Operation Neurosurgeon Read online

  “Nice job, driver,” Danny said to the man who had given him report. He pressed ahead with his writing without looking at him.

  “I’m not just an ambulance driver,” the man said sarcastically, “but a highly trained EMT. A paramedic. And unlike you, I’m launched in my career. You’ll be pussyfooting around for the next five years before getting yourself established.”

  The female nurse didn’t move.

  “Shut up, Casey,” Danny said with a small grin.

  The nurse exhaled. “Phew. I thought you two were for real.” She untwisted an ivory earring.

  “We’re throw backs to grade school. It’s just that he never grew up.” Danny glanced sideways at his friend. “And I still think you should’ve been a quarterback. Thick neck, muscular build, and all.”

  Before Casey could open his mouth, Danny continued, “I’m not touching a book tonight, so pop over. Sara and I could use some deck time.”

  “Okay. For Sara. But don’t let that baby fall asleep until I see her awake. What do you two do, tranquilize her?”

  “That’s what babies do, Casey, they sleep.”

  Casey weaved out of the trauma room through the diminishing gawkers. As the patient’s stretcher rolled past, Danny paged his chief resident to give her a report. “When the CT is finished, meet me in radiology,” Dr. Welch said.

  Chief residents, in their final sixth year of neurological surgery, were in charge of lower residents and had an attending physician available for counsel. Danny had an appreciation for Dr. Welch, a thick-waisted, fast talking female whose gender in her specialty made her rarer than lobster ice cream.

  Karen Welch stood in the CT scanning office when Danny arrived. She had evaluated the patient before they had transported her to the ICU. She glanced up and down the CT images on the viewer, hands on her hips.

  “Dr. Tilson, glad you could join me. So your college-bound, buck-startled patient has a high-density area on CT,” she said, pointing.

  Danny carefully looked through the images, careful not to let Karen bait him into hurrying the probable diagnosis, or missing something else evident.

  “A cerebral contusion from a sudden deceleration of the head.”

  “Is there more to that story?”

  Danny took a step off the imaging room’s platform to establish better eye contact. “The brain impacted on bony prominences. A coup injury occurred where the skull struck the brain. A contrecoup injury is an injury directly opposite the impact site.”

  Karen Welch turned to her resident. “Surgical treatment is not indicated at this time. When will surgical decompression be warranted?”

  “With threatening herniation. If she becomes refractory to medical management. With increased ICP.”

  “Ah, yes. The magic three letters for increased intracranial pressure. You know what to do.” She winked at the radiologist sitting in front of his equipment.

  She handed Danny the patient’s chart from the table and began walking out. “I’ll talk to the general surgery resident. Most of the patient’s scalp wounds are only a few inches long. They can clean and suture them without bringing the patient to the OR.”

  ________

  That evening, Danny left Vanderbilt University Hospital and traveled southeast to the wedding present Greg had given them almost two years ago. Greg had hired the builder, but Danny and Sara had approved the plans and construction, giving the builder lots of latitude with his work. Since they chose a lot in a newborn subdivision, their split-level ranch at the end of a cul-de-sac faced woods in the back. Danny and Sara liked the outdoor, natural environment and had a wooden deck built on the front and back of the single-story house.

  Danny hit the remote and pulled his four-year old Toyota into the garage. “Hi girls,” he said, entering the door. Melissa sat in her high chair, her right hand swinging a red rattle, the other hand holding a small white stuffed dog with a ribbon collar. She shook with glee when she planted her eyes on Danny. Sara graded the sprawling papers in front of her but got up to meet Danny halfway.

  Danny put his right arm around Sara, pressing his head into her blonde-peppered hair. Her bob cut accentuated the contour of her cheeks and her silky hair made him linger and revel in its fragrance. He pulled back. Sometimes her hair stayed behind her ears, but sometimes she’d purposefully leave it up front and kink it softly around her face. Danny liked it either way.

  “Good day, night, and day?” Sara asked.

  “Actually, yes. I got an entire eight hours of sleep,” Danny said. “Did you have a nice day?” He planted a kiss on Melissa’s forehead.

