In 2018 Fall Out Boy was on stage when Ruby saw two versions of Patrick on stage. "Paddy why there was two of you?" Patrick looked at Pete Wentz and Pete knew he had to stop the show as Ruby fainted. She didn't wake up. "Ruby?" Patrick called out as she was out cold. His heart was pounding in his chest and suddenly the roar of the crowd felt a million miles away. Pete was already waving frantically at the crew to cut the music and bring up the house lights. Patrick dropped to his knees beside his sister, his hands hovering over her like he was afraid to touch her, afraid of what it might mean. "Ruby, come on, wake up," he said, his voice breaking. She was always the one who made touring bearable, who saw the world in ways that made him remember why they did this in the first place, and now she was just lying there, pale and still. "Get the medics," Pete shouted into his mic, and the whole arena seemed to hold its breath. Patrick brushed Ruby's hair back from her forehead, and his hands were shaking. "Please wake up," he whispered. "Please, Rubes." But she didn't move, and for the first time in a long time, Patrick felt absolutely terrified.
Ruby was rushed to hospital as she was out cold. Patrick sat in the back of the ambulance, holding her hand so tight his knuckles were white. The paramedic kept asking him questions he didn't know how to answer. Had she ever fainted before? Was she on any medications? Did she have seizures? "I don't know, I don't know," Patrick kept saying, hating how useless he sounded. He was her brother, he lived with her, toured with her, and he should know these things but his mind had gone completely blank. When they got to the ER, they wouldn't let him go back with her at first, and he stood in the waiting room feeling like his chest was caving in. Pete arrived twenty minutes later, still in his stage clothes, eyeliner smudged, and found Patrick pacing a groove into the linoleum. "Any news?" Pete asked. Patrick shook his head. He couldn't stop thinking about what Ruby had said. Two of him. Why had she seen two of him? The doctors came out after what felt like hours but was probably only forty-five minutes. Ruby had woken up, they said, but she was confused and they were running tests. CT scan, blood work, the whole deal. "Can I see her?" Patrick asked. The doctor nodded and led him back through the maze of hallways to a room where Ruby was lying in a hospital bed, looking small and scared under the harsh fluorescent lights. "Paddy," she said when she saw him, and started crying. Patrick rushed to her side and pulled her into a hug, careful of all the wires and tubes. "It's okay, Rubes, you're okay," he said, even though he had no idea if that was true. "I got scared," Ruby said against his shoulder. "There was two Paddys and then everything went dark." "I know, I know. The doctors are going to figure out what happened, okay?" Ruby pulled back and looked at him with those wide, trusting eyes that had always made him want to protect her from everything. "Am I going to die?" she asked, and Patrick's heart broke. "No," he said firmly. "No, you're not going to die. You just had a little scare, that's all." But even as he said it, he wondered if he was lying. The doctor had mentioned something about neurological symptoms, about needing a specialist, and Patrick didn't know what any of that meant but it sounded bad. Pete appeared in the doorway, and Ruby's face lit up. "Pete!" she said. "I fainted!" "I heard," Pete said, coming over to squeeze her hand. "Pretty dramatic way to get out of watching the rest of the show." Ruby laughed a little, which made Patrick feel marginally better. If she could laugh, maybe things weren't as bad as they seemed.
As hours passed Patrick was by Ruby side as she had another seizure "Paddy I feel.." before she said something she seized again. Patrick hit the call button so hard he thought he might break it and within seconds nurses were flooding into the room pushing him back away from the bed even though every instinct in his body was screaming at him to stay close to her. "Ruby, Ruby it's okay," he kept saying but she couldn't hear him, her body was rigid and shaking and her eyes had rolled back and Patrick felt like he was going to be sick. The seizure lasted maybe thirty seconds but it felt like a lifetime and when it finally stopped Ruby went limp against the pillows, breathing hard, confused. "What happened?" she asked in a small voice and Patrick realized with horror that she didn't remember. "You had another seizure, Rubes," he said gently, moving back to her side now that the nurses were stepping back. One of them was adjusting her IV, adding something to it, and Patrick wanted to ask what it was but the words wouldn't come. Ruby started crying, not the loud dramatic crying she sometimes did when she was upset about little things, but quiet tears that tracked down her cheeks like she was too exhausted to sob. "I don't like this Paddy," she whispered. "I want to go home." "I know baby, I know," Patrick said, and he was crying too now, couldn't help it. "They're going to figure out what's wrong and fix it and then we'll go home, I promise." But he didn't know if he could keep that promise and that terrified him more than anything. The doctor came in a few minutes later, a neurologist this time, young guy with kind eyes who explained that they were going to do an MRI, that the double vision and seizures suggested something serious, maybe a tumor or an aneurysm or something else Patrick's brain refused to process. "Is she going to be okay?" Patrick asked, and his voice sounded like it belonged to someone else. The doctor hesitated just a fraction of a second too long before saying "We're going to do everything we can." Pete had been standing in the corner the whole time and he stepped forward then, put a hand on Patrick's shoulder. "The band's here," he said quietly. "Joe and Andy are in the waiting room. We cancelled the rest of the tour." Patrick nodded numbly. Of course they had. Ruby was family.
7 hours after at by 2am Ruby woke she was out of it and mumble talking fairies as it was funny. Patrick had been dozing in the chair beside her bed and jolted awake when he heard her voice, all slurred and dreamy like she'd had too much wine even though she never drank. "The fairies are wearing Pete's hats," Ruby mumbled, giggling to herself, and Patrick didn't know whether to laugh or cry because it was so absurd and so Ruby but also so wrong because she shouldn't be this out of it. "Rubes, hey, can you look at me?" Patrick said, leaning forward. Ruby's eyes drifted toward him but didn't quite focus, like she was looking through him at something else entirely. "Paddy you're all sparkly," she said, reaching out to touch his face with clumsy fingers. "Did you become a fairy too?" "No baby, I'm just regular Paddy," he said, catching her hand and holding it. Her skin felt too warm. He reached up and pressed the call button again because this wasn't right, she was supposed to be getting better not worse. "There's so many colors," Ruby said, her voice full of wonder. "Do you see them? They're dancing on the walls, Paddy, look!" Patrick looked at the plain white hospital walls and saw nothing but he nodded anyway. "Yeah Rubes, I see them," he lied, because what else could he do. The nurse came in and checked Ruby's pupils with a light, asked her some questions that Ruby answered all wrong, thought it was 1995 and that she was at Disneyland and that Patrick was their dad. "I need to page the doctor," the nurse said quietly to Patrick, and the worry in her voice made his stomach drop. "What's happening to her?" Patrick asked. "Why is she like this?" "It could be postictal confusion from the seizures, or it could be pressure building in her brain, the doctor will need to assess," the nurse said, and then she was gone and Patrick was alone with Ruby again. "Tell the fairies to be quiet," Ruby said, pressing her hands over her ears. "They're being too loud, Paddy, make them stop." "Okay, okay," Patrick said, moving to sit on the edge of her bed. He put his arms around her and she curled into him like she used to when they were kids and she'd had a nightmare. "Shh, I'm telling them to be quiet now, they're leaving, see?" Ruby nodded against his chest but she was still trembling.
