An inconsistently written tale, written mostly at a very low reading proficiency level, about a young woman weeks away from her wedding who is in a MVA (motor vehicle accident), while her boyfriend is driving them to a restaurant after a day fishing and sunning on the lake on his parents' boat. The boyfriend is fairly badly injured, but when the first responders see her lying so far from the accident scene, they believe she is dead. But when the EMTs go to recover her body, they discover she is still barely alive. They stabilize her neck and back and airlift her to a trauma center, where she appears to be in a coma, though it is possible she is "locked in," aware but unable to communicate. They have drilled holes in her skull and inserted tubes to relieve pressure on her brain and spinal cord, something that is usually treated with dexamethasone IV, or other strong steroid medication, used to reduce inflammation in the brain and thus swelling. The use of drilled holes, while not uncommon as a treatment, is generally done if steroids fail and there are no other options, such as removing a section of skull to allow for the brain to swell without compressing. Removing a section of the skull may seem radical compared to drilling a hole, but the drain will also take the cushioning cerebral spinal fluid down for the entire central nervous system - the brain and the spinal cord - hence there is often a choice to take a section of skull out. Burr holes, as they're called, are more often used to drain a hematoma - a tumor-like blood clot - that is exerting pressure against a section of the brain, where steroids are helpful but limited in their use. Also, a burr hole may be used to limit active bleeding in the brain from destroying brain tissue. Most of this is done under CT guidance to pinpoint the specific area needing intervention. Had there been an active brain bleed, even one addressed immediately, she would have still had some brain damage from the amount of time the bleed had likely been ongoing, due to the treatment delay. It would have cost her too much brain tissue loss in the event the 3 layers of the brain's protective covering, the meninges, had torn (the meninges wrap the brain and spinal cord, and are the part infected in meningitis). FYI there are 3 layers 9f meninges: the tough, outer dura mater, the middle, spider-web appearing arachnoid mater that is a cushion and functions closely with the inner or pia mater, or "tender mother," that hugs the contours of the brain and contains the arteries, veins, and lymphatic fluid, that latter which protects from infection. Despite some attempts to call it that, the word doesn't mean "matter," but "mater," Latin for "mother" and named for their overall protective nature, as a mother protects a child. "Dura" is the root of our word "durable." Why Latin? For centuries, most educated people in Europe, and even the Middle East and North Africa, learned Latin from a young age, making the language the universal language of medicine and science. Also, as a PS, the brain itself is further cushioned by CSF, or cerebrospinal fluid. The whole is an intricate web of protection and nourishment, and that there are neurologists and neurosurgeons who see these intricate designs that to me are only possible by intelligent design, and see random molecules evolving over eons into humans and ignore God, surprises me. I would think anyone seeing how the body is constructed (anatomy) and how it all works together (physiology) couldn't help but praise God, just as the Renaissance doctors did with every new thing they learned about it, as every doctor until recently in human history has done as they have seen God's wonders laid before them. At this point, an apology. Old nurses who also have teaching degrees tend to get carried away.