  “Every day is fine with Melissa in it.” Sara sat back down and crossed her trim legs, exposed from a corduroy skirt. “I finished meiosis and mitosis at school today, so tomorrow I start high school biology’s version of human anatomy. Although for fourteen and fifteen year old boys, that may only mean this …” She waved an outline of a shapely female in the air.

  Danny laughed. Sometimes he accentuated his laugh, and added some on at the end for effect. Sara liked it. Along with his wide, white smile, and his jovial manner, he entertained her.

  “You eat yet?” Danny asked.

  “Homemade soup. And the salad’s over there,” she said, pointing with her whole arm.

  Danny went to the counter and came back to sit with her carrying a bowl. “Casey’s coming over later. He wants to see Melissa awake.”

  “Did you tell him babies don’t keep single guy’s hours?”

  Danny wolfed down two servings while Sara finished putting A to D on test papers. He grinned. “Come on,” he said.

  Danny opened the back glass door while holding Melissa. Sara followed with Fluffy the dog and a light cotton baby blanket. Outside sat two oak porch rockers and one double, which Danny and Sara eased into. Melissa cooed and clutched Danny’s fingers as she sat on his lap, facing forward. The early evening hinted of summer. Tree buds were making their debut and a few sparrows flew limb to limb, singing to each other.

  Empty hooks like horizontal question marks hung from the porch beams. “Time to put out the feeders,” Sara said, following her husband’s gaze. “The hummingbirds are depending on us.” She buttoned her camel sweater as Casey jauntily came around the side of the house.

  “Not even a front door greeting,” Casey boomed, standing in front of the railing. “A bunch of rocking chair slackers.” He walked up the steps and handed Sara an elongated brown bag. “Home grown,” he said.

  Sara pulled out a bottle of wine, the label from Stonehaus, a Tennessee winery. “Sweet Muscadine. Thanks, Casey. Have a seat after you go inside.” She swept her arm forward, pointing directly with her index finger. “Glasses upper right.”

  Casey squatted in front of Melissa. “Wow. You’re beautiful, for a baby,” he said, bouncing his head for her amusement. Melissa sputtered gibberish, her diaper bound bottom squirming in Danny’s lap.

  Casey brought three thick wine glasses. “So how’s Jane Doe?” he asked Danny. Danny eyed him wondering if he had meant to be facetious by using the name Doe, but Casey was being straight.

  “Who’s Jane Doe?” Sara asked.

  “Deer accident this morning on a side road off of I-40. College girl with a cerebral contusion,” Danny said. Sara crossed her legs the other way and Danny resumed slowly rocking. “I checked on her before I left and she’s showing progress. She opened her eyes, responded to commands. Cerebral edema is getting better, but I’ve ordered another CT in the morning.”

  “That’s good,” Casey said, turning his head towards Sara “Her boyfriend driver got intubated and went for surgery, but another driver averting the accident got killed.” Danny clasped Melissa closer and Sara shook her head.

  “Sara, Casey and I will put Melissa to bed tonight, if you’d like. I’ll change her diaper, put her pajamas on, skip a bath. That okay?”

  “Sure. I’d appreciate that.”

  Sara dripped a few more ounces of Muscadine into her glass then Danny resumed rocki
ng. A hummingbird scout whizzed by, taking a momentary pause near the roof gutter to view them, determining if they had yet placed a plastic bulb with red nectar. Danny broke the silence, and poked Casey. “Anybody new?”

  “Got a date with an x-ray tech on Saturday. We’re going to see John Mellencamp at the Ryman Auditorium.”

  “Bet she’s a knockout,” Sara said. “You date the most beautiful and intelligent women. I don’t know where you find them.”

  “He doesn’t find them,” Danny said. “They find him.”

  “She’s a nice lady,” Casey shrugged. “I’ve taken her out a few times.”

  “Come on, then,” Danny said. “Help me out. Get lessons for what comes after the wedding rings.” Danny got up, swung Melissa once in the air, the glee of the ride spreading across her face like sunshine on the horizon.

  “Daddy’s little girl,” Sara said. “You three have fun.” She chuckled as they left, while noting Casey’s worked-out gym body in blue jeans and a cotton shirt, and Danny’s tall height. Two grown men … all their attention centered on a little baby girl.

