What's Eating Timothy McGee? 4/? gen.
Arriving at the hospital, Ducky leaned over the back of his seat and pointed a finger at McGee. "Stay put while I fetch a nurse with a wheelchair."
If Tim was going to argue, one look from Gibbs stopped him in his tracks. "Yeah, okay."
"Good lad. Now, I'll be back in just a moment."
Letting his head fall back against the seat, McGee closed his eyes. Ducky appeared to suspect what was wrong with his leg and he was taking no chances, insisting that it be kept perfectly straight as Tony helped Gibbs get him into the car. His door opened and Gibbs was right there, supporting him as he was slid out of the backseat and into a wheelchair. The nurse was very careful as she settled his leg onto the raised footrest before he was whisked into the Emergency Department.
Ducky and Dr. Malone were already deep in conversation when Tim was wheeled into the room. Gibbs followed behind and helped McGee as he was transferred to the narrow bed. A shot of painkiller was given before they did anything else. The older agent got his first view of the infected wounds when the nurse helped him remove his shirt before cutting away the bandages.
Even Gibbs had to look away for a second after seeing the weeping, oozing mess that was once McGee's arm. "My God, Tim, how did it get this bad?"
When Tim nodded his okay to discuss the situation, Dr. Malone joined them. He supervised as the nurse began irrigating the wound, flushing out the draining pus and fluid and easing the packing materials out of the deepest areas of the wound.
"Unfortunately, it's a combination of several things. The infection is one that is apparently resistant to most antibiotics, which mixed with Tim's allergies to several families of antibiotics has made it difficult to find an appropriate combination. Of course, the cocaine that was introduced into the injury when he was attacked further weakened his body's ability to fight off the infection by damaging the tissue and masking the early signs of the infection. The grinding motion of the animal's teeth worked it in very deeply, much deeper than you would find in a normal injury."
"Cocaine? From the dog's saliva? There was enough cocaine in his saliva to affect McGee?" Gibbs glanced over at Ducky, noting the guilty expression on the other man's face. Neither of them had taken that into account when they'd slapped a bandage on his arm and sent him off with the dog.
The nurse had the wound cleaned out, so she stepped back to give Dr. Malone room. He sat down next to the bed as she wheeled over a large magnifying lens surrounded by lights. With both Gibbs and Ducky watching over his shoulder, Malone carefully examined the wound before letting the nurse take photos.
"I want copies of those."
The request from the senior agent seemed to catch the doctor off guard. He glanced up at McGee who hesitated, then nodded. "All right, do you just want the photos from today or do you want the complete records?"
Gibbs was still staring at the magnified view of the wound. "All of it."
Malone moved closer once the nurse was finished and began scraping at the wound, first taking a sample for the lab before continuing to remove the dying tissue as Ducky started to question him.
"How often does Timothy undergo debridement?"
"For a heavier debridement, usually two or three times a week. We do a lighter version like this every time we repack the wound."
"I see, and how often is that?"
"Every other day unless the drainage soaks though earlier."
As the two doctors discuss antibiotic options and the various problems the patient had with them, Gibbs watched in morbid fascination as the strips of surgical gauze were soaked in saline solution before being wedged into the deepest parts of the damage.
Just as Gibbs thought he was going to have to step away, it was finished and the entire arm was wrapped in dry gauze from the hand to the elbow. "You okay, McGee?"
"Yeah, sure, I'm getting pretty used to it by now." Despite the brave words, Tim's forehead was covered with sweat and he was slightly trembling. Never having seen Gibbs that ashen, Tim asked his own question. "Are you okay, Boss?"
Still staring at the now wrapped arm, Gibbs absently nodded.
Dr. Malone stripped off his gloves as he stood. "Well, it certainly didn't help, but I don't think falling made it any worse. Now, let's take a look at your leg."
With Gibbs' help, the hurting man slid down his slacks, showing the dark bruise that had already formed on the front of his thigh. Gibbs thought back, remembering exactly how McGee had fallen. His leg hadn't hit anything on his way down. "How did that bruise happen? Did you fall while you were in the head?"
"No, Boss." Tim was staring at his leg as Dr. Malone ordered an immediate MRI. As soon as the doctor hung up the phone, Tim turned to him. "What's happening to me?"
Malone exchanged a look with Ducky. "There have been a few reported cases where Ciprofloxacin has caused some - unusual - side effects."
"Like what?"
"I'm sorry, Tim, it looks like the tendon has ruptured."
"Ruptured?"
As Dr. Malone continued to explain how the four major muscles of the quadriceps joined together to form the patellar tendon Tim stared at his leg, wondering if this was going to destroy his career before his arm did the job.