But I was surprised that the protagonist's master mechanic father in the story could give such an exact description of what happened to his daughter, and how her restraints allowed what had happened, and be so precise, a sign of the author's research and well done. Yet, there was not the same intricate or even moderate research about her injuries as a result of the physics of the accident give her height and weight. There is also an inconsistency in her descriptions of the protagonist's self-described sensations internally. Her descriptions are initiallly those of a semi-concious person aware of the movement and pain and traveling from one place to another, then losing consciousness. An EEG can tell if a person is merely unconscious or in a coma, and the book states they were done, as they would be, so the options did not include conscious v. unconscious if the 2 options are, as described, coma or locked in state. What she describes feeling internally is reaching through a light, possibly resolving coma to a familiar voice and touch, and feeling too much pain to respond further, she lapses into what she describes as the painless blackness - back into a deeper coma that allows the body to heal itself. Patients in pain can't easily, if ever, be medicated for it if there is brain injury, especially if there is no certainty of the extent of injury. When our hero does respond verbally, she is better able to withstand the pain. While it is possible she felt the drilling for the burr holes, she'd have done as she had indicated doing before her attempt to respond to a familiar voice - she indicated she had gone into that pain-free darkness again - meaning she had done so before, likely when she felt the drill. It is not uncommon for a coma patient to go back and forth between stages of a coma, and this initial sequence she describes to herself is consistent with that. Later, however, the author has her make the claim that she was "locked in" the entire time and fully aware of everything that had occurred, no retreating into painless blackness, but that she simply couldn't respond. Coma does lock you in...until you come out of it fully, you can't respond to the world around you. It is also not uncommon to recall lighter periods of a coma, physical sensations, and hearing people around you. Hearing is the last sense to go away. This is why families and close friends are encouraged to talk to comatose patients about what is going on in their lives as the patient recovers, who has said hi or sent wishes or messages to the patient, and events important to the patient. They're also encouraged to read books the patient has enjoyed in the past, or books they have indicated wanting to read. Christians especially are encouraged to have the Bible read ro them, as most believers treasure it. The idea is the familiar voice relating news from home and stories they enjoy might continue to lighten the coma until, hopefully, they come out of it. In the case of the protagonist, her mom's, but especially her dad's, voices are enough. The author describes the push and pull of a coma state but then makes her character claim an alertness to her surroundings and inability to respond back throughout the time she was hurt. The 2 are largely inconsistent with one another.
Her early response to her father's voice, and her early discharge are medically highly unlikely. The coma, with that extensive traima.and s treatment delay, would last longer. She would be given initial PT in a hospital and be kept to ensure she didn't lapse back into a coma or a locked in state. It would have taken a minimum of a week to ensure she was sound enough for discharge, and discharge would have to have been to home health care. Then there is how quickly a guest room was made into her room with her things. I have had to rearrange a household for someone sick returning home, and it cannot be done as easily as stated in the book. I had enough other things going on at the time that it was a good thing I didn't have to build a ramp!
I also doubt seriously that, so soon after major head trauma, they'd have given her a regular diet when she has a head injury...there is a much higher risk of vomiting with a head injury, and vomiting is the last thing you want. It increases intracranial pressure, and since reflexes such as the gag refles may be impaired, vomiting is more likely to result in aspiration pneumonia, which is just what it likely sounds like - something goes down the trachea to the lungs instead of the esophagus, or leaks back down the trachea. Rje resultant pneumonia can be rapidly fatal because it isn't just bacteria or a virus, it is stomach acid as well. No intelligent doctor would order such a rapid transition in diet - and any decent neuro nurse would question him if he tried. The first order of business would be a swallowing study, and if the patient was deemed able to swallow safely, then "sips and chips," allowing a patient to suck on ice chips and take small sips of water. If the patient didn't get sick from that nor choke on it, then a clear liquid diet would be next...the dreaded hospital jello and apple juice. After every attempt at oral intake, she'd have had to sit uo ar a 45 degree angle or higher for an hour at least. Once that was successful, they would likely try her on liquids - all types, like pudding, for example. After that would be soft foids, then regular diet. At each stage they would watch her closely. Considering how long she would be there before it would be safe to release her home, both her day of discharge and her final transition to regular food would likely coincide. She would need visits by home PT and OT, as well as a nurse, for at least a week after discharge, likely longer. Exercises requiring her to be