For Mac (4 page)

H
E
AND
Andy were trained to do Mac’s range of motion (ROM) exercises on his legs and shoulders to try to keep his muscles from atrophying, but since Branson’s arm was still in a cast, it was Andy who actually did them, as well as the staff, of course… at least at first. They couldn’t do much about the ROM of Mac’s arms since they were also still in casts.

When the casts finally did come off in late January, Branson still had to do his own physical therapy before he was much help with Mac’s, but as soon as he could, he took over the exercises, which now included Mac’s wrists and elbows. It helped him feel closer to Mac. Touching him, moving him.

One Monday, during range of motion exercises, Mac began to moan. It startled Branson so badly he dropped Mac’s arm, which he had been manipulating.

“Mac,” Branson gasped. “Did that hurt?” As much as he hated the thought that he had hurt his brother, he was thrilled to hear the sound. Mac hadn’t tried to make any noise at all in the almost two months he had been in the hospital. Branson knew he was coming out of it, and everything would be fine now.

He called for the nurses again, as he had when Mac had first opened his eyes. They came in and did everything they’d done before. See if he could make the noise when asked to, or in response to pain. He didn’t seem to do any of that. He simply moaned sometimes—not necessarily in response to anything, it seemed.

Still, Branson tried to look at it as an improvement.

T
HE
DOCTORS
had long since assessed Mac’s level of coma and of course reevaluated frequently. He currently had a Glasgow Coma Score of seven—anything lower than eight was considered severe on that particular scale—and Branson was trying to hold on to the fact that Mac had improved from a three to a seven in a couple of months. It wasn’t the spectacular recovery he had wanted, but it was something. The fact that Mac had improved at all was a good sign, they told him.

He now spontaneously opened his eyes from time to time. That gave him a four on the eye response section of the scale. He still didn’t look at anything, though. He didn’t turn his head or his eyes. He didn’t track anyone or anything. Given where most of the brain damage was, the doctors weren’t sure he could actually still see. There also didn’t seem to be any rhyme or reason to when or why he opened them. He didn’t open them in response to commands at all. He sometimes opened them at the same time a voice or sound was introduced, but that happened so inconsistently, the doctors weren’t sure if it was a coincidence or a true response. He got the points for opening them spontaneously anyway.

He didn’t react to touch—even to pain. Branson had been told that some comatose patients would pull away from pain, but Mac didn’t; he was perfectly still, unless he was having a seizure. He didn’t squeeze a hand or twitch a finger, nothing. So he only got a one for the physical response category. Everyone got at least a one on each section. A one meant “no movement.”

He did make noise from time to time, so he scored a two in the vocal response section. He didn’t seem to vocalize at any particular time. Sometimes seemingly in response to pain, but mostly not. Sometimes in the presence of stimuli, but just as often not. And, while making noise indicated a higher level of coma than not vocalizing at all, Branson found it disturbing when Mac vocalized. All he ever did was a low moan, and it made Bran think his brother was in pain. The doctors said that wasn’t necessarily what it meant, though the nurses were good about checking for anything that could be troubling Mac when he did that. But they told Branson coma patients often vocalized for no apparent reason. Branson just hoped Mac wasn’t in pain. It was bad enough that his brother was in this condition and Branson couldn’t do anything at all about it, but the thought that Mac might be in pain and Bran sat at his side and did nothing to help literally kept Branson awake at night with worry and guilt.

Before long the doctors told Branson that they thought this might be as good as Mac was going to get for the foreseeable future. They assured him that Mac might continue to get better for the next year or so, but they didn’t hold out hope that it would happen very rapidly… if it did at all.

They had made it clear to Bran, though, that they didn’t feel they could do any more for Mac at the hospital. They had found a cocktail of medications that seemed to work. Mac’s seizures were at the lowest rate they’d been since he came in. He didn’t seem to need a vent or any other medical care that he couldn’t get at a good rehab facility. So they gave Branson a handful of pamphlets for facilities in the area that had immediate openings, and Branson looked at them automatically… not realizing what he was seeing until the doctor told Bran that they’d like to move Mac by the end of the following week. All Branson could think was
He’s not getting better
.
He’s not getting better.

