“Look at all of these degrees, Seabury.”
Sea Bee looked at the walls and suddenly seemed engaged. He got up and started to read the inscriptions.
“Pieter J. Blauw, Bachelors of Science, Biology, University of Leipzig; Pieter J. Blauw, MD, Boston University; board certified in neurology and psychiatry? This guy’s a shrink?” Seabury said.
“He’s a geriatric psychiatrist and neurologist Mr. Campbell. My colleague said he is the best of the best,” Raines said trying to defend the credentials of a man whom she had never met.
“Best at what?”
“Honey, Leslie says he’s a professor, the director of the hospital’s memory center and the associate director of the Alzheimer’s Disease Center,” Ruth summarized.
The exam room door opened, and Dr. Blauw extended his hand to greet all parties. Though he had earned his advanced degrees in the states, he still couldn’t hide his German accent.
“You’re German!” Sea Bee said dismissively.
Blauw gazed quickly at his wall of fame.
“Born and raised in Hamburg, medical degree in Boston, residency at Columbia Presbyterian in New York, a fellowship in Behavioral Neurology and Cognitive Neuroscience in the Netherlands, now I cheer for the Eagles and Flyers in Philadelphia,” Blauw said.
“Did you hear that, Seabury, said he’s a Presbyterian,” Ruth emphasized with assurance.
“Well, actually,” Blauw started, but decided it was better to just let it go. “Mr. Campbell, why are you here today?”
“My wife thinks I’m nuts!”
“Do you think you’re nuts?”
There was a long pause. “I’m not as sharp as I used to be.”
“In what ways?”
“I can’t find the words I used to know…I can’t find the doors I once walked through…and I’m not real sure what to do when I finally find those doors.”
“Does that bother you?”
“That’s a pretty stupid question for such a smart Presbyterian with a bunch of fancy degrees on his wall…Of course it bothers me.”
“Seabury!” Ruth interrupted. “Mind your manners.”
Dr. Blauw raised his hands in a calming manner. “No, that was a fair response. In fact, the fire in your belly is helpful. We can use that. There’s nothing I’ve seen in your medical records over the last 40 years or in just a few minutes of talking with you that would suggest we’re dealing with a severe mental illness.”
“Well then we’re in good shape, Dr. Blauw, because my husband has an endless supply of piss, fire and vinegar!”
“Mr. Campbell, let me explain what I do from the 30,000-foot level, then I’ll bring it back to what I want to do with you.”
“Now he wants to drop me out of an airplane.”
“Not exactly. I both see patients – as a doctor – and I also conduct research on the diseases I treat in a laboratory, as a scientist. I’m a clinician, and I’m a researcher. When I’m not seeing patients like you, then I work in my lab with mice and other animals that have been genetically bred to have the same diseases people develop. In the clinic, I treat patients who mostly have neurodegenerative diseases; those are fancy words for diseases that usually attack us when we get older. In the laboratory, I focus on cellular and molecular neuropathology and the clinical biomarkers in aging.”
“So what have I got, Doc? Harry Tasner said it was hardening of the arteries. Do you think I have Alzheimer’s?”
“AD, Alzheimer’s disease, is hard to diagnose; it’s more of a judgment first, then followed by some specific tests that would confirm if you have AD. Your family doctor has taken great care of you for many years. But now you’re suffering a little bit of dementia. I need to figure out if that’s due to Alzheimer’s or something else.”
“What kind of tests can you do, Dr. Blauw?” Ruth asked.
“Today we’ll do a complete physical exam to check Mr. Campbell’s overall neurological health. Reflexes, muscle tone and strength, ability to get out of a chair and walk across the room, sense of touch and sight, coordination and balance.”
“But you ain’t gonna check my nuts to see if I’m nuts, are you?”
“Seabury!” Ruth scolded.
