by Barbara Ebel
It took a minute to pull up Rob King’s chart on a computer for the ER notes and his colleague’s. He noted the patient’s Glasgow Coma Scale and the time of admission. Time mattered when it came to an acute subdural hematoma so Danny was extra happy to see how fast they’d evaluated and gotten Rob to the OR.
He stopped at the OR front desk where they told him Dr. Jacob was in Room 3 and they were preparing Rob for surgery. When Danny got there, Matthew was still scrubbing his hands.
“Sorry you know this man,” he said. “Sometimes it’s a small world.”
“Smaller than we’d admit. And even smaller when you don’t want a particular person anywhere near your life.”
They both continued working the soap lather between their fingers when Danny said, “I looked through the admission data in the doctor’s lounge. Looks like he has no real medical history.”
“Not a thing, and no history of surgeries or allergies to medications. He’s on no meds, either.”
“I figured,” Danny said. “Is the CT hanging up in there?”
“Sure is. This should be straightforward. Want some help getting started?”
Danny looked through the glass window at staff, anesthesia, and the patient. “Come on in for a few minutes so we can continue a smooth transition.”
Matthew nodded as they both left the sink and pushed against the OR door.
-----
After they had gowned and gloved, both men looked at the CT scan knowing that anesthesia was still extra busy with their own set-up and monitoring.
“One of my attending mentors in residency,” Danny said, “always made a point that the first CT scan may underestimate the size of parenchymal contusions. That may be a negative thing for our patient but, on the bright side, his age is in his favor.” Danny looked at his colleague with a question mark.
Matthew smiled under his mask. “I always like the professional interaction; otherwise, I’d be in a solo practice. Patients over forty with acute subdural hematomas have a mortality rate over 65-percent. Your trainer here is under forty so has a mortality rate of 20-percent.”
“I hope and I trust that Jeffrey would know the same thing.”
“He probably does. Danny, we’re all board-certified so don’t worry.”
“Sorry. I guess I’m becoming more ‘fatherly’ like Bruce. Protective of the group?”
“Fatherly perhaps, but not like Bruce.”
“Hmmm. Cheryl mentioned something along those lines.”
He turned around and acknowledged the anesthesia doctor. “I’m working on the patient’s high intracranial pressure,” the other physician said. “Nothing a little mannitol and hyperventilation can’t fix.”
Danny nodded his appreciation and took the drill from the scrub tech. It felt odd for him because he’d met Rob and yet his patient had already been prepped and draped when he arrived so he never got to see him. When he turned the power on, he began drilling into Rob’s skull, the noisy sound overshadowing everything else. Getting through the skull to relieve the pressure and accumulated blood underneath was now his primary focus. He sighed with relief when he got through while Dr. Jacob silently left to go home and get some sleep.
Danny trudged through the rest of the day like a rubber boot stuck in mud. The neurosurgery kept coming. He left the hospital late in the evening after checking on Rob King one more time. The fitness trainer’s chest went up and down with the timing of the ventilator and his eyes were closed. Danny hoped that Matthew’s citation of a 20-percent mortality for an under forty-year-old with an acute subdural hematoma would turn out to be a zero chance for Rob.
-----
There were few lights on in the house when Danny got home. Dakota sensed his arrival and whined and pranced outside at the back French doors. When he got to the kitchen, Danny opened one of the doors and found Casey with his arm draped around Mary. They were still a picture of newlywed bliss as they slumbered together on a lounge chair. Danny smiled; in another thirty years, he thought, they will be doing the same thing.
“Hey,” Casey said. “You finally got out of there. First things first.” He pointed to the rock wall where a canvas stood upright from the patio floor.
“I just finished it this evening,” Mary said. “My signature is still drying.”
Danny’s mouth slacked as he gazed with amazement and emotion caused his eyes to well with tears. He stepped a little closer due to little light from one porch bulb.
“When … when did you do this?”
