by Barbara Ebel
Silent Fear
A Medical Mystery
by Barbara Ebel
A Dr. Danny Tilson Novel
*****
This is a stand-alone novel, even though it is
Book Two in the Dr. Danny Tilson series.
Book One is Operation Neurosurgeon.
*****
Silent Fear: a Medical Mystery
Copyright © 2014 by Barbara Ebel, M.D.
This book is also available in a print edition.
License Notes
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.
Ebook ISBN: 978-0-9911589-1-1
Paperback ISBN: 978-0-9911589-0-4
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.
However, this novel from the credible medical fiction writer is based on an organism that really exists.
In celebration of fine books
that aren’t discovered yet.
.
*****
Silent Fear: a Medical Mystery
Chapter 1
Danny rolled over as the first rays of daybreak slid through the blinds. His dog, Dakota, stood next to the bed, his amber eyes inches away. The retriever’s devotion inspired Danny to smile as Dakota hoisted his front end onto the bed and nuzzled into his owner with a great push.
Danny rustled Dakota’s sorrel head and coat, shoved him aside, and got up. It was nice having a weekend off like a few weeks ago when he’d been suspended from his group. He dressed quickly and passed the coffee pot his sister Mary had left warming in the kitchen. This morning he’d attend to the family garden and trees like his parents did when they were still alive. He stepped into the garage, grabbed a saw, and walked back through the kitchen and French doors to the expansive yard. Dakota ran ahead chasing a squirrel. After it scampered up a tree, Dakota used the trunk as a fire hydrant marking the maple as his own.
After one hour of pruning lower limbs off several stately trees and listening to the warbling of the birds, Danny had one area remaining. He hoisted the saw and with multiple attempts, cut a chest-high limb off the nearest evergreen. He threw it to the side, stepped to the right, and again raised the saw. He wished he’d had that cup of coffee as he sliced through the limb. The mid-morning late July sun warmed the temperature and even Dakota sprawled in the shade nearby, spent after his backyard excursions. As the remaining bark broke from the trunk, the blade hit Danny’s left hand, too slow to sweep out of the way.
The pain and the suddenness caught him by surprise. Damn, he thought as he dropped the tool and blood began dripping onto the dirt. Dakota sprang next to him thrusting his snout into Danny’s hand all the way back to the house where Danny sat on a deck step and took a careful look. The injury appeared jagged but clean. Dakota’s tongue took a generous swipe of his palm.
The door opened and his sister, Mary, came out with his best friend, Casey, behind her. “We found the perfect wedding bands,” she said. “The jewelry store is engraving our inscriptions.”
Danny glanced up at her, letting Dakota have more liberal access to sopping up the blood saturating his hand.
“Danny!” Mary crouched down. “What happened?”
“I was trimming trees. I handle a scalpel much better than a saw.”
Mary gave Danny a hard stare as he continued giving Dakota free rein. “Would you quit letting him lick you like that. Isn’t that cut too deep?” She looked up at Casey. “You’re the paramedic. Would you talk some sense into him?”
“I shouldn’t meddle with medical suggestions” Casey said, shrugging his shoulders. “I’ve given him enough advice the last few months. He owes me a punch and after all, he outranks me and he’ll start in with his ‘you’re only an ambulance driver’ routine.”
Mary looked up at her fiancé and grinned.
“All right,” Casey relented. “Does it need stitches?”
“Not on my day off from being near a hospital,” Danny exclaimed. “Do you have any Steri-Strips in your supplies?”
“I’ll go check but you wash it first.”
Mary got up and Casey linked his arms around her waist for an affectionate squeeze. “Casey Hamilton, you’re incorrigible.” She lowered her voice and added, “Fix my brother’s wound and I’ll sidetrack Dakota.”
----------
On Monday morning, Danny had only one elective surgical case scheduled. He stopped at the OR front desk after changing into scrubs and studied the caseload board hanging on the wall. He noticed that Harold Jackowitz, one of his partners in The Neurosurgical Group of Middle Tennessee, still had a case going from the middle of the night, with another emergency to follow.
“Dr. Tilson, you’re just the doc I want to talk to.” The head nurse leaned over the counter. “Dr. Jackowitz is finishing up his night call. Can you pick up his next emergency we didn’t get to and follow that case with your own?”
“Sure thing,” Danny said. “I’ll go tell Harold.”
The nurse succumbed to a smile behind Danny’s back as he left because he’d straightened out his work behavior. He had been more than infatuated with Rachel, one of the scrub techs who had worked there only a few months.
Danny hurried down the hall after putting on an OR hat. He grabbed a mask, slapped it over his face, and swung into OR 2. Staff counted sponges and accounted for instruments in anticipation of finishing their case, but they looked like they’d been dodging thunderstorms all night.
“Am I glad to see you,” Harold said after looking across at Danny. “There’s a fourteen year old in the ER with an intracranial bleed due to a boating accident. Can you take care of him for me before draining your own patient’s residual abscess? I sure would appreciate getting home to bed.”
“Sure thing,” Danny said. “Tell me what else you know about the patient.”