Andy

T
HAT
EVENING
found Branson and Andy sitting beside Mac’s bed, talking about the upcoming move.

“Andy,” Branson choked out, while squeezing Mac’s hand. “It feels like they’re giving up on him. If I move him to one of these places, am I giving up on him too?”

“What choice do you have, Branny?” When Andy saw Branson bristle, he was quick to add, “About moving him, not about giving up. The hospital won’t let him stay here any longer. He has to go somewhere else.” Andy picked up one brochure in particular. “This long-term care facility, Silver Linings Rehab, looks like a good place.” He held the pamphlet in front of him. “They’ve got nurses there who know what to watch for, the orderlies and other care staff all have first responder training and know when to call the nursing staff if they can’t handle an emergency. Each patient is assigned a certified nursing assistant who has a total of only four patients to look after personally. There is always a doctor on call, and one makes the rounds on a regular basis to make sure everyone there gets the best care possible. They have a lot of patients who are in comas, so they know what to look for. And they’re only fifteen minutes outside of town, so it’s close enough for all of us to visit often, and for them to get Mac back to the hospital if they think that’s what he needs.”

Branson continued to look at his brother and almost seemed not to be paying attention to Andy until he finally answered, “It does look like a good place. Better than the others, judging by the pamphlets. I just….” He finally turned to look at Andy. “Should I take him
home
instead? I could hire someone to stay with him. He’s taken care of me all these years. Don’t I owe him? I could work from home and take care of him myself, I could….”

Andy decided to let the “I owe him” remark go ’til later and addressed the more immediate concern. “You looked into all of that already, Bran. You don’t have the medical knowledge necessary to take care of him by yourself, even with Amy helping on her off hours. He’s not on a vent yet, but his oxygen sats need to be monitored, and he still stops breathing sometimes when he has seizures. He needs to be suctioned pretty often because he can’t swallow, and he’ll aspirate on his saliva if we’re not careful. He’s going to need lots of ROM exercises to keep him from getting permanent contractures in his joints. He needs to be moved often to avoid bedsores, and a million other things you’re not prepared to do at home, especially not by yourself, and that wouldn’t leave you any time to work. You’d need to buy medical equipment and a hospital bed, some kind of apparatus to help you move him by yourself, and the insurance won’t pay for any of that or for full-time in-home care, but they will pay for the long-term care center. At least part of it.”

Branson didn’t respond.

“Branny?” Andy tried to get Branson to look at him. “Think about it, huh?”

Andy was already concerned about Branson sitting at Mac’s bedside all the time, let alone if he tried to take him home and provide for his care there. Branson had always been in Mac’s shadow, and Mac seemed to like it that way. But at least before, Branson had friends, had socialized, had a life. Now it was like Branson was trying to live for Mac. Not that he hadn’t always been, in a way. Branson had always tried to do what Mac wanted him to, be who he thought Mac wanted him to be. It was no different now. Andy had no doubt that a large part of why Bran was always at Mac’s side was because he thought Mac would want it, would demand it. It was like Branson was losing himself in Mac’s care.

Andy was going to do everything in his power not to lose Branson even more.

He’d been trying, along with Amy and Mrs. White, to get Bran to be who he was, regardless of what Mac thought. It was obvious to all three of them that he was miserable trying to fit into a life that was tailor-made for someone else, at least romantically. Branson hadn’t bothered with girls, even when Mac pushed them at him. And of course he wouldn’t admit, possibly not even to himself, that he was romantically interested in guys. If he didn’t want one and wouldn’t accept the other, Andy was afraid that Branson would be alone for the rest of his life.

