled dramatically like a classic movie Machiavellian villain, announcing a text from Kono. He breathed a sigh of relief, seeing that Commander Tobin had called to say that Steve was improving. A second evil cackle and another text downloaded. Kono informed him that Mamo was once again wondering whether or not he should travel to Germany.

They had debated long and hard about grabbing a flight to Landstuhl. But in all honesty, Steve would not have thanked them if they had dragged Mamo all the way to Germany. Mamo was in robust health for a seventy-six year old, but -- after a heart attack a couple of years back -- he still took warfarin everyday to thin his blood and diuretics. To be trapped in a plane for a long haul flight was not medically recommended by any stretch of the imagination.

The question ever-looming in Chin’s mind was whether or not he should travel out to Germany independently of the US Naval Machine, since he wasn’t listed as Next of Kin. He didn’t even know if he would be allowed to see Steve in ICU.

Chin was scrolling through his contacts and calling Kono before he realised he was doing so.

“Cousin, where were you?” Kono said in lieu of greeting.

“I stopped by the market to grab some fresh fish. I guess it’s too solid a building for cell phone signals. Steve’s doing better?”

“Yeah, that’s what Mamo said. I mean Mamo talked to Commander Tobin.” Her voice was tight. “I’m worried about him. Mamo. And Steve. I’m worried about everyone.”

“Calm,” Chin said soothingly. “I’m on my way home. Look after Mamo.”

“Okay--” Kono gnashed her teeth loudly, “--I’ll see you in half an hour.”

Chin stared at his abruptly silent phone. There was nothing in his previous experiences to deal with this, not his Auntie Mele’s death due to kidney failure, not when his parents had thrown him out of his family home, not when his father had died in a botched store robbery before they could reconcile. He was torn between looking after his family in Hawaii and his family in Germany.

~*~

I will never surrender of my own free will.’ Steve kept the words close to his heart as he strove to understand his environment. He was hot. He was cold. He was in pain. He was numb. He thought that he was being interrogated, but no one asked any questions as he coughed under their opened handed slaps against his painful ribs.

The woman with the dark brown eyes approved of his coughing, which made no sense whatsoever.

He kept losing time. He was too weak to move. The only constant was Freddie.

His fellow Navy SEAL stood sentry in the corner of the white room. Sometimes he sat. Sometimes he paced. Sometimes he crouched down on his haunches, elbows resting on his knees, his expression weirdly flat. Mostly, Freddie stood tall -- shoulders back, chin raised, feet together as he guarded Steve, and Steve was glad to have him close.

McGarrett, Steven J.; Lieutenant Commander; 942 29 4935; 3/10/77.

The mantra gave him something to cling onto with tooth and nail.

~*~

“He’s very combative, or he would be if he had the energy.” Randy flopped back along the length of the sofa in the doctor’s lounge.

“How do you know then?” DiFiore asked. She liked to catch up with her staff on the hoof; it gave her a better idea of the pulse of her department. Randy, after a dedicated long series of shifts, was currently trying to gather enough energy to either go home and start packing down his apartment prior to transferring to PACCOM, or drag his sorry ass down to the canteen and eat. A nap was probably going to win.

“The guy can probably never play poker. He’s angry. He would probably try to bite us if he wasn’t on oxygen. Well,” Randy revised, “he’s furious and anxious when he’s awake.”

DiFiore thought on Commander McGarrett’s MRI results. Yes, he had a moderate concussion, with a tiny sub-arachnoid bleed that was slowly being absorbed, but it shouldn’t have caused personality changes. But complicated by no doubt nasty ongoing vertigo, light-headedness, and nausea, his confusion was understandable.

“Hmmm?” Randy lifted his head off a cushion.

Her staff were getting as good as reading her as she was of them. It was a pity Randy was heading off to Tripler.

“He’s confused, Sophia. He got his brains rattled, he’s got vertigo, deaf, exhausted….”

DiFiore accepted that with a nod. “And you think he’s well enough to go home?”