Ruby drift asleep again as Patrick slept in chair as Patrick was snoring as Pete walk in it was funny. Pete stood in the doorway for a second just taking in the scene, Patrick's head thrown back at what had to be an uncomfortable angle, mouth hanging open, snoring like a chainsaw, his hand still clutching Ruby's even in sleep. It would've been hilarious under any other circumstances and Pete pulled out his phone to take a picture because Patrick was always saying he didn't snore and here was definitive proof. Ruby stirred a little and mumbled something about purple elephants before settling again and Pete pocketed his phone, the moment suddenly not funny anymore because she looked so small in that hospital bed, so fragile. He walked over and put a hand on Patrick's shoulder, shaking him gently. Patrick jerked awake with a snort, looking around wildly like he'd forgotten where he was. "What, what's wrong, is she okay?" he said, already reaching for Ruby. "She's fine, she's sleeping," Pete said quietly. "You sounded like you were trying to saw through the building though, thought I'd better wake you before you brought the whole hospital down." Patrick rubbed his face, realized he'd been drooling a little, wiped his mouth. "What time is it?" he asked. "Almost four," Pete said, dropping into the other chair. "Couldn't sleep?" Patrick shook his head. "Every time I close my eyes I see her seizing again," he admitted. "I keep thinking what if she has another one and I'm asleep and I don't notice and something happens." "The monitors would alarm," Pete pointed out, gesturing to all the machines Ruby was hooked up to, but Patrick just shrugged. Pete got it though, he did, the terror of something happening to someone you loved while you weren't paying attention. "I brought coffee," Pete said, holding up the cup he'd been carrying. "It's hospital cafeteria coffee so it tastes like burnt sadness but it's caffeinated." Patrick took it gratefully and took a sip, made a face. "That's disgusting," he said, but kept drinking. They sat in silence for a while, listening to Ruby's steady breathing and the beep of the heart monitor and Patrick's occasional slurp of terrible coffee. "The guys want to come by later," Pete said eventually. "Joe's losing his mind in the hotel, keeps stress-baking, I think he's made like six batches of cookies in the last twelve hours." That got a small smile out of Patrick. "Tell him to bring some," he said. "Ruby loves Joe's cookies." "Will do," Pete said, and then more seriously, "Have the doctors said anything else?"
By 6am Patrick woke himself up "dude you good?" Joe asked. Patrick blinked hard trying to figure out when Joe had gotten there and why he was holding a massive tupperware container that smelled like chocolate chips. "Yeah I'm, wait did I fall asleep again?" Patrick said, his neck screaming in protest as he tried to straighten up in the god awful hospital chair. "You were out cold, man," Joe said, settling into the chair Pete must have vacated at some point. "Also you were doing this thing where you'd snore, then stop breathing for like ten seconds, then snore again. It was deeply concerning." "I don't snore," Patrick said automatically, and Joe just raised his eyebrows and pulled out his phone, turned it around to show a video of Patrick absolutely demolishing that claim, mouth wide open, rattling the windows. "Pete sent this to the group chat," Joe said. "Andy wants to use it as our new intro music." Patrick groaned and Ruby stirred in the bed, her eyes fluttering open. "Why's everyone so loud?" she mumbled, and then she saw Joe and her whole face lit up. "Joey! You brought cookies?" "Of course I brought cookies," Joe said, moving to her bedside. "What kind of monster would I be if I didn't?" Ruby tried to sit up and winced, hand going to her head. "Ow everything hurts," she said, and just like that the lightness in the room evaporated. Patrick was on his feet immediately. "Scale of one to ten, Rubes, how bad?" he asked. "Like a seven," Ruby said, which meant it was probably a nine because she always undersold her pain. "Can I have a cookie though?" "After you take your meds," Patrick said, checking the time to see if she was due for anything. The nurse came in then like she'd been summoned, checked Ruby's vitals, gave her some pills that Ruby swallowed with a grimace. "These taste like feet," Ruby announced, and Joe laughed. "How do you know what feet taste like?" he asked. "I licked Pete's shoe once on a dare," Ruby said matter-of-factly, and Patrick remembered that, remembered being horrified while Pete had laughed so hard he cried. "That was like eight years ago and you still bring it up," Patrick said, but he was smiling a little because if Ruby was making jokes maybe she was okay, maybe this was all going to be fine. Then Ruby's face went strange and she said "Joe why are there three of you?" and Patrick's blood ran cold.
Doctor came in at 10am and Ruby was awake and bugging Patrick doctor had Ruby test as Ruby was still out of it. "Paddy I want pancakes," Ruby said for the fifteenth time, tugging on his sleeve like a little kid even though she was thirty years old. "Paddy the TV is broken, Paddy my foot itches, Paddy why does that doctor look like a penguin?" The neurologist, Dr. Chen, did not look like a penguin but Patrick could kind of see it with the white coat and the way he waddled when he walked. "Ruby we need you to focus okay?" Dr. Chen said gently, pulling up a chair. "I'm going to ask you some questions." "I want pancakes though," Ruby said, but she was looking at the doctor with unfocused eyes, her words slurring together. Patrick squeezed her hand. "After the questions, Rubes, I promise," he said, even though he had no idea if she'd be allowed to eat. Dr. Chen started with easy stuff, what's your name, how old are you, what year is it. Ruby got her name right, said she was twelve which made Patrick's heart sink, and insisted it was 2003. "Ruby it's 2018," Patrick said softly. "We're on tour with Fall Out Boy, remember?" Ruby looked at him like he'd grown a second head. "You're not in a band, Paddy, you're in high school," she said, and Patrick had to look away because this was so much worse than the seizures, this was Ruby disappearing right in front of him. Dr. Chen did the physical tests next, had Ruby follow his finger with her eyes except she couldn't, kept losing track of it, said there were multiple fingers when there was only one. He had her squeeze his hands and her right side was noticeably weaker than her left. He scraped something along the bottom of her foot and her toes did something they apparently weren't supposed to do. "I'm ordering an emergency MRI," Dr. Chen said to Patrick. "We need to see what's happening in her brain right now." "Is it a tumor?" Patrick asked, because he'd been googling on his phone when he should've been sleeping and everything pointed to tumor. "It could be a lot of things," Dr. Chen said, which wasn't an answer. "We'll know more after the scan." They took Ruby away twenty minutes later, wheeled her bed right out of the room with her still asking about pancakes, and Patrick stood in the empty room feeling like the floor had dropped out from under him.
Ruby woke as nurse walk in Ruby who are these 4 men?" Ruby was groggy "My big brother and his friends they Patrick friends they do whatever Patrick tell them to do". The nurse looked confused, glanced at Patrick and Pete and Joe and Andy who were all crammed into the small hospital room. "Ruby sweetie, do you know who these people are?" the nurse asked gently. Ruby squinted at them like she was trying to solve a puzzle. "That's Paddy," she said, pointing at Patrick. "He's bossy but nice. And those are his friend boys. They follow him around." Pete snorted despite the tension in the room. "Friend boys," he repeated. "That's our new band name." "Ruby do you know our names?" Andy asked, leaning forward. Ruby studied him for a long moment. "You have nice arms," she said finally. "You hit things." "Drums, yeah," Andy said. "What's my name though?" Ruby's face scrunched up in concentration and Patrick could see the panic starting to creep into her expression when she couldn't find the answer. "It's okay Rubes, you don't have to," he started to say but Ruby cut him off. "I know you!" she said, voice rising. "I know all of you, why can't I remember? Paddy why can't I remember their names?" She was getting agitated now, hands clutching at the sheets, and the nurse moved to check her vitals. "Ruby I need you to take some deep breaths for me," the nurse said. "You're okay, sometimes after seizures people have trouble with memory, it's normal." "It's not normal!" Ruby shouted, and Patrick had never heard her sound so scared. "I'm not stupid, I know I know them, I know their names, why won't my brain work?" "You're not stupid," Patrick said firmly, moving to her side. "Ruby you're not stupid, your brain is just tired right now." "I'm broken," Ruby said, and started crying, not the quiet tears from before but big heaving sobs that shook her whole body. "Paddy I'm broken, something's wrong with my brain." Patrick gathered her up in his arms, careful of all the wires, and let her cry into his shoulder while he tried not to fall apart himself. Joe had tears running down his face and Pete was staring at the floor and Andy had his hand over his mouth. "You're not broken," Patrick kept saying. "You're going to be okay."
