Читать книгу Clover: A Dr. Galen Novel - R. A. Comunale M.D. - Страница 5

Death is simple.

The heart stops beating.

The River of Life ceases its flow through the miracle of the human body.

We die.

There is, however, another death, a living death, one which takes away our very being while the heart still beats.

“Hidalgo, get your team together. We’ve got a C-5 cord injury on the way.”

Jerry Fromm, the first-year resident, felt every bit as tired as the tall medical student who had worked with him for the past 12 hours in the emergency room. Now both seemed to shed the fatigue that had lain across their shoulders. They were needed.

Tony Hidalgo hit the instant message button on his cell phone, and three signals went out simultaneously to the other members of his ER team: Julius Petrie, aka JP, roommate and friend; Sarah Knowlton, friend and lover, and Judy Hicks, friend to all and beloved of JP.

This was a race against time, a battle of technology and teamwork against the second hand to save a life and prevent a living death.

Tony heard the running footsteps just before his three colleagues appeared.

He yelled out, “Neck injury, C-5!” and their running pace doubled.

They were the new lords of creation, one month from graduation and the title of Doctor of Medicine. The initial tremors and pit-of-the-stomach queasiness at the beginning of their clinical rotations two years earlier now became a focused algorithm of emergency care that blocked sweaty palms and loose bladders.

The team of five dashed to the special elevator and rode it to the roof heliport, their minds running through the protocols they were about to use to prevent their new patient from becoming permanently paralyzed.

They heard the rapid whacka-whacka-whacka of the approaching Medevac helicopter’s rotors even before they opened the outside door. As soon as the pilot brought the chopper in for a gentle landing the team raced crouching across the pad to its side door. The whoosh-whoosh-whoosh of the slowing blades surged through them as they took the spinal-trauma cart holding the patient from the two EMTs aboard. Then they wheeled it to the trauma emergency enclosure on the rooftop.

Top priority: Be sure the patient’s breathing and heart functions are stable. Soon the detailed stuff would follow, the painstakingly precise, step-by-step stabilization of the injured spine. But first they needed to perform more critical preparation.

“Good, they’ve got the exoskeleton in the supply dock,” Petrie muttered, as he and Tony grabbed the grasshopper-shaped metal contraption from its container.

Fromm rapidly programmed the stimulator units built into the device’s pads that would apply pressure to specific sites above and below the injury.

Sarah and Judy prepared the injector dispensers with their life-sparing drugs.

“How did this happen, Ted?” Tony asked the EMT who had accompanied the boy on the copter, and who was struggling with his own fatigue from a long day.

“Six minutes from injury, Tony,” he replied. “It was pure luck. We were almost overhead, returning from another transport when we got the call. We landed in the kid’s front yard. Sammy Tignor here just got a skateboard for his fourteenth birthday and forgot to wear his safety helmet. He went ass over teakettle off a homemade ramp. He’s breathing well, and we’ve already cathed him and given him a starter dose of Methylprednisolone and Dexamethasone. We also got a signed release from his parents authorizing all treatment. They’re on the way by car.”

“I can’t feel anything! Why can’t I feel anything?”

“Easy, easy now,” Judy whispered. “We’re going to help you.”

They quickly enveloped the boy in the lightweight duralumin exoskeleton, which prevented motion. A specially programmed nerve-muscle stimulator sent timed electric impulses to maintain muscle tone below the cut in his spinal cord.

The team focused low-power lasers on the injury site that fired preset light pulsations to stimulate the growth of stem cells in the spinal cord. This would provide clusters of new stem cells to participate in the regeneration process.

Tony took the entry pad containing all of the accumulated patient data during the transport flight from the medtech.

“He’s able to talk and breathe,” JP noted, “but he can’t feel anything from the neck and shoulders down.”

Sammy’s spinal cord, the massive communications cable from the brain that travels down through the bony spinal canal, had been torn. The connecting wires carrying instructions from the brain—move here, feel this or that—no longer worked.

At the level of the fifth cervical vertebra, Sammy could breathe and talk but little else.

Sarah was performing a quick but systematic exam on the boy. She looked up at Tony and nodded.

“Yep, a lower C-5. Judy, get the neurosurgeon on call. We’ll get him prepped for OR.”

