by Barbara Ebel
Table of Contents
Collateral Circulation
Copyright
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
From the Author
Collateral Circulation
A Medical Mystery
by Barbara Ebel, M.D.
Book Three of the Dr. Danny Tilson Novels
Book One: Operation Neurosurgeon
Book Two: Silent Fear: a Medical Mystery
Book Four: Secondary Impact
Copyright
Collateral Circulation
Copyright © 2015 by Barbara Ebel, M.D.
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
Paperback ISBN-13: 978-0-9911589-5-9
eBook ISBN-13: 978-0-9911589-6-6
This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.
For Brendan
Chapter 1
Danny Tilson had performed surgery on many brains during his career but never before had he been as mystified about a patient’s arterial anatomy as now. His afternoon case was all he thought about as the automatic doors of the ER slid open to the fading daylight and he stepped outside. He scanned the vehicles at the curb looking for the ambulance operated by Casey, his best friend and brother-in-law.
The vehicle abutted the curb but his paramedic buddy wasn’t anywhere to be seen. Looking down the parking lot at the long corridor of concrete and the few remaining cars, Danny began a slow jaunt across the lot to his vehicle at the far end. Sometimes heading home was the best part of the day.
Like his just-finished intracranial case which continued to bother him, it dawned on him that the sky had taken on a strange quality. Storm clouds stacked up and a thunderstorm brewed in the distance. The westerly wind which had brushed across his face died down as the air became very still. Danny rubbed his eyes. Was the greenish tinge to the air an optical illusion?
As Danny passed empty parking spots, a light bulb in a tall overhead pole flickered on and off. He darted his gaze away from the overhead fixture which seemed to have become possessed and he picked up his pace. Ahead, there appeared to be precipitation; the nasty weather was growing closer.
The faster Danny walked, the faster the green wall of rain approached. His heart rate sped up as the shower began drenching him and he spurted forward. But it didn’t last … golf-ball-sized hail took its place.
Danny raised his right arm over his head for protection. His feet already felt soggy as he splashed along the asphalt. The condition of his new shoes was easy to dismiss as he spotted an umbrella-shaped cloud in the near distance and he had a bad feeling that a tornado might develop.
His instincts did not betray him as a single funnel cloud formed. Yet he wondered if it was his ears that were deceiving him; it sounded like bees were swarming.
The noise switched to one of a loud train but that didn’t make sense either. As fear struck him, a fully-formed tornado sped his way.
Through the nightmarish weather, Danny realized he’d never make it to his car. But he wasn’t sure that getting there would render him any more safety than out in the open. He ran as fast as he could towards the next light pole, ducking all the while to ward off being hurt by the bombardment of hail.
It was too late. He knew it. The feeling of dread ebbed away as he became mesmerized by the twister. He slowed – transfixed - and held his position. He’d never witnessed such spectacular raw power, beautiful yet deadly. It had started thin but had grown wider. Watching the counterclockwise spinning spectacle, the thought came to him in a flash that he was witnessing near-biblical weather.
Now the tornado was directly overhead.
When the winds hit Danny’s face, he thought he was being slapped backhanded at one-hundred miles per hour. He then left what was known and familiar and was swept away to a rarely, if ever, inhabited place. He found himself inside a swirling cloud. It felt like air was being pulled out of his lungs and he gasped for oxygen while warmth and humidity made his already wet clothes cling to him like honey. An unfamiliar odor also washed over his nostrils – unpleasant and strong.
Danny looked up. With nothing to compare it to, he had no sense of distance but the circular opening stretched to heaven, if there was such a thing. Through the wide interior, lightning darted from one side to the other. He felt small and meek and figured the lightning would zigzag straight through his chest.
Time lingered. This must be what it’s like in a coffin, he thought, as the stillness and dankness overwhelmed him. The light show continued, illuminating the rotating cloud walls; he liked their blue tinge better than the green he encountered outside the twister.
A sudden loud noise erupted like a hissing snake as a secondary small tornado formed, then spun away. A whishing sound engulfed him and then darkness.
-----
Danny bobbed in a red liquid. The viscosity was somewhat between water and creamed soup so he realized he was floating in blood. The material sped so fast, he barely had time to figure out where he was.
He recognized the pumping chamber all around him – the left ventricle. But whose heart was he in? It must be his last patient’s.
Of course, he thought, he hadn’t directly dealt with cardiovascular anatomy while being a neurosurgeon but that’s what medical school had been about – learning it all before branching out into a specialty. In any case, the heart and its blood vessels had major significance for what he did since the heart supplied fifteen percent of its blood flow to the brain. Brains needed all of that, yet too much or too little had dire consequences for his patients.
