Gravity

3

July 10

Dr Jack McCallum heard the scream of the first ambulance siren and said, ‘It’s show time, folks!’ Stepping outside to the ER loading dock, he felt his pulse kick into a tachycardia, felt the jolt of adrenaline priming his nervous system into crackling live wires. He had no idea what was coming to Miles Memorial Hospital, only that there was more than one patient on the way. Over the ER radio they’d been told a fifteen-car pileup on I-45 had left two fatalities at the scene and a score of injured. Although the most critical patients would be taken to Bayshore or Texas Med, all the area’s smaller hospitals, including Miles Memorial, were braced for the overflow.

Jack glanced around the ambulance dock to confirm his team was ready. The other ER doctor, Anna Slezak, stood right beside him, looking grimly pugnacious. Their support staff included four nurses, a lab runner, and a scared-looking intern. Only a month out of med school, the intern was the greenest member of the ER team and hopelessly fumble-fingered. Destined for the field of psychiatry, thought Jack.

The siren cut off with a whoop as the ambulance swung up the ramp and backed up to the dock. Jack yanked open the rear door and got his first glimpse of the patient—a young woman, head and neck immobilized in a cervical collar, her blond hair matted with blood. As they pulled her out of the ambulance and he got a closer look at her face, Jack felt the sudden chill of recognition.

‘Debbie,’ he said.

She looked up at him, her gaze unfocused, and did not seem to know who he was.

‘It’s Jack McCallum,’ he said.

‘Oh. Jack.’ She closed her eyes and groaned. ‘My head hurts.’

He gave her a comforting pat on the shoulder. ‘We’ll take good care of you, sweetheart. Don’t worry about a thing.’

They wheeled her through the ER doors, toward the trauma room.

‘You know her?’ Anna asked him.

‘Her husband’s Bill Haning. The astronaut.’

‘You mean one of the guys up on the space station?’ Anna laughed. ‘Now, there’s a long distance phone call.’

‘It’s no problem reaching him, if we have to. JSC can put a call right through.’

‘You want me to take this patient?’ It was a reasonable question to ask. Doctors usually avoided treating friends and family; you cannot remain objective when the patient in cardiac arrest on the table is someone you know and like. Although he and Debbie had once attended the same social functions, Jack considered her merely an acquaintance, not a friend, and he felt comfortable acting as her physician.

‘I’ll take her,’ he said, and followed the gurney into the trauma room. His mind was already leaping ahead to what needed to be done. Her only visible injury was the scalp laceration, but since she had clearly suffered trauma to her head, he had to rule out fractures of the skull and cervical spine.

As the nurses drew blood for labs and gently pulled off the rest of Debbie’s clothing, the ambulance attendant gave Jack a quick history.

‘She was about the fifth car in the pileup. Far as we could tell, she got rear-ended, her car spun sideways, and then she got hit again, on the driver’s side. Door was caved in.’

‘Was she awake when you got to her?’

‘She was unconscious for a few minutes. Woke up while we were putting in the IV. We got her spine immobilized right away. BP and heart rhythm have been stable. She’s one of the lucky ones.’ The attendant shook his head. ‘You should’ve seen the guy behind her.’

Jack moved to the gurney to examine the patient. Both of Debbie’s pupils reacted to light, and her extraocular movements were normal. She knew her own name and where she was, but could not recall the date. Oriented only times two, he thought. It was reason enough to admit her, if only for overnight observation.

‘Debbie, I’m going to send you for X rays,’ he said. ‘We need to make sure you haven’t fractured anything.’ He looked at the nurse. ‘Stat CT, skull, and C-spine. And…’ He paused, listening.

Another ambulance siren was approaching.

‘Get those films done,’ he ordered, and trotted back outside to the loading dock, where his staff had reassembled.

A second siren, fainter, had joined the first wail. Jack and Anna glanced at each other in alarm. Two ambulances on the way?

‘It’s going to be one of those days,’ he muttered.

‘Trauma room cleared out?’ asked Anna.

‘Patient’s on her way to X-ray.’ He stepped forward as the first ambulance backed up. The instant it rolled to a stop, he yanked open the door.

