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Episode 53, "Damage"


This episode deals with radical heart transplants, a procedure that saves over 2,000 people a year, as well as medical “brain death.” Some foreign terminology might be used. Click on the links for further information. Thanks to Heart Center Online and Dr. Larry W. Stephenson, as well as TransWeb.org for information and insight on the actual procedures involved.


Previously, on Friends and Foes:
Alex had sustained a possibly fatal wound to the heart. Devin, a wound to the brain. While doctors continued to try and stop the bleeding in Alex's heart, his girlfriend Candice and his best friend Taylor found solace in one another. Taylor's wife Amber ran into Kathleen, an old friend of Devin's, who questioned her emotional investment, accusing Amber of being relieved that it was Alex and Devin, rather than her own child. Shaken, Amber returned to find that Doctor's had word on Devin's condition.


HOSPITAL WAITING ROOM

Amber links arms with Taylor and gazes into his eyes. He is worn, tired, emotionally exhausted. In her heart, she knows that what is about to come will far surpass any emotional pain the group has felt yet.

Candice breathes for a moment as she looks over at Taylor and Amber, awaiting the news on Devin. While Alex is her fiancee, she is equally concerned about one of his best friends. She clutches her chest to try and stop her heart from beating so rapidly.

The doctor clears his throat.

“I'm Dr. Marchese, I'm the Chief of Staff here at Cedars Sinai. I would first like to extend my best wishes to you. I understand the past few hours have been incredibly trying and there is an enormous media frenzy just outside those doors. However, there's no easy way to deliver news such as what I'm about to tell you about Devin.” The doctor frowns. “In fact, I'm going to need to speak to someone in the family, or the next of kin.”

Taylor's heart drops. For a moment, he frowns and looks at Candice and Amber worriedly. He knows that Devin has no next of kin. He became estranged from his family years ago. Devin had always relied on Taylor in tumultuous times, when there was no family to support him. And he had been more than willing to oblige. It was more than an obligation. It was his honor. Still, Taylor was more than enough to fill the shoes of Devin's family. More than a substitute. He was his best friend. His brother. Family.

“That's me.” Taylor blurts, stepping forward. He pauses for a moment, anxious, then continues, “I'm his brother, Taylor.”

The doctor pauses for a moment, but decides not to pursue it. “Taylor, will you follow me into my office for a moment?”

Taylor nods his head, wringing his hands nervously. He turns back to Candice and Amber, waving his hand to gesture that he has it under control as he follows the doctor.

OPERATING ROOM

Alex lies on an operating table, unconscious, and a team of surgeons circle him. The lead surgeon stands over his body with a large scalpel and mechanical saw.

“The incision will be made through the chest and the sternum, and the ribs will be separated. We'll use an electric saw for this procedure. At this time, we must work quickly to contain bleeding and determine how severe the damage to the heart is. This patient does not have any cardiovascular diseases but if the heart is permanently damaged, we may need to put him in line for a donor, as soon as possible.”

“Sir,” a nurse interrupts, “Its highly unlikely that a donor will be found in time. He will have to apply for the donor through the U.N.O.S. And even then it will take months, if not years....this wound is urgent-”

“I'm well aware of the statistics,” The doctor frowns. “We have no alternatives, and I am trying to save this man's life. Marker, please.”

The nurse hands him the marker, and the Doctor begins to draw the points of incision on Alex's chest. He lies lifeless as the nurse rushes to check Alex's vital signs. The surgeon sighs as he prepares to turn on the saw.

DR. MARCHESE'S OFFICE

“Take a seat.”

Taylor looks around the office nervously, anxious. He rubs his palms together and cuts to the chase, “Forgive me for skipping the pleasantries, Doc. I don't think I can handle much more of the suspense. What's up with Devin? Is he going to live?”

A moment passes and Doctor Marchese takes a deep breath. He hates this part. Destroying lives through the bad news he delivers, day in and day out. Watching loss, grief, pain turn into something tangible in the eyes of his patients' friends and family. At night, he is haunted by the family members and friends whose spirits he breaks in one instant, in just a few words. A few words that he knows last a lifetime.