“He’s an orphan.” Randy struggled up onto his elbows. “His only family is on Hawaii. His Grandfather is an old man, and Mr. Kahike can’t come to him. He’s lost in a sea of faces that he doesn’t know. I think that he needs familiar faces around him. To help him heal.”

It was a romantic notion, but that didn’t make it incorrect.

“Look.” Randy found the energy to push up and swing around to put his feet on the floor. “The Aeromedical Evacuation Squadron C-17s are practically ICUs in the air. We transfer sicker people back home. McGarrett’s ill, there’s no argument there, but I don’t think that it’s an insurmountable risk.”

“Okay.” DiFiore stood. “You’re flying out in seventy two hours. We’ll review McGarrett in forty eight and make a decision then.”

~*~

“Stevie’s coming home!” Mamo shouted.

~*~

The long trip started with the 86th Aeromedical Evacuation Squadron flying back to the East Coast U.S. from the Ramstein Air Base in Germany. The C-17 Globemaster cargo plane was outfitted with hospital class three-tiered litter bunk beds set rank and file on either side of the hold.

Lieutenant Colonel Jennifer Chatsworth, veteran army nurse and the senior clinical advisor, oversaw the transfer of all patients, from the critically ill to the ambulatory, onto the plane. She eyed Dr. R. A. Warring as she simultaneously checked the manifest of patients and equipment. He chanced a smile that transformed his curiously gap-toothed visage into something that her daughter would swoon over. Colonel Chatsworth just hoped that he would defer to the Critical Care Aeromedical Transport Team without having to be put in his place. He might have been experienced and qualified on the ground, but this was her flight, and the idiosyncrasies of an ICU-Critical Care and general ward in a giant hold at twenty eight thousand feet wasn’t a place for an earthworm. He could watch and learn, and maybe one day officially fly with them, but she wasn’t going to directly utilise his skills unless there was a serious emergency.

The majority of the litters were filled and they had a handful of ambulatory patients, but they weren’t at capacity, which was for the best on a long haul flight, and spoke of a lull in fighting, which everyone appreciated.

The loadmaster, Technical Sergeant Zachary Mitchell, stood by the ramp as it was slowly raised preparatory to takeoff. He nodded, and Chatsworth moved to the litter station double-checking that a defibrillator, which didn’t look like it was sitting just right, was safely stowed.

Her staff were busy, each patient provided with the level of care relevant to his or her status.

Major Dr. Frederica -- Freddy -- Kerr registered her approach, categorised it as non-relevant, and continued to ensure that her patient, a young Naval Intelligence officer, was comfortable. He was lightly sedated and wore a bulky pair of ear defenders. Chatsworth quickly scanned the associated medical records travelling with the patient, noting that the accompanying, brief service record was heavily redacted and that he had been injured in Chashmeh-e-Dalkhak. She was much more interested in reading his medical profile to facilitate his safe arrival on home soil: flail chest; three broken ribs; chest tube; pulmonary contusion; splenectomy; complications due to pneumonia; auditory and vestibular dysfunction associated with blast-related traumatic brain injury.

“Hmmm.” Information digested, introspectively, she moved onto the next patient -- who had serious head injuries, and was almost hidden amidst an array of supporting ventilator and web of multiple IVs -- wanting to have an overview of all the patients under her care before takeoff.

~*~

Someone caught a hold of his hand as he tried once again to get free of the infernal mask wrapped around his face. Steve was fairly sure that he was now on a plane, and an enormous plane at that -- Globemaster, he judged from the configuration. He was on a transport: MEDEVAC? He wasn’t in the white room. There was an infernally loud roaring, a roaring that never dissipated but rose and ebbed, but at least he wasn’t sick to his stomach. The someone leaned over him -- Steve tracked the movement -- reaching over his head for a panel. Steve took the opportunity in both hands, gripping the woman’s sleeve and pulling it close to scrutinise the badge. Squinting, he could make out a distinctive red cross over a winged snake. The embroidered writing against a blue background was blurry. Aeromedical Evacuation, he deciphered.

Safe? Yes, safe. He had been rescued. Freddie had found help. Bracing himself against the dizziness he knew would result, he lifted his head looking for Freddie.

