by Barbara Ebel
Danny signed the paperwork to become a gym member at the front desk and then looked around with Casey. Besides a locker room, the facility was one big area with the back wall fully mirrored. To the right of the registration desk were four round tables accompanied by an area of vendor machines stocking granola bars and hyped-up men’s athletic snacks; a long refrigerator section carried Gatorade, protein, power and energy drinks.
Danny noticed arm and leg machines which he didn’t know how to use but soon found solace seeing the aerobic cardiac machines; he could use them for starters. In the weightlifting area, the dumbbell assortment started with heavier weights than other gyms he’d ever seen. Although he didn’t expect to mimic the firmness of Casey’s muscles or gain his strength, something was better than nothing.
“Why don’t you go do some cardiac conditioning on a bike or a treadmill today and we’ll ease you into weights on return visits?” Casey said.
“My thinking precisely,” Danny replied. As he determined a good resistance and pace on the reclining bike, he noticed the other patrons. Eight men and two women looked like regulars. He finally got into a mentally-relaxed rhythm and allowed his mind to wander.
Danny knew most of the people in the world didn’t have it as good as he did, he thought. He worked hard for his accomplishments but he was given opportunities just by being the son of two hard-working, conscientious parents. He was in good health, had escaped a near-death experience, and had children who were on the right path and not getting into trouble. His gratitude for the good things in his life swelled as the minutes ticked by on the machine.
I am blessed, he thought, and if there is a higher power, thank you for being so kind to me.
Chapter 7
Casey and his paramedic partner, Mark, got up from the cafeteria table and bused their trays to the return bin where the same grease seemed to cover all the dirty dishes.
“That was a barely edible Friday night dinner,” Mark said.
“At least we ate without being disturbed,” Casey replied. “Good timing for this next run.”
They sprinted up the steps from the basement floor and out the back door to their ambulance.
“I’ll drive,” Casey said, tossing his set of car keys in the air and catching them in the darkening twilight.
“What’s the patient’s name?” Mark asked when they got in and he grabbed the clipboard between the two front seats.
“Garret Archer, fifty-one years old. He called in petrified to drive to the hospital himself; he’s complaining of significant weakness of his right leg.”
When they arrived at the townhouse complex, Casey backed up into the nearest spot. The units were aged but had character with tall trees and potted plants. A patch of dirt was in front of each address, some with weeds and others with flowers or bushes.
“He said the front door would be open,” Casey said as he noted Mr. Archer’s small plot to the side of the entrance with herbs and baby tomatoes in rich, composted soil. He knocked before they entered.
“I’m back here,” came a broken-up voice.
The place wasn’t more than twelve-hundred square feet between the upstairs and ground level so the two men were in the kitchen with a few long strides. Mr. Archer sat on a wooden chair pulled out from a round table and scratched the front of his bald head, his right leg straightened out in front of him.
Casey put his things down on the faded linoleum counter next to a bowl of avocados and tomatoes but he accidentally knocked over an unopened can. As he righted it back up, he glanced at the power drink.
Mark started asking questions and they gathered the man was in relatively good health except for recent headaches and this evening’s weakness of his leg. “I tried to get up but I knew I would land on the floor,” Archer said.
“You’ve never had a stroke or a mini-stroke?” Casey asked.
“Absolutely not.”
“Are you a Harley rider?” Casey asked, noting his T-shirt with a motorcycle emblem.
“Not as much as I’d like. Seems like my life any more is just a job and working out.”
Casey grabbed a blood pressure cuff from his bag and wrapped it around the man’s arm. As it deflated, Garret said, “I’m getting some t…ingling in that leg.”
The man’s expression turned into a wince and his leg started to shake involuntarily. “What the …?” he said.
Casey and Mark looked at each other and Mark nodded. He ran out and brought in the stretcher as Garret started to feel dizzy.
After the two men got the brawny man into their ambulance, they called in a report and headed to the hospital.
