Trauma

CHAPTER 16

The operating room was Carrie’s amphitheater, and she was the violinist about to dazzle. She was back in uniform: green scrubs underneath a white lab coat. Soon she would enter the preoperative holding area to visit a patient, her first at the VA. His would be the first burr holes she would drill in almost two months.

Jealousy from the other resident physicians had been an initial worry. Other residents had competed for their positions, while Carrie had been handed what many would perceive as a post-resident fellowship, working directly with one attending on a single project, without the onerous responsibilities of taking call or being responsible for patient care. It was a plum assignment for sure, but Dr. Finley made it clear to everyone that Carrie would not receive credit toward her residency requirements. No, this was a different trial for her. Would she perform to her ability?

While the DBS procedure she would perform would be relatively simple and straightforward, it was by no means free of complications. Opening the brain involved significant, life-threatening risks, every time. Still, implanting wires was not like sucking out blood clots deep in an already swollen brain where the surgeon had to be both swift and meticulous. DBS required a tremendous amount of patience and an OCD-like attention to detail. Carrie took a few calming breaths. She ought to wait for Dr. Kauffman, the anesthesiologist, but felt she could handle the preoperative consultation just fine.

Five minutes later Carrie entered the preoperative holding area, where she was struck by the sight of a man who could have been her brother’s twin. Seated on a beige armchair, reclined ever so slightly, the man looked like Adam not before the war, but after. He had Adam’s strong jaw and sharp-featured face, but his shaved head called attention to his concave cheeks, and he appeared frail and skeletal. His arms were spotted with ugly purple bruises that spiraled outward like mini nebulas. But it was the eyes that truly alarmed her. They looked hollow, a stare that seemed to stretch out into space.

Carrie was not sure what to expect from patients after they’d been subjected to the virtual reality therapy, but it certainly was not this. Her patient had the dazed look of a car accident victim. She knew he would be sedated, but it was tough to see his suffering. Carrie usually treated the sorts of injuries and ailments that appeared on an MRI. This man’s wounds were just as significant, even if they couldn’t be imaged.

She checked her chart. She knew the soldier’s name, but wanted to double-check to make sure she got it right. Her father’s lesson on the importance of details had taken root.

Abington. Staff Sergeant Steve Abington.

Carrie helped Abington out of the chair and onto the exam table, positioned kitty-corner in one end of the room near a counter with a built-in sink. Above the sink was a steel medical supply cabinet affixed to the wall. At first Carrie thought Abington was too thin, but once he was standing she could see he was rippled with muscle. He had the minimal body fat of an athlete.

“How are you doing today, Steve?”

No response.

Abington had fixed his gaze on the framed print of the Boston Common on the wall before him, but he seemed to be looking through it, not at it. Carrie was close enough to smell detergent and cleanser; he smelled institutionally clean. She checked her chart again. No address listed. No emergency contacts. He could have been homeless, and now in the care of the VA system. What did they use for soap where he lived?

“I’m the surgeon who is going to perform your DBS procedure today. I wanted to meet you before the operation in case you had any questions for me. Do you have any questions, Steve?”

Abington turned his head slowly, dreamlike, as through pushing through molasses. His mouth began to twitch, perhaps to form a word. But all that came out was a guttural noise like the clearing of a throat.

Carrie knew that the DBS had to be done within a window of opportunity immediately following the virtual reality simulation, when the negative memory was most fresh in the mind. She did not know exactly where DARPA conducted the simulations, or who had escorted Abington to the exam room, or where that person had gone. Those questions were well outside her area of responsibility.

“There are lots of bruises on your arms, Steve. Can you tell me how you got them?”

Abington shifted his gaze to one of his battered arms. He lifted the limb slowly, like a marionette whose string was pulled, and studied the arm with detached, vague curiosity. Then his face slipped back into that dead-eyed gaze.

Carrie moved to check his vitals, and he did not resist. Blood pressure: 90/60. Perfectly normal. His temperature was 98.6 degrees, and his reflexes were normal. Heart rate was also in normal range for a resting adult. She put a penlight up to his eyes — five-millimeter pupils, a bit dilated but equal, and briskly reactive to the flashlight. Good. All the consent forms had been signed. There was no reason not to proceed with the surgery.

“Steve, do you understand what’s going to happen? You’re scheduled for a very important operation.”

Once again, Abington’s mouth began to twitch with words he could not quite form. Then, surprisingly, he started to move his body, bouncing where he sat like an anxious child, and massaging the bruises on his arms. To Carrie it looked as though his drained battery had somehow sparked back to life.

“You don’t know — you don’t know,” Abington mumbled. He periodically stopped rubbing to run his fingers over his newly shaved pate.

“What don’t I know?” Carrie asked.

“I don’t belong here.”

“I know you’re scared, Steve. But we’re here to help.”

Abington shook that off. “It’s not all right. I don’t belong here.” His voice rose in pitch and volume. “You don’t know.”

“Steve, take it easy.”

Abington went still. His arms dropped to his lap.

Carrie let out a relieved breath, wishing that she’d waited for Dr. Finley or Dr. Kauffman before starting the consultation. Dr. Finley had warned her that patients could be highly agitated pre-op. They were fragile following the virtual reality treatment.

