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PART ONE

Manchester Royal

 

Pivotal Point

       

On the 24th November 1999 my son Richard was critically injured in a car crash. He was on his way home from work and was showing off his newly acquired flame red Toyota MR2 to his business partner Andrew. It was a foul evening with strong winds and lashing rain, the car failed to take a bend, left the road hitting a tree and turned over. Some points in our lives are pivotal, and this was such a point.

Richard broke his right collarbone and hip socket, but importantly, much more importantly, his head was severely shaken about and banged by the various impacts as the car came to rest upside down. Andrew had the presence of mind to clasp his hands over his head and adopt a semi-foetal curl as the car careered on its path. He was, thank God, uninjured and turned his attention to Richard. Richard was trapped, suspended upside down, unconscious, and bleeding from a head wound. He was making moaning noises and things were dire. Andrew managed to free himself from the wreckage, and used his mobile to phone for help.

By this time another motorist had stopped to help, and together they tried to get Richard free, but to no avail. The emergency services arrived, and the Fire Crew set about cutting my son out of the car. Andrew wanted to phone me but did not know my number, but knew it would be in Richard's File-O-Fax in the car, and asked one of the fire crew to retrieve it. There was understandable reluctance as the car was a hazard, however the File-O-Fax was found and Andrew set about giving me the call that was to start an irrevocable change to my life.

 

Death, Taxes and Pain

It was I think an American president who once said that life held only two certainties, death and taxes. He could have added a third, pain. The certainty is that if you have children then you will know pain, having a child is like having a third Achilles Heel. I have three sons, three extra Achilles Heels. I have a wonderful wife Dawn; she is step-mum to the boys. I knew I had a great wife second time around, and just how good I was to realise over the coming months.

I put the phone down shocked, Dawn was looking at me ashen faced. Just two hours earlier I had spoken to Richard,  I had implored him to be careful in his new car; his answer was an exasperated yes-yes-yes. Now he was being taken to Wythenshawe Hospital seriously injured. Richard and Andrew had been on their way home from their office, located in Altrincham, Cheshire, a business that they had teamed up to run just a few months earlier, and they were on their way home to Macclesfield, but that journey came to its fateful end in Knutsford.

It's a one-hour drive from our home in Burscough to Wythenshawe Hospital; we set off in a state of numbness, I wondered out loud if my words to Richard of two hours ago were going to be the last I would have with him. Dawn used the mobile to phone our eldest son James, and he drove to Wigan to pick up Michael our youngest from his work, he was on a late shift and not due to finish until 8.00pm.

We arrived at the hospital near Manchester Airport at 8.30pm, and despite having been many times before, struggled to find the place. My mind was seizing up with fear and inadequacy, I could not think straight and was feeling fraught and desperate.

We were ushered into a waiting room, Andrew was already there, and a couple that had stopped to help. After an update from Andrew, I thanked the couple for what they had done and they left. We did not know it, but we were to spend many anxious hours in many such rooms over the coming days. Andrew looked shocked; he had survived a terrible accident but had seen his good friend and business partner badly injured. He felt a sense of guilt that he was okay but that Richard was not. I asked him was Richard still alive at the time the ambulance took him, "Yes" he said, "He had a pulse but was unconscious." Then close to tears told me that Richard was solidly trapped in the car, and that despite help and the use of a makeshift lever, had been immovable and had remained upside down in the car until the fire crew arrived.

James and Michael came in, Michael white and stiff, clearly frightened. James angry and railing against Richard's decision to buy the car that all of us had advised, pleaded with him not to get. And yet I have to admit that when I first saw it, my thought was that it was the first sports car I had seen that I liked, and almost a sense of pride that my son was going to buy it. And then I remembered that just a few days earlier, Richard had said to me that if I had just pushed a bit harder, resisted a little more, then he would not have got it. How many of us tend at times to live our lives vicariously through our children, and at what cost.

A doctor came into the room. Richard had sustained a broken collarbone and pelvis, but the main worry was his deep unconsciousness, and that he was undergoing a CT scan to establish the extent of the head injury. James had left his partner Janet at my mother's house; I rang them to bring them up to date. Quiet shock.

 

More Bad News

Half an hour or so later, the doctor returned. Richard's brain was bleeding; he needed emergency surgery and would be transferred to Manchester Royal. Arrangements were being made for the transfer but there was time for us to see him. Andrew, James and myself went into Richard's room, by this time I was finding it hard to function at all, hard to walk, speak, think. Just to be was hard. And then I saw him, his head encased in a protective transit block, his face hardly marked, and for a second my spirits lifted, oh he's not too bad I thought, and then the realization of what was going on in his head hit home. I touched his face, told him I loved him. I'm not sure what the others said, I was so absorbed in my own pain and then hospital staff came in, and the transfer was underway.

It was decided that I was in no fit state to drive, likewise Michael, and so Andrew who knew the way to Manchester Royal drove Michael's car, and James drove mine. A courageous and clever move on Andrew's part to drive just hours after the accident. We arrived at 11.00pm and were again shown to a waiting room, this room was just a short distance from the intensive care unit, clearly people spent time here for it was equipped with tea and coffee and a couch that converted into a bed, also a TV. There was a second smaller room more private adjacent, a bad news room I thought. At 12.00 midnight a nurse came into the room, the operation was due to start shortly and would take about three hours. We would be advised as soon as there was something to tell us. Claire, Andrews partner arrived and together we began our wait.

I became aware of a change in my own feelings, I knew this was real and yet I felt that I was acting out a part, and even that my performance was being observed, real and yet unreal. This had the effect of allowing me to function a little better. I started to notice my surroundings, cards from grateful previous visitors to this room were on the wall just outside, also a gently worded notice encouraging organ donation. Please God that I don't have to make that decision. And then I saw that Dawn was pale and suffering, I had been so absorbed in my own pain I had forgotten that I was not unique. We hugged and we wept.

James was still angry, angry with Richard for having gone ahead buying a car that none of us wanted him to get, angry with the dark and bad weather, and angry that this had happened to his brother. He James had done stupid things in cars and on bikes and had got away with it, why could his brother not have had say just a bad fright, a warning, anything rather than this. I could empathise with this feeling of injustice; I had turned a car over in the most irresponsible of circumstances at high speed and without a seat belt, but had walked away unhurt, and that at the same age Richard was now. Over the coming days James's anger was unabated, it was his way of coping. Michael was still quiet and pale and frightened, he would at times say something to Dawn, and then withdraw again. Andrew made copious cups of tea and coffee for everyone. Claire seemed lost as to what to say in this ferment of anger and grief.

I didn't leave my seat, it was close to the door, I was able to watch the corridor and listen for the sound of approaching steps, of which there were many, but all had so far passed by. It was 3.30am, surely the operation was over by now, and then steps came that did not pass by, it was a nurse, she told us that things were coming to a conclusion and that the surgeon would be in to see us soon. She could not answer our questions, as she was not part of the team working on Richard. She left. I felt a little easier, the operation was only a little over time, things must be ok, Richard wasn't dead, they would have told us if he was. We waited but no one came, by now it was 4.30am. I said that there must be a problem; our spirits having lifted a little were now back down again.

 

From Bad to Worse

At 5.00am, two sets of steps approached and a neuro-surgeon and nurse came into our room. The nurse was carrying a box of tissues. Not a good omen, I had not noticed the tissues but Dawn had. The surgeon's body language said it all, his shoulders were drooped, he looked tired, he looked like a bringer of bad news. First he checked that all in the room were Richard's relatives and friends, and then he told us that the operation to remove blood from Richard's brain had been difficult, and stopping the bleeding even more so, in fact some bleeding was still occurring and so a drain tube had been left in situ to cope with this. He described the severe shaking that Richard's brain had suffered, that his brain had hit the inside of the front of his skull, then bounced back to hit the rear (coup and contra-coup) also that the left side of his brain was damaged due to contact with the rough inside of his skull. At this point I stopped him, and said to him, are you telling us that my son is dying, a short pause and then with his face looking toward the floor he said yes, I think so.

