by Gen LaGreca
David arrived galvanized for work. “Where was the accident?” he asked a passing doctor.
“Don’t know.”
Rescuers clustered around a gurney coming into the ER. A blue-tinged body lay motionless on the stretcher. One rescuer was pressing both fists against the victim’s chest. Another was pumping air through a rubber bag into the patient’s lungs. A third had his fingers on the victim’s pulse. A fourth held an IV solution that was dripping into the patient’s arm. A fifth steered the gurney, with the whole entourage careening to the left or right with every turn.
“Male in full arrest. No vital signs,” said one of the rescuers.
David joined the retinue, following the gurney into one of the rooms.
“This is Mr. Reiner. He’s fifty years old. When we found him at the explosion site, he was complaining of chest pains. He arrested on the way over,” a rescuer explained.
With the personnel who normally handle such situations already engaged, David took charge. He examined the patient, directing the rescuers to assist: “Check his airway. . . . Position the monitor leads. . . . Start a DT4 drip. . . . Get a cardiologist in here.”
Wires, patches, and tubes soon connected Mr. Reiner to the room’s equipment. Buttons flashed, monitors brightened, numbers flickered on electronic screens, and beeps sounded. David had made the room come alive. Could he do the same for the patient? His eyes turned to the monitor, shaking his head in disapproval of the graph traversing the green screen. He tried chest compressions, electric currents, drugs, every remedy he knew.
“Still no pulse,” reported one of the nurses who had joined him.
He repeated the maneuvers.
“Still no pulse, Doctor.”
He tried the maneuvers again. With each effort, David’s eyes returned to the stubborn monitor until, finally, the green screen relented, presenting a more pleasing picture.
“I have a pulse,” the nurse uttered at last.
After a few minutes, Mr. Reiner slowly opened his eyes. David explained what had happened and assured the patient that a cardiologist would arrive to continue his treatment. Mr. Reiner grasped David’s hand in relief and gratitude. As a pink glow began to color the victim’s face, a smile warmed the doctor’s features; life seemed to have returned to both men. David had done what he did for a living. Nothing more could ever fascinate him; nothing less could sustain him.
He placed a comforting hand on Mr. Reiner’s arm. Mr. Reiner placed two weak hands over David’s one and squeezed with all the strength he could summon, his eyes containing the whole of his relief and gratitude. David held his glance and smiled in answer. The same current that had jolted Mr. Reiner’s heart seemed to charge David’s own face with exhilaration.
He’d never understood why people said that doctors should derive no selfish reward from the care they provide. He felt the most glorious sense of pride from saving someone’s life, and he could not make the grueling effort that medicine required without fervently loving his work. He knew the world meant that he could love his profession and derive spiritual fulfillment from it but that he should not love making money from it.
“Doctors must work for the good of others because they possess special skills that are critically needed by society,” his teachers had said.
Was he supposed to offer people the ultimate value, their very health and existence, yet not desire a financial reward for his services the way in which the provider of a house, a car, or a swimming pool would? Because their services are more valuable than those offered by others, are doctors to be prohibited from setting the terms of their own compensation? Are doctors to be punished because they offer so much? Because they are . . . good?
“Unless restrained, a doctor will work for selfish gain, not for the patient’s welfare,” the politicians had said.
Did this mean that harming his patients benefited him, or harming himself benefited them? If he received all the value from his work and the patient derived none, didn’t that make him a thief? If the patient received all the value and he derived none, didn’t that make him a slave? Was his only choice between robbery and slavery? He had always believed that what was good for his patients was good for him. If he were gifted, then his patients would thrive and his career would prosper. If he were incompetent, then his patients would suffer and his career, as well as his supreme pride in his own being, would be destroyed. What perversion linked his self-interest to his patients’ detriment, and their self-interest to his own destruction? Wasn’t that the premise behind his oath to the board? Wasn’t treating his patients leading to his own demise, and wasn’t he vowing to compromise treatment to save his career? While he monitored Mr. Reiner, a voice inside him asked why it was necessary to make such a promise to the board.
