Chapter 13
A voice said, "Dr. Williams, I'm sorry to interrupt your conversation but we have an urgent medical matter. I was hoping you would be willing to use your medical gifts to help."
Harry responded, "What sort of medical matter?"
"We have a man who has lost consciousness and is seizing."
"Another complication of your brain worms?" Angie stiffened noticeably with his reply and he saw the look of consternation on her face.
The voice replied, "Quite possibly, but someone in the need of medical care nonetheless. Are you willing to help?"
"Yes, but my wife comes with."
"As you wish."
The crackling sound indicated their conversation was over. Angie asked, "What are you talking about? Brain worms?"
Harry gently replied, "It's a long story. In short, our host has genetically engineered these brain worms and inserted them into his people. I innocently kept a couple to show my patient and that's what started our trouble. They have gone to a lot of effort to keep this secret."
"You mean this whole thing is about worms eating someone's brain?"
Harry tried to explain, "The worms don't actually eat the brain; they secrete chemicals which control emotions. Somehow Ahmad has learned to control the secretion of the chemicals which gives them control of the person."
"But why would they do that?"
"Controlling a soldier's emotions would be a powerful weapon. Armies have always tried to indirectly do this. Now the soldier is being directly controlled."
"I thought he was a scientist. Why does he need soldiers?"
"That is the $50 question."
Angie responded, "He is such a gentle man. It doesn't seem possible that he would do this to people."
Harry looked questioningly at his wife before replying, "I think our Dr. Ahmad has more than one side to him. The side I've witnessed hasn't been gentle."
"You mean he's like Dr. Jekyll and Mr. Hyde?"
Harry had to smile at the analogy before saying, "I would think maybe that's a little too strong. More like we're seeing different aspects of someone on a mission who presents only those aspects needed to accomplish what needs to be accomplished. I doubt he would let much come between him and his mission - whatever that is."
Their conversation was interrupted by the sounds of someone approaching in the hallway and the distinct sound of a key working the lock. The door opened to reveal two uniformed men carrying automatic weapons. They had an air of competency about them and their weapons were both aimed at his wife. The more senior appearing one said, "Come."
As Harry stepped through the door, the soldiers stepped back keeping a little distance between them and Harry's reach. They weren’t going to give him an opportunity. While they moved toward the elevator, Harry leaned towards Angie and whispered, "If I say Alamo, raise a ruckus."
The guard growled, "No talking."
The hallway was about 50 feet long, pocked with several doors secured with deadbolt locks. An elevator near the end waited with open doors. The guard motioned them in and closed the door, obviously not wanting to be in such a small space with Harry. The door had no sooner closed when Harry asked Angie if she had a pin. Angie removed one of her hairpins and Harry immediately began working with the emergency stop lock on the elevator. The elevator moved upwards, then stopped as Harry successfully turned the lock. He pried open the elevator door. They were only a few feet shy of the next floor. Using his feet to prop the car doors open, he pried apart the outer doors using his powerful fingers.
His plan changed when he saw Dr. Ahmad looking at him in surprise. The two guards had already leveled their automatic weapons at him. Harry said, "Seems your elevator isn't working right."
Dr. Ahmad had recovered his composure and said, "Dr. Williams, it would seem my elevators are a special attraction to you and they seem to work fine when you're not involved. It would be best if we got on with our work. You can play with the elevators later."
One of the guards said, "Have the lady climb out first."
Harry told Angie, "Climb up over my back. I'll hold the doors open."
Angie did as directed and had no sooner regained her feet when one of the guards pointed his automatic rifle at her and the other guard said, "Now you climb out. No tricks or the lady dies."
Harry obeyed. As he clambered through the doorway though, the elevator doors closed on his left foot and he had to twist it through. His still unhealed blisters flared and he let out a groan. Angie, startled at the painful sound, moved forward to help Harry. The guards shouted in Arabic and Dr. Ahmad cautioned, "Mrs. Williams, please don't move."
Angie responded, "But, Harry is hurt."
Harry had already recovered and proceeded to pull himself through the outer doors. Dr. Ahmad asked, "Dr. Williams, are you all right?"
Harry said, "The door scraped the blisters I developed with my stroll through the desert. I'll be okay."