Patrick said "what is wrong with her?" Nurse asked "Do you mean what caused the swelling or what's happening to her right now?" and Patrick wanted to scream because he meant everything, all of it, why was this happening to Ruby who'd never hurt anyone in her entire life. "Both," he managed to say. "I mean what's causing all of this, the seizures, the confusion, why she can't remember things." The nurse glanced back at Ruby sleeping in the bed then gestured for Patrick to step into the hallway. Pete followed without being asked and Patrick was grateful because he didn't trust himself to remember whatever she was about to say. "The MRI showed a mass in her brain," the nurse said quietly. "We can't say for certain what it is until we do a biopsy but given the rapid onset of symptoms and the location, Dr. Chen suspects it's either a fast-growing tumor or possibly an abscess." Patrick felt the words hit him like physical blows. Tumor. Mass. Brain. "How long has it been there?" he asked. "We don't know," the nurse said. "It's possible it's been growing slowly for months or even years and only recently got large enough to cause symptoms, or it could be aggressive and new. That's part of what we're trying to determine." "Can they remove it?" Pete asked, always practical even in a crisis. "That depends on where exactly it is and what it is," the nurse said. "Dr. Chen will go over all the options with you but I wanted to prepare you that surgery might not be possible depending on the location. If it's too deep or near critical structures it could be too dangerous." Patrick's legs felt weak and he leaned against the wall. "So what do we do?" he asked. "Right now we focus on managing her symptoms and reducing the pressure in her brain," the nurse said. "We've got her on anti-seizure medication and steroids to bring down the swelling. Once we have more information from the biopsy we'll know what our next steps are." She left them standing in the hallway and Patrick slid down the wall until he was sitting on the floor. "This isn't real," he said. "This can't be real, Pete." Pete sat down next to him.
Ruby had no choice to have operation. Dr. Chen came in an hour later with a tablet full of scans that looked like abstract art to Patrick, all swirls of gray and white with a dark mass sitting right in the middle that the doctor circled with his finger. "This is what we're dealing with," Dr. Chen said. "It's pressing on several critical areas which is why we're seeing the vision problems, seizures, and cognitive changes. If we don't operate soon the pressure will continue to build and we'll see more deficits, possibly permanent ones." Patrick stared at the scan, at the thing that was stealing his sister piece by piece. "What are the risks?" he asked. "All brain surgery carries risk," Dr. Chen said carefully. "There's risk of stroke, infection, bleeding. Given the location we could see changes to her memory, her personality, her motor function. But Patrick the risk of not operating is worse. Without intervention I'd estimate Ruby has days, maybe a week before the pressure causes irreversible damage or death." Days. The word hung in the air like a guillotine. "When?" Patrick asked. "We can have an OR ready in two hours," Dr. Chen said. "I've already consulted with our best neurosurgeon, Dr. Patel. She's willing to take the case." Two hours. Patrick looked at Ruby sleeping peacefully in the bed, drooling a little on her pillow, completely unaware that in two hours someone was going to cut into her skull. "Does she have to be awake for it?" he asked, remembering some documentary he'd seen once about brain surgery. "No, she'll be under general anesthesia," Dr. Chen said. "The surgery will take approximately six to eight hours depending on what we find." Patrick nodded numbly. He didn't feel like he was in his body anymore, like he was watching this happen to someone else. "I need to tell her," he said. "I need to explain it to her." "Of course," Dr. Chen said. "Take your time. We'll start prep when you're ready." The doctor left and Patrick sat on the edge of Ruby's bed, put his hand on her shoulder. "Rubes," he said softly. "Ruby, wake up." She blinked at him, confused for a moment before smiling. "Paddy," she said. "Did I get my pancakes yet?"
As operation started Patrick was pacing a groove into the waiting room floor while Pete sat in a chair pretending to read a magazine he'd been on the same page of for forty minutes. Joe had gone to get coffee nobody would drink and Andy was staring blankly at his phone, refreshing Twitter over and over like the internet might have answers the doctors didn't. They'd wheeled Ruby away an hour ago after Patrick had tried to explain what was happening, watched her face crumple when she understood they were going to cut into her head. "Will it hurt?" she'd asked, and Patrick had lied and said no even though he had no idea. "You won't feel anything, you'll be asleep," he'd told her. "And when you wake up you'll feel better." Ruby had grabbed his hand so tight it hurt. "Promise you'll be here when I wake up?" she'd asked. "Promise Paddy." "I promise," he'd said, and kissed her forehead, and then they'd given her something that made her loopy and giggly. "Paddy you're getting blurry again," she'd said, laughing. "Everything's blurry, it's like I'm underwater, like I'm a mermaid." "You're the prettiest mermaid," he'd told her, voice cracking, and she'd smiled at him with unfocused eyes. Then she was asleep and they were rolling her away and Patrick had stood in that hallway watching the doors swing shut behind her feeling like his heart was being ripped out of his chest. That was an hour ago and Dr. Chen had said six to eight hours and Patrick didn't know how he was supposed to survive that. Every minute felt like an hour, every hour felt like a year. "Sit down," Pete said without looking up from his magazine. "You're making me anxious." "I can't sit," Patrick said. "If I sit I'll think and if I think I'll lose it." His phone buzzed, his mom calling for the third time. He'd talked to his parents earlier, tried to explain what was happening, and his mom had wanted to fly out immediately but Patrick had told her to wait, wait until after the surgery, wait until they knew something. Now he wondered if that had been a mistake.
It took 10 hours when they bought her back she was deeply sedated and was intubated. Patrick stood up so fast he almost fell over when the doors finally opened and they wheeled Ruby's bed through, except it didn't look like Ruby anymore, it looked like something from a horror movie. Her head was wrapped in layers of white bandages already seeping red in places, a breathing tube down her throat connected to a machine that was doing the breathing for her, tubes and wires everywhere, monitors beeping, and she was so still, so pale, like all the life had been drained out of her. "Oh god," Patrick heard himself say, and Pete caught his arm like he thought Patrick might collapse. Dr. Patel came through the doors behind the bed, still in her surgical scrubs, mask pulled down, and she looked exhausted. "The surgery went as well as could be expected," she said, which seemed like a weird thing to say when Ruby looked half dead. "We were able to remove most of the mass but there were sections too close to critical structures that we couldn't safely access without risking permanent damage." "Most of it?" Patrick repeated. "What does that mean, most of it?" "We removed approximately eighty-five percent," Dr. Patel said. "The remaining tissue we'll have to address with radiation and possibly chemotherapy depending on what the pathology report tells us." Chemotherapy, radiation, pathology, the words kept coming and Patrick couldn't process any of them because he couldn't stop staring at Ruby's chest rising and falling mechanically, the machine breathing for her because she couldn't breathe for herself. "Why is she on a ventilator?" he asked. "When does that come out?" "Her brain needs time to recover from the trauma of surgery," Dr. Patel explained. "We're keeping her in a medically induced coma for at least forty-eight hours to minimize swelling and give her the best chance at recovery. Once the swelling goes down and her brain function stabilizes we'll start weaning her off sedation." Forty-eight hours minimum, Patrick thought, two days of Ruby lying there like this, two days of not knowing if she'd wake up the same person or wake up at all.
4 weeks after the operation Ruby remained in a coma. Patrick had stopped counting the days after the second week because it made everything worse, made him think about how long she'd been gone, how much time was slipping away while she just lay there breathing but not living. The ventilator had come out after twelve days and the doctors had said that was good, that was progress, her body was strong even if her brain wasn't ready to wake up yet. They'd stopped the sedation completely after two weeks, told Patrick she could wake up anytime now, just had to wait for her brain to heal enough, except it had been two more weeks since then and nothing had changed. Ruby just lay there, eyes closed, perfectly still except for the rise and fall of her chest, and sometimes Patrick would sit there for hours just watching her breathe because at least that meant she was still alive. The doctors did tests constantly, shining lights in her eyes, checking her reflexes, doing EEGs that showed brain activity but not consciousness, not awareness, not Ruby. Dr. Morrison kept saying it was too early to lose hope, that they'd seen patients wake up after months, but Patrick could hear what he wasn't saying which was that every day that passed made it less likely she'd wake up at all or if she did that she'd be the same Ruby she was before. His parents had been out twice, his mom stayed for a week each time but she had to go back, had responsibilities, a job, a life that couldn't just stop even though Patrick's had. Pete was still here though, had been here the whole month, sleeping in the hotel room they were splitting, bringing Patrick food he barely ate, sitting with Ruby when Patrick needed to step out of the room before he lost his mind. Joe and Andy visited when they could but they had lives too, families, things they needed to do. The tour was cancelled, the album pushed back, everything on hold indefinitely and Patrick didn't even care because none of it mattered if Ruby didn't wake up.
