by Tom Sullivan
One day a week he gave his time to the military here at Seattle Veterans Hospital. From his office window on the top floor of the administration building on the top of Beacon Hill, he could look out over the bay and then let his eyes take in the mountain vistas to the west. All in all, it was a wonderful setting, and he thought of his time here as doing something important for his country—even though by anyone else’s standards he was well compensated for his work.
Others sometimes called him arrogant, but he supposed there was a major difference between arrogance and confidence. He liked to think—though his two ex-wives would disagree—that he was supremely and appropriately confident. He was an Ivy League man all the way. He had attended Yale as an undergraduate and then Harvard Medical School, where he had graduated in the top ten of his class. After residency he had migrated to the Northwest, believing that his talent was needed in what he thought of as the hinterlands of America, and he had been right.
Big bucks followed. Though he was paying two alimonies, his lucrative real estate investments, along with timely positions in the stock market, had made him a wealthy man. For him, wealth meant that if he retired tomorrow at forty-five, he could continue his lifestyle unchanged, living on the interest from his capital investments.
The chart he had just reviewed was on Corporal Antwone Carver. He sighed, understanding that even with his talent, the Marine’s prognosis was not good. He noted that Carver had a complete transection of the spinal cord, meaning total separation at—he looked down again at the chart—at thoracic or T-10. Turning in his chair, he studied the skeletal model on his wall and sighed again, thinking about how he would explain the devastating condition to the young man.
He rehearsed it in his mind. If you drew a line across a person’s navel, below that line would be a loss of all reflex. He decided he would show the Marine what he meant by doing a couple of tests. Show-and-tell was always a better method in these cases. It left no room for doubt. He would begin with the pinprick test and then follow it up with the traditional tuning fork demonstration, in which the fork does not vibrate because there is no stimulus response from the muscle. Even by expanding the tuning fork test to the old ping hammer test on the knee, there would be no reflex. Ergo, the man would have to face the reality of his condition without developing any false hope. Dr. Jonathan Craig believed very much in leaving no doubt—absolutely no doubt—in the mind of a patient.
It doesn’t do them any good to give them hope, he thought. If I can’t fix them, why should I lie to them? This was especially true in cases like Carver’s, because often, after a few days, patients became hyperreflexive. The muscles, spasming, could easily give the impression that feeling was coming back and that they would one day walk again.
Dr. Craig knew there were great possibilities for spinal injury patients with the development of genetic mapping and electronic stimulation, but the probability was that spinal cord injuries of this kind would not be corrected surgically during Carver’s lifetime. Given that set of parameters, honesty is always the best policy, as his mother used to say.
He noted that Carver was retaining a great deal of urine in his bladder, indicating that he was losing tone and was becoming flaccid in the anal sphincter. A catheter that would likely be permanent would drain the urine, but the man would have to face a lifetime of colon cleaning by an ongoing series of embarrassing enemas—not pleasant but livable, and certainly better than having to be bagged. Not that Dr. Craig needed any more support for his prognosis, but he also saw that the chart indicated positive Babinski. This is when the toes involuntarily point upward, almost as if the patient was stiffening in the throes of death.
He decided that the doctors in country had done the right stuff. A complete spinal X-ray and MRI had been taken, supporting the diagnosis. They had treated Carver with large doses of corticosteroids in an effort to bring down the swelling. With the swelling reduced, there was nothing left to doubt in the prognosis. Corporal Antwone Carver was now a paraplegic. Craig was sure of that fact as he put on his blazer, straightened his tie, and prepared to visit the patient.
Just tell it to him straight, he told himself. Better to get it over with and let the kid begin to deal with it.
Doing the obligatory knock and then entering the room, he saw that Carver was not alone. A beautiful woman was sitting with him and holding his hand; Dr. Craig assumed she must be his wife.
Darn, he thought. That means there’ll be tears. I hate it when the spouses are here. It complicates the conversation, especially when you have to talk about sexual function. Well, let’s get it done.