Someone gasped and my face crumpled, and the box of tissues was offered to me. Again I had the strange sensation of acting out a part, and of being observed, but I knew this was real, my son was dying. Then frightened that he might die alone, I asked if I could go to him now and be with him while he died. The surgeon told us that Richard was being settled into the Intensive Care Unit, that his death was likely to be some hours away, and that as soon as the ICU staff were ready we would be able to join Richard. I thanked the surgeon and nurse, and they left. I looked at my other two sons and at my wife, it was my job to say something supportive, but nothing came, I could find no words of comfort or solace. Their brother, our son was dying and I could do absolutely nothing. My mind went back to Good Friday of 1982 the day that their mother, my first wife left the family home. I knew nothing of it, but she had started a relationship with another man, and chose Good Friday to leave us. After she had left the house with the new man in her life I sat at the foot of the stairs and wept, James 8, Richard nearly 5, and Michael only just 3 gathered themselves around me and gave me solace. And now for them in this crisis I could not reciprocate, I had no words, I could offer no comfort, these were no longer young boys, they were young men, and they were having to face a terrible reality from which I could not save them. Andrew with difficulty apologised to me for not having looked after Richard properly. Three months earlier, Richard was living in London with his girlfriend Cheryl, by then they had been together for three years, but when Richard decided to come back north and team up with Andrew in a business that he, Andrew, had been running for the past year, Cheryl decided that her relationship with Richard was not worth the move, and stayed in London. This had hurt him deeply, and I had asked Andrew to -as it were- look after Richard. I tried to reassure Andrew that the looking after meant was at the emotional level, and that this was not his fault, I don't think it helped. I rang my mother; she was shocked but controlled it well. I did not know it, but she too was ill and would soon be in hospital, fighting her own battle.

 

A Dilemma

And so it was that at 6.00am on the 25th of November 1999, Dawn and I went into the Intensive Care Unit to be with our son for his final hours. Only two visitors at a time are allowed, and I had unwittingly offended James by leaving him in the waiting room, his feeling that this was a time for blood family to be first was probably right, but I could only respond to my own deep need to be with Richard now, pecking order was not on my mind.

We were shown to Richard's bed, his head totally swathed in a dressing, his face was uncovered and unmarked. His nurse Peter sat us at the bedside and told us to ignore him whilst he worked, and that he would talk to us shortly. I through tears asked Richard what had he done to himself, and Dawn said it was a terrible waste. I asked could I touch my son, and Peter said yes. And so I held Richard's hand, kissed his face and told him I loved him. I love you my son I love you. That was all I could say, and yet that short phrase encapsulates so much. Peter was reading the mass of complex machinery that was collected about Richard's bed, and connected to him via a plethora of tubes; he had tubes to his head, neck, chest and arms. He also had a large pipe going into his mouth and down his throat; this was connected to a machine that was breathing for him. Monitors were reading his heart rate, blood pressure, blood oxygen level, intra-cranial pressure, breathing rate, breathing volume and various other life signs.

Peter having set the alarms and monitor parameters to his satisfaction turned his attention to us. I was concerned that Richard should feel no pain, Peter assured us that it would be quite impossible for Richard to have any sense of pain whatsoever, as he was on a regime of drugs that were both paralytic and analgesic. Richard would neither move nor feel pain, I felt a little easier, safe in Peter's reassurance. He went on to describe how this regime would hold for some days, at this point I stopped Peter and told him that we knew Richard was dying, would be dead within a few hours. Peter frowned a little, and in a quiet voice bordering on the conspiratorial indicated that we should be careful as to what we said within Richard's earshot. He advised us that although Richard was deeply unconscious he may still be able to hear us and to understand what we said. We should therefore choose our words carefully and be encouraging in what we said. I made it my business to pass that warning on to the others. Peter told us that although the limit for visitors was two at a time, there was no limit on duration, and we could come and go at will, day or night.

I felt it was right to let James and Michael have some time with their brother, Michael had not seen Richard at all, and was nervous about doing so. I told him that Richard looked quite normal and to be as upbeat as possible. I asked James to come for me straight away if Richard's condition changed. Dawn and I went back to the waiting room and updated Andrew and Claire: Andrew made us more tea. Then suddenly I realised that I would have to tell Richard's mother what had happened. It had been fifteen years since I'd last had contact with her, and that was in a courtroom. The last I knew of her was that she was living in Southport, but that had been years ago, I could probably contact her via her sister whose address I did know. Later James and Michael were to implore me not to contact their mother until after the funeral, she would make a terrible and false fuss, and they could not cope with that. I remembered that Richard on our last visit to his flat in London had talked about his mother; he had had several meetings with her and made it clear that he wanted no further contact. I don't know what had gone wrong, and felt that I should not ask, and was surprised that he should have made known such strong feelings, as Richard kept his emotional feelings very much to himself. And so I faced a dilemma, undoubtedly she had a moral right to know of her son's condition, equally James and Michael had a right to ask me not to heap more pain upon them. It didn't take much thinking about, I would tell her after the funeral.

 

Emphatic Confirmation

At about 8.00am James and Michael came back to the waiting room, and Andrew and Claire took up their vigil with Richard. Over the coming days, Richard was to have at least one of us at his bedside at all times, we would not let him die alone. There were phone calls to make, my work to inform, my manager was very empathetic, the reason for which I was to learn about much later. As coincidence would have it, Dawn was due for an appointment that morning at Fazakerley Hospital in Liverpool, and that had to be cancelled. The last thing I wanted to do with this precious time was to make phone calls, but the rest of life goes on.

Andrew took it upon himself to phone Richard's friends, Cheryl his partner for three years, Steve whom Richard had known along with Andrew since their A-level days and through to graduation at Manchester University, also Kelly and her partner Gregor, friends of Richard's from time spent in Lancaster, although they now lived in Edinburgh, and Richard's current girlfriend Janine. Andrew also had their business to look after, he could not bring himself to leave Richard at this point and so made some essential phone calls and in effect put the business on hold.

At 8.30am and unexpectedly my mother and Janet arrived, they had come by taxi. James's continued anger made it difficult for Janet to comfort him, he seemed almost to resent the presence of non-blood-family into his grief, a shoulder to cry on was not what he wanted, he wanted someone to blame, someone to be the cause of his anger and pain, someone to throttle and in reality that someone was Richard.

And so the morning spent itself with a succession of us going two by two taking up our position at Richard's bedside, awaiting the inevitable outcome. I started to look beyond my son's bed; there was no shortage of pain around me. An Irish lad in the next bed, his mum and dad newly arrived from Ireland, and with the same grief stricken attitude as had hung itself about me. A young Italian woman in a bed diagonally opposite to Richard's, her father quite unable to bring himself to come into the Intensive Care Unit sat in the hallway just beyond the waiting room, her mother attentive to her daughter's plight hovered in and out of the ward. Her boyfriend whom had lost a leg in the same accident wheeled himself to her bedside and spoke quiet words to her, no response.

At midday Dawn and I were with Richard, an earlier change of nursing shift had seen the highly attentive Peter finish his shift, his place taken by a lovely coloured nurse named Trisha. She told us that she too liked fast cars and bikes; also that she had a young son. I asked did what she see in here not put her off, she said it made her careful. She was less pedantically structured in her attitude, and when Michael and James joined us making four at Richard's bedside, she said it was ok. A little later Dr Joyce Eccleston introduced herself to us, she was the Doctor that headed the Intensive Care Unit and as such had overall responsibility for Richard's care. She wanted to talk to us but away from Richard's bedside, we went into the hallway outside. She told us that she had spoken at length to the surgeon that had performed Richard's craniotomy, and she had looked at the CT scans done prior to, and after the operation, and that she had never known anybody with Richard's degree of brain damage to make a recovery, he was dying but that his death might be protracted. I asked what she meant by protracted, and she told us that it might take as long as five days for Richard to die. I asked that if he were still alive in five days, would his life support station simply be disconnected, what was the procedure. Dr Eccleston explained that it was very likely that Richard's brain stem, which was already damaged, would suffer further damage due to post operative swelling. The swelling being an unavoidable consequence of all that had happened to him, and that although all steps that could be taken to mitigate against this had been taken, it was very probable that his brain stem would die. Two doctors with long standing experience of diagnosing brain death would independently carry out a series of tests, and only if both diagnosed that Richard was brain dead would his life support system be turned off. Also the two doctors would have no direct connection with any transplant team.