“Yesterday and today. I never planned it. It just came to me when I walked into Julia’s room yesterday morning and saw the two of them. I got started and it took form like magic.”
He finally had to wipe his eyes. The little girl and the dog in the acrylic painting was Julia and Dakota; not a photographic, realistic painting, but more impressionistic. They both were standing, the dog’s eyes and posture fixed on her; her mouth was open and one arm was higher than the other as if she was talking to him. There was no background, just the beauty of Julia and Dakota.
“I’m not being biased but this is your best work ever, sis.”
“That’s what Casey says.”
“Are you selling it? In which case, I must buy it.”
“Never. It stays with all of us. I don’t think I can ever part with it.”
“Wow. You are amazing.”
Danny finally sat on the opposite chair which allowed Dakota to push between his legs and nuzzle into him.
“So, how did he do?” Casey asked. “I knew Matthew would be calling you to take over the case. Otherwise, I would have phoned you myself.”
“There was a significant accumulation of blood between his brain and skull,” Danny said for the benefit of Mary. “We kept him asleep and on the ventilator. I won’t know his neurological status until he starts waking up. I left word for Jeffrey to call me tomorrow since he’s on call and will be making rounds. What was the accident scene like?”
Casey closed his eyes for a second. “A friend of his was driving and Rob was thrown out. They were avoiding someone who came around a curve in the middle of the road and never stopped. It could have been a lot worse if trees on the hill hadn’t of slowed and stopped their car.”
“You never know when some other driver is almost going to take your life away,” Mary said. Her sandals were on the ground and she rotated her foot as if it were exercise for her arch.
“Where are Sara, Nancy, and Julia?” Danny asked.
“Sara and Nancy are at the movies and Julia is fast asleep. She and Dakota were thick as Harry Potter books tonight.”
Danny laughed. “Thanks, Mary, for watching her today. I know we have the sitter all week, but I appreciate everyone otherwise chipping in to take care of her.”
“You’re welcome. Actually, Sara and Nancy took her to the zoo today.”
“That’s really nice,” he said, taking a deep breath. “She must have loved that. By the way, Rachel is driving into town tomorrow for her first postop surgery appointment. She wants to see Julia. Now that we know her old boyfriend was responsible for my daughter’s abuse, I’m okay with her spending time with her alone.”
“Can you do that, however? That’s not the last word from the court.”
“I checked with Mark Cunningham. He’ll draw up a short motion that parties have agreed to unsupervised visitation.”
“You’re generous,” Mary said. “I doubt if she would do the same for you. Do you want to know what I hear about married couples who have broken up, especially when one really wants a divorce and one doesn’t?”
“Tell me,” Danny said.
“There’s the parent who’s on the up-and-up. But sometimes the other one is the apparent saint to the child, but is really a back-stabbing ne’er do-gooder who’s badmouthing the other parent.”
“I take it you’re wondering about Rachel?” Danny laughed. “Nah, I can’t imagine someone doing that to their own child.”
The conversation quieted w
hile Casey and Mary gazed at the sky. The crescent moon had a perfect outline and stars twinkled like miniature torches. The night air had cooled to a perfect seventy degrees and Mary slid up a little further into her husband’s lap.
Danny reached down further to rub his fingers along Dakota’s belly. The dog had assumed a rare pose with his hind legs extended and open; a vulnerable position usually assumed by submissive dogs who don’t want trouble from other canines. As he gently massaged, he thought over an esoteric subject. Finally, he asked his sister and Casey their opinion.
“Do either of you think dogs have souls?”
“That’s a question overloaded with possibilities and other questions,” Casey said cautiously while his fingers slowly rubbed Mary’s shoulder.
Danny felt the weight of his sister’s gaze, as if she were trying to figure it out herself.
