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“You’ve always been the strong one,” Isobel continued, her voice trembling. “Don’t quit on me now. I need you. We all need you.”

Something shifted in the room—a sharper, more commanding presence arriving. Ruth felt it before she heard the calm, firm voice: “Dr. James Blackwell, neurosurgery. What are her vitals?”

“Pressure’s still climbing, heart rate’s bradycardic—46,” someone answered.

Warm breath touched her forehead. “Classic signs of rising intracranial pressure,” he said. “Dr. Langford, have them start prepping an OR. We need a baseline estimate before we proceed.”

“Ruth, I’m going to touch your eyes.” James carefully opened one of her eyelids, his touch gentle.

“Checking for papilledema,” he murmured. “Swelling of her optic disc, an unmistakable sign of increased ICP. It’s significant. Definitely elevated.” Next, he gently pressed along her scalp. “Did someone say there was a possible skull fracture?”

His fingertips kept touching her head. “What’s the latest non-invasive reading?”

“Transcranial doppler shows her cerebral blood flow velocity is low. Suggests her ICP is around 22 to 24,” the nurse replied.

“That tracks with her symptoms. She’s teetering just below the threshold for critical intervention.”

He placed a hand on her shoulder. “Ruth, we’re going to help you now. Your brain’s under too much pressure, but we’ve caught it. Just hold on for me, okay?”

His tone shifted back to command mode. “We need that OR now. She needs direct monitoring. Prep for a burr hole and set up the ICP catheter.”

There was movement in the room. She felt his warm breath against her as he exhaled.

“We need imaging immediately, and prepare to evacuate any hematoma if necessary.”

She felt herself moving. Suddenly, it got cold.

“Ruth, you’re going into the CT scanner now.” The doctor’s voice was like steel, cutting through the noise with precision and authority. Her mind clung to the sound, recognizing the tone of someone who knew exactly what needed to be done.

She felt herself being moved again. There was a whooshing sound. She began to shiver.

Suddenly, something warm covered her. “Here you go, honey. This should warm you up,” a lovely voice said to her. Hands pressed a blanket around her.

“Ruth, it’s Dr. James Blackwell, Tristan’s brother, and I’m here to help you,” he said gently. “The pressure in your head is too high. You have a large blood clot pressing against the back of your brain. I need to remove it and insert a monitor to measure the pressure directly and keep it under control.”

Her eyelids only fluttered faintly. They felt like lead.

His voice remained calm, steady. “When you wake up, hopefully you won’t feel the headache you must be having.”

She felt herself rolling again.

* * *

The OR wassilent except for the rhythmic beeping of monitors and the soft hiss of the ventilator. Ruth lay motionless on the table, her head secured in a Mayfield clamp. James Blackwell, a seasoned neurosurgeon, stood at the head of the table, clad in sterile blue scrubs. His sharp gaze moved between the monitors and the exposed surgical site, a small area of shaved scalp at the back of Ruth's head.

“Scalpel.” James extended his gloved hand. His tone was steady—the kind of voice that inspired confidence in the OR.

“Scalpel,” echoed the scrub nurse, placing the instrument firmly into his palm.

With precise movements, James made a clean incision over the occipital bone. Blood welled at the edges, but the OR team was prepared.

“Keep suction steady,” he instructed.

“I’m on it,” replied the surgical assistant, positioning the suction device to keep the field clear. A soft slurping noise accompanied the removal of excess blood.

“We’ll need the craniotome next. Prep the drill,” James added.

Dr. Elena Torres, the assisting neurosurgeon, stepped closer, holding the sterile craniotome. “Ready when you are.”