“I haven’t seen him because I’ve been wrapped up here. We put the ER doc’s call on the intercom. He said this kid got hurt on Saturday but the parents brought him in around midnight after he complained of a headache and he started to get lethargic. C.T. scan is positive for an acute subdural hematoma.”
Harold took a step back and let the anesthesiologist start moving the table back to him. He wiggled his shoulders to loosen up.
“Okay,” Danny said. “Go get some sleep as soon as you can. You had a bad call.”
“I know, this is your kind of luck, not mine.” He snapped off a glove and picked up his pager. “Speaking of luck, how’s your situation? I don’t ask because I never know if I should bring it up.”
Danny hesitated at the loaded question. “Thanks for asking. I’m back on track. Even my personal life has calmed down, but that’s only because Rachel got what she wanted and I’m taking a wait-and-see approach as far as our baby. More importantly, I’m glad I still see my ex-wife, Sara, because of our girls.”
“You must be the only divorced guy I know who wants to see an ex.”
Danny nodded. Harold had a point.
“I’m glad to know life has turned around for you.”
Danny took a step towards the door. “Thanks, I appreciate that. Okay, you’ve got orders to write. I’m off to see this kid and whoever’s with him. What’s his name and what’s his Glasgow Co
ma Scale?”
“It’s Michael Johnson. His parents are with him and he’s got a decent score of thirteen.”
----------
As Danny walked over to the pre-op area he thought about the summer months. The last four weeks of getting up early and going back to work had been a welcome relief. Before that, suspension from his group and sleeping late had made Danny feel useless. The best tranquilizer for his body and mind, he had learned, rested with the steady purpose of productivity. He had yearned for the tempo of the O.R., the urgency of the neurosurgical trauma cases, and the pride he felt using his astute diagnostic and surgical skills. Except, of course, for the mistake he had made with a Multiple Sclerosis diagnosis.
Because of that case, Danny hoped to never use the services of malpractice attorneys again. As it was, he kept lawyer Mark Cunningham gainfully employed with his post-divorce matters with Sara and the separate Rachel Hendersen debacle. He’d had an extra-marital affair with Rachel which resulted in a baby he hadn’t known about. Although he resembled many other men paying an ex-wife child support and alimony, he considered himself more rare to be paying a second woman he hadn’t married, especially since he’d been deceived. Sometimes he was tempted to put ‘stupidity’ on forms where it asked for a middle name.
Danny thought back to the issue at hand as he entered the holding area where a nurse greeted him and laid a patient’s binder in his hands.
“Good morning Tracy. Thank you,” he said. When he finished reading the E.R. notes, Tracy handed him the C.T. envelope. A laugh tumbled out of his mouth at her promptness and she smiled. Even though she’d had a poor plastic surgery repair of a cleft lip, her smile glowed. He snapped the film onto the view box behind them and evaluated the hematoma showing a concavity towards the brain.
“Has anesthesia seen him?” Danny asked.
“Yes, Dr. Talbot came by and did an evaluation.”
She motioned to the first cubicle to let him know where the patient waited. Danny peeled open the curtain as Tracy followed. Michael Johnson filled the length of the stretcher, which made him a good six-foot-two like Danny. They don’t grow fourteen year olds like they used to, Danny thought.
“This must be Michael. Are you both his parents?”
A mid-forties couple, sitting on opposite sides of the stretcher, nodded.
“I’m Dr. Tilson, the neurosurgeon.”
“Nice to meet you, doctor,” the man said. “We’re John and Stella Johnson.”
“Nice to meet you also. I’m sure this isn’t where you’d like to be. Michael, how are you doing? Could be better, right?”
“Mmm,” slurred the teen. “Did you come to take more blood?” Michael closed his eyes again.
“Doctor, he’s a little confused.” The woman sat forward and toyed with the leather handle of her purse.
“Please, tell me what happened,” Danny asked.
The couple looked at each other. “You go ahead,” John said to his wife.
“Saturday we went boating on Center Hill Lake. We’ve got a small pontoon boat. We were close to an island where Michael and his friend and younger brother were swimming. Michael also kept climbing up and jumping off the adjacent rocky cliff. It’s a good twenty foot plunge into the lake. Funny thing is, we get worried when he does that. We tell him not to do it, but it’s to deaf ears. But that wasn’t the problem.” Stella stopped to collect her thoughts. She dipped her hand into her purse and pulled out a tissue.
“Doctor,” John said, “after the kids climbed back on the boat, some idiot came flying by on his motorboat, which tossed our boat around from his waves. I always tell my son reckless boaters are mayhem. Anyway, Michael was the only one standing and spilled forward smashing his head into the boat’s console.”
“Did he pass out?” Danny asked.
“No, but we thought he would.” John looked over at his wife, who now held her son’s hand on the stretcher.
“The E.R. doc must have explained what’s going on,” Danny said. “The hematoma Michael suffered in his brain must be managed by surgical evacuation otherwise his prognosis is going to deteriorate. The blood in there will continue to cause pressure on his brain or increase his intracranial pressure. We can’t let that happen, okay?”
“Dr. Tilson,” Stella said, “Do you have children of your own?”
“I do.”
