What she said did sound reasonable. If Kathleen had gone into shock, resuscitating her with fluid and pressor drugs would be tricky, since overshooting the mark could send up her pressure to the point it could cause another hemorrhage. He would want a central line to monitor her response, Richard thought.
"I hope you're not going to be second-guessing everything we do, Dr. Steele," the nurse added.
He turned on his heel and returned to Kathleen's cubicle, determined to be more laid back, then started to explain why Hamlin had stuck a needle in her neck.
No, no, no, she blinked, her eyes flaring. Alarms started to buzz on her monitors as her pulse and pressure climbed.
The curtains behind him whipped open. "Dr. Steele, what are you doing to her?" demanded Hamlin, gaping at her monitors.
To Richard's horror, her numbers shot higher.
"Nurse, get me IV midazolam!" snapped the neurosurgeon, shoving past Richard and moving to Kathleen's side. "Okay, Dr. Sullivan, we're going to sedate you, and all will be well in a New York minute."
The chirpy young nurse who'd warned about upsetting her followed behind, giving an / told you so look as she swiftly reached into one of the medication shelves, retrieved a small, brown glass vial, and snapped it open. Within seconds she'd drawn the contents into a syringe, and Hamlin slowly injected the clear solution through a side portal in the IV.
Richard quickly tried to tell him what had happened. "I was just trying to explain why you had to put a line in her neck—"
"Yes, luckily we didn't need it." He continued to infuse the sedative. "But why the hell are you bothering her with medical gobbledygook at a time like this, Richard? Act like family, for Christ's sake, not her doctor. Shit, you know it could be lethal, agitating her like that." Kathleen's eyes and lids slowed their movements, then drifted shut, and the numbers on the screens coasted back down into neutral territory. He stopped pushing in the plunger at that point, and withdrew the needle.
"Goddamn it, Tony, listen to me. I wouldn't jeopardize her for the life of me, but she seemed really upset about what happened during the angiogram, and I was simply trying to help her understand it so she'd relax—""From now on, Richard, I think it best she be more heavily sedated. These patients commonly have panic attacks as you can imagine, given the state they're in. And I don't have to tell you about the effects of morphine."
He meant how morphine, though it helps pain, can sometimes induce delirium and agitate a patient, even produce disturbing hallucinations.
"Look, our best hope is that she not rebleed, giving us time to wait until she's more stable before I operate. Now, I've tentatively scheduled the surgery for Tuesday, next week. That's seven days. Until then, no more upsets. You can give her head rubs, massage her hands, and whisper sweet nothings at her all you like, but nothing else, and certainly no interrogations. Agreed?"
"Interrogations?"
The nurse shot him a smug grin confirming that she'd ratted on him after all. Eyeing her pointy hairdo, he refrained from saying, "Thanks, Spike."
Everything Hamlin had said was absolutely right. Yet he still felt angry. Maybe, he thought, if Hamlin had explained things better the previous night, Kathleen wouldn't have been so upset about the needle in her neck. Richard wanted to rail at the pompous little man, but for Kathleen's sake he held his tongue. As far as technique went, especially for working in the brain stem, nobody had hands or experience like Hamlin's. Better to avoid a tiff with him than risk his taking offense and transferring Kathleen to someone with less expertise. "Agreed," Richard finally said, his face burning from being so thoroughly chastised.
Spike gave him another / told you so stare.
Holding her gaze, he added, "And I'm sure that from now on your staff will explain what they're doing before proceeding to touch Dr. Sullivan, also to avoid upsetting her?"
"Of course, Richard. We always do that," he replied. "Isn't that right, nurse?"
"All the time, Dr. Hamlin," she said, disposing of the syringe and broken vial in a plastic container before scooting out of the cubicle.
Yeah, right, thought Richard.
The entire incident fueled an icy burning in his stomach as he ran down the stairs to the ground floor. Why had Hamlin chosen to put the line in her neck anyway, he fumed, retreating to his office. He could have gotten the same information he needed to infuse her by going in under her collarbone, and wouldn't have frightened her nearly as much. Not for the first time he found himself wondering how the man could have spent the better part of his life poking around people's brains and yet be so clueless about human nature.