-----
Danny and Sara sat across from each other in a nearby restaurant where the most popular dish was catfish. The waitress hurried to their table and put down two heaping dinner plates, everything on them a crusty brown except for the cole slaw.
“Thank you for waiting and letting me put Julia to bed,” Danny said to Sara. “She was pretty tired, and you and I seldom get time alone.”
“We’re fortunate Nancy and Mary are at the house. But let’s hope you have a quiet night on call.”
Danny split a hush puppy in half with his fingers and put one piece in his mouth. “There’s nothing like a local family-owned restaurant.”
Sara’s mouth watered at the smell as she sampled a French fry. “Especially when they keep secret recipes for that hush puppy you just inhaled. This is the craziest fried food; the party starts in your mouth no matter what you begin with.”
Danny laughed but then he gave her a thoughtful look. “It is a party but mostly because you’re here. Do you mind? There is something I’ve been meaning to ask you.”
“What? Feel free. There shouldn’t be anything we can’t ask to clear up any misgivings.”
“Did you ever go out on another date with the principal of your school? What’s his name?”
“Ross Robinson?” Smile lines crinkled at the sides of her eyes.
“Yeah. That’s him.”
“Why, you’re jealous!”
Danny’s eyes welled up with moisture. “I thought I wasn’t intolerant about something like that but not when it comes to you.”
“No, I didn’t go out with him again, although he asked me. He waited a while. I think he sensed the first time around that he was too fresh from his wife’s death to be approaching me. But he worked up his courage again. I hope I didn’t hurt his feelings by saying no.”
A sigh escaped from Danny’s lips. “Lucky for me. I hope you stay focused on us but I realize I have to work day by day to retain your trust again.”
“There’s some truth to that.”
They sat in silence for a moment then Sara looked at her dinner again. “Having one arm in a cast is slowing down my eating but I don’t mind the inconvenience since we got to talk.”
“And speaking of inconvenience, what’s the latest on the house?”
“The contractor delivered all the materials today for the repair of the porch and front of the house. And they tarped the roof but I’m on a waiting list for a subcontractor to finish the job.”
“That’s great,” Danny said knowing it wasn’t easy for Sara and Nancy to be dislocated from their home. His mouth turned downward wishing he could do something more.
“What?” she asked, setting down her iced tea.
“Besides the fact that we’re sharing a bedroom, it’s that I’m enjoying you in Mom and Dad’s house. I’ve been selfish … almost wishing the work progresses slowly.” Her orange-ginger smell carried over the fish dinner, making him desire her more than the food on his plate.
Sara blushed and waved one free hand; bound by her arm cast, her usual mannerism of talking with both hands wasn’t easy to do and Danny missed her usual animation.
“Actually,” she said, “should we resume living together again in our old house?”
Danny couldn’t believe his ears and his eyes grew wide. “Perhaps,” he said when he had caught his breath. “But here’s another optio
n. There are bad and good memories there. We lost our first daughter. Every day we can’t forget Melissa. And I was unfaithful to you and we split up while there. I now have Julia and our other two daughters are mature ladies now, soon to be out in the world. What if we rebuild to suit our different needs?”
“Hmm. That’s an interesting idea.” She thought about it as she ate another French fry. “A new house would be like a new start,” she added. “However, no new wedding bells for us. Okay?”
“Whatever you want or don’t want, Sara.” It disappointed him to hear that additional request, but his love was solid and he’d consider them married – the only difference being they wouldn’t have the certificate. What’s a piece of paper anyway, he thought.
-----
After Danny cleaned his plate, his pager beeped. He called the hospital while Sara scooped leftovers into a small container to take home. When he finished talking, he looked sorrowfully at his ex-wife.
“I shouldn’t be too disappointed to call it a night with you since we had more time together than I banked on. But they need me at the hospital so I’ll drop you home on the way.”
When they pulled into the driveway, Danny ran around the front of his Lexus and opened the door for her. “I’ll let Dakota out,” she said. “He’s going to be included in our future living arrangement, isn’t he?” she pleaded.