  Upstairs, they went to the bedroom directly across from Sara and Danny’s. Casey took a back seat to the bedtime routine, but gave Melissa a kiss after his friend laid her down in her crib. Danny nestled a lightly frayed blanket around his daughter as her movements slowed and her eyes closed.

  Chapter 3

  “That crazy bitch. She nailed me.”

  Danny listened to a patient on an ER stretcher, intrigued by two inches of nail jutting out of the man’s head. Maybe a five-inch nail including the part imbedded in his brain. The hem of the man’s blue jeans were caked with mud and his Henley shirt had missing buttons. He wore a two-day five o’clock shadow and his offensive odor masked background smells of open wounds and vomiting.

  “What did you do to her?” Danny asked, urging him to talk. He wanted to assess the man’s reasoning and appropriateness, look for mental deficits due to his injury. On second thought, however, Danny figured his baseline mental status might be someone else’s deficit.

  “Are you stupider than my wife?” the man asked, wiggling his body all over the sheet. “What the fuck difference does that make?”

  “Whether or not you walk around the rest of your life as a coat rack depends on me. Maybe you’ll talk to me nicely.”

  The man’s eyes opened wider and he grinned in disgust.

  “You need to tell me what happened and if you passed out,” Danny said, putting on gloves to examine the injured man’s scalp.

  “I was drinkin last night. But I fished yesterday. Drinkin then, too. All I knows is she was mad when I got home. I must’ta passed out in the garage, where I got a little workbench and tools there. I dunno.”

  “So you were in a drunken stupor before you got nailed in the head?”

  “Yeah. I reckon.”

  Danny assessed his patient’s pupils, which were equal and reactive to his penlight, and obtained a negative previous medical history from the man. He went to the desk to write orders and asked the secretary to call radiology to book a CT scan.

  Danny was in his fourth year of residency, a PGY4. He’d been thrown into the trauma month because a resident was out on medical leave, and Vanderbilt needed the coverage. Otherwise, he would have finished his sixth month at the VA. The beginning of the year, he had done six months of pediatric neurosurgery, but found it depressing. It made him more appreciative of Melissa, now two and a half, and his second daughter, Annabel, six months old, who were both the picture of health. His little girls could undo the pediatric neurosurgery blues any day.

  Danny slid into a rolling chair and scooted around Casey, who half sat on the desk, legs extended and crossed at the bottom.

  “I’m working graveyard shifts this week,” Casey said. “Your patient was my last run. His wife called it in. When we got there, she waved an automatic nail gun and asked me if I wanted the weapon. I told her I wasn’t the police.” Casey leaned backwards and selected a glazed Krispy Kreme from the morning box of twelve donuts on the counter top. “You going to do the surgery?”

  “Probably. I’m hoping Mr. Rhine’s blood alcohol level is low enough that anesthesia clears him. I’m the highest-ranking resident on this service right now besides the chief, so I think he’ll let me do it if he supervises.”

  Casey took a napkin to hold the uneaten end of donut and nodded. “How are Sara and the girls?” A nurse stalled while grabbing a chart behind him. She opened a tab and glanced alternately between the page and Casey.

  “They’re fine. You’re welcome to meet us all at Downtown Italy tonight,” Danny said, referring to his parents’ original Italian restaurant on Broadway.

  “I’m going to grab a nap and then go to the gym. Then I have to get back here for another tour of duty. I’ll take a rain check.” Casey got up, smiled at the nurse, and pitched the wadded napkin into the trash.

  Danny called his chief resident, Dr. Vince Aaron, and shortly later met the group rounding on patients in the CT room. After the other residents saw Mr. Rhine, the gaping mouths of junior residents closed and they congregated around his CT results.

  “Clean penetrating injury,” Vince said, waving his pen at the scan and addressing the PGY2. “Do you see the bleed inside the skull?”

  “No, sir, I don’t see any evidence of that.”

  “Very nice. Correct. So we suspect the nail avoided major blood vessels. Now, Dr. Tilson and I must be careful not to cause bleeding while surgically removing it.” Dr. Aaron spun around, sat on the desk, and continued. “What about the nail’s location?”