Joyce Eccleston had given us the most emphatic confirmation of what we already knew, she did not pull her punches and I was grateful to her for that. To have given false hope at such a time would have been a cruelty. But now instead of it being a few hours, it was to be a few days. We all needed a wash and a change of clothes, something that couldn't be contemplated with just hours to go, but now with some days ahead had become an imperative. Andrew and Claire left together, and were soon back and with them was Cheryl, they had collected her from Piccadilly Railway Station, she had lost no time since hearing of Richard's condition.  James and Michael went soon after, taking my mother and Janet with them, the intention being to get some sleep, but found sleep impossible and were back within three hours. Whilst this was going on Dawn and I were of course with Richard, his head was clearly starting to swell. His ears though remained as it were, fixed to his skull and the swelling was starting to engulf his ears, leaving them partially hidden in tunnels behind his cheeks.

I took Cheryl into see him warning her as to his condition, and also relating Peter's warning of earlier in the day. She was shocked and teary but did well, chiding him for not looking after himself properly. There had been a further change of nursing shift and after being assured that Richard's condition had not worsened, and James and Michael having returned, Dawn and I decided to go home. We too could not sleep, and by 10.00pm were back at Manchester Royal. The trip home had been unreal, and home was foreign and gave no succour, all of life's anchor points had gone, also the feeling of acting out a part had left me, and so I was no longer partially protected from the full horror of what was happening. The journey back to the hospital was better; we were getting closer to Richard. And there wasn't enough time left to spend any of it away from him.

 

Night on a Bare Mountain

With a sense of relief we got back to the hospital and into the IC Unit. It was decided that James and I would spend the night at Richard's bedside but that James would get some sleep first; Michael would spend the night initially with James and then with Dawn when James joined me. The waiting room had a couch that converted to a bed, and James settled into that for an hours sleep.

The night shift was now on duty, and Richard's nurse was Tony a rather large, avuncular and friendly chap, whose first action towards Dawn and myself was to swap our standard plastic chairs for a pair or comfy easy chairs, and suggested to us that we might as the night progressed get a little sleep. After about an hour, Michael came to tell us that James was well asleep, we told him to leave James to sleep for as long as possible, and to get some rest himself. Michael found the nights the most difficult of all to cope with, my hope was that tiredness would have its way and that Michael would sleep along with James until daybreak at least. When an hour or so later I went to check on them, my hope was being realised, both of them were asleep. I hoped too that Andrew, Claire and Cheryl whom had gone back to Andrew's flat were also asleep.

I sat with Dawn at our son's bedside and talked to Richard, his head was now very swollen, his ears totally sunken into tunnels of swollen tissue. I asked Tony about the swelling, he said it was a normal postoperative condition, and that it would in time dissipate of its own accord. I asked about the swelling going on inside Richard's head. That was a serious problem, the brain would swell for certain, but it was the extent of the swelling that was critical. Richard's brain would swell and take up all the room available in his skull, but if the swelling continued beyond that, the risk was that his brain stem would be forced down into the top of his spine and therein die. I wondered how we could tell if this was happening. Tony explained that the many times he and others looked into Richards eyes, and shone a light into them, was to test for a basic brain stem function, did Richards pupils close up as they should. His right pupil did, but his left did not. Tony went on to explain that at some point, usually after about three to five days, Richard's drug regime would be reduced and a reaction would be looked for, if the reaction was there then Richard would go back on full drug measure, if not then the business of establishing brain stem death would be initiated.

The night seemed to close itself about me, Dawn dozed a little, I looked at my son and asked God to spare him, and take me instead. How many fathers had sat in this ward and implored God to do the same. You're a loving God, he's only 22 years old, let him keep his life, please God please spare him. I reminded God of the occasion when Richard was at Manchester University and lived in an upstairs flat in Burnage, the downstairs flat being occupied by two men who were care in the community cases. They were being pestered by a group of youths who found it funny to taunt them, Richard talked to the youths and they left. I only knew this because one of the men shook my hand and thanked me for what Richard had done for them. He told me they felt safe with Richard there. Also there was the time that Richard had taken a knife from a young lad who was threatening someone with it. Dear Lord, this is a good young man please please let him live.

An intensive care unit is indeed a strange place at night. Each patient has a nurse in constant attendance, the lights are dimmed and conversation is at a minimum. The corridor outside is quiet and there is almost no noise save for the strange electronic alarms that warn of a multitude of parameters failed or exceeded. They sound like the unearthly call of some alien and frightening electronic bird. First one calls, and then from across the ward another replies. This patient is ill, ah but this one is worse they seem to say. And I wonder how anyone can choose to work in this and then not go mad. They are good people doing good work, and my son's life depends on them. It's 3.00am and I take a moment out to check on James and Michael, they are both sleeping, good.

The night passes I'm not sure if I've slept at all, this is by far the longest period that I have gone without proper sleep, but I have no wish to sleep, these moments are precious and should not be squandered in sleep, I will be with my son to the end, and then I will carry him in me. There is an unwelcome symmetry to his life, born 1977, and to die 1999 age 22 years. He has packed so much into his short life, he has used his 22 years to the full, has lived life, has made use of this unique gift that we simply refer to as life. I on the other hand have done nothing, life has just happened to me, I have just been carried along with it, I will stumble along being no more than a passenger, whereas my son who would have shaped life, made a difference to it is to be snuffed out, it's so bloody unfair, good God please let him live.

I am pulled from my reverie by James. It is 6.00am and he apologises for sleeping so long. I am pleased that he has, Michael is still asleep and so James joins me, and Dawn goes to the waiting room, I hope she will sleep. The hospital is starting to come to life, the noises of linen trucks with cargo come from the corridor, Tony smiles at me, a new day is about to dawn and Richard is still alive.

 

Richard's Friends Gather

Today is Friday and Richard's friends are either on their way, or preparing to come. Cheryl is already here; she came from London as soon as she got Andrew's phone call. Steve is on his way from Harwich, Janine, Richard's girlfriend of just three weeks will arrive today, and Kelly along with Gregor will make their way from Edinburgh tomorrow. Saturday will see all of Richard's close friends here to bid their final farewells to him, for all it will be difficult, for some it will be the most difficult thing they have ever had to do. Somehow I have to oversee this, I have to coolly walk them to Richard's bedside and then leave them to say their private and final goodbyes. But I will not say goodbye, Richard will be a part of my life and in my life for as long as I live, he will be with me everywhere. For others he will fade, their lives will take them along avenues that Richard will not walk, the passing of time will secure for them distance, separation, and the eventual non-existence of him other than for the occasional fleeting memory. For me that will not happen, I do not want it to happen, I will not allow this new reality to separate me from my son.

Friday passes, Richard's condition remains unchanged, his face is now however grossly swollen, and if I did not know this was my son I would not recognise him. Janine arrives; she already knows the situation, as do all of Richard's friends thanks to Andrew's handling of the situation. He has shown remarkable maturity and control for one so young, and my respect for him grows. Steve arrives and I am pleased to see him, he is a good friend of Richard's and too has lost no time in getting here. The gathering is now nearly complete and quietly they talk amongst themselves, Andrew tells them of the accident and of all that has happened since. I am largely silent.

Friday lunchtime and James and I are in the waiting room, we have it to ourselves the others are in the hospital's restaurant, or are with Richard. Unexpectedly a doctor comes into the room, he is Dr Almond an African man, rather short with a warm smile. He explains who he is, and what his function is but I fail to take this in. He starts to talk of Richard's injuries and then hesitates; I lift my hand as if to bid him pause, and then say that we know Richard is dying. He asks who has told us, I tell him. Dr Almond now more surefooted with us goes on to detail the extent of the damage to Richard's brain, and tells us that during surgery some brain matter was lost. I have the ghastly image of part of my son's brain falling out of his head and onto the floor. I ask him if Richard were to live, would his damage be intellectual or physical, the immediate answer is both, both. And then with a heave of his shoulders and with much compassion utters what can I say, what can I say, I am so sorry. The doctor leaves us to our thoughts, I look at James, he is angry, very angry. He feels his brother is being treated like Frankenstein's monster, that he is already dead in the sense that his spirit has left his body, and that his life support station should be switched off and his body allowed to die. He says this with such vehemence that I am frightened he may do it himself, I need not have feared. James and I agree that in all probability Richard died at the scene of the accident, and James says he will go there to the scene of the accident as Richard's spirit will be waiting to be collected and taken home, and that he James will collect Richard's spirit and bring it home. I am now in uncontrollable tears and quite unable to speak. In our despair we are being driven into irrationality.

