Trauma (15 page)

Carrie inserted her fingers to enlarge a pocket where the subcutaneous pulse stimulator would fit. Then she inserted a t-tunneler and pushed it under the scalp and through the neck to reach the chest wound. The exposed lead was next introduced through the tunneler and connected to the generator in the chest. The scalp and chest were closed. The system was now in place, and potentially operational.

Five hours of surgery were complete.

Abington would spend the night in neuro recovery. Then it was home, wherever that was, and back in three weeks to follow up with Dr. Finley, who would assume responsibility for adjustments of the stimulus generator signal.

Dr. Finley checked the signal readings once more. “Dr. Bryant, you've just hit a grain of rice in a three-pound mass of Jell-O. Congratulations!”

Carrie removed her mask and grinned.

 

CHAPTER 19

During the day the canteen in the basement of the VA hospital buzzed with activity, but at this late hour it was a ghost town. Food service stopped at three o'clock for everything except K-cup coffee and whatever the vending machines supplied. Food at the VA was partly subsidized by the government, which could explain why there was no dinner service for the staff.

Carrie had slipped on a fresh pair of scrubs and joined Dr. Finley at a long table. Steve Abington was in neuro recovery and, Carrie figured, emerging from the effects of anesthesia about now. She could enjoy a cup of coffee and then go check up on her first, and most eventful, DBS patient.

Dr. Finley was all smiles. “Carrie, that was just splendid. You were like a veteran in the OR, no pun intended.”

Carrie's face lit up with a genuine smile and she blew on her coffee to cool it. “Thanks, I appreciate the compliment.”

“The microelectrodes are perfectly placed,” he continued, “right in the basolateral nucleus of the amygdala. The neuronal firing pattern, the post-op CT, everything's perfect. You were so calm and focused. I knew you could do this work.”

“It was a team effort, like you said it would be.”

“Ha! A modest neurosurgeon—now that might be a first.”

One small step for Carrie Bryant, one hopefully enormous leap for Staff Sergeant Steve Abington.

“Given all that you've been through, and I don't just mean the attack, what you did today was nothing short of astonishing. I really can't say enough good to you, Carrie.”

Carrie tried to keep her composure, but blushed at his praise. She'd fought so hard to find her way back to her field, she was amazed to be here. Now, given the extent of her day, Carrie figured she'd be bone weary, but it was the opposite. Maybe she'd crash later, but for the moment Carrie felt electrified.

After about twenty minutes talking about DBS, the surgery, and Abington's prospects for recovery, Dr. Finley glanced at his wristwatch. “Whoa. It's after eight. I mean, I love this place, but I gave up on the idea of using any hospital as a bunkhouse back in my residency years. So will I see you tomorrow?” Dr. Finley winked.

It was his way of asking if Carrie was coming back. Given the threat to her life, it was a reasonable question.

“You couldn't keep me away,” Carrie said with a smile.

“Well, no more unaccompanied consultations,” Dr. Finley said. “We need our best DBS surgeon safe, if we're going to fix the PTSD problem one patient at a time.”

Carrie saluted. “Dr. Bryant will be reporting for duty, sir.”

Dr. Finley chuckled as he stood. The crow's-feet marking the corners of his eyes seemed to have deepened. “We're lucky you're both resilient and dedicated. But I suggest you go home and get some rest. It's been an eventful day.”

Carrie nodded. “You go on ahead. I'm going to nurse this coffee a while longer and catch up on some e-mails.”

Dr. Finley gathered his briefcase and gave Carrie's shoulder a couple of friendly pats before heading for the door. Carrie sipped her drink and watched him go. She took in the quiet; it was one of her favorite times to be at a hospital. At Community, Carrie had been responsible for a whole team of patients, any of whom might turn for the worse at a moment's notice, and too often did. She had always been grateful for any fifteen-minute respite.

Maybe this job would be a stepping-stone back into other types of neurosurgery, but maybe not. Her mother preached mindfulness, living in the moment. Carrie was not opposed to the idea of making a long-term commitment here. Perhaps after she spoke with Abington, once Carrie could see the impact the procedure had made—a Don McCall miracle—it would encourage her transition to becoming a career DBS surgeon.

