Intensive Therapy Part 19

36.

Just as the ambulance was pulling up to the emergency room, Victoria's phone rang. She put it to her ear but she was too overwhelmed to speak.

"Victoria?" Jonas said. "It's me. Are you still in the ambulance?"

"No, we just arrived at the hospital. They must have known we were coming because everyone dashed out the minute we pulled in. There's a lady in blue pants and a white coat sprinting toward us. What's going on?"

"Listen to me, Victoria. That's probably Dr. Anna Breckenridge. She's an experienced neurosurgeon. We don't have time to wait for the attending. It could take hours for him to get to the hospital in the storm, and that's too long."

A pa.s.sel of aides and nurses whisked Gregory through three sets of automatic doors into the trauma bay, where the team was ready to take over. A woman in civilian clothes carrying a clipboard intercepted Victoria as the trauma bay doors closed.

"They closed the doors," Victoria said, shocked at how fast the doctors had taken control of Gregory.

Jonas said, "They have to get a CT scan of Gregory's head. We suspect there's been a leakage of blood that's increasing the pressure inside Gregory's head. Pressure, that's the enemy. The skull is like a rigid box. It's not like your skin that can expand when there's bleeding or a bad bruise. Imagine a water balloon inside Gregory's skull: If you press on the top the bottom bulges. That's what's happening inside his head-the pressure has nowhere to go except downward to the base of the skull, at the brain stem. That's the area that regulates blood pressure, breathing, and heart rate. Unless we relieve the brain-stem pressure, Gregory's heart will stop. Or, just as bad, the increased pressure will choke off the arteries and keep blood and oxygen from nouris.h.i.+ng his brain, which will cause a ma.s.sive stroke."

"Oh my G.o.d! You mean he could wind up ...?"

"That's what they're trying to prevent."

A bright light from inside the trauma bay drew Victoria's attention to the door's window. "Wait a second. They just turned on a giant overhead light. My G.o.d. There must be eight or ten people in there. Jesus! They're poring all over him."

"That's right," Jonas said. "They have to make sure he's getting enough oxygen and that his circulation is okay."

"The doctor in the blue pants is rubbing his chest and s.h.i.+ning her penlight into Gregory's eyes."

"That's right," Jonas said. "She's rating the depth of the coma and she's checking his brain-stem reflexes, trying to a.s.sess how bad the brain is injured. That's exactly what she should be doing."

"She's coming out of the room. She wants to talk with me."

"Fine. Talk with the doctor, Victoria. Make sure she knows I'm listening. Tell her to speak up so I can hear."

A minute later, the doctor spoke. "I'm Dr. Anna Breckenridge. I'm covering pediatric neurosurgery this weekend. I've been in touch with Dr. Speller. We don't have a lot of time to discuss options now, Mrs ... Mrs ...?"

"Braun. Victoria Schone-Braun. Dr. Speller is listening." Victoria pointed at her cell phone. "I want him to hear what you say. He's already explained the pressure issue. What can you do about it?"

"Based on the history and my examination, I think the fall ruptured a blood vessel on the left side of your son's brain," she said, pointing to a spot midway between her temple and the crown of her head. "If it's what I think it is, he'll need an operation."

"An operation! Did you hear that, Jonas?"

"Yes, I did, Victoria," he said.

"What kind of operation?" Victoria asked Dr. Breckenridge.

Dr. Breckenridge said, "It's too early to tell. We'll know more after the CT scan. That's the best test to look for bleeding and skull fractures. I'm leaving for the radiology scan suite now; it's on the third floor." She pointed to the woman with the clipboard, who had been at Victoria's side all along. "This is Mrs. Siskind, our social worker. She will take you to the radiology waiting room. I'll meet you there in about fifteen minutes." She departed hurriedly, joining several people who were rus.h.i.+ng Gregory's gurney past Victoria into an open elevator. One of the people was squeezing an inflatable bag connected to the breathing tube inserted into Gregory's throat.

Chilled by the sight of Gregory attended by so many people, Victoria, still on the phone, said, "I don't believe this, Jonas. She's talking about an operation. Are they serious?"