Blauw laughed. “It’s okay, Mrs. Campbell. I can assure you that it’s nothing compared to surgeon talk in an operating room. No, you should still see your family doctor for all your annual physicals. My nurse will draw some blood so we can rule out thyroid disorders or vitamin deficiencies. If you’re okay with all that, then I’d like to get started with a 10-minute ‘mental status test.’ Colonel Raines, you’re welcome to stay for the mental test but only family members during the physical portion.”
“She’s our daughter-in-law,” Ruth blurted out before Raines could speak. “She is family.”
“Look who’s nuts now, woman!” Seabury quipped.
“I understand, Dr. Blauw,” Raines answered amid subtle embarrassment.
“Okay, this should take 10 minutes. You can use the clipboard for the written answers. Are you ready?”
Sea Bee nodded.
“Number one; draw the face of a clock with the hands showing four-thirty.”
Sea Bee looked over at Ruth and rolled his eyes.
“Two, what’s today’s date, and where are you right now?”
Sea Bee answered but couldn’t hide his contempt. Blauw held up a laminated sheet of paper with a picture on it.
“Three, here is a picture of two pentagon shapes intersecting. On your paper draw the same thing, or as close as you can come.”
Sea Bee looked at the picture and reproduced it on his clipboard.
“Number four, Mr. Campbell; I’m going to hand you a note card with instructions on it. Please read the card silently and then follow the instructions written on the note card.”
Blauw handed him the card. Sea Bee stood up and walked over to the door. He knocked on the door two times quickly.
“I have 40 cows in the field,” Sea Bee announced to the room then knocked on the door two more times, turned around in a circle and sat down.
“Number five, Mr. Campbell, here is a blank note card. Write down one complete sentence that tells me about your family.”
“Can’t do it in one.”
“Please, try to limit your thoughts to one complete sentence.”
Sea Bee looked at Ruth for inspiration, but she refused to make eye contact with him. He started to write fast and furiously then handed the note card back to Dr. Blauw who read it to himself.
“Okay, two more and we’re done. Mr. Campbell, count backwards from 100 by sevens, out loud.”
A strange gaze grew over Sea Bee’s face.
“I’m not following you.”
“Start with 100 and count backwards by sevens. For example, take 100 and subtract seven, which would give you 93, then keep subtracting sevens.”
Sea Bee didn’t speak. His breathing became more pronounced. He started to panic.
“Seabury, you’ve always been a math whiz. Just count backwards,” Ruth said trying to encourage him.
“Mrs. Campbell, please,” Blauw stopped her as the intensity with Sea Bee started to ramp up.
“Well he is,” Ruth whispered to Raines. “He was the one who always helped the children with their math problems.”
Leslie held up her hand to help quiet Ruth who was starting to panic more than Seabury.
“Mr. Campbell? Can you count backwards from 100 for me…by sevens? I’ve already given you the first answer.”
Sea Bee looked down at the floor in defeat. He said nothing.
“Okay, number seven, the seventh and final question, Mr. Campbell. Are you up for one more?”
Sea Bee nodded his head.
“I’m going to say three words out loud with a pause between each word. Once I’ve said all three words, simply say them back to me. Okay?”
He nodded again.
“Sliding…slippery…sidewalk...”
Sea Bee moved his lips. He wa
s trying to say the words. Both Ruth and Raines could see the anguish on his face as he struggled to recall the pattern that flashed through his brain but quickly disappeared.
Sea Bee was lost.
“That’s okay…I understand that you are a farmer so let’s try these three words instead. Cow…barn…pasture.”
Sea Bee smiled as he searched for the words. Finally it came.
“Junior…my boy. He used to help me on the farm. He was a good boy, Dr. Blauw, a good boy.”
The room was silent. Dr. Blauw recorded some notes and then stood. “Mr. Campbell, I’ll give you a couple of minutes to change into this hospital gown for your physical exam.”
“And I really need to get back to Fort Detrick,” Raines said as she gathered up her things.
Blauw walked over to Raines as Ruth tended to Sea Bee.
“Colonel Raines, I’ll walk you out. You must have gotten a very high level referral. It’s not often that we can take new patients on such short notice.”
Raines and Blauw emerged in the corridor away from the exam room.
