Trauma

CHAPTER 30

Clutching a cup of coffee, Carrie made her way to Dr. Alistair Finley’s office after making sure his midnight blue E-class Mercedes coupe was parked in its assigned space. The parking lot was already half full, and the hallways around the main entrance were starting to bustle with activity. The hospital had yawned and stretched, and was coming to life like a once dormant giant.

Around her the gloom of the early morning gave way to sparkling sunshine and a pleasing warm breeze. By all accounts, it would be a glorious day. Carrie wondered where Fasciani and Abington might be experiencing it.

She walked to Dr. Finley’s office in a bleary-eyed daze, having secured just two hours of sleep on a lumpy mattress while baking inside a stuffy on-call room. Dr. Finley always began his day at eight; Carrie rushed to get there without any primping at all. This had to be the first news of his morning.

When she arrived at five minutes to the hour, Carrie found Dr. Finley’s office door was closed — the equivalent of a hotel’s Do Not Disturb sign — but she knocked anyway.

Typically genial, Dr. Finley came off a bit gruff when he summoned Carrie inside. As she entered, she noticed that he hadn’t yet turned his laptop on, and she doubted he’d finished his first cup of Starbucks. The action was happening before he was officially ready to face the day.

Dr. Finley looked surprised to see Carrie. He took a quick glance at the surgical schedule, tacked to a cork bulletin board that hung on the wall over his computer.

“We don’t have surgery today, do we?” he asked, picking up his coffee.

“They’re gone,” Carrie said. “Abington and Fasciani. They’ve disappeared. I can’t find either of them.”

Dr. Finley squinted. “What are you talking about?” he said as he gestured toward one of the metal office chairs. “Carrie, sit down, please. You look awful. Have you had any sleep?”

Carrie had not checked her appearance in any mirror, but suspected it bordered on grisly. She’d slept in her lab coat and scrubs, and it showed. Her hair was a tousled mess. By contrast, Dr. Finley was well-groomed and dressed neatly in a striped oxford and sharp red tie.

Realizing she had barreled in like a hurricane, Carrie sat down as directed. She worked to slow her thoughts. Neurologists of his stature at White Memorial would have panoramic views of the Charles River, but here, Dr. Finley had a view of an abandoned construction site. He was uncelebrated and understated, and Carrie wanted to do right by the man who’d brought her under his wing and given her a chance at redemption.

Dr. Finley swiveled his chair to face Carrie. He leaned back and rested his chin on his thumb, his other arm folded across his chest. “Now, just what are you talking about? Can I get you some coffee or something?”

Carrie showed him her coffee. “No, thanks. I’ve got some.”

Carrie’s stomach used that particular moment to rumble like approaching thunder. She had not had a decent meal in hours. After her visit to the med ICU, Carrie had spent some time sitting practically alone in the cafeteria, nursing a cup of coffee and staring at a scoopful of powdered scrambled eggs and canned fruit that stared back at her.

“What’s on your mind?” Dr. Finley asked.

“I checked up on Steve Abington after his surgery,” Carrie said. “I didn’t think anything of it. It’s something I’ve always done with my patients. It’s something you would do, too. You feel responsible when you order tests or perform a procedure on someone to follow up on their status, right?”

“Of course. I think I know where this conversation is headed.”

“Evidently that’s frowned upon here. Dr. Goodwin and Dr. Navarro both told me — no, make it insisted — that I not follow up on my patients. But I only heard that after I went to see Steve Abington.”

“You went to the ICU post-op?”

Carrie nodded. “I’ve got to tell you, Abington was not doing well at all. He was still confused and agitated when I saw him, but that’s probably because he was just coming out of anesthesia. But then it got worse. The nurse and I ended up having to give him a drip of haloperidol in addition to Valium.”

Dr. Finley grimaced. A line had been crossed. “Yeah, Goodwin accosted me in the hall and spoke at length about your conversation,” he said. “But I didn’t know you had done any post-op care. Now I know why she was so pissy with me.”

“What did she say?”

Dr. Finley chuckled. “Nothing I need to repeat. I promised her I was going to speak to you, but as a point of protest I decided to not bring it up all. You’re an adult and I trust you to follow department protocols. That said, I think Goodwin possesses all the tact of a wrecking ball.”

Carrie deflated in her seat. She had more to share, but Dr. Finley’s look of sympathy was a sharp stab of guilt to the chest. Instead of being a team player, taking her probationary period seriously by following the departmental rules, Carrie insisted on creating chaos.

“Well, I didn’t set out to violate hospital policy,” Carrie said in her own defense. “After I got home, that’s when I learned Abington had been moved to the med ICU because of a cardiac problem, but before I could go in to see him the next morning, Dr. Goodwin confronted me and told me I should stay away, that he was somebody else’s concern now.”

“As much as I hate to admit it, she’s right, Carrie,” Dr. Finley said, trying to not sound overly reproachful. “The day-to-day care of patients has to be maintained by a coherent and well-organized staff, and that has to be under the direction of those two. Even though you’re kind of my private hire, you technically fall under her department’s responsibility. The truth is, I stay away from them as much as possible, and I suggest you do the same. It would just be too confusing otherwise. Besides, Goodwin can make a mess of things if she decides she doesn’t want you on the staff.”