Like being on a fast-moving waterslide, he shot through the aortic valve when the heart pumped during its next beat. Now he was in the ascending aorta. It was nice and wide – enough space that his body did a full somersault. Red blood cells and white cells and platelets ricocheted off him.
He made it to the arch of the aorta and a to the arch of the aorta and a sharp left turn catapulted him straight up the left common carotid artery through the patient’s neck straight into the left internal carotid artery. What a ride!
As he heard the resonance of each heart beat in the human pipeline, he came to the point where the internal carotid artery branched inside the brain. He loved the anatomy and name given to the major circular vasculature he now flowed in – the Circle of Willis – so called after an English physician in the 17th century. He also respected the offshoot of smaller arteries which supplied the much needed oxygen to over
eighty percent of the cerebrum.
The passage got narrower. He tucked his arms straighter alongside his body as he traveled along in the middle cerebral artery. If he had a choice, he didn’t know which path to choose; which one would be a clever way of looking at all the branches called striate arteries. There are many such arteries, but this patient has many more than normal.
Danny took the next left turn and zoomed along into the patient’s temporal lobe, a lateral section of the brain. His own heart thumped as further arterial channels presented themselves. There were so many collateral arterial blood vessels that he couldn’t fathom how they all got there.
-----
Casey Hamilton was not only one of the regional paramedics, he was also Danny Tilson’s best friend from grade school. He had also married Danny’s sister, Mary, almost a year ago in the fall. Casey had finished his shift and had taken the ambulance for a late afternoon service appointment. After bringing it back to the hospital, he went inside to the small ER break room to grab a cup of coffee and check one more time for a weather update before heading home.
After seeing the empty coffeepot, he opted for a can of coke. His muscular physique leaned back against the counter as he looked up at the television in the upper corner.
A tall nurse, much younger than Casey’s age of forty-nine, walked in. “I thought you left hours ago,” she said.
“I did. But I brought the ambulance for a tune-up. I’m leaving now. You trying to get rid of me?”
“Never,” she smiled, blushing and pulling a paper cup off the shelf.
“Be careful when you leave,” he said. “Bad weather’s been heading northeast from Texas and Arkansas and they just said we’re under a tornado watch.” He nodded up at the television.
Taking a sip of his soda, he looked out the door and was glad he did. Danny passed through the hallway headed out the back door and Casey stepped forward to catch up with his friend.
“I can never get it straight,” said the nurse. “What’s the difference between a watch and a warning?”
Casey paused, knowing he’d be able to catch up to Danny. “They issue a watch when there’s the potential for a tornado. I know it’s confusing. The skies can be clear, it’s just that the conditions are ripe. A warning means that a funnel cloud has actually been sighted or they’ve seen one on radar.”
“You’re so smart.”
“Not really. I just better know that if I’m transporting and caring for sick people.” He dropped the soda can into the recycling container. “I have to run. Have a good night.”
“You, too,” she said.
Casey stepped forward and was out the door as the nurse’s smile faded with disappointment to see him leave. His steps quickened because he wanted to talk to Danny and make sure he knew about the weather threat.
When he exited into the back lot of the hospital, he was taken by surprise. He spotted Danny running as a pounding rain with a putrid color quickly made its way to the covered entrance. It changed to hail which pinged off the roof so Casey had no choice but to wait. For sure, he wouldn’t be able to catch Danny now and he decided not to run to his own car. In any case, he’d see Danny later at home.
As Casey’s ears strained at a sound like a locomotive roaring his way, a tornado dipped straight down from the angry sky. The funnel cloud looked like a gloved finger from above stretching out towards the parking lot, zooming around counterclockwise at an incomprehensible speed. No weather video or movie he had ever seen could have prepared him for the actual phenomena which evolved on the far side of the lot.
As Casey gaped at the spectacle, visibility became nearly impossible. However, it was what disappeared inside the tornado that took his breath away … his best friend and brother-in-law was gone.
Chapter 2
The hail abated as a secondary funnel spun off the first one while the main vertical cloud headed westward. Casey narrowed his eyes and held his hand on the top of his crew cut in disbelief, then dug his hands into his pockets for his keys. He’d never make it to his own vehicle in time to chase after Danny so he opted for the ambulance and darted towards the vehicle. Once inside, he turned on the ignition, backed out, and the preposterousness of it dawned on him - how life can change in a heartbeat. In a few short minutes he had turned into a storm chaser, following a twister that had sucked up his best friend and his heart galloped thinking of the worst possible outcome.
