Robin Cook - Seizure

“Why not take the patient to the X-ray room,” Spencer suggested suddenly. “It’s not that far.”

The others had thought of the idea but dismissed it. Now they reconsidered the suggestion. Taking a patient from the OR to the X-ray room in the middle of a procedure was hardly routine, yet it wasn’t out of the question in the current circumstance. The facility was brand-new and practically empty, so contamination was less of an issue than it would have been normally, especially since the craniotomy had not yet been made.

“I have to say it sounds reasonable to me,” Daniel said optimistically. “We’ve got enough hands. We can all help.”

“What’s your opinion, Rashid?” Paul asked.

Dr. Nawaz shrugged. “I suppose it would work, provided we keep the patient on the OR table. With him sitting up and the stereotaxic frame in place, it would be ill-advised to move him on and off a gurney.”

“The OR table is on wheels,” Dr. Newhouse reminded everyone.

“Let’s do it!” Paul said. “Marjorie, alert our imaging tech we’re on our way to X ray.”

It took a few minutes for Dr. Newhouse to detach Ashley from the cardiac monitor as well as untie his arms from the armboards. With them sticking out laterally, it would have been impossible to get out through the door. When all was ready and Ashley’s hands were safely in his lap, Dr. Newhouse released the wheel lock with his foot. Then, with Dr. Newhouse pushing and Marjorie and Paul pulling, they rolled the OR table into the hallway. Except for the scrub nurse, who remained in the OR, everyone else trooped behind. Ashley stayed asleep and completely oblivious to the unfolding drama, despite his being in a sitting position and being jostled. With his head locked into the futuristic-appearing stereotaxic frame, he could have been a slumbering actor in a science-fiction movie.

Once in the corridor, everyone but Dr. Nawaz lent a hand pushing, although it was hardly necessary. The OR table rolled easily across the composite flooring, with only a quiet rumble from its considerable weight. When the group arrived in X ray, a discussion ensued whether to move Ashley from the OR table to the X-ray table. After weighing the pros and cons, it was decided it was best to leave him on the OR table.

Dr. Nawaz donned a heavy lead apron, as he insisted on personally aligning and supporting Ashley’s head while the films were taken. Everyone else retreated back out into the hallway. Ashley never awoke.

“I want the films developed before we move him back,” Dr. Nawaz told the technician, when she came in to retrieve the exposed plates. “I want to be absolutely certain they are adequate.”

“I’ll have them back in a jiffy,” the technician said brightly.

Dr. Newhouse returned inside the X-ray room to check Ashley’s vital signs. Paul and Spencer accompanied the X-ray technician to await the emergence of the X-ray film from the developer. Daniel and Stephanie found themselves momentarily alone.

“This is like a comedy of errors that’s not at all funny,” Stephanie whispered, with a disgusted shake of her head.

“That’s not fair,” Daniel whispered back. “The X-ray misunderstanding was nobody’s fault. I can see both sides, and it’s already water under the bridge. The X rays have been taken, so the implantation is back on track.”

“It doesn’t matter if it’s anyone’s fault or not,” Stephanie retorted with a pshaw. “It’s still a screw-up, and it’s been one thing after another from that fateful, rainy night in Washington until now. I keep asking myself what else can go wrong.”

“Let’s try to be a bit more optimistic,” Daniel snapped. “The end is in sight.”

Paul and Spencer emerged from the processing room with the technician a few steps behind. Paul clutched the X rays in his hands. “They look good to me,” he remarked, as he passed Daniel and Stephanie and went into the X-ray room. The others followed. Paul snapped the films up on the viewing box, switched on the light, and stepped to the side. The images were of Ashley’s skull surmounted by the opaque image of the stereotaxic frame.

Dr. Nawaz moved over, and with his nose close to the films, he carefully examined each in turn, orienting himself mostly by the indistinct shadows of fluid-filled ventricles in Ashley’s brain. For a moment, no one spoke. The only sound was Ashley’s deep breathing briefly obscured by the noise of Dr. Newhouse inflating the blood-pressure cuff on Ashley’s arm.

“Well?” Paul questioned.

Dr. Nawaz nodded reluctant approval. “They look okay. They should work.” He took out a marking pen, a protractor, and a precision metal ruler. With great care, he located a specific location on each film and marked it with a small X. “That is our target: the pars compacta of the substantia nigra on the right side of the midbrain. Now I have to figure out the x, y, and z coordinates.” He set to work drawing lines on the X rays and measuring angles.

“Are you going to do that here?” Paul asked.

“This is a good light box,” Dr. Nawaz said. He was preoccupied.

“We should get the patient back to the OR,” Dr. Newhouse said. “I’ll feel more comfortable with him reattached to the cardiac monitor.”

“Good idea,” Paul said. He immediately went to the foot of the OR table to lend a hand. Dr. Newhouse released the brake on the wheels.

Both Daniel and Stephanie peered over Dr. Nawaz’s shoulder and watched in rapt attention as he plotted the coordinates for the implantation needle, the guide of which would be firmly affixed to the frame.

With Paul pulling and Dr. Newhouse pushing, they maneuvered the OR table out of the X-ray room. Dr. Newhouse kept one hand on Ashley’s shoulder to help stabilize him as they moved. It probably wasn’t necessary, since Dr. Newhouse had taped Ashley’s chest to the cranked-up part of the OR table earlier, but he wanted to be certain.

Once in the hallway, Paul turned to face forward while holding on to the foot of the OR table behind his back. It was easier than trying to walk backward. He continued pulling, but his contribution was more for steering, since the OR table, with its four casters, had a tendency to yaw. Marjorie walked alongside, holding up the IV bottle but also ready to help support Ashley if need be. Spencer brought up the rear, giving occasional orders, which everyone ignored.

“His color is not great,” Dr. Newhouse complained in the bright fluorescent illumination of the hallway. “Let’s move it!”

Everyone upped the pace.

“His color was pasty from the moment he entered the front door,” Spencer said. “I don’t think it has changed.”

“I want him back on the monitor,” Dr. Newhouse said.

“We’re here!” Paul announced, as he thrust open the OR door and entered without turning around to face the OR table. In his haste, he failed to align the table with the doorway, causing the table to come in at an angle. The result was that one of the front corners thumped into the metal doorjamb with enough force to cause Ashley’s body to jolt against the tape that bound his chest to the table. The inertia of the stereotaxic frame caused a mild whiplash effect, snapping Ashley’s head forward obliquely. Both Dr. Newhouse and Marjorie reacted swiftly and caught Ashley’s arms, which had also flopped up from the impact.

“Good grief!” Dr. Newhouse blurted.

“Sorry,” Paul said guiltily. Since he was mostly responsible for the steering, the collision was his fault more than anyone else’s.

“Did the frame hit the doorjamb?” Dr. Newhouse questioned, as he patted Ashley’s hand down into his lap.

“No, it missed,” said Marjorie, who was on the side of the collision and might have been able to avert it had she seen it coming. It just happened too quickly. She let go of Ashley’s arm to push the front of the OR table away from the doorjamb.