The guards moved back a step, giving themselves a little more room and separating Harry from Dr. Ahmad. Dr. Ahmad said, "The patient is in our infirmary straight ahead. He began complaining of headaches a few days ago followed by dizziness and loss of appetite. Yesterday he developed incontinence and lethargy. He began having seizures shortly after we arrived."
"Sounds like obstructive hydrocephalus. Pretty similar to the other guy I saw with your brain worms. I suppose this patient also benefited from your experiment?"
"Dr. Williams, the progress of science is always associated with some cost. We had predicted a 1% complication rate and it is only slightly higher than that. With refinement of our technique I would expect this complication rate to decrease significantly. For now this patient needs your help."
"Lead on; I'll do what I can."
The infirmary consisted of a well-equipped treatment room and an adjacent two bed recovery area. In one of the beds, a young Middle Eastern man was attended by a middle-aged woman in nurse's uniform. She was trying to place an IV in the man's arm. His arms were partially restrained, but ongoing seizures were making her task impossible. Harry stepped forward and fully restrained the patient’s arm, allowing the nurse to finally get the IV needle inserted and secured in place. The nurse nodded in appreciation and began injecting medication into the IV tubing.
Harry asked, "Valium?"
The nurse responded in Arabic and Harry looked at Dr. Ahmad for a translation, but he was talking to one of the guards and not paying attention. Harry picked up the bottle. Although the writing was in Arabic, the chemical name was duplicated in English: diazepam. He asked the nurse, "How much?"
She looked puzzled momentarily but responded in broken English, "5 mg."
Harry shook his head and held up both hands with his fingers spread and said, "10 mg."
The nurse nodded and drew up some more of the medication and injected it into the IV line. The seizures began to soften; the patient remained unresponsive, but his violent thrusting against the restraints was reduced to an ongoing trembling. Harry tried to examine the patient. Other than noting the stiffness of his neck there wasn't much to examine. Pulling open the eyelids revealed dilated pupils with significant random motion. Harry used an ophthalmic scope to look at the back of the eye for the telltale sign of edema of the optic nerve, but the eye motions made it impossible. Using the handle of the reflex hammer he stroked the bottom of the man's foot and watched the toes. The toes straightened upwards instead of flexing as they normally would, a positive Babinski sign. The patient's breathing was somewhat irregular with pauses followed by rapid breaths, but the lungs were clear and the heartbeat regular and strong.
Harry stepped back from the bed and turned again to Dr. Ahmad. Dr. Ahmad asked his opinion and Harry said, "Moderate obstructive hydrocephalus with early compression of the brainstem. He needs to be evacuated for immediate surgery to decompress the brain."
"And if that is not possible?"
Harry shrugged h
is shoulders and said, "Progressive compression of the brainstem and death."
Dr. Ahmad asked, "What timeframe are we talking about? Can it be delayed medically?"
Harry explained, "High-dose steroids will buy a little time. But if he does not get to surgery in the next couple of hours there won't be much left to save."
Dr. Ahmad looked thoughtful and a bit sad when he explained, "It will be almost 12 hours from now before he can be evacuated. He's a good young man with a strong interest in religious study; a shame to lose him, but if it is God's will, so be it."
Angie spoke up with a sense of bewilderment, "You have a helicopter, why can't you get him to the hospital?"
Dr. Ahmad turned towards her saying, "If only I was free to do as you suggest… However, our commitment to the work of God comes first. The life of one, though important, must never take precedence over the well-being of the many. Our inspired work of God must be brought to completion, if we are to save this great country of ours."
Angie turned toward Harry, "This doesn't make sense. This young man, he's hardly more than a boy, is going to die. Isn't there anything you can do?"
Harry said, "If I had an MRI scan and my surgical equipment it would be a simple thing to drain off the excess fluid. Operating without proper equipment and an MRI scan would be dangerous and I could end up killing the patient. Our host needs to get him to the hospital."
Angie looked at Dr. Ahmad, who responded by frowning and saying, "If it is God's will, he will survive. Otherwise his reward is already waiting for him in heaven. If your husband is unable to help here, then all I can do is offer up my prayers."
Angie looked from Dr. Ahmad to Harry. They both appeared resolute. She finally said, "Harry, please help this young man. I'm not sure what game you two are playing, but I don't want to see him die. Please, do it for me."