No Freddie. He must be reporting to their commanding officer.

An unfamiliar face came in close, and Steve was distracted by his clownish reflection in her gold-rimmed glasses. The doctor’s mouth moved extravagantly, but Steve couldn’t make the words out. Why, Steve wondered, was she talking so weirdly? He let go of the sleeve, almost ripping the badge off the Velcro patch. Another set of hands stopped him trying to take off the pinching, heavy weight over his ears.

“No,” the doctor mouthed clearly, shaking her head.

How could they hear anything over the roaring? Why didn’t the medics have ear defenders on? Was the plane in trouble? He knew Boeing C-17 Globemasters and they were noisy but they weren’t deafening. Slowly, excruciatingly, he turned his head, braced for pain, to scan the crew. They were going calmly about their duties. Why was it noisy and wrong?

“Ears?” he croaked, working a throat that felt like it could crack into pieces. Everything was distortedly muffled, but dead on his left side. And why were they speaking to him like he was deaf….

~*~

Watching closely, Kerr saw McGarrett turn sheet white under his mask, colour bleeding away. The cardiac monitor pinged high and fast, emphasising her patient’s distress. Drawing in a stressed breath, Commander McGarrett coughed deep and hard, which was clinically good to see, but the increase in pain due to his healing ribs added to his distress. Phlegm spattered over the inside of his BiPAP mask.

“I want some diazepam,” Kerr ordered. “0.06 mg/kg IV over two minutes. Now.”

Her nurse, working in tandem, was already presenting a vial for her scrutiny to double-check that the correct medication had been selected. Captain Dean Roman drew the required amount of liquid into a syringe, double-checked the math, and then injected the anti-anxiety drug in the IV, titrating the rate to the correct infusion.

Time always elongated like taffy when a patient was in distress. Diazepam was an excellent anti-anxiety medication, but had its side effects, and required careful monitoring, especially with a patient in respiratory distress.

“Give me a 3cm H20 increment on the BiPAP, both IPAP and EPAP,” Kerr directed, flicking a glance at the falling oxygen saturation results on the monitor, but more concerned with the rosy grey tinge lightly touching McGarrett’s lips.

“Come on, kid,” Dean cajoled, rubbing his large hand along the length of McGarrett’s back as he curled into the coughing. “It’s okay. It’s okay.”

The benzodiazepine finally hit her patient’s system, and McGarrett sagged, allowing Dean to guide him back into a reclining position. Best for breathing but a bitch for his vertigo; there really wasn’t any choice.

“Hey. Hey,” Dean kept soothing with hands and words. Carefully, the nurse released the mask. McGarrett worked his jaw, clearly enjoying being free of the confining mask. But his O2 sats were not in the optimum range; he was wearing the mask for the duration of the flight.

“Gonna clean you up.” Dean held a disposable wipe before McGarrett’s eyes, patiently waiting until he noticed the cloth.

“Not… baby.” McGarrett twisted his head away from the wipe.

“I know you’re not, son.” Dean deftly wiped him down. McGarrett submitted to the mopping of his mouth and nose with poor grace, but he didn’t have the co-ordination to stop Dean. Gently, Dean dried the cough-wrought tears from his cheeks. “I’m going to give you a drink. You need to drink. Okay?”

Once again, Dean patiently telegraphed his actions, showing McGarrett the sports bottle of water before helping him drink.

Kerr swapped out the mask, wiping out the mucous covered one, and throwing it in the biohazard bag to be cleaned and autoclaved later. She connected a new mask to the ventilator, and held it up.

“I want the BiPAP back,” Kerr directed. She should have waited for the respiratory therapist, but he was busy with another patient.

Dean dipped in, smoothing emollient cream over the red dints marking McGarrett’s cheeks from the firmly fitting mask. He then, typically, took over fitting the new mask. McGarrett protested weakly as the mask was positioned. But it wasn’t up for discussion in the face of the oxygen monitor’s results.

“Dean, I want a maintenance dose of diazepam: 0.3 mg/kg/hr by continuous IV infusion. Add 50mg of Demerol over three hours. Keep a close eye on O2 sats.”

