Chapter Text
Author's Chapter Notes:
Spoilers for 3.10 "Similitude" and all the episodes after it and up to 4.03 "Home," however some things that happened are changed due to the injury Trip received.
Even slight brain damage can affect you your entire life, recovering from a severe injury is a long process and you never fully get back to where you were before the injury. I may have speeded up Trip's progress for the purposes of this story. His speed of recovery and the amount he recovers is unique to himself. It is neither typical, nor is it too far from norm to be realistic.
I have given Corporal McKenzie the name Samantha for this as tribute to a friend. The character of Corporal McKenzie never given one in canon. All characters mentioned can be found at this site: http://canon.entstcommunity.org/ Episode information and summaries from http://www.tvtome.com/Enterprise/eplist.html were consulted.
Acknowledgements: the following sites were extremely helpful in helping me to understand a bit about brain injury and are useful resources should you know someone affected by it.: ; http://www.nidcd.nih.gov/health/voice/tbrain.asp; http://www.personalinjuryfyi.com/brain_injury.html; http://www.merck.com/mmhe/sec06/ch087/ch087a.html; http://www.biausa.org/Pages/home.html especially the What is Brain injury? ; and Treatment & Rehabilitation sections; http://www.craighospital.org/TBI/HealthandWellness.asp; http://www.biausa.org/Pages/coma.html; http://www.neurologychannel.com/tbi/diagnosis.shtml ; http://waiting.com/comawaiting.html ; http://www.waiting.com/brainfunction.html.
Betas: Many thanks to Redheadheart and Purpig, I could not have done it without their help. They provided much information, advice and helped correct some of the medical/therapeutic areas. Any remaining inconsistencies with reality are my fault alone.
Sparks shot everywhere, the ship shuddered underneath his feet and Trip desperately fought to keep his balance. The ship then ground to a halt, bucking him off the warp core. He was thrown backward, hitting his head on a rail, everything going black.
Phlox saw the medics bringing in Commander Tucker in, a bandage on his head, neck collar on, carefully tied to the stretcher to prevent movement. Knowing from their contacting him on their way to sickbay that Tucker's life signs were stable, he motions them to place the engineer into the Imaging Chamber. Having been informed that the Engineer has suffered a head injury and had fallen from a height of about 8 feet, he quickly adjusts the IC. Giving him a Magnetic resonance angiography (MRA) giving him a clear picture of the vessels in the head and neck, then adjusting the IC allowing him to see the full damage to the head and brain. Setting aside his feelings he quickly focuses on the information the scans give him.
"The commander's spine seems to be bruised, but no break or fracture and there does not seem to be any damage to the spinal cord. He has suffered a Basilar Skull fracture, causing part of the skull to push in towards the brain. There is artery impingement from the forceful impact to the back of his head and indications of shock. The skull fracture has caused his brain to swell, but has allowed in the reduction of squeezing of brain tissue due to their being more room to swell, so to speak. Unfortunately, a bone fragment entered his brain and caused further injury. We need to stop the bleeding into the brain, reduce the swelling and repair what we can. We also have to remove a bone fragment from the brain tissue." While speaking the Imaging Chamber, releases his patient and Phlox assesses Trip using the Glasgow Coma Scale, thus giving him further insight into the severity of the injury. "The GCS is at 7, thus indicating coma and severe injury, full recovery from the injury is thus uncertain at this time." The medical team carefully moves the man to surgery, shoving to the back of their minds that this man is their friend. Allowing them to forget this and concentrate on doing what is necessary—to do what needs to be done.
The doctor and his team work diligently for hours on the commander, repairing what damage they can, to the brain, one nurse attaching the patient to an IV and then inserting a Foley Catheter as the operation progresses. Once Phlox has stopped the bleeding he removes the bone fragment from the brain, and saves it aside in the proper environment to be replaced once the swelling goes down; he closes. The nurse prepares Trip for transfer to main sickbay, making sure to secure him to the gurney. Adjusting the biobed to monitor his respiration, EEG—for electrical readings of the brain, ICP- Intracranial Pressure, and Oximeter readings to be taken to monitor the oxygen level of the blood, so as to be warned of any complications. The doctor puts him on full life support, making sure the ventilator is functioning properly, and inserts a Nastrogastric tube so as to make delivery of nutrients easier. Phlox then adjusts the biobed to send a signal to him at any sign of consciousness, seizure, or difficulty. He knows that the longer Commander Tucker is in coma, the more severe the injury is and the greater possibility of permanent disability.
He goes to his office and pages the bridge, "Captain; I need you to come down to the bridge as soon as possible in regards to Commander Tucker."
"I'm on my way doctor." Phlox noting the captain's anxious tone, releases a tension filled sigh in anticipation of passing along the bad news. He knows the Captain is the closest thing to family the Commander has on board and that it will be difficult to look into his eyes and tell him that there is nothing more they can do but wait.
"Doctor how is he?" Jonathan asks him as he enters his office.
"He has suffered a traumatic brain injury, the focal point, the point of greatest impact was to the back of the head, and thus there is significant damage to his Occipital lobe. However the impact to the back of the head also shifted the brain forward, resulting in damage to the Frontal lobe as well. The damage is greater to the left hemisphere of the brain for reasons unknown. There is evidence of brain activity, though he has not regained consciousness since the injury. I regret to say that Commander Tucker is in a coma and I cannot say when he will regain consciousness.
"Doctor, we need Trip, without him the ship and the mission will be in grave danger. There has to be something you can do."
"We've already done as much as we can captain. We've repaired what we can and can now only wait for Commander Tucker to wake to see how the damage has affected him."
"But...but...before there has always been something one of your animals could do, like your eel helping to repair internal damage. Please, there must be something you can do to help Trip, fix whatever is wrong in his brain."
"I'm sorry Captain, I wish there was something more I could do. However, neurological tissue is the most complex in the human body and there is very little we can do even now to repair it. Short of pulling a duplicate of the Commander from up my sleeves, with all his memories and capabilities intact, there is nothing I can do, and unfortunately even that is impossible as I do not know how to perform magic."
Jonathan stood for a moment, concentrating on breathing in and out, head in his hand, trying not to break down. He knows that he needs to keep his control, that at the moment the ship will have to take priority over his friend. That regardless of the fact that Trip is like a brother to him, he must put aside his anxiety, his urge to cry, his desire to yell at the universe, until there is time to do so. "Okay, so the damage affected different parts of his brain, when he comes out of coma, what will that mean for him? He will recover enough to eventually take up his duties as Chief Engineer, won't he?"
"I'm afraid there is no way of knowing for certain just how much he will eventually recover, how much function he will have until he regains consciousness. I can say that the recovery will be a long process and that the longer the Commander remains in a coma, the possibility of permanent brain damage increases." Phlox touches Jonathan's shoulder, attempting to ease the pain this news will cause.
"I see." Swallowing hard, he says "let me know of any changes in his condition. I will visit him as often as I can."
"Engineering to the captain," the COMM sounds, Lieutenant Hess' voice drifting through sickbay, "we've repaired the damage the cascade failure caused, however we can not seem to get the ship to move. Can you see if Commander Tucker will be available to assist soon?"
"I'm in sickbay now, I'm afraid Commander Tucker will not be available for the foreseeable future. I will come down and explain the situation." Nodding to Doctor Phlox, he leaves sickbay, his face grim. Dreading breaking this news to Trip's people, as he knows how popular the southerner is to his crew.