Pain? He tried to think but couldn't decide. So, he shrugged.
"Okay fair enough. We want you to be comfortable but not so gorked that you can't function, ya know?"
He indicated the right side of the bed where John noticed row after row of medical instruments with clear tubing running through them. "We have you on a lot of drugs right now." He pointed. "We will back them off and DC them when we can. I'll see about switching the Dilaudid for fentanyl and I'll keep weaning you down from the propofol."
None of that made the slightest sense to his addled brain so he just looked back at the ceiling and drifted off.
***
His dreams were fraught with horrific images of pain, fear, and rage. The images were as disjointed as there were graphic and they faded from his memory as quickly as they entered his mind. A woman with terrifying demon face. A huge dark man who shook with mocking laughter. Another dark figure who screamed unintelligibly down at him before raising a huge, booted foot over his face. Sudden sharp pain and a bright flash followed by blackness.
***
It was getting difficult to breath. He felt like he had to struggle before air would suddenly fill his lungs. Every so often a loud alarm would sound on his left side. He could not see though because the left side of his face remained bandaged. He coughed and it was like fire in his throat and chest.
"Easy does it." A gentle female voice said from the foot of his bed. "You are doing okay John. Great in fact." A blonde face appeared above him, standing on his right side. "I'm Sarah. I'm a respiratory therapist and we are trying to wean you slowly from the ventilator so that you can breathe on your own. Are you in pain?"
He nodded vigorously as the sharp pain in his face made itself apparent. His legs were moving again and this time he noted the weird robot attachments that were making him walk in place on his back.
"I'll go get Jodi your nurse."
Another woman in scrubs appeared but he drifted off before he knew it.
***
He was awake when they removed the ventilator from his tracheostomy and replaced it with a misting blue hose. They had him sitting up high and he was able to notice more detail around him. His feet and legs were free of the robotic torture devices at the moment, and he felt more alert than ever before.
It was a busy morning for him. Doctors came and went along with nurses, CNAs, and therapists. He was wheeled out of his room to another part of the hospital where they transferred him onto a hard board and scanned him from his head to his feet. The nurses kept congratulating him on his progress and mentioned all the ways he was improving. No more pressors (whatever those were), volume expanders, prophylaxis, crystalloids, antibiotics, pain meds, etc.
He was made to get up in a chair several times a day and even helped to stand and ambulate for very brief sessions. The doctors assured him that his brain was intact and that he was neurologically sound. Apparently he suffered a massive TBI or traumatic brain injury. It was fortuitous that his skull was essentially shattered as it allowed his brain to swell and not herniate(?). His most memorable and pleasant experience to date was having the foley catheter removed from his penis so that he could urinate on his own. Simple pleasures, he mused.
***
He awoke again to find several strangers gathered about him in his room. He was back in his bed, and he looked at their faces trying to recognize any of them. None of them were hospital staff, he was certain, as they were all wearing dark suits. An uneasy feeling arouse in the pit of his stomach.
"Mr. Doe." The tallest of them said as he moved closer to the bed. He had unruly red hair, shot with gray, a solid gray goatee and dark bushy eyebrows that curved sharply over a pair of penetrating brown eyes. John got the distinct impression that this man rarely, if ever smiled. "My name is Dr. Everett J Malcolm." He made no effort to shake his hand or even gesture in greeting.
John swallowed and nodded his head nervously. He still had the trach tube, but they had replaced it with a smaller one that allowed him to speak if he had his Passy-Muir valve in place. He did not at the moment so remained silent.
"I represent a medical research consortium that is widely involved in some of the most forward thinking and state-of-the-art medical and biochemical breakthroughs in modern times." He was matter of fact and almost dismissive in his tone. "We have been observing your progress and have, in fact contributed to it over the past 7 weeks."
He shrugged his arms eliciting a frown from the man. "We wish to speak with you about your ongoing rehab and therapy and discuss a few 'other' options for you to consider. In order to do that, we must insist that you first sign a few forms pertaining to protected health information as well as our standard non-disclosure agreement."
John reached for his dry erase board and marker and, with a shaky hand wrote: What is this about?
Dr Malcolm glanced at the board and considered his words. "Perhaps it would be best to discuss your present circumstances and what led up to them, before we consider any options going forward." He gestured to one of the people in the room, a woman with severely short hair and an equally dour expression. She was the only member wearing a white lab coat and she stepped forward producing a tablet.
She stood on the opposite side of his bed (his left) and began speaking in a monotone voice. "Mr. Doe you have been hospitalized for nearly 2 months." She raised a hand pausing his sudden urge to write. "First off, we don't know the exact circumstances of your injuries—only that you were found by passersby and were thought to be dead from what appeared to be a severe beating." She tapped on her tablet and turned it so that he could see the admission pictures from whatever ER he was at. He had to turn his face further to his left so that he could see them clearly. They were beyond gruesome.
"The ambulance crew took you to the nearest emergency room for the sole purpose of having you declared, but when the ER staff evaluated you they discovered that you were still alive; though barely. This was in the early hours of August 14th of this year." He blinked as he absorbed this information. "You had no identification on you and your fingerprints were no match for any person on any database. Likewise, you had no distinguishing tattoos, scars, or surgical procedures to aid in this effort." She swiped through several images showing his initial treatment. "Obviously we could not rely on facial recognition either."