Moments like this when he forgets that he saves lives for a living.

“This is going to be hard, but understand that there are still decisions to be made and arrangements and such. We tried our best, but the repercussions of Devin's injuries were almost instantaneous. The gunshot wound caused destruction of brain tissue and swelling of the brain. We tried to stop the brain swelling, which was the true detriment.”

“So what does that mean? We have to wait for the brain swelling to go down?” Taylor sits forward.

“Unfortunately, no. Because the brain is enclosed in the skull, there IS no room to swell. This causes some intracranial pressure that can be fatal.”

Taylor begins to see the picture. He tries for a moment to deny the truth internally. “I'm sorry? Intracran-- what?”

“The pressure inside his skull increased rapidly, and within minutes of the gunshot wound it had stopped blood flow to the brain and consequently killed his brain cells. Unfortunately, when brain cells die, they don't regenerate or come back. I'm incredibly sorry, Taylor, but as a result the damage is permanent and cannot be undone.”

“What does that MEAN?” Taylor shouts, frustrated. Tears spill from his eyes and he wipes them away quickly, trying frantically to control his emotions. Confusion and grief consume him. He wishes he could UNDERSTAND.

“About 5 minutes ago, we declared Devin as brain dead.”

HOSPITAL WAITING ROOM

Candice shuffles her feet, looking at them impatiently as she waits. Amber sits next to her, even more restless. Anxious, Amber stands up and paces a little.

“I know this is a dumb question,” Amber says, “but how are you feeling?”

Candice looks at her, half-smiles, then looks back down at her feet. She twiddles her fingers. “I don't know. I'm starting to feel numb.”

“Numb.” Amber repeats. She shakes her head and sits back down next to her. “Numb?”

“Numb.” Candice says. “You know? Numb? I can't take it anymore. I'm not ready to lose him, Amber. You know? You live your life day to day never expecting something like this to happen. It just feels...so ironic. Alex is my lover, my best friend, he has saved me time and time again from every horrible thing that has happened to me. And now here we are.”

Amber leans forward. She takes a deep breath and tries to be frank. “You know, I feel really guilty about what I said earlier. About praying that it was Alex and Devin, and not my child. I don't know what to say.”

“I understand, I really do. I'm sorry for reacting the way I did. In a way, despite all this, I am so thankful that the baby is fine.”Candice's lips tremble as tears well up in her eyes at the thought of what she is about to say next. “And if Alex dies, then the baby is always there to carry on his name. Little Alex Jr. And I want you to know I will always be apart of your life, and Taylor's, and I will always be there for that baby.”

Amber puts her arm around Candice, who curls up into her embrace. In the distance, Kathleen crosses her arms and exhales. "Whatever happens, I hope Devin is alright. He has to be. For me."

DR. MARCHESE'S OFFICE

“Oh God!” Taylor spits as he buries his face in his hands. He keeps muttering “Oh my God, Oh my God.”

Dr. Marchese shakes his head sympathetically, watching this young man deal with such a blow. It never gets easier. He can pretend as much as he want, he has even perfected the art of keeping a straight face. But it never gets easier. Never. He is silent for a moment. Taylor cries for a minute. His heart is so heavy.

“I...We've been close for so many years. I have known him my entire life, and I... Never even got to talk to him or say good bye. All of this just-” He whimpers. “- it just happened so suddenly. So last second. And...”

He wails now, trying to control himself to no avail. “Now its just his body and I won't ever...I don't know I won't get to say goodbye to him. Right? I mean is it just his body?”

Dr. Marchese clears his throat, trying to be unaffected by Taylor's grief, watching sympathetically as he struggles to articulate his feelings and repeating himself almost psychotically. He wants to tread lightly. “California state law says that a patient who is declared brain dead is legally deceased. Devin's vital organs are all being kept alive artificially, and you have to think now long and hard on whether or not you would like to keep him sustained through machinery. I know it's tough.”

“Tough,” Taylor laughs through his tears. “Tough...”

“Taylor, I know that--”

He looks up suddenly. “I want to see him.”

ROLL CLOSING CREDITS

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