Trauma

CHAPTER 33

Java du Jour, the quaint and cozy coffee shop a block away from the VA, was surprisingly only half full. The place was usually jumping with activity, so perhaps four thirty was a slow time. Carrie stepped inside and saw David sitting alone at one of the few wooden tables adjacent to the stone fireplace, tucked invitingly beneath the large bow window. Their eyes met. He got to his feet and held out a chair.

Nice touch, Carrie thought. Her ex hadn’t been given to such chivalrous behavior — nor were most of her contemporaries, for that matter.

“Thanks for meeting me,” he said. “Cappuccino?”

Carrie took notice of David’s style of dress. He had on a blue oxford shirt, dark jeans, and polished black shoes. He was taller than she remembered, and his outfit revealed a pleasing fit and trim frame. Not a gym rat, but clearly somebody who liked to keep his body in shape. As for the coffee, Carrie usually went for the black gold, but the way David said “cappuccino” somehow made it seem like the perfect choice.

“Yeah, a cappuccino sounds great.”

Carrie took a seat and was already starting to doubt her plan when David went to place the order. Maybe it was foolish to go looking for these men, but she didn’t know what else to do. She could not shake the thought that somehow the DBS, and more specifically her technique, might be behind the singularly rare complications of palinacousis and poor judgment. These conditions would surely have presented before in other PTSD patients. Since it had never been reported, Carrie could look only at the mirror for a culprit. She struggled to fit all the pieces together.

Carrie glanced up and saw David already seated, looking soothingly at her with two cups of cappuccino in front of him.

“Twenty seconds,” David said with a glint in his eyes.

“What?”

“That’s how long it took for you to realize I’d come back.”

Carrie gave an embarrassed little laugh. “Sorry. I was just thinking. Excuse me.”

“No worries,” David said. “I’ve been accused of doing that from time to time.”

Carrie laughed again as David pushed her cappuccino across the table. She picked up the cup and the aroma came at her with force. She savored it before taking a sip. Maybe she was a cappuccino girl after all.

“I’m glad we could meet up,” David said. “To tell you the truth, I’d been meaning to give you a call. I thought we could talk about Adam, but I’d first like to find out what’s going on with you.”

Carrie found something very comforting about David. The way he’d handled her brother’s assault was impressive enough. But more was going on here than that. He radiated confidence, and perhaps that was what intrigued her. He seemed so comfortable in his journalistic skin that she held no reservations about confiding in him. It did not hurt that he was damn good-looking, too.

Carrie knew her work at the VA would be of great interest to David and his story, but she had a different agenda. The conversation hit a lengthy lull as Carrie contemplated how to proceed.

“Are you always silent as a lamb?” David asked playfully.

Carrie laughed a little.

“Sorry. Lost in thought again. And that was an utterly terrifying movie, by the way. Couldn’t watch it.”

David pretended to look offended. “It’s only one of the best.”

“What about Titanic?”

“Knew the ending going in. Kind of spoiled it for me,” David said with a wink and a smile. “What about The Killing Fields?” he asked.

“Never saw it,” Carrie admitted. “And my father and I watch old movies all the time.”

“New York Times journalist covering the civil war in Cambodia?” David said. “No? Doesn’t register? Now that’s a film after my own heart.”

“Have you always worked for—” Carrie looked somewhat embarrassed. “What’s the paper again?”

“That would be the Lowell Observer,” David said. “And no. I’m a stringer, what you might call a freelancer. I go to places like Cambodia and Thailand, and pretty much anywhere the government would warn us against visiting.”

David went on to talk at some length about his adventures overseas and his kidnapping episode in Syria that led to his taking a job with the Lowell Observer. Carrie found this facet of David’s personality quite intriguing. In medical school, she had done a research paper on why some people were drawn to intense, often fear-inducing thrills while others shunned the thought.

Evidence exists to suggest that dopamine stimulates the insular cortex, a portion of the cerebral cortex deep within the temporal lobe. The trait was thought to be a carryover from the earliest humans who’d risked everything to feed and shelter their families. Carrie had often caught herself analyzing her ex Ian’s behavior based solely on what she imagined was going on in his brain. She was doing the same now with David, after only minutes alone together. Carrie had wished she and Ian had more adventures together, and David’s active insula fascinated her.

“So enough about me,” David said. “Tell me more about your work at the VA.”

“I don’t know quite where to begin,” Carrie said. She slowly circled the rock sugar swizzle stick in her cappuccino, and looked up directly into his hazel eyes. “This is pretty confidential stuff and you’re a reporter.”

