Trauma

CHAPTER 21

The house was quiet when Carrie got home. The front porch light was on; it was always on when Carrie stayed out after her parents had gone to sleep. Traffic on the Mass Pike had been mercifully light, but it was still almost midnight when Carrie pulled into her parents’ driveway.

She’d spent the drive running Abington’s surgical procedure through her mind. It had been an exhilarating, terrifying, and utterly strange first day on the job and she was glad to be home. Carrie had given some thought to moving out now that she had an income stream again, but opted against it. Until she had some permanence she was not going to make any big changes.

When Carrie walked into the kitchen, she was delighted to find a card waiting for her on the table, propped against a small vase of flowers — daisies mostly, her favorite. The handwritten note from her mom and dad congratulated her on what they assumed had been a successful first surgery. She had debated telling them about Abington, but worried they would worry.

Reading her parents’ note, Carrie became keenly aware of the soreness around her neck. It was tight, and every time she looked to the left, she felt a sharp, gripping pain that stretched across the back of her head. It was the pain of a muscle spasm, not a fracture. She also had additional pain along the outside of her right knee, but not with every step. In the morning she’d probably wake up with visible signs of the day’s violence. Those would need to be explained, or perhaps just covered up.

Carrie heard a floorboard creak behind her and turned to see Adam in the entrance to the kitchen. He was wearing a T-shirt and sweats. For a moment she saw him as her little brother again, but that vision was blown apart by his haunted, hooded eyes. Eyes that resembled Abington’s.

“Hey Carrie,” Adam said as he trudged over to the fridge. “How’d the first surgery go?”

“Pretty good,” Carrie said. “Nobody died.”

Adam returned a fractured smile. “Well, I’d call that a big success.” He chuckled. “Want some OJ?”

“Love some.”

Adam poured two glasses and joined Carrie at the kitchen table. Carrie moved the flowers and card to the side to make room, surreptitiously checking her arms to make sure there were no visible marks or scratches. If her parents found out, they’d certainly be concerned about safety, but Adam could go ballistic.

“Can I ask you something?”

Adam took a swig of OJ. “Anything.”

Carrie softened her voice. “What do you think would happen if you saw a virtual reality simulation of something that happened to you over in Afghanistan?”

“What do you mean by that? Like a computer simulation?”

“Along those lines,” Carrie said. “But hyper-realistic.”

Adam tossed his hands in the air. “I dunno.”

Carrie thought not only of Abington’s initial assault, but of his second outburst after the surgery, which required a haloperidol drip to calm him. Having experienced Adam’s explosive temper, it was not a stretch to envision her brother in Abington’s place.

“Could you maybe … become violent?” Carrie asked.

This was a sensitive subject for the family. Adam owned several guns, including a pistol and rifle, and threatened to move out before he’d give them up. He was a lawful and responsible gun owner, and nobody disagreed, but nobody wanted him to have those weapons either. The worry was for Adam’s safety, since PTSD and gun ownership were often a lethal mix. Adam returned an indifferent shrug.

“I hit a reporter for no real good reason. So I suppose anything is possible.”

Carrie laughed. “Did you call to apologize?”

“I did better than that,” Adam said. “I met the guy for coffee. Gave him everything he could possibly want to hear, and probably more than he expected.”

Carrie made a mental note to call David Hoffman; she’d agreed to a coffee date as well. Seeing sadness in her brother’s eyes, Carrie reached across the table and took hold of Adam’s hand. “Even I haven’t heard those stories.”

Adam squeezed her hand. “For a reason.”

“If you ever want to talk about it—”

“You’re here for me. I know that, Carrie. You’ve always had my back.” He raised his hands in a pantomime of a pneumatic drill. “Hey, what do you think of this work you’re doing? Should I have you drill into my head and stick me with wires?” Adam gave a cartoon evil scientist’s maniacal laugh.

Based on Abington’s reaction to the treatment, Carrie could not say with certainty, but she still believed in the program and its promise. It might be worth the pain of reconsolidating bad memories through virtual reality therapy to get positive results, though Carrie had reason to worry about potential side effects.

