Trauma

CHAPTER 32

“That just doesn’t make any sense,” Carrie said. She studied the papers clutched in her hand, head shaking slightly, incredulous.

Dr. Finley’s deeply troubled expression mirrored Carrie’s growing dismay. He bit the tip of his reading glasses, and rotated his chair to face Carrie.

She looked up from the medical discharge forms to see his puzzled expression. “Goodwin signed off on this?” she asked.

“She did,” Dr. Finley answered.

Carrie lowered her gaze and rested her chin on her knuckles, striking a pose reminiscent of Rodin’s The Thinker. She recalled a lecture from medical school that included the fact that 1 to 2 percent of all hospitalizations resulted in the patient leaving AMA — against medical advice. The percentage was skewed to those with alcohol and substance abuse problems, which applied to both Abington and Fasciani. It was not an entirely surprising statistic, given how powerfully some patients needed to get back to whatever substance they abused. But her two DBS patients had exhibited no notable withdrawal symptoms. Something else was going on with them — confusion and agitation for sure, but she did not believe they left AMA to go get high.

Carrie leaned across Dr. Finley’s desk and pointed to the box on the AMA form indicating the date for a follow-up visit. “Do you think they’ll show?”

Dr. Finley looked sad. “This is a large program,” he said. “Cal Trent has a number of different specialists involved. I do my part, but that’s certainly not the whole. We’re a part of a much larger effort involving VR technicians, accident reconstruction specialists, psychiatrists, psychologists, and even biochemists. Each patient knows they’re going to receive monitoring and study over the course of many months. But not everybody is diligent about coming to the VA or DARPA’s other facilities for the follow-up appointments. In this case, I’m afraid we might have lost two of our participants. And it’s not going to reflect well on us. Cal will be most displeased, I’m sure of it.”

Carrie thought back to the presentation Dr. Finley had given in the grand rounds during her first week on the job. She remembered the bald man with close-set eyes and a round face who’d sat next to Trent. At the time she’d found it interesting Dr. Finley did not introduce him, but it made more sense to her now. The scope of this effort extended far beyond the confines of the VA, and Dr. Finley probably did not even know Trent’s companion. The insight did nothing to assuage her concern for these missing patients.

“Why would they leave? Where would they even go?”

“I’m as troubled as you are. We’ve got two guys out there with wires stuck in their heads who are technically our responsibility. I want to find them as much as you do. Goodwin had no choice but to let them walk. This isn’t a prison. But the behavior is highly anomalous. We’ve treated dozens of vets in the DBS program, and these are the first two who have done anything like this. Sure we have to coddle and remind them to come in for follow-up appointments from time to time, but to leave like this? To just walk out? It hasn’t happened. Not ever.”

Carrie shrank in her seat, but Dr. Finley did not appear to take notice. It was his word choice that had really struck her. Anomalous. The palinacousis was beyond strange, but now each patient had exhibited what appeared to be extremely poor judgment. If it had never been observed before, then the only common factor, the only real link, was Carrie. She had done both surgeries only to discover each patient had presented with the same bizarre set of symptoms.

“Well, I don’t have any idea what Abington was like when he requested to be discharged,” Carrie said. “But I had just seen Fasciani last night, and I don’t think he was coherent enough to do something like that.”

“I know what you say you saw, Carrie,” Dr. Finley said. He took the papers from Carrie’s hands to look them over again. “But here are the forms. Signed by Abington and Fasciani. Look. Their signatures match with the pre-op releases.” Dr. Finley turned the pages so that Carrie could see where his finger was pointed. “Both have been countersigned by Dr. Goodwin. She told me she tried to convince them to stay and admitted they both seemed a bit wifty, but she made the judgment call that they were sufficiently compos mentis to leave AMA. Evidently, after you left, the overnight night nurse called Navarro and he went to Goodwin because Fasciani was demanding to be discharged.”

Carrie stiffened.

“Don’t worry,” Dr. Finley said. “I didn’t get the sense Goodwin knew about your after-hours visit. And from what I’m reading here, Abington had signed himself out earlier in the day. His cardiac condition had stabilized. In fact, she said he had no more arrhythmia and his mental status had cleared dramatically. They sent him to the neuro unit and he demanded to be discharged, just like Fasciani.”

“Well then, why wasn’t there any record of Abington in the med ICU?”

“That’s a good point. I forgot you told me that. Let’s have a look, shall we?” Dr. Finley logged into his computer. Moments later he was able to access Abington’s electronic medical record. Carrie stood and looked over Dr. Finley’s shoulder as he navigated a series of menus and forms displayed inside various gray-colored boxes.