“Yes, ma’am.”

The small amount of drama had exhausted their patient. He was pliable under Dean’s hands as Dean checked lines -- cardiac and IV -- and was stoic as the Foley catheter was untwisted.

Kerr turned on her heel to update her patient’s log and came nose-to-nose with a camo-decked officer. They were so close that Kerr was treated to startling hazel green eyes under very heavy dark eyebrows. His insignia indicated that he was a doctor, and the badge over his right breast pocket gave his surname as Warring. Kerr didn’t recognise him; he wasn’t a new crewmember -- they would have been introduced long before take off. Warring straightened but stepped adroitly aside to allow Kerr to pick up the patient records in the folder at the end of the litter.

“And you are?” Kerr said conversationally as she updated the file.

“Randolph Warring. Steve was my patient in Landstuhl.”

Kerr refrained from pointing out to the young man that McGarrett was currently her patient.

“You cadging a lift?” Kerr judged.

“Yes, I’m going out to Tripler, PACCOM.”

Kerr flipped through to the patient’s transport orders.

“You’re accompanying, McGarrett.”

“Not officially.” Warring glanced at the patient who was now balanced on the edge of sleep as Dean flittered efficiently around him. “He had a rough time of it.”

“If his O2 sats don’t improve, we’ll be taking him straight to Walter Reed when we land,” Kerr said directly.

Warring nodded sharply, concurring without argument.

~*~

“Mamo, calm.” Chin got the elderly man sitting on the armchair in the waiting room. He knelt, watching Mamo closely. The strain and stress was draining the patriarch of Seolh. Once again, he was reassured that they had made the correct decision to not let Mamo travel to Germany, but it had been difficult to swallow. It galled Chin; he should have headed out on day one, but hindsight was, as ever, twenty-twenty. There had always been a sharp edge of ‘wait for more information’ before making a decision. Tobin handed out pieces of information like carefully hoarded doubloons: a little improvement; the antibiotics are working; a significant improvement in the ICU; Steve had been upgraded to the critical care unit; while, guarded, the prognosis had improved, and then Steve would maybe be coming home, yesterday, today, tomorrow…. But even if he had not been legally named Steve’s Next of Kin, Chin thought he really should have been there for Steve, as his ‘Ohana.

“Here you are, Uncle.” Kono stooped at Mamo’s side, offering him a plastic cup of water and a wobbly smile.

“Thank you, keiki.” Mamo took the cup with a hand that shook.

Kono tucked in next to Mamo, perching on the arm of the chair, leaning in. Automatically, Mamo put an arm around her waist, offering comfort, and receiving it in turn. Chin smiled; focusing on Kono, Mamo forgot his fear as he worked to soothe her.

Chin wanted to pace. He took a deep, careful breath finding calm in the face of his family. There was a painting on the waiting room wall. It was actually quite good, an abstract landscape in the golds and ambers of a Hawaiian dawn. A lot like the dawn this morning, which he had greeted on the porch, knowing that Steve’s plane was landing at Hickam Field. They had been asked very politely, but with absolutely no room for argument, to allow time for the medical staff to settle Steve at Tripler rather than converging on the airport.

Chin worked the plastic cover of his visitor’s pass between his fingers as he turned to look at the door, mentally requesting it to open. They had been directed to the private waiting room, nominally for a quick chat, before being conducted to Steve. Commander Tobin had been with them every step of the way, keeping them updated, and Chin was not expecting a pretty picture.

His wish was answered and the doors opened. Two men, wearing blue hospital scrubs, entered together. One, maybe younger than Kono, was Mainland haole with no tan whatsoever, and the other was older than Chin, wearing a mien of wisdom mantled by a full head of white hair.

“Hello,” the older one spoke, “I’m Dr. Pierre Magnus, and this is Dr. Randy Warring.”

“Randolph.” The younger man stepped forward, offering Chin his hand.

Chin shook it solemnly, appreciating the firm grip. Randolph looked tired under heavy stubble, which was worrying.