It is 7.00pm and my mother and Janet are leaving after another unexpected visit. My mother is clearly unwell and it is to be her last visit to Richard in hospital, she has said her goodbyes, I marvel at her mental strength, in a week's time she will be in hospital herself. Two of our group are with Richard, the rest of us are talking in the waiting room, I have raised the subject of Richard's funeral arrangements, when a young lad he and his brothers had been choristers at St Luke's Parish Church in Orrell near Wigan where we lived, and where James still lives, and so I say that I would like to bury Richard at St Luke's, James agrees and Michael with his head lowered nods, Andrew says that that seems fitting. But Cheryl is upset, I put my arm around her and ask her are we upsetting her talking of Richard's funeral when he is still alive, but no it's not the funeral, it's the burial, Richard had told her that he wanted to be cremated. I thanked her for that, Richard and I had talked on many subjects, but not his death, it would be me to die first wouldn't it, and so that ground had not been touched. Thus it was decided that Richard was to be cremated, and his ashes laid in the garden of remembrance at St Luke's. And that after the midnight service at the church on Christmas Eve we would come out of the church, gather around Richard's ashes and see Christmas day in with him. Through teary eyes, this was agreed by all.  


Dawn and I go home to wash and change, again I find that home is not where I want to be, it is an alien place, offers no comfort, indeed I feel what is almost revulsion at being in a safe place while my son is dying, and very quickly we are on our way back to Manchester Royal's ICU. It is 10.00pm we are with Richard, and are about to witness for the first time something that we are destined to see many times in the coming weeks, and it is to haunt me. Tony is on duty, again he is doing the night shift and I am aware of some activity surrounding a patient in the bed opposite Richard's. The curtains are drawn around Richard's bed, but a small gap at the corner allows me to see what is going on outside, I ask Tony is it Richard, but he shakes his head. Then I see that all the beds in the ICU are having their curtains drawn. A metal box the size of a coffin is taken through the curtains to the bed opposite, and suddenly I realise what has happened, it is a sickening moment, a moment of realising the obvious, the moment of knowing that people die here, that my son will die here, that a coffin just like that one, maybe it will be that one, will come and take my son's body away. The metal coffin was taken away by a porter but no family were there, a man had died on his own and now his body was being taken away by someone to whom it was just a job. This must not happen to my son, I will take that walk with him, he will not be alone.

James joins me at Richard's bedside, and Dawn goes to the waiting room. Tonight she and Michael will sleep. James has brought with him some tins of pop, these are welcome. We talk of the metal coffin and of death, I weep. Tony brings us two comfy chairs and all the time he is watching the monitors that tell of Richard's precarious hold on life. It is 3.00am James and I have talked ourselves quietly to a standstill and James has dropped off to sleep. I look at Richard and think of the many times we drove to and from Welbeck, the Army's sixth form college. Much to my surprise Richard came home at every opportunity, even though this on most occasions was for one day only. This residential college was giving him a taste of a life style I knew nothing of. A taste of pomp and ceremony and of grandeur and comradeship, the responsibilities and privileges of the officer class.

I looked at my watch, 6.00am, and noticed that a blanket had been placed on me, I glanced at Tony, he smiled and said, "You've slept at last". James had also been given a blanket. These good people are not only looking after my son, they are looking after us too. Later on today, Peter the nurse whom was on duty the night that Richard came onto the ICU is to arrange the use of a flat for us within the hospital so that those of us not at Richard's bedside will have somewhere private to go, somewhere to wash and change, somewhere to sleep. This will mean fewer trips home, less time away from Richard. These truly are caring people.

In the corridor outside the ICU Dawn and I were approached by an elegant lady, she is the mother of the Irish lad in the bed next to Richard. She had seen us with Richard and wanted to know how he was. I told her of the hopelessness of his situation and that it was just a matter of time. She gave us her heartfelt sympathy and was far from clear as to how her son Patrick would progress. Her husband joined our group and having missed the conversation started with a polite and upbeat wish for our son, his wife quickly stopped him, he understood and as we parted company expressed his wish for a miracle for our son. A warm and compassionate couple, is it shared adversity that brings out the best in people?

It is 12.00 noon Saturday three days on from Richard's accident and he is still alive, James and I are in the waiting room as are some other people, this can be a rather public place. A doctor comes in, not one that I've seen before, I assume he wishes to talk to the other people and I make to leave the room, "Mr. Cook?" he asks, and together we move into the small adjacent bad news waiting room. James, the doctor and I sit down. He gives his name and position; again I fail to take this in, my mind is saturated with the words of people telling me that things are dire, so again I decide to speed us past this difficult opening phase, "Doctor we know he's dying" I say, he pauses and then, "Who has told you this!" And so I relate to him the words of the surgeon and those of Dr Eccleston. A further pause, he seems to be searching for a reply and then says, "You have been very well briefed," but there is a sense of irony about it, could he possibly have meant to convey to us that maybe, just maybe we had been over briefed? My heart raced, this tiny nuance, this barely perceptible inflection of tone had given me a straw to grasp at, and I held it tight.

I missed the next few words and rejoined at a point where the doctor was giving us details of the procedure involved in slowly taking Richard off his paralytic analgesic drug regime, and then the life support system and the way that things may go from there. If his brain stem were dead, then he would not be able to breath for himself, nor regulate heartbeat or blood pressure or temperature, nor would there be the means for his upper brain to function, in short Richard would be dead. However if his brain stem was functioning then it should with assistance be able to maintain Richard's basic life systems. Then over a period of time it would be possible to assess the deficits caused by the severe damage to the various parts of Richard's upper brain.

For the first time there had been talk of something other than death for Richard, and however bleak that something might be, it was better than death. But not for James, this talk of possibly surviving was cruel. We all knew he was dead already and that this was a ghastly charade, and what was the point of living with a shattered intellect and a useless body. I had no answer.

Dawn did her best to keep my feet on the ground and I tried hard too, but for the first time I had been given a glimmer of hope. It seemed best to keep these thoughts to myself; after all, the straw I had grasped might well be imaginary.

2.00pm and Kelly and Gregor arrive, now all of Richard's close friends are here. Andrew gives them the details of what has happened, and I warn them as to Richard's current condition and appearance. Kelly goes to see Richard but Gregor elects to stay put. I think this is out of respect for Richard.

The hours of the afternoon spend themselves as timelessly as the days that have elapsed since the accident. In this place time flows rapidly and at the same time stands still. But for the watch on my wrist I would have no idea of date, day or hour, and yet these seconds are the most precious and painful of my life.

 

The Reflections of Friends

6.00pm and all of Richard's friends are talking in the waiting room, they talk with life and humour, and I learn that Richard had a nickname for me, it was mother hen, really I am quite pleased and not surprised that years of heading a single parent family have brought me this sobriquet. Richard had a tiny flip top mobile phone lost in the accident; it looked like a communicator out of Star Trek, and he was very taken with it, Andrew said that Richard had developed a posing walk with phone in hand, palm outward showing to the world this little wonder of modern technology, we all laughed. I listened to this group of young people talking with affection about my son, all of them in their early twenties, all handling the situation with maturity beyond their years. I learned things about my son that I had not known, and felt that if you can measure a man by the company he keeps, then my son was indeed special, for so was this company.


Andrew suggested that Richard should by cremated wearing his Armani suit and his beautiful cashmere overcoat, the idea appealed to me. A year earlier, Dawn, Michael and I had gone to London on our first visit to see Richard and Cheryl's flat. Richard had met us straight from work and was wearing his cashmere overcoat. He is over six feet tall and as he lead the way out of Euston station Michael turned to me and said, "He really fits here doesn't he?" I knew what he meant. Richard was confident and purposeful, he was beautiful. And yet the fit wasn't perfect for one year later he was back in Manchester.

And so the evening went, as always, two of our number with Richard and the rest in the waiting room telling their various stories of him. I listened and I learned. My turn to be with Richard. "Mother hen here" I said, and then I told him I loved him. I told him he was a very fine young man, and had some very fine friends.

