Collateral Circulation

by Barbara Ebel

  “Quite a coincidence,” she said.

  “What is?”

  “Looks like you also had something recently done to you head.” She raised her arm; a three-quarter length lemon chiffon sleeve hung like silk and a silver bracelet shimmied past her wrist as she pointed to the left side over his ear.

  “Oh, that. It’s nothing. I mean, nothing like what’s happened to you.”

  Her eyes glared.

  He bumped his free hand against his forehead and placed his drink on the table. “I’m so sorry. I didn’t mean it to sound like that. I bet when you recover from your injuries you are a beautiful woman. Even now I can see that.”

  In a way, she realized his dilemma. Hell, she knew how bad she looked.

  “I will get out of your way,” he said looking at Julia one more time. He picked up his drink, took a step and stopped. “If you weren’t married, I’d ask for your forgiveness again over dinner.” He grinned tightly with his lips closed.

  “I’m not married … not in the least bit.”

  The smile lines around his eyes brightened. “I hope your marital situation is not because a husband was beating you up and you had to rightfully divorce him.”

  “No, it’s not like that. My facial injuries are due to a fall.”

  “I bet you are not clumsy so, therefore, it must have been some kind of inadvertent disaster or misadventure because you look well-conditioned.”

  “Are you a car buff? You make me sound like a tuned-up motor.”

  “No. I’m sorry again. My sister tells me I don’t talk like most people and that it’s getting worse.”

  Rachel smiled and pulled Julia in closer, putting her arm around her. “That’s two apologies you’ve given me. Maybe we can go for a third over the dinner you suggested.”

  Varg grabbed the nearby chair, sat down, and took a large sip of his drink. It was time to ask this lady for her phone number.

  -----

  The best motivation Danny had for weight training was standing alongside his brother-in-law with a set of dumbbells and realizing how fit Casey was. In their short sleeve workout tops, the difference showed in their biceps and triceps; the definition of their chest and back was also apparent. Although some of their strength training was similar, Casey held much heavier weights.

  “Looks like the next thing Rob gave you to do,” Casey said looking at Danny’s sheet, “is dumbbell half-squats. The trick is to keep our movements controlled and carefully defined.” They both hydrated from their bottles while Danny glanced at the other side of the gym to check on Julia.

  His daughter hung at Rachel’s side. However, it looked like Varg Dagmar had arrived for their meeting and he was talking a blue streak like usual … with Rachel.

  Danny cleared his throat and nodded as Casey followed his stare.

  “I think your patient has found something else to have a meeting about,” Casey said.

  Danny replied, “Yeah, so I better go talk with him first. Do you want to hear what he has to say about lakefront property?”

  “For sure. We’ll come back if this doesn’t take too long.”

  They approached the table and Varg immediately grinned. “Dr. Tilson, Casey Hamilton,” he said, acknowledging them and standing up. “I’m glad we could meet tonight. I was just chatting with this lovely lady but we’re finished.” Turning to Rachel, he said, “This is the doctor who did the surgery on my head.”

  “I know Danny, too,” she said. “He happens to be Julia’s father.”

  Varg stood speechless, wondering how and if this changed anything to do with their potential dinner. Apparently Dr. Tilson was not only a fine surgeon but he also had fine taste in women.

  “What was the surgery for?” Rachel asked.

  “Oh that. I had a lesion inside my brain.”

  “What kind?” she asked thoughtfully. “I’m in the medical field.”

  “Really?”

  She shook her head, quickly looked at Danny and Casey, then planted her eyes back on Varg.

  “It was a benign meningioma,” Varg said.

  “By the way, did you have your testing today?” Danny asked him. “If so, we can go over the results during your office appointment tomorrow.”

  “Yes, I did.”

  “Good … so would you like to discuss real estate now or did you want to work out first?”

  “Real estate?” Rachel interjected.

  “Yes,” Varg said. “I am a broker. I have hired realtors who do most of the work. I split my time between another business and particular real estate clients.”

