by Andy Siegel
After sterilizing and injecting Cookie’s lower back with a local anesthetic, he takes out a large metal syringe. He holds it up to the camera. It’s one formidable instrument. “This is a spinal tap syringe,” he starts. “It’s a three-inch-long needle”—he indicates—“specifically designed to enter the spine with a minimum of resistance and is hollowed to perform its function. I’m going to insert it between two vertebrae, which are the bones of the lower back, into a space where Cookie’s cerebral spinal fluid circulates.” He takes a deep breath.
“Cerebral spinal fluid, or CSF, is a clear liquid that circulates around and inside the brain. It also flows all the way down and around the spinal cord, occupying a channel known as the subarachnoid space. That’s what I’m aiming for. The arachnoid mater is the middle layer of brain cover, formally called meninges, and the pia mater is the meninges closest to the brain. It’s between these two layers that encase the brain where this fluid circulates, hence the term subarachnoid space.”
“Hurry, Major, with your lecture. The pressure’s building.” Cookie says. Urgency is in her voice. He continues at a pace that indicates he knows exactly how much time he has before things might get messy.
“The function of CSF is to provide protection to the brain and cushion the spinal cord against jarring forces. It also distributes neuroendocrine factors, but that’s beyond what we need to discuss here. In Cookie’s case, she sustained an injury that penetrated through the dura mater or the outermost meninges, and through the arachnoid into this subarachnoid space at the C4 level of her neck. The C stands for cervical, which is the medical name for the neck, and the 4 stands for the vertebral level in her neck.
“Each vertebra in the stack of bones in the cervical spine has a corresponding number, beginning with C1 at the base of the skull and ending at C7 at the base of the neck where it meets the shoulders. Because of the surgical injury caused by Dr. McElroy’s malpractice, Cookie’s CSF no longer flows freely through that region. A partial damming effect has developed, causing it to slowly accumulate at the C4 level. The fluid builds and builds, backing up into her skull.”
“Major! Hello?” Cookie’s getting unhappier by the second.
“Rate the pressure, my dear.”
“Four out of ten.”
“Let’s not go past seven. Is that satisfactory?”
“Fine. Just enough already with the detail.”
“As we all know,” he continues smoothly, “the brain is located in a self-contained housing, the skull. Inside, there’s normal pressure that’s regulated by Mother Nature. However, when spinal fluid backs up, it causes increased intracranial pressure. This is because the hard structure does not expand. So, as the fluid builds up, it slowly but steadily compresses the brain within the skull. As you might imagine, this results in the development of headaches, loss of balance, blurred vision, and other classic neurological signs leading to loss of cerebral functioning. It will result in death by brain compression if the pressure’s not released and brought back to normal.”
Trying to get a different angle, a better angle, I take a half step to the side and partially kneel. Perfect. Man, those lovely breasts now on screen are truly fabulous. Uncertain for an instant, Major pauses. Don’t worry Major, I’ve been in the business a long time, and I know what’s important to the future viewers of this video. A good lawyer always knows his audience. It’s all part of the legal process.
“Hurry!” Cookie presses him. “Please!” He does.
“The only way to release the pressure is to drain the excess fluid by spinal tap. It’s purely a mechanical release, and that’s what I’m going to do now by inserting this needle into Cookie’s spine to withdraw CSF into the collecting tube of this device. There are newer instruments that are now used to perform this procedure, but I’m comfortable with my old one.”
Major now moves in to insert the big needle in her lower back, a tad left of center. I zoom in for a close-up.
“Easy, my dear,” he says, “just a pinch, that’s all.”
He inserts the needle. Then, all of the sudden, without notice, bam! Cookie’s left leg rockets back, kicking Major squarely in the gut. And I mean, her leg exploded backward in some form of hyperreflex with a force like I’ve never witnessed before. It sends him flying as if he were a rag doll.
Major’s flight ends when he slams into the base of my desk four feet away. Oh, shit! He’s motionless. I’m thinking mild concussion and massive internal bleeding. Wait a minute. He shakes his head, the way boxers do after taking a hook to the temple. Slowly, he regains his composure and, with a confused expression, looks up.
Boy, is this crazy! But I’ve got it videoed and can’t wait to share it with Mick and Henry.
“Cookie, don’t move!” Major yells, fixated on her back.
“What’s going on?” she asks. “What was that bang I heard?” She obviously has no idea what just happened.
I help him up with one hand, keeping the camera steady with the other and still aimed at Cookie. I don’t want to miss one frame of this bizarre, highly unnatural moment. I zoom in. The large needle is hanging out of her spine. It’s stuck in there.
Major straightens himself out in exactly the way anyone might after being mule-kicked during a spinal tap gone wrong. “Over here,” he says, directing me to return the camera focus to him, as he grasps the syringe.