Dr. Craig cleared his throat. “Corporal Carver?” he said, crossing to the bedside. “I’m Dr. Jonathan Craig, the neurosurgeon reviewing your case.”
“Thank you, Doctor,” the man said from the bed as the woman stood and put out her hand. The surgeon noted that she was strikingly beautiful, even exotic. He loved exotic women. He always had. And this one was a stunner. She wore very little makeup. Her high cheekbones and dark eyes seemed in perfect balance with her full lips and great body. Her toned legs caused him to struggle to concentrate.
“I’m Antwone’s wife, Darla,” she said, interrupting his wandering thoughts. “We are both very grateful for your help, Dr. Craig. Do you have recommendations for a course of treatment?”
Not only gorgeous but well spoken and intelligent, he thought. What a shame she’ll be denied a lifetime of sexual pleasure.
Again the doctor cleared his throat. “Yes, well, about the case . . .”
As before, the woman held the man’s hand, and both sets of eyes were on the doctor’s face.
“Before I talk about your prognosis, let me show you some things.”
Over the next few minutes, Dr. Craig went through the song and dance of pinprick, tuning fork, and ping hammer, demonstrating the lack of feeling or reflex from the waist down. He observed that the woman remained extremely composed and that the man seemed to be handling it all with stoic bravery.
Good for them, Craig mused. Nice to see people who are courageous, rather than whiny or overdramatic.
At the end of the show-and-tell, the doctor put down his demonstration tools. “So you see,” he said, looking directly at the young Marine, “it is clear that you have no feeling from the abdomen down. You have suffered a complete severing of the spinal cord, bringing about your present paralysis.”
The man in the bed turned his head away and buried his face in the pillow, not looking at Dr. Craig. But the woman’s eyes never left the doctor’s face. It was she who spoke.
“Okay,” she said, “Antwone’s paralyzed. I’ve been reading a lot about guys in chairs and how much they’ve done with their lives.” She reached out and touched her husband’s face. “Antwone? Antwone, look at me, please. We can handle this together. I know we can. I love you, Antwone.”
The doctor dropped his eyes, feeling embarrassed as the woman leaned over and kissed her husband. Embarrassed? Is that what I’m feeling? Craig wondered. Or is it something else? Jealousy? No, no, I’d call it envy. Nodding to himself, he knew those thoughts were for another time, and he pushed them out of his head for the moment, going on with his discourse.
“There is another issue that needs to be discussed,” the doctor stated.
Both young people turned to him, their eyes questioning.
“Other issues?” It was the woman who spoke.
“Yes, ma’am.” Dr. Craig paused, looking directly at Darla as he spoke. “I mean that along with total paralysis from the waist down, there is also the loss of sexual function.”
The room was silent for a moment, and then a sound came from the man in the bed; it began as a low, soft “no” and cre-scendoed to a guttural sound that became a high-pitched wail that sent a chill down the doctor’s back. “Noooooooooo!”
The woman was holding her husband now, rocking him gently, talking quietly, and soothing him. “It’s okay, baby. It’s okay,” she was saying. “It’s okay. I love yo
u, baby. I love you. It’s okay.”
Dr. Craig rose, wanting to avoid this tableau of wasted emotions. Sure, it wasn’t easy for a man to accept impotence, but what choice did he have? The Marine was still alive, wasn’t he? He had made it through the war, hadn’t he? And he had come home to this strong, beautiful woman.
Craig cleared his throat, interrupting the couple’s intimate moment. “I’ll be consulting with your physical therapist and your occupational therapist about their recommendations for a course of treatment. In the meantime, I’ll prescribe some medication to help you sleep and recommend a psychiatric consult.”
The man’s keening had now become a more controlled moaning, and the woman was clearly in charge of the situation. “Thank you, Dr. Craig,” she said.
Craig reached into his wallet and pulled out a beautifully embossed business card. Removing a pen from his jacket, he wrote his cell number on the back.