“I know John Paul II,” she finally said, “made a statement about that years ago. Even though the pope said something like animals were also given the ‘breath of life’ by God or they are as ‘near to God’ as men are, I think it gets a bit muddled. I know the church was clear that mankind should respect all the creatures of God, live in close harmony with them, and love all of them. I think that is true … regardless if they have a soul or if the pope did indeed mean that animals do.”
“What do you think, Danny? Do you think the four of us here will be somehow linked after our physical deaths or that dogs have souls?” Casey narrowed his eyes, clueless as to how his best friend would respond.
Dakota easily flipped over and, after shooting a glance at Danny, lay comfortably alongside his feet.
“I think not all animals have souls.”
“But some do?” Mary asked.
He nodded and went on. “I think a totally innocent animal, let’s say a dog, with blind, trusting dependence on a human being is capable of drawing out hidden depths of buried affection; he has a soul. However, a dog with the same love towards a human may be abused by a human. He also has a soul. And I would like to believe that dog will be given a highly spiritual afterlife and the human will suffer for eternity. But since we think in physical terms, the suffering for that individual would be incomprehensible for us to imagine.”
Chapter 15
“Look at you!” Danny exclaimed after he’d helped Julia get dressed. “Let’s go see Sara.”
The two-year-old followed her father and ran ahead to the next bedroom. Dakota followed them in and Sara stretched her arm, stroking him while lying on her side. Danny settled next to her.
“This is the best trio I’ve ever seen,” she said. “Especially as a wake-up committee. And Julia, what a pretty dress and fancy shoes. And who put that clip in your hair?”
“Daddy. He brushed it like this,” she said, running her fingers through Sara’s hair.
“Are you two going somewhere?”
“To church. But Daddy said we can’t take Da-Ka. Can you babysit him?”
“Yes, I’ll take good care of him.”
Danny put his hand on Sara’s hip. “Did you see Mary’s painting when you got home last night?”
“Did I?” She darted her eyes towards the ceiling. “She caught the essence of both of them. It’s a winner.”
“The closer she is to her subject matter, the better her work.”
“I hope she’s selling some at the gallery. She says artists often can’t make a living even if they’re good.”
“Good thing Mom and Dad left her a hefty inheritance; otherwise, she wouldn’t be pursuing what she loves. They wanted more than anything for the two of us to be happy.”
Sara squeezed Danny’s hand. “I loved the both of them as much as you two loved them.”
“I always figured that.”
-----
Downstairs, Danny let Dakota out the back door and poured water into the coffeepot. He turned around as Sara came into the kitchen. She’d washed and thrown on khaki shorts and a loose button-down shirt.
“What kind of coffee should I put on?”
She rummaged through several plastic bags in the closet and handed him a flavored macadamia nut.
Danny smiled. Any choice would work for him. He measured the grinds into the filter as Julia stood breathing against the door waiting for Dakota.
“Tomorrow night at the gym, I’m meeting that realtor patient of mine that I told you about. Would you like me to ask him to list your house or our old house? I won’t do it if he doesn’t take a reasonable sales commission. Does that sound okay?”
“That sounds fine,” she said, gesturing with her hands, her fractured arm freed from appendages. “It’s time we move forward.”
The water dripped into the pot as the smell of nuts began permeating the kitchen. Danny let Dakota back in and then hoisted Julia into his lap, a glass of milk and a cut-up banana beside them.
Sara got two mugs and stuck each one under the hot stream, filling them to the top; she set one next to Danny.
“Thanks.” He waited patiently for Julia to finish her breakfast. “We sure don’t get mornings like this very often. Although the coffee is delicious, it masks that lovely lemon-ginger aroma you carry with you everywhere you go.” He broke into laughter. “If I were ever on a couple’s trivia show, I’d have to answer some question with the fact that my ex-wife not only looks heavenly but smells heavenly, too.”
-----
In the back of the high-ceilinged church – with Julia in his arms - Danny headed to the votive candle stand underneath a statue of Mary. He put a donation in the money holder and lowered himself to the kneeling bench. Julia stood next to him.
