Trauma

CHAPTER 25

The Department of Neurology and Neurosurgery at the VA occupied an H-shaped section of the second floor in the main building. There was some talk that the department would move if they ever finished construction on the annex, but that was a very big “if.” While it was a bit cramped, there was a certain convenience to having the surgical suites and the neurology exam rooms all in close proximity.

Dr. Finley led Carrie at a brisk pace to exam room five in the neurology unit. The exam room was like most Carrie had been in over the years; not that different from the one where she’d almost died. It had a waist-high counter, a sink, and various instruments for checking vitals.

Seated in the aluminum chair next to the examination table was a clean-cut, neatly but casually dressed and well-groomed Hispanic gentleman, who stood and shook hands with Dr. Finley. He was powerfully built and quite handsome, Carrie noted.

“Hey, Doc. Good to see you.” He spoke with a youthful and vibrant voice, the voice of somebody excited for the future.

Carrie had to look carefully to see the slight asymmetry of the neck where the stimulating wires had been tunneled from the scalp, running down beneath his right clavicle to attach to the battery pack in his upper chest.

“This is Dr. Carrie Bryant, who has taken over for Dr. Rockwell.”

“Yeah, I heard about his accident,” Ramón said. “Terrible. He was a terrific guy. Nice to meet you, Dr. Bryant. You’ve got big shoes to fill.” Ramón’s hand, half the size of a baseball mitt, swallowed Carrie’s as he gave her a firm but gentle handshake.

“I’ve heard only great things about Dr. Rockwell,” Carrie said.

“Mind if she examines you, Ramón?”

“Be my guest,” Ramón said. “But I can probably examine myself by now.”

Carrie resisted the urge to come right out and ask if he ever heard the same words spoken over and over again. Her old pal Val would say Carrie possessed all the subtlety of a jackhammer.

Carrie proceeded through a series of questions pertaining to Ramón’s current lifestyle. It was clear that he was socially appropriate, concentrated well, and attended to questions with insight and flexibility. He enjoyed his work, and even gave some thought to getting married to his longtime girlfriend.

“Considering she could have charged me with domestic assault not that long ago, I’d say I’ve come a long way.” Ramón’s smile projected the kind of cocky confidence required for the battlefield.

“Can you elaborate?” Carrie asked.

How far had Ramón really come, she wanted to know.

“I used to get drunk and jealous. I hit her. More than once. Not something I’m proud of, obviously. Once I got my anger under control with the DBS I could actually listen to what the therapists were trying to tell me.”

“And that is?”

“That I was trying to control her because I was really afraid I was going to lose her.”

The insight impressed Carrie, but she was curious to see how he would react to questions about his war memories. “What happened during that ambush? Do you mind talking about it?”

Ramón’s eyes flashed, but he just shrugged. “Honestly, I don’t remember all of it.”

“Share what you can,” Carrie said.

“I was stationed at Camp Dwyer in the Helmand Province, a place we lovingly referred to as ‘Hell, man.’ Luxury there was a sandbag that could double as a couch,” Ramón said, with the detachment of a newscaster. “We were on a scouting mission, looking for a terrorist named Nasser Umari. He was a big-time anti-Coalition dickhead, pardon my language — hooked up with the Taliban, and other militant groups, too, I suppose. We had just fast-roped from an MH-47 helicopter, did our patrols, and after that, exfiltrated back toward our extraction point. There were about fifteen of us in the fire team.” He paused to remember. “Yeah, about fifteen. It was the usual oven hot that day. A few more degrees and the sand would have turned to glass. We had just vaulted a mud wall in what looked like an abandoned town when machine-gun fire seemed to come out of nowhere. Me and three other guys fell back into an alley where I figured we’d get a better read on the enemy position. But the Taliban had machine-gun positions all around and next thing I knew I got shot in the arm. Hurt like a mother, you know what.”

Ramón rolled up the sleeve on his white cotton T-shirt to show Carrie a scar on his bulging trapezius a little bigger than a quarter. She was sure his body was riddled with other scars that had nothing to do with DBS surgery.

Ramón continued. “We were returning fire, but I had crawled into a doorway to try and clot the wound. Next thing I knew, an RPG struck our position and two of the guys in the alley with me couldn’t have an open casket at their wakes. It was that fast. But, I guess that’s war. The bad guys are after us, and we’re after them. Kill or be killed, right?”

Carrie was taken by how calm and controlled Ramón seemed. She saw no reticence or protectiveness. He remained focused, his mind targeted in the present, the past trauma mitigated by perspective. She was duly impressed. If emotion was a color, Ramón’s ambush had been rendered in simple black and white.

“So, what sort of problems are you having?” Carrie asked.

Ramón gave this some thoughtful consideration. “Well, sometimes I don’t seem to care about things all that much,” he eventually confessed. “I don’t get as worked up about a lot of things that used to bother me, either. Mostly that’s good, but I wonder if sometimes I’m too relaxed. If I get behind in work, I don’t seem to care or worry as much. That’s not me. And I don’t remember a lot about my time in Afghanistan. I mean I do, but I don’t. There’s lots of holes. People have to tell me things, and sometimes it doesn’t make sense. But I can live with that.”

“What about your hearing? Do you hear voices?” Carrie asked.

“No.”

“How about hearing sounds or voices that you know are real, but they seem to go on and on in your head, like an echo that never stops?”

Dr. Finley looked at Carrie, nonplussed. She knew these questions would produce that kind of reaction. They were way off base for this sort of exam, but Dr. Finley did not intervene.

“No,” Ramón said.

Carrie went on to complete her examination, standard bedside tests of memory and cognition that she knew he would pass with flying colors. She analyzed his vision and eye movements, his hearing, speech, and swallowing. His motor functioning, gait, sensation, and reflexes were all perfectly normal.

“Thanks,” she said. “It was a real pleasure meeting and talking with you. And thank you for your service.”

“My pleasure. See you again. And good luck with the program.”

She shook hands again and Carrie followed Dr. Finley out of the exam room. Dr. Finley had more to discuss with Ramón, but he said he wanted to speak with Carrie in private first.

“Amazing, right?”

“I’m truly astounded,” Carrie said.

Dr. Finley’s pride and enthusiasm were infectious, but Carrie could not embrace the moment to his degree. Ramón had reinvigorated her mojo, but her curiosity had not been fully satiated.

“Was Steve Abington ever diagnosed with schizophrenia? Any history of the disease in his family?”

Dr. Finley thought on it and shook his head.

“No, why do you ask?”

“Just curious,” Carrie said.

The answer was expected and did nothing to waylay her concerns. Post-op delirium or some strange side effect to DBS? It was impossible for her to say. Carrie contemplated her next move. She was scheduled to be back in the OR on Friday, for a DBS surgery on a marine named Eric Fasciani. Before she could share Dr. Finley’s enthusiasm completely, she had to see whether the condition happened again.

If she were careful, Carrie could go see that patient post-op, and Goodwin would never be the wiser.