The evening thus spent it was time for the friends to leave, they would be back tomorrow. Tonight they may have a drink or two, perhaps more tales of Richard and then sleep at Andrew and Claire's flat. James and I took up our places for the night at Richard's bedside, Dawn and Michael went upstairs to the flat that had been made available to us, it was our fourth night at the hospital and I recalled Dr Eccleston's prognosis of a protracted death, maybe five days, tomorrow would be the fourth.                  

 

With no Fanfare

It is Sunday, and with no fanfare it has been decided that now is the time to put Richard to the test. His paralytic/analgesic drug input will be halted and a reaction will be looked for. We are gathered about his bed, well exceeding the limit of two, many pairs of eyes are watching Richard as the small valve that permits the drug flow into him is shut off. "How long will the effect of the drugs take to leave his system?" I ask Tony who for once is on a day shift; "Within half an hour" is his reply. All eyes turn again to Richard, I am watching for anything, any movement. Ten minutes pass and nothing, quarter of an hour nothing, and then a twitch at the corner of Richard's mouth, yes there it is again. I shout at Tony and at the same time James points to Richard's hand, "he's moving his hand, he's moving his hand," "good enough" says Tony, and after checking Richard's eyes restores the drug regime. Within seconds the movements stop and Richard is motionless once more, but hopefully no longer moribund.

Dr Eccleston talks to us outside the ICU, what we have seen is of importance, it shows that Richard's brainstem is not dead and the significance of that cannot be overstated, but, and it's a big but, he has suffered severe damage to the Frontal Lobe of his brain used for Thought, Reasoning, Behaviour and Memory, severe damage to his Occipital Lobe involved in Speech, Motor, and Sensory functioning, also Abstract Thinking, added to which his Temporal Lobe involved in Emotional functioning is damaged, and then there is generalised damage throughout his brain. The effect of all this is that despite his brainstem showing signs of having survived the onslaught upon it, it may be for naught as he may not be able to function at a higher level, in other words he might be trapped in a persistent vegetative state. It seemed that Richard had overcome this essential hurdle just to be faced with a brick wall. And then she used a phrase that we were to hear more than once, a phrase that gave me hope, she said, "Richard will be given his chance, we will do all we can to give him his chance."

The first step in giving him his chance was to perform a tracheotomy, this is a surgical procedure whereby a cut is made in the throat and an entry made into the windpipe. This allows the pipe that does Richard's breathing for him to be removed from his mouth where it would cause problems if left long-term, and alternatively be placed in his windpipe. This relatively minor operation is to be carried out in the ICU without moving Richard away from all his life support and monitoring equipment.

Monday morning the 29th of November, all of Richard's friends have returned to their homes and their work. Andrew reluctantly has accepted the need to get back to the office, he is now without his business partner and to keep things afloat must do the work of the two of them. I have given my heartfelt thanks to all of Richard's friends; they are indeed a fine group of young men and women. Later today Richard is to have his tracheotomy performed, and when that is behind us I will talk to James and Michael about their return to work. They are reluctant to leave Richard and I can well understand this, but particularly in Michaels case I feel the sooner he gets away from the intensity of all this the better, he needs the mundane routine of work to restore some sort of normality to his life.

It is the afternoon, Richard's operation is about to start and we are camped in the corridor just outside the ICU. I am nervous, we are all nervous, but things go well, and an hour later we are back at his bedside. The large mouthpiece and pipe are gone, and a smaller pipe passes through Richard's throat and into his windpipe. I look at the readings on the various monitors, I am coming to understand a little of what they mean and they all look as they did before. Dr Eccleston assures us that he has come through it well and that the next step will be to wean him off his life support system, but not today. I thank her and she leaves. Again I am daring to think that my son might live, would they really go to such trouble if he had no possibility of survival, or are they just giving him his chance. Dr Eccleston's words echo in my mind-a protracted death, it may take up to five days-today is day five, and Richard is still alive. I hold his hand and I weep.

        

Automatic, Assist, Spontaneous

Dawn is with Richard; I am with James and Michael in the waiting room, I put it to them that they should consider returning to work. Neither of them will accept that now is the right time, they say they cannot consider leaving until Richard is weaned off his station (life support system). I understand this and accept what they say, but I am worried about Michael he is looking drawn and very tired, he finds the nights the most difficult to cope with, even James has had a fright, when in the main corridor leading from the ICU he heard footsteps approaching him from behind, and on turning to see who it was found no one. Clear signs that the strain is really starting to tell. He has also come close to having a fight with a man who was attempting to use a mobile phone outside the ICU, mobiles are banned inside the hospital because of the interference they can cause to monitoring equipment, this near fight was averted by a nurse who insisted the phone be turned off.

Back with Richard I am looking at the machine that is doing his breathing for him, it has many readouts on it most of which I can understand, but with each breath the machine delivers, the word Automatic comes up, the duty nurse explains to me that Richard's drug regime is such that the machine is totally responsible for every breath that Richard receives, but that as he is withdrawn from these drugs, and if all is as it should be, we will start to see Assist in place of Automatic. This will indicate that Richard is starting to make some attempt to breathe for himself but is being assisted by the machine, and that finally if Richard can breathe fully on his own behalf, then the word Spontaneous will come up on screen. So there I had it, I now knew what to look for, what to hope for, and what to pray for.

Tuesday the 30th 1.30pm and James, Michael, Dawn and I are at Richard's bedside, the process of weaning him off his paralytic/analgesic drug regime is about to start, and we are ushered into the waiting room, I am not sure why, but assume it is purely so that the medical staff can concentrate solely on Richard, and without interruption. Mercifully it doesn't occur to me that there may be other reasons for moving us away. We spend a difficult half hour in the waiting room, and then a nurse comes into the room, she is smiling, we can go back in to be with Richard, but she wants to warn us that not uncommonly when patients are taken off the drug mix that Richard is on, it can cause a sort of fit and that he is having just such a fit. However we are not to worry, as it will pass before long. We rejoin Richard in the ICU and I am relieved to see that the fit is not as bad as I had imagined, his right arm is raised off the bed and is shaking in tremulous fashion, James goes to that side of the bed and holds Richard's hand and arm, and soon the arm steadies leaving just a tremor in his hand. I look at the various readings on the monitors, Richard's heartbeat is higher than before, 120bpm also his blood pressure is up. His nurse assures me that this is to be expected and that we will see greater variations in his parameters now than before. I feel uneasy, it's as if a safety belt has been taken off, and yet Richard is one step further on than he was previously.

Michael says he wants to take some time out and will go upstairs to the flat loaned to us. Really I should have sensed Michael's mounting stress, but I did not. I look at the respirator monitor, it still says Automatic, I watch for several minutes but every breath registers as Automatic, I'm willing it to say Assist but no, it just repeats Automatic, Automatic, Automatic. Some time has passed since Michael left and Dawn is concerned, so she and I leave James with his brother and go upstairs to find Michael. In the corridor leading away from the ICU we pass the father of the Italian girl, the one in the bed across from Richard's, still he cannot bring himself to enter into the ICU. His is indeed a solitary vigil, he sits on a low window sill and seems lost, I want to sympathise with him, he is frightened and in a foreign country, I want to tell him we share a common pain, I want to weep with him but instead all I can do is nod as we pass by and say hello, he nods back and smiles, it is a smile heavy with grief. We go through the door leading to the stairs and there is Michael sat on the stairs, his face is pale, he does not see or hear us, he is deep in thought and clearly a very troubled young man. "What's up son?" I ask. Michael's answer makes it clear to me that I really have to convince him of the need to get away from this place and go back to work, just to do something, anything as long as it gets him away from the awful intensity of this place. He has been struggling to come to terms with the prognosis that Richard would be dead within five days, and now five days later we have been given just a slight hope, and Michael is at the end of his tether, he really can't take anymore. Events later in the day plus an intervention from James are to resolve or at least ease the situation.