Mr. Reiner, now breathing on his own, whispered, “Everything was fine when . . . I heard . . . a loud bang. . . . The floor . . . rumbled, the chandeliers . . . shook, people screamed. I felt . . . a sharp pain that . . .”—the victim breathed laboriously—“. . . scared the hell out of me.”
“Take it easy,” a nurse warned, as she helped him out of his clothing and into a hospital gown.
By this time, a cardiologist had entered the room. David briefed him, and then headed for the door.
“The stage buckled,” Mr. Reiner continued.
David stopped. “The stage? What stage?”
“The stage.” Mr. Reiner grew pale. “I was in . . . a . . . theater.”
“What theater?” David moved close to the man but received no response. The man’s eyes were closing eyes and his head was drooping.
“Blood pressure’s falling!” cried a nurse.
“Respiration’s becoming shallow!” said another.
“We’re losing him.”
“Get out of the way, Doctor,” the cardiologist ordered, shoving David aside, giving directions to the nurses, and springing into action.
“Where was the accident?” David asked the group at large, but no one responded.
He lifted a large plastic bag in which the nurse had placed the man’s clothing, and he reached inside the shirt pocket. There he found something that made him gasp—a ticket stub to Nicole Hudson’s show.
In an instant, he ran into the corridor. He hunted for Nicole in the rooms containing the seriously injured. To his relief, she was not there. He searched among victims in the other beds. Again, he did not find Nicole. Suddenly, he stopped. An attendant was wheeling a gurney holding the slim lines of a woman’s body under a sheet that covered her completely—including her face. He ran toward the delicate, oblong form, knocking the gurney off course. He pulled the sheet down—and saw the ghastly blue tinge of death on the face of an old woman.
The attendant was startled. “Hey! What’s the matter, Doctor? Are you okay?”
“Are there any more . . . fatalities?”
“One more, DOA, at the end of the hallway,” the attendant pointed to a stretcher with a body under a white sheet. “She was a young blond. You could tell she was pretty before her skull got smashed. What a shame!”
David grimly walked down the long corridor. Was he to regret for the rest of his life that he had not approached Nicole at the flower shop? he wondered. She had sought him; he had run away. Walking down the stark white hallway, he was suddenly aware of how brief life was. He wondered whether he was treating his own precious days with the proper reverence or wasting irreplaceable time on matters that only brought him grief. He reached for a white sheet over a cold body. A patch of golden hair froze his features into a solid block of pain. With a trembling hand, he lifted the sheet. He winced at the pulverized pulp that was once a living brain. But hope beat wildly inside him again, for the stony eyes he closed were not Nicole’s.
He scanned the adjoining radiology unit, peering into cubicles where patients were being X-rayed. He found a room that he had to enter.
“Stop! The machine’s on! You know better than that, Doctor,” a technician exclaimed from behind a partition.
David rushed to a man wearing stage makeup who was lying on the table. The patient was the dancer who played Prometheus.
“What happened?” David placed a sympathetic hand on his shoulder.
“Broken . . . ribs . . . they think.” The dancer flinched in pain.
“What happened to Nicole?”
“Who’re you?”
“I’m her doctor.”
“Don’t . . . know,” the dancer struggled. Every word seemed to unleash a searing pain.
“Where was she when the explosion occurred?”
“Nicole was . . . on . . . the cliff with me,” the patient whispered.
The technician approached. “We need to take another picture,” she said, repositioning the machine.
“A loud boom . . . like a bomb . . . shook the stage. A light . . . fell on me,” the dancer continued.
“What happened to Nicole?”
“She fell . . . off the cliff. . . . I called to her.”
“What did she say?”
“Nothing.”
“What do you mean nothing?”
“She was . . .” The man winced.
“She was what?”