She looked at her son, deeper into a sleep, and lowered her voice. “Then you may understand the bond and how scary it would be to have a child near death’s door.”
Danny briefly closed his eyes. “I’ll take care of your son, Mr. and Mrs. Johnson.”
After Danny finished examining Michael, he left. Tracy put another cotton blanket over the teen while his parents watched. Stella followed Tracy as she went out. “I hope Dr. Tilson does a good job,” she said. “I hope he felt our concern. We’re worried we may lose him.”
With a soulful stare, Tracy looked into her eyes. “Dr. Tilson understands your worry more than you know, Mrs. Johnson. He lost a daughter a few years older than your son.”
----------
The buzz of the Monday morning OR chit-chit subdued while the nurse and Lucy Talbot, the anesthesiologist, explained a few things to Michael. Danny came in early to the OR room to evaluate Michael’s last minute progression of symptoms before they gave him sedation and put him to sleep. Finally, Lucy gave a dose of Pentothal and Vecuronium and opened Michael’s mouth. “Sure is juicy in here,” she said. She grabbed the suction tip under the headrest and suctioned out his copious secretions. After she inserted the endotracheal tube and confirmed placement, she nodded with approval.
Danny grinned under his mask at all the slobber. The only oral secretions he ever dealt with were Dakota’s, and his were enough.
The rail-thin anesthesiologist pulled out the tube she’d just placed and put it on the patient’s chest. “He’s quite mature for his age, isn’t he? I need a bigger one.” She gave Michael some more puffs of oxygen from the mask she’d placed over his face. Dotty, the OR nurse held up another package and Lucy Talbot shook her head. “An eight should do.”
She slid the next tube into the trachea, confirmed correct placement, and slid off her blue gloves to put the patient on the ventilator with inhalational anesthetic. Danny and Dotty both handed her the wet array of packaging, contents, and laryngoscope. “What a sloppy mess,” Dotty said.
After preparing his initial part, Danny went to the sink outside and removed the Steri-Stips from the palm of his left hand to scrub. Healing had begun on Sunday’s cut, but it hadn’t yet totally epithelialized. He went back in and after donning the rest of his surgical attire, sat at the head of the table where Michael’s head was ready. They put drapes and Danny asked James, the scrub tech, for his second most important instrument – the drill.
Dotty put the radio on. “Is it okay if I keep my genre of choice, y’all?”
An iconic female country singer’s voice filtered the room. “The only thing more theatrical in these OR’s besides the conversations,” Danny said, “is the music. How can we argue listening to her in the Music City?”
“She’s playing at Opryland next weekend,” Lucy said. The little anesthesiologist popped right up from her catch-up charting. “Anyone have tickets?”
“I wish,” Dotty said.
James stood poised with the suction tip as Danny drew nearer to finishing the bur hole in Michael’s skull. The drill bit stopped, the bone dust stopped, and the evacuating noise of the hematoma began.
“Seeing her is on my bucket list,” Danny said a minute later. “She’s got my respect. Not only does she have a distinctive voice and talent, but she’s a heck of a business woman. I think she keeps plastic surgeons gainfully employed, too.” His laugh, which rolled over extra, infected them all, causing copious chuckles.
“I admire her philanthropic nature,” James said. “She does programs for disabled kids and has a free kid’s summer camp in eastern Tenness
ee. Kids are picked by one of her committees and they go in two week increments.”
“I think the program’s called ‘It’s the Best Summer After All,” Lucy said, “and unlike some entertainers, she stays out of trouble.”
Except for the music, the room got quiet until the OR doors swung open and the head nurse came walking in. She stopped behind Danny’s shoulder. “Dr. Tilson, we’ve brought down you’re first scheduled patient to the holding area. They wanted me to tell you he has a small fever.” She looked at Dotty and James. “You two are staying in this room to do it. It’s the brain abscess drainage.”
“Okay,” Danny said, “thanks.”
“Dr. Tilson, I’m doing the next case as well,” Dr. Talbot said.
----------
Danny looked over his patient’s chart, the case they had delayed, while he sipped coffee. Troy Neal was a sixty-five year old farmer who had been hand reaping and managed to fall on his nearby sickle. The resulting skull fracture had introduced the infection resulting in his brain abscess. Danny told him it could have been far worse. Despite appropriate antibiotics, the remaining pus needed surgical drainage and this appeared to be the last surgery he’d require.
After leaving a small amount of his coffee on the counter and hearing Tracy’s voice inside Mr. Neal’s cubicle, Danny stepped inside. He stretched out his hand for a thorough handshake from the wiry bald man. He’d been a true gray before they’d shaved off his remaining hair.
“Don’t want to meet you like this anymore, Doc, and I don’t want to be carrying around these Staph and Strep guys in my head anymore, neither.”
Danny rolled out a chuckle. “I’m sorry to laugh, Mr. Neal. You get an A in the crash course you’ve taken on medical jargon. Just don’t use yourself as the patient next time.”
“I didn’t plan on no metal in my head. You have any ancestors with farming blood?”
“No. My Dad and Mom were primarily in the restaurant business. Right here in Nashville. My Mom’s parents ran nurseries, which is where she got her green thumb.”