“Chin Ho Kelly.” He nodded. “This is Mamo Kahike and my cousin, Kono Kalakaua. We’re Steve’s family.”

“Please to meet you.” Randolph smiled. Magically, he suddenly had an interesting, engaging face, framed by teeth that were too big for his mouth. Chin wanted to paint him.

“Hello.” Kono sat up straight, almost quivering, every motion proclaiming her need to jump to her feet and demand information, but she stayed on the arm of the chair by Mamo.

“Doctor, how’s my grandson?” Mamo said getting straight to the point.

“I travelled with Commander McGarrett, Steve, from Landstuhl --”

That explained the bags under his eyes -- jetlag.

“Let’s sit,” the older doctor said, following his own instructions.

Chin sat because, while he wanted to stand or perhaps even, uncharacteristically, pace, he wanted information more. Kono stayed perched, waiting, while they settled in mismatched chairs pushed into the corners of the small room.

“Firstly, Steve is doing well,” Dr. Magnus said. “He’s had a long trip and is understandably exhausted and he’s sleeping at the moment.”

“Can we see him?” Kono piped up.

“Yes, but we’d ask you not to wake him,” Dr. Magnus said. “What we want to speak to you about -- before you see Steve -- is basically to tell you how he’s doing.”

Magnus paused a moment, waiting for Kono to chime in, but she stayed mute.

“Both Dr. Warring and I work in the Department of Medicine here at Tripler. Dr. Warring specialises in Critical Care, and treated Steve when he first arrived at Landstuhl in the ICU. I’ll be Steve’s primary care physician while he’s with us.”

“Is Steve in ICU?” Chin asked. “I thought that he was improving.”

“Steve is being carefully monitored in ICU for the next twelve to twenty four hours. We’re keeping a close eye on him,” Magnus said. “Steve, as you know, has pneumonia after being injured in Afghanistan. He’s responding well to the antibiotics that we currently have him on, and he is improving. But he is on oxygen and has a mask to help him breathe. We hope to move him into a step down unit first thing tomorrow morning.”

Dr. Magnus, Chin realised, was tailoring his account for Mamo. He made a note to talk to the doctor later, because while he doubted the man was lying, he was carefully editing.

“The pneumonia is our main concern at the moment. But Steve did have surgery and he also needs to heal.” Dr. Magnus regarded them soberly. “When Steve was injured, he sustained… the blast damaged his ears.”

“Commander Tobin said something about that,” Kono volunteered. “He said that often happened if you were caught in an explosion. But that can like be reversed, can’t it?”

“There will be surgery on both ears in the near future, but especially on his left ear, which sustained the most damage. At the moment, Steve is severely if not profoundly deaf.”

“You mean he can’t hear?” Kono interjected.

“Yes,” Dr. Magnus said ruefully, revising his words. “Steve is deaf.”

“Forever?” Mamo asked softly.

“We don’t know,” Warring said patiently. “There is significant damage; while we hope some hearing will be restored, we need to be prepared that Steve may be permanently deaf.”

“You don’t know?” Chin asked, because surely they should know.

“We know that there’s damage,” Warring said. “And we know that he needs surgery, but we’ve delayed most tests until he’s more recovered.”

That, Chin thought, seemed sensible.

“So we write on notepads?” Kono said pragmatically, fingers twitching.

“Or an iPad,” Chin offered.

Warring smiled again. “Good idea. At the moment, and for a while, Steve is just going to be sleeping. But yes, notepads -- paper or electronic -- are the way to go.”

“So, can we see Stevie now?” Mamo levered himself out of the armchair, not accepting any answer other than yes. Kono was on her feet beside him.

“Yes,” Magnus said.

Chin braced himself as they were led in to a ten-bed unit, beds set like radial spokes, separated by flimsy curtains, around a central unit where banks of monitors manned by doctors and nurses were set up.

Kono was latched onto Mamo like an opihi. Chin took his post by his shoulder, so as one they could approach Steve’s bed.