“Feel free to call me anytime,” he said, handing it to the woman. His fingers lingered a moment on hers, and he gave her the warm smile that always worked on the women he hit on. “Please let me know if there’s anything I can do to make your husband more comfortable or”—he gently let go of her hand, his fingers subtly brushing her bare leg—“if I can help you in any way.” He looked at her meaningfully, making sure she caught his insinuation.
The woman quickly pulled her hand away. “Thank you, Doctor,” she said coolly. “We’ll call if we need anything.” Immediately she turned back to her husband.
I’ve been dismissed! I can’t believe it, Dr. Craig thought. Okay then, good luck, little girlie. Have a good life.
With dignity in his step and his ego firmly in place, the doctor strolled out of the room and closed the door. Looking at his watch, he decided that even though it was early in the afternoon, he’d had quite enough of needless emotional engagement for one day. I think I’ll go to the club, play a little squash, have a massage, and then treat myself to a couple of martinis and a fine dinner. I’m not operating for a couple of days, so there’s time for some of the good life.
As he walked down the hall and took the elevator to the parking garage, he shook his head twice, putting Antwone Carver and his beautiful wife, not just on the back burner of his mind, but right out of his head.
BRENDEN KEPT HIS PROMISE to his friend and called Dr. William Harrison, the director of the psychiatric department at Seattle Veterans Hospital, located high above the city at the top of Beacon Hill. Harrison agreed to meet McCarthy for lunch in the hospital’s cafeteria on Tuesday afternoon and then follow it up with a tour so that Brenden could get a feel for the facility.
As Brenden tended to do, he forgot to tell the unsuspecting Dr. Harrison that he was blind, so it came as quite a shock to the gray-haired psychiatrist when the tall, blond, blind doctor arrived for lunch with a big black Lab named Nelson as a third party. It was obvious to Brenden right away that Dr. Harrison was not an animal person.
“You mean the dog makes rounds with you, Dr. McCarthy? He’s involved in your daily patient caseload?”
“Sure!”
“Isn’t that somewhat disconcerting?” Dr. Harrison asked. “Some people are not . . . I mean, not everyone has a predisposition to like dogs.”
Brenden had heard this kind of thing before, so his response came easily. “It’s been interesting, Dr. Harrison. I think of Nelson as a therapy dog, and in that role he brings almost all of my patients a terrific sense of comfort, even those who might be somewhat frightened at first. I find that after they spend some time with him, they tend to overcome their fear—and that in itself, I believe, is healthy.”
As he spoke, he reached down and stroked Nelson’s fur, reassuring both the dog and himself. He made a mental note: I’ll bet this guy will never get comfortable with Nelson.
Brenden also noticed that Harrison had an annoying habit of constantly playing with his pen, clicking it repeatedly, suggesting that his mind was elsewhere or that he was nervous and overwhelmed by his responsibilities.
After ordering their food—a chicken sandwich and soup for Harrison and a tuna on sourdough for Brenden—Harrison finally stopped flicking his pen and leaned in close to Brenden. “I was delighted to get your call, Dr. McCarthy. Frankly, we’re completely overloaded here. We really don’t have time for one-on- one patient engagement. Almost everything we do is group based because we’re so understaffed, due to federal cutbacks.”
“Cutbacks?” Brenden queried. “In the middle of a war?”
The doctor sighed. “Sadly, it’s much easier to procure money to carry on the killing than it is to provide funding for healing. There’s been no retrofitting for veterans hospitals around the country for the last twenty years. Even with all the hubbub over conditions at Walter Reed, there hasn’t been any trickle-down effect that I’ve noticed.”
Dr. Harrison was back to flicking his pen again, only now Brenden understood that the nervous quirk was based on real frustration.
“Anyway, Dr. McCarthy, you’re going to be working with Corporal Antwone Carver, an African-American Marine from Compton who has suffered complete spinal cord separation and paralysis from the waist down.”
Dr. Harrison sighed. “His case has been reviewed by our best neurosurgeon, Dr. Jonathan Craig, confirming the in-country diagnosis. From my visit with Corporal Carver, beyond the expected deep depression, I think you can assume the onset of post-traumatic stress disorder.”