It was a man this time, middle-aged and overweight, his skin pale and clammy. Going into shock was Jack’s first assessment, but he saw no blood, no signs of injury.

‘He was one of the fender benders,’ said the EMT as they wheeled the man into the treatment room. ‘Got chest pain when we pulled him out of his car. Rhythm’s been stable, a little tachycardic, but no PVCs. Systolic’s ninety. We gave morphine and nitro at the scene, and oxygen’s going at six liters.’

Everyone was right on the ball. While Anna took the history and physical, the nurses hooked up the cardiac leads. An EKG blipped out of the machine. Jack tore off the sheet and immediately focused on the ST elevations in leads V1 and V2.

‘Anterior MI,’ he said to Anna.

She nodded. ‘I figured he was a tPA special.’

A nurse called through the doorway, ‘The other ambulance is here!’

Jack and two nurses ran outside.

A young woman was screaming and writhing on the stretcher. Jack took one look at her shortened right leg, the foot rotated almost completely sideways, and knew this patient was going straight to surgery. Jack quickly cut away her clothes, to reveal an impacted hip fracture, her thigh bone rammed into the socket by the force of her knees hitting the car’s dashboard. Just looking at her grotesquely deformed leg made him queasy.

‘Morphine?’ the nurse asked.

He nodded. ‘Give her as much as she needs. She’s in a world of hurt. Type and cross six units. And get an orthopod in here as soon as—’

‘Dr McCallum, stat, X-ray. Dr McCallum, stat, X-ray.’

Jack glanced up in alarm. Debbie Haning. He ran out of the room.

He found Debbie lying on the X-ray table, hovered over by the ER nurse and the technician.

‘We’d just finished doing the spine and skull films,’ said the tech, ‘and we couldn’t wake her up. She doesn’t even respond to pain.’

‘How long’s she been out?’

‘I don’t know. She was lying on the table ten, fifteen minutes before we noticed she wasn’t talking to us anymore.’

‘Did you get the CT scan done?’

‘Computer’s down. It should be up and running in a few hours.’

Jack flashed a penlight in Debbie’s eyes and felt his stomach go into a sickening free fall. Her left pupil was dilated and unreactive.

‘Show me the films,’ he said.

‘C-spine’s already up on the light box.’

Jack swiftly moved into the next room and eyed the X rays clipped to the backlit viewing box. He saw no fractures on the neck films; her cervical spine was stable. He yanked down the neck films and replaced them with the skull X rays. At first glance he saw nothing immediately obvious. Then his gaze focused on an almost imperceptible line tracing across the left temporal bone. It was so subtle it looked like a pin scratch on the film. A fracture.

Had the fracture torn the left middle meningeal artery? That would cause bleeding inside her cranium. As the blood accumulated and pressure built up, the brain would be squeezed. It explained the rapid deterioration of her mental status and the blown pupil.

The blood had to be drained at once.

‘Get her back to ER!’ he said.

Within seconds they had Debbie strapped to the gurney and were wheeling her at a run down the hallway. As they swung her into an empty treatment room, he yelled to the clerk, ‘Page neurosurgery stat! Tell them we have an epidural bleed, and we’re prepping for emergency burr holes.’

He knew what Debbie really needed was the operating room, but her condition was deteriorating so quickly they had no time to wait. The treatment room would have to serve as their OR. They slid her onto the table and attached a tangle of EKG leads to her chest. Her breathing had turned erratic; it was time to intubate.

He had just torn open the package containing the endotracheal tube when a nurse said, ‘She’s stopped breathing!’

He slipped the laryngoscope into Debbie’s throat. Seconds later, the ET tube was in place and oxygen was being bagged into her lungs.

A nurse plugged in the electric shaver. Debbie’s blond hair began to fall to the floor in silky clumps, exposing the scalp.

The clerk poked her head in the room. ‘Neurosurgeon’s stuck in traffic! He can’t get here for at least another hour.’

‘Then get someone else!’

‘They’re all at Texas Med! They’ve got all the head injuries.’