As an image, it was one that would be burned into Chin’s mind’s eye forever. It actually wasn’t as bad as he had imagined. Steve lay propped on a wide bed. The mask that Magnus had mentioned was a complicated affair mostly obscuring Steve’s face, and there were thin tubes taped to junctions at his wrists and the base of his throat. But he was clean, quiet, and comfortable, wrapped up in a thick white blanket.

Together, he and Kono got Mamo sitting on the stool by Steve’s bed. Tentatively, Mamo reached out and carefully picked up Steve’s hand. They weren’t expecting Steve to wake after Magnus’ words, but at the touch, his eyes slid open a fraction. His blue grey gaze fixed unerringly on Mamo. His brow wrinkled, in confused question.

“Son,” Mamo whispered. He lifted Steve’s hand to his lips and brushed a kiss over his knuckles.

Chin held his breath.

Mamo?’ Steve mouthed, perplexed, looking to Chin, and Kono, who smiled and gave a tiny wave.

“Hi, Steve,” Chin spoke clearly, enunciating carefully.

Home?’ Blinking, Steve looked back to Mamo. ‘Home?’’

Mamo sniffed hard, gleaming tears unshed, and bestowed another light kiss.

“Yes, son, you’re home.”

The beginning.

Date: 2014-04-05 08:38 pm (UTC)
From: [identity profile] nacinom.livejournal.com
This was a wonderful read, rich in both medical and emotional drama.

Date: 2014-04-06 08:08 am (UTC)
From: [identity profile] jimandblair.livejournal.com
I'm glad that it worked for you -- it was by necessity somewhat dark.

thank you for commenting.

Date: 2014-04-05 09:44 pm (UTC)
From: [identity profile] simplyn2deep.livejournal.com
The medical stuff made my head swim, but I loved this. especially the ending/beginning. Adding Freddie was also a nice touch too.

Date: 2014-04-06 08:09 am (UTC)
From: [identity profile] jimandblair.livejournal.com
it is canon that in the h50 'verse folk see ghosts.

details ❤

Date: 2014-04-05 10:17 pm (UTC)
From: [identity profile] kristen999.livejournal.com
I'm in awe at how wonderfully you weaved multiple POVs so skillfully while conveying both medical circumstances and charge, raw emotion. The tiny bits of Steve's awareness were perfect. Confused, fighting. And my heart at Steve seeing Freddie who guarded over him in the hospital.

We'd never gleam what truly happened to Steve without an outside's POV and I wibbled at the extent of his injuries and each connection one of his caregivers made with him.

Thank you for the amazing research, giving this such an edge of realism, opening my eyes to every level of injury and making me appreciate the Steve we've grown to know in The Co-Operative.

I ached at Chin, Mamo, and Kono's struggles with crumbs of information. I especially hurt for Mamo, his pain knowing he couldn't be there with Steve. The last scene was so visceral, I teared up with Steve being reunited with his ohana after such a long struggle, fully aware of his long, long road to recovery.

Amazing job, babe. Thank you.

Date: 2014-04-06 08:34 am (UTC)
From: [identity profile] jimandblair.livejournal.com
it's actually quite interesting (to me) that I always knew all of these details. I knew that, yes, the blast damaged Steve's ears, but gentamicin to treat his pneumonia added to the sensorineural hearing loss. That his brain got rattled. It's all so explicit. I forget that the episodes haven't been written. I know how Mrs. Mackenzie weaved the tapestry. How Mary felt when she was shipwrecked and ‘Aukai found her.

The OCs were important to this story, I wanted to capture that enrolling line of care. I know that OCs aren't everyone's cup of tea, but they were intrinsic to this story, and actually a lot of fun to write. Whilst I know a lot of details, when Randolph A. Warring, the Third, inserted his grumpy way into the fic, I was quite enchanted.

I'm glad that it worked for you. \o/

Date: 2014-04-06 12:17 am (UTC)
From: [identity profile] amyjanehi.livejournal.com
How can I say this and not seem weird.

I sat at the screen with my fork and spoon and gobbled this up like the delicious heart-wrenching pastry I knew it would be. My heart broke for Steve, Chin, Kono and precious precious Mamo. My soul was torn asunder as beautiful Steve endured lights, hands, faces that he didn't understand all while he could only see clearly his poor Freddie that wasn't really there.