flat would be done on her bed, no rolling onto a thin mat from a wheelchair. A bath in a tub would have to be supervised by someone very close who would insist on a conversation behind a shower curtain for safery and privacy. There would be no risking her becoming too weak to stay above water in a tub. The same would be true of a shower, for which she would need a shower chair and room to transfer onto it...if the shower was part of a tub/shower combination, she would need a transfer bench. Those can be rented as well as purchased, so if the perceived need isn't long term, or is uncertain, a rental is a good solution until a decision is made. Accommodation in the kitchen can be made by giving the person a cutting board and sitting them at the table to allow them to help cut up meat and/pr veggies or fruits. A protecctive tea towel can be put across a lap so the person in a chair can carry dishes into the kitchen and load the dishwasher without help. An OT, or occupational therapist, is the one who sees to those things - finding ways to be more independent in a wheelchair, however temporarily that may be, accommodating independence in ADLs or Activities of Daily Living, and exercises that strengthen the upper body, which is a key part of independence - and helps a person, however strong they may have been physically before the accident, gain the specific strengths needed for increased independence. PT and OT would likely be home based for at least 2 weeks prior to discharge to an outpatient facility - and that would have been only to a facility that also had OTs, with a prior assessment of the suitability of the facility for the patient's needs, and a conference with the inpatient and future outpatient staff along with all family members, and friends if napplicable, involved in the patient's care at home when no one professionally trained was around. In addition, massage would have been a regular feature of PT after exercise, to relax strained miscles that may start cramping, to increase circulation to the muscles and thus, oxygen supply to them. This might also be accompanied by a therapy using electrical stimulation to aid massage, and hydrocollator packs for warmth to augment relaxation, circulation, and oxygenation of the muscles used. None of this was even peripherally mentioned as a pathway to restored function. Again, the research I see about the MVA itself was enough for me to be disappointed that more wasn't done on the treatment and recovery phases. I know the inclusion of sisterly conversations and parental interactions, plus the interactions of friends is a necessary component of a novel, but the novel could have been expanded to include these since the book itself is pretty short. When I look at 4 more books after that, and the 3 sample chapters included at the end of this book are 95% recaps of just one book, I can only foresee the recaps of each book taking more and more chapters until it wouldn't surprise me if half of book 5 wasn't recaps of the previous 4 books. Putting a short squib as a preface hitting the highlights of the previous books and advising readers it would be best to read the series in order would leave plenty of room for the necessary details that would offset the tendencies of people to assume recovery was always this painless. If her rapid recovery is the result of a miracle, say so plainly. Otherwise, portray it more realistically. Those disabled by similar trauma will thank you for being honest about what it really takes.
If you have the $15 (for the ebook series) and aren't worried about accuracy, and promise not to hold real trauma patients to this standard, have fun. It's not a terrible series, though you'll endure a lot of recap repetition - always with enough new information sprinkled. through it that you need to read it all. Romantically, the big question is whether or not her impending marriage will survive and, if not, will her then-ex have second thoughts and be able to woo her back? Or will she and her PT hit it off - or is he more for her sister than her?
I do appreciate the author addressing the regret of girls who say they are believers, and yet give up the most precious gift God gave them for their future with a believing man, to some guy under peer pressure. Once you "do it," as a young teen friend once observed, they switch from making fun of your virginity to calling you a slut. And as I told her then, if you're going to be condemned either way, why not be condemned for the option that saves you from STIs, HIV, herpes, drug-resistant STI strains, unplanned pregnancy, and serial partners whom you know only want one thing, and that isn't a soul to soul, spirit to spirit, God blessed marriage, just one loser after another. You can't attract a high values male (nor a high value one) with low values - and a low value - of yourself. That they realize this is great. That they don't mention repenting and confessing is odd in a supposedly Christian romance. That, in fact, Daddy never asked the young man, with whom he apparently got along so well, whether or not he was saved since the young man planned on marrying his daughter, and that she never mentions church attendance in connection with him, tells me she will be miserably unequally yoked, and, if premarital sex was no impediment, divorce won't be, either. In fact, the family mentions rigorous church attendance but not salvation at all. Again, a bit of a surprise. No mention of baptism, either, whether infant or adult. So, since standing in a church doesn't make you a Christian any more than standing in a garage makes you a car, I will assume this is not a Christian romance, but a romance about people for whom church and a modicum of faith are a part of, but in no way central to, who they are.