5.00pm and again I am watching the respirator display, I look to the side and am a little concerned to see that Richard's blood oxygen count is down from 98% to 95% when my eye is drawn back to the respirator display by something different, at first I can't grasp what it is, then suddenly I realise that the word Automatic is absent and Assist is there instead, just for one breath then Automatic is back. Just as I doubt what I have seen, there it is again, Assist then again Assist. I look at Tony, he smiles, "Yes, he's just starting to do a bit for himself." I thought I had seen the first of Richard's assisted breaths, but Tony tells me he's been assisting on and off for the last hour. I am elated, I feel unbridled joy but know that I must keep a lid on my feelings, Richard is still critically ill. I go to find James and Michael and give them the news; they are talking and have decided to go back to work but are not sure that they are ready to leave Richard just yet.

7.00pm and now all of Richard's breaths are assisted, James and I are watching Tony working around Richard, he asks us to go outside for a few minutes, as he just wants to do something. Unquestioningly we obey. Five minutes later Tony calls us back in and nods towards the ventilator, and oh joy of joys the display is showing Spontaneous. Richard is breathing for himself his brain stem is not dead. I don’t know what Tony did while we were outside, but Richard is breathing for himself, my son is alive.

8.00pm and Dr Eccleston comes to talk to us. Richard continues to breathe for himself and Dr Eccleston tells us that now she can change her prognosis, Richard's condition remains very serious, but that he is not brain dead, however he may get no further than he is at the moment, and she gestures with her arms stiffly at her sides in just the posture that Richard strikes in his bed. He may have got as far as he can get, in short he may be in a persistent vegetative state and if so then this could go on for weeks or months. On the other hand, six months on from now and he may be attending my outpatients clinic. She carries out a number of pain reflex tests on Richard that produce no result and then she leaves us to our thoughts.

If it is possible to be both elated and troubled at the same time, then that is how I feel. And my sensitive and supportive wife knows this, and cautions me not to fly too high on the cloud that I'm on, for it is still likely that Richard will not pull through. She is a wonderful wife, and I am suddenly aware that it is only because of the prop that she and the boys have been, that I have kept my sanity. I have given them nothing being so bound up in my own pain and quite unable to ameliorate theirs.

And now that possibly weeks or even months of this situation lie ahead of us, it is time to make some hard decisions. Tony advises us that he is concerned that we are all becoming very tired and stressed, and that we need to pace ourselves for the long run. He suggests that tonight we should all go home and sleep in our own beds, he tells us we can phone at any time to check on Richard and that if there is any change in his condition then they will phone us. James and Michael agree that now they can return to work, I think I see in Michael some sense of a lessening of the pressure he is under. And so we hand back our key to the flat, kiss Richard goodnight and leave. Please God that one of those awful metal coffins doesn't come for him in the night. I feel very uneasy at leaving him, it takes an hour and a half to get here from home, and if his condition suddenly worsens then the thing that I've dreaded the most, him dying alone, may come to pass. But tonight is to be quiet, there is to be no emergency call, this night at least will pass untroubled.

 

A Very Very Good Morning

Wednesday the 1st 6.30am and I phone the hospital, Richard is ok, his condition is unchanged, somehow he has survived a night without us at his bedside, and somehow Dawn and I have had some sleep without being at his bedside. By 10.30 we are back at the hospital, Richard is indeed as he was but I notice that his blood oxygen count has dropped a little lower, it is now at 93% and I ask his nurse about the reduction. She tells me that Richard has developed a chest infection and that this is the cause of the lower reading. Dawn notices that Richard's facial swelling is not so severe and that his ears are starting to show beyond his swollen cheeks. The probability is that the swelling has been reducing for a little while, but our continual presence here has made this less easy to spot. But now after a night away we are seeing things through less jaded eyes.

I look around the ward and am concerned to see that the bed next to Richard's is empty, and I wonder what has happened to the Irish lad, but it's ok, he has made good progress and no longer needs to be in the ICU. This is heart-warming news indeed, Dawn and I hope to see his parents again, they must be so pleased. Next I look across at the young Italian woman, her father still sits on the low window sill in the main corridor, he still has not been able to bring himself to come inside the ICU, for him this must be a truly terrible ordeal. I look at his daughter and she is moving, she has her eyes open, seconds later her mother comes into the ward, she is excited, and then tentatively and with difficulty her father comes into the ward, he sees his daughter with her eyes open and moving an arm, and he goes to her, I can only guess what his emotions are at this time, but it is a truly wonderful moment and this is a very very good morning.

Two doctors come up to Richard's bed, they have a pulley and weights and some cord, they set about arranging a sort of gantry at the foot of his bed, it is a traction device and after some discussion it is all put together, then Richard's right calf is encased in a sleeve and the hanging weight is attached to the sleeve. His right hip socket was broken in the accident, and now this too was being given attention, he truly was being given his chance. In a few hours it will be seven days since the accident, a protracted death we were told maybe five days, but now almost seven days on and Richard is still alive.

It is lunch time and Dawn and I decide to go for a cup of tea together, we are on our way to the small tea room near the entrance to the hospital and en-route come across the parents of the Irish lad. They confirm that he has made good ground since last we met, so much so that they are about to return to Ireland, we give them our encouraging news on Richard, they are genuinely delighted for us and she reaches into her bag and takes out an amulet. She tells us that she is not at all a religious woman, but that if we keep this amulet and trust in it then our son will not die. Her sister had brought it back from Lourdes, and now she was giving it to us. We thank her and her husband and I am touched by the generosity of spirit in this gesture. I have no faith in lucky charms, but this little amulet represents a sincere and generous action and I will cherish it.

The afternoon passes with no incident but Richard's blood oxygen count has dropped a little further, it seems his chest infection has intensified somewhat. We are told not to worry unduly; this is a common enough complication in patients with Richard's injuries. At 8.00pm we kiss Richard goodnight and reluctantly head for home. I ring the hospital at midnight and again at 6.00am, all is well.

For reasons that neither Dawn nor I can remember, I am at the hospital on my own, and now Richard's blood oxygen count is causing some concern. Dr Eccleston thinks that Richard has a mucus plug in a lung and that this is the cause of the low blood oxygen reading, and she is going to perform a Bronchoscopy on him this afternoon. As with the Tracheotomy, this will be done in the ICU ward, Richard will not have to go into theatre and I find this reassuring although it could be an indication of just how poorly he is, but luckily this does not occur to me. I ring home and tell Dawn of what is happening, and that I won't leave the ward until after Richard's operation.

4.30pm Thursday 2nd of December, I am sat outside the ICU ward and the Bronchoscopy is underway. Dr Eccleston has told me that it will not take long, she exudes confidence and calm but I am nervous and tight. At 5.30pm Dr Eccleston emerges, all has gone well, she has found and removed a mucus plug from Richard's lung and his blood oxygen count is now 98%. She explains to me that it will be a few minutes before I can go into the ward as they are fitting a sort of physiotherapy machine about Richard's chest and that from time to time it will emit a series of musical sounds. Twenty minutes later I am beckoned back into the ward, and Richard is wearing a shaped plate that covers his chest. The mother of the Italian girl glances at Richard and then at me, her look seems to say oh dear what has gone wrong now. The promised musical tones start up, sounding like a double bass being played by someone totally devoid of musicality.

8.00pm and with a heavy heart I kiss Richard goodnight, I do not like leaving him and tell him that tomorrow I will be back early, and that Dawn will be with me.

 

Progress Indeed

Friday morning and Dawn and I are back at the hospital, the musical breast plate has been removed and Richard's blood oxygen count is holding at 97%, also his swollen face is now much less swollen, and the dressing on his head has been removed revealing an enormous wound that runs from a position one inch above the centre of his left eyebrow to the rear of his head, and then curls back running above his left ear to finish two inches away from the left corner of his left eye. The wound is held together with a series of metal staples, and these are to be removed later today. It is sickening to know that such a large section of Richard's skull had to be removed, dear God what has happened to my son's brain? The surgeon had told us on that awful morning that removing the blood clot from Richard's brain had been difficult, and stopping the bleeding even more so. But now looking at this wound, at its size, knowing that about a third of my son's skull was removed has hit me hard. We have been told of the extent of the damage to his brain, but I do not really understand what this means. I just want him to live, but if he does live, just how much of Richard will have survived? Impossible questions.