Your writing is such a gift. I appreciate your willingness to share that gift with us.

Date: 2014-04-06 08:43 am (UTC)
From: [identity profile] jimandblair.livejournal.com
It's not weird. It's very flattering that the story spoke to you so deeply. I'm enchanted, thank you. And I appreciate the time that you took to comment.

Date: 2014-04-06 08:23 am (UTC)
saphirablue: (Hawaii 5-0)
From: [personal profile] saphirablue
I think you broke me.

The tiny bits of awareness of Steve - being confused, hurting, not understanding whats going - within the Outsider POV which told us what's going on -> great!

My heart broke when Steve saw Freddie guarding him. *meep*

My heart also broke for Mamo when he got informed that Steve has been hurt and all the time afterwards when he wanted to be with Steve but couldn't. The same for Chin. *hugs them both*

I love your OC's.

Thank you very much for this fic.

Date: 2014-04-06 08:53 am (UTC)
From: [identity profile] jimandblair.livejournal.com
I think you broke me.

sorry (well, I'm not really).

Yes, poor Steve, thinking at times that he was being tortured, when people strove to heal him. I'm rather fond of my OCs and they're rather fundamental to this type of story. Chin and Mamo couldn't go to LRMC. Danny is currently trying to figure out how to move to Hawaii unaware that an important drama that will affect his life is being played. So Randolph Warring appeared, and Alima, Captain Kirsten Schreiber, Kerr, all with important parts to play and a common goal: to help

Date: 2014-04-06 03:05 pm (UTC)
ext_550863: (Taste the rainbow)
From: [identity profile] usakiwigirl.livejournal.com
Aw hell, those last few lines made me cry. I mean, serious mascara tracks. Even knowing the first season of Seolh, and loving the second - thereby knowing all about Steve's injuries - you still managed to kill me. So bloody well done, as always.

Date: 2014-04-17 06:56 am (UTC)
From: [identity profile] jimandblair.livejournal.com
*pats* Sorry. Poor Steve. It was also quite cathartic to write it.

Date: 2014-04-07 02:00 am (UTC)
From: [identity profile] rungirl60.livejournal.com
OMG, that was so intense!! I have tears rolling down my cheeks. You did such an excellent job of showing us what was going on from both Steve's perspective and the various doctors' perspectives as well as what his Ohana was feeling, stuck at home, helpless. Steve thinking he was tortured due to being ill, disoriented and deaf was just heartbreaking!!

Date: 2014-04-17 06:58 am (UTC)
From: [identity profile] jimandblair.livejournal.com
writing the OCs really helped the story because the line was solid. Regardless of their characterisation, the story was still Steve's .

Crying *pats*

Date: 2014-04-08 03:36 am (UTC)
From: [identity profile] lodondria.livejournal.com
One project down, two to go, and what an immensely enjoyable break from schoolwork. I'm in awe at your skill manipulating the various viewpoints into a cohesive narrative stream.

Date: 2014-04-17 06:59 am (UTC)
From: [identity profile] jimandblair.livejournal.com
I hope that the schoolwork is going well.

Date: 2014-04-18 08:43 pm (UTC)
From: [identity profile] lodondria.livejournal.com
I have no brain left. Or right. I think I blew the final exams. I am drowning my sorrows in coffee and fic. Monday I get onto making the projects look shipshape. This going back to school in your dotage is for the birds.

Date: 2014-04-08 10:39 am (UTC)
From: [identity profile] mcparrot.livejournal.com
Well done. Bravo. That is a perfect example of what I call hospital porn. It has all the details and yet, like all good porn, it's actually all about the character development and the feelings.

Yep. Bravo.

Date: 2014-04-17 07:00 am (UTC)
From: [identity profile] jimandblair.livejournal.com
Thank you. I wanted to engage with all the characters regardless of their role. That was my personal drive in this story.

thank you for your comment.
(deleted comment)

Date: 2014-04-18 05:26 pm (UTC)
From: [identity profile] jimandblair.livejournal.com
seriously?

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