by Barbara Ebel
Danny stood next to his bed - the ICU nurse next to him – and grasped the thick hand below the IV, patting it. He also stimulated his feet, shined the pen light in his eyes and checked the last ICU nurse’s notes.
Danny let out an audible sigh as he looked at the male nurse and shook his head. “Prepare him for transport to the radiology suite. I’ll call the radiologist myself.”
While Rob was moved for head scans, Danny’s first scheduled case kept his attention focused. The patient had a metastatic lesion in his cerebral cortex caused by a lung cancer from cigarette smoking. That history was also clouded by the fact that he smoked cigars and drank alcohol on a daily basis. Just what caused his primary cancer was subject to debate, but Danny figured it was the combination of his unhealthy habits which caused a synergistic effect.
Just when he thought he’d seen it all in his profession, something more remarkable would show up. As he peered into the man’s gray matter and defined the lesion, the mass was an almost perfect sphere of cancerous cells that he’d ever needed to remove. He teased it from the surrounding tissue and dropped it into the specimen cup.
As he dabbed pledgets around the area to assure it was dry, the radiologist called and the circulator put the call on the loudspeaker.
“I hope you have some promising results,” Danny said.
“I’m afraid not, Danny. Rob King has a re-accumulation of his subdural hematoma.”
His optimism sank. A repeat operative intervention would increase Rob’s risk of neurologic deterioration, infection, abscess and other complications, postoperative seizures being one of them. He put down the suction catheter.
“Thanks, Joel. You’ve been helpful getting the CT done so fast. Did you get to do the angiogram as well?”
“This is the real kicker. The good and the bad. He has a profuse blood supply of his parietal lobe, but that may be the reason his subdural bleed is re-accumulating.”
“He’s not on any blood thinners and he has no history of anticoagulation. He’s a thirty-five year old fitness trainer.”
“Danny,” the radiologist sighed, “have you ever seen snowflakes crystallize on a window pane?”
“For sure.”
“Mr. King’s middle cerebral artery has prolific offshoot vessels … like water’s dripping and forming all those crystallized tributaries!”
Danny didn’t say anything. He just stared across at the intercom. After a dozen seconds, his eyes locked on to the anesthesiologist. The other male doctor gave him a thumbs up that his current patient was doing well with his anesthesia and vital signs and then said, “It sounds interesting, Danny. What’s causing that?”
“Your guess is as good as mine.”
“Danny, are you still there?” Joel asked.
“Yes, I’m sorry, but something is perplexing me. You said his parietal lobe, right?”
“That’s correct.”
“I need for you to do me a favor. I could pull the reports and results myself, but two heads are better than one.”
“I’m listening. And I’m a glutton for medical mysteries.”
“Keep Rob King’s results there and get CTs and angiograms for a lady named … let me think … it’s Branson, Paula Branson. And a Varg Dagmar.”
“Spell it, Danny.”
He spelled Varg’s name while looking at the surgical site below him, confident there was no oozing, before he began to close.
“I won’t be down there until later today,” Danny said.
“That’s fine. I’m curious about what we’re going to see. Knowing you, it can’t be trivial. You’re a magnet.”
Danny allowed himself to laugh which relieved the tension he felt in his neck.
“What is it you think I’m a magnet for?”
“Controversy,” he joked, mispronouncing the word, “and intellectually stimulating or cerebral cases. I won’t add the ‘personal trouble’ part.”
Danny laughed again. “Hey, I’m staying out of trouble these days.”
“What do you call swirling around in a tornado? A picnic? Listen, I’ll see you later.”
As Danny cleared his throat, the radiologist hung up and the OR scheduler walked in lugging her clipboard lists with all the daily cases and add-ons. She tilted her head at Danny. “Are you wrapping up? Can we send for your next patient?”
“Smile, Nurse Ratched,” he said. “We’ll postpone my next elective case and send for Rob King instead. Book him as a re-operation of an acute subdural hematoma.”
-----
As he lathered between his fingers at the scrub sink, Danny watched his favorite anesthesiologist doing ten things at once to get Rob King situated for surgery. He didn’t envy the professionals hidden in the OR behind masks who not only knew how to render patients unconscious and without pain, but also handled their medical care, resuscitation and acuity of problems. He knew that the ‘ologists’ who did liver and heart transplants or premature infant cases were even more specialized and Danny wouldn’t want to be in their shoes.
Dean first hooked the patient’s breathing tube into the anesthesia machine where he cranked on inhalational anesthetics, verified breath sounds – making sure the endotracheal tube hadn’t changed position during transport – attached all the monitors and then sorted out the maze of IV tubing. One of the IV’s didn’t work as well as it should, so Dean started a new one and removed the old.
Danny came in and, after the drapes settled over his patient’s long face and husky upper body, he started surgery. He had said a prayer last time for Rob. Did that mean it had been pointless? With his newfound spirituality, he didn’t want to abdicate prayer so soon. After all, he thought, there was such a thing as faith and he firmly believed that certain credible beliefs in the world had no basis of proof. When Danny began the slow suctioning and removal of the blood which was pressing on Rob’s brain, he mentally whispered an earnest request for his patient’s recovery. His surgical skills and experience were vitally important but prayer wouldn’t hurt.
