by Barbara Ebel
“Mmhmm,” she mumbled.
He checked on Julia – who was fast asleep – then glanced at Mary and Casey’s bedroom door wishing Casey was on duty. After letting Dakota out for a short romp, he poured fresh coffee in a beverage cup and left.
Sometimes Danny marveled at the expeditiousness of medical care, especially early in the morning when the ER had cleared the previous night’s drunk driving accidents, domestic violence cases, and bruises and broken bones from folks not seeing curbs and obstacles after partying hard in Nashville.
He went through the back door so he didn’t encounter Rachel and walked into Varg’s room as the anesthesiologist was removing his gloves.
“Hey, Danny,” Dean said. “He was a precarious intubation, so they called me. Job’s done.”
Danny studied the situation; Varg with an endotracheal tube, breathing from a ventilator and eyes shut. “Thanks, Dean. He’s been a patient of mine.”
Dean picked up his stethoscope, adjusted it around his neck, and went off to write a procedure note.
As Danny proceeded to evaluate Varg, the ER doc motioned across his white-sheeted body. “Let’s see what you get,” he said, referring to the Glasgow Coma Scale.
Besides not opening his eyes, the most Danny got from Varg were incomprehensible sounds and extension to painful stimuli. “A five.” Danny scowled. The two doctors looked forlorn since the scale’s best or normal score was a fifteen.
After a more thorough examination, the x-ray technician brought films into the room for the ER doc. They studied them together, alongside the post-op films from when Danny had done surgery on his benign meningioma. He felt so distraught, the technician lingered and asked if he’d like to sit down. The ER physician pulled a chair beside him.
“This is because of that devil’s drink,” Danny managed to say. “I can admit him and my group and I can take care of him. Dr. Banks as well, if needed.”
He gazed over everyone in the waiting room. Behind a thick pole, Mary Ann was hunched over a table and Rachel sat with her back to the same table, swinging her leg with boredom or anxiety - he couldn’t tell which. When he approached, he touched Mary Ann and Rachel turned.
“Dr. Tilson, I’m so glad it’s you. How’s my brother?”
The secluded area had few other people and Danny lowered himself into a plastic chair. He took Mary Ann’s hand. “He’s nonresponsive and his breathing was so negligible, they’ve put him on a ventilator.”
“But that’s for right now, correct? I mean, he probably had some kind of spell and will wake up in a day or two?”
He let a few silent seconds elapse. Rachel clasped her hands and twisted her thumbs while Mary Ann’s grief showed in her pale face. She leaned in closer to Danny to hear his reply.
“I would like to offer you hope like that. However, the pictures taken of his brain are ominous.”
“He was complaining of a headache last night,” Rachel said, pulling at a breast pocket of her blouse. “He said he never had them before.”
Mary Ann stared at Rachel. “Why didn’t you take him to the hospital?”
“For a headache?”
“Yes, for a headache. Isn’t that apparently what was needed?”
“In retrospect, but not at the time.”
“Sure. I can guess that would have interfered with you digging your claws into him. A nice business he set you up with.”
“Ladies, please.” Danny leaned back. “Look, the bottom line is that there are structural changes to his brain, his left temporal lobe.” He pointed for Mary Ann’s benefit. “There is a great deal of brain tissue no longer receiving oxygen and blood flow.”
“Can’t you operate?”
Tormented, he looked down at his hands. “I am sorry, no. There is no fix for this.”
“But what caused it?”
Careful not to glare at Rachel, he looked from one to the other. “My suspicions? I would put my two cents on that harmful drink you’re peddling.”
-----
Danny passed right by the soup pot, the cold cuts, and the three leftover donuts hardening in a box as the doctor’s lounge was the last place he wanted to eat lunch. He drove straight home and found Annabel’s car in the driveway. Parking behind her, Danny went in the front door, his spirits rising upon hearing the jovial noise from the kitchen. Almost everyone who mattered the most to him had assembled in one room.