“Owww, it hurts!” The man grimaced.
“Easy, now—we’re almost through,” said the technician, as she adjusted the man’s position.
“Nicole was what?”
The task of breathing presented an agonizing struggle for the patient. He gasped for air, then moaned at the pain that the act caused.
David’s voice was sympathetic, but he persisted. “You called to Nicole, and she said nothing because she was—what?”
“Out.”
It was David’s turn to gasp. “She was . . . unconscious?”
“Yes.”
“Where is she?”
“Ambulances came. People . . . carried us out. . . . I don’t know.”
David’s white coat swung like a cape behind him as he flew to the ramp, skirting stretchers and colliding with people. He breathed stifling, humid air heavy with gas fumes and vomit but had no time to notice. Nicole was in trouble, and he needed to find her! He scanned the victims being carried from the ambulances. No Nicole. Then another ambulance arrived. He flung its rear door open and peered into the long tunnel. On his right he saw victims sitting on an overcrowded bench, their bandages seeping blood, their bodies sweating. On the left, his eyes caught a patch of gold as bright as a field of sunflowers.
She lay on a stretcher in the truck, still wearing her stage makeup and sheer costume, her voluminous straw hair pulled around her like a blanket, her eyes closed. She might have resembled a princess in repose—except for the purple bruises and swelling across her forehead, the blood dripping from her nose, the raccoonlike black circles under her eyes, the red-stained bandages over lacerations on her arms, the IV line attached to her wrist. Her head was at the front of the vehicle. Without waiting for the others to exit, David climbed over the protesting tangle of bodies on the bench.
“Nicole! Can you hear me?”
There was no reply.
He worked quickly, aided by equipment in the truck. Her airway was clear; she was breathing on her own; her blood pressure and pulse were steady. Her skin color was pink, a sign of oxygen in her bloodstream. Her body responded to stimuli when he performed a few simple tests. She had fallen on her face and broken her nose, he surmised. He would take her inside and run brain scans. Her warm breath on his hands reassured him.
He removed a penlight from his pocket. She was alive; her vital signs were good; she was not deeply unconscious. He opened one of her eyelids. She could awaken at any moment and flash a radiant smile at him. Then they would both laugh at their two peculiar meetings in recent weeks, one in an ambulance and the other outside a flower shop. He aimed the penlight into her eye, expecting her to awaken, to recognize him and smile. Then he could forget the sickening fear he never had to—
Sweat suddenly beaded his forehead. He stared incredulously at her serene face. He slowly opened her other lid and shone the little light into that eye. He shook his head in denial and repeated the test on both eyes. Then he gasped. He was confronted by two tiny demons that did not respond to light. Instead of constricting as they were supposed to, they remained fixed, dilated . . . lifeless. The demons were Nicole’s pupils.
He pulled his feverish face to within inches of her composed features. Her eyes were cold and blank. His were filled with fear.
Just then the dainty head began to move. The eyelids blinked. Nicole was awakening.
“It’s dark. Very dark,” she said, her eyes wide open.
Trembling, David cast the penlight directly into one eye, then the other.
“I . . . I can’t . . . see . . . anything,” she whispered. Then her face fell to the side and her eyes closed once again.
Chapter 11
The Diagnosis
David Lang pushed his unconscious patient to Imaging at an alarming speed. He was oblivious to the curious looks of the people he passed and to the gurney wheels that squealed in protest around the corners. A brain scan in the ER had indicated a fracture at the base of Nicole’s skull. He urgently needed to run another kind of scan, one that would reveal soft tissue, to learn more about Nicole’s condition. Traveling with his precious cargo through a maze of pastel corridors streaked with a myriad of black-lettered signs, he considered the possible causes of his patient’s condition. With every hypothesis, the corrective measure that he would take flashed instantly in his mind, as if healing were synonymous with injury.