Her mind picked at the odd verbal exchange with Abington right before he went off the rails. The man’s voice had sounded so distressed as he repeated, “Follow my light, follow my light.” It was like he heard my voice in his head over and over again, Carrie thought.

“I don’t know yet,” she said to Adam. “I need more time to see it in action before I can say, though I do think there’s tremendous promise.”

Adam swallowed his orange juice in a long gulp and pushed back his chair to stand. “I’m beat.” He stretched and yawned.

“Hi Beat, I’m Carrie.” She held out her hand and Adam shook it, smiling at their long-running joke. “Have a good night. I’ll see you in the morning.”

“Night, Carrie.” At the doorway Adam paused and turned. “Hey, it’s good to have you here. It’s good for all of us.”

Carrie blew him a kiss. “When are you going to take me for a ride in that Camaro of yours?”

“I almost got it running today.”

Carrie grimaced as she recalled the last time Adam almost got it running.

Adam noticed her reaction. “Don’t worry,” he said. “I’m not going to go all Christine on it.”

Christine, the film adaptation of the Stephen King novel, was Adam’s favorite movie these days. He’d seen it on cable after he came home from the war. He was referring to the scene when the high school kids trashed the car named Christine using aluminum bats, only to be killed after the car magically repaired itself and sought revenge. Adam seemed to like the idea of a thing that was indestructible, perhaps because he felt so vulnerable.

“Good night, Adam,” Carrie said, crossing the room to give her brother a warm embrace. God, she hoped the DBS treatment worked. She hoped it was the cure for PTSD. She wanted her brother to feel whole again, but he was more like his Camaro he could not get running than Christine, which could magically put itself back together again.

Upstairs in her bedroom, Carrie went to put her phone on the dresser, and saw by the display that she’d missed a call during her drive home.

“Dr. Bryant, this is Marianne from the VA. You asked me to call if there was any problem with Patient Abington. He was rushed down to the medical ICU by a nurse on Dr. Goodwin’s staff. Abington developed an arrhythmia and his blood pressure fell. The monitor showed ventricular tach with a wide QRS. I’m sorry to have to leave you this message. I tried you a couple times, but I couldn’t reach you.”

Carrie felt her own heart start to race. She checked the call log, and sure enough: two missed calls from the VA, including the call where Marianne had left her the voice message.

Carrie muttered to herself, “The haloperidol, dammit.”

She probably should have just given Abington more Valium, since it was already in his system from before. Except she had checked his ECG, and the Q-T interval was not prolonged or anything, and it had calmed him down. She felt physically ill. She had made the call, she had ordered the drug, and Steve Abington in the ICU was on her.

Carrie thought of other ways she could have handled the situation, but kept returning to the haloperidol. He had seemed so crazy, beyond agitated. She had never experienced a post-op patient with symptoms resembling anything like Abington’s. His repeating the same phrase, and that look in his eyes — that was fear and terror she saw. It was different from the confused agitated state or delirium she’d seen time and time again, whether someone was in the throes of DTs, or suffering the consequences of acute stroke, or sepsis, or, well, a host of other medical and surgical disorders. This was something unique, and she did not know what to make of it.

What else could have caused the arrhythmia?

A hemorrhage?

Goodness, that was always a risk after surgery. And Carrie had seen at least one case where a subarachnoid hemorrhage had resulted in a serious arrhythmia. While negative drug reaction remained the most probable event, other considerations besides a hemorrhage dotted her thoughts. It could be an infection. Fever. Perhaps a seizure, or even a stroke. A CT of the brain would be the logical first step.

However, she could do nothing about it now. Abington’s welfare was in the hands of the med ICU team. Before she could do anything, Abington needed to be stabilized. His blood pressure, heart rhythm, vital signs in general had to be under control. To go barging in there at this late hour would be counterproductive. They would take all the necessary precautions. She could picture Abington lying in an ICU bed, intubated again and hooked to a ventilator, IV fluids and antiarrhythmic drugs flowing through his veins. Dopamine and other vasopressors keeping his blood pressure up. The baton had been passed; Abington was not a neurosurgical post-op case any longer.

Still, she would go see him first thing in the morning.