At the end of the operation, Dean, the nurses and other personnel transported Rob back to the ICU and Danny grabbed a donut. Before long he’d be wrapping up another surgery and meeting with the radiologist.
-----
Within the semi-darkness of the radiologist’s room where Joel was reading films, Danny tapped him on the shoulder.
“Am I glad to see you,” Joel said. “You’ve made my day with these unusual and journal-worthy results all at the same time.”
“So I’m not imagining things?” He leaned his palms on the desk and looked squarely at the other doctor, yet he couldn’t slow down his heart rate which pumped ahead like a jaguar on the move.
“No. You’ve made a connection. Three different patients with similar angiograms.” He swiveled his chair around and pointed to the back wall.
It took Danny a few seconds to figure out each patient’s films while Joel waited for his reaction. “Extraordinary collateral circulation in three separate individuals,” Danny said, “and it’s not limited to one specific lobe.”
“Precisely,” Joel said. “We’ve got temporal, occipital and parietal lobes all represented.”
Danny laughed. “This isn’t funny, but have we been infiltrated by other-worldly beings?”
“Sometimes humor is the next best thing to seriousness,” Joel said, rubbing his glasses with a lens cloth. “I’m not kidding, you have made my day. Maybe my entire year. I’m reporting these to the Radiological Society of North America and writing them up for the “Radiology” journal.”
“That’s what the ophthalmologist said about reporting Paula Branson’s eye testing results along with her angiogram. Dr. Reaper is sending them to the Ophthalmology Society and The Journal of the American Academy of Ophthalmology.”
Chapter 16
Rachel reached over to the passenger seat and grabbed a pink straw sun hat and matching handbag. Since her accident eight days ago, she dressed more fashionably before venturing out to deviate atte
ntion away from her face. She closed the car door, arranged the hat over her hair, and headed for her oral and maxillofacial surgeon’s appointment.
Inside the small examining room where she waited, she read his credentials on the wall and found it ironic that a person with the last name of “Pain” would become a physician. When the door opened, he came in and shook her hand.
“Ms. Hendersen,” he said, already scrutinizing her face. “Let’s see what kind of progress you’ve made.”
She’d forgotten he was a good-looking man or perhaps it was because, a week ago her head had been swirling with medications. Nodding, she glanced at his left hand where a wedding band fit snugly.
The doctor reached over to the counter and pulled a tongue blade out of a glass container while she straightened her elbows and leaned back.
“I am not a complainer, Dr. Pain. In actuality, I hate people who whine about what – in essence – are their good lives. However, my face is as numb as a bottle of local anesthetic and as ugly and colorful as a crocodile.”
“You have a right to say something along those lines. People who bemoan petty things make themselves unbelievable when something happens that warrants complaining about.” He looked carefully at the right side of her face and pressed below her eye.
“Well put,” she said.
“Does that hurt when I press there?”
“Not too much.”
“I told you while you were in the hospital about the titanium plates I put in your face. This is the top edge of one of them, under my fingers. It shouldn’t bother you too much. As far as the numbness, I assure you that your nerves are regenerating. It can take up to one year to regain all or almost all of your feeling back.”
“So if I fall again and want to not hurt, I should do this next year.”
He stepped back and smiled. “That’s not a good plan. Now, say ‘ahh’.” He put the tongue blade in her mouth and looked beneath her upper lip.
When he stopped, she said, “That piece of tissue still feels weird.”
“In your last appointment, we can decide if you want me to do a quickie surgery and snip it.”
“No, actually not. However, I don’t think my lip is settling back the way it was, especially on the right side. It’s as if I lost most of it … like it’s turned under.”
“I see that. Let’s give it some time. If you are unhappy with it months from now, I can suggest a plastic surgeon who can pop some tissue filler in there.”
“Brilliant idea,” she said and smiled.
“You are healing appropriately,” he responded, throwing the tongue depressor in the garbage. “Your facial color is changing and will go through the spectrum of the rainbow, yet pale as it goes along. Have patience.” He waited a few seconds. “I want to see you in three weeks and then a month from then. Also, I’m writing out a slip suggesting a total of two weeks medical leave. By next week, I don’t think there’s any reason not to work.”
Rachel gasped. “Even though I look like …” She stopped. Although her face would scare anybody on the job, there wasn’t a medical reason for him to allow her leave to continue
“Do you have any questions?”
She gave him her widest smile possible; it couldn’t hurt as divorces do happen.
“No,” she purred. “I believe you have answered them and, by the way, I’m very grateful. Hopefully, I will look more than presentable again in a few weeks.”
“Maybe sooner than that,” he said.
-----
“You’re sure juggling a lot of issues around these days,” Casey said.
Danny and Casey made a right to the tables and chairs in Serious Gyms and put down three bags. Danny let go of Julia’s hand and patted her on the head.
“So how is it any different than usual?”
Casey shrugged his shoulders.
“However, our communal home situation benefits me more than anything else,” Danny said. “It’s a godsend.”
“We’re having more fun than most families these days,” Casey said. “Did you bring the workout sheet Rob had prepared for you?”