Having detected no direct trauma to Nicole’s eyes, David suspected that a behind-the-scenes culprit was responsible for Nicole’s blindness, the prime mover in the magnificent production called vision—the optic nerve. Although sight seems to occur in the eyes the way a play occurs onstage, it’s directed behind the scenes, as is any great performance. The optic nerve carries impulses from the eye to recesses at the back of the brain, transforming stimuli from the outside world into sensations grasped by our minds in the unique phenomenon called sight. By enabling humans and other animals to see, the optic nerve allows Earth’s creatures to discover the world outside of themselves. Fitting with its vital function, this nerve belongs to that elite corps of tissue comprising the central nervous system.
As if the brain were concerned with the disastrous effect of injury to its precious optic nerve, it produces two, one emanating from each eye, with each able to bear the entire burden of vision should its twin die unexpectedly. The two optic nerves are protected from simultaneous injury when separated, but in their travels from the front to the back of the brain, they intersect, charting a course that resembles a large X. This means that despite nature’s careful duplication, an injury at the crossing point could harm both visual fields. To make matters worse, the delicate nerves travel along a dangerous route right by their intersection. There they lie on top of something as thin as fine crystal, the delicate sinus bones that line the nasal cavity and form the base of the skull. Nicole had sustained a fracture in that area, and the gauze that David had just placed under her nose was already darkening with blood.
David had asked an ophthalmologist to meet him in Imaging to examine Nicole’s scans. The eye surgeon, a trim, handsome man in his fifties with a kind face and an engaging smile, was waiting when David arrived.
“What’ve you got there, David?”
“A fall on the forehead from a distance of about twelve feet. The patient momentarily regained consciousness, reporting a total loss of vision. Both pupils are nonreactive to light, and she has a skull-base fracture.”
The ophthalmologist shined his pocket light on the stagnant blue pools that were Nicole’s eyes. “Let’s take a look,” he said, his smile vanishing.
The imaging room was dark and bare, as if staged for a mystery. A spotlight on the ceiling beamed a cone of light on the room’s lone furnishing, a pale-gray machine with a narrow sliding table at its mouth. The sleeping Nicole was to take center stage.
The two men lifted her onto the table and positioned her head by the arched opening. The white sheet draping her body hung from both sides of the table, concealing the support so that she seemed suspended in space. The only soft touch in the stark setting was eighteen inches of lustrous gold hair, disobediently tumbling off the table, despite David’s attempts to restrain the tresses for a ride into the machine.
A monitor hung by Nicole’s side, its wires attached to sensors on her skin. David frequently glanced at the electronic charts and numbers, reading her heart rate, pulse, and respirations. He mentally rehearsed the scene that he would direct should the metal box sound an alarm.
After positioning Nicole, the surgeons stepped into the adjoining control room to watch her through a large window. A technician sat in the darkened room by a computer console and monitor. The operator activated a command that sent Nicole’s head slowly into the mouth of the machine. The ophthalmic surgeon settled into a chair next to the technician. David, too troubled to sit, paced restlessly behind the men, his black hair blending with the dark walls, his face reflecting the ghastly gray of the monitor.
The scanner was an advanced model that would pass a harmless substance through Nicole’s lovely head, providing exquisitely detailed pictures of her brain to transform ignorance into knowledge and to rescue David from the worst fear of all—the unknown. The machine would endow him with a superhuman power, like the childhood legend who could see through walls. He was thankful that he could spare Nicole the ordeal of exploratory brain surgery in which her skull would be opened by a surgeon as blind, in a way, as she, not knowing in advance the nature, extent, or location of the injury. In a few minutes the remarkable block of metal, his oracle, would enlighten him.
The machine hummed its electronic tune, and the screen displayed its first picture, an overview of Nicole’s brain. David examined the artistlike rendering. The machine produced images that distinguished tissues, bones, and vessels with a fine precision.
“Let’s get cuts through the sinus and the sella turcica,” David directed the technician, “so we can see the pathway of the optic nerves.”