After 400 days Ruby woke up she was confused and couldn't remember names she knew them but not names. Patrick had been reading to her from some celebrity gossip magazine, something stupid about the Kardashians because Ruby used to love that trash, when her fingers twitched against the blanket and he stopped mid-sentence. He'd seen false alarms before, little movements that meant nothing, reflexes the nurses said, but then Ruby's eyes opened and Patrick dropped the magazine on the floor. "Ruby?" he said, barely breathing. "Rubes can you hear me?" Her eyes moved slowly, unfocused at first, then gradually found his face. Her mouth opened but nothing came out, her throat raw from months of disuse, and she looked terrified. "It's okay, it's okay, don't try to talk," Patrick said, hitting the call button frantically. "You're in the hospital, you had surgery, you've been asleep for a long time but you're okay now, you're awake." Ruby stared at him like she was trying to solve an impossible puzzle, her eyes tracking over his face, his hair, his glasses. She lifted one hand slowly, shakily, and pointed at him. "I know you," she croaked out, voice barely a whisper. "You're my person." "Yeah, yeah I'm your person, I'm Patrick, I'm your brother," he said, and he was crying now, couldn't help it. "Do you know my name? Do you remember?" Ruby's face scrunched up in concentration and Patrick could see her struggling, searching for something that wouldn't come. "No," she finally said, and started crying too. "I know you, I know I love you, but I can't find your name, why can't I find your name?" The nurses rushed in then, checking her vitals, paging doctors, and Patrick had to step back while they worked but he kept talking to her. "It's okay Ruby, it's okay, your brain just needs time, the names will come back," he said, praying he wasn't lying. Dr. Morrison came in ten minutes later, did all his tests, had Ruby follow his finger with her eyes which she could do now, squeeze his hands which she did weakly.
"Ruby can you remember your name?" Dr Morrison asked. Ruby looked at him with wide, frightened eyes, her mouth opening and closing like she was trying to catch the word before it floated away. "I'm..." she started, then stopped, her face crumpling with frustration. "I'm me, I know I'm me, but the word for me, I can't..." She looked at Patrick desperately. "What's my name? Please tell me my name." Patrick's heart shattered. "Your name is Ruby," he said gently. "Ruby Stump." "Ruby," she repeated slowly, like she was tasting it. "Ruby. That's a pretty name. Is that really mine?" "It's really yours," Patrick said, moving closer to take her hand. "You've been Ruby your whole life, thirty years." "Thirty?" Ruby looked shocked. "I'm thirty? I don't feel thirty. How old are you?" She pointed at Patrick. "I'm thirty-six," he said. "I'm your big brother." "Big brother," Ruby said, nodding like she was filing that information away. "Okay. And what's your name again? I'm sorry, I know you told me, I know I should remember, you feel important like you're the most important person but the name won't stick." "Patrick," he said, trying to keep his voice steady. "My name is Patrick but you call me Paddy." "Paddy," Ruby said, and something flickered across her face, some ghost of recognition. "Paddy. That feels right in my mouth. Paddy." She said it again and again like a mantra. Dr. Morrison was making notes on his tablet, asking Ruby more questions. Did she know what year it was? No. Did she know where she was? Hospital but not why. Did she remember anything from before she woke up? Ruby shook her head, looking more and more panicked. "I don't remember anything," she said, voice rising. "Why don't I remember anything? What happened to me? Paddy what happened to me?" "You had a tumor in your brain," Patrick explained carefully. "You had surgery to remove it and you've been asleep for a long time, over a year."
Pete and Joe and Andy walked into the room "I know them but I can't remember their names". Ruby's eyes went wide when she saw the three of them pile through the doorway, and her face broke into this huge smile like her body remembered being happy to see them even if her brain couldn't find the words. "It's my people!" she said, trying to sit up more and wincing. "Paddy look, it's the other people, the ones who are always around." Pete stopped dead in his tracks when he realized Ruby was actually awake, actually talking, and his eyes immediately filled with tears. "Ruby?" he said, like he couldn't believe it. "You're really awake?" "I'm awake," Ruby confirmed, then her smile faltered. "I know you. I know all of you. You're important to me, I can feel it in my chest that you're important, but I can't remember what your names are and it's making me so frustrated I could scream." She looked at Patrick desperately. "Why can't I remember their names, Paddy? I remember yours now because you keep saying it but theirs won't stick." "It's okay Rubes," Patrick said, squeezing her hand. "Your brain is still healing, the names will come back." "I'm Pete," Pete said, coming closer to the bed. "We've known each other for like twelve years Ruby." "Pete," Ruby repeated, staring at him intently. "Pete. You have a nice face. Are we friends?" "Yeah," Pete said, his voice breaking. "Yeah we're really good friends." "And I'm Joe," Joe said, already crying openly. "And that's Andy." Ruby looked at each of them in turn, her forehead creased with concentration. "Pete, Joe, Andy," she said slowly. "Pete, Joe, Andy. Paddy. I'm Ruby. Okay. Okay I'm trying to remember, I'm really trying." "You don't have to try so hard," Andy said quietly, speaking for the first time. "Just take it easy." "But I should know you!" Ruby said, getting agitated.
Ruby tried to pick up a cup but she dropped it "Paddy!" she cried. The plastic cup hit the floor and water went everywhere and Ruby stared at her hand like it had betrayed her, her fingers trembling and not cooperating. "Paddy my hand won't work right, why won't my hand work?" She tried again to make a fist but her fingers barely curled, the right side noticeably weaker than the left, and the panic in her eyes was growing. "Make it work, Paddy, please make it work!" "Hey, hey it's okay," Patrick said, moving quickly to her side. "The doctors said you might have some weakness after the surgery, it's normal, it'll get better with therapy." But Ruby wasn't listening, she was staring at her hand and crying now, real sobs that shook her whole body. "I'm broken," she said. "Everything's broken, I can't remember names and my hand doesn't work and I don't know where I am or why or what happened to me." She looked up at Patrick with tears streaming down her face. "Paddy I'm scared, I'm so scared, what's wrong with me?" Patrick sat on the edge of the bed and pulled her into a hug as carefully as he could with all the wires still attached to her. "Nothing's wrong with you," he said firmly even though his own voice was shaking. "You had a tumor and you had surgery and your brain just needs time to heal, that's all. You're going to be okay Ruby, I promise you're going to be okay." "But what if I'm not?" Ruby sobbed into his shoulder. "What if I never remember? What if my hand never works? What if I'm like this forever?" Pete had dropped to the floor to pick up the cup and clean up the water with napkins from the bedside table, his own face wet with tears. Joe had turned away, shoulders shaking, and Andy was gripping the back of a chair so hard his knuckles were white.
By dinner nurse had fed Ruby as Patrick watched he left the room "Pat where you going?" Pete asked. Patrick didn't answer, just kept walking down the hallway, past the nurses station, past the waiting room, until he found an empty stairwell and shoved through the door. He made it down three steps before his legs gave out and he sat down hard on the concrete, put his head in his hands, and finally let himself fall apart. He'd held it together for 400 days, held it together through the surgery and the coma and the waiting and the not knowing, held it together when Ruby woke up and couldn't remember their names, held it together when she dropped that cup and looked at her hand like it was a stranger, but watching the nurse feed her like she was a child, watching Ruby struggle to swallow, watching her need help with something as basic as eating, that had broken something in him. The door opened above him and Pete's footsteps echoed down the stairs. "Figured I'd find you here," Pete said quietly, sitting down next to him. Patrick couldn't speak, could barely breathe through the sobs that were tearing out of his chest. Pete didn't say anything, just put an arm around his shoulders and let him cry. "She can't even feed herself," Patrick finally choked out. "She's 30 years old and she can't feed herself, can't remember our names, can't use her right hand, and the doctors don't know if any of it will come back." "It's only been a few hours since she woke up," Pete said. "Give her time." "What if time doesn't fix it?" Patrick asked, looking at Pete with red, swollen eyes. "What if this is it, what if this is who Ruby is now? What if I made the wrong choice telling them to do the surgery? What if I should have just let her..." he couldn't finish the sentence. "Let her die?" Pete said bluntly. "That's what you would have been doing, Pat. She would have died."