Carrie looked alarmed. “She could do that?”

Dr. Finley did not appear overly concerned. “Your salary may come out of my private funds, but ultimately it’s all the government’s money. So technically it’s Goodwin’s show to run,” he said. “That said, if we’re successful here, you and I will share all the accolades and honors and Goodwin will have to take a backseat.”

Carrie could not quite grasp the logic. But, if Dr. Finley agreed to the policy, it made a little more sense for her to retreat. However, two patients were missing. Surely Dr. Goodwin would not be satisfied by that outcome.

Dr. Finley chuckled. “Trouble seems to find you wherever you go, doesn’t it? So how much damage control do I need to do here? And what’s this talk about missing patients? I thought you said you only went to see Steve Abington.”

Carrie shrank further in her seat. “Well, I have to confess I couldn’t keep myself from at least following up on Eric. I know, I know — I shouldn’t have done it. But I had only done his surgery a few hours before and I was worried he was going to have the same post-op reaction as Abington. Wouldn’t you do that, too?”

“Maybe.”

Carrie cringed at his disapproving tone. To violate protocol inadvertently with Abington was one thing, but to blatantly disregard Goodwin to check up on Fasciani pushed the boundaries of what Dr. Finley could condone. But Carrie couldn’t do anything about that now. She had to press her case.

“When I went to see Fasciani, he wasn’t there. The unit was empty and closed,” she said with measured composure. Carrie left out the part about going home to order the labs. Now was not the time to bring up her larger concern. “Since I was at the hospital, I decided to pop down to the med ICU to see Steve Abington.”

Dr. Finley slapped his hand to his forehead. “Good gracious, Carrie! You’re trampling all over Goodwin here.”

“But Abington wasn’t there,” Carrie said, ignoring the rebuke. “And Dot, the nurse in the med ICU, had no record of him ever being there.”

“What time did all this start?” Dr. Finley asked.

“It was probably after ten,” she said. “I grabbed a bite to eat after the surgery, and then I came back to get something I left in my office. That’s when I decided to check up on Fasciani.”

“Carrie.” Dr. Finley was obviously displeased.

“I know I shouldn’t have done it,” Carrie said. “But I was curious. I’m just not used to letting go of my patients. It’s hard for me.”

At last, something Carrie said seemed to sit well with Dr. Finley. A trace of a smile put her slightly at ease.

“I get it,” he agreed. “You have a unique job in the VA’s unique culture. There’s a lot of bureaucracy to navigate, and your position here doesn’t make it any easier. So after you couldn’t find our patient in neuro recovery, you went to see Abington in the med ICU — do I have that right?”

“That’s right,” Carrie said. She had knowingly bent the truth, but did not break it. “Call it professional curiosity.”

“I’d call it very, very strange,” Dr. Finley said, rubbing his chin. “Not what you did, but these patients going missing. Honestly, I don’t know what to tell you at this moment, but I promise you that I will look into this right away. Let’s meet again this afternoon. I’m booked all day, but I’ll make room for you at four. That will give me time to get to the bottom of this. But you, my dear, should take advantage of your day off and go home and get some sleep.” He rose from his chair. The solicitude reminded her of her father. “Let me do the work. And take my advice and stay away from Goodwin. She has fangs.”

“Navarro too, I suppose.”

“That one also bites.”

“In that case, I’ll see you at four.”

Carrie walked out of Dr. Finley’s office, glad she had not shared her worry about palinacousis. She’d thought about it, but resisted the temptation. Her concern about the cause behind the condition — a stroke or hemorrhage, a seizure or some unrecognized complication of the DBS procedure itself, or who knows what — remained unchanged. All of medical literature held only a handful of palinacousis case reports, and seeing it in two patients back-to-back was more than coincidence. For this reason she would need evidence before calling Dr. Finley’s entire program into question. She would need to see the cold, hard facts. She needed the CAT scan and EEG to help exclude a more common explanation for what she observed.

Instead of driving home and driving back, Carrie decided to grab a few more hours of sleep in the on-call room, and spend the afternoon doing research before her four o’clock meeting with Dr. Finley. After downing a protein bar purchased at the cafeteria, Carrie had no trouble finding a vacant on-call room this early in the morning. She fell down on the mattress and closed her eyes.

Her thoughts kept her from falling asleep right away. She had so many possibilities to consider. What if the condition no longer presented in Abington and Fasciani once they were found? It might suggest the palinacousis was temporary. In that case, Carrie could push for a neurological post-op exam as a component of the DARPA program to see if it manifested in others. The plan was not optimal, because Carrie hesitated to do any more surgeries until she could rule out the potential side effect. A lot would depend on her meeting at four.

Unable to focus, Carrie closed her eyes. She took a couple of calming breaths and tried to clear her mind. Exhaustion made her wired, and she could not let it go. Again she focused on the idea of the condition being temporary. The more she thought about it, the more it made the most sense. Otherwise, Dr. Finley would have come across it by now and said something to Carrie. Perhaps Goodwin knew about the side effect and was keeping it a secret. But why would she do that? Carrie could not come up with anything.

A thought occurred to her and she bolted upright in bed. Her stomach lurched. What if nobody had seen the condition because it had never happened before? What if Carrie had caused it during surgery? What if she was the problem, and not DBS?