"How bad is this? Can it be fixed?"
"Since your kneecap is still in position, and Dr. Mallard was so careful to limit the movement, I suspect that you've only suffered a partial rupture. That's a good thing because with this infection we really don't want to have to cut into your leg right now."
"So it will heal on its own?"
"If the MRI confirms a partial rupture, we'll put your leg in an immobilizer for six weeks. After that, we'll reevaluate."
Gibbs looked over at Ducky. "Will he regain full strength in his leg?"
Ducky heard the unasked question. "With luck and a great deal of therapy, his leg should recover enough for Timothy to return to the field, Jethro. It will take some time, but I suspect his arm will take even longer."
Two orderlies arrived to take McGee for the MRI, ending the conversation.
---NCIS---
After helping Gibbs and Ducky get McGee into the car, Tony returned to his desk and rested his head in his hands. At the nearby desk he could hear Ziva quickly typing and repeatedly backspacing before muttering under her breath. Finally he looked up at her. "What are you doing?"
"I am trying to find the medicine that Ducky was talking about, but I cannot determine the spelling."
Tony scrambled to his feet. "Abby will know." With Ziva at his heels, he went straight to the lab. Down in the lab, Abby jumped when they came rushing in.
"Whoa, guys, where's the fire?"
Tony didn't waste any time. "Abs, what can you tell us about an antibiotic called ciro... ciro... ciro-something."
"No, the short name was more like cipo."
Abby looked between them. "Maybe it was Cipro? Ciprofloxacin?"
"Yes, that was it."
"Yeah, Abs, what can you tell us about it? Ducky said something about major problems."
"Serious, he called it serious, Tony."
"Major, serious, whatever. The point is that McGee collapsed and they rushed him to the hospital."
"Collapsed? McGee collapsed?" Abby screeched as she grabbed Tony's jacket. "What do you mean he collapsed? Why didn't anybody come tell me?"
"I thought you did not care what happened to McGee. Abby."
"That's not true, Ziva. I just wanted him to..."
"Bend over backwards and do whatever you wanted no matter how rough it was on him?" Tony finished for her, his own feelings of guilt weighing him down.
Abby didn't answer, busying herself with a search on the drug. The first handful of sites she found gave the standard information, then she found a patient's forum where the discussion was on what they called the darker side of Cipro. She paled even more than normal. "Umm, guys, this is bad. This is really, really bad. They're talking about it causing seizures and neurological problems and partially crippling people, sometimes for months." Leaning closer to the screen, she continued to search. Eventually, she seemed satisfied and turned to face them.
"Okay, they're rare problems and the AMA and the FDA haven't agreed with a lot of them yet, but one rare complication they've admitted to is that sometimes it will weaken a tendon and cause it to tear apart."
Tony glanced over at Ziva. She had arrived moments after Ducky so she didn't see McGee go down, but Tony remembered every detail. "His left leg just buckled and he was in a lot of pain."
"Why would a drug with such serious side effects be allowed on the market?"
Ziva had posed a good question and Abby wasn't sure how to answer it. "Most of the time the patients are elderly or have other medical issues or they're being given pretty massive doses. I don't know, McGee's young and he's in pretty good health, so... How many of those pills has he been taking?"
"Not pills, Abby. Gibbs told Ducky that Tim's been in the hospital every night for an IV of that stuff."
"IV antibiotics, Tony? That's bad, that's really, really bad."
"Yeah, I know."
Major Mass Spec chose that moment to beep and Abby printed out the findings for Ziva. "Here, this is the test you wanted me to run." Feeling guilt on several accounts, Abby wouldn't look Ziva in the eye as she handed the paper over.
---NCIS---
"Well?" Gibbs was sitting next to McGee when Dr. Malone returned with a troubled look on his face.
Malone didn't beat around the bush. "I've been consulting with a wound specialist that's been traveling between military hospitals for the last six months. He's arriving here at Bethesda tomorrow and you've just been bumped to the top of his list. He's recommending that we try one more antibiotic tonight. I'll warn you, thought - it's a derivative of one we tried a few weeks ago. The one that made you break out in hives. You could have a similar reaction, possibly even worse."
Gibbs didn't like the sound of that, nor the passive way that McGee accepted the decision. "What are you going to do to prevent it from happening again?"
"We're going to start him on a course of antihistamines and corticosteroids. Hopefully that will keep any reaction under control." the doctor checked his watch. "All right, I've got a consult with Orthopedics to review your MRI results. We probably won't start the antibiotics for at least another three hours, so why don't you try and get some rest. It could be a long night."