With the medazzle whatchamacallit medicine that the white-haired creep had given her, Kathleen went floating off into darkness, but not quite out. At least not right away. She had feigned that part, deliberately closing her eyes just before he injected enough of the drug to close them for her. As a result she could still hear what he'd said. And Hamlin's statement that he intended to operate as soon as she was stabilized chilled her.
No way that son of a bitch was going to put a knife in her brain, she thought, feeling her heart start to palpate again despite the sedation. By sheer willpower she brought her panic under control. Otherwise, she realized, she would set off those damn alarms again and bring back the ring-nosed she-beast with another shot. She struggled to remain calm as she wondered how she could make Richard, or somebody, understand Hamlin mustn't be let near her? How could she tell Richard he'd already put something into her he shouldn't have. And who would believe her? After all, she'd have to pretend that she was half-zonked most of the time, or they would medicate her into the twilight zone for real. She had to keep Hamlin and that rat-faced buddy of his fooled into thinking she was out of it, at least until she was safe from them. Plus it sounded as if there were others involved in whatever they're up to. How had rat-face put it? "Steele could get us all sent to jail— for homicide." Maybe if she was lucky, Hamlin and rat-face would let slip who "all" involved. Not that she'd be able to do a lot about it, she concluded, her head reeling. Considering her current repertoire of moves— look up, look down, and blink— how the hell could she say anything to anybody if they didn't ask the right questions?
She found it increasingly hard to think clearly as the medication gained the upper hand. Her head began to fill with darkness. She hadn't stopped him and his needle in time after all, only delayed its full effect, she realized as it sucked her down, whirling her faster and faster into a black sleep. And what a perfect lie he's told, she thought in the final seconds of her descent. Now even if she did figure out a way to say what the good Dr. Hamlin had done, everyone would dismiss her story as the ravings of a drugged-out lunatic.
Chapter 3
Richard couldn't believe the change since morning.
As he watched, spasms snapped through her hands, arms, and legs, coiling them so tightly he couldn't undo so much as her fingers. He knew it meant the brain's cortex was shutting down in the area of the bleed, whether from damage already done or a new hemorrhage, he couldn't tell. Either way, it left her folded into a ball, the way a child who is cold huddles in bed. Even her ability to understand him had become erratic. At times she no longer responded to his questions, or if she did, giving appropriate yes and no answers seemed beyond her.
"Kathleen," he said, again and again, as if his calling her name could penetrate her confusion when all the skills of his profession could not.
No response.
Images of their time together, fourteen months compressed into a flash, flew through his head. "We've beaten worse odds, you and me," he whispered into her ear, thinking of how they'd nearly died at the hands of a wacko terrorist who'd unleashed genetic weapons into the nation's food chain. "How many couples can say they fell in love escaping a would-be killer? And we've got such luck," he went on, hoping even if she couldn't understand, the sound of his voice would let her know he was there, "our kids taking to each other the way they have. Chet, he adores you, and Lisa, I love watching h
er big-sister him. He's exuberant again, I never thought I'd see that after his mother died. It's due to you, my love. You brought him and me back from the dead. . . ."
He continued his murmuring, keeping it steady as a heartbeat, driven by an insane fear that if he paused for so much as a breath, he'd lose her.
Yet it all seemed so horribly familiar. He'd stood at hundreds of bedsides observing people whose signs of life, like tenants about to vacate dwellings, hovered within for a last look around before departing. It always struck him how the work of muscles on automatic pilot— breathing, pulsing, contracting— had so little to do with who a person was, yet in the final hours were all that stood between sleep becoming death. But he kept talking, pulling her with words and pleading she not leave, sending any message of love he could think of into her ravaged brain to coax her back.
A half hour later the spasms cleared, and she continued to blink.
Over and over.
At first he thought brain damage had recruited her eyes into the same grotesque dance it had put the rest of her through. "Can you hear me, Kathleen?" he asked. Her lids paused, then blinked yes.