Harry was quiet for a minute before saying, "I could try to insert a small drain catheter to relieve the pressure. Without imaging studies it will be completely blind. But it may buy him the 12 hours he needs so he can be transported to a real hospital."
Angie reached over and took Harry's hand. Her delicate fingers felt lost in Harry’s huge grip. Dr. Ahmad acknowledged the response with a slight nod of his head and said, "Dr. Williams, we appreciate your efforts. Your good Samaritan act will be rewarded. What supplies and equipment do you need?"
Harry said, "What I would like is a real hospital, but what I need are some basic surgical instruments, a drill and a sterile catheter."
Dr. Ahmad spoke to the nurse in Arabic and after a few minutes of discussion told Harry, "We have something called a laceration tray and IV supplies, but the only drill we would have would be in our shop. My nurse wanted to know what type of catheter you wanted?"
Harry thought for a minute before saying, "It needs to be about 3 inches long. Either a subclavian catheter or a spinal tap catheter would work. We can make one of the battery-powered drills work but I will need at least a half inch bit."
Dr. Ahmad again spoke to the nurse in Arabic. After several minutes of discussion she brought forth a variety of needle catheter units most of which were too short. Harry selected one he thought would be long enough. He said, "We need to shave his head and prep it with something. Do you have any injectable steroids?"
Before Dr. Ahmad answered, they were interrupted by a guard who began speaking excitedly to Dr. Ahmad in Arabic. Dr. Ahmad listened intently and gave a short reply before telling Harry, "I will leave this work to you. Other things need my attention. I pray that God's hand guides your work. The guards will of course keep watch."
Dr. Ahmad left before Harry could even reply. The two remaining guards moved back against the walls and kept their weapons pointed at them. The guards obviously had some professional training and were not taking any chances. Angie asked, "Harry, what can I do to help?"
Harry said, "I'll need your help holding things and handing the instruments to me. Sure wish this nurse spoke English. Maybe you can try communicating with her. We need to shave his head and wash it."
Angie began playing a game of charades with the nurse indicating their desire to shave the head. It took a minute for the nurse to relate Angie's finger motions of scissors and shaving to the surgical preparation of the patient. She became excited when she realized they were proposing to operate and immediately went to a cupboard returning with scissors, a razor and surgical prep soap. Harry pointed to the right part of the skull and the nurse immediately began trimming the hair. Harry interrupted by saying, "I need some steroids; ask her if she has any IV medications."
Angie was at a loss on how to relay the question until Harry pretended to inject his arm. The nurse looked confused until Angie repeated the motion into the patient's IV line. The nurse responded in Arabic which just added to the confusion. Angie pretended to hold up different bottles and repeated the motion of injecting into the IV line. The nurse nodded and opened up a locked drawer. Harry began looking through the medicine collection. The main labels were all in Arabic but the chemical name was listed in fine print in English. Harry identified some lidocaine for anesthesia and found a small vial of dexamethasone, but it was the suspension and designed for joint injections. He wasn't sure of the dosage but figured it would be impossible to give too much. He scrounged around looking for syringes. The nurse looked up from her surgical prep and pointed at a cupboard. Harry opened the cupboard and found a nice assortment of syringes.
Harry drew up the entire vial of dexamethasone and injected it into the patient's right shoulder muscle. He would have much preferred the soluble form so he could have given it intravenously; the suspension form would help, but worked much slower than the IV form. The lidocaine was 2% strength and would work fairly well for local anesthesia. Harry drew up 20 cc in a syringe and after the right scalp was shaved, he injected an elliptical area 3 inches across with the anesthetic agent. He then made scrubbing motions with his hands over the scalp. The nurse nodded and began washing the patient’s shaved scalp with the surgical prep solution.
Harry began opening cupboards searching for surgical supplies. The nurse looked up and said something in Arabic. Harry made the motion of cutting with a scalpel and sewing. The nurse pointed to the cabinets at the end of the room. Harry opened the doors and found several laceration trays. There were a few miscellaneous instruments and a small selection of sutures. Harry took one of the trays and a few of the sutures and placed them on the small table next to the bed. He went back and looked for some sterile towels or drapes. They were in a lower cupboard. He chose several and added them to his collection. The cupboard doors and drawers were pretty much all open by now and Harry still hadn't found any scalpels.
Angie asked, "What else do you need?"
"I need a damn scalpel! I can't just chew through this patient's scalp! This should be done in a hospital with real equipment."
