Trauma

CHAPTER 24

The timing could not have been better.

Functioning as Dr. Finley’s private DBS surgeon, Carrie had no clinic responsibilities, but he had sent her an e-mail to ask her to join him this morning because of a specific case on the schedule, one of his first patients who had undergone DBS for PTSD. The stars appeared to have aligned just for her.

Carrie had replayed her conversation with Abington dozens of times in her head. She had no doubt that he had repeated the phrase “follow my light” numerous times, and seemed to answer her question each time he thought it was asked, but that was not proof of palinacousis. Since Abington was off-limits, the best way to learn more, Carrie concluded, was to see another patient like him. Dr. Finley’s e-mail was like manna from heaven.

At this point, Carrie’s investigation into palinacousis was nothing more than an intellectual challenge. She simply wanted to know if the behavior ever manifested in others, or if Abington was truly an outlier. She was not in a position yet to broach the subject with Dr. Finley. Her confidence was nowhere near where it should be, and any claims made had to be based on evidence, not conjecture.

She had found nothing that reported auditory illusions in DBS cases treated for Parkinson’s or other movement disorders. But with these PTSD patients, electrodes were being placed in a completely different area of the brain, the amygdala nucleus.

Carrie pondered this. The amygdala was not generally associated with hearing perception. She knew that. But this was an experimental program, and the brain was still an organ of profound mysteries.

Carrie was scheduled to meet with Dr. Finley on Wednesday morning, after the general neurology clinic. Dr. Finley was supposed to supervise the neurology clinic, which was otherwise run largely by the residents who rotated on three-month shifts through the VA. But Finley’s increasing commitments to the deep brain stimulation program had gradually displaced his direct teaching and supervisory obligations, and on a typical Wednesday he would hold court from his office, making himself available as needed for residents. For the most part, the residents preferred to leave him alone and solve clinical problems by themselves.

Carrie had attended just one clinical round since she joined the VA’s rank and file, but the DBS patients she saw that day were being treated for movement disorders, not PTSD. She had no way to correlate those patients to Steve Abington’s condition. Traumatic brain injury patients comprised the majority of cases Carrie observed, with cognitive, perceptual, and language deficits usually accompanied by a hemi- or quadriparesis or seizures. Those patients whose foremost symptoms were post-traumatic stress were often referred to the psychiatry clinic, which was bursting through its seams.

Everyone realized these veterans were suffering from a brain disorder, but treatment was limited to antidepressants, antianxiety medication, or ineffective psychotropics. Acceptance into the DBS program was extremely limited during these early clinical stages, and the pent-up demand dwarfed the number of operations performed to date. Unless humanity put an end to war — likely only if humanity put an end to itself — a cure for PTSD seemed the only palliative measure for the VA’s mushrooming resource woes.

Carrie arrived at Dr. Finley’s office five minutes after the clinical rounds concluded and gently knocked on his door. She worried about interrupting him, but he threw the door open, as if in anticipation. A reassuring smile eased much of her concern, and he was filled with effervescence.

“Really exciting day, Carrie. I’ve just been reviewing the neuropsych tests on Ramón. We are clearly on track. Look at this.”

He handed Carrie a bulging manila folder full of test results and graphics referencing one Ramón Hernandez, a thirty-two-year-old male, and a veteran of war in Afghanistan. Carrie leafed through the studies.

“He was one of our first DBS cases, because he failed all the usual therapies,” Dr. Finley said. “I remember that Sam Rockwell had some difficulties with his surgery, and actually had to reposition the stimulating electrodes several times before we got adequate signals from the amygdala, but fortunately there were no obvious complications.”

No follow my light, Carrie thought. No arrhythmia.

With an expression like a proud papa’s, Dr. Finley went on.

“Ramón Hernandez has gone from living on the streets, or in jail, to holding a respectable job as a logistics analyst for a Target distribution center. He’s still on sertraline one hundred and fifty milligrams, but the Oxycontin, benzos, and beta blockers are gone, and he regularly attends the weekly counseling sessions with his clinical social worker. Last I heard, he’s even got a girlfriend.”

Lifting the folder, Dr. Finley said, “This battery of psychometrics documents Ramón’s impressive progress. In addition to the MMPI, we concentrated mostly on tests of all aspects of memory function, emotional intelligence, and executive functioning. There’s an alexithymia scale.”

Carrie was familiar with the Minnesota Multiphasic Personality Inventory, or MMPI, but had not heard of the alexithymia scale and asked Dr. Finley to clarify.

“It’s when people have difficulty describing and expressing their own emotions,” Dr. Finley said. “Kind of a measure of how much people are in touch with their feelings. It’s a useful addition to other tests of emotional intelligence and frustration tolerance. They’re far from perfect, but we get a pretty good picture of someone’s personality when we analyze the entire test battery results.”

Adam didn’t seem to have that much difficulty there, Carrie thought. He seemed as caring and understanding as ever. But she could not deny his explosiveness, as seen in David’s bloodied nose and the damage Adam had inflicted on his Camaro. Adam was a firework of violence, awaiting only a match.

“You thought Don McCall was impressive,” Dr. Finley said. “Wait until you meet Ramón.”