Trauma

CHAPTER 53

With a scowl across her face, Carrie leaned against a wall outside Dr. Finley’s office, arms folded tightly across her chest, and waited for Goodwin and Navarro to depart. As he walked out, Navarro shot Carrie a smarmy, sidelong glance that made her blood boil once more. But her real anger was saved for Goodwin, who refused to look Carrie in the eyes.

Are you surprised I’m still alive? Carrie wanted to shout.

Goodwin could not have been completely dissatisfied, though. She had played the same blackmail card twice, but this time to greater effect.

Carrie stormed back into Dr. Finley’s office as soon as the other two were out of sight.

“I can’t believe you let Goodwin do that to me,” Carrie snapped as she closed the door behind her.

Seated at his desk, Dr. Finley looked utterly besieged. He let go a loud sigh and ran his fingers through an unruly tangle of hair.

“We can retreat now and regroup later, or Goodwin will put a permanent end to your career,” he said. “She’ll trash your reputation so that you’ll never match for another residency, and I doubt you’ll find a situation like this one at some other hospital. Think about what’s best for your career here, Carrie. Take the time off. Let the dust settle and hope to allow cooler heads to prevail. The program has to be protected at all costs.”

Though it stung to hear, Carrie was not entirely surprised by Dr. Finley’s stance. Any threat to the program, in his view, had to be neutralized. He had gone out of his way to hire Carrie in a rather unorthodox manner to avoid significant delays following Rockwell’s accident. He would do what was necessary to keep the OR active.

“Speaking of the program, did you know Bob Richardson works for CerebroMed?”

Dr. Finley’s brow creased and he looked a little puzzled. “I’d never met Richardson before your demo. But I’m not entirely surprised.”

“No? Why?”

“DARPA hired them.”

“DARPA contracted with CerebroMed?” Carrie was surprised. “We deal in DBS, Alistair, not neurological drugs.”

“I’m well aware,” Dr. Finley said. “Cal Trent told me that CerebroMed has been developing software for studying and re-creating traumatic events. DARPA has been partnering with them, but that’s all I know. It’s part of the VR program, and not really within my area of expertise. How did you learn this, by the way?”

Carrie shrugged off the question. There was no use debating. Carrie knew she had lost her greatest ally. This program was Dr. Finley’s greatest love, and it meant more to him than the truth about Goodwin. That much was obvious. Until she could give him definitive proof, he would always find a logical explanation for any concern Carrie raised.

“Well, can I at least review the files I requested?” Carrie asked.

“Yes, of course,” Dr. Finley said, and he presented Carrie with a large stack of files. Carrie glanced at them briefly.

“These are neurological reports,” she said.

“Yes.”

“I’m looking specifically for postoperative complications.”

Dr. Finley grimaced a little. “I’m afraid that would require Dr. Goodwin’s involvement.”

Carrie just smiled and clutched Dr. Finley’s files to her chest.

“No worries then,” she said. “I’ll just look over what I have.”

Carrie retreated to her office. She set Dr. Finley’s files on her desk. From her purse, she dug out Evan Navarro’s hospital ID and log-on credentials. They were written on the same piece of scratch paper as the main number for the VA, which Carrie had jotted down the night Eric Fasciani disappeared. Carrie might not be able to view the medical records of DBS patients who had spent time on the neuro recovery floor, but Navarro could.

The electronic medical records system, known as VistA (for Veterans Health Information Systems and Technology Architecture), offered a variety of specialized enterprise applications, including electronic health records. The system, one of the largest in the United States, contained the records of more than eight million veterans, and personal data for hundreds of thousands of medical personnel and operating staff. Carrie was interested in only a handful of patients, specifically vets like Abington and Fasciani who had DBS surgery to combat PTSD symptoms.

Carrie launched the VistA program and entered Navarro’s ID into the log-on screen. It took her almost thirty minutes to figure out the system, but eventually Carrie got the hang of it. It was different from the electronic medical records system at BCH, but intuitive enough for her to search for Steve Abington’s name. From there, Carrie was a few clicks away from the problem list detailed in the computerized patient record system, abbreviated on the graphical user interface as “CPRS.”