  “Lucky guy,” the PGY3 said. “The right frontal lobe. Probably forgiving.”

  “What if it had been his temporal lobe?”

  “The dominant hemisphere of the temporal lobe houses Wernicke’s speech area. But no telling if a penetrating injury there to this Tennizzee hunter would have enhanced or deteriorated his speech.”

  “Fisherman,” Danny corrected him.

  “Whose name is probably Bucky,” the PGY3 said.

  Laughter erupted from the residents in the back.

  “Okay, very funny, Mr. New Englander,” Vince said. “Now, everybody get down to business. Danny, I’ll meet you in the OR after the case is booked, you’ve got consent and labs, and the anesthesiologist gets the ball rolling.” Vince pocketed his pen. “In the interim, I’ll be the photographer.”

  ________

  Danny scrubbed while watching the attending anesthesiologist and resident say goodnight to, and intubate, his patient. The anesthesiologist probably didn’t bother to ask Mr. Thine to count backwards. When Danny walked through the double doors, the OR table had been turned ninety degrees from the ventilator, the anesthesia circuit had been carefully secured; and one arm of the patient with IV access was wrapped on an arm board and the other arm was tucked alongside his body. A blue warming blanket covered the patient and draped over the sides of the table.

  A nurse unfolded Danny’s surgical gown allowing Danny to slide into it. The circulating nurse tied it from the back as he stepped to the patient’s head. The area around the nail had been prepped and shaved. Danny affixed a bolt-like contraption to hold the head and put a sterile drape with a hole to expose the surgical site.

  The scrub nurse stood closest to him, her instruments laid out neatly on moveable tray tables. Danny incised a wide circular margin, cutting down to skull. “Drill. Suction,” he said. The nurse handed him both, and he started to drill, applying pressure to bone. Danny knew his chief resident had scrubbed and readied after him; he now looked closely over Danny’s right shoulder.

  Vince dripped saline over Danny’s drill bit and surgical area. Danny continued drilling firmly, then eased up when he felt no resistance, which meant he was inside the skull and near the brain.

  “Dr. Tilson, you scattering bone dust around here?” the anesthesiologist quipped.

  “I’ll be sure to glue it all back together before we leave,” Danny said, smiling
under his mask.

  Danny suctioned. He slowly pulled out the incised skull bone. Perfect. The major venous sinuses weren’t anywhere close and the nail wasn’t too far in. Vince kept quiet; Danny had the situation under control. The small defect in the pulsating brain wasn’t bleeding, so Danny and Vince turned their attention to pushing the nail out of the bone from where it had entered.

  “Fine job,” Vince said. He stepped back and took off his gown. The scrub nurse took the suction tip from Danny. He appreciated her methodical style and her respectful treatment of residents, who often weren’t assisted with the same professionalism as senior staff.

  Minus the nail, Danny inserted Mr. Rhine’s skull piece back into the hole like a single cardboard piece into a puzzle, and stapled the scalp flap back onto the adjoining skin. He was grateful that the case had been straightforward and that a good senior resident had done the anesthesia. He’d get out at a reasonable time to spend the evening with Sara, Greg and the girls.

  ________

  Greg’s chef, Gianni, from Downtown Italy eyed his pesto sauce for color and texture. He sampled it and nodded his approval. He slid chopped onion and garlic to Greg from a butcher block, for Greg’s customary part in preparing the appetizer while Sara and Danny were on their way. Greg sautéed them, added browned eggplant, and stirred in tomatoes. He mixed capers, anchovy paste and olives in the pan drippings, spooned it over the eggplant and covered it. “Sara’s favorite,” Greg said.

  Greg and Donna had foreseen Nashville’s potential for a fine, pricey Northern Italian restaurant. While entrepreneurs concentrated on pulled pork and ribs, Greg and Donna figured the country superstars and entertainment folks had extra cash, and there was only so much barbecue people could eat. So when downtown Nashville was in its infancy, springing more and more café’s, buffalo wing restaurants and sports bars, Greg and Donna bought a large, old bookstore and renovated it. Sending for Gianni from Italy sealed the deal. Later, when they opened a second and third restaurant, they sent for two more chefs, but remained attached to their original Downtown Italy.