It is Friday afternoon, and Dawn and I have just been given some news that staggers and surprises us. Richard's staples have been removed and Dr Eccleston tells us that providing Richard's condition holds, then tomorrow, Saturday, he will be transferred out of the ICU and into the High Dependency Unit. I can't keep the smile from my face; I want to hug all the nurses and all the doctors. Richard although still in a coma, is stable enough not to require the services of Intensive Care, but merely the ministrations of the High Dependency Unit, and this is progress indeed. And yet at the same time as I smile, I worry. Richard has had the very finest attention possible in the ICU, one-on-one nursing twenty-four hours a day, a mass of monitoring and life support equipment, but what will be the regime in the HDU. What is abundantly clear to me is that at this the most acute end of medical nursing, the National Health Service is without equal, my son has received the very best of attention, and we have been treated with frankness, sensitivity and warmth. But now I must accept a level of care that is a little less intensive as Richard is now just a little less poorly.

I had no need to worry, for now it is Saturday and Richard has crossed the corridor from the ICU to the HDU and all is well, life's delicate child is being looked after very closely. There are two nurses and three patients and I feel assured that he is all right here. Dawn and I have given our profuse thanks to the staff on the ICU, and they have wished us well, but they have not yet finished with Richard, for we will need them again, but not just yet. For now things are going well, indeed Richard's blood oxygen count is so good that the percentage of oxygen in the air mix he is on is being reduced, and is only a few points higher than normal air. A doctor comes to speak to us, he is not Richard's doctor but seems to know of our son, he is reassuring, he says that Richard has his age on his side, that if I had suffered such an accident, then I would already be dead. And then he uses the phrase that Dr Eccleston used, and that gave me such hope, he says, "Richard will be given his chance". I thank him.

It is Saturday afternoon, we are with Richard and I am wondering how I am going to be able to visit my mother who's gone into Whiston Hospital in Liverpool and is facing a colostomy operation. She is very poorly, has a weak heart and there is a significant chance that she will not survive the surgery. It occurs to me in a black moment that we may be celebrating Christmas this year with a double funeral. It is while in this black moment that I notice that Richard has opened his eyes, they are only slightly opened, but I can see his pupils, they don't look like pupils that are seeing anything and I'm not sure if he has opened them himself, or if his eyelids have just relaxed a little. And then they close again. I watch him intently; a few minutes later they open again, "hello Richard" but no response. I tell the nurse, she makes some checks and tells me that he may be starting to come out of his coma, but that it may take days or even weeks, and then again he may not come out of it at all. None the less I am excited, the last two days have seen changes, all of them positive.

Sunday the 5th of December, Richard is stable, his breathing is good but his eyes are closed. I'm expecting too much. The nurse tells us that the plan for Richard today is to transfer him out of the HDU and into Ward 28, a neuro-surgical ward. We are as amazed by this planned move as we were by the last, and I have the same fears.

 

Ward 28

Sunday afternoon and Richard is about to make his trip, we are told how to find ward 28, it's about as far from the main entrance as it's possible to get and quite some way from the HDU. The route to ward 28 takes us past the hospital chapel, and there in a neat row are those ghastly metal coffins. The inevitability of life ending in death does not stop them seeming incongruous here. Hospitals are for making you better, and the coffins represent failure and I fear them. Eventually we find ward 28, and Richard is there before us, staff are getting him settled in the ward but we are soon allowed in, and given a sheet that amongst other things details the visiting hours. Yes, now that we are a little further from death's door, we will have to comply with normal hospital etiquette.

Richard's temperature and blood pressure are taken, and then we were left together. Dawn and I look at each other, in a two-day period Richard has gone from one-to-one nursing, masses of monitoring and life support equipment, to a bed and enriched air supply, and I feel unsafe. I cannot look at various screens and see just how he is doing. As we get toward the end of visiting time, I notice that Richard's breathing is becoming more laboured. It is as if the air he breathes is not getting into his lungs, and although I worry, I say nothing. When someone has saved your son's life, as the people here have saved Richard's, you just can't doubt them, but there are times when you should, and this is one of those times.

It is now the end of visiting time, and yet again with heavy heart we leave him. I have not seen his eyes open today, and now I know that his breathing is not right, and yet I am leaving him and saying nothing. And as we walk away my heart lightens and I realise with self-disgust that because I can no longer see my son's laboured breathing then I have also shut my mind's eye to it. I voice this self-disgust to Dawn and Michael, and Michael to his credit tries to defend me, and Dawn reassuringly reminds me that we aren’t leaving him on his own, there are nurses and doctors there.

We are at home, it is 7.30pm, the telephone rings, I answer it. It is the staff nurse on ward 28, she tells me that Richard's condition has worsened considerably; his blood oxygen count is down to 46%, I ask her is he dying, she says it's possible and knows it will take us some time to get back to the hospital. I shout to Dawn and Michael, then ring James, and minutes later we are on our way back to Manchester Royal Infirmary. I am shaking and Michael offers to do the driving, I decline, I cannot face the drive back doing nothing, the shaking passes off.

We arrive at the hospital at the same time as James. A torrent of thoughts and emotions sweep through me as we make the long walk to ward 28. Please God don't let my son have died on his own, no one should have to endure that. As we reach the chapel I strain to see the coffins, but the light is dimmed and I'm not sure if they are all there or not. We round the slight curve and fifty yards ahead I can see ward 28. It must be the extreme emotional stress of the moment that makes the corridor seem to stretch out ahead of us, for now fifty yards has become five hundred, and our group are walking in slow motion. It is surreal and nightmarish; the emotional pitch is unbearable as we pass over the threshold of ward 28. The staff nurse greets us and apologises, the crisis has passed and Richard is ok. After talking to me on the phone, emergency physio's had worked on Richard, cleared his chest and brought his oxygen count up into the nineties again. It seems that his chest infection is at the root of the problem, and he is to have physio' at regular periods throughout the night. The weight falls away from me and I weep. Staff nurse apologises again, but I reassure her that she did the right thing in phoning and please to do so again if a crisis looms. We spend half an hour with Richard and then go home, but now he has a blood count monitor on his finger and I am easier. If only I had raised my doubts earlier then this might have been avoided. I will not fail him again.

 

MRSA

Monday the 6th and now we are confined to visiting Richard at hospital visiting times only, but the staff on ward 28 say that if this presents a difficulty then they will arrange alternative times for us. It's not a difficulty now, just a restriction, but I must now start to think about returning to work, and I wonder how visits will work out then. Visiting time is 4.00pm to 8.00pm, and so at just before 4.00pm Dawn and I enter ward 28 but Richard is not in his bed. Staff nurse comes to us, all is ok, but Richard has been found to have developed, or is a carrier of Methicillin-Resistant Staphlococcus Aureus (MRSA), and for that reason has been moved to a side room. She stresses to us that although we may have read lurid accounts of what MRSA is, and what it can do, however for the most part Richard will be unaffected by it. He does though present as a risk to other post-operative patients, and that is why he is in a side room. The staff nurse goes on to explain that every time they go into Richard's room they will don plastic aprons and gloves, and that as they leave the room, the aprons and gloves will be disposed of in a special bin. This is to limit the chance of any staff member transferring the MRSA bug to other patients via clothing. I ask do we need to do the same, but no, we only need to wash our hands when we leave.

And so we go into Richard's side room, he is still in a coma, his eyes shut, but his breathing easy. We sit down and I talk to him, I tell him he is getting better now, and is in an ordinary ward and because of that we can only visit him during visiting hours. I read to him his favourite newspaper-The Independent-and hope that through his coma and through the terrible damage to his brain some of my words may carry, and give him reassurance.

It is time to leave, I am heartened by the fact that his pulse rate and blood oxygen are being monitored, also that the monitors have parameter alarms set. But I am disheartened that Richard has not opened his eyes for us. Once again I'm expecting too much.

As Dawn and I drive home, we think of past events, we pass the halls of residence that Richard lived in, when at Manchester University and we both remember the two fingered salute he gave us from his window as we left him on his first day there. Typical of him to do something slightly outrageous to take the sting out of departure, how I wish he were safely back there now. The pain is terrible and I weep.

I am pulled from my tears by the thought that I must make a decision about returning to work, and decide that provided Richard is ok, then I will go back to work on Wednesday. My work is repairing TVs and VCRs in customer's houses, and as I cover the Wigan area I can order my work in such a way that I finish at the eastern end of my patch. This gives me only a half hour drive to the hospital, but it will be without Dawn. This upsets both of us, but we see that the logistics of me doing my days work, then driving home to collect Dawn before going to the hospital would mean Richard having only a very short visit. And so it is decided, I will return to work, and on Wednesday and Thursday I will visit Richard alone, but on Friday, Dawn will come with me on my work, and we will both then go on to visit Richard.