Judy smiled at Sammy. He looked so small, so vulnerable, so scared. He reminded her of the younger brother she had lost in an auto accident four years earlier. She wanted to cry—they all did—but that wouldn’t have helped the kid.

“Hey, big guy, you doing okay?”

Barely audible, the pubertal voice replied.

“No-o-o. Are my mom and dad here?”

“They’re on the way, Sammy. We’re going to see if we can glue you back together again. You hang in there.”

She pulled out her phone, touched the extension for neurosurgery, and began the arrangements for what would happen next.

It was called the Joshua Protocol. The team of four, under Fromm’s guidance, inserted entry ports into the boy’s veins. They had no time to ride him down the elevator into the main hospital so they worked in the specially outfitted enclosure.

“Judy, Sam here looks to be about 43 kilos,” Tony called out.

The special cart had its own built-in electronic scale and measuring devices.

“Give him 1500 milligrams of lazaroids and sialidin. Sarah, get 2200 milligrams of erythropoietin-neurotrophin mixture ready. JP, have we got the nanos?”

Fromm watched the students carefully, constantly on guard for errors in judgment. There were none.

“All set,” Judy called out.

“Okay,” Fromm said, “watch for anaphylaxis. Sarah, start the factor infusion. Tony, stay ready for problems.”

He kept his fingers crossed.

The death throes of a complex organism, like that of a single cell, follow their own protocol. There comes a steadily increasing cascade of deadly chemicals coursing through the body that must be stopped or neutralized if the individual is to be saved.

The lazaroids and sialidin streamed through the boy’s veins, blocking the lethal showers of destructive, tissue-necrosis factors that would prevent return of function. Neurotophins, nerve growth-stimulating proteins carried by microscopic nanoparticles, homed in on the site of the nerve destruction. Slowly they stimulated the nerve endings, while the erythropoietin and 810-nanometer laser pulses attempted to induce natural stem-cell production.

“He’s starting to seize!” Sarah yelled.

The boy’s eyes rolled upward and his jaw muscles tightened.

Tony reached for a prefilled syringe containing Lorazepam, a tranquilizer commonly used for anxiety and also used for rapid control of seizures, and stuck the needle into the IV port on Sammy’s right arm. Slowly, counting out, “one-thousand one, one-thousand two...” he administered the drug, and the young patient’s face slowly relaxed.

Next JP inserted a tongue guard into Sammy’s mouth and administered low-dose oxygen via mask.

“Okay, let’s get him to the OR.”

Two on each side and one behind, they wheeled the cart with the exoskeleton stabilizer and portable heart-rate and respiratory monitors to the special wide elevator doors.

As the elevator descended, Judy looked at Sammy’s peacefully sedated expression and surprised her teammates with a comment.

“I wonder what he’s dreaming.”

“Dr. Castro, Sam’s been given the Joshua Protocol. Are you going to do a Reeve Procedure on him?”

Tony was glad Roxanna Castro was on call. She was a world leader in her field.

The neurosurgeon, an African-American in her late 50s, nodded. She was tired from a night of dealing with auto-accident trauma, but nothing mattered more now than the well-being of this kid the resident and his team had brought her.

Her mind went into overdrive and the fatigue vanished.

“We need to go in and restore neurilemma continuity.”

Neurilemma, the magic covering of the nerve axon, acts like a continually expanding tunnel through which the long finger of the neuron, the nerve fiber, travels to its destination. Disrupt that sheath and the nerve ending has no way of finding its path. It becomes effectively blind and wanders aimlessly, often forming an ineffective—though painful—tangled, ball-of-yarn nerve clump.

The four almost-doctors, now in OR sterility suits, clustered around the large, flat-screen monitor, watching Castro activate the surgical microscope field and micro-Waldo units.

The anesthesiologist had used a Ketamine derivative to put Sammy into a form of dissociative anesthesia that would not suppress his breathing. His mind would float in a netherworld of non-existence; his body would feel nothing.

The chief OR nurse activated the exoskeleton controls and rotated the patient’s carefully immobilized body to a face-down position.

Todd Baker, the assisting neurosurgery resident, activated the mini-MRI unit. A portion of the viewing screen showed the havoc within Sammy’s neck.