Angie and the nurse looked at each other and Angie tried to imitate the cutting action of a knife. The nurse nodded and held her soapy hands high as she walked over by Harry and pointed at a box sitting out in the open right in front of Harry. Harry picked up the box and recognized the scalpels. He mumbled a thank you and the nurse went back to finish scrubbing the patient's scalp. Another cuss word escaped from Harry's mouth when he dropped the box of scalpels. As he bent over to pick them up, he palmed one of them and slid it inside his stocking. He placed the box back in the cupboard and added the scalpel to this instrument collection.
Turning towards the guards Harry bellowed, "Where is the damn drill I asked for? I can't operate without it!"
One of the guards began talking into a small radio. There was a knock on the door and the guards assumed a more ready posture as they opened the door. A boy entered the room carrying a battery-powered drill and a box of drill bits. The guard spoke to him in Arabic and the boy turned and looked at Harry with a wide-eyed look of anxiety. The boy slowly walked towards Harry and hande
d him the tools. Harry had no sooner accepted the tools when the boy almost ran from the room. The guards kept their automatic rifles pointed at Harry the whole time.
Ignoring the situation, Harry looked through the drill bits and picked out the largest one which was less than a half-inch. He took the bit to the sink and began scrubbing it with soap and water. After satisfying himself that it was reasonably clean, he opened a bottle of alcohol and dropped the bit in trying to sterilize it. He washed his own hands and then tried to fit into the sterile gloves, but it was hopeless. The gloves must have been ordered for the nurse and his huge hands were never going to fit without tearing the gloves apart. The nurse had already used some towels to drape the patient and was opening the surgical tray when Harry realized he would not have any cautery. He was mumbling to himself about how foolish this all was when Angie asked if he was all right.
"Yeah, I'm all right. It just isn't right to risk this man's life because of some grand plan to save our country… I'm talking like a doctor not a soldier. I have to wonder what our host has planned. He talks about saving our country but I bet there are a lot of folks who will disagree with his idea. Any idea what he is planning?
Angie replied, "At dinner one night, I can't remember when exactly, he talked about the evils of gambling and how he was risking everything to try and stop it. He seemed really sincere."
Their conversation was interrupted by Dr. Ahmad's voice over the intercom saying, "Dr. Williams, I will explain my intentions at dinner. How are things going?"
Harry responded, "I'm ready to start, but this really should be done at a hospital."
"What should be and what is, are frequently incompatible. I again thank you for your efforts and pray for guidance of your hands. I'll check back with you shortly."
Harry put off thinking about the bigger picture and concentrated on the present. He used the sterile drapes to cover the drill motor as best he could. He then palpated the patient's skull identifying the intersection between the frontal and temporal bones. Using his large finger to approximate the 2 cm he needed forward of the suture line, Harry picked a point straight above the right pupil and used the scalpel to cut through the scalp. He made his incision about 3 inches long and blood began immediately welling up. Trying to identify and grab the bleeding vessels with the poor quality instruments, which were normally found in laceration trays, was becoming a major annoyance and Harry mumbled under his breath repeatedly.
The nurse was watching and brought over a battery operated cautery unit. It was nothing more than a miniature soldering pencil, but it was effective in controlling the bleeding from the smaller vessels. After about 15 minutes of diligent work, the bleeding was under good control.
Angie tried to help by blotting the blood with a gauze sponge but it was all she could do to concentrate. She had never watched Harry perform surgery before. Her queasiness was a combination of her artistic temperament and general anxiety. Harry had her pulling back the scalp with some clamp things so he could see better. Retreating into her music, she concentrated on humming a difficult musical score which forced her to control her breathing. Things were a little better until Harry picked up the drill and started drilling into the poor man's skull. Her humming became louder as she tried to block out the sound of the drill.
Harry looked over at his wife and asked, "You going to be okay?"
Angie tried to smile and said, "I think so. How do you know where to drill?"
Harry went back to drilling and answered over the noise, "It's an educated guess; our catheter is short, so I needed an approach which would match the catheter length. Sure would have been nice to have had a MRI scan."
Angie really wasn't listening and had already retreated into her music. She was on her third song before Harry put down the drill. She looked at the hole he had created in the man's skull and saw some white material at the bottom. She asked, "Is that his brain?"
