Trauma

CHAPTER 4

Dr. Metcalf had made the semicircular incision in the temporal-parietal craniotomy site. He was so skilled, had so many years of training, he probably could have done the procedure blindfolded. Nothing was remarkable about his deft handling, except that Carrie could not recall him doing it. It had happened, of course. The skin flap was there, and Dr. Metcalf was busy setting the Raney clips in place, but somehow Carrie had no memory of him actually making the cut. It was like highway hypnosis, only in the OR.

Carrie’s body burned with exhaustion that did not justify her lack of concentration. She had pulled plenty of long shifts without her performance suffering. Then again, she’d never been primary surgeon on an operation with serious complications.

Beneath her mask, Carrie gritted her teeth against an onslaught of memories — the blood that kept seeping, the blackened subdermal patches of clotted blood. Beth’s operation was hours in the past. She needed to stop it from affecting her performance here and now. Adding to her burden, Carrie’s back throbbed from fatigue. Her calf muscles were bowstring tight, and every two seconds she had to fight the urge to rub at her bleary eyes.

Carrie wondered if she’d ever be able to emulate Dr. Metcalf’s level of discipline and focus. How did he never seem to tire, no matter how difficult the operation? One thing Carrie knew for certain: She would need his Zen-like mastery of that particular skill to achieve all her professional goals.

“How about some Gelfoam here,” Dr. Metcalf said.

The command snapped Carrie out of her daze. She went to work on the incision area, using Avitene on a pledget and Gelfoam to stanch the bleeding.

“Drill.”

Sam Talbot placed the stainless steel handle of the Midas Rex pneumatic drill in Dr. Metcalf’s outstretched hand. The specialized air drill was designed to stop drilling as soon as the skull was penetrated, preventing injury to the brain. With enviable control and precision, Dr. Metcalf whistled a low and indistinct tune as he created the burr holes, each perfectly placed, one behind the standard key point, others located posteriorly in the temporal bone.

“Vitals?” Dr. Metcalf asked.

The anesthesiologist checked his monitors. “All fine,” Dr. Fellows said.

Dr. Metcalf switched to the footplate attachment and started at the temporal burr hole, cutting in a curvilinear fashion, until this region of bone could be removed. Carrie helped by stanching the annoying small bleeders that cropped up on occasion. Everything appeared to be going exactly as planned. Because Leon’s tumor was situated deep within the brain, and not a part of the meninges, the dura would have to be excised, which Dr. Metcalf did with great care.

Soon it was time to locate the actual source of Leon’s troubles. In the absence of the NeuroStation, Dr. Metcalf relied on the MRI film Carrie had put up on the viewbox to show him where to insert the needle probes. The needles were not really necessary, and Carrie knew Dr. Metcalf was using them for teaching purposes.

Carrie had done this procedure many times herself, but always under careful supervision. Because Dr. Metcalf could not see the tumor, he used the probes to feel for subtle texture changes indicative of touching a growth. For guidance, he occasionally glanced at the MRI while advancing the needle. Carrie knew from her read of the film that the tumor site was approximately 3.5 centimeters deep within the temporal lobe, and Dr. Metcalf was probing in that exact spot.

Carrie watched him work, admiring his steady hand, calm concentration, when Beth again entered her thoughts. Seeing someone so close to her in age suffer like that was a stark reminder of her own good fortune. It was shameful that it took an incident in the OR to make her appreciate her many blessings: her career in medicine, the mentors like Dr. Metcalf who had helped bring her to this point, her family — and even Ian, for ending the relationship and giving her a chance to learn more about herself.

Dr. Metcalf advanced the probe a bit further, then paused. Lifting his head, he gave Carrie a curious stare — not a disapproving look, but something in his eyes looked nonplussed. He maneuvered the probe some more, but this time without a second glance at Carrie. The bleeders were typical for the surgery. No alarms for the patient’s vitals, either.