“Meaning you don’t trust me.”

“But I’m desperate for some investigative expertise. My career may depend on it.”

“Oh, a conundrum. I love it. Do you know the term ‘deep background’?”

“No, but if you hum a few bars I can fake it.”

It took David a minute before he smiled.

“Cute,” he said.

“Old family joke.”

“Deep background means you can’t be quoted in any story I might write. You’re just enhancing my view of a topic.”

“This might turn into a story, but for now, I’d like to talk friend-to-friend — or maybe as colleagues on the issue of PTSD.”

David was cautious. “All right, I’m not taking notes. But if you tell me something I think I can use, I’m going to be pushy about asking for permission to use it. That’s my job.”

“I understand that,” Carrie said. “And I wouldn’t tell you any of this if I didn’t think it might eventually turn into a story for you.”

“Go on, then,” David said.

“DARPA and the VA have launched a joint pilot program to try and cure PTSD. Not treat it, cure it.”

David’s expression brightened as if a movie star had walked into the coffee shop. He leaned forward with an ardent air. “You might be my new hero,” he said. “Although my editor will think otherwise.”

Carrie pulled back. “Why is that?” she asked.

“Because if you have something really interesting here, I’ll have to push out my deadline again, until you give me permission to use this. Anneke will be none too pleased.”

“Until I get permission from my boss, this is off the record,” she repeated.

“Deal,” he said.

“No, I’m being serious, David. I need your help with something and I’ll trade information for assistance, but we have to do everything aboveboard. If word leaks about the program, it could jeopardize funding. A lot of vets are counting on this, my brother included.”

“Helpful is my middle name. Well, actually it’s Charles.”

“We’re off the record,” Carrie reminded him. “Because I need your help.”

David held up two fingers and said, “Scout’s honor.”

Carrie appeared dubious. “Adam was a Boy Scout,” she said. “I think it’s three fingers, and your hand is supposed to go the other way.”

David took his hand down and gave Carrie a sheepish look. “You get the point,” he said.

Carrie smiled. For whatever reason, she trusted him. “Well, I’m the surgeon responsible for inserting electrodes into the brains of vets with PTSD. We’re using DBS — that’s electrical deep brain stimulation — to try and eliminate the emotion from memory of what’s causing the PTSD.”

David looked incredulous. “Um, you can do that?” he asked.

“It’s very experimental, leading-edge stuff. For it to work, we have to reconsolidate the fears and horrible memories these soldiers have suffered.”

“Reconsolidate how?”

“With virtual reality,” Carrie said. “Those memories, and especially the fear and other emotions associated with a traumatic event, are processed to a great extent in a nucleus of cells deep in our brains called the amygdala.”

“Is it cheesy to say I like it when you talk science?”

“A little,” Carrie said, not bothered at all. “Anyway, we reconsolidate the memories by subjecting the patients to a virtual reality program that is supposed to vividly reproduce that bad memory, and right after that we stick an electrode into the amygdala. In theory, when we then stimulate the amygdala, we hope to erase any fear associated with that memory, and perhaps the memory itself.”

“And it works?”

“Four major successes so far, and one who I examined personally could be called a total cure without much of a stretch.”

“Who qualifies for the surgery?”

“The program is only for vets who have failed all other forms of conventional drug and psychotherapy. Some of the participants are homeless, but I understand that they’ve got living support from this program. I think they’re housed somewhere on the VA campus. I’m sorry I can’t give you more specifics.”

She stared at David, but no need to worry. He hadn’t taken his eyes from her, nor sipped his coffee. Carrie felt bad about being a tease, but she would reward him with the scoop by getting Dr. Finley and the folks at DARPA to agree to let David cover the story. After.

“Carrie, are you telling me that you may be curing these folks?”

Everyone was familiar with post-traumatic stress — called shell shock in World War I — at least to a degree of having sympathy for these vets, and although the problem was probably bigger than anyone wanted to admit, the idea of having a possible targeted and effective treatment was beyond exciting.

“Well, that’s the idea. But some things don’t seem right, David, and that’s why I really wanted to talk to you.”

“And I thought it was my infectious personality that got you to go out with me for coffee,” he said.

“Honestly? It was the bloody nose.”

“Oh, that.”

“And my problem,” Carrie added.

“What’s going on?”

“I’ve operated on two patients so far,” Carrie said. “I thought the surgery went well, and so did Dr. Finley.”