"No, it's the durra, the brain covering. I'm going to try and advance the catheter without opening the durra. It'll be much safer if we don't have to open this lining."
Angie watched as Harry picked up a needle sort of thing about 3 inches long and began pushing it into the man's head. She had to ask, "Doesn't that hurt?"
Harry replied, "No, the brain doesn't actually have pain sensors, so it can't hurt."
The needle was now almost two thirds of the way gone as Harry slowly pushed it forward into the man's brain. He would push a little and then look to see if any fluid was draining out. Angie asked, "How will you know when you're in the right spot?"
Harry replied, "In the operating room we have equipment that shows you exactly where you are. Here it’s just a guess until the fluid starts to flow."
The needle was pushed all the way in and still no fluid. A soft "damn" escaped from Harry as he withdrew the needle. Angie asked what was wrong. Harry explained, "I must have angled too far lateral. I'll change directions and try again."
Angie watched as Harry again advanced the needle slowly into the man's brain. She had a puzzled look on her face as she asked, "What happens to the brain when the needle goes in? Does he lose 1976 in one spot and 1984 in another?"
Harry continued advancing the needle in steps as he explained, "The needle does do a little damage, so I try to avoid the most sensitive areas of the brain. It's not that the frontal lobe isn't important; actually, we seem to function pretty well despite significant damage here. By contrast, in other parts of the brain even a pea size area of damage, can produce severe disability. The brain doesn't really work like a regular computer. It’s more analog-like with only certain areas responding to different stimuli."
Angie found herself more intrigued by the surgery and was now leaning forward to get a better look at what Harry was doing. He had advanced the needle most of the way when fluid started running out of the needle. Harry responded with a simple, "Finally." The fluid didn't gush out, but a steady stream of drips was coming from the end. Angie tried to mop up the leaking fluid which had the texture of the sugar water she put in their hummingbird feeders at home. Harry very carefully slid the metal needle out from the plastic sheath that surrounded it.
Harry asked for the suture and Angie knew enough to hand him the threads he had laid out. When he asked for the needle driver Angie was uncertain. Harry pointed to a pliers-like instrument which Angie handed him. She watched as he most delicately pushed the needle just under the white shiny layer and out again. The instrument seemed almost like a toy in his big hands. His strong fingers gently tied a series of knots around the plastic tube he had left inside the brain. Angie tried to keep the area clean by mopping up the fluid which kept dribbling out of the tube, but every time she tried, she seemed to get in Harry's way.
Harry finally said, "Don't worry about the fluid. It won't hurt anything."
Angie relaxed some and just cleaned up the fluid as it drained onto the young man's scalp. Harry asked for another suture, which she handed him, and he began sewing the scalp shut. It was kind of like the sewing her mother had taught her. He kept dividing the space in half with each new suture he put in. When he was finished the wound was closed with only the hub of the plastic tube sticking out. Harry spent a lot of time tying this hub securely to the skin of the scalp. He asked for an IV tubing but Angie was not sure what he meant.
Harry pointed at the tube leading into the man's arm and the nurse went to a cupboard and brought out a box. She opened it and Harry took out the clear tubing. He plugged one end into the hub sticking out of the man's scalp and attached the tubing with another suture. The nurse had a pretty good idea of what was next and already had bandage materials ready which Harry used to completely wrap the man's head. Harry stretched and said, "Well, we've done our best. Now all we can do is hope it was enough until they transfer him to a real hospital."
The fluid was now dripping out of the tube and Angie asked, "Shouldn't we collect the fluid?"
; Harry responded, "I suppose it's going to make a mess."
He pointed to the plastic IV bag and after a minute of pantomime motions, the nurse understood and got Harry another bag of IV fluids. Harry exchanged the bag with the almost empty one draining into the man's arm. He emptied the remaining fluid into the sink and then plugged the end of the tube draining the man's brain into the bag.
Harry had no sooner finished when a voice came from the overhead speaker, "Dr. Williams, a job well done. We will transfer our man to a hospital as soon as possible. Your humanitarian efforts are much appreciated. I would ask that you and your wife join me for dinner."
Harry looked a little puzzled when he responded, "I could do with a bite to eat, but isn't it a bit early for dinner?"
The voice answered, "It would depend upon which time zone you were functioning in. The guards will escort you to our dining room."