“Certainly,” Brenden agreed. “It’s highly likely. It’ll be at the top of my list when evaluating him.”
“I’m glad you’re with us, Dr. McCarthy. Let me show you and your friend to your temporary office space, and then we’ll take a walk around the ward to give you a feeling for our overworked facility.”
WHAT STRUCK BRENDEN MOST on his tour was the quiet in the place. It was as if the patients had drawn inside themselves, and when he spoke to them, asking them how they were, almost all of them gave the same answer.
“I’m fine,” they would say, or “No problem, Doc.”
When he asked if they were being well cared for, the answer was similar, something like, “I guess people are doing the best they can,” or “All I really want to do is get out of here.”
Brenden wasn’t a fool. He didn’t expect a veterans hospital to be a festive place, but what worried him was the pall of sadness and apathy that hung like the Seattle fog in every corner of the hospital.
At the end of the hour, he, Nelson, and Dr. Harrison were back in the cramped office Brenden would be using. Nelson sprawled under the desk as if he understood that they would be doing some work in the crowded space.
“I’ll inform Dr. Craig that you’ll be taking on Antwone Carver’s case,” Dr. Harrison said.
“Fine,” Brenden said, handing him a card. “There’s my office, answering service, and e-mail. Please tell him I’d be happy to talk with him at his convenience.”
“Okay,” Harrison said, shaking hands. “We’re glad to have you on the team. Good luck with your first case, Dr. McCarthy.”
“Thank you,” Brenden said. “I’ll do the best I can.”
When Harrison was gone, Brenden sat in the squeaky chair with Nelson at his feet, considering how much he had to learn about the issues confronting veterans of war. As he often did when challenged by the problems of a new patient, he found himself reaching down and patting the big dog. There was so much comfort in touching the animal. To Brenden, it was as if bonding with Nelson reassured him that he could connect with Antwone Carver.
He hoped that was true.
chapter six
Brenden couldn’t believe it. He had just received a cursory e-mail from Dr. Jonathan Craig, and its contents revealed all he needed to know about where this guy was coming from.
To: Dr. Brenden McCarthy
From: Dr. Jonathan Craig
Subject: Patient Antwone Carver
Corporal Carver has suffered complete separation of the spinal cord. Paralysis is permanent, including s
exual function. The patient is depressed and unresponsive. Please consult.
What was it about surgeons that made them so arrogant and dysfunctional when it came to expressing any semblance of empathy and appropriate postoperative patient care? Brenden sat back in his chair, wondering—not for the first time—why people like Dr. Craig even enter the medical profession. Sadly, he agreed with many of his friends who believed that being a surgeon—most particularly, a surgeon with a significant subspecialty—caused them to become isolated in their technical skills, prompting them to lose their connection with patients.
Actually, looking at it with his clinical eye rather than his personal bias, Brenden reasoned that doctors like Craig were like Olympic athletes going for the gold. Their myopic view focused on one objective and on one person: themselves. Then when they failed somewhere in life, as everyone does, they fell back on their basic survival tactic: avoidance. They blocked their lack of achievement from their minds as they focused on their personal goals once again.
Brenden’s education in orthopedic surgery came to mind. If he had completed his residency, what type of surgeon would he have become? He was an entirely different person now—not just because he had adapted to blindness successfully, but because he had changed on the inside. His focus had moved outward, away from himself, and, ironically, he was happier as a result.
To be fair, Brenden had met some extraordinary surgeons, but he had come to think of these colleagues as the mechanics of medicine. It was the diagnosticians who demonstrated they cared and were the true healers. Both his personal and professional experience had solidified this belief.
“Okay,” he sighed, muttering out loud to Nelson, who was resting at his feet. “Let’s get to the case of Antwone Carver.”
Brenden rose, straightened his tie, and put on his sports jacket. As he did, Nelson shook himself and moved to the heel position, so that when his master dropped his left hand, it fell naturally over the handle of the harness.