“What you just witnessed,” he continues, earnestly eager for audience understanding, “is one of the risks and complications of a spinal tap. You see, this is a blind procedure, and as I was entering the needle to access the subarachnoid space, the tip penetrated a nerve root. These exit the spinal canal at each vertebral level and branch out to different parts of our body, hence the term peripheral nervous system. These nerves have two aspects, with one of those controlling sensory perception, or what our brain interprets from external stimuli. For instance, when Cookie kicked me, that was the stimulus causing the nerves in my abdomen to send a message of pain to my brain. The other aspect of the nerve controls motor coordination or movement. I obviously stuck the needle into the motor centers of Cookie’s nerve, as evidenced by her violent kick.”
“Major! Major! Please!” Cookie is losing her remaining composure. And justifiably so. “I’m at six, approaching seven. And, what kick? I didn’t kick you! Did I?”
“Yes, in fact, you did. It was a reflex induced by my contacting your nerve, and, since your lower back is numbed, it’s not surprising you didn’t know about it. I realize it wasn’t intentional.”
“I really kicked you?”
“Yes.”
“Oops.” She frowns, suddenly more concerned about Major than her own increasing discomfort. “Are you okay? Did I hurt you?” I marvel at her solicitude. She’s the one with the needle jutting hideously out of her back, a hair away from her spinal cord.
“I’m fine.”
“Are you sure?”
“Remember,” I interrupt, “we’re still on camera here. I think we need to focus on the task at hand.”
Cookie starts to say something, when a rictus of pain freezes her.
“Now, Major! It’s got to be now!” she commands.
He resumes the procedure and completes it without further incident. Whew. When he’s finished, he explains that the meter on the device is a gauge for measuring spinal-fluid pressure. The fact that her fluid is clear means there’s no evidence of infection.
I’ve learned a lot in the past few minutes. And seen things I never imagined. Speaking of which, Cookie is still topless. I’ve never been near a woman so comfortable with her nakedness. She gives me one of her innocent smiles, and Major catches it.
Man, what’s going on here? She’s such a babe, and he’s this old dude who seems to command her total devotion. He appears resigned to the fact that my watching her get dressed is unavoidable at this point. However, I’m particular to keep a very p
rofessional look on my face. (I think.)
INCOMPLETE AND FILTERED
Once we’re all seated again, I clear my throat. “I have to say, I can’t believe you’ve been doing that all this time. I’ve never heard of such an intervention. Isn’t there another form of treatment?”
“Well, Cookie could have a shunt surgically sewn into her brain that would drain the excess CSF into a tiny tube implanted just underneath her skin running down her neck and around her shoulder with its spout ending in the peritoneal cavity in her abdomen, the most common site for fluid diversion. The fluid would drain through the tube and drip into her abdomen, then be reabsorbed naturally by her body. But she’s against it.”
“Why are you against it?” I ask her, thinking, Shit, yeah, I would be too.
“I’m against it because I could end up like a vegetable. The risks are off the charts. No way. Not for me. I’d rather be doing this than wind up brain damaged or worse. Besides, the shunt can fail, clog up, need adjustments, and worst of all, I’d have to totally give up dancing with one of those implanted in my brain.” She pauses. “No way,” she repeats. It’s all I got left in my life. Oh yeah, and you, Major. Sorry.”
She reaches over and takes his hand. But I can tell it’s a guilty gesture and not a sincere one by the way she quickly lets go.
“Understood,” I respond.
They look at me, waiting to hear what’s next. I pick up the file. “Major, is there any reason why your medical records aren’t in here? Or, for that matter, why Chris Charles didn’t list your name as a witness or as a treating physician? You’re obviously both, not to mention key to proving the tapping, which clearly is the largest element of damages.”
Okay, Major, let’s hear it, the voice in my head says.
“Early on,” he begins, “I told Chris to try to keep me out of this, given the nature of my relationship with McElroy.”
And this guy denied appreciating conflicts, I think to myself. Jeez.
“But, seeing how things are turning out, if you need to identify me as a witness or treating physician, please do so. Anything to help at this point.”
“Good. I’ll also need to provide defense counsel a copy of your medical records to go with the video.”
“What about the clinic records, then?” Cookie adds. “From the day you saved my life.” She’s smiling again now.
“Clinic records?” I repeat, interested to know.
“Oh, he’s so shy. When the headaches first came on, Major took me to his old medical clinic for evaluation. Two days of testing. It was there that he made the diagnosis and performed my first tap.” She says it as if remembering a first kiss.
“Then I’ll need the name and address of that facility, too,” I point out. “Anyway, best now to finish the remainder of the agenda I had planned for our meeting today. Sound okay to you guys?”
“Sounds good,” Major answers for both of them.
“Cookie, I’ve read your records and have seen for myself what you have to endure. Now I’d like to hear from your own lips how this injury has compromised your enjoyment of life, which is an item of noneconomic damage in the New York Pattern Jury Instructions. This will be important during negotiations. So I need you to proceed without holding anything back.”
I can tell by the way she’s looking at me that a gut spill is on the horizon. At the same time, Major’s sitting next to her. She’s going to tread carefully because of him. It’s obvious by the way she’s subtly just repositioned herself, adding a hint of distance. The inch tells the whole story.