“Actually my boss, Dr. Ernst Groenwald, said you were the best on the East Coast.”
“Ernie? He’s a great guy. I haven’t seen him in years.”
“He said you two once worked together.”
“A hundred years ago in The Netherlands. Ernie was one of many brilliant minds who rotated in and out of Rotterdam. I worked for a few years in the Daniel den Hoed Clinic, part of the Dijkzigt Hospital, while Ernie researched infectious diseases and pandemics. Once you get accustomed to the American way of life, even an impressive place like the Brezden University Medical Center can’t keep you.”
“Well, I hope you can do something for Mr. Campbell.”
“Hard to say, colonel, we’ll see how the tests come back.”
“I presume you’ll do the standard battery: CT, MRI, and PET?”
“Colonel, the best hope we have for AD is early diagnosis and prevention. By the time we cinch the diagnosis of AD we’re already in trouble. Too late. Think of the fireman holding the hose, spraying water into your living room, and yelling ‘fire’ while you’re sitting on the couch reading a book. It’s kinda too late to be at the bedside when the fire department shows up. That’s why I work on the bench as well. We’ve got to find better diagnostic tests, biomarkers, vaccines, early detection and prevention.”
“I work with infectious diseases and bioterrorism. Prevention is the name of the game.”
Blauw pulled the note card out of his lab coat and handed it to Raines.
“Colonel, hang on to this. Guess his son must be a Navy SEAL. The family will appreciate it one day, but probably sooner than they would like to admit.”
* * *
8
* * *
Datta Khel, Miran Shah District
North Waziristan, Pakistan
The table next to the woman’s bed was set. Ether, surgical sutures, a scalpel and two industrial grade silicone breast implants were staged for the operation.
“Why were these taken out of their packages? It’s hardly a sterile environment in the first place,” Banks said with full irritation as he pointed to the silicone implants just lying on the wood surface of the dirty table.
“They are fine, Dr. Banks. The commander wanted them modified,” Kazi defended as he turned on two more lights, all powered by an outdoor generator. “I want to introduce you to Dr. Ja’far. He will be assisting you.”
Ja’far had arrived the night before. He was an older man, bespeckled, and of slight build. He wore the traditional salwar kameez.
“What kind of a doctor are you, Ja’far?” Banks asked as the old man looked back puzzled.
“He does not speak English. Dr. Ja’far is a professor, a scientist by trade,” Kazi said. “Tell me what you’re doing, how you’re doing it, and I will translate everything for Dr. Ja’far. Perhaps he can learn to do the procedure himself in the future.”
Banks took a long glance at Kazi and shook his head with not-so-subtle contempt. He figured his only ticket out was to perform the surgery and hope that Kazi was telling him the truth.
“Well, Ja’far, then it looks like we’ll learn this thing together. I operate on women, but usually I’m working on the other end. I don’t know of anywhere in the world where they still use ether for anesthesia, but that’s what we’re going to do today, Ja’far. Pour some on these rags and hold it over her nose. I’d recommend you boys take the tape off now so she doesn’t gag, choke and drown in her own vomit. Better hold her down too. I have this feeling she’s not anymore thrilled to be here than I am, so she’s going to fight you.”
Kazi told Ja’far what to do and nodded to two of the abductors. They held her head down as Kazi pulled the face veil and hijab off before pulling the duct tape from her mouth. Her blood-curdling scream filled the entire village until Ja’far covered her nose with the ether rag. Slowly, she stopped fighting and settled down into a slightly disturbed sleeping pattern.
“Normally we do this sort of thing in a hospital,” Banks said as he reached for some alcohol and swabs.
“Most women have the procedure done as outpatients, Dr. Banks, in less than two hours.” Kazi’s reassurances were hardly reassuring. “This will be fine.”
“Thanks for the news flash, Kazi.”
Banks stopped working and stood still as he stared at Kazi.
“Well?”
“Well what?”
“Would you like me to perform the surgery by cutting directly through her burka or are you going to take it off?”
