Secondary Impact Read online

  Table of Contents

  Secondary Impact

  Copyright

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  Chapter 29

  Chapter 30

  Chapter 31

  Chapter 32

  About the Author

  Secondary Impact

  by Barbara Ebel, M.D.

  Book Four of the Dr. Danny Tilson Novels

  Book One: Operation Neurosurgeon

  Book Two: Silent Fear: a Medical Mystery

  Book Three: Collateral Circulation: a Medical Mystery

  Book Four: Secondary Impact

  Copyright

  Secondary Impact

  Copyright © 2015 by Barbara Ebel, M.D.

  All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

  Paperback ISBN-13: 978-0-9911589-7-3

  eBook ISBN-13: 978-0-9911589-8-0

  This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.

  Chapter 1

  The home-court spectators cheered as their Alabama opponents missed an easy basketball shot. Danny Tilson gave his ex-wife Sara a thumbs up while his daughter Annabel sat back down with a sigh of relief. Playing skillfully and competitively, the Nashville college’s team yearned for a solid ranking and their possible inclusion into the March Madness frenzy.

  The white-uniformed home team regained the ball. Advancing toward their basket, they passed it between players. The Tilsons keenly watched Annabel’s quick-moving boyfriend, David, whose six-foot-three height was average amongst his teammates. He caught the ball, dribbled, and broke short of an opponent. With fingers spread and the ball at his fingertips, he sailed up with a shot that dropped the ball dead center through the basket.

  Bolting up, Danny hollered. Annabel waved her arm in a power fist, proud of David as well as her school; and Sara beamed a smile, as happy for her ex-husband and daughter’s enthusiasm as she was for their hometown score. As they settled down in their chairs and watched the scoreboard, they tried not to let the next point from Alabama upset them. Nashville was still ahead by one point.

  Excitement was high - muscles tensing, sweat accumulating, eyes sharply focused - as the home team again ran, dribbled and passed the basketball back and forth, the net drawing nearer and nearer. A lanky opponent almost intercepted the ball but the point guard dodged and turned, sending the ball flying to David.

  The roar echoed in the arena as fans cried out. With his four teammates skillfully positioned and helping him, David found Alabama’s weak spot. He zigzagged, eluded opponents, and prepared for a jump shot with a natural rhythm like an eagle in flight. He soared and, while in midair, released the ball over the head of a defender.

  However, Alabama’s Number 9 shadowed David’s movements and simultaneously touched the ball on its downward trajectory to the basket; he snapped his elbow out, smashing David on the side of the head.

  While a referee was already signaling the violations and an outcry was heard from the crowd, David went down with a thud, his head whacking the floor.

  -----

  Danny’s eyes narrowed and he gritted his teeth as he stood up in an attempt to closely watch the scene on the court. He could feel Sara and Annabel brush against him on either side as they, too, were locked into the scenario unfolding below.

  “I’m going down,” Danny said.

  Although he knew his daughter’s college sports’ games always had a team doctor present - an orthopedic surgeon named Roberts – he wanted to offer his services as a neurosurgeon. He excused himself and passed in front of other people in the row. Sara and Annabel followed behind him as spectators groaned for blocking their view.

  As Danny made it to the stairs, he stole a glance at the offensive zone. To his surprise, David had gotten up; the coach was next to him and players were closing in. When Danny got to ground level, he lost sight of the situation. He weaved through crowds and onto the court as play was still suspended while Sara and Annabel stopped and waited several feet behind the backboard.

  Getting inside the group of towering players was fairly easy as Danny’s six-foot-two height helped him fit in like he belonged. When he got close to David, the two surgeons made eye contact.

  “He’s standing,” Dr. Roberts said. “Glad to see you, Danny.”

  Danny nodded; David stood quiet, his eyes set in a squint while he rubbed the back of his head.

  “How about we walk you off the court?” Roberts asked.

  David glanced at both doctors and followed them on his own accord.

  -----

  Danny walked with David and the team’s doctor into the locker room where they were greeted with a smell of dirty athletic uniforms. Sara and Annabel stayed in the hallway, respectful that it was a male changing room.

  Both doctors signaled for the young man to sit down on a bench and David’s perfect square shoulders seemed to slope as he took his hand off the back of his head. He looked imploringly at Danny as if realizing his body needed medical care.

  Dr. Roberts took a step back. “Danny, I couldn’t have a better expert here for a fall like that. I don’t mind if you take over.”

  “Sure. I’d be happy to. Anything for the team. And for David and my daughter,” he added. He winked at David, who responded with a small smile.

  David had been dating Annabel for six months, since the beginning of their fall term. His mild manner and the dimple in his chin had attracted Annabel from the first night they met at a party. They shared a biology lab class together and had even been caught red-handed at the family’s log cabin retreat after a ‘sleep over.’ As Danny thought about David’s relationship in the family, he glanced towards the hallway. Annabel stood watching, her hands wringing in front of her blue jeans.