As usual, Dakota broke away first and wiggled in front of him, waiting for recognition; Danny wrestled him while greeting his family.
“Hey, Dad,” Annabel said. “I thought I’d come over for a few hours and then David and I are going to the movies and back to campus.”
David stood behind her and extended his hand for a hello. “Nice to meet you,” he said.
“Likewise,” Danny said, immediately noticing the dimple in his chin.
Sara crouched down and edged Julia toward her father who picked her up to give her a kiss. “This is a very pleasant place to come home to.” He locked eyes with his ex-wife and she stroked his arm as Casey walked in the room wearing sweatpants and a football team T-shirt, rumpled from sleeping in them.
“You’re already up?” Mary asked her husband. “That’s not enough sleep after an 11-7 shift.”
He shrugged. “I’ll live. I wouldn’t miss this gathering. Let’s have some kind of brunch. And glad you’re here, David and Annabel.” He lightly shook David’s hand.
Danny looked at Casey questioningly. “Have you two met before?”
Casey opened his eyes wider and peeked toward Annabel who twisted her mouth. Nancy shot a glance at her sister and slipped onto a stool, waiting for the fireworks.
“Uh, well …,” David stumbled.
“We met,” Casey said. He focused on Annabel, but no one continued.
“We met David at the lake house, Danny.” Mary had stepped up to the kitchen counter, a cup of tea in her hand.
“I guess I’m out of the loop,” Danny said. “Sometimes I’m working too hard.” He was met with another silence. “Oh. Now I get it.” He turned to Sara. “Did you know about this?” She indicated ‘no’ with a shake of her head.
Danny put Julia down and clasped her hand, his eyes blazing with fury at Casey. “I don’t appreciate not being told.” He took a step back. “And, you, young lady,” he said, looking at Annabel, “You’re grounded. But, since you’re away at college, I don’t think that’s going to work!!”
Casting another derogatory glance at Casey, he took Julia downstairs, Dakota at his heels.
-----
Danny went to sleep early before Sara.
When he awoke in the morning, he didn’t wake Sara and he didn’t hear any footsteps overhead. He made Julia a piece of toast and then they went out their back door to accompany Dakota. The air was crisp and dry and high clouds passed swiftly.
He sipped from an oversized mug full of hot, steaming French roast and looked forward to Sunday mass. What was it? The serenity? The only time in the week he had to reflect? Or was it the thoughtful sermon or the chance to communicate silently and freely with god or a higher power? Of course, he loved having Julia with him. He hoped she would benefit from their excursions and keep spirituality close to her heart as she aged.
They arrived with twenty minutes to spare. His shoes echoed off the wooden floor as Julia skipped ahead to the white beeswax candles. He smiled at her enjoyment; she seemed to be fond of their ritual.
When Danny reached his daughter, she sat down on the kneeling step. “Would you like to be next to me while I light a candle for your grandma and grandpa?”
Julia looked at her black patent leather shoes. She tapped them with her hand.
“Julia?” Danny asked.
She stood quickly but didn’t respond.
“Julia, come here.”
She stepped backward and twirled her hair. “I like Mommy’s candles better.”
“What candles, sweetheart?”
“On our table. All of those candles
there.”
“Glowing, like these?”
“Yes… Mommy and I do candles.” She gave her father a scornful look and sat back down facing away. She mumbled something and Danny’s heart thumped. He could swear he heard her say, “And she loves me more so I belong with her.”
-----
Danny opened the door to see Sara putting on her shoes while Julia ran into her bedroom. “I don’t think you needed to get that upset last night,” she said.
He grimaced while running his hand over his head. “Our realtor is in the ICU, Sara. He’s barely neurologically alive. Customers of that energy drink are having major intracranial crises and I can’t get Rachel to lay low with its advertising. What I’m dealing with is serious.”
He continued while she softened her expression and looked up at him. “I don’t know what’s going on with our daughter in college, my best friend and sister hide things from me, and there’s trouble on the horizon with Julia.”