Jesus, we’re screwed, thought Jack, looking down at Debbie. Every minute that went by, the pressure inside her skull was building. Brain cells were dying. If this was my wife, I wouldn’t wait. Not another second.

He swallowed hard. ‘Get out the Hudson brace drill. I’ll do the burr holes myself.’ He saw the nurses’ startled looks, and added, with more bravado than he was feeling. ‘It’s like drilling holes in a wall. I’ve done it before.’

While the nurses prepped the newly shorn scalp, Jack put on a surgical gown and snapped on gloves. He positioned the sterile drapes and was amazed to find his hands were still steady, even while his heart was racing. It was true he had drilled burr holes before, but only once, and it was years ago, under the supervision of a neurosurgeon.

There’s no more time. She’s dying. Do it.

He reached for the scalpel and made a linear incision in the scalp, over the left temporal bone. Blood oozed out. He sponged it away and cauterized the bleeders. With a retractor holding back the skin flap, he sliced deeper through the galea and reached the pericranium, which he scraped back, exposing the skull surface.

He picked up the Hudson brace drill. It was a mechanical device, powered by hand and almost antique looking, the sort of tool you might find in your grandfather’s woodshop. First he used the perforator, a spade-shaped drill bit that dug just deeply enough into the bone to establish the hole. Then he changed to the rose bit, round-tipped, with multiedged burrs. He took a deep breath, positioned the bit, and began to drill deeper. Toward the brain. The first beads of sweat broke out on his forehead. He was drilling without CT confirmation, acting purely on his clinical judgment. He did not even know if he was tapping the right spot.

A sudden gush of blood spilled out of the hole and splattered the surgical drapes.

A nurse handed him a basin. He withdrew the drill and watched as a steady stream of red drained out of the skull and gathered in a glistening pool in the basin. He’d tapped the right place. With every trickle of blood, the pressure was easing from Debbie Haning’s brain.

He released a deep breath, and the tension suddenly eased from his shoulders, leaving his muscles spent and aching.

‘Get the bone wax ready,’ he said. Then he put down the drill and reached for the suction catheter.

A white mouse hung in midair, as though suspended in a transparent sea. Dr Emma Watson drifted toward it, slender-limbed and graceful as an underwater dancer, the curlicue strands of her dark brown hair splayed out in a ghostly halo. She grasped the mouse and slowly spun around to face the camera. She held up a syringe and needle.

The footage was over two years old, filmed aboard the shuttle Atlantis during STS 141, but it remained Gordon Obie’s favorite PR film, which is why it was now playing on all the video monitors in NASA’s Teague Auditorium. Who wouldn’t enjoy watching Emma Watson? She was quick and lithe, and she possessed what one could only call sparkle, with the fire of curiosity in her eyes. From the tiny scar over her eyebrow, to the slightly chipped front tooth (a souvenir, he’d heard, of reckless skiing) her face was a record of an exuberant life. But to Gordon, her primary appeal was her intelligence. Her competence. He had been following Emma’s NASA career with an interest that had nothing to do with the fact she was an attractive woman.

As director of Flight Crew Operations, Gordon Obie wielded considerable power over crew selection, and he strove to maintain a safe—some would call it heartless—emotional distance from all his astronauts. He had been an astronaut himself, twice a shuttle commander, and even then he’d been known as the Sphinx, an aloof and mysterious man not given to small talk. He was comfortable with his own silence and relative anonymity. Although he was now sitting onstage with an array of NASA officials, most of the people in the audience did not know who Gordon Obie was. He was here merely for set decoration. Just as the footage of Emma Watson was set decoration, an attractive face to hold the audience’s interest.

The video suddenly ended, replaced on the screen with the NASA logo, affectionately known as the meatball, a star-spangled blue circle embellished with an orbital ellipse and a forked slash of red. NASA administrator Leroy Cornell and JSC director Ken Blankenship stepped up to the lectern to field questions. Their mission, quite bluntly, was to beg for money, and they faced a skeptical gathering of congressmen and senators, members of the various subcommittees that determined NASA’s budget. For the second straight year, NASA had suffered devastating cutbacks, and lately an air of abject gloom wafted through the halls of Johnson Space Center.