Trauma

CHAPTER 27

The doctors’ parking lot at the VA was virtually deserted when Carrie drove up in her trusty Subaru. She parked some distance from the entrance, out of the way of prying eyes. Only the residents’ on-call spaces were occupied, and somebody working for Navarro might recognize Carrie’s car. That could lead to questions, and Carrie’s workday had technically ended the moment Fasciani got wheeled out of the OR. A little extra precaution was the right prescription for this evening’s unsanctioned jaunt.

The VA was not in the best neighborhood, and the quiet of the surrounding streets set Carrie on edge. A biting wind rippled the plastic sheets draped over the long-neglected scaffolding that framed much of the darkened annex. Carrie did not know if the VA’s administrators were counting on continued DARPA funds to get construction going again, but she had her suspicions.

Carrie pinned a clipboard to her side with one arm, and shielded her hands from the cold within the thin fabric pockets of her long white lab coat. Some spring. Beneath her coat, Carrie wore a clean pair of blue scrubs. She needed to look official, here on hospital business.

The automatic doors of the rear hospital entrance swooshed open as Carrie approached. Once inside, Carrie scuttled past the lone security guard stationed at a wood podium with a quick flash of her hospital ID. To him, she was another doc on the job and nothing more. The VA’s empty corridors amplified Carrie’s footsteps. At this hour, BCH would have been bustling, and Carrie was reminded of the days when ambulances arrived in steady streams hauling everything from panic attacks to gunshot wounds.

On her way to the elevator, Carrie spied a young woman dressed in green scrubs who approached from the opposite direction. She could have been one of Navarro’s, but Carrie did not take a close look to confirm. With the clipboard to her face, Carrie lowered her head and pretended to study something important.

The ruse worked. Not a glance. Not even a hitch in the other woman’s stride. The experience made Carrie feel a little bit foolish. She was a surgeon, not some fly-by-night medical detective. It was all a bit absurd, but exhilarating at the same time. Most of her life Carrie had been a rule follower, not breaker, but in this instance she felt justified, and believed her actions were absolutely necessary. Carrie quickened her pace and was a bit breathless when she reached the elevators.

Moments later, Carrie was back on neuro recovery. She pushed the intercom and waited for the duty nurse to unlock the double doors securing access to the unit. Carrie heard a faint click, pulled on the door handle, and headed inside.

Marianne was off tonight, apparently, and a different nurse occupied the nurses’ station. Carrie did not recognize the attractive black male in his thirties who was too busy charting to bother to look at whom he buzzed inside.

“Good evening,” Carrie said.

The man glanced up from his monitor. He had a handsome face and almond-shaped eyes the color of dark caramel. Carrie’s eyes dropped to his ID badge, but it was concealed by shadows and impossible to read.

“Quiet night tonight,” Carrie said.

Only one doc was supposed to be doing rounds, and it was certainly not Carrie. For this reason alone, Carrie would have preferred to avoid conversation altogether, but that would have come across as odd. Nurses expected a bit of small talk from the doctors.

“Only got one patient on the floor tonight,” the nurse said. His resonant voice sounded neither pleased nor bothered by the lack of activity. Abington had also been the only patient on the floor the night Carrie visited, which pinged her curiosity. Were vets slated for DBS surgery specifically on days when no other major neuro surgeries were scheduled? It would make sense to isolate them, given how agitated and volatile these patients could become. Either way, the scheduling practice worked in Carrie’s favor.

“How’s our patient doing?”

“He’s been pretty quiet. But these vets aren’t in the best of shape to begin with.”

“I’m just going to pop in and check on him. I’m the surgeon who did his DBS installation.”

“Um-hum.” The nurse could not have sounded less impressed if he tried. On a whim, Carrie decided to secure a little extra insurance on her clandestine visit.

“What’s your name?” she asked.

The nurse returned a wary glance. Docs do not always bother with such pleasantries. “Lee Taggart,” he said, holding up his badge for Carrie to see and read.

“Look, Lee,” Carrie said, leaning over the nurses’ station to deliver her message. “I’d appreciate it if you kept my visit here a secret. I’m really supposed to let the residents handle things, but I guess I’m a bit of a control freak.”