As weeks passed Ruby was placed in a wheelchair and she went home. On the other hand Patrick wasn't coping well. He couldn't look after her. The first morning home Ruby woke up calling for Patrick and he just stood outside her door, hand on the doorknob, completely frozen. He could hear her getting more agitated, hear her starting to cry, but his feet wouldn't move, his hand wouldn't turn the knob. Pete had to push past him to go help her, shooting Patrick a look that was half concern and half disgust. "I can't do this," Patrick said to no one, and went back upstairs. It got worse from there. Ruby needed help with everything, getting dressed, using the bathroom, eating, taking her medications, and Patrick couldn't do any of it. He'd try to go into her room and his chest would get tight, his vision would blur, and he'd have to leave before he had a full panic attack. Joe took over the morning routine, getting Ruby up and dressed and fed. Andy handled the medications, had them all organized in a pill box with alarms. Pete did the physical therapy exercises with her that she was supposed to do three times a day, helped her try to strengthen her weak side even though she cried through most of it because it hurt and she didn't understand why she had to do it. And Patrick hid in his room like a coward. "This isn't sustainable," Joe said on day five, cornering Patrick in the hallway. "We can't do this without you, man. She's your sister." "I know she's my sister," Patrick snapped, and then immediately felt terrible because none of this was Joe's fault. "I know, I'm sorry, I just... I can't look at her without seeing what I did to her." "You saved her life," Andy said quietly from the doorway. "The doctors said she would have died without the surgery." "Yeah well maybe that would have been better than this," Patrick said, and regretted it the second the words left his mouth but couldn't take them back.
Patrick had nightmares about Ruby. Every night it was the same thing, Ruby on the operating table except in the dream Patrick was the one cutting into her head, his hands covered in blood, and she was awake, screaming, asking him why he was hurting her, begging him to stop. Sometimes the dream changed and Ruby was the way she used to be, happy and whole, dancing around backstage, and then she'd look at him and ask "Paddy why there was two of you?" and she'd collapse and he'd watch her die over and over, unable to move, unable to help. He'd wake up drenched in sweat, heart pounding, and he could hear Ruby down the hall sometimes, hear her calling out in her sleep or crying or asking whoever was on night duty where Paddy was, why Paddy didn't love her anymore. He started not sleeping at all, would stay up until four or five in the morning just to avoid the dreams, and when he did finally pass out from exhaustion the nightmares were even worse. Pete found him one morning at six AM, still awake, staring at nothing. "You look like death," Pete said bluntly. "When's the last time you actually slept?" "I sleep," Patrick lied. "Not well but I sleep." "The nightmares?" Pete asked, and Patrick nodded because there was no point denying it. Pete had heard him a few times, had come to check on him when he woke up shouting. "It's always the same," Patrick said quietly. "I'm the one hurting her, or I'm watching her die, or she's asking me why I let this happen to her." He rubbed his face with both hands. "Last night I dreamed she could walk again but then I looked at her and half her head was missing, just gone, and she was asking me where it went, why I took it." "Jesus, Pat," Pete said, sitting down next to him on the bed. "You need to talk to someone, like a professional someone, because this isn't healthy."
Patrick helped Pete. He forced his legs to move, forced himself to cross the room even though his hands were shaking and his chest felt like it was being crushed. He knelt down next to Ruby and together with Pete they lifted her carefully, checking for bruises or breaks. Ruby was still crying, clutching at Patrick's shirt with her good hand. "You came," she said, sounding surprised. "I thought you didn't want to anymore." "I always want to," Patrick lied, or maybe it wasn't a lie, maybe he did want to but his brain wouldn't let him. They got her back into bed and Patrick sat on the edge while Pete went to get ice for her hip. Ruby wouldn't let go of his shirt. "Paddy why don't you come see me anymore?" she asked, looking up at him with those wide confused eyes. "Everyone else helps me but you stay upstairs. Did I make you mad?" "No, Rubes, you didn't make me mad," Patrick said, and his voice cracked. "I'm just... I'm having a hard time right now." "Because of me?" Ruby asked. "Because I'm broken now?" "You're not broken," Patrick said automatically, but Ruby shook her head. "I am though," she said matter-of-factly. "I can't walk and I can't remember things and my hand doesn't work and I can't even go to the bathroom by myself. I'm broken and it makes you sad to look at me." Patrick felt like he'd been punched. "Ruby, no, that's not—" "It's okay," Ruby interrupted. "I make me sad to look at too. I don't remember who I used to be but everyone acts like she was better than me now, so she must have been really good." She wiped her eyes with her left hand. "I'm sorry I'm not her anymore." Patrick pulled her into a hug then, careful of her injuries, and let himself cry into her hair.
Patrick fed her as she was watching cartoons. Ruby had her eyes glued to SpongeBob, giggling at something Patrick didn't find funny but at least she was happy, at least for right now she wasn't crying or frustrated or asking why her body didn't work right. He scooped up some oatmeal and brought the spoon to her mouth and she opened automatically, still not looking away from the TV. "Good?" he asked, and Ruby nodded, chewing slowly because her right side didn't coordinate well and sometimes she had trouble swallowing. "SpongeBob is stupid," she said after she swallowed, but she was smiling. "Why does he live in a pineapple? Pineapples don't go underwater." "I don't know Rubes, it's a cartoon," Patrick said, getting another spoonful ready. "Cartoons don't have to make sense." Ruby finally looked at him and her whole face lit up. "Paddy you're feeding me!" she said, like she'd just noticed even though they'd been doing this for ten minutes. "You haven't fed me in forever, I missed you." Patrick's throat got tight. "I missed you too," he said quietly. "Open up." She did, took another bite, then said with her mouth full, "Pete says you have nightmares about me. Are they scary nightmares?" Patrick hadn't expected that, didn't know Pete had told her. "Sometimes," he admitted. "But they're just dreams, they're not real." "I have nightmares too," Ruby said. "I dream that I can walk and run and my hand works and then I wake up and I can't and it makes me really sad." She looked down at her right hand curled in her lap. "Is that what you dream about? That I can't walk?" "No," Patrick said. "I dream about... I dream about the surgery, about when you were sick." Ruby was quiet for a minute, watching Patrick scoop up more oatmeal. "Do you wish you didn't do the surgery?" she asked suddenly. "Do you wish you just let me die instead?" "Ruby, no—" "Because sometimes I wish that," she continued like she hadn't heard him.
Ruby went to her disability day program she was in wheelchair but old Ruby the annoying side of her was there but she couldn't remember or move much. Patrick wheeled her in on her first day and immediately wanted to turn around and leave because everyone there looked so disabled, walkers and wheelchairs and helmets and drooling, and he hated that Ruby was one of them now, hated that this was where she belonged. But Ruby didn't seem bothered at all, she was looking around with interest, waving at people with her good hand. "Hi I'm Ruby!" she announced loudly to the room. "I can't walk or remember stuff but I can still talk a lot!" One of the staff members, a cheerful woman named Linda, came over to greet them. "Welcome Ruby! We're so glad you're here, we've got lots of fun activities planned today." "What kind of activities?" Ruby asked suspiciously. "Are they baby activities? Because I'm thirty years old not three." "They're age appropriate," Linda assured her, but Patrick had seen the schedule on the wall, arts and crafts and music time and sensory play, and it looked exactly like preschool. He stayed for the first hour because Ruby kept grabbing his hand whenever he tried to leave, and he watched her do a puzzle with pieces so big a toddler could manage them, watched her paint a picture that was just blobs of color because her fine motor control was shot. But the annoying Ruby, the one who asked a million questions and had opinions about everything, that Ruby was still in there. "Why is everyone being so nice?" she asked loudly during snack time. "It's weird, everyone keeps smiling at me like I'm going to break." "Ruby, inside voice," Linda said gently. "But this is my inside voice!" Ruby protested. "My outside voice is way louder, want me to show you?" She proceeded to shout "THIS IS MY OUTSIDE VOICE" and half the room startled.