“Steve, let me explain what—”

Abington reached out and seized her by the throat, pressing on her windpipe. Shocked, Carrie started to panic, her eyes bugging out, able to take only tiny gasps of air. She reeled backward, pulling Abington off the exam table. As he dropped to the floor, Abington let go of her throat, so Carrie whirled around and sprang for the door. But Abington charged her. With speed that belied his earlier torpor, he snatched the back of Carrie’s flapping lab coat just as she was within reach of the door handle. He pulled her toward him and she fell back into his arms, then he spun Carrie around to face him.

His mouth formed a fearsome snarl — from lifeless to rabid in a matter of moments. His sedative must have worn off, revealing murder in his eyes.

“I don’t belong here,” he hissed in her face. “Got to get out!”

His back was to the door she had closed for their interview, and hers was to the counter and medicine cabinet. Carrie wriggled free from Abington’s grasp.

“Somebody please help me!” Carrie yelled, though it was doubtful anyone would hear her. The walls were made of thick concrete, and the nurses’ station was located way down the hall. Carrie flashed on an idea and turned her back to Abington to focus on the locked supply cabinet.

“Help!” Carrie cried out again. “Somebody help!”

From behind, Carrie heard Abington gibber unintelligibly. Carrie fumbled in her pocket for the keys. Did she dare risk turning her head? She could not resist. Abington paced in front of the door like a caged animal. He took a step toward Carrie and said, “I’m not here. I don’t belong here.”

He could have left the room, but he wanted something else. He wanted her. Carrie retrieved the keys, but her hands shook so violently it could be impossible to work the lock. Which key opens the damn cabinet, anyway?

Carrie fumbled with the keys some more. There were too many attached to the ring. She heard Abington take another step toward her. One. Single. Step. Carrie’s throat ached where he had grabbed her. The soldier’s labored breaths seemed to come from every corner of the room.

Carrie located a small key among the jumble on her ring and tried to jam it into the lock. No good. Wrong fit. She searched for another. The cabinet was made of metal; otherwise she would have broken the glass.

“Help!” Carrie yelled.

There was another small key on the ring. But was it the same one she had just tried?

Abington muttered, “Listen to me. I don’t belong here.” Carrie jammed the second key into the lock, and this time it fit. The lock turned easily and Carrie ripped open the door. Mixed in with a number of medical supplies she found various vials of medication and several wrapped syringes.

“I don’t belong here,” Abington said from someplace behind her.

Carrie fumbled through many vials of medicine, until she found the Valium. She held the Valium in one hand, and used her teeth to rip open a syringe package. Carrie kept her back to Abington as she worked to get the syringe inserted into the top of the vial.

“Steve, it’s okay. You’re going to be okay. Please believe me. I’m going to give you a shot to calm you down.”

Carrie filled the syringe just as Abington charged and struck her in the back. His momentum slammed Carrie against the lip of the counter hard enough to take away her breath. Abington wrapped his arms around her waist and together they tumbled to the floor. Carrie held on to the syringe with her life. She twisted underneath him, intending to claw at his face. But Abington flipped her onto her back and dug his knees into her ribs hard enough she feared he’d snap her sternum.

Once again Abington took hold of Carrie’s throat, but this time he did not squeeze. “Where’s Smokes? Hunter. Is Hunter here? What about Roach?” His voice was plaintive. “Roach!”

Carrie forced herself to stop struggling.

Just don’t squeeze … please don’t squeeze.

Years of surgery gave Carrie tremendous hand dexterity. She was able to position the syringe for an effective strike without drawing Abington’s attention.

“Please, Steve, I’m not here to hurt you.”

“That you, Roach?” Abington said. “You got to get me out of here. I don’t belong.”

Abington tightened his grip around Carrie’s throat like a python readying to squeeze. She had one chance. One. It was hard to hit under normal circumstances. But induction time was everything. The drug needed to work and work fast. Abington squeezed some more. Carrie could still get air into her lungs, but it was barely a breath. Gurgling noises bubbled up from her throat, from all the saliva that had no place to go.

One chance … one …

Abington’s jugular vein pulsed like a thick blue target. Carrie swung her arm in a wide arc. Abington leaned away from the strike and his body position shifted. Instead of hitting his neck, Carrie slammed the needle into Abington’s shoulder, right into the muscle. It would delay induction, but she depressed the plunger anyway.

Carrie tried to speak, but no words came out. She left the syringe dangling in Abington’s arm and used her fingers to try and pry Abington’s hands free. Abington acted unfazed. He pressed harder on Carrie’s throat. The loss of oxygen started to get to her, and she couldn’t control her panic. She kicked and bucked wildly, but could not toss him. Her legs began to spasm and her eyes watered.

This isn’t how I’m supposed to die.…

Gripped by panic, Carrie thrashed beneath Abington, kicking over a metal stool that clattered noisily to the floor, but it was no use. He would not let go. She felt herself slip into unconsciousness. Her body became heavy, Novocain for blood. Carrie closed her eyes. She did not want the last thing she’d see to be the face of her murderer.

And then she was filled with a sense of profound peace, of weightlessness. She felt her fear fall away as the darkness grew deeper and darker.

In the very next moment Carrie could breathe again, and the room went from dark to bright. The feeling of weightlessness slipped away as she blinked her eyes open. Dr. Finley knelt beside her. He looked as worried as her father might.

“Carrie, are you okay? Can you hear me?”

Through her blurred vision, Carrie saw Dr. Kauffman and a sizable orderly restraining Abington.