  “I know when I’m not wanted,” she said while looking at Danny. “I’ll mind Julia at the next table. However, Varg, I am moving to Nashville and maybe you can help me find a place to rent.” She got up and smoothed out her skirt.

  Varg glanced at Danny, then back at Rachel. “That depends. Are we still on for dinner?”

  Without a pause, she answered, “No question about it.”

  “Then we shall spend an afternoon looking at rental properties followed by fine dining in downtown Nashville.” He took her hand and kissed it.

  Chapter 17

  The three men dwarfed the circular table. Although Casey and Varg had toned, solid shoulders, Danny’s six-foot-two height made him feel like he had an edge at something.

  “Here’s the address of my old home,” Danny said to Varg, “where my ex-wife was living until recently. We’d like to put it on the market and list it with you.”

  “Wait a minute,” Varg said. “You know how to confuse a person.”

  Casey jumped in, knowing that sometimes Danny got tired of explaining his circumstances. “Danny was married once and is now good friends with his ex-wife. They are going to list their old house and buy something new with your help. Rachel is a former girlfriend and you’ve met their daughter, Julia.”

  “Thank you,” he said, still looking bewildered.

  Danny rolled his eyes. “It’s not what it seems. Let’s change the subject. Show me what you have.”

  Varg pulled a folder out of the bag he’d left on the floor; he slapped it in front of them and opened it up. “Number One. A 2,200 square-foot log cabin on Center Hill Lake, grandfathered in close to the water under previous terms and conditions with the Tennessee Valley Corps of Engineers. Since that time, properties are not allowed to be developed right near the shore. A country singer was and is the owner and wants to sell. They’ve hit the big time and are on the road for concerts all the time.”

  Danny looked at the pictures one at a time and passed them to Casey.

  “You would have your own dock, doc,” he said pointing at a picture. He crushed his drink can and slipped out the next photo from his bag’s pouch. “This beauty is a steal. I would buy it myself except for my business interests. “At $750,000, it’ll cost you just pennies each time you go swimming or boating on this pristine lake for the rest of your lifetime. USA Today has called Center Hill Lake one of the best lakes in the nation for houseboats. Which tells you how desirable it is.”

  Danny scrunched up his forehead. “Are you saying this is the only house on the lake where you have access in your front yard to the lake?”

  “That’s what I’m saying. That’s what I’m talking about.”

  Varg let them glance through all the photos, then took out the next set of clipped papers and pictures. “Here’s my penultimate listing, gentlemen.”

  With heightened interest over the first listing, Danny and Casey breezed through the next two while Rachel strained her ears the entire time. Knowing that Danny might spend three-quarters of a million dollars on a cabin may weigh heavily in her favor, she thought, when she convinced a judge she deserved more time with Julia so was deserving of more child support from Mr. Moneybags.

  -----

  Danny arrived for rounds so early in the morning that he beat most 7:00 a.m. shift workers.

  Rob’s EKG pranced across the monitor above the bed with a normal rate and rhythm, and the cont
rolled mechanical ventilation for his breathing made the same rhythmic sounds as his heart. Danny stared at the two-hundred pound personal trainer who had made no progress awakening from his traumatic brain injury surgeries. At least the hematoma was not re-accumulating blood but his patient was showing no signs of stirring.

  Danny changed the orders to half the sedation Rob currently received as he wanted no medication to interfere with his waking up. Before he left, he pulled a vinyl chair alongside the bed and lowered himself despondently.

  Perhaps he wasn’t good enough to say prayers or have any answered for Rob King. After all, God had already shined down on him and been more than merciful. Or, he wondered, perhaps his appeal to a higher deity had made a huge difference. Worse things could have happened to Rob, even the loss of his life. Danny closed his eyes. It is God’s will for you to be healed, he said silently, and I will leave it at that.