It must have been nothing, because Metcalf removed the probes and was getting the bipolar coagulator and aspirator ready to go. It was time to get Leon’s tumor out, or as much of it as they could.

Dr. Metcalf adjusted the frequency on the bipolar coagulator, an instrument with two electrical poles used to cauterize and remove tissue. The tissue here was soft and would require a lower frequency than something more fibrous. The disposable forceps with two small electrodes decreased risk of thrombosis formation, caused minimal tissue damage without suturing, and were effective at hemorrhage prevention.

Dr. Metcalf carefully advanced the bipolar coagulator through the inferior temporal gyros, using a surgical aspirator, more crudely known as a “sucker,” to remove blood and fluids while taking away as little good brain tissue as possible.

Should be at the tumor site any second now, Carrie thought.

The sounds of machinery thrummed in Carrie’s ears as her anticipation grew. As Dr. Metcalf shifted his attention from Leon to the MRI image, a shadow crossed his face, and his furrowed brow put Carrie on edge. Focused again on the work site, Dr. Metcalf advanced the coagulator perhaps a centimeter more, then stopped. Carrie tried to read his expression. He was obviously anxious. Could it be another complication? Goodness, she had no stamina to endure another surgical mishap.

Dr. Metcalf adjusted a power setting on the frequency generator. A second later, the persistent hum of the bipolar coagulator came to an abrupt stop. The absence of sound filled the room.

Dr. Metcalf looked up and his eyes narrowed in a way that made Carrie shrink inside. “Carrie, I can’t find any abnormal tissue here, and I’m at the tumor site.”

A chill raced up Carrie’s spine.

No … no … everything is fine … it’s not panic time … not yet …

“Let’s take a closer look at the MRI,” Dr. Metcalf suggested.

Carrie followed Dr. Metcalf over to the viewbox and saw up close what she had observed from a distance. The mass was easy to spot in the medial temporal lobe. It was obvious Dr. Metcalf was seeing the same thing.

“What’s going on here?” he asked, mostly to himself. “Jesus, could this be the wrong patient?”

Carrie and Dr. Metcalf simultaneously looked down at the name on the film. As soon as Carrie saw the lettering, a jolt of horror ripped through her body and her breathing stopped. The name was correct, but the letters were reversed!

Oh, God, Carrie thought. Oh my God, no. Please no!

Grim-faced now, Dr. Metcalf let his arms fall limply to his side as he fixated on the text, disbelieving.

“Carrie, do you see this? The film was put up backward.”

Carrie staggered on her feet as the room began to spin. She had reversed the film. Following a backwards image, Carrie had set the patient up for an operation on the wrong side of his brain.

She flashed on her brief meeting with Leon, and it hit her. Not only did he have a droopy face, his reflexes were heightened in the right arm and leg, indicative of a left-side problem. But more telling was his speech. He had trouble saying simple words and had not been able to follow one of her commands; those were left-sided problems. If she had remembered, Carrie would have seen her mistake and clipped the image up properly.

This can’t be happening … this cannot be happening.…

The shattered look in Dr. Metcalf’s eyes cleaved Carrie’s heart.

Leon, who already had damage to the left temporal lobe because of the mass, would now have additional damage to the right side of the brain where Dr. Metcalf had probed and removed completely viable brain tissue. It was all her fault.

Dr. Metcalf glowered at the new circulating nurse, Margaret, with venom in his eyes.

“What happened here? What the hell happened here? Don’t you know how to read?” Dr. Metcalf’s wrathful voice sent Margaret scurrying to a corner.

Dr. Fellows and Sam Talbot stared at each other in disbelief. Carrie took in a shaky breath, but could barely get a sip of air into her lungs. Her face felt flushed, burning hot, and soon the rest of her skin prickled with sweat as a sick feeling washed over her from head to toe. She opened her mouth to speak but at first no sound came out. Courage finally came to her.

“I put the MRI on the viewbox, not Margaret,” Carrie said. “It was my error.”

With that, she lowered her head and began a solemn march to the exit door.