Her eyes are filling with tears, but she won’t let them run. It’s Major, for sure: she doesn’t want to worry him. Or hurt his feelings, either. Whatever she’s about to say will be incomplete and filtered because of his presence, I realize. I’ll have to speak with her alone to get it all.
She lets out a long, slow breath. “First of all,” she plunges in, “I always wanted to be a mother, but because of this I can’t have kids. The way I understand it is, if the pressure in my head increases too much during pregnancy or at childbirth, I could become brain damaged, die—or worse—compromise the health of my child from oxygen deprivation. Right, Major? I don’t want to be brain damaged—I already said that—but more horrible would be having to live with myself if I caused any harm to my unborn child. No way.”
She stops to compose herself. “So I’ll never be a mother, and that’s a pretty big loss, especially because I don’t have any family of my own. Except for Major, that is.” Time for another guilty hand pat.
“I grew up the only child of a single mother who died when I was twelve. I always hoped to start my own family, a big one with lots of children, but now that’s never going to happen.”
I say nothing, but it’s a sympathetic nothing. Major clears his throat but also remains silent.
Cookie’s eyes tear up again. “I can’t do anything alone. I have to stay close to Major because I never know when my head pressure’s going to get out of control. The normal tap cycle is every three to six days, but I’ve needed repeat taps as soon as twelve hours later. It’s just not predictable. I had a tap the evening I met you, and that was two days ahead of schedule. And then there are times after the tap where I suffer from spinal headaches with nausea. They’re awful. Besides, I’ve taken Major’s life away from him, which I feel terrible about. He’s got to stick around me, be close by at all times without any breaks, because … you just never know. I’m a big burden on him, and I hate myself for that. He deserves better.”
Hand touch number three.
She’s looking at him, wearing a sad smile and blinking back tears. “Then there’s dancing. I don’t care what any doctors say, I need to dance. It defines me. I won’t give it up. No matter what. You have no idea what it’s like doing the thing you love most in the world and having to do it in agony. But I can’t disappoint all those guys who love me, ’cause I love them back. We’re like family. And I won’t give it up. Even though it hurts. It’s who I am.” Now she’s got a defiant expression.
“Okay. I think I’m understanding the essence of this now,” I tell her. “You’ve done a fine job of explaining your history and the toll it’s extracted from you. I’m sorry I had to put you through it, but it was necessary. I’m going to start setting things up for settlement. This case demands it—from what I read in the file, from what I’ve now witnessed, and from what you’ve just said. I want to set the wheels in motion. You can consider the video we made today a big first step forward toward our goal.”
I stand up, indicating our meeting’s now come to its end. But what I’m thinking is: of course there’s only a two fifty offer. The insurance carrier never even considered the tapping. They had no records, nor the chance to question Cookie about it before she took ill at her oral deposition.
As they make their way toward the door, I realize one other thing I need to ask. “Listen, I know this is going to sound strange.” They both stare at me curiously. I hesitate. Out with it. It’s just that I don’t want to sound like an idiot. Okay, here I go. “But do either of you know any reason why some person might not want me to handle this case?”
They give each other puzzled looks. “No,” answers Cookie. I can tell she’s confused by the question.
“What do you mean?” Major wants to know.
“What I mean is, would there be any reason why representing Cookie might make me unpopular? You know, like Chris Charles being pissed that he was substituted out or anything like that?”
Major studies me. I’ve thrown him a curve ball. “No,” he answers. “I spoke to Chris, and he understood the conflict. He wasn’t happy, but he wants what’s best for Cookie. We all want what’s best for Cookie. Why do you ask?”
“Just curious, that’s all. No reason really. It’s just when you take a case over from another attorney they can get a little resentful, even start to act out. That’s
all.”
“What’s happened to arouse your concern?” It’s reasonable that he should want to know.
“Nothing.” I hate withholding information from a client, but I see no sense in sharing my Minnow encounter. Yet.
“All right then. If you say so.” He resumes his solicitous escorting of Cookie from my office. Moments later, Lily buzzes.
“What’s up?”
“Some guy called three times while you were in conference. He seemed real anxious. He’s probably an HIC. But I couldn’t get any info from him. He said just to tell you he called.”
“So are you going to tell me his name or not?”
“Minotero. That’s a strange name. Sounds like one of those masked Mexican wrestlers.”
Speak of the devil. “Wonderful.”
“Wonderful what?”
“Wonderful, nothing.”
“Well, you said ‘wonderful.’ Did you mean it in a good way or a bad way?”
“I’m not positive, but I’m pretty sure it can’t be good. Listen, I’ve got to catch up on some paper, so try not to disturb me.”
“Okay, I’ll give you the envelope later.”
“Lily, what envelope?”
“The envelope someone dropped off on our reception counter.”
“Who dropped it off?”
“I don’t know. I went into the supply closet, and when I came back there was an envelope sitting on the entry counter with your name on it.”
“Bring it in, please.”
“Now?”
“Yes, Lily, now.”
She brings it in, flips it on my desk, and huffs out, sighing ostentatiously. Like you’d think I was bothering her.
It has one word on it: Wyler.
Chapter Nine
