Who says a rising neurosurgeon can’t fall from his pinnacle? From the skullduggery taking place deep in the Tennessee woods to the silent tension in the OR, Doctor Danny Tilson’s life takes an abrupt turn after performing surgery alongside a scrub nurse with aqua eyes and a velvet voice.
Can Danny’s situation get any worse after the alluring lady disappears, he inherits her roguish retriever, and his Albert Einstein historical book turns up missing? A pack of Tennessee attorneys pursue Danny while he develops a scheme with his paramedic best friend to payback the mysterious woman who left in a hurry.
That’s the set-up for Dr. Barbara Ebel’s medical thriller Operation Neurosurgeon, introduced with a 7,500-word excerpt today through our Free Kindle Nation Shorts program!
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An excerpt from
You never know … who’s in the OR
By Barbara Ebel MD
Copyright 2009, 2011 by Barbara Ebel and reprinted here with her permission.
– 2009 –
Through the desolate winter woods, she could see a run down single story house. She firmly pressed the accelerator to climb the hilly, rutted road as pebbles kicked up from the gravel, pinging underneath her sedan. All around her, tall spindly trees stood without a quiver, the area still, quiet and remote. On this damp, cold February afternoon, she had come to conclude a deal with a man named Ray.
The road narrowed past the house, fading over the hill, but she veered slowly to the left, a barren area in front of the peeling house, where a dusty red pickup truck stood idle and a black plumaged vulture busily scavenged. Deliberately she left her belongings, clicked the lock on her car and walked to the front door. She threw the long end of her rust scarf behind her shoulder. The raptor grunted through his hooked beak as he flew off to the backwoods. The door opened before she knocked.
“Nobody visits a feller like me,” the man said, smiling at her while adjusting his baseball cap, “unless we’re buying and selling. You must be the lady with the book.”
The tidily shaven man wore a salt and pepper colored beard and mustache and an open plaid cotton shirt with a tee shirt underneath. The boots peeking out from under his blue jeans had seen muddy days.
The woman smiled pleasantly at him and went in the front door empty handed. If the man had any furniture, she wasn’t aware of it. Car parts lay strewn everywhere, which made her wonder if he slept in a bed.
Ray followed her glance. “You nearly can’t find one of them no mores,” he said, pointing to a charcoal colored, elongated piece of vinyl plastic on the floor. She looked quizzically at him and shoved the woolen hat she’d been wearing into her pocket.
“It’s an original 1984 Mercedes dashboard. See, the holes are for vents and the radio. Got a bite on that one from a teenager restoring his first car.” She didn’t seem interested though. She eyed the dust, in some spots thick as bread.
“Are you sure you have twelve-thousand dollars to pay for this?” she asked, unbuttoning her jacket.
“You come out thirty miles from Knoxville? That baby in your belly may need something,” he said, pointing to her pregnancy. “You want a soda or something?”
“No thank you,” she said, grimacing at him.
“Oh, yeah. I got the money,” he said. “All I got now to my name is seventy-five thousand dollars. I got ruint in Memphis. Was a part owner in a used car dealership. Went away for a little while, and the other guy cleaned me out. Can’t afford nothing like a lawyer to chase ‘im down.”
She tapped her foot.
“Anyhow, I won’t bother yer with all that. I got a thing going good on eBay. I got a reputation, it ain’t soiled. You can trust me, I give people what I tell them, whether I’m buying or selling.”
A beagle-looking mutt crawled out from behind a car door. “Molly, you’re milk containers are dragging on the floor. Better get out to your pups,” the man said, prodding her out the partially closed door.
“You like dogs?” he asked.
“I suppose so.”
“I got no use for people who don’t care for dogs. Something not right about people like that.”
The woman turned and followed the clumsy dog outside, grabbed a bag from the front seat, and came back in. She took out a book, opened the back cover, and handed him a folded piece of paper. Certificate of Authenticity, the man read, from a company in New Orleans, verifying the signature on the front page to be Albert Einstein’s. He inverted his hand and wiggled his fingers, gesturing to her if he could hold the aged book.
“Where’d you say you got it?” He observed her carefully.
“It’s been in the family for years. I took my precious belongings with me when I left New Orleans because of Hurricane Katrina. Since I lost my house there, I decided to stay in Tennessee. Now I’m selling my expensive things. I have to make ends meet, especially with a baby coming.”
“Good thing you got this certificate with it, then. Twelve-thousand dollars, we’ve got a deal.”
He walked away to the back of the house while she held on to the physicist’s 1920 publication. He came through the doorway with a stack of money and a brown paper bag. She nodded once when she finished counting the bills, so he handed her the empty bag.
“I still got your email address and phone number,” he said. “I keep track of what goes and comes.”
“You won’t need them,” she said and left abruptly.
He watched her back out, stood there until the car disappeared out of sight down the gray road.
– 1989 –
“You dawdling over there?”
“No. Peeing, Dad.” Danny zipped his fly and wheeled around, his boots sinking in soft leafy earth. His father, Greg, stood on polished creek stone at the river’s edge beside Danny’s wife. “And on rounds, the proper term is urinating.” Danny slipped from the woods and approached them.
Greg threw a few red salmon eggs into the Caney Fork River and handed Danny his spinning rod. “I better catch up to the better half of you newlyweds.”