“I’m guessing it didn’t,” David said.

Carrie spent some time going over the cases of Abington and Fasciani, and in the telling gave a detailed accounting of Goodwin and Navarro’s ambush. In doing so, she felt compelled to vaguely explain her unorthodox hiring, while omitting all details about Leon Dixon and her decision to leave residency. She did not know this man well enough to share such a painful experience. After three coffee dates maybe, but certainly not on the first.

“A persisting echo? That sounds like a nightmare,” David said when Carrie described palinacousis.

“There are only a handful of case reports in the literature,” Carrie said. “I have no idea what could be causing it. In the cases I’ve read about, some patients had a stroke. In others it was attributed to a seizure or a hemorrhage in the part of the brain where auditory information is processed. Some may have had an unusual encephalitis, or even a rare form of migraine. The point is, I doubt whether a neurologist or a neurosurgeon would ever see a single case, let alone two in a row. So I can’t help but think this is something I’ve done. Did I put the electrodes in right? I can’t say for sure. But they’re not placed anywhere near where the brain deals with acoustic processing. Did I cause a bleed? Could it be the first sign of a brain infection? These are things I have to wrestle with. But there’s more.”

Both cappuccinos were getting cold. David wiggled his chair a bit closer.

“Both of these patients have disappeared,” Carrie said. “They signed out against medical advice, and I have no idea how to find them.”

David’s expression became slightly strained — evidence of deep thought. The compassion and steely determination in his eyes set Carrie further at ease. She felt right to have confided in him.

“So what can I do to help?” David asked.

“I need to find these guys — Steve Abington and Eric Fasciani. I don’t even know where to begin to look.”

David leaned back in his chair with a confident air. “You need help finding people? Well, I’m your man for that gig.… I’m guessing my getting the scoop on this DBS program is contingent on patient location?”

Carrie held up her hands to show him that was her plan, straightforward and simple.

“This is even more up my alley than you know,” he said. “I’ve been working on this story for a lot longer than my editor wants. I know the shelters, the different services they might go to. And by ‘services,’ I mean flophouses and crack dens. It’s lovely how we let some of the people who fought for our freedom waste away — but we’re not here to fix the system, right?”

Carrie bristled a little. “I am,” she said.

David finally took a sip of his too-cold cappuccino. “I get your worry about these guys,” he said. “The only things I can hurt are people’s reputations and feelings.”

“The pen is mightier than the sword.”

“But perhaps less potent than the electrode.”

Carrie’s smile was genuine. “Are you always this clever?” she asked.

“Only when I’m having coffee with an intellectual dynamo I’m trying to impress.”

“You only want the scoop,” Carrie said. “I know your type.”

“I want to help,” David said in a serious tone. “You’re telling me nobody has ever seen this condition before?”

“I’m telling you that the DBS surgeons aren’t supposed to check up on the patients post-op, per Herr Doktors Goodwin and Navarro. We are persona non grata outside the OR.”

“You are,” David corrected. “You told me Goodwin’s beef was with you. She wanted a more traditional hire, right? And you’ve kept your concern about the palina-whatever-it’s-called a secret from your boss because you think you might have caused it.”

“Palinacousis,” Carrie corrected. “And sort of. It’s not a secret. It’s a theory. I need more data before I start making unsubstantiated claims that could put an end to this whole program. It’s a quandary, and I’m not doing another DBS surgery on a vet until we find these guys. If we can’t find them, I’ll come forward about my concerns and resign from the program. Essentially, I’ll hammer the last nail in the coffin of my career.”

“These two are important to find. I got it.”

“And you’re right about Goodwin having it out for me. But why is that important?”

Things were clicking for him; Carrie could see that in David’s eyes. At that moment, Carrie suspected David Hoffman was a supremely competent reporter, which only enhanced his attractiveness.

“Maybe somebody else has seen the same symptoms, but didn’t even know what was happening. You’re a bright doctor; I’m guessing more observant than most.”

Carrie blushed a little. “I don’t know about that,” she said, and felt forced to look away. “But I’ve thought the same.”

“Who was the surgeon before you?” David asked.

“Sam Rockwell. He was in a car accident, and he’s still in the hospital in a medically induced coma.”

David took the information in. “I’d put in a call to that hospital of his if I were you,” he suggested. “Doc Rockwell wakes up for some reason, maybe he has answers. In the meantime, get your best walking shoes out of the closet. Tomorrow you and I are going on a hunting expedition.”