Right away Carrie could see a long list of medical treatments and corresponding chargemaster codes pertaining to his care. Toward the bottom of the ledger was an entry for Abington’s transfer to med ICU. It was all there. Everything the med ICU nurse could not find, including treatments, nursing notes, physician notes, and lab tests ordered. The last entry was the AMA request and signatures. Abington had not gone missing after all. He had simply wanted out.

A fresh spike of anxiety put a tight band around Carrie’s chest. Could the DBS be affecting their judgment, too? The electrodes had been placed in the amygdala, that almond-shaped nucleus deep in the anterior medial temporal lobe. That section was at the heart of the brain’s processing of fear and its memory. This type of DBS work was uncharted territory, and Carrie’s concerns about having caused post-op complications had doubled. The need to locate the missing vets and gather the pertinent data felt even more pressing than before. She had to rule out all other possibilities before she’d willingly shoulder the blame.

“What now?” Carrie asked.

“Now we have a new vet scheduled for surgery later this week. I guess we’ll have to proceed as planned, and hope these two missing guys turn up.”

Another person for me to injure? Carrie thought. No, thanks.

On the spot, Carrie made herself a promise. If she could not locate Abington and Fasciani in time, there would be no more surgeries. Simple as that. She would resign and the whole program would be cast into limbo. Her deadline was set, and would not move.

“Are you worried about infection?” Carrie asked. “What about trouble with the DBS system itself?”

“Well, of course, I’m worried,” Dr. Finley said. “On both those counts. But what do you suggest?”

“Looks like I have some days off before our next surgery. Let me see if I can find them.”

Dr. Finley gave no apparent objection. He mulled over the idea a moment, humming softly with a tip of the glasses back in his mouth. “I do think the situation warrants a bit of extreme measures, if you’re willing to put in the effort.”

“What about Goodwin? Should I go speak with her?” Carrie asked. “Maybe she has some thoughts on where they might have gone.”

Dr. Finley scratched at his head. “To be honest, I’m not sure that’s such a great idea,” he said. “She doesn’t know you went looking after her patients.”

“What if I told her?”

“If you speak with her, what would you say?”

“I’d ask what the patients were like when they requested the AMA,” Carrie said.

Dr. Finley raised his eyebrows. “And how do you think she’ll respond?”

Carrie thought a beat. “She’ll want to know why I care. It’s not my problem. It’s none of my business.”

“And then?” Dr. Finley was goading Carrie, encouraging her to play out the scenario to its inevitable conclusion.

“She’ll wonder why I haven’t understood my job here.”

“And that will put us right back to square one, that being Goodwin doing her very best to get you ousted. So I’ll have two missing patients and no DBS surgeon, and that might just put an end to my involvement with DARPA. I think I liked your other plan better.”

“Go looking for them?”

Dr. Finley smiled and returned a playful wink. “I know it’s outside your job description.”

“I’m highly motivated,” Carrie said. For reasons you don’t even know, she thought.

Carrie’s phone buzzed inside her lab coat pocket. The sound startled her. She retrieved the device and saw a text message from David Hoffman.

I’m at the VA for an interview. Can I buy you a cup of coffee?

“Well, it’s our lucky day,” Carrie said with a slight smile.

Sure. Java du Jour, 15 minutes?

She sheathed the phone back in the pocket of her lab coat.

Dr. Finley returned a curious look.

“And why’s that?”

“Well, I may not be a detective, but I just got invited out to coffee by an investigative reporter.”

“Will he help you?”

“I can be pretty persuasive,” she said. “I’m going to find them, Alistair. It’s a promise.” And with luck, I’ll prove it wasn’t me who did anything wrong.

Leon Dixon seemed destined to loom over Carrie like a shadow she could never discharge. Her thoughts went from Dixon to Abington, and her mind flashed on Abington’s terror-filled eyes during the attack. She saw him hovering over her, and felt his strong hands around her throat applying exquisite pressure.

She paused at the door, thinking. What had triggered Abington’s insane outburst? She knew prior to surgery Abington had been subjected to his most traumatic war memory via virtual reality. At that moment, Carrie wanted to know as much about these vets and the DBS program as she could. Goodwin could think what she wanted, but Carrie would never willingly put herself into a silo.

“Dr. Finley?”

He turned to face her.

“I’d like to try out that virtual reality device.”