Jonas said, "I'm sure they won't do anything unnecessary. You better hang up now and get to radiology. Call me after Dr. Breckenridge gives you the results of the CT scan."

Mrs. Siskind led Victoria into a different elevator, which took them to a small waiting room on the third floor. "I know how upsetting this must be, Mrs. Braun," the woman said in a consoling voice. "But we do this all the time. There's no better hands your son could be in than the neurosurgery team at Children's Hospital."

Not long after, Dr. Breckenridge entered the waiting room. "Good. You're here," she said to Victoria. "Mrs. Braun, the scan confirmed my diagnosis. There is a considerable amount of blood inside Gregory's skull under what we call the dura mater, the tough membrane between the brain and the skull. The medical term is subdural hematoma. I can't be one hundred percent certain if the bleeding has stopped completely, but either way we must operate immediately to relieve the pressure.

"There is a good chance we will have to do what is called a hemicraniectomy. It's a relatively new procedure, Mrs. Braun. But it works dramatically well. It's the best chance your son has to escape devastating consequences from traumatic brain injury. Gregory has unmistakable signs and symptoms of brain-stem compression because of increased intracranial pressure."

"Procedure? What's involved here?"

"First, we shave Gregory's head. Then we make a large, question-mark-shaped incision and elevate your son's scalp and muscle off of his skull. Then we remove a large piece of the skull, and we evacuate the blood clot and make sure the bleeding is stopped. We keep the piece of bone sterile and place it in a freezer. With the bone off, the brain can swell against the soft and pliable scalp tissue, which we sew over to protect the brain from infection. When the brain swelling goes down we reattach the skull, but that can take weeks, even months."

"You must be out of your mind!" Victoria said. "You want to remove my son's skull?"

"I wish I had more time to explain, but we can't wait. Increased pressure keeps blood from flowing into your son's brain, and that means anoxia-not getting enough oxygen-which causes brain-cell death."

"I know. Dr. Speller explained it to me. This isn't some kind of experimental procedure, is it? Gregory's not going to be a guinea pig, is he?"

"Oh no, Mrs. Braun, I can a.s.sure you this procedure is the state-of the-art treatment for life-threatening closed-head injuries."

"Life-threatening?"

"Here, let me show you. Follow me." Dr. Breckenridge conducted Victoria through a doorway into a crowded, windowless s.p.a.ce that looked like a war room. The walls ahead and to the left contained light-boxes, computer screens, and X-ray equipment. Through the gla.s.s wall on the right, Victoria saw several people transferring Gregory from the CT machine back onto his gurney.

"Quiet, everybody," Dr. Breckenridge spoke up, stilling the crush of doctors and technicians scurrying about. "This is Gregory's mother. Make room so I can show her the scan."

Dr. Breckenridge led Victoria to the main screen and pointed to a large glob of white inside the outline of a skull. "See this, Mrs. Braun? That's the blood clot inside Gregory's brain." Dr. Breckenridge enlarged the image and pointed to what looked like an inward-jutting jagged rock surrounded by a thin line. Everyone huddled closer so they could see and hear.

"This is where the skull is indented," Dr. Breckenridge said. "See how the white from inside traverses the line? That tells me that the blood is under pressure, probably from a ruptured artery on the surface of the brain. We have to get in there now, not only to evacuate the clot but to identify and cauterize the artery. Otherwise, it will start spurting once the pressure is reduced."

Dr. Breckenridge ushered Victoria back into the waiting area and said, "Wait here with Mrs. Siskind. I have to go back inside for a moment. Would you like to call your husband now?"

"I'll call my doctor first."

"Fine," she said, as she left waiting room.

Victoria called Jonas, who picked up immediately. "Victoria?" he said.

"I don't believe this, Jonas. They want to operate. Gregory was just riding the banister with his cousins. He just stuck up for his sister. It was only an hour ago, and now they're talking about taking out part of Gregory's skull. Can this really be happening?"

"The operation is the best option for acute traumatic brain injury," Jonas said. "We've been doing the same procedure at Mount Sinai. It's particularly effective in children. There's been a flurry of case studies from all over the world, and every patient got better. Every patient. Dr. Breckinridge a.s.sures me it's done routinely at Children's Hospital. She doesn't strike me as scalpel-happy. Listen to her."