A solitary lifestyle had seemed to fit Mac just fine. He was friendly enough, and he liked being around people on his own terms, but he was basically a lone wolf. Always had been. But Branson wasn’t like that. Bran needed people, he needed to be social, and he needed to be accepted. Andy was pretty sure that was one big reason why Bran had tried to fit himself into the mold that Mac had made for him. He needed to be accepted, and Mac had been the be-all and end-all of Branny’s world for so long that Branson didn’t even know how to be simply Branson, and not “Mac-and-Bran.”

Andy worried about him for a variety of reasons regarding this whole situation with Mac. How was that going to affect Bran? He couldn’t sit at his brother’s bedside for the rest of his life, but Andy knew that he’d surely try. Moving Mac to a rehab facility was only one hurdle Branson had to get over. Andy knew, being married to a nurse, that Mac’s condition wasn’t good, and it wasn’t going to go away. Bran was in for a long road, and Andy—and Amy—had vowed to be there every step of the way, if he’d let them.

But the first step was to get Mac settled someplace where he’d get excellent care, while freeing up Bran’s life a bit.

“Let’s try this place, Bran,” Andy finally offered when Branson still hadn’t acknowledged him one way or the other. “Let’s get him settled in. Give it a couple of months. See what you think of the care there. See how it fits into your schedule to go visit. See how long your work will let you stay with him and keep sending stuff in. Let’s see what it’s like first, and then you can make an informed decision. You can always move him home if you don’t like it at this place.” Andy waved the brochure around again.

Branson seemed to agree with Andy’s reasoning, but it was obvious to Andy that Branson still felt like moving his brother out of the hospital at all was like admitting that this was as good as he was going to get. Andy didn’t know what else they could do, though. Branson didn’t have much of a choice about the move.

I
T
TOOK
almost a week to get the paperwork filled out and the insurance onboard. In that time, Branson, along with Amy and Andy, went to visit Silver Linings. Even Branson had to admit it looked nice, for what he had thought was a glorified nursing home. There were numerous other patients who were in comas, and Branson got permission to look in on them. He saw firsthand how well cared for they were. Nursing staff of one level or another were in and out of the room quite often. Several of the patients had their CNAs sitting beside them, reading a book, or in one case, singing to them. The staff seemed to genuinely care about all the patients—the ones who would interact with them, and the ones who couldn’t. The place was clean, well lit, and painted in cheerful colors—not at all the drab, institutional setting that Branson had feared.

But he said he found it depressing too. He and Andy had talked with the nursing staff about some of the patients, and while there were numerous details they couldn’t share with him because of confidentiality, he did find out that some of the coma patients had been there for years. One man, down the hall from the empty room that Mac would soon occupy, had been in a coma for over three years. Despite the staff’s best efforts, the man had obvious contractures and was painfully thin. Unlike Mac, this man moved his head and moaned almost constantly. The nurses wouldn’t say much about his prognosis, but Branson said he couldn’t imagine that, after three years of being in this condition, the prognosis could possibly be good.

B
EFORE
ANYONE
could believe it, it was time to take Mac to Silver Linings. Branson tried to convince them to let him ride with Mac in the ambulance they were using for transport, but apparently it was against policy, so Andy gave him a ride.

“I want to see Mac settled in anyway, bro,” Andy had said. “Amy had to work, or she’d be here too.”

They rode in silence the whole way there. Andy could tell that Branson still wasn’t sure about this move and needed time to think, so he stayed quiet. Normally, he would have tried to cajole Bran out of his funk, but he was pretty sure it wouldn’t work this time, and frankly he couldn’t stand the thought of trying and failing.

Once they got to the facility, it took a while to get Mac settled. They finally had the machines all set up, and Branson sat down beside his older brother’s bedside. It was as if they had never changed buildings. Mac alternated opening and closing his eyes but otherwise was completely insensate. Branson picked up where he’d left off in the book he had been reading to Mac, but his older brother made no indication that he heard him.

Andy shook his head. He felt like he was losing both friends and didn’t know what on earth to do about it.