“Yup, if you take one, you have to take the two of us.” He swung the door closed and laughed. “However, I think we’ll have to share him a little bit with Casey and Mary.”
Sara gently squeezed his arm while he helped her out. “Some dogs don’t even end up with one home yet Dakota is going to have two vying for him.”
He nodded at the funny thought and leaned into Sara, their lips brushing in a brief kiss. “Don’t wait up for me. I could be gone half the night. It sounds like I’ll be bringing someone to surgery.”
-----
Danny parked under a set of fluorescent lights in the hospital’s lot and, as he walked towards the automatic doors, he felt uneasy. Nowadays it happened routinely as he traced his steps along the same route as his weather fiasco.
The memory of the surreal storm and his time in the twister wasn’t something Danny could shake off. Yet since he had escaped the worst wrath – death – he was slightly glad he encountered what he did. The event reset and forced him to reexamine his thinking about everything, even the fundamentals of the rest of his life, and he no longer thought of each new day as ‘business as usual’.
In the cluttered ER hallway, Danny passed staff going in and out of the trauma room where an MVA had most people’s attention. Two bloodied women inside had an ER doc and trauma surgeon barking orders and putting in chest tubes. Casey and Mark saw Danny and left the back of the room.
“It’s been busy,” Casey said. “I heard they called you about the last patient we brought in, Garret Archer.”
“We may have a breather,” Mark interrupted. “Call me if you need me. I’ll be studying in the lounge.”
He exited quickly and Danny gave Casey a questioning look.
“Mark’s still trying to get into med school. He’s going to retake the MCAT.”
Danny nodded with understanding and looked at the ER patient names up on the board.”
“He’s in Room 4,” Casey said. “When I gave the emergency room doc the history of our getting him from his house and that he had some involuntary jerking of his leg, the doc thought it was a simple focal seizure. Archer’s never had them before and he has a negative medical history except for recent headaches. He actually seems to be in above-average shape and takes good care of himself.”
“They told me radiology finished getting an MRI and an arteriogram which is quite impressive,” Danny said. “Want to go see it with me before I talk to him?”
“You know I do.”
The two men lengthened their stride towards the X-ray department, especially when they passed a rank hallway due to disinfectant. Danny saw a radiologist sitting at his desk in an ill-lit room.
“Good evening, Joe,” he said. “Busy ER night.”
The doctor pulled his eyes away from the screen and focused on Danny and Casey. “It keeps me on my toes.” He smiled, then said, “You’re here to see Archer’s films. Never seen anything like it.” He waded through a stack of oversized brown envelopes next to him, grabbed what he wanted, and stuck the contents up for Danny to see.
“See the MRI? There’s no intracranial bleed. You won’t be doing a burr hole tonight to relieve pressure.”
Danny nodded in agreement as he traced his finger along the edge of the skull and looked at Casey. “See, no fluid along here.”
The radiologist took a pen and tapped on the next one. “Look at this Circle of Willis.”
“Here’s the anterior cerebral artery,” Danny said for Casey’s benefit, “which supplies the medial portion of the frontal lobe.” He looked at the radiologist and took a big gulp of air.
“Don’t look at me,” Joe said, shrugging his shoulders.
“Now that’s an aneurysm,” Danny said. He pointed out the bulge in the artery to Casey. “But there’s nothing after it. In other words, the blood vessel snakes around here, pouches out, and that’s the end of it. No further artery the way it should be. Which means the frontal lobe distal to it isn’t getting much of a blood supply and the brain here seems to be atrophying because I don’t see a collateral flow from other vessels.”
Casey ran his hand along the back of his crew cut. “What does it mean clinically?”
“It’s very strange. But in answer to your question, this aneurysm is problematic enough. It’s probably producing pressure on the adjacent brain tissue which is why Mr. Archer had weakness of his leg and then a seizure.”
“He also mentioned his leg felt numb.”