“We’ll make the initial incision 2 centimeters below the break,” Castro said, speaking slowly as she brought the ultrafine laser scalpel down on the patient’s skin. It parted, bloodlessly. She peered through the microscope as she penetrated, layer by layer, down to the muscles and ligaments surrounding the neck bones.

“There it is, ladies and gentlemen.”

Tony, JP, Judy and Sarah all stared in wonder at the thin-walled portions of the fifth cervical vertebra and the red, swollen nerve ending capped by a blood clot where it should have continued down the spine.

Castro adjusted the laser’s controls and the light beam vaporized the clot.

Baker, one month from entering the world as an attending, carefully handed her a vial of stem cells. Subconsciously he felt like an acolyte on the altar presenting an offering to the officiating priest. In turn, Castro used a special glass syringe to draw up the mixture of stem cells and neurilemma growth factor, and began to infiltrate the severed nerve ends. Then she activated the micro-Waldo operating hands. This computer-guided machine allowed her hand and finger movements to be imitated in miniature by tiny robotic appendages.

Peering through the operating microscope, every movement of Castro’s fingers was reduced to micrometer-fine motion that allowed her to rejoin the neurilemmal sheaths. Meanwhile the surgical resident applied neurotrophic factor/stem-cell mixture and nerve glue each step of the way.

Castro smiled in satisfaction then turned to the intense young man standing beside her.

“Okay, Petrie, now what?”

“Restoration of vertebral integrity.”

“That’s right! Hicks, how would you do that?”

“Synthetic bone graft and bone glue.”

“Good! Knowlton, what’s the risk?”

“Rejection of stem cell graft or adverse reaction to injected nanos.”

“If none of that happens, Hidalgo, what next?”

“Continual intense neuromuscular stimulation by both electrical pulsation and laser, and then physical therapy after primary nerve regeneration and wound closure. His limbs will need frequent motion, and his skin needs to be protected from pressure sores while recovery takes place. At the same time his neck must remain immobilized, and unwanted calcification in the wound area must be prevented from disrupting the regeneration process.”

“And…?”

Castro stared, remembering herself as a young medical student answering questions from an older doctor in a similar situation.

Hidalgo’s manner resembles that doctor’s. Could it be?

“His head and neck will need to remain in a halo unit until stability of the cervical spine is confirmed.”

Tony mentally pictured the unit they called the “crown of thorns,” which would keep Sammy’s head from a damaging involuntary muscle spasm.

Then Baker jumped in.

“What’s the anticipated recovery time?”

The neurosurgery resident added his two cents, practicing his attending’s voice.

Won’t be fun unless I can pimp the med students with my questions.

“About one month.”

“Before the Joshua Protocol and the Reeve Procedure, what was the recovery time?”

The four students paused for a moment, watching the still-unconscious boy lying in his metal cocoon.

Tony whispered his answer.

“Never.”

Castro let the surgical resident do the wound closures. Then an orderly wheeled the surgery cart into recovery, the patient even more firmly restrained.

She summoned Tony outside the OR.

“Hidalgo, are you by any chance related to a Dr. Galen?”

“Robert Galen?”

“Yes.”

“He’s my guardian, Dr. Castro. I call him Tio. He and his two friends, my Tio Edison and Tia Nancy, adopted my sister and brother and me. We all live at a place we call Safehaven, in Pennsylvania.”

“Would you give him my best? I was a student of his … a long time ago.”

“You all did a great job, guys!

Jerry Fromm was one happy resident. His team had done well, and in doing so reflected on his ability to supervise. No doubt the other residents would recognize him as a good teacher.

He also knew he was lucky. He had heard the nurses gossiping about this group—they called the kids “the A-Team.”

“How’s it going, kiddo?”

“I can feel stuff now, Dr. Hicks.”

“That’s great, Sammy!”

“Uh ... Dr. Hicks, is Dr. Petrie your squeeze?”

She grinned at him and nodded.

“Good, I like him. He looks and talks funny.”

“What about Dr. Hidalgo and Dr. Knowlton?”

“Who’s been talking to you, kid?”

“Well, what about them?”

“Yeah, they’re an item. Just don’t tell them I said that, and don’t ask Dr. Petrie what you asked me.”

“I already did.”

“What did he say?”

Sammy grinned back at her.

Judy wanted to kiss his forehead but didn’t; she gave him a thumbs-up instead.