  He got up and left, finished rounds, and was in the office before Cheryl. After putting on a pot of Columbian, he carried a hot mug to his desk and sat with the neurologist’s report which he’d been expecting from Penny Banks. He began reading her preliminaries on Garret Archer, mostly from condensed information he had sent her:

  51-year-old male status post anterior cerebral artery aneurysm clipping with new onset simple focal seizures.

  He speed read, glanced over the social history of ‘motorcycle rider,’ and continued to the MRI results which had shown a lack of normal brain circulation after the area of the aneurysm he had clipped. Next was an explanation of what Dr. Banks did:

  Because of Mr. Archer’s apparent deficit of circulation to the frontal lobe, I performed a comprehensive neuropsychological evaluation which involved measuring motor skills, social behavior, spontaneity, impulse control, memory, problem solving, language, and more.

  For the time being, Danny skipped over some of the actual testing and read her impression and summary.

  I found a direct correlation between Mr. Archer’s physical circulatory deficit and the role that the frontal lobe plays in mental processes such as planning or being able to speak fluently (without fault) and meaningfully.

  Of note is that this patient does not have these results as would a patient who suffered a stroke. On the contrary, it is like the anterior cerebral artery’s circulation to the frontal lobe was chopped off in some mysterious way.

  I suggest further follow-up (which is probably already planned). Treatment and rehabilitation may enable Mr. Archer to regain a degree of prior functioning. Strengthening existing skills and compensating for lost skills are the goals of rehabilitation and recovery.

  However, in this case, compensation for an area of the brain without an adequate blood supply, hence oxygenation, has a poor prognosis.

  He realized he’d been clicking his pen on and off; he put it down and instead sipped his coffee. The report made sense and was what he expected. So he’d see Garret Archer in the office and schedule him for rehab. His motorcycle days were over but Danny would allow Garret to continue whatever workouts he could endure at the gym.

  -----

  Danny strode through the hallway and into the kitchen, mostly to see if Dr. Foord had arrived, if the front desk personnel had arrived, and if Cheryl was getting his patient’s charts and pending results lined up for the morning. Plus, his mouth watered. It had been several weeks since his nurse had brought in something she’d baked and she’d promised something for today.

  Jeffrey beat him to it. The quiet doctor leaned over the table eating a slice of peach bread as Danny slid a piece on a plate and said, ‘Good morning.’

  “It is with this to eat,” Jeffrey replied.

  Cheryl walked in and adjusted the band on her ponytail. “I heard that. And good morning, Dr. Tilson.”

  “Likewise.” He gave her a broad smile. “Dr. Jacob will be in surgery all day today,” he said when he finished.

  “And he’s also the doc on call,” Cheryl said.

  “Okay. We have a full line-up, including Varg Dagmar who may tend to get chatty about real estate ... you may need to help me out with that.”

  “No problem.”

  “I hope there will be some peach bread left over for later.” Jeffrey said as he got up, washed his hands, and sadly gave the bread a farewell look.

  “Jeffrey,” Danny said, “what you have to do is smuggle a piece into your office for later. And it’s not bread; it’s dessert cake.”

  Cheryl smiled at the two men as she watched Dr. Foord follow this suggestion. She also knew Danny would refrain from doing that himself so everyone else would get their fill.

  -----

  Late in the morning, Danny saw Varg Dagmar in the waiting room with his head bent over a thick book. In the minute it took him to give a patient’s paperwork to the girls at the front desk, Varg turned two or three pages. It reminded Danny to duck into his office and read the report from Marlene Bowen.

  At his desk, Danny opened up the psychologist’s folder to a substantial stack of papers. The assessment included the results of Varg’s clinical interview, intellectual functioning, and personality and behavioral assessments … it was a mind-boggling thorough appraisal.

  Danny took a deep breath and eyed the phone. He decided to call Marlene - a friendly lady he knew from college - to thank her for such a quick faxed report and to talk to her about her findings.

  “Oh, Danny Boy,” she said when she answered. “Every time I hear from you, I want to break out in a ballad!”

  Danny laughed, started to respond, but broke out into more laughter. “Marlene, you’re priceless. Thank you for that exuberant greeting.”