Gibbs turned to McGee. "I'll let the Director know what's going on and pack up some clothes for you since you'll be staying at my place for a while." When Tim started to argue, Gibbs stared him down. "Between that leg and your arm, you're not going to be climbing those stairs any time soon. It's not open to discussion, McGee."
Tim started to open his mouth, then thought better of it and just nodded a reluctant agreement. Gibbs patted his good arm. "I'll check in with Ducky and be back before you know it. Anything besides the basics you want me to grab from your place?"
He thought about spending entire evenings with Gibbs, the functional mute. No cable, no internet either. "There's some books on my nightstand."
"All right, see you in a couple of hours." Gibbs followed Dr. Malone out into the hallway. "Okay, what aren't you telling him?"
Malone hesitated and Ducky joined them, fresh from reading through McGee's entire file. "Jethro, they're running out of options. If this last antibiotic doesn't at least slow down the infection, we will have to seriously discuss whether the chances of saving his lower arm is worth the risks involved in delaying surgery. It may sound cold-hearted, but he'll have more function with a lower arm prosthetic than one goes up to his shoulder."
Gibbs looked horrified and Ducky rushed to reassure him. "We're not to the point where we need to have that discussion yet, but be aware; it may be a possibility."
"We're not there yet, Duck. I'm running back to the Yard for a few minutes. Are you staying here or coming back?"
"I'll return with you so I can fetch my car and check on Mother." Ducky picked up the folder of photos and followed Gibbs out to the car, not speaking again until they were on the road.
"I'm afraid I have done that young man a great disservice. The day he was mauled, I did not take the cocaine exposure into consideration."
"None of us did, Ducky."
"Yes, well, cocaine was originally developed as a numbing agent for surgery, Jethro. I based a great deal of my concern on Timothy's pain levels without taking into account the fact that he'd basically had a nerve block ground into the injury. Perhaps if I'd insisted he go to the hospital to have the bites surgically cleaned out and attended to, he might not be in this situation right now."
"Like I told DiNozzo, we all screwed this one up. Best we can do is to stop digging and start helping."
Ducky didn't look entirely convinced so he changed the subject. "What are your intentions with these photographs, Jethro?"
"He was injured on the job. I want the case file to reflect that."
"And it has nothing to do with making sure a few somebodies know exactly how much young Timothy has been suffering all this time?"
The corner of Gibbs' mouth twitched slightly. "That's just a perk, Ducky."
If Tim was going to argue, one look from Gibbs stopped him in his tracks. "Yeah, okay."
"Good lad. Now, I'll be back in just a moment."
Letting his head fall back against the seat, McGee closed his eyes. Ducky appeared to suspect what was wrong with his leg and he was taking no chances, insisting that it be kept perfectly straight as Tony helped Gibbs get him into the car. His door opened and Gibbs was right there, supporting him as he was slid out of the backseat and into a wheelchair. The nurse was very careful as she settled his leg onto the raised footrest before he was whisked into the Emergency Department.
Ducky and Dr. Malone were already deep in conversation when Tim was wheeled into the room. Gibbs followed behind and helped McGee as he was transferred to the narrow bed. A shot of painkiller was given before they did anything else. The older agent got his first view of the infected wounds when the nurse helped him remove his shirt before cutting away the bandages.
Even Gibbs had to look away for a second after seeing the weeping, oozing mess that was once McGee's arm. "My God, Tim, how did it get this bad?"
When Tim nodded his okay to discuss the situation, Dr. Malone joined them. He supervised as the nurse began irrigating the wound, flushing out the draining pus and fluid and easing the packing materials out of the deepest areas of the wound.
"Unfortunately, it's a combination of several things. The infection is one that is apparently resistant to most antibiotics, which mixed with Tim's allergies to several families of antibiotics has made it difficult to find an appropriate combination. Of course, the cocaine that was introduced into the injury when he was attacked further weakened his body's ability to fight off the infection by damaging the tissue and masking the early signs of the infection. The grinding motion of the animal's teeth worked it in very deeply, much deeper than you would find in a normal injury."
"Cocaine? From the dog's saliva? There was enough cocaine in his saliva to affect McGee?" Gibbs glanced over at Ducky, noting the guilty expression on the other man's face. Neither of them had taken that into account when they'd slapped a bandage on his arm and sent him off with the dog.
The nurse had the wound cleaned out, so she stepped back to give Dr. Malone room. He sat down next to the bed as she wheeled over a large magnifying lens surrounded by lights. With both Gibbs and Ducky watching over his shoulder, Malone carefully examined the wound before letting the nurse take photos.
"I want copies of those."
