Robin Cook - Seizure

Dr. Newhouse’s intravenous cocktail had been everything he’d promised and then some. Currently, Ashley felt considerably more content and calm than if he’d downed several tall tumblers of his favorite bourbon, and this was in spite of being seated in a tiled operating room on an operating table cranked up to a sitting position with both arms splayed out to the sides and secured to armboards. Even his tremor was better, or if it wasn’t, at least he wasn’t aware of it. He was clothed in a skimpy hospital johnny with his stocky, pasty white legs thrust out in front of him. His bare, dry, and bunioned feet with curling yellow toenails pointed up at the ceiling. The IV was in one arm and a blood-pressure cuff around the other. EKG leads were attached to his chest, and the beeping of the readout echoed about the room.

Dr. Nawaz was busy with a tape measure, a marking pen, and a razor, as he prepared Ashley’s head for the stereotaxic frame, which Ashley could see next to a collection of sterile instruments on a draped table off to the side. Despite the frame appearing like a torture device, Ashley, in his drugged state, was unconcerned. Nor was he bothered about Dr. Lowell and Dr. D’Agostino, who had appeared with Dr. Spencer Wingate and Dr. Paul Saunders at a window looking out into the operating suite hallway. Dressed in scrubs, the foursome seemed to be watching the preparations as if it were entertainment. Ashley would have liked to wave, but he couldn’t with his hands tied. Besides, it was hard to keep his eyes open, much less lift his arms.

“I’ll be shaving and prepping small areas on the sides and back of your head,” Dr. Nawaz announced, while handing the marking pen and tape measure to Marjorie Hickam, the circulating nurse. “These will be the sites where the frame will be secured to your head, as I explained earlier. Do you understand, Mr. Smith?”

It took a moment for Ashley to remember his assumed name was Mr. Smith and that he was being addressed. “I believe I do,” he announced in a slurred monotone. “Perhaps you could shave my face while you’re at it. Without my medication, I’m afraid I did less than a commendable job this morning.”

Dr. Nawaz laughed at this unexpected humor, as did the other occupants in the room, which included a scrub nurse by the name of Constance Bartolo. She was already gowned and gloved, and stood next to the table with the frame and the instruments as if on guard.

A few minutes later, Dr. Nawaz stepped back and eyed his handiwork. “I’d say that looks rather good. I’ll duck out to scrub, then we’ll drape, and we can begin.”

Despite what should have been a terrifying circumstance of waiting to have a hole drilled into his skull, Ashley fell into a peaceful, dreamless slumber. He was soon partially awakened by the sensation of sterile drapes settling over him, but he rapidly fell back asleep. What succeeded in waking him a few minutes later was a sudden, searing scalp pain on the right side of his head. With great effort, he partially pulled up his heavy eyelids. He even tried to lift his right arm against its restraint.

“Easy!” Dr. Newhouse said. He was standing behind and to the side of Ashley. “Everything is okay!” He laid a restraining hand on Ashley’s arm.

“I’m just injecting some local anesthesia,” Dr. Nawaz explained. “You might feel a stinging sensation. There are going to be four locations.”

“Stinging sensation!” Ashley marveled silently in his stupor. It was just like a doctor to downplay the symptom, because the pain was more like a white-hot knife cutting his scalp away from his skull. Yet Ashley was strangely detached, as if the pain involved someone else and he was a mere observer. It also helped that in each instance, the pain was fleeting, to be replaced by absolute numbness in the area.

Ashley was only vaguely aware of the process of being fitted with the stereotaxic frame. He floated effortlessly in and out of consciousness during the more than half hour of manipulations and adjustments it took to anchor the frame with pins attached firmly to the outer table of his skull. He had no awareness of the past, the future, or the passage of time.

“That should do it,” Dr. Nawaz said. He reached up and grasped the calibrated semicircular arms that arched over Ashley’s head and gently tested the frame’s stability by trying to move it in any direction. It held solidly, with its four setscrews rooted into the senator’s cranium. Pleased with the result, Dr. Nawaz stepped back, clasped his sterile, gloved hands against his gowned chest, and cleared his throat. “Miss Hickman, if you would be so kind, please let X ray know we are ready for them.”

The circulating nurse stopped in her tracks en route to getting another bottle of IV fluid for Dr. Newhouse. Her gray-blue eyes first looked at her colleague Constance for a modicum of support before meeting Dr. Nawaz’s gaze. For the moment, Marjorie was at a loss for words, since she’d had experience during her training with neurosurgeons’ short fuses and operating-room tantrums, and she expected the worst.

“I say,” Dr. Nawaz announced with an edge to his voice, “let’s not dally. It is time for the X ray.”

“But we don’t have any X ray,” Marjorie said hesitantly. She switched her attention to Dr. Newhouse for corroboration, lest she bear the full brunt of responsibility for the current problem.

“What do you mean there’s no X ray?” Dr. Nawaz demanded. “You bloody well better have an X ray, or we’ll be wrapping up and going home! There’s no way I can do an intracranial implantation without an X ray.”

“What Majorie means is that these two operating rooms were not set up for X ray,” Dr. Newhouse explained. “They were designed primarily for infertility procedures, so they have state-of-the-art ultrasound available. Would that be of assistance?”

“Absolutely not!” Dr. Nawaz snapped. “Ultrasound would be no help whatsoever. I need a full size X ray to get accurate measurements. The frame’s three-dimensional reference grid has to be related to the patient’s brain. Otherwise, it would be like shooting in the dark. I need some bloody X rays! You mean to tell me you don’t even have a portable machine?”

“Unfortunately, no!” Dr. Newhouse said. He waved through the window for Paul Saunders to come into the room.

Paul poked his head through the door while holding a mask to his face. “Is there a problem?”

“You’d better believe there’s a bloody problem,” Dr. Nawaz complained angrily. “I’ve been informed belatedly that there is no X ray.”

“We have X ray,” Paul said. “We even have MRI.”

“Well, get the blasted X ray in here!” Dr. Nawaz commanded impatiently.

Paul stepped into the room and looked back out at the others through the window. He waved for them to come in, which they did, holding masks to their faces like he was.

“There is a problem no one thought of,” Paul said. “Rashid needs X ray, but the room is not set up for it, and we have no portable unit.”

“Oh, for Christ’s sake! After all this effort, is it going to come down to this?” Daniel asked rhetorically. Then, looking directly at the neurosurgeon, he said, “Why didn’t you mention you needed an X ray?”

“Why didn’t you tell me it wasn’t available?” Dr. Nawaz retorted. “I’ve never had the dubious honor of working in a modern OR that didn’t have access to X ray.”

“Let’s think about this a moment and let cooler minds prevail!” Paul suggested. “There has to be a solution here.”

“There’s nothing to think about,” Dr. Nawaz snapped. “I cannot localize an injection into the brain without X rays. It is as simple as that.”

Except for the metronomic beeping of the cardiac monitor, the room sank into a strained silence. Everyone avoided locking eyes with anyone else. No one moved.