“We will say a little prayer for your grandma and grandpa, my mommy and daddy,” Danny whispered. “Their names were Donna and Greg Tilson.” He took a wood stick, lit it in the closest candle, and then held it over a new wick in the center of the stand.
“Thank you, Mom and Dad, for everything you did for our family. We miss you both so much. Maybe someday I’ll see you again. I’m sure there is a way for that to happen … I just don’t know how.” The flame caught and its brightness deepened.
“And this is Julia, another grandchild. She’s my third living daughter but Sara isn’t her mother. Maybe she was meant to be because, as you know, our daughter Melissa left Sara and me too soon. Maybe Melissa is with you both.” Danny ran his fingers through Julia’s soft hair and hugged her closer to him as she stood on the kneeler.
“I love you, Mom and Dad,” he whispered under his breath, “and I’m sorry I never told you that enough.” He put the long wooden stick back where it belonged and made the sign of the cross. Picking up Julia, he walked halfway up the aisle for the service that was about to start.
-----
During Monday morning rounds, Danny wished he’d seen Rob King first. He could think of nothing better for the man than if he were at Serious Gyms giving people individual fitness training. But he was not pleased with Rob’s progress since his surgery on Saturday, even though Jeffrey had called him yesterday and said he was having a slow yet uncomplicated recovery. Yet Rob still hadn’t been weaned from the ventilator and there had been no change in his neurologic status.
Danny stood next to his bed - the ICU nurse next to him – and grasped the thick hand below the IV, patting it. He also stimulated his feet, shined the pen light in his eyes and checked the last ICU nurse’s notes.
Danny let out an audible sigh as he looked at the male nurse and shook his head. “Prepare him for transport to the radiology suite. I’ll call the radiologist myself.”
While Rob was moved for head scans, Danny’s first scheduled case kept his attention focused. The patient had a metastatic lesion in his cerebral cortex caused by a lung cancer from cigarette smoking. That history was also clouded by the fact that he smoked cigars and drank alcohol on a daily basis. Just what caused his primary cancer was subject to debate, but Danny figured it was the combination of his unhealthy habits which caused a synergistic effect.
Just when he tho
ught he’d seen it all in his profession, something more remarkable would show up. As he peered into the man’s gray matter and defined the lesion, the mass was an almost perfect sphere of cancerous cells that he’d ever needed to remove. He teased it from the surrounding tissue and dropped it into the specimen cup.
As he dabbed pledgets around the area to assure it was dry, the radiologist called and the circulator put the call on the loudspeaker.
“I hope you have some promising results,” Danny said.
“I’m afraid not, Danny. Rob King has a re-accumulation of his subdural hematoma.”
His optimism sank. A repeat operative intervention would increase Rob’s risk of neurologic deterioration, infection, abscess and other complications, postoperative seizures being one of them. He put down the suction catheter.
“Thanks, Joel. You’ve been helpful getting the CT done so fast. Did you get to do the angiogram as well?”
“This is the real kicker. The good and the bad. He has a profuse blood supply of his parietal lobe, but that may be the reason his subdural bleed is re-accumulating.”
“He’s not on any blood thinners and he has no history of anticoagulation. He’s a thirty-five year old fitness trainer.”
“Danny,” the radiologist sighed, “have you ever seen snowflakes crystallize on a window pane?”
“For sure.”
“Mr. King’s middle cerebral artery has prolific offshoot vessels … like water’s dripping and forming all those crystallized tributaries!”
Danny didn’t say anything. He just stared across at the intercom. After a dozen seconds, his eyes locked on to the anesthesiologist. The other male doctor gave him a thumbs up that his current patient was doing well with his anesthesia and vital signs and then said, “It sounds interesting, Danny. What’s causing that?”
“Your guess is as good as mine.”
“Danny, are you still there?” Joel asked.