“Next time you see me, Dr. Hicks, I’ll give you a thumbs-up, too!”

“It’s a deal!”

Galen walked over to the calendar on his bedroom wall and crossed off another day. He looked at the date circled in red: May 9, 2025, the day Tonio would graduate from medical school, less than four weeks away.

He shook his head as he looked in the mirror and saw the unruly gray-white hair flowing over his ears. He remembered the sideburns he had grown over 50 years before, all the rage in the late ’70s of the last century. His beloved Cathy liked to run her fingers through them and call him her “mutton-chop.”

His eyes started to mist as he remembered his second wife. No, he couldn’t let the brooding despair overtake him again. He was on the wrong side of 85. He was too old to cry in his beer of memories.

He felt totally drained that night as he changed into his pajamas, washed his face to remove the residue of dried tears, and slowly climbed into bed. It was only 9 p.m.

Edison and Nancy were still watching a History Channel program. They weren’t surprised when he had gotten up and said he was going to bed early. The strain of the impending graduation was beginning to tell on the old man.

He took off his eyeglasses, set them on the bedside table, and turned off the lamp. He lay back on the old foam pillow he and his beloved first wife Leni had slept on and stared at the blur of the darkened ceiling. His eyelids fluttered as he felt the tension of the day leaving...

He was walking on the hard dirt road, the dust of passing chariots raising clouds that obscured the blue Mediterranean sky. The highway marker pointed toward the distant temple and he knew he would soon arrive at his destination: Eleusis.

He turned to the young boy walking beside him and raised his walking stick.

“There, do you see it?”

“Yes, Tio.”

They walked on. The nearer they came to the temple the older the boy became. Once no higher than the old man’s chest, by the time they reached the marble steps he now towered above his guardian in the full bloom of young manhood.

“Tio, is this our destination?”

“Yes, boy, and your destiny. Come; the son of Apollo awaits us.”

They climbed the steps, the boy with vigor, the old man with increasing difficulty. Soon they passed between the high Doric columns to enter the darkened portal.

“Is that you, Galen?”

The voice boomed from the main altar.

“Yes, Aesclepius.”

“Come forward and bring the boy with you.”

“Tio, I am afraid.”

“As was I, Antonio, and as once was my mentor, Corrado Agnelli.”

“Galen, prepare the boy.”

The bearded god raised a golden shaft entwined by a single serpent.

Simultaneously Galen raised his walking staff. The coiled serpent leapt to the old man’s stick and he held it high for a brief second before calling out, “Antonio Hidalgo, do you understand the responsibilities you are about to take on?”

“Yes, Tio Galen.”

“Then accept the Staff of Aesclepius and the burden of carrying on from me.”

The young man’s hand reached out and grasped the radiant rod in Galen’s hand.

The old doctor felt the weight lift from his shoulders...

The buzz of the phone broke the reverie. Galen sat up in bed, his senses on alert. The dream seemed so real that he felt annoyed at the untimely interruption.

“Yes, who is it?” he asked, in his best gruff voice.

“Tio Galen, it’s me, Tonio.”

Galen’s heart skipped.

Was something wrong? Was the dream all a lie?

No, not this close to graduation!

He calmed himself and softened his voice.

“What’s happening, boy?”

“I had to tell you. We did our first cord-trauma salvage today.”

Galen’s mind hesitated then clicked into place.

“The Joshua Protocol?”

“Yeah, Tio, how did you know?”

The old doctor laughed to himself. The young always think that they are the first to have learned how to suck eggs.

“Tonio, I may be as old as Methuselah but that doesn’t mean I’m senile. Remember, I lived through the changes in development and practice of medicine that you now take for granted.”

“Sorry, Tio, it’s just ... well ... it was an awesome thing to be a part of. This fourteen-year-old boy severed his cord at C-5 and now he stands a good chance of full recovery.”

“I’m proud of you, Tonio. Tell you what. The four of us are coming down to Richmond for your graduation. Think you and your friends would like to hear how the Joshua Protocol came about?”

“Of course, Tio!

“By the way, the neurosurgeon said to send you her best.”

“What’s the name?”

“Dr. Castro.”

“Good student.”

He lay back down once more, sighed, and stared at the ceiling.

Four years already!