"Are you trying to say something?"
Yes.
What he continued to fear most was that the hemorrhage had extended itself. "Do you feel new symptoms?"
Yes and no.
Not this again, he groaned inwardly, keeping a wary eye on the monitors showing her pulse and pressure. Above all, he had to keep from exciting her. "Is your dizziness worse?" he said, still whispering, knowing if the nurses overheard a repeat performance of his quizzing her they'd throw him out for good.
Her eyes shot up to the ceiling.
Wrong question, he thought, watching her pulse pick up a few beats. "Okay, so you don't want me re-asking all that stuff."
She resumed the steady, repetitive blinking, and her pulse settled down. "Then what?"
The blinking continued.
After a few seconds he recognized that the movements had a pattern. He grabbed the pad of paper he'd used that morning to draw the human form, flipped over the page, and jotted down what seemed to be the sequence. Nine times she'd open and close her eyes in rapid succession, then look up. Three more times, pause, one time, pause, fourteen times, and then she'd look up again. Nineteen blinks in a row he counted next, followed by five, followed by twelve, two times. Then she'd repeat the whole cycle again. What the hell? he thought, once he'd been through the repetitions often enough to realize they weren't a fluke.
Did she know Morse code? he wondered. No, it couldn't be that. One blink wasn't longer than another to suggest dots and dashes. Then he got it, and kicked himself, it was so simple. He quickly jotted down the alphabet, and, starting with a, assigned each letter a number, from one to twenty-six. In less than sixty seconds, he'd translated all the different blinks into icanspell.
"Well, I'll be damned," he muttered, flush with excitement. "Looking up once is the end of a word, twice the end of a sentence?"
Yes.
"We can talk!"
Yes.
"What did you want to tell me?"
He carefully recorded a much more elaborate sequence of numbers. Occasionally she'd lose track of her count and signal "No" repeatedly, indicating she wanted to redo the word they were working on. After five minutes he'd written, Hamlin gave me something bad.
"Hamlin gave you something bad," he repeated out loud to make sure he had it right.
Yes.
Oh, Jesus, he thought. She must be getting confused by the medication.
"It's okay, Kathleen. Nothing bad is being given to you—"
Yes, yes, yes.
"Kathleen, everything's all right. What he's prescribed is to help you stay quiet—"No, no, no.
Her pulse and pressure started to rocket again.
"Kathleen, calm down." He dropped the pad on the bed, grabbed her hand, and started to stroke her forehead. All four of her limbs curled even more tightly into spasm. Alarms began to sound from her monitors.
Two nurses ran into the cubicle. "What the hell's going on here?" said the one with gray hair.
"Christ, is she seizing?" her spike-haired companion asked, reaching for a syringe.
"She's becoming more decorticate," said Richard. "It may be a rebleed. Get Hamlin, fast!" Bending down over her, he called, "Kathleen, can you hear me?"
No response.
Oh, Jesus, he thought.
The monitors continued to sound.
"It's a second hemorrhage," said Hamlin, shoving a film up on the viewing box.
He and Richard were huddled in a tiny room outside the X-ray department's magnetic resonance imaging suite, or MRI, peering at a string of small images showing Kathleen's brain in cross sections. They were like rows of snaps from a dollar-photo machine, except these, unlike any regular X rays, provided the detail of anatomy specimens.
Hamlin pointed to where the pons, a bulbous upper section atop the cone-shaped stem, peeped out from under the rounded cap of the cerebral hemispheres. Or "an upright turnip stuck into the bottom of a cauliflower" as Richard had always described the structure to first-year medical students. Tonight he had eyes only for the black sphere of blood that occupied the center of that bulge, its edges extending to within a millimeter of rupturing through the cortex's surface.
"She won't survive a third," added Hamlin. "I'll have to operate as soon as I can get a team together, tonight if possible."
"Tonight?"
"Another bleed could occur at any second, even if we kept her completely sedated. And by the way, one of the nurses gave me this." He handed Richard the pad where he'd been decoding Kathleen's blinking. "I can't believe you violated my orders and got her all worked up again with crap like that." He grabbed the paper back. "Well this time you might have killed her."