“I have it. And I didn’t tell you, but the unusual vascular brain pattern Rob displayed is present in two other recent patients. One of them you already know about - Varg Dagmar.”
Casey ran his hand along his crew cut. “The big Norwegian realtor who I met in here last time? The one you had the dream about?”
“Yeah. That’s him. And he’s coming here tonight about lakefront property. Besides the fact that we’re going to list our old house with him.”
“Sounds reasonable to me.”
They both took water bottles from their bags, then Danny opened a small container with Cheerios and set it before Julia. She looked as sporty as they did with a headband in her dark blonde hair and sneakers on her little feet.
Casey signed them in and came back. “I’ll watch Julia if you want to start warming up.”
“No, that’s okay. Rachel’s walking in to get Julia for visitation as we speak.”
Rachel stepped in and, after looking around, spotted them and walked over. “Hello, Danny.” She mumbled a “Casey,” and then stooped down.
“If you aren’t a picture,” she said, and embraced her daughter. When Rachel let go, Julia scrunched up her face and stared at her mother.
“The boo-boos on my face will get better, sweetheart.”
“How did your surgeon’s appointment go?” Danny asked.
Rachel lifted her head. “I can’t thank that stupid Evan Parks for suggesting we hike where we did but I can thank you for procuring me a decent surgeon. I think.”
Danny relaxed into a faint smile. “A Le Forte II fracture takes time to heal. You’re still lucky he didn’t wire your mouth shut.”
“I don’t know about that,” Casey murmured.
Rachel gave Casey a dirty look, then turned to avoid him and stared at Danny. “I have something to tell you.”
“I’ll be working out,” Casey said. He grabbed his water bottle and strode towards the treadmill.
Rachel put her purse on the table, sat down, picked up Julia, and kissed the top of her head. “I’ve decided. I have another week of leave from work but I’m calling in to give notice that I’m quitting. I’ll find a job in the Nashville area so I’ll want to see Julia more often.”
A nastiness like sour milk popped up in Danny’s mouth. “But you’d be much farther away from Evan.”
“Doesn’t matter. I have no one or nothing holding me in Knoxville anymore.”
“The hospital here probably won’t hire you back since you previously skipped out on your job.”
“There are more ORs in this town than General Mills has Cheerios,” she said glancing at Julia’s bowl.
“Okay, I hear you. Yet let’s keep visitation smooth … not only for us, but for Julia, too.” He didn’t want to talk about it anymore and glanced over at Casey who was moving at a quick pace.
“Enjoy some time with Julia. I have to get going,” he said, nodding towards the machines. “I’m meeting someone else in a little while.” He grabbed his athletic bottle, filled it from the water fountain, and went to the floor mat. Not remembering his workout, he took out Rob’s paper and referred to the first page.
-----
Rachel finally let Julia wiggle off her lap. She slipped a cardboard children’s book from her purse and opened it to the first page. This won’t work, she thought; her daughter had already outgrown the whole picture book. All the things that she previously had at Leo’s place were for infants, not for a walking, talking two-year-old. She let out a sigh and turned around to face the table. Slipping the book back into the bag, she looked for something more amusing for Julia.
Meanwhile, the front door of Serious Gyms opened and a man entered - a pony-tailed Norwegian. Heading straight to the registration desk, he signed in and told the employee to put a few cold drinks on his account. Not that it mattered that much anyway as it was his business which supplied the
m to the gym.
The man walked along the wall with the refrigerated units and, when he reached the first one near the front window, he fumbled around inside, bypassing the common workout thirst quenchers. His palm wrapped around a twenty-four ounce can of Blue Bridge which he put in the netted side sleeve of his bag. Reaching back in, he took another one and popped open the tab.
As he took his first swig, something slapped into his bare calf. He quickly looked down and, to his surprise, a little girl proceeded to tumble on top of his sneakers. As his instincts kicked in and he crouched down to see if she was alright, she hastily crawled away. In his squatted position, he moved the same short distance towards her.
At first, he didn’t come face-to-face with Julia’s destination. In front of him was a pair of sandals and a very nice pair of legs, definitely dressed in a skirt. He put his free hand on the floor to stabilize himself and gazed up. His head bobbed back and his mouth fell open.
“I haven’t always looked like this,” said a velvet voice.
He composed himself. “Neither have I.”
Rachel smiled, impressed at the astute comeback.
“Is this pretty little girl yours?” he asked. Even though something had happened to her face – he wondered if she’d been slapped around – he now recognized that her eyes were a stunning aquamarine color.
“Yes, she is. Her name is Julia.”
“And what is her mother’s name?”
“I’m Rachel Hendersen. And you are?”
“Varg Dagmar.” He continued to stay in a crouched position holding on to his drink while Julia clung to her mother’s skirt. “Is she shy?”
Rachel wrapped her arm around her. “Mostly to men she doesn’t know.”
“Ms. Hendersen, that is an asset for a tyke her age. You are a smart mother to not change her leeriness of strangers.”
“I’ll remember that. And you can call me Rachel.”
She swiveled her legs to the side as he started to get up, allowing him to lean on the edge of her seat for support.