"Are you sure?"

"As sure as anyone can be. The older, more conservative therapies don't work well, especially when there's a lot of swelling. It's the pressure, Victoria. Remember that. The operation reduces the pressure immediately. The earlier that happens, the better the results."

"Jesus, Jonas. You want me to put Gregory's life in the hands of this doctor? She looks like a kid."

"Victoria, opening up the skull is something neurosurgeons do all the time. She's had plenty of experience, and it's the only chance for Gregory to come out unscathed. You've got to give your consent to the operation, Victoria."

"You mean he could wind up ...?"

"Permanently brain-damaged. That's right."

"Like those children who spend their lives in wheelchairs with horrible impairments?"

"That's right," Jonas said.

"My G.o.d, you're telling me this could happen to my Gregory?"

"Yes, Victoria. It's what we're fighting against."

"No. Not my Gregory. Not my Gregory," she cried.

"Trust this doctor, Victoria. We don't have much time. Now, I have to get back to Martin about Melinda. I have to get hold of Milroy, too. We'll need him to deal with her."

Victoria's hair stood on end. "Melinda. What about her?"

"She's missing. The last I heard, the police were mobilizing a search. As soon as Melinda is located, if exposure hasn't lowered her body temperature, I want her brought to wherever Milroy can get her a bed. I'm leaving for Philadelphia now."

"You're coming here? Why?"

"I'm not sure why, but something tells me you might need me."

"What should I do until then?"

"Trust the doctor. Give her permission to operate. It's the right thing. I'm going to hang up now and get going. I'll try and call from the road. I'll see you as soon as I can. Okay?"

The line went quiet.

"Okay?" Jonas repeated Victoria could hardly speak.

"Victoria? Are you still there?" Jonas asked.

"Yes," she managed weakly before saying good-bye.

Dr. Breckenridge returned to the waiting room with a white-jacketed young man who handed Victoria a manila folder.

She said, "I know this is hard for you, Mrs. Braun, but I need you to sign this consent form so we can operate. I also need to know when Gregory last ate and if he has any medical problems or bleeding problems. We also need to know if he takes any medications. It makes a difference in the anesthesia."

Victoria looked at her watch. "He had dessert at my in-laws' two hours ago. Are you sure about this ...?"

Dr. Breckenridge looked Victoria in the eyes and said, "If we don't operate now, your son's heart will surely stop within the next half hour."

"Do you have any children?"

"No. But I hope to someday."

"Do you have family?"

"I have two younger brothers. I always looked out for them when I was younger. I still do."

"Can you save my son's life?" Victoria asked, tears streaming from her eyes.

"I'll try. I promise you, I'll do everything in my power to keep Gregory alive."

"Where do I sign?" Victoria said. Dr. Breckenridge indicated where to sign and initial.

Dr. Breckenridge said, "I wish we had more time, Mrs. Braun, but I have to get to the OR and scrub up." Pointing to the young man at her side, she said, "This is Dr. Jonathan Bell. He's a first-year resident; he'll explain everything."

"Please. Please save my son."

Dr. Breckenridge touched Victoria's good arm lightly. "Someone will talk with you as soon as we know anything," she said.

Dr. Breckenridge left hastily, then reappeared with the trauma team, who whisked Gregory's gurney past Victoria on the way to the elevator.

Victoria barely had time to squeeze Gregory's hand and kiss his pale cheek.

"Is anesthesia ready?" Dr. Breckenridge asked someone.

"They'll be waiting when the elevator opens on the fourth floor," an intern replied.

"I want four pints typed and cross-matched, in case there's rebleeding once I remove the clot."

"Already done."

"Good. Let's go, let's go," the doctor commanded, as they wheeled Gregory into the elevator.

Once inside, Dr. Breckenridge turned to Dr. Bell, "As soon as you're done with the consent form, get to the OR and scrub in. I'm going to need you."

As the elevator doors closed, the bottom fell out of her stomach. Victoria wondered if she would ever see her Gregory again.

37.

Jonas apologized to the Bodenheims for departing abruptly. He hugged his wife and children tightly after Eddie rea.s.sured him that he and Margo would transport everyone home safely.