Patrick had told disability day program that Ruby might have seizure. Linda had nodded seriously when he'd explained it during intake, wrote it all down on Ruby's emergency form, the medications she took, the warning signs to watch for, what to do if it happened. "We're trained in seizure response," Linda had assured him. "We have several clients with epilepsy, we know what to do." But Patrick still felt sick leaving her there, kept imagining Ruby seizing and falling out of her wheelchair and nobody noticing until it was too late. He'd made it halfway to the car when his phone rang and his heart stopped, convinced something had already happened, but it was just Pete asking if he wanted to grab lunch. Three hours later when Patrick came back to pick Ruby up she was in the middle of telling some elaborate story to another client, a guy in his forties who was nodding along even though Patrick was pretty sure he wasn't understanding a word. "And then Paddy said we had to do surgery but I don't remember the surgery because I was asleep for like a hundred years, well not a hundred years, four hundred days which is more than a year but less than a hundred years, and when I woke up I couldn't remember anyone's names and my hand didn't work and—" She spotted Patrick and her whole face lit up. "Paddy! I didn't have a seizure!" "That's great Rubes," Patrick said, relief flooding through him. "Did you have a good day?" "It was okay," Ruby said, which coming from her meant it was probably terrible. "The activities were kind of boring, like we made friendship bracelets but I can only use one hand so mine looks stupid, see?" She held up a lopsided bracelet made of plastic beads. "But I made a friend! His name is Marcus and he doesn't talk but he likes when I talk so I talked a lot." Linda came over with Ruby's bag. "She did wonderful," she said. "Very social, very engaged. We did have one small incident—" Patrick's stomach dropped. "What kind of incident?" "Nothing serious," Linda said quickly. "Ruby got frustrated during physical therapy because she couldn't do one of the exercises and she threw a ball at the therapist."
But they got home Ruby spaced out for a long time. Patrick had just gotten her settled in her bed, was asking her what she wanted for dinner when her eyes went unfocused and she stopped responding, just stared straight ahead at nothing like someone had turned off a switch inside her. "Ruby?" Patrick said, waving his hand in front of her face. Nothing. "Rubes, can you hear me?" He grabbed her shoulder gently and she didn't react at all, didn't blink, barely seemed to be breathing. Patrick's heart started racing because this looked like the beginning of a seizure, this was how they sometimes started according to the neurologist, with this absence, this disconnection. "Pete!" he yelled, fumbling for his phone to time it because the doctors always asked how long the episodes lasted. "Pete get in here!" Pete came running, took one look at Ruby and went pale. "Is she seizing?" "I don't know, she's just gone, she's not responding," Patrick said, watching the seconds tick by on his phone. Thirty seconds, forty-five, a minute. Ruby just sat there staring at nothing and Patrick was about to call 911 when she suddenly blinked and looked around confused. "What happened?" she asked. "Why are you both staring at me? Why do you look scared?" "Ruby you just spaced out for over a minute," Patrick said, his hands shaking. "Do you remember that? Do you remember us talking?" Ruby's forehead wrinkled in confusion. "No, I don't remember anything. We were in the car and now we're here. Did I fall asleep?" "You weren't asleep, your eyes were open," Pete said. "You were just... gone." "Oh," Ruby said, and she looked more annoyed than scared. "That happens sometimes. The doctors at the hospital said it's called absence seizures or something. It's like my brain just turns off for a little bit." "Why didn't anyone tell us about this?" Patrick demanded, already pulling up Dr. Morrison's number.
Patrick called Dr Morrison's. The receptionist put him on hold for ten minutes while Patrick paced the living room, watching Ruby through the doorway as Pete sat with her trying to keep her calm. When Dr. Morrison finally picked up Patrick didn't even say hello, just launched into it. "Ruby just had some kind of episode, she spaced out for over a minute, completely unresponsive, and then she came back and doesn't remember any of it, she said something about absence seizures but nobody told us this could happen." "Patrick, slow down," Dr. Morrison said calmly. "Take a breath. Is Ruby okay right now?" "She's fine now, she's talking, she's alert, but she was just gone, completely gone, and what if it happens again? What if it happens when she's eating and she chokes or what if—" "Patrick," Dr. Morrison interrupted. "This is a known complication. We discussed the possibility of ongoing seizure activity after surgery, the absence seizures are a form of that. They're generally not dangerous in themselves though you're right to be concerned about safety." "Generally not dangerous?" Patrick repeated, his voice getting louder. "She disappeared for a full minute, how is that not dangerous?" "Because she's not losing consciousness, she's not falling, her body continues to function," Dr. Morrison explained. "But yes, we need to monitor the frequency. How many has she had today?" Patrick looked at Ruby. "Rubes, has this happened before today?" Ruby nodded. "A few times at the day program. Linda said it was fine, that I just needed a minute. I thought it was normal." "You thought spacing out was normal?" Patrick said, trying not to yell. "Ruby why didn't you tell me?" "I forgot," Ruby said simply. "I forget a lot of things now, remember?" Dr. Morrison sighed on the other end of the line. "Patrick, I need you to keep a log of these episodes. Time, duration, any triggers you notice. If they're happening multiple times a day we may need to adjust her medication."
Later that night Ruby tossed and turned she had this dream where she woke up and couldn't speak and she was a vegetable. In the dream she could see everyone around her, could hear them talking about her like she wasn't there, Patrick and Pete and Joe and Andy standing over her bed discussing whether to put her in a home because she was too much work, too broken to keep around. She tried to scream that she was still in there, still Ruby, but nothing came out, her mouth wouldn't move, her body wouldn't respond. She watched herself being wheeled away to some facility with white walls and fluorescent lights where people in scrubs moved her around like a doll, changed her clothes and fed her through a tube and she couldn't tell them she was scared, couldn't tell them anything. In the dream years passed and everyone forgot about her, the band went on tour without her, Patrick got married and had kids and she was just this thing in a bed drooling on herself, aware of everything but unable to communicate, trapped in her own head forever. She woke up screaming, or trying to scream but it came out as this strangled sob, and within seconds Patrick was there even though it was three in the morning. "Ruby, what's wrong? Did you have a nightmare?" he asked, turning on the lamp. Ruby was crying so hard she couldn't breathe, couldn't get the words out. "I couldn't talk," she finally managed to gasp. "In the dream I couldn't talk and nobody knew I was still in there and you all left me in a hospital forever and I was awake but I couldn't move or speak or do anything." "Oh Rubes," Patrick said, sitting on the edge of her bed and pulling her into a hug. "That's not going to happen, okay? You can talk, you can move, you're getting better every day." "But what if I'm not?" Ruby sobbed into his shoulder. "What if I get worse? What if I have a seizure and it damages my brain more and I end up like that for real?"
By 6am Ruby was asleep again. Patrick sat in the chair next to her bed watching her breathe, too wired from the nightmare crisis to even think about going back to his own room. She'd cried for almost two hours, kept asking him to promise she wouldn't end up like her dream, wouldn't become a vegetable, and he'd promised even though he had no idea if he could keep that promise. The doctors had been clear that Ruby's condition was unpredictable, that she could have another seizure any time, that more brain damage was possible. Eventually she'd exhausted herself and fallen back asleep still hiccupping from crying, her good hand clutching Patrick's, and he'd stayed there because every time he tried to move she'd whimper and hold on tighter even in sleep. Pete found him like that when he came downstairs to make coffee, still in the same chair, Ruby's hand in his, both of them finally quiet. "You okay?" Pete whispered from the doorway. Patrick shook his head. "She had a nightmare that she turned into a vegetable," he said quietly. "That she was aware but couldn't communicate and we all abandoned her in some facility. She was hysterical, Pete. Absolutely terrified." "Jesus," Pete said, coming into the room. "That's heavy even for Ruby." "I don't know how to help her," Patrick admitted, his voice cracking. "I don't know how to make this better. She's scared all the time, I'm scared all the time, and the doctors just keep saying we have to wait and see how she progresses but what if she doesn't progress? What if this is as good as it gets?" Pete didn't have an answer for that because there wasn't one. They both just sat there in the early morning light listening to Ruby breathe and wondering what the hell they were supposed to do next. Ruby stirred around seven, blinked awake and looked confused about why Patrick was still there.