  He then focused on David as he squatted in front of the bench. “I lost sight of the field as I walked down to the court after you hit the floor,” Danny said. “Did you lose consciousness?”

  With a subtle shake of his head, David said, “Not that I know of.”

  Danny looked up at Roberts. “No, he didn’t Danny, but he sure looked stunned.”

  “Yeah, stunned isn’t the word,” David added. “And really lightheaded when I got up although somebody gave me their hand and helped me to my feet. And I have a little headache.” His long arm reached behind his head and massaged into his ample brown hair.

  “Are you seeing any bright lights, hearing any ringing in your ears, having any blurred vision?” Danny asked.

  “No.”

  “Good. In particular, because I saw that nasty fall, we’re going to play it safe. I’d like to take you to the emergency room right now where I c
an get a better look at you. Not to worry, okay?”

  David glanced towards the door and his eyes narrowed as he saw Annabel’s concern. “Sure, Dr. Tilson.”

  “I’m going to ask Annabel and Sara to come in here. Tell them where your duffel bag is with your clothes and we’ll bring it along.”

  Danny nodded at Roberts and they both stepped into the hall while the team’s coach, Lester Newman, hurried their way.

  “We’re at half-time,” the man said, catching his breath. “How’s he doing?”

  “Not bad as far as I can tell,” Danny said, “but I’m taking him to the ER where I can examine him. You gentlemen may know there is no universal agreement on the definition and grading of concussions but my guess is that he has a very mild one.”

  “Are you sure you need to take him?” Lester asked.

  “I’m as concerned about a skull fracture which would require at least a CT scan. As Roberts probably knows, specific guidelines for when to perform brain imaging on a head-injured athlete also don’t exist. Let me take him and we’ll all rest more comfortably about it tonight.”

  Lester rubbed his chin. “Okay, doc, thanks. I’ll talk with him for one second to tell him we’re all concerned about him and then I have to get back on the court.” He turned toward the doorway.

  “Just one thing,” Danny said. “When’s your next game?”

  “In six days. Not home court, so we’ll be traveling.”

  “I don’t want him in that next competitive game no matter what. I’m being extra cautious with the only information I have now and if I find anything more deleterious with his condition once we get to the hospital, I’ll let you know. However, I’ll issue him my own medical clearance when I deem it appropriate as well as in compliance with the school’s return-to-play policy.”

  Lester flinched with disapproval. “We sure need him on the team.”

  “Better to have him out for a short time than the whole season.”

  “I understand. I’ll talk to him real quick and also tell him what you just said, doc. Thanks for your help.”

  “One more thing … can you get word to his parents?”

  “They’re in one of the front rows. I’ll make sure they know he’s doing okay and to meet you all at the hospital.”

  “Thanks. I prefer to take him with us so I can keep my eye on him.”

  -----

  The ER doctor did an initial screening of David knowing that he was passing his care along to Danny. After he left, Annabel walked in and, for the first time, David and her were alone. She took his hand and with her brown-auburn eyes softening, she squeezed.

  “Don’t worry about me,” David said. “I don’t think I’m good enough to make the NBA so my career isn’t in jeopardy.”

  “You’re good and you know it. You’re just too modest to say so.” She leaned in and they kissed briefly, then touched their foreheads together.

  A short knock sounded at the partially-closed door and Danny entered.

  “Should I leave?” Annabel asked.

  “I think that would be better,” Danny replied.

  Annabel nodded. “I’ll be in the waiting room with my mom. I’ll see you in a bit.” She left but still glanced backwards at him from the door.

  Knowing he had to focus on the possible signs and symptoms of a concussion, Danny asked David to stand up.

  “Are you feeling dizzy?” Danny asked.

  “No.”

  “Why don’t you walk back and forth to the counter? Turn quickly, too.”

  David did as he was asked, came back and stood still. It appeared as if he had no difficulty with balance or coordination and looked extra tall in the small room, still dressed in his team uniform.

  “What day is it?” Danny asked.

  David frowned.

  “Just checking,” Danny said.

  “Friday.”

  “What did you eat for lunch?”

  “The team and I had lousy sandwiches in the back room of our school cafeteria hours ago.”

  “Do you have any nausea and is your headache still there?”

  “Don’t feel sick and my head hurts a little back here,” he said, pointing. “It’s only natural. I cracked it pretty hard, Dr. Tilson.”

  “Yes, you did.” Danny smiled as he took a penlight from the counter. Besides giving favorable answers to his questions, David didn’t answer slowly or inaccurately so he was feeling relieved that the young man would be fine.