Wednesday is here and I am back at work, I have made a very early start. The regime that my company operates is such that once you have done your calls, you are free to go home. I determine that I will do my calls very quickly, and am lucky, by 2.00pm I'm finished, by 2.30pm I'm at ward 28 and the staff nurse says that as Richard is in a room of his own, then the normal visiting hours can be stretched, and I'm allowed in one and a half hours early! Richard is still in his coma, I talk to him, I read his paper to him, I read an article about his beloved Everton FC, and when I look up from the paper his eyes are open, he is looking at me, I hug him, I tell him I love him, I hope he does not notice my tears. As I move about his bed his eyes attempt to follow me, I tell him I'm just going out for a second to see the doctor and I forget to wash my hands. The doctor says that Richard has had his eyes open a few times today, I tell him that he is making some attempt to follow me with his eyes and that surly this means that his upper brain must be functioning at least at some level. The doctor says that this may be so, but that it could just be his brain stem automatically causing his eyes to track a moving object. Consciousness but not necessarily sentience. I am crushed, what kind of bloody cruelty is this, and then I hear myself asking the doctor if I can tell Richard about his accident, and what has happened to him. He nods, I thank him. I will not ask about awareness again, I will make my own judgement, I'm sick of being knocked back, and yet I know that the doctor's caution is justified.

Richard still has his eyes open, I tell him of his accident and of how well he is doing and he looks at me. Please God that he is seeing me. I love him so much, and in the way that only a father can. A nurse comes into the room pulling me from my self-indulgence, "I've come to suction Richard," she says in a way that assumes I know what she is talking about, and moves Richard's air supply pipe to one side, then she puts a flexible tube into the hole in his throat and down toward his lungs, all the while a sucking noise is coming from the pipe, and then Richard convulses and mucus is drawn up the pipe. The nurse withdraws the pipe, replaces the air supply, and Richard settles back down, his eyes now shut. I ask the nurse how often this is done. "Every two hours" is the answer. I thank her, she takes off the plastic apron and gloves, washes her hands and leaves. "That's a bit rough old cock" I say to Richard, his eyes are still shut.

It is time for me to go home, I kiss Richard goodnight and manage this time to hold back the tears, I tell him I will bring him in a radio tomorrow and then he can listen to Radio 4. I promise him that I will make an early start and will be in to see him as soon as I can. I leave, this time I wash my hands. Five and a half hours have passed and I have not noticed their passing; it seems that once again time has been suspended.

 

World Wide Web

Now it is Thursday evening, I am at home arranging tomorrow's work and the phone rings. I am startled, but it's ok, it's James, he sounds excited, he has just got home from visiting Richard (well outside the visiting hours), and tells me that Richard is responding to commands to look to his right. I ask him if he James was moving to the right or standing still, standing still is the reply. This is excellent, for if intended and not just coincidence then Richard can hear, he can understand and comply with a request. Surely this demonstrates that Richard has some level of awareness, and that his upper brain has some ability to function, and that therefore he is not in a persistent vegetative state.  I decide that despite my earlier reservations, I will again ask the medics for their opinion. James had noticed, as had I, that Richard seemed unable to move his eyes to the left beyond centre, also that the range of movement of his left eye was less than that of his right.

Friday the 10th December and Dawn has come to work with me, she sits in the car whilst I do my repairs, again things go well and we are at the hospital for 3.00pm. I can't wait to talk to someone about James's visit of yesterday, and I don't have to wait long, for the staff nurse sees us and comes to us. "Richard's brother was in last night" she says, "and had quite an effect on him, he had Richard looking to his right and back to the centre again, it was quite good". "Surely this must indicate that he has some level of awareness?" I implore. "It's encouraging," says the staff nurse.

The afternoon becomes the evening; Richard is at times opening his eyes, and at one point has moved his left hand and arm. We don't know if this is with a purpose or just a random movement. I am starting to really think that Richard is going to survive this, but I am also beginning to realise that if he does, then his recovery is going to take a very long time. I need more information about brain injury, about recovery, the level of recovery; it was Dr Almond who in answer to my question had told me that if Richard were to survive, then his damage would be both physical and intellectual. But what sort of physical disability, and what level of intellectual impairment were likely. I think I knew that the question was too amorphous to put to a doctor, also far too loaded for the doctor to risk a reply to the father of a patient with such injuries. And then it occurred to me that I might find answers, or at least information on the World Wide Web.

Back at home I spent many hours clicking on links, I printed off a mass of information and after ingesting as much of this as I could, I started to more fully understand just how bad things were. According to the Glasgow Coma Scale, Richard, even in his current state stood less than a 50% chance of survival. I came across the terms Traumatic Brain Injury, Closed Head Injury, and Open Head Injury. There was a real possibility that even if Richard survived and gradually came out of his coma, he may have no conception of his own identity, or mine. The possibilities that lay ahead frightened me. I felt that whatever changes lay ahead for Richard, there must be one central constant, his family. Dawn and I must spend as much time as possible with him, he must relearn who we are, and through us who he is. There were to be many changes ahead, many hospital wards in several hospitals, but just one family. We must not fail him.

The brain is a totally unique organ in the sense that the rest of the body is just the vehicle through which the brain expresses itself. Every facet of what we are is brain centred, memory-the reference by which we know and evaluate ourselves and others-is entirely within the brain. It is where all our senses are located; it is where our intelligence resides, it is the very core of our being. And yet nature has seen fit to endow us with just one, then to house it in a skull the lower part of which is rough enough to cause severe damage to its precious cargo in the event of severe impact.

There were other matters to sort out, Andrew gave me all of Richard's personal papers, I would have to write to his bank, credit card company, Student Loans Company, and of course his car insurance company. I could not bring myself to look at the car or where the accident occurred, it would be too painful and perhaps irrelevant, also Andrew advised me that without any doubt the car was beyond repair following the accident, and doubly so after the fire service had cut Richard from it. The police had of course to carryout their duties and came to the hospital to talk to me, no one else was involved, and there was no third party damage. The policemen themselves were sensitive and considerate; it is not an enviable task that they have, but they did it without intrusion and I was grateful.   

 

Goodbye for Now

A week has passed for now it is Friday the 17th of December and Richard's condition remains about the same, sometimes he is partially conscious and watches me move about his room, but for most of the time he is deeply asleep. It is clear that his journey out of coma is to be a slow one.

There is encouragement from other quarters, the Irish lad is up and walking, also his speech is clear. He is well on the way to a remarkable recovery. The young Italian girl is now fully awake, her mother wheels her about the hospital in a wheelchair, she tells me in limited English that her daughter has broken bones, but is recovering day by day, and that they hope to return to Italy soon. She asks after Richard, I tell her he is alive.

I am with Richard and am about to be surprised for a third time by an impending change. A doctor comes into Richard's room and tells me that they are planning to move Richard to a hospital near his home. I am staggered that someone in Richard's condition can be moved at all, and in particular that he can be moved from a specialist hospital to a general one. The doctor seeks to reassure me by telling me that paramedics will accompany Richard, and that what he needs now is a period of general nursing as he is through his acute phase. The doctor wants to know if Macclesfield Hospital is Richard's local hospital, I explain that his Macclesfield address was temporary, and that his home now and for as long as he needs it is our home in Burscough, and that our local hospital is Ormskirk.  

And so it is that on Tuesday the 21st of December 1999, Richard is loaded into a Paramedic Ambulance and together with his carers sets out on his journey from Manchester Royal to Ormskirk General. Dawn and I say our goodbyes to the nurses and doctors on ward 28. Our relationship with them is not quite as intimate as with the staff on the ICU, after all whilst there, we were grieving for our dying son, they saw our pain, they knew and nursed our vulnerability, they stood with us at the very brink of our son's life and edged him and us gently away from the precipice, this is indeed an intimate state of being. We shall not forget them, we owe them much, and our debt is to be greater, for they have not yet finished with Richard, he is to stand at that same precipice again, and us with him.

 

       

 



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