Carrie flashed a playful smile that did not appear to soften Lee any. She got the distinct impression that Lee Taggart did not care about hospital politics in any way, shape, or form, so long as his checks cleared.

“You do what you need to do,” Taggart said as his focus returned to his charts. “I don’t tell people anything they don’t ask or need to know.”

Carrie gave Taggart an appreciative smile he did not see, and left.

Fifteen steps later, she was inside Fasciani’s room. These hospital quarters were nothing but glass cubicles with a freestanding wardrobe closet and a flimsy curtain for privacy. The patients were kept isolated to reduce the spread of infection, and while there were not many rooms to choose from, Carrie observed that Fasciani occupied the same bed as Abington had before his transfer to med ICU.

A gooseneck lamp mounted above Fasciani’s hospital bed illuminated his face enough to show Carrie his glassy-eyed stare. He was awake, and Carrie commended herself for getting the timing of the anesthesia right. She closed the door, pulled the curtain shut, and turned on the overhead fluorescent.

Fasciani’s eyes were sunken and ringed with dark circles. His hollow cheeks, missing teeth, and shaved head made him look more like a POW than a hospital patient. At least Fasciani did not have that accusatory stare and look of terror she had seen in Steve Abington’s eyes. Maybe this was all for naught. She would know soon enough.

Carrie approached Fasciani’s bed and spoke in a whisper. “I’m Dr. Bryant, Eric. I did the surgery on you earlier today.”

Nothing. If anything, his vacant gaze worked harder to penetrate the wall in front of him.

“I just came to check on you,” Carrie said, resting her hands on the bed railing. “I hope you’re doing okay. Sometimes, patients feel a little nauseated from the anesthesia right about now, and I suspect you have a bit of a headache.”

More silence. Fasciani’s only response, if it could be called that, was to turn his head away from Carrie. His movements came in slow motion. Carrie’s stomach tightened and her earlier confidence fell away. She thought of only one cause for such languorous motility.

He’s still too sedated, dammit!

She was certain she had given him enough recovery time. This many hours post-op, Fasciani should have been coherent enough to play checkers. In his current condition, there would be no way for Carrie to effectively evaluate him. She doubted Fasciani would spend another night in the neuro ICU. If Carrie was going to evaluate him, it needed to be tonight. She had no other option. Carrie would have to retreat and come back later. Her curiosity had become its own gravitational force. She hoped whoever worked the overnight shift would be as accommodating as Lee Taggart.

Carrie came around to the front of the bed and examined his chart. With a quick scan of his meds, she saw the problem right away: Valium, a lot of it. Fasciani must have become agitated at some point and the nurse had wisely put him under. Evidently Lee Taggart thought an infusion of a major sedative was a detail Carrie did not need to know, and certainly she had not thought to ask. Well, at least she could trust the tight-lipped nurse to keep her visit here a secret.

Dammit again!

The situation was essentially hopeless. Fasciani was going to spend the night sedated. Carrie could come back at midnight or two in the morning, and it would not make a difference.

Though daunted, Carrie was not ready to give up. She had inherited her mother’s willful determination. Addressing Fasciani from the foot of the bed, Carrie asked, “Eric, can you tell me how you’re feeling?”

He gave no response, but Carrie expected none. She went around to the left side of the bed to check Fasciani’s pupil reaction to her penlight, and saw that his lips looked dry and chapped. She smoothed an ice chip taken from a plastic cup at his bedside over his cracked lips like a healing balm. Fasciani’s empty stare went beyond a thousand yards. After several passes with the ice, Fasciani turned away from Carrie, his movements slowed by the drugs in his system, and came to a rest with his head facing the door. Carrie wondered if he was going to call for the nurse, but Fasciani was so doped up she doubted he even knew where he was.

She decided to make one more attempt, though it was an obvious sucker’s bet. She went around to the other side of the bed so she could look him in the eyes.

“Eric, I want to help you,” Carrie said. Her voice cracked slightly under the strain of emotion. The pang in her chest felt like heartbreak; her deep compassion went far beyond her duty as a doctor. The rawness of these feelings came from Adam. She heard echoes of her brother in Fasciani’s struggles. Abington’s, too. And while Adam seemed to be coping, a distinct possibility remained that he could one day fall into the abyss — first to the streets, then to drugs, the shelters, and eventually maybe to some hospital bed at the VA, with or without wires in his brain. In this way, Fasciani was not just another wounded vet. He was like family.