Steve Abington’s arrhythmia was logged as “inactive,” but she could see the onset date, last update, and location of the incident, which was the neuro recovery floor. The application said nothing about Abington’s transfer to the med ICU, probably because Navarro did not have access privileges to that part of his medical record. Navarro was a neurosurgeon, and it seemed the walls Goodwin had erected between her department and the rest of the VA applied to this software application as well. No matter. Using Abington’s case file, Carrie retrieved the clinic-specific procedure code for DBS and used that to search all DBS patients in the past twelve months.

There they were. Some names Carrie recognized: Steve Abington, Eric Fasciani, Don McCall, Ramón Hernandez, Gerald Wright, and Terry Bushman. Some she did not. Based on the patients who were fully anesthetized during their operation, it was easy to distinguish between DBS patients treated for movement disorders, and those treated for PTSD.

On a piece of paper, Carrie made a two-column table and filled it with information from Abington’s patient record. She ignored details such as clinical reminders, recent lab results, patient record flags, postings, and active medications to focus solely on significant problems that might have resulted in a patient being transferred to another unit.

She started with the patients she knew, and in a matter of minutes had a list of four names, with one medical complication post-DBS among them.

The next patient Carrie looked up was Jim Caldwell. According to the record, Sam Rockwell had done his surgery. Seven hours after the operation, Caldwell’s blood sugar levels dropped. Carrie could not see in the VistA system whether he remained on the neuro recovery floor, but now she had another name for her expanding table.

This process went on for several hours. Carrie combed through the records of every vet who had come through the DARPA program seeking a cure for PTSD. Twenty names in total.

By this point Carrie’s eyes were like sandpaper. But her mind was reeling, and her whole body pulsed with an intense energy like nothing she’d ever experienced. She scanned the list, utterly incredulous. Of the twenty patients in total, fifteen had experienced complications, eleven of which were not typically associated with the surgery.

Carrie made a second table that summarized her findings.

Once again, Navarro’s access restrictions prevented Carrie from seeing what happened to each patient following his medical complication, but she presumed many would have been transferred to the med ICU or some other acute care department within the hospital. Carrie was not certain of the percent of DBS surgeries that resulted in post-op complications, but she knew the number was not 75 percent.

It would be Goodwin’s job to bring these astronomical numbers to Dr. Finley’s attention — which, of course, she would not do if her intent was to hide them. With Goodwin’s philosophy of “turfing” so ingrained, by getting the patients off the floor, she essentially made them disappear.

Carrie tried to come up with ways those complications could be induced. Potassium certainly could produce arrhythmia, and insulin obviously made the blood sugar levels drop. Beta blockers were a possible cause for a sudden drop in blood pressure, but Carrie knew of several drugs that would induce hypotension.

Five patients appeared to have no postoperative side effects whatsoever, but that included Eric Fasciani, who had improbably overcome the effects of Valium to check out AMA. Two of the other five vets Carrie knew: Ramón Hernandez and Terry Bushman. The remaining two must have been the patients Dr. Finley said had results similar to Bushman and Hernandez.

Carrie thought back to the night Fasciani disappeared and recalled that only one nurse was working the floor, the same man she thought she’d recognized in the photograph at Rita Abington’s home. If Nurse Taggart were involved, Fasciani could have been removed from the floor without intentionally inducing some medical complication.

Carrie took out her phone to call David, and tried to quell the intense feelings of anger that coursed through her veins.

David picked up on the second ring.

“Do you still have the temporary ID for Michael Stephen?” she asked.

“And hello to you, my dear,” David said in a cheery voice. “I’ve been worried about you all day. How are you?”

“No time to chat. I need to know if you still have that ID.”

“I’ve still got it,” David said. “Why?”

“Because I’m now persona non grata on the neuro recovery floor, and in the VA as well, but you’re not.”

“And what, pray tell, will I be doing on the neuro recovery floor?”

“You’ll be helping me figure out what really happens to Evan Navarro’s very first DBS patient after his surgery is done.”