Then they heard thump as Ruby had seizure it was a bad one. Her whole body went rigid and then started convulsing violently, her head slamming back against the pillow over and over, arms and legs jerking so hard Patrick was terrified she'd hurt herself. "Ruby!" he shouted, trying to hold her steady but Pete pulled him back. "Don't restrain her, you'll make it worse," Pete said, his voice tight with panic as he grabbed his phone. "I'm timing it, just make sure she doesn't fall out of bed." Patrick positioned himself to keep her from rolling off while her body thrashed, foam starting to appear at the corners of her mouth, her eyes rolled back so far he could only see the whites. It was so much worse than the first seizure at the concert, so much more violent, and it wasn't stopping. Thirty seconds, forty-five, a minute, and Ruby was still seizing, her face turning red from the exertion, a horrible gurgling sound coming from her throat. "It's been over a minute," Pete said, already dialing 911. "Patrick it's not stopping." "I know, I know," Patrick said, his hands shaking as he tried to turn Ruby on her side like the doctors had taught them, tried to make sure she could breathe. Two minutes now and the seizure showed no signs of slowing down, Ruby's body still jerking violently, and Patrick felt completely helpless watching his sister's brain short-circuit right in front of him with nothing he could do to stop it. "Yes, we need an ambulance," Pete was saying into the phone. "My friend is having a seizure, it's been going for over two minutes now and it's not stopping. She has a history of brain tumor, she had surgery." Joe and Andy came running down the stairs, woken by the commotion, and both stopped dead in the doorway staring at Ruby convulsing in the bed. "Oh my god," Joe said, his face going white.
Ruby was rushed to hospital as Dr. Morrison was there he knew what to do. The paramedics had given Ruby medication in the ambulance to stop the seizure which had lasted almost six minutes by the time they got it under control, and she'd been unconscious ever since, her body limp and unresponsive as they wheeled her into the ER. Dr. Morrison met them there, must have been on call or gotten the alert somehow, and he took one look at Ruby and started barking orders to the nurses. "Get her on oxygen, I need a full neuro panel, CT scan immediately, and push another dose of lorazepam, I don't want any breakthrough activity," he said, checking Ruby's pupils with his penlight. "Patrick, how long was the seizure before the paramedics arrived?" "Almost four minutes," Patrick said, his voice shaking. "Maybe longer, I don't know, it felt like forever." "And has she woken up at all since it stopped?" Dr. Morrison asked, still examining Ruby, checking her reflexes which were barely there. "No, nothing, she's been out cold the whole time," Patrick said. "Is that normal? Should she be awake by now?" Dr. Morrison's expression was grim. "After a seizure that long it's not unusual for the patient to be postictal, essentially their brain is exhausted and needs recovery time. But given Ruby's history we need to rule out any new bleeding or swelling." They took Ruby away for the CT scan and Patrick was left standing in the hallway with Pete who had driven behind the ambulance, both of them silent and terrified. Twenty minutes later Dr. Morrison came back with the scan results on his tablet. "There's some new swelling in the area where we removed the tumor," he said. "Not significant yet but enough to be concerning. The seizure was likely caused by scar tissue irritation combined with the existing damage. We're going to admit her, keep her sedated for the next twenty-four hours to give her brain time to calm down."
Ruby was placed in another coma and Patrick freaked out. "No, no, no, you can't do this again," Patrick said, his voice getting louder, bordering on hysterical. "You can't put her back under, she was awake, she was getting better, you can't just—" "Patrick, we don't have a choice," Dr. Morrison said firmly. "Her brain is swelling again and if we don't reduce the metabolic demand by keeping her sedated she could have permanent damage or another massive seizure that could kill her." "She just woke up from 400 days!" Patrick shouted, and people in the hallway were starting to stare but he didn't care. "Four hundred days she was gone and she finally came back and now you want to take her away again? How long this time? Another year? Two years?" Pete grabbed Patrick's arm, trying to calm him down, but Patrick shook him off. "You don't understand, she had nightmares last night about being trapped in her own body, about being a vegetable, and now you're going to make that real, you're going to lock her in there again!" "It's temporary," Dr. Morrison said, staying calm even though Patrick was losing it. "We're talking days, maybe a week, just long enough for the swelling to go down and her brain to stabilize." "That's what you said last time!" Patrick yelled. "You said temporary and it was over a year, so forgive me if I don't believe you!" He was crying now, couldn't help it, the fear and anger and exhaustion all pouring out. "I can't do this again, I can't sit by her bed for months waiting for her to wake up, I can't watch her disappear again." "Then don't," Dr. Morrison said bluntly. "Go home, let us do our job, come back when she's stable. But Patrick, we are putting her in a medically induced coma whether you consent or not because it's the only way to save her life right now."
Patrick went home and he got drunk. He went straight to the kitchen, ignored Pete trying to talk to him, pulled out the whiskey they kept for celebrations and poured himself a glass that was more whiskey than glass. He downed it in two gulps, felt it burn all the way down, and immediately poured another. "Pat, maybe you should slow down," Joe said carefully, watching from the doorway. "Maybe you should mind your own business," Patrick shot back, taking another drink. "My sister is in a coma again, I think I've earned the right to get drunk." He took the bottle and went to his room, slammed the door, sat on his bed and just kept drinking. By the time the bottle was half empty the room was spinning and Patrick felt numb in a way that was almost pleasant, like all the fear and guilt and pain had been wrapped in cotton and shoved somewhere he couldn't reach it. He pulled out his phone, thought about calling the hospital, thought about checking on Ruby, but what was the point? She wasn't there anyway, she was gone again, locked away in her own head while machines breathed for her and pumped her full of drugs. Four hundred days the first time and she came back broken, what would she be like after this? Would she remember him at all? Would she even be Ruby anymore or just some shell that looked like his sister? He took another drink, then another, until the bottle slipped from his hand and hit the floor and he didn't even care. His phone buzzed, Pete texting asking if he was okay, and Patrick threw the phone across the room. Nothing was okay, nothing had been okay since that night at the concert when Ruby saw two of him and fainted, and Patrick was starting to think nothing would ever be okay again. He passed out sometime around midnight, still in his clothes, room reeking of whiskey, and dreamed about Ruby trapped behind glass screaming for him while he just stood there and watched.
Couple days later Ruby woke but she didn't speak "hey Rubes" Joe said she looked at him and said inside her mind "where Paddy?" but Joe got nurse and Dr. Ruby's eyes were open, tracking movement, clearly awake and aware, but when Joe asked her questions she just stared at him, her mouth moving slightly but no sound coming out. "Ruby can you hear me?" Joe asked, leaning closer. "Blink once for yes, twice for no." Ruby blinked once, and Joe felt a wave of relief that she could at least understand, but then her eyes filled with tears and her mouth kept moving, forming words that wouldn't come, and Joe realized with horror that she was trying to talk but couldn't. "It's okay, it's okay, let me get the doctor," Joe said, hitting the call button repeatedly. Ruby's good hand grabbed at his shirt, desperate, and she was crying now, frustrated tears streaming down her face as she tried over and over to make sound come out. The nurse arrived first, then Dr. Morrison right behind her, and they did their checks, shining lights in Ruby's eyes, asking her to squeeze hands which she did with her left but barely with her right, asking her to stick out her tongue which she could do but it deviated to one side. "Ruby, I need you to try to say your name for me," Dr. Morrison said. Ruby's mouth moved, her face straining with effort, but nothing came out except a breathy whisper that might have been trying to be words but wasn't. She looked terrified, her eyes darting between Joe and the doctor, and Joe could practically hear her screaming inside her head even though she was completely silent. "It appears the seizure caused damage to her speech center," Dr. Morrison said quietly to Joe. "This could be temporary or it could be permanent, we won't know for a few days."
"Why is she moving?" Joe asked as Pete called Patrick but Patrick wasn't at home nobody had seen him for 5 days. Ruby's mouth kept working, her good hand gesturing frantically, pointing at the door, at Joe, making motions like she was trying to write or sign something but they couldn't understand what she wanted. "I think she's trying to communicate," the nurse said. "Ruby, do you want something? Are you in pain?" Ruby shook her head violently, tears still streaming, and pointed at the door again, more insistent this time. She brought her hand to her chest, then pointed out, and Joe suddenly understood. "She's asking where Patrick is," Joe said, and Ruby nodded so hard it looked like it hurt. "She wants Paddy." Pete was in the hallway on his phone, pacing. "Straight to voicemail again," he said, coming back into the room. "I've been calling him for two days, nothing. Andy went by the house this morning and his car's gone, his room looks like a tornado hit it, and there's an empty whiskey bottle on the floor." "He's been gone for five days?" Dr. Morrison asked, frowning. "Nobody's seen him?" "Not since the day you put Ruby in the coma," Joe said. "He came home, got drunk, and then next morning he was just gone. Didn't tell anyone where he was going, won't answer calls or texts." Ruby was getting more agitated, trying to sit up, her silent mouth forming what looked like "Paddy" over and over. She grabbed Joe's arm, squeezed it hard with her good hand, her eyes pleading. "I don't know where he is, Rubes," Joe said gently. "I'm sorry, we're trying to find him but he's not answering." Ruby's face crumpled and she started sobbing without sound, just her body shaking, tears pouring down her face, and it was somehow worse than if she could scream.