Fasciani’s bedsheets rustled as he turned away from Carrie to face the wall opposite the door. This time his movements struck Carrie as a bit strange. Did he just turn away intentionally? Carrie waited a moment, perhaps as long as two minutes, purposefully silent. When enough time passed, she repositioned Fasciani’s head so he again faced the door. He offered no resistance and stayed with his head in that direction, unmoving, hardly blinking. She took a couple steps toward the door.

“Eric, can you hear me?” she asked.

One second … then two … then three … then …

Fasciani turned his head and faced the wall opposite the door.

Twice. That’s nothing, Carrie thought. I spoke and he turned his head away from my voice twice. Could just be a coincidence. For a third time Carrie repositioned Fasciani’s head to face the door. Again she spoke. “Eric, can you hear me?”

To herself, Carrie counted: One … and two … and three …

Fasciani showed Carrie the back of his head as he again faced the wall opposite the door. She repeated the test again with the same result. She spoke to Fasciani from the right side of the bed, and he turned his head to the left.

Carrie said, “Holy crap. It’s as though he’s hearing my voice from that side of the room!”

Carrie tested him one more time, but in a different way. “Eric, I want you to answer me each time you hear this,” she said.

Fasciani repositioned his head to face left and mumbled in a groggy, drug-slurred voice, “I hear you, I hear, I hear you.”

Carrie’s breath caught. This was classic and just what she had read in the literature. Many patients were able to localize their illusion to the side opposite the pathology in the brain. She felt certain the auditory processing of the right temporal lobe in Fasciani’s brain was not working right.

Carrie’s training kicked in as she battled to slow her thinking. She did not want to be reactive, but found it hard to control her emotions.

Abington and Fasciani both exhibited symptoms of palinacousis, and the commonality was DBS. But was that the root cause? Carrie could not say with certainty. Again she went back to a hemorrhage, but could there be a stroke from a blocked blood vessel? She wanted a CT scan or MRI, stat. An EEG, too. Could it be a seizure? Something else? Why didn’t Ramón experience anything like this? Or had he, and his memory was fogged?

Carrie felt urgency and curiosity, but also anger. She was trapped. She had no business being here, and had no one to call on for help. She couldn’t even order these tests without Goodwin torpedoing her career.

She had no authority to intervene, unless she went to Dr. Finley. But what then?

Hi boss, sorry I put your program and the hospital at risk by acting like a resident when I haven’t been credentialed.

That could create all sorts of problems. At a minimum, Dr. Finley would have to make some excuse for Carrie examining Fasciani, or he’d simply lie and say that he himself had followed up on the patients. But Dr. Finley was not even a surgeon, and that explanation, Carrie knew, would not wash.

Before Carrie could approach Dr. Finley, she needed more specifics. The worst thing she could do would be nothing at all. The second worst thing would be to make some wild claim about a huge DBS side effect, one that nobody else had noticed before, without any supporting evidence. Her credibility was still in the repair stages, and Carrie was already on unstable ground. She thought she was onto something, but what? She could not do anything about it at nine thirty at night.

Unless …

An idea came to Carrie so ingenious her whole body tensed. The next shift was due to come on at eleven o’clock. Carrie could go home, call the duty nurse, and order a CAT scan using Dr. Navarro’s hospital ID. It was pinned to the nurses’ station for everyone to see.

It was a risky move, but asking for a scan was not like ordering narcotics. She could say that Navarro had personally asked her to call in the labs. Chances were nobody would question the order. If the nurse on the next shift was anything like Lee Taggart, it was almost a certainty. The scan could be done overnight or very early in the morning. Carrie would go by radiology first thing and have a look at the films herself. No one was likely to see her if she showed up early enough. Once she checked out the CAT scan and the EEG, she’d decide what to do from there. Carrie gently touched Fasciani’s face. His skin felt spongy, no give. Her heart ached for him. Something had to be done.

It was not perfect, but at least it was a plan.