“Keeping things from us, Danny. She’s my daughter, too.”
“I’m sorry,” he said, crouching down.
A knock came from the door above and it opened slightly. “Danny and Sara, can you come up, please, so we can talk?” Mary hollered. “And Annabel is on the phone.”
Danny first checked on Julia lying with Dakota, then he and Sara went upstairs. Mary stood with the phone against her chest and Casey was on the stool next to her.
“I can’t believe you both didn’t tell us,” Danny said as he took the phone out of Mary’s hand.
“Dad, wait,” Annabel said. “I’m sorry. And don’t blame Mary and Casey for anything. They told me …” she said with a quivering voice, “to talk to you about what I did. It was my responsibility and not theirs. I didn’t get to it, not yet anyway. Again, I’m sorry.”
He glanced at Sara and his expression softened. “I can guess what happened. It’s not so much what you did but how it was handled. I suppose you are not our baby anymore.”
“David and I stayed at the lake house without your permission and it’s what you think. I am careful and you don’t have to worry about my male choices, okay? And they’ll be few and far between.”
Danny stepped to the French doors. Staring out, he couldn’t believe he was dealing with this stage of her life in this kitchen that had such a long family history.
“I want you to call your mom this week and arrange to see her so you two have a heartfelt mother-daughter conversation. How does that sound?” He turned to find Sara at his elbow, nodding her approval.
“Okay, Dad.”
Danny said good-bye, went over and put the phone back in the cradle. “I wondered at church this morning what I would have done in your shoes. Looks like you handled it the best you could. I’m really sorry I jumped to conclusions and got angry with you both.”
Mary walked over to her brother; they hugged and then Danny made eye contact with Casey.
“So are we going to the gym today or not?” Danny asked. His mischievous grin turned into a smile.
Chapter 33
Danny quickly made rounds the next morning, leaving the ICU as his last stop. He hated what he saw, hated the results of his neurological exam, and hated to write the new Glasgow Coma scale into the chart; he downgraded Varg to a three, indicating deep unconsciousness.
The nursing staff had untied his ponytail, allowing it to fan around his head, and his hair was almost ashen in color as if deteriorating like his brain. Danny closed his eyes, thought about Varg’s Norwegian spirit, and said a prayer for the man to have a tranquil sleep. And if he must pass on, to grant him longevity in his next life or heavenly abode.
At the office, Danny smiled and greeted staff while the first patients began to arrive in the waiting room. He went back, shut the door and called Grant Edwards. Perhaps he hadn’t heard from the FDA recently because they were seriously concentrating on Blue Bridge.
“Danny!” Grant said. “Sorry I didn’t get back to you sooner. You’ll be glad to know that, while I worked on getting that drink slapped with its carcinogen warning label, the lab was working magic on getting some definitive research done.”
“While you catch your breath,” he said despondently, “my first brilliant Blue Drink patient - the one I told you about who owns the company, Varg Dagmar - had a massive shriveling up of his temporal lobe vasculature and is now in a coma.”
“I’m so sorry. This does change things, doesn’t it? But you know, it doesn’t surprise me.” After a pause, Grant said, “If you’re ready, I have new information.”
Danny cleared a pile of phone messages out of the way. “Tell me.”
“It’s all about what we talked about. Vascular endothelial growth factor is the culprit. The constant surge in the brain’s vasculature of this synthetic VEGF from the drink causes inhibition of the true vascular endothelial growth factor signaling in the brain. Therefore, the brain’s normal supply of VEGF dries up.
“You see, apparently this aberrant collateral circulation is caused by both growth factors working simultaneously – the intrinsic which is supplied by the brain and the extrinsic being supplied by the drink. But then - when the brain has had enough exposure to the synthetic or extrinsic VEGF - the intrinsic VEGF isn’t produced any more, and we have no further vasculature or maintenance of vasculature. The delivery of oxygen ceases and the brain tissue being supplied is deprived resulting in transient ischemic attacks or full-blown tissue death or stroke.”