  After Danny finished his assessment, he leaned against the counter. “To dispel any doubt about a significant brain injury or skull fracture, I’m going to send you for a CT scan. It’s probably overkill, but it’s a rapid and superb diagnostic test appropriate for this situation.”

  David looked worried about how long he’d have to wait to play again and Danny patted his knee.

  “It also serves as a baseline head image. Trust me, okay?”

  David nodded and cracked a smile.

  -----

  Danny waited on purpose. The last thing he wanted was to talk to his daughter, his ex-wife - who he was as good as married to - or to David’s parents and give them encouraging information only to find out that the young man’s CT bore bad news.

  He slipped into the small ER break room, poured coffee, then went to the CT suite. He sat in the technician’s room watching as the table moved David into the large-domed machine.

  Light poured temporarily through the door as Casey - Danny’s best friend and brother-in-law - stepped in.

  “I heard what happened. Is he alright?”

  “I think so,” Danny replied, “but I have to check if he has a slight subdural hematoma or skull fracture.”

  “I hope you don’t find anything. He’s a good kid.”

  Danny laughed. “It’s funny that I’m fifty and you’re forty-nine and we now refer to college-aged students as kids. They’re not really, you know.”

  “But just think of everything that’s happened to us in the last thirty years. In that respect, we were kids.”

  Danny smiled as he realized the truth behind Casey’s point, especially to think he had lost a teenaged daughter during those years. That was enough experience for a lifetime.

  “Good point. Men and women that age are grown and possibly mature. However, their wisdom will accumulate.”

  Casey’s hand ran over his crew cut, his biceps flexing in his short-sleeved paramedic uniform. He regularly worked out, with or without Danny, though he had made strides with helping his friend get more fit and toned than he was a year ago.

  “By the way,” Danny said. “I agreed to do Matthew’s morning rounds on Sunday because he signed up for a mini-marathon. I can’t drive Julia over to Rachel’s place for visitation so she agreed to stop by the house. Can one of you make sure all goes well?”

  “I have off Sunday. No problem.”

  The Tilsons had a unique family situation, mostly attributed to their parents leaving their large house to their daughter, Mary.

  Casey and Mary lived there as a married couple but Danny and Sara lived there as well because they had converted the downstairs to a separate residence. Annabel lived at college most of the time but their next daughter – Nancy – was still in high school and also lived with them. In addition, Danny’s young daughter by an extra-marital affair, Julia, resided with them, too.

  Since the family situation had recently grown into a more thought-provoking one, Danny liked to think that with modern times come modern family situations and living arrangements; this was particularly true since he and his ex-wife were expecting a baby. He loved Sara dearly and they now lived together although she did not want to marry him a second time.

  He grinned thinking about Casey’s response to his request as well as his own relationship with his children. He was the father of two living children by his previous wife and, with a baby-on-the-way, he would have one child with her not as husband and wife. And Julia’s mother, Rachel - the ‘other woman’ - was a source of never-e
nding trouble. He often wondered what was the more complicated part of his life … being a neurosurgeon or a family man.

  Chapter 2

  “I’ll see you at the house later,” Casey said to Danny. “Mark is getting information at the ER desk and we’re off to pick up a patient.” He placed his hand on his friend’s shoulder for a second, trying to alleviate Danny’s concern over David.

  Danny glanced up. “When is Mark quitting before starting medical school?”

  “Definitely in a month, if not sooner … if I get a decent paramedic partner. Spending time in an ambulance with someone else requires solid teamwork and compatibility. I have my fingers crossed.”

  “I bet,” Danny acknowledged. “It’s almost like a marriage.”

  Casey left and Danny resumed sipping on his coffee. The CT table backed out making loud bleeping noises and then stopped; David was escorted back to the ER and the technician processed the films. Before putting them in the radiologist’s stack to be read, the tech handed them to Danny.

  With a deep breath, Danny felt better looking at the results on the X-ray viewer. He pitched his empty cup and went to talk to David and his parents as well as Annabel and Sara.

  -----

  Without expecting it, Danny found all of them with David who sat sideways on the table, legs practically touching the floor and absent-mindedly rubbing his head.

  Aware that he wasn’t wearing his white lab coat and knowing he had never met Mr. and Mrs. Bell before, Danny realized he was meeting them under both professional and social circumstances.

  “Mom and Dad, this is Dr. Tilson, Annabel’s dad,” David said as soon as Danny entered the room.

  Mrs. Bell gave a warm smile. “I’m Tara and this is Floyd,” she said waving to her husband on the other side of the table. “We’re happy to meet you. We’ve heard … good things about you and Sara from our son.”

  Tara had an intermittent stutter especially after she briefly closed her eyes in thought. Danny figured she was younger than Sara’s age of forty-eight although she had striking silver-blonde hair.