Richard felt as if he'd been bludgeoned.
"From now on you're not even going to be allowed near Dr. Sullivan," continued Hamlin, "provided she survives. And just so you know, the nurses are already urging me to lay a professional misconduct charge against you."
"Jesus, Tony—"
"I'm not going to, out of deference to your emotional stake in the case. But so help me, if you interfere with the well-being of my patient again, I'll do it."
"Please, stop, Tony," Richard said, his voice shredding.
Hamlin simply studied him, his expression impenetrable.
"Let me see her, I beg you, before you take her in to the OR. It won't do any harm. My God, man, I need to say good-bye!"
The neurosurgeon seemed to make a calculation in his head. "Of course. But keep it short. Now I've got to get scrubbed." Richard walked through the doors of ICU and straight to Kathleen's bed without a glance at the nurses.
He gently kissed her on the side of her flaccid face, avoiding the airway hanging out of her mouth. "I love you," he said, over and over.
The gray-haired supervisor approached. "Dr. Sullivan's in no condition to give informed consent for her surgery. It says on her admission sheet the next of kin is her daughter, Lisa, but there's no answer at the number we have."
Richard found it obscene that life and death required so much paperwork. He could remember the thousands of dying he'd worked on who'd struggled for breath as a clerk pestered them for their mother's maiden name. He straightened, but kept his hand on Kathleen's. "Lisa is staying at our house now. Let me call her."
"Please make it fast. We just got word from OR. They want the patient up there in half an hour."
When he looked down at Kathleen, he was surprised to see her eyes open again. Ever so slowly, her lids lowered, then raised. Three times.
No, no, no. Last-minute orders from Hamlin's residents ripped through the air.
"Up her 02!"
"Set the respirator at eighteen!"
"Get me a blood gas!"
Lisa arrived within ten minutes.
Richard felt the thin young woman tremble as he guided her toward her mother's bedside. The nurses were too
busy getting Kathleen ready for her ordeal to enforce Hamlin's order and keep him away.
Some hastily drew bloods.
Others adjusted her IVs and checked her monitors.
The older nurse with the gray bun rolled Kathleen on to her side and hastily sheared the back of her head with scissors and an electric hair-clipper. Hunks of auburn-gold hair tumbled over the pillow and onto the floor. Looking frightened, Lisa reached down and retrieved a lock of it, slipping it into her pocket. She then inserted herself between the crush of men and women around her mother, leaned down, cupped her face, and kissed her eyes. She whispered something.
"Everyone ready?" the supervisor asked.
Turning to Richard, Lisa said, "Chefs outside. He wants to see her, too."
His son approached the bed with the stiffness of a sentry, but he never faltered. "Can she hear me, Dad?" he said, eyes shimmering as he leaned over and kissed Kathleen on the temple.
"I think so."
He squeezed her lifeless hand. "I love you, Kathleen. I know you're going to be all right."
The nurses started to pile the various monitors onto the bed for the trip upstairs.
"Let's roll," said one of the senior residents.
"How long will the surgery take?" Richard asked him. "At least six hours."
Richard managed to stroke her brow one more time before they wheeled her out of the room. As she vanished down the hall, the white circle where they'd shaved her head looked luminous under the dim overhead lights. Soon Hamlin's scalpel would slice through her scalp at that spot and his bone saw tear into her skull. It reminded him of a target.
He suggested they do their waiting back at the house, and told his answering service not to interrupt them. It was nearly midnight, and there shouldn't be any incoming private calls. Chet and Lisa might at least catch snatches of sleep without thinking the worst every time the phone rang. But there'd be no rest for him. Richard knew he'd be pacing until it was over, one way or the other.
At twelve-thirty he called the OR and got a report from the nursing station.
"They've just opened the cranium and are about to cut through the dura, a membranous covering over the brain," he said to Lisa and Chet after hanging up. "In other words, so far so good."
Critical Condition Page 4