"Ok Ruby I am touch your arm ok can you tell me you feel ok blink yes or no ok" Dr said. He pressed his fingers against Ruby's left arm and she blinked once for yes, then he moved to her right arm and pressed and Ruby's face scrunched up in confusion and she blinked twice for no. "You can't feel this?" Dr Morrison asked, pressing harder on her right arm, and Ruby blinked twice again, looking scared now because she was watching him touch her but couldn't feel it. He moved down to her legs, tested both sides, and Ruby could feel her left leg but not her right, couldn't feel him touching her foot or her ankle or even when he pinched the skin on her thigh. "The seizure caused more damage than we initially thought," Dr Morrison said to Joe and Pete, keeping his voice low but Ruby could still hear and her eyes went wide with panic. "She's lost sensation on her entire right side and the speech center damage is significant." Ruby was shaking her head frantically, her good hand touching her right arm like she was trying to prove she could feel it, but her face showed she couldn't, showed she was touching dead weight that used to be part of her body. She looked at Joe with such terror in her eyes, her mouth moving in that horrible silent way, and Joe grabbed her good hand and held it tight. "It might come back, right?" Pete asked Dr Morrison. "The feeling, the speech, it could be temporary?" "It's possible," Dr Morrison said, but he didn't sound convinced. "We'll start aggressive therapy, speech and occupational and physical, but I need to be honest with you that the likelihood of full recovery at this point is very low." Ruby heard that, heard "very low," and the silent sobbing got worse, her whole body shaking with cries that had no sound, and Joe felt completely helpless because what could he even say to make this better?
"So she a vegetable?" Joe asked as Pete tried to call Patrick. Dr Morrison hesitated, choosing his words carefully while Ruby stared at him with desperate, terrified eyes. "Technically speaking, Ruby is in what we call a minimally conscious state," Dr Morrison said quietly. "She has awareness, she can respond to stimuli, but the extent of the damage from the seizure has left her with significant deficits. She can't speak, can't move her right side, has lost sensation. Whether this is permanent or temporary, we simply don't know." "But is she... I mean, will she stay like this?" Joe pressed, and he immediately regretted asking because Ruby's face crumpled, her silent mouth forming the word "no" over and over. "We don't know how long she'll be in this state," Dr Morrison admitted. "It could be days, weeks, months. Some patients recover function over time with intensive therapy, others don't. We're in a waiting period right now." Ruby was shaking her head frantically, her good hand clutching at the sheets, and Joe could see the absolute terror in her eyes because this was her nightmare come true, she was trapped, aware but unable to communicate properly, unable to move half her body, and the one person she wanted most wasn't there. "Still voicemail," Pete said, lowering his phone. "Patrick's been gone five days and now Ruby's like this and he doesn't even know." He looked at Ruby. "I'm sorry Rubes, I don't know where he went." Ruby's eyes filled with fresh tears and she pointed at the door, then brought her hand to her heart, then pointed out again. The gesture was clear even without words: find him, I need him, please. "We're trying," Joe said, but it sounded hollow even to his own ears.
"Ruby ok I want you blink yes or no, do you know who this man is?" Dr pointed at Andy Hurley. Ruby looked at Andy, really studied his face, and her expression went from scared to confused. She stared at him for a long moment, her forehead creasing with concentration, and then she blinked twice. No. "She doesn't recognize me?" Andy said, his voice breaking. "Ruby, it's Andy. We've known each other for over ten years." Ruby kept staring at him like he was a stranger, no recognition in her eyes at all, and she blinked twice again when Dr Morrison asked if she was sure. "What about him?" Dr Morrison pointed at Joe. Ruby looked at Joe and something flickered across her face, some ghost of memory maybe, but then it was gone and she blinked twice. No. She didn't know Joe either. "Pete?" Dr Morrison asked, pointing. Ruby looked at Pete and there was a longer pause, like she was really trying to pull something from the depths of her damaged brain, but eventually she blinked twice. Three people she'd known for years, three people she'd lived with and toured with and loved, and she didn't know any of them. "Do you know where you are?" Dr Morrison asked. Two blinks. No. "Do you know why you're here?" Two blinks. "Do you know your own name?" Ruby hesitated on that one, her face scrunching up with effort, and finally she blinked twice and started crying again because she didn't even know who she was anymore. "The seizure caused significant damage to her memory centers," Dr Morrison explained to the guys who were all standing there looking shell-shocked. "She may have retrograde amnesia, meaning she's lost access to memories from before the injury." "What does she remember?" Pete asked quietly. "Ruby, do you know who Patrick is?" Dr Morrison asked. Ruby's whole face changed at that name, lit up with recognition, and she blinked once hard. Yes.
"Ok do you remember Patrick?" Dr asked. Ruby blinked once emphatically, yes, and her good hand went to her chest like she was trying to hold onto something, her mouth forming "Paddy" silently over and over. Tears were streaming down her face but they looked different now, not just scared tears but desperate ones, like Patrick was the only solid thing in a world that had become completely unfamiliar. "What does Patrick look like?" Dr Morrison asked. Ruby's hand moved shakily, touching her own face, then making gestures - glasses, she pointed at her eyes and made a circle with her fingers. Short, she held her hand up to indicate height. Her mouth moved trying to describe more but no sound came out and she got frustrated, hitting the bed with her good hand. "Do you know Patrick is your brother?" Dr Morrison asked. Ruby blinked once, yes, and nodded, more tears falling. "Do you remember anything else about him? What he does, where you live?" Ruby's face scrunched up with concentration and effort, like she was trying to pull memories through thick fog, and finally she made a gesture like playing guitar, strumming an invisible instrument. "He plays guitar," Joe said softly. "She remembers that." Ruby blinked yes and kept making the guitar motion, then pointed around the room at all of them and made the motion again, like she was trying to say they all played music maybe, but when Dr Morrison asked if she remembered that she blinked twice. No. She only remembered Patrick playing. "Where is Patrick now?" Dr Morrison asked. Ruby's face fell and she looked at Pete and Joe and Andy, her expression pleading, and fresh sobs shook her body. She pointed at the empty chair next to her bed, then covered her face with her good hand.
Ruby was exhausted "do you want to sleep?" Dr asked. Ruby blinked once for yes, her eyelids already drooping from the effort of trying to communicate, from the emotional toll of waking up and realizing she couldn't talk, couldn't move half her body, couldn't remember anyone except Patrick who wasn't even there. Her good hand was still clutching at the sheets weakly, like she was afraid if she let go she'd disappear again. "We're going to let you rest," Dr Morrison said gently. "When you wake up we'll start working on ways for you to communicate better, maybe a letter board or tablet, okay?" Ruby barely responded, already drifting off, exhausted from crying without sound, from the terror of being trapped in her own body. Within minutes she was asleep, her face still wet with tears, her right side completely motionless while her left hand twitched occasionally like even in sleep she was trying to reach for something. Joe, Pete, and Andy stood there watching her sleep, all of them looking shell-shocked. "She only remembers Patrick," Andy said quietly. "Out of everyone, just him." "And he's been missing for five days," Pete added, running his hands through his hair. "This is so fucked up. She needs him and he's god knows where probably drinking himself to death." "We need to find him," Joe said. "I don't care if we have to check every bar and hotel in the state, we need to find Patrick and get him back here because Ruby's not going to get better without him." Dr Morrison cleared his throat. "I need to be clear with you all - Ruby may not get better at all. The damage from this seizure combined with the existing brain injury, the likelihood of her regaining speech or full mobility is very low. You need to prepare yourselves for the possibility that this is Ruby's new reality." "Don't say that in front of her," Pete said sharply.