  “No, you’re the one who’s priceless sending me that patient of yours. I’m going to skip the chitchat about how well you are doing and get to the reason for this call. Did you see the remarkable results of your Varg Dagmar?”

  “Yes, that’s why I’m calling … to get to the bottom of it. I need a layman’s, errr … I mean, neurosurgeon’s interpretation from the psychologist so I can save three hours of my time.”

  “Now I’ll do the laughing. Okay. You probably have the four major types of testing on him in your hands. You sent him to me because you wanted hard-core data on his psychological or mental health problems, personality, IQ, or whatever. What you know about testing is that it identifies someone’s weaknesses and their strengths.”

  She paused and continued while Danny relaxed, gazing at the Norman Rockwell print he’d brought from his old office.

  “But get this. In Dagmar’s case, my evaluation only identified strengths. In other words, he has no weaknesses. I have never seen this before but I gathered from the clinical interview - which closely explores various stages of a patient’s life - that this is a relatively newer phenomenon for him. And since you recently operated, I was wondering what you did,” she said jovially.

  After a chuckle, Danny said, “I assure you, it wasn’t from anything I did.”

  “Dagmar’s verbal comprehension scale was the topmost I’ve ever seen. I couldn’t tell what was more enjoyable for me – seeing the results or listening to him myself. With his working memory scale and arithmetic skills, I asked him if he wanted a job doing my books but he said ‘no’. You also have before you outstanding perceptual reasoning and processing-speed results. In our lifetimes, we may not personally encounter a human being with a Wechsler Adult Intelligence Scale this high ever again.”

  Danny mulled it over as if deciding how to answer a critical board question.

  “Are you still there?” she asked.

  “I am. Varg has an enormous collateral circulation to his temporal lobe, you know.”

  “Why is he so special? Can you reproduce what he has that the rest of us don’t?”

  “I’ll get right on it.”

  “Okay, Danny Boy. I hate to be informal with you but anybody who put up with me in college is undoubtedly a friend and I need to run.”

  Danny hung up and headed straight to room 2 where Varg Dagmar wai
ted.

  Chapter 18

  Danny opened the door and both men made eye contact as Varg reached down from his chair, placing his book on the tile floor. His patient had obviously avoided waiting on the examination table.

  “I hope you followed my advice after we left the gym last night,” Danny said. “Did you keep your routine to a minimum?”

  “Statistically speaking, I pumped half the number of repetitions of a normal workout and performed them at one-third the resistance. Does that have your seal of approval?”

  “That was fine.”

  “Doc, overall that calculates out to be approximately a quarter of what I normally do for strength training. That’s a slow start. And, cardiac wise, the statistical analysis of what I did bordered on thirty-three percent of normal for me.”

  “You are a good patient. Thank you for that.” Danny lowered himself into the desk chair close to Varg. He peered at the book title: Chesapeake by James A. Michener.

  “I just started it.”

  “I’ll expect a full book report by the weekend,” Danny countered.

  “You sent me to a challenging appointment yesterday,” Varg said. “Dr. Bowen kept tossing one test after the other at me. I’m not worried. I think I passed.” He smiled at his comment, displaying his missing tooth.

  Danny started to explain it wasn’t about ‘passing,’ but stopped. The last thing the overly-smart man needed was an explanation of his evaluation the day before.

  “I have Dr. Bowen’s report already and spoke with her as well.”

  Varg hunched over, his thick hands clasped between his thighs.

  “Speaking to the psychologist proved to be revealing. She’s as curious about you as I am. I’ll have Cheryl copy it, though I may not have considered this for another patient. However, in your case, I know you are going to read and digest all of Dr. Bowen’s reports and understand every word.”

  Danny rose and opened the door. When Cheryl passed, he asked her to give the file to the front desk staff to print. “What I’m saying is that you score extremely above average in I.Q., verbal comprehension, memory and all other parameters,” he said stepping back into the room.