The request from the senior agent seemed to catch the doctor off guard. He glanced up at McGee who hesitated, then nodded. "All right, do you just want the photos from today or do you want the complete records?"
Gibbs was still staring at the magnified view of the wound. "All of it."
Malone moved closer once the nurse was finished and began scraping at the wound, first taking a sample for the lab before continuing to remove the dying tissue as Ducky started to question him.
"How often does Timothy undergo debridement?"
"For a heavier debridement, usually two or three times a week. We do a lighter version like this every time we repack the wound."
"I see, and how often is that?"
"Every other day unless the drainage soaks though earlier."
As the two doctors discuss antibiotic options and the various problems the patient had with them, Gibbs watched in morbid fascination as the strips of surgical gauze were soaked in saline solution before being wedged into the deepest parts of the damage.
Just as Gibbs thought he was going to have to step away, it was finished and the entire arm was wrapped in dry gauze from the hand to the elbow. "You okay, McGee?"
"Yeah, sure, I'm getting pretty used to it by now." Despite the brave words, Tim's forehead was covered with sweat and he was slightly trembling. Never having seen Gibbs that ashen, Tim asked his own question. "Are you okay, Boss?"
Still staring at the now wrapped arm, Gibbs absently nodded.
Dr. Malone stripped off his gloves as he stood. "Well, it certainly didn't help, but I don't think falling made it any worse. Now, let's take a look at your leg."
With Gibbs' help, the hurting man slid down his slacks, showing the dark bruise that had already formed on the front of his thigh. Gibbs thought back, remembering exactly how McGee had fallen. His leg hadn't hit anything on his way down. "How did that bruise happen? Did you fall while you were in the head?"
"No, Boss." Tim was staring at his leg as Dr. Malone ordered an immediate MRI. As soon as the doctor hung up the phone, Tim turned to him. "What's happening to me?"
Malone exchanged a look with Ducky. "There have been a few reported cases where Ciprofloxacin has caused some - unusual - side effects."
"Like what?"
"I'm sorry, Tim, it looks like the tendon has ruptured."
"Ruptured?"
As Dr. Malone continued to explain how the four major muscles of the quadriceps joined together to form the patellar tendon Tim stared at his leg, wondering if this was going to destroy his career before his arm did the job.
"How bad is this? Can it be fixed?"
"Since your kneecap is still in position, and Dr. Mallard was so careful to limit the movement, I suspect that you've only suffered a partial rupture. That's a good thing because with this infection we really don't want to have to cut into your leg right now."
"So it will heal on its own?"
"If the MRI confirms a partial rupture, we'll put your leg in an immobilizer for six weeks. After that, we'll reevaluate."
Gibbs looked over at Ducky. "Will he regain full strength in his leg?"
Ducky heard the unasked question. "With luck and a great deal of therapy, his leg should recover enough for Timothy to return to the field, Jethro. It will take some time, but I suspect his arm will take even longer."
Two orderlies arrived to take McGee for the MRI, ending the conversation.
---NCIS---
After helping Gibbs and Ducky get McGee into the car, Tony returned to his desk and rested his head in his hands. At the nearby desk he could hear Ziva quickly typing and repeatedly backspacing before muttering under her breath. Finally he looked up at her. "What are you doing?"
"I am trying to find the medicine that Ducky was talking about, but I cannot determine the spelling."
Tony scrambled to his feet. "Abby will know." With Ziva at his heels, he went straight to the lab. Down in the lab, Abby jumped when they came rushing in.
"Whoa, guys, where's the fire?"
Tony didn't waste any time. "Abs, what can you tell us about an antibiotic called ciro... ciro... ciro-something."
"No, the short name was more like cipo."
Abby looked between them. "Maybe it was Cipro? Ciprofloxacin?"
"Yes, that was it."
"Yeah, Abs, what can you tell us about it? Ducky said something about major problems."
"Serious, he called it serious, Tony."
"Major, serious, whatever. The point is that McGee collapsed and they rushed him to the hospital."
"Collapsed? McGee collapsed?" Abby screeched as she grabbed Tony's jacket. "What do you mean he collapsed? Why didn't anybody come tell me?"
"I thought you did not care what happened to McGee. Abby."
"That's not true, Ziva. I just wanted him to..."
"Bend over backwards and do whatever you wanted no matter how rough it was on him?" Tony finished for her, his own feelings of guilt weighing him down.
Abby didn't answer, busying herself with a search on the drug. The first handful of sites she found gave the standard information, then she found a patient's forum where the discussion was on what they called the darker side of Cipro. She paled even more than normal. "Umm, guys, this is bad. This is really, really bad. They're talking about it causing seizures and neurological problems and partially crippling people, sometimes for months." Leaning closer to the screen, she continued to search. Eventually, she seemed satisfied and turned to face them.