He raced the ambulance through the lot and made a right turn onto the multi-lane parkway. The secondary twister dissipated as fast as it had formed though the main revolving cloud stayed parallel to the street, avoiding the buildings and businesses farther to its right. Bushes and signs were disappearing in its wake as Casey kept a distance. For what seemed like practically a half a minute, the tornado spun upwards into the sky while debris was left on the ground or sputtered downward as the funnel ascended.
After passing another vehicle, Casey accelerated onto the shoulder lane and then slowed when he drove on the grass. He stopped and flung off his seatbelt, opened the door and ran to the three-foot trench created by the storm where a huge tangled mess of soft material lay. Even as he ran towards it, the monster was reforming again down the parkway.
Casey scrambled through some branches, careful not to slip into the deeper dirt. The area of destruction encompassed almost fifty feet and backed into a drainage ditch. He paused a second to surmise the situation and focus on looking for his friend.
“Danny!” he shouted as he walked along the left side. Casey knew he may have to backtrack and pull out a lot of junk to get a look at what lay further below … then he spotted a blue color from the other side. Running to the storm ditch, he crossed over and hurried back along another ten feet where he found a dirty shirt he’d spotted through the brush. An arm was poking through and lying near the surface.
“Danny?”
Casey cleared soggy grass, pieces of sign wreckage and soft plant material off his friend. Danny’s eyes were closed, his face was dirty and bruised, and his clothes looked like they’d been reused for a month after serious yard work.
“Talk to me, buddy.” Casey grabbed his arm and pulled him out just enough to get a better look and to place his fingers along his neck. “Thank goodness,” he murmured after confirming a good pulse. He tilted Danny’s head back to allow for a better passage of air and simultaneously watched his chest moving.
Satisfied he’d evaluated Danny’s airway, breathing and circulation, he got a firm grasp of his head and shoulders and extracted him a little further.
“Danny … come on, buddy. Wake up.”
Less than a mumble came out of his friend’s mouth as Casey examined his upper body for wounds and possible fractures. Then, thinking he could safely get Danny further out from the jumbled mess ensnarling him, he ran off to the ambulance and drove it over as close as possible to the site.
-----
Danny’s eyes stayed shut as he peered into their darkness and the awareness of his own existence slowly returned. He felt calm, practically sedated, and knew he was lying on a bed. As he methodically remembered what happened after leaving the hospital, he couldn’t fathom how he could be thinking or feeling anything.
I should be dead. How come I’m still alive?
At the bottom of the bed near his legs, he felt a small movement. He opened his eyes to a darkened hospital room with a dim light by the sink. Casey sat in a cushioned chair with his feet propped on the end of the bed; he was asleep with his arms crossed and chiseled mouth slightly ajar.
He looked over at his own vital signs displayed on the monitor. They looked fine, including his oxygen saturation from the probe on his finger. An IV catheter was plugged off in his forearm with no fluids being infused. Surmising the situation, he did feel bruised in a few places but figured it didn’t amount to anything significant. He shook his head. I survived a tornado unscathed.
Danny heard a thump as Casey’s feet moved off the mattress and landed on the floor.
“You’re awake!” Casey slid his chair over and stared into his eyes. “How are you feeling?”
“Grateful to be alive,” he whispered.
Both men thought about that and, like reflecting on the passage of a loved one, they contemplated Danny’s unique second chance to continue living. They let a silence pass.
“You can tell me how I got here,” Danny said slowly, as if testing his vocal cords. “But more importantly, did any family member get hurt in the storm? Sara, Mary, Annabel, Nancy, Julia or Dakota?
“Sara and Mary only left an hour or two ago from the ER.”
Danny squirmed. “Was someone …?”
“Let me finish. Everything could have been a lot worse. Sara and the girls were fleeing into the house for cover, the twister getting unnervingly close. Your ex-wife took a bad fall and broke her right humerus; they treated her downstairs for a spiral fracture. She has a cast and won’t be using that arm for a while. Mary went with her and the only thing the two of them were concerned about was you.”
“A spiral fracture. Ouch. That must have hurt,” Danny said, grimacing. “I don’t deserve an ex like her or even a sister like Mary. Besides the fact that you and Mary need to boot me out of your house.”
“It’s your house, too, and I’m sick and tired of reminding you. But you’re not going anywhere soon because our bed and breakfast, in a matter of speaking, is expanding.”
Danny gave him a questioning look.
“The cul-de-sac over at Sara’s took a beating. The front porch of her house - your old house - blew away and there’s roof damage. Your older girls are safe and went to our place. After Sara went to the ER, Mary came too because all three of us were here.”
As Casey continued, Danny listened intently and reached over to a pitcher on the nightstand.
“Here, I’ll get that,” Casey said, pouring him a glass of water and handing it to him.