“That, too,” Danny said. “So we have two things going on here. First, I have to clip this unruptured aneurysm because it’s producing symptoms and it can be deadly if it ruptures. But secondly - and independent of the aneurysm - why has this artery and the arteries which are supposed to come off the anterior cerebral artery behaving like this? It’s like they’ve stopped at a red light and aren’t moving forward.”
Danny raised his arms and took two steps back. “There’s no distal flow.”
Chapter 8
“That doctor,” Garret said while lying flat on his back on a stretcher.
Danny shoved his stethoscope back in his pocket and let his hand rest on the railing, waiting for Archer to continue.
“That ER doctor. Is he right about that? I had some kind of … a seizure … back at my place?”
“It appears so.”
“But I’m healthier.” He scratched his shiny head in thought. “I mean I couldn’t be healthier. I mean a GNC model isn’t as healthy.”
Danny patted Garret’s shoulder. “Do you mean to say you’re healthier than a GNC model?”
His patient nodded and looked to the side, confused.
“We’ll get to the bottom of what’s going on, Mr. Archer. But first and foremost, I must get you to surgery as soon as possible. You have a bulging artery, an aneurysm that is likely to rupture in your brain if we don’t clip it. We categorize them by size and I have no doubt yours is considered large. You are starting to have symptoms from it putting pressure on other brain tissue. For instance, your new onset of headaches.”
Garret’s horror-stricken face made Danny put his hand on his upper arm.
“This can’t be.” The fifty-one year old stared past Danny and his eyes grew big. “Operate inside my brain?”
Danny scooted the nearby chair right up to the railing so that, when he sat down he was eye level with Garret. “I know. This sounds scary and it is. At this moment, it is both dangerous for you to have this aneurysm and dangerous for you to have the surgery. You could die if the artery ruptures and causes massive bleeding inside your brain. Your best chance is for me to try and prevent that. I can only do this particular aneurys
m with surgery.”
Danny squeezed his arm. “Would you like to think it over for a few minutes?”
Garret squeezed his eyes shut. When he opened them, he said, “Dr. Tilson, please.” A few seconds later, he continued. “Do the surgery.”
“I assure you - with positive energy, skillful hands and even a prayer or two - I will do my best.”
-----
The OR staff had done a fine job of expediting Danny’s case despite a full emergency schedule. A line-up of cases was typical for a Friday night but not necessarily so for neurosurgery as the trauma service took the bulk of weekend emergencies. At least, Danny thought, Garret wasn’t having the operation because of a motorcycle accident. He always secretly hated those cases. Motor vehicle head injuries were one thing but motorcycles were time bombs waiting for their next victim.
Danny glanced around the OR checking out the staff for his case while his favorite anesthesiologist, Dean, put his patient to sleep. The general anesthetic induction went well, Mr. Archer was intubated, and Dean worked on getting more IV access.
“Well, Mr. Archer saved us a step,” Danny said while the nurse scrubbed the antibacterial solution over the surgical site. “He must have shaved his head this morning.”
After he scrubbed his hands, gowned and gloved, Danny reviewed the films. He took a deep breath under his mask as he drilled into the frontal area.
When he removed a section of the skull, he peered over at Dean. “This is going to be a large aneurysm. Anyone want to spout off some small talk ahead of time?”
“Thanks for letting me know,” Dean said. “Let’s send for two units of blood then, just in case.”
“Dr. Tilson,” the circulator said, “we can forego the small talk right now until you get this patient’s problem resolved.”
“Hopefully, we get to small talk later. Right now this aneurysm has me worried.” He looked at the anesthesiologist and they both nodded. Danny moved the large portable microscope closer, but now he had to spread brain tissue apart with instruments and get as close to the defect as possible. Although he heard the bellows of the anesthesia machine and the tones and whistles reflecting signs of life on the monitors, his attention and concentration were on moist gray matter. Perhaps the tissue he now touched held the memories of Mr. Archer when he was twelve years old or perhaps when he turned forty and had gotten a job promotion. He could only guess. But he never wanted to somehow disturb a patient’s memory so he had to make sure the arterial deformity didn’t tear as he approached it.