Sara propped her pole on the cooler, held up a rainbow trout in front of Danny, and exclaimed “Tah-dah.”
“We’re just here to have fun.” Danny grinned at both of them. “It’s not as if our lives depend on it.” But Danny knew the Tennessee Wildlife Resources Agency had recently stocked the river. The three of them had been bottom fishing since before the morning fog lifted like a friendly ghost drifting away to expose the slow but noticeable current.
“You’re right, Danny. You know what I say.”
Sara plucked algae off her four-pound test line and looked questioningly at her father-in-law. She waited to wade into the water, figuring one of Greg’s metaphorical sayings or idioms were forthcoming. She’d dated Danny throughout his four years of medical school at Vanderbilt and had spent so much time at his Dad’s house, where Danny had lived, that sometimes more lipsticks and tampons had been in Danny’s bathroom than her own.
“You may want to fish for dinner,” Greg said, “but if you must fish to catch dinner, you’ve screwed up.”
Sara pushed dew-misted hair behind her ear. “Danny’s one of only two residents they’ve accepted into the neurosurgery program, Dad. That doesn’t qualify as, umm, messing up.”
Danny beamed at his wife. During med school, almost two dozen students were already married or headed that way, but some couples split with the strain of exams and deadlines, hours in labs, physician’s offices and clinical rotations with overnight calls. Sara kept busy teaching high school biology and running, and always helped Danny focus. When he needed long-term perspective, objectivity, or softening after his brain was slammed shut for hours between pages of Principles ofPharmacology, she could turn him around. She would run her hand through his hair, or massage between his shoulder blades, or whisper to him under the sheets after they made love. When they took their vows a month ago, Danny secretly promised to nourish the effect they had on each other.
Greg had forgotten to bring wading boots, so he stayed on shore while Sara and Danny carefully picked their steps. Occasional diehards just sucked it up and waded in. The water was as warm as it would get, a cold summer temperature, unforgiving for anyone without proper gear.
Quiet spread across their sanctuary except for a small surface splash or a fish tail grazing the surface. A young man in a small canoe paddled by and without any fanfare hoisted his baby boat onto a jeep rack and left.
Danny and Sara finally came to shore, each with a brown trout. “Both about the same size,” Sara said. Danny agreed, leaned over and pecked his wife on the cheek as they crouched, holding their fish like new baby birds. The trout squirmed in their hands, then darted away. Sara smiled, pleased with their release.
“Time to go Dad. They’ll be generating soon.” Danny nodded at the Center Hill Dam, the nearby Goliath. Sara picked up their poles and Danny and Greg grabbed the unused salmon eggs, cooler, and tackle boxes; they walked slowly up the road to the parking lot as they heard the generating dam gushing Center Hill Lake water into the Caney Fork.
“This is the last load, Dad,” Danny said.
Greg waved his hand as Danny walked by him with a flat cardboard box and suitcase and entered his bedroom. Inside, ebony blue curtains framed windows to a view that appeared as if by magic despite his mother’s illness. She had died three years ago from ovarian cancer.
Danny looked out over south facing slopes of grown hickories, southern red oaks and maples, white and Virginia pines. Donna had assisted the native habitat by producing a real show for early spring. She’d worked with Mexican migrants from a wholesale nursery to plant rows of redbuds and terraced beds of mountain laurel, rhododendrons and wildflowers. Specks of white, hints of pink and tinges of purple had helped her to divert thoughts of a possible short life expectancy to reminiscing about her family and their accomplishments. She would leave behind a wonderful marriage, two fantastic children, and a beautiful estate.
Danny turned his head to find Greg at his doorway. “I miss her, Dad. There’s not a day …”
“Me, too,” Greg said, gazing at his shoes, his thick dark eyebrows practically covering his eyes. “I still can’t believe I’m without her at fifty-two years old.”
Greg walked in and sat on Danny’s bed, his shoulders slumping over. Greg had gotten married in 1960, after only dating Donna for six months. They never missed Sunday devotion together until Donna had been bedridden. Greg’s gaze averted to the outside hallway where one of his wedding pictures hung, the loving couple fixed in an embrace.
“You know what I told her?”
Danny shook his head no.
“A girlfriend who prays with me is worth keeping.”
Danny did know that, as well as the adoration his father had shown his mother for as long as he could remember. He patted his father’s knee once and got up. Danny unfolded the cardboard box, and then dumped it in front of his dresser.
“Dad, Sara and I can’t thank you enough for the wedding present. The house is home already. Sara’s summer vacation and my break before residency made it all work out.” Danny looked around. “Will you turn my room into a guest bedroom?”
“Yes. And I’ll keep it the same. For visiting grandkids?”
Danny laughed. “Are you prying, Dad?”
“If there are plans for me to be a grandfather, I want to be the third one to know.”
“Done deal,” Danny said, checking his top drawers to make sure he’d emptied them on a previous trip. He opened the last drawer and threw his winter stash of sweaters into the box. A large baggie still sat at the bottom, which Danny picked up, then sat next to Greg on the cream-colored bedspread. The mattress indented with their weight and their knees lined up together, their six foot two frames carbon copied from similar blueprints.
Danny’s eyes gleamed. Greg reached to touch the plastic storage bag, an uncanny method to preserve the emotionally stirring and valuable treasure. Danny opened the bag and took out the brown hard-covered book as gently as he had held