Carrie laughed at herself as she got up to throw her coffee cup away. Who knew how long Carrie would last at the VA? Hell, she was happy just to be back in the OR. But the same ambition that drove Carrie into neurosurgery had climbed back into the driver's seat of her mind.

From now on, Carrie would focus just on her patients. She'd barely started this job. She needed to be here a while and experience the whole program before making any decisions. Best to get her head on her task. And right now, that was checking up on Steve Abington before checking out for the day. This crazy day.

Even though Carrie functioned as an attending physician, her instinct was to go see her patient post-op. It had been ingrained in her for the past four years. One of an attending's privileges was being able to do the surgery and leave the scut to the residents. But Carrie was still a resident in both her heart and mind, and so a check on Abington was almost like a reflex. Steve Abington might well have taken Carrie's life, but he had also been instrumental in giving back her career.

Inside the elevator Carrie pressed “3” and headed up to the neuro recovery floor.

The hall outside the elevator was dim, quiet, and empty as she walked down to the four-bed unit. Hospitals could be lonely places in the evenings, but the VA seemed especially dormant.

Carrie pushed the intercom and waited for the double doors to buzz open. Inside, three of the four glassed-in rooms were empty. Steve Abington was in the bed at the far end of the last room, extubated and resting comfortably, reclining with his head up fifteen degrees, IV in place, a bedside gooseneck lamp illuminating his face.

Marianne, the full-figured night nurse, sat behind a wide desk with her face buried in a book. In front of Marianne was a row of monitors, all dark except for the one reporting Abington's heart rate and BP. Taped to a wall in the nurses' station, easy to read from a distance, was a list of phone extensions for ordering various tests. As if Carrie needed another reminder she did not belong on the floor, at the bottom of the list, in bold lettering, was Evan Navarro's ordering number, as well as his user name and password to the system where lab orders and such were entered. This was clearly his domain.

“It's all quiet tonight.” Marianne spoke in a reedy voice, alert to her surroundings, despite keeping her eyes on her book, a bodice-ripper romance. Carrie grabbed Abington's chart and walked toward his bed.

“I'm not used to seeing docs up here at this hour,” Marianne called out. “Usually, I just call 'em if things go bad, and they usually don't with these DBS folks. Anesthesia extubates them and they breathe just fine. Haven't had a problem yet. Hey, you new here?”

Carrie came back to the desk. With a smile, she extended her hand. “I'm Dr. Carrie Bryant. I work with Dr. Finley. I'm the new DBS surgeon.”

*   *   *

ABINGTON'S HOSPITAL
room held little warmth. With a crush of high-tech gear and monitors, the place was intimidating at best, and not intended for long-term stays. The electric hum of equipment buzzed, and in the quiet of the floor every beep could be heard in perfect clarity.

Carrie paused at the door and eyed her attacker with compassion. She reminded herself that the man who hours ago had his hands wrapped around Carrie's throat was not the same person who lay on this hospital bed. The image of Abington's crazed-eye look flashed through her mind and sent a chill down her spine. She could recall every detail of the attack: the feeling of pressure on her throat, the coursing terror as her windpipe closed. The smell of his hot breath when he hovered over her, his eyes aglow. But—it wasn't with hate, was it? It had been fear. Yes, Abington was terrified when he attacked. In a way, the assault was more like a drowning person flailing at a would-be rescuer.

She went to Abington's bedside and pulled a penlight from her coat pocket.

“Good evening, Mr. Abington,” Carrie said. “I'd like to check your pupils. Would you kindly follow my light?”

Steve Abington opened his eyes ever so slowly and stared vacantly toward his doctor. If he remembered Carrie and what he'd done to her, it did not register on his face.

Carrie quickly checked his pupillary reactivity and then his eye movements. “Now please follow my light. Up … good. Left. Right … good.”

Abington's shaved head was dressed in bandages, but the stereotactic frame had been removed and he looked handsome now that he was free of the elaborate computerized apparatus.

“Well, you've had quite a day. We haven't had a proper introduction. Do you remember anything about meeting me?”

