Trauma

CHAPTER 13

Carrie could not shake the smile off her face. The occasional glint of sunlight slipping through a persistent cloud cover seemed intended just for her, and buoyed her spirits. Her footsteps on her walk to the VA parking lot came quick and purposeful.

She no longer felt directionless or adrift. After two hours with Dr. Alistair Finley, she could visualize some kind of future. It wasn’t a fully realized vision, but a sprig of hope had sprung from her despair. Carrie could not help but think of the final line from Casablanca, which she had watched with her dad the previous night. “Louie, I think this is the beginning of a beautiful friendship.”

It was funny that David Hoffman’s bloody nose was partially responsible. His passion for his work, undaunted by a violent subject, had reminded her of herself.

I don’t back down so easily.

She’d been in no mood to socialize, but after Carrie cleaned David up, it was easy to say yes to an invitation to have coffee later. She was under no illusions about his motives: He wanted information about Adam and their family for his story. But he’d made her laugh.

“I usually only have coffee with rocket scientists,” he said. “I guess I could slum with a brain surgeon.”

Adam never came back to make amends, leaving Howard and Irene to do the apologizing.

“Don’t even mention it,” David had said with a wave of his hand. His battered nose would heal just fine. “If it’s okay with Adam, maybe we can try again sometime. People need to know what’s happened to our servicemen and — women. They need to see the war after the war.”

For the rest of that night, Carrie thought only of her father’s suggestion and David’s persistence. She had come too far to quit. She called Dr. Finley’s office at the VA the next morning.

To Carrie’s surprise, Dr. Finley answered his own phone.

“My name is Carrie Bryant,” she said. “My father, Howard, suggested I give you a call.”

For whatever reason, Carrie felt at ease with Dr. Finley. His voice was intimate, with no discernable accent, and he spoke to her as a colleague. He remembered her father, and was interested in her background and experience.

“Can you come by the hospital this afternoon?” he asked.

Carrie hadn’t expected that. It felt fast, but that was good. No chance to get cold feet. A few hours later, she was sitting in Dr. Finley’s office anteroom, flipping through an issue of People magazine. Five minutes later, she was in front of Dr. Finley himself.

Unlike his fancy headshot on the VA Web site, Dr. Finley looked every bit the harried professor. His long hours showed in the silver that streaked his mop of wavy, light hair, and in his pale cheeks and burrowed eyes. He might have been intimidating, except for his cheerful expression and a slightly disheveled appearance.

Dr. Finley shook Carrie’s hand firmly. “Please, come into my office. The executive suite,” he said with a smile.

She wouldn’t have called the attendings’ offices at Community comfortable, but they seemed luxurious compared to the décor here. Two metal folding chairs faced an L-shaped desk that looked like a Walmart special. An overhead fluorescent light fixture gave off a persistent hum. The walls were bare, except for a couple of diplomas and the requisite pictures of the president and the secretary of Veterans Affairs. The VA reeked of institutionalism, like body odor. Still, the man seated at the desk had a warm and inviting smile.

Carrie gazed out a square window that overlooked the parking lot, focusing on an adjacent multistory brick building under construction. The building was covered in rusted scaffolding and tattered blue tarps, but Carrie could still see signage over the front entrance: VA HOSPITAL ANNEX. Most of the windows on the annex were boarded up, but some remained intact.

Dr. Finley noticed her looking. “That was supposed to be our gleaming new facilities,” he said, a bit wistful. “But we’ve been caught up in a bit of a funding crunch, I’m sorry to say. Work stopped almost two years ago.”

“The building has been vacant this whole time?”

“Unfortunately, yes,” Dr. Finley said. “There were ambitious plans for hospital expansion, but most everything has been put on hold because of ongoing budget constraints. Perhaps one day the fortunes will change. But we’re not here to discuss the fiscal woes of the VA.”

“No, we’re not,” Carrie said, taking a seat on one of Dr. Finley’s metal chairs. “My father sends his regards.”

“He’s a good man,” Dr. Finley said of Carrie’s father. “That was a great time. Great. Internship was without a doubt the hardest year of my life, but it was probably the best, too. I want you to know he’s not the reason I invited you down here. Your call may have come at a fortuitous time for us both, and I’d like to know more about you.”

For the next thirty minutes Carrie shared her experience, career plans, and ultimately the incident that had derailed her. Dr. Finley listened with rapt attention. His avuncular interest let Carrie tell him all the whys and wherefores without embarrassment.

“And so I resigned,” she concluded. “I couldn’t see how I could continue a surgical residency. But now that I’ve had a few weeks to think about it, I realize that doesn’t mean I need to be finished with medicine.”

Dr. Finley added some final notes to those he’d been keeping during Carrie’s story.

“Well, let me tell you a little bit about our work here.”

For several minutes, Dr. Finley detailed what sounded to Carrie like a typical neurological practice. The hospital had a fully staffed neurosurgical department with an accredited residency program. Together with Dr. Finley’s neurology practice, they treated everything from brain tumors to migraines. But of all the work being done by the Department of Neurology and Neurosurgery at the VA, Dr. Finley was most excited about his deep brain stimulation program.

He talked at length and with great enthusiasm about how DBS uses a neurostimulator placed in the brain to deliver electrical impulses to targeted regions, and the great potential it has for treating a wide range of neurological conditions. Mostly he focused its application for treating movement disorders, and he made several references to the patient Carrie’s father met during that sponsored dinner on Parkinson’s disease. He hinted at other applications for DBS, but kept those allusions intentionally vague, she believed.

“Look, Carrie,” Dr. Finley said after his impromptu lecture on DBS, “I can’t offer you an actual residency position here. Our program is fully staffed — and besides, it’s mid-year.”

Carrie tried not to look deflated. In their brief conversation, her expectations had gone from zero to high.

“But I do think I may be in a position to help,” Dr. Finley continued. “And I suspect what I have to offer would help renew your confidence.”

“I’m interested,” Carrie said.

“A stint with the VA would, in my opinion, increase your chances of getting back into a formal neurosurgery residency program next year, while teaching you an awful lot about brain diseases one normally doesn’t deal with in the usual neurosurgery program.”

If the residency positions were filled, what could he have in mind? “I could certainly do some research on depth electrode stimulation treatment for Parkinson’s disease,” Carrie said, anticipating what she assumed Dr. Finley would be able to offer, some sort of research position, nothing that involved actual patients. “It sounds like fascinating medicine.”

Again Dr. Finley checked his notes. “I tell you what. Better than that, I’ve got clinic on Thursday morning, and some follow-up patients will be there. Could you come?”

“You want me to come on rounds with you?”

“If you’d be so inclined.”

“I’m just curious,” she said. “If there’s no residency positions, why was the timing of my call fortuitous for us both? How are you in a position to help me?”

“Come to rounds on Thursday,” Dr. Finley said. “I’ll explain everything then.”