Danny carefully considered what Grant had said. “So what we have here is like biologic feedback loops: the positive feedback loop accelerated the collateral circulation and the negative feedback loop not only slowed down the process but caused it to cease functioning. It’s like the hypothalamic-pituitary-adrenal axis which is largely controlled by such feedback.”
“Yes. And all going on in a subset of the population, some of whom go overboard trying to be extreme health fanatics by drinking Blue Bridge!”
“We have a huge job on our hands reversing this.”
Grant shuffled through the reports Danny had sent him. “No. The FDA has enough clout that we can get this drink recalled and off the market so fast, it’ll make you dizzy.”
“This news would be upsetting to Mr. Dagmar. I think he is … or was … a good man who single-handedly cultivated the company he owns, Energeta, that sells Blue Bridge.”
“We’ll be pulling this drink but not doing anything about the company as they may have other products. I’ll also make a statement to the media. Perhaps you can do the same over there in Tennessee.”
-----
The national news already had a hold of the story before Danny was pinned down by Kathleen Fairbanks. They met at the medical complex sandwich shop where Danny gave the young reporter a better inside story than the FDA’s report to the newscasters by explaining the pharmacology of the drink and the resultant physiology it caused in a human brain.
Kathleen slowly nursed a bowl of soup and, when she finished with her questions, she said, “Of course, I’ve tried to get a statement from Energeta. The president of the company, as you know, is in a coma and the woman who is in charge will not comment.”
“Who is that?” He was dying to hear the answer.
“Rachel Hendersen. She said it is not appropriate for her to be the spokesperson while Mr. Dagmar is in his present condition.”
“How convenient,” Danny mumbled.
-----
Rachel had money on her mind … how could she not? It was still streaming in like they’d opened a spigot on a hot summer day.
She peered over the bookkeeper’s shoulder in the front office, amazed at the numbers he seemed to generate out of thin air. But they made sense as Blue Bridge had seen a surge in sales before the FDA recall took effect. The drink was craved by its normal customers; the addictive quality even more important to most of them than the ‘secondary’ benefit of becoming brain wizards in some way so they wanted to stockpile the stuff before they couldn’t get it any more
.
As Rachel continued to look at the Excel sheet with a huge smile on her face, she heard the jingle of the front door.
“I want to know how you did it!” Mary Ann Benson stood across the desk, her eyes afire.
Rachel jerked her head back. “Did what?”
“Took control. And siphoned the profits of Energeta while my brother lies in that hospital bed.”
“Don’t ask me,” Rachel responded as Trent slinked out of the room. “That’s the way your brother did it with his attorney. He liked my initiative with his drink and he rewarded me for it. Plus, you know, we had something going on.”
“’Had’ is correct. You haven’t been to see him since Dr. Tilson gave him that neuro score of a three. Since he won’t know you’re not there, why bother? Right?”
As Mary Ann studied her face, a faint smirk crossed Rachel’s lips.
“Why, you bitch.” The fifty-three-year-old lunged across the desk like a twenty-year-old and Rachel jerked back. Mary Ann thumped her fist on the hard surface, causing papers to scatter.
“You wait! Just wait! Sooner or later, you’ll get what’s owed to you.” She turned, taking her temper with her, and the front door slammed.
Mary Ann composed herself in her car. Her brother wasn’t going to wake up and she needed to find a long-term facility where he would spend his days relying on a ventilator. That was reason enough for her to have been a party to sharing his company’s assets.
-----
It was imperative that Danny meet with the ophthalmology department so he asked Matthew and Jeffrey to work his last patients into their schedule so he could leave the office at four.
In their meeting room, Danny leaned over the large mahogany table, palms on the table, and explained more thoroughly what they already knew and didn’t know about Blue Bridge. He suggested that Paula Branson be pulled from their research study. “She’s an anomaly and doesn’t represent a normal aging patient,” he said. “You don’t want your results skewed. However, I’d still go ahead with an article on the amazing ophthalmic history of this case.”