Abington, who appeared quite groggy still, didn't respond. Carrie checked his reflexes, and made sure he was moving all fours pretty much equally.

“You were extremely upset when they brought you in,” Carrie said. “Do you remember? You were very confused, telling me you didn't belong here.”

Abington mumbled something under his breath. He looked utterly lost and alone. Confusion smoldered in his darting eyes.

“Steve, can you tell me the last thing you remember?”

Like a veil had been lifted, Abington came alive and looked wildly about. His jaw set and a snarl overtook his face. He covered his ears with his hands and began to shake his head as if something was lodged inside his ears. Carrie worried he would rip the IVs out of his arm.

“Enough. Shut up, shut up, shut up,” Abington said. His speech came out thickly. His expression was that of a cornered animal.

“Steve, what's wrong? What's going on?”

Abington continued to turn his head frantically from one side to the other, keeping his hands over his ears.

“Where are you? Stop it! Stop saying that! Follow my light, follow my light, follow my light! What light? What light? Stop it!”

“Steve, calm down. You've got to calm down. Everything is all right.”

Abington appeared to have heard Carrie, but his expression became even more agitated.

“Why do you keep saying it's all right? Nothing is all right. Nothing is all right! Nothing is all right! Stop saying that!”

Abington flipped onto his stomach and buried his head under the pillow. But Carrie could hear him muttering the same words over and over.

“Follow my light … follow my light…”

Carrie bolted for the door. It would be easy to get Abington sedated. The question was, could she ever get him cured?

 

CHAPTER 20

The badge dangling from a red lanyard identified the nurse as Lee Taggart. He wore crisply pressed white scrubs and unblemished matching canvas sneakers that carried him down the long hallway at a brisk pace. He stopped in front of Marianne's workstation and leaned forward, hoping to catch her eye.

“Reading anything good?”

Lee's warm voice drew Marianne's attention. When she looked up, he flashed her a brilliant smile. Marianne smiled back. Lee had an athletic body and smooth ebony skin, and was not unaccustomed to flattering looks. He had never met Marianne before, but that was not so unusual here. Staff seemed to change as often as shifts, and Marianne would need only to see the red lanyard and white uniform to believe he was a staff nurse.

Marianne glanced down at the cover of her book, which featured a bare-chested Adonis riding a stallion with a scantily clad buxom woman clutched in his massive arms. She laughed flirtatiously.

“Oh, just something to pass the time,” she said, embarrassed enough to cover the book jacket with a clipboard.

The look in Lee's brown eyes turned conspiratorial. “Another slow night, eh?” he said.

He knew it had not been slow in the least. Everything that could have gone wrong with Abington had gone wrong.

“I prefer that to the alternative,” Marianne said as she glanced at one of the dark monitors and caught a glimpse of her reflection within. She noticed her hair was a bit tousled, which she promptly corrected, using her hand as a comb.

“Well, I got assigned to Dr. Goodwin's staff tonight,” Lee said. “Just got to go in and check on the patient. He's in four, right?”

“That's right. He's in four.”

*   *   *

Marianne was having a heck of a time keeping her eyes off this new nurse. She was also struggling with Tinder, and every other dating site where she'd posted a profile. The VA offered slim pickings when it came to the opposite sex, so she was enjoying this pleasant surprise to the fullest.

Before Lee headed off to room four, Marianne checked Abington's vitals in the only active monitor. His heart and pulse were optimal, but the patient had been in a blissful haloperidol stupor for the past couple of hours, with not a peep since his earlier outburst. She had been told to be extra vigilant for any Q-T prolongation or incidence of arrhythmia, but so far he and the drug were working well together.

Dr. Bryant had ordered ten milligrams of diazepam IV after Abington went crazy, and Marianne had bolted from her chair and gotten the syringe promptly. Within a few minutes, the patient was relaxed again, and his eyes closed.

“Looks like he didn't need too much on top of that residual anesthesia,” Dr. Bryant had said.

Having had enough excitement for one night, Marianne had been satisfied with that explanation, but Dr. Bryant still looked perplexed.