Trauma

CHAPTER 26

Carrie had never acquired much of a taste for alcohol. She seldom drank, but on Friday night, two days after meeting Ramón Hernandez, she sat alone in a booth at Bertucci’s and sipped from her glass of Sauvignon Blanc. Her thoughts were dim from fatigue. She had spent seven grueling hours on her feet performing another successful DBS surgery on Eric Fasciani.

The operation had gone smoothly enough, and it was easy to see how her job could become routine. Two Parkinson’s cases were already on the schedule for next week, and they would be virtually identical procedures. Today it had been Eric Fasciani’s turn on the table, and depending on what Carrie found out, it could change everything.

A middle-aged waitress with a kind face and friendly smile scuttled past Carrie’s table, but backtracked when she noticed the empty wineglass.

“Do you want another?” She cleared the glass along with the remains of Carrie’s salad meal. “Maybe some dessert? The chocolate mousse is amazing.”

“Sounds tempting,” Carrie said, “but I’ll just get a coffee. Black.”

The waitress departed and Carrie checked the hour on her smartphone, then frowned. She was eager to get to Fasciani on the neuro recovery floor, but it was too early to see him. Her latest DBS patient represented a possible answer to the Steve Abington mystery, but he would be too heavily sedated for Carrie to properly evaluate. She needed him more alert.

Fasciani’s operation had been long, but without incident. At the advice of Dr. Finley, Carrie had skipped pre-op consultation altogether. Better for her nerves, it was thought. Instead of greeting a troubled and nervous patient, Carrie saw only a shaved, bald-headed young man, deeply sedated and intubated with his endotracheal tube tied to a ventilator, and an IV drip open to KVO. It was probably better this way, and it fit right in with Dr. Goodwin’s view of her role as hired help. Carrie was a technician, not a doctor. At least Dr. Finley had briefed her on the poor fellow’s history.

“Three tours in Afghanistan, but it was the last one that did him in,” Dr. Finley had said. “Apparently, the attack was highly organized. A hundred fifty Taliban came running down the hillsides from four directions and riddled his base with gunfire and RPGs.”

Carrie wondered if anybody came back from the war unchanged.

“The outpost went up in flames,” Dr. Finley continued. “After this, he was a quivering wreck. He couldn’t sleep without his dead buddies waking him in a sweat. They MedFlighted him out of there and eventually got him back home to Worcester. But he failed reentry miserably. He suffers from horrible flashbacks and daily panic attacks. We actually found him on the street, living out of an old shopping cart. We’ve got him in a shelter now, but he’s made little progress.”

Carrie felt a fleeting sense of gratitude. Adam had a home, loving and helpful parents, and her. She looked over at Fasciani and saw the scars and needle tracks in his arms and neck, and the dozens of skin-raising scars on his limbs and trunk. One of his demons was heroin.

“He hasn’t done too well with talk therapy,” Dr. Finley added. “And most of the time, his blood work comes back with no evidence that he’s even taking the antidepressants we’ve prescribed. Just Valium, alcohol, Oxycontin, and other opiates. So in this case, Carrie, DBS is not just a treatment, it’s his only hope, a prayer.”

The surgery was Abington redux. The small burr holes for fixing the stereotactic frame, the CT scan and superimposed computerized mapping with his earlier MRI images. The 14mm burr hole placed just where the images told her to drill, the cannula driven through to the basolateral nucleus of the amygdala, finally the electrodes, only to await Dr. Finley’s confident voice coming up from the monitor on the other side of the table: “Great, Carrie. Precise and perfect signals. Lock ’em in.”

After, Dr. Finley and Carrie had met outside the OR. Her boss was beaming with pride, overjoyed.

“This is your second case this week, and you are, in a word, terrific,” Dr. Finley said. “Trust me, Carrie, you have what it takes to do this. You’re a machine. I mean despite all those computerized gizmos, a lot of times Dr. Rockwell had to reposition the cannula, three or more passes at times, and I always worried about an increased risk of infection or hemorrhage. But with you, I’m sure we’ve got those electrodes placed where they need to be, and I’m just that much more confident in the results.”

From the corner of her eye, Carrie could see Eric Fasciani’s stretcher being wheeled into the elevator on its way up to the third floor, neuro post-op ICU.

“Thanks for the vote of confidence,” she said.

“Rockwell’s a fine doc,” Dr. Finley said. “And I pray he makes a full recovery. But no matter what happens, I think you’ve got his job.”

Carrie blushed, a little uncomfortable that her good fortune had come at another’s misfortune. She politely refused Dr. Finley’s invitation to dinner, instead heading off on her own to kill time.

That was three hours ago. Carrie checked her smartphone once more, paid her bill in cash including a hefty tip, and slid out of the booth. As she hurried to her car, she thought: If Fasciani exhibits the same symptoms as Abington, nobody is going to have Sam Rockwell’s job.