Kazi looked over at the woman, now unconscious, and at the two captors who stood guard.
“It’s called a chadri, Dr. Banks. We are not permitted to take it off her. You’ll have to do that.”
“You have got to be -.”
Banks closed his eyes in boiling anger and walked over to the woman. As he started to pull the chadri up and over the woman’s head the guards looked at him in disgust. He was fulfilling their vision of the Great Satan, the infidel. Under the burka the woman was wearing the traditional trousers and black shoes. Banks removed her shirt and her bright blue bra.
Kazi, Ja’far and the two armed men were obviously disturbed by the sight of the bare-breasted woman.
“Sorry guys, but this is the only thing I can think of doing for this particular surgery. Better keep the ether handy, Ja’far.”
Banks poured rubbing alcohol on some Q-Tip swabs and scrubbed the area around each nipple.
“What are you doing, Dr. Banks?” Kazi asked.
“I’m trying to sterilize the area before I cut.”
“I realize that, but why are you going to cut there? Shouldn’t you be under her arm?”
“Transaxillary? In this dirty hellhole shed of a surgical suite? Give me a break. A transaxillary incision under the armpit tissue requires a channel up to the breast. We’d need an endoscope, and I certainly don’t see one here on my table of barbaric Barney Rubble tools.”
“Endoscope?”
“It’s a small tube and inside is a light and a camera that’s embedded in the end of the tube. If I had one, I could watch the movement of the endoscope on a TV monitor so I could position the implants at the exact spot, planted and centered behind each nipple.”
Kazi shook his head as he and Dr. Ja’far traded epiphanies in Pashtu.
“Perhaps that’s what we did wrong?” Kazi said to Ja’far.
Banks kept cleaning the breasts.
“Thought he didn’t speak any English?”
Ja’far moved in closer.
“You make incision on nipple?” Ja’far asked in broken English.
“It’s called a periareolar incision. I’ve never done this myself, Ja’far, but I’ve watched several when I was in school. Can’t be that hard, I guess. Plastic surgeons do this procedure. You cut right at the edge of the areola. We want the incision between the dark areola and surrounding breast skin so it can be hidden. Most women – maybe even this
one – would rather not have visible scarring on their breasts.”
“This is better method?” Ja’far asked.
“Yes, for two reasons. First, we can place the implants in a precise pocket formation. They’ll be exactly where we want them to be and, ah, where your commander wants them to be. Second, absolute controlled bleeding. Bleeding is our enemy, especially in here.”
Ja’far smiled. It was all making sense now.
“Unfortunately, we have to get these huge-ass PIP implants in and through a very small incision.”
“How big the cut?”
Banks picked up the number seven beaver scalpel. He pressed the edge of the blade down on her right breast and started to cut.
“Five centimeters, seven at most. Kazi, I don’t have the skills or the tools necessary to do this thing submuscular. I’ve gotta go subglandular.”
“Whatever,” Kazi mumbled as he observed the first incision.
“I can’t put these things behind the pectoralis major muscle. I’m placing them in the retromammary space – subglandular – it’s like a pocket between the gland of the breast tissue and pectoralis muscle.”
“Is that bad?”
“Can be. Can cause capsular contracture of the immune system. Her body might reject the implant.”
“How long, Dr. Banks? How long before she could reject the implants?”
“I don’t know, six months, a year, two years. You need to get her to a hospital if she starts to run a fever, feels pain, or develops hematomas or the settling of blood in her breasts.”
“We’ll let the commander worry about all of that,” Kazi opined.
After an hour with each breast and a couple of doses of ether from Ja’far, Banks sutured the woman up with the Ethicon Prolene cartridge spools. He walked over to his bed and sat down followed closely by his two armed captors.
“There you go, Kazi. Tell the commander that his woman will be good as new in a week or so. He should go easy on her for the first month. She’s gonna be sore to the touch.”
“I will let him know, Dr. Banks.”
“So how ‘bout that ride back to Thunder? When do we leave?”
Jericho 3 Page 7