He cleaned off his board and began to write again before she stopped him. "It is not important to us who you are Mr. Doe. For all intents and purposes, you are truly dead." She revealed a screen shot of a death certificate. "In fact, you died three separate times during the first week of your care." She looked up at him from her computer and sighed. "During the 57 days of your inpatient care you have accrued a substantial medical bill." She flipped the tablet again and his eye widened at the amount displayed. It was over a million dollars.
"That does not include the interventions we made early on to try and preserve your life." Dr. Malcom added, nodding to the woman who stepped back. "So, you see you have yet to truly begin your rehabilitation, with little hope of full recovery, and you are already crippled with debt."
'Helluva bedside manner ass hole!' John thought to himself as he stared away from them.
"Which brings us to your current situation." He added. "Your unique circumstance provides us with opportunities that we feel you should consider before deciding the next course of action." He indicated another man of oriental persuasion who stepped forward and bowed slightly from the foot of his bed.
"Mr. Doe, to put it succinctly you have a long way to go before you have any hope of resuming a 'normal' life again. You are still suffering from a massive head injury, broken bones too numerous to list here, a significant spinal cord injury that is responsible for at least partial paralysis to your left side, and your left eye has been destroyed along with most of the supporting tissue and bone. Your reproductive organs have suffered tremendous trauma and it remains to be seen if your right testicle is still viable."
It was all getting to be too much for John as he struggled to come to terms with everything all at once. No one would give him any information about what had occurred or how badly he was hurt, until now. He grimaced as he tried to remember anything concrete. Only the nightmares came to him and vaguely at best.
The group either didn't notice or did not care about his obvious anxiety.
Dr. Malcolm cleared his throat to get his attention once more. "In a way you can thank our early intervention for allowing you to be with us here today." He mentioned casually. "But let us consider the two avenues before you for a moment." He removed his gold rimmed spectacles and fogged them with his breath before wiping them with a silk cloth. "You can go ahead with the current care plan which is to transfer you to another facility that specializes in rehabilitation where you can continue working to regain your strength, mobility and independence." He placed his glasses back on his head. "With no insurance or significant payor information you can be assured that your care will be third rate at best."
His anxiety was giving way to emotion, and he desperately wanted them to all go away and leave him be.
"There is another option." The tall man concluded and stepped back to permit a younger skinny black man to approach the bed with another tablet.
"Ahem... Mr. Doe." He stammered with a nervous voice. "Before we can continue any further discussion we must have you provide your signature on a few documents." He presented the tablet to him, and John took it gazing at the small print on the screen. "You may of course read each item in its entirety, but we will all be old and gray by the time you finish." He gave a weak laugh that prompted utter silence before clearing his throat once more. "Mmm... yes. Your first signature basically covers these first three items that give your authorization for us to treat you, allows us access to all your files and records and authorizes us to act on your behalf for the immediate future for things like press releases, medical legal issues, powers of attorney, etcetera." He indicated the yellow button for John to press to sign.
John tapped it and scribbled his finger in the box that appeared.
"Excellent." The black man flipped the tablet and access another screen. "These last two items are covered by your next signature." He explained. "First, by agreeing to this treatment you are attesting that you understand and accept the risks involved and will not hold our organization liable for any mishaps or misfortunes or adverse conditions that may arise from your care." He winked at John and continued. "Don't worry Mr. Doe. You will be in much better hands than you would be if you went with hospice rehab." He swiped to another screen. "This other item is our non-disclosure agreement that, by signing, you agree to never discuss any aspect of your care from this moment forward." He readied the tablet for his signature and handed it back to him.
John hesitated and then set the tablet aside to pick up his white board.
If I do sign this, what can I expect in return?
Dr Malcolm nodded his head. "A fair point Mr. Doe." He conceded. "While I cannot guarantee that you will be returned to 100% of your prior abilities, I can assure you that we will give you the very best possible outcome in all regards." He crossed his arms. "In some respects, with the unique technologies we have at our disposal, we might even exceed your previous norms. Understanding of course," he paused, "that there are no guarantees."
He nodded towards the tablet and John lifted it up, still hesitant.
The black gentlemen softly cleared his throat again, earning a frown from the taller man. "If I may sir." He said quietly and then turned to the patient. "Mr. Doe it should also be mentioned that by 'volunteering' to be part of our experimental program, your entire financial liability will be forgiven—regardless of the outcome."
John glanced back at Dr. Malcolm who gave a subtle nod. With a deep breath he held the tablet and scribbled in the box again before handing it back.
"Excellent Mr. Doe." The doctor said with a satisfied gleam to his eye. "We will begin your new program very soon. You will be transferred to our facility by this evening."
***
"When you first came to our attention, you only had a less than 5% probability of survival." The stunning female doctor said to him as she familiarized him with the institute and the technologies they would be trialing with him. Her name was Janice Willoughby and she stood about 5' 6" tall, wore shoulder length brown hair and had sparkling blue eyes, tucked behind big-framed glasses. She was rail thin in scrubs but mostly kept her features hidden within an oversized white coat.