"Okay, they're rare problems and the AMA and the FDA haven't agreed with a lot of them yet, but one rare complication they've admitted to is that sometimes it will weaken a tendon and cause it to tear apart."
Tony glanced over at Ziva. She had arrived moments after Ducky so she didn't see McGee go down, but Tony remembered every detail. "His left leg just buckled and he was in a lot of pain."
"Why would a drug with such serious side effects be allowed on the market?"
Ziva had posed a good question and Abby wasn't sure how to answer it. "Most of the time the patients are elderly or have other medical issues or they're being given pretty massive doses. I don't know, McGee's young and he's in pretty good health, so... How many of those pills has he been taking?"
"Not pills, Abby. Gibbs told Ducky that Tim's been in the hospital every night for an IV of that stuff."
"IV antibiotics, Tony? That's bad, that's really, really bad."
"Yeah, I know."
Major Mass Spec chose that moment to beep and Abby printed out the findings for Ziva. "Here, this is the test you wanted me to run." Feeling guilt on several accounts, Abby wouldn't look Ziva in the eye as she handed the paper over.
---NCIS---
"Well?" Gibbs was sitting next to McGee when Dr. Malone returned with a troubled look on his face.
Malone didn't beat around the bush. "I've been consulting with a wound specialist that's been traveling between military hospitals for the last six months. He's arriving here at Bethesda tomorrow and you've just been bumped to the top of his list. He's recommending that we try one more antibiotic tonight. I'll warn you, thought - it's a derivative of one we tried a few weeks ago. The one that made you break out in hives. You could have a similar reaction, possibly even worse."
Gibbs didn't like the sound of that, nor the passive way that McGee accepted the decision. "What are you going to do to prevent it from happening again?"
"We're going to start him on a course of antihistamines and corticosteroids. Hopefully that will keep any reaction under control." the doctor checked his watch. "All right, I've got a consult with Orthopedics to review your MRI results. We probably won't start the antibiotics for at least another three hours, so why don't you try and get some rest. It could be a long night."
Gibbs turned to McGee. "I'll let the Director know what's going on and pack up some clothes for you since you'll be staying at my place for a while." When Tim started to argue, Gibbs stared him down. "Between that leg and your arm, you're not going to be climbing those stairs any time soon. It's not open to discussion, McGee."
Tim started to open his mouth, then thought better of it and just nodded a reluctant agreement. Gibbs patted his good arm. "I'll check in with Ducky and be back before you know it. Anything besides the basics you want me to grab from your place?"
He thought about spending entire evenings with Gibbs, the functional mute. No cable, no internet either. "There's some books on my nightstand."
"All right, see you in a couple of hours." Gibbs followed Dr. Malone out into the hallway. "Okay, what aren't you telling him?"
Malone hesitated and Ducky joined them, fresh from reading through McGee's entire file. "Jethro, they're running out of options. If this last antibiotic doesn't at least slow down the infection, we will have to seriously discuss whether the chances of saving his lower arm is worth the risks involved in delaying surgery. It may sound cold-hearted, but he'll have more function with a lower arm prosthetic than one goes up to his shoulder."
Gibbs looked horrified and Ducky rushed to reassure him. "We're not to the point where we need to have that discussion yet, but be aware; it may be a possibility."
"We're not there yet, Duck. I'm running back to the Yard for a few minutes. Are you staying here or coming back?"
"I'll return with you so I can fetch my car and check on Mother." Ducky picked up the folder of photos and followed Gibbs out to the car, not speaking again until they were on the road.
"I'm afraid I have done that young man a great disservice. The day he was mauled, I did not take the cocaine exposure into consideration."
"None of us did, Ducky."
"Yes, well, cocaine was originally developed as a numbing agent for surgery, Jethro. I based a great deal of my concern on Timothy's pain levels without taking into account the fact that he'd basically had a nerve block ground into the injury. Perhaps if I'd insisted he go to the hospital to have the bites surgically cleaned out and attended to, he might not be in this situation right now."
"Like I told DiNozzo, we all screwed this one up. Best we can do is to stop digging and start helping."
Ducky didn't look entirely convinced so he changed the subject. "What are your intentions with these photographs, Jethro?"
"He was injured on the job. I want the case file to reflect that."
"And it has nothing to do with making sure a few somebodies know exactly how much young Timothy has been suffering all this time?"
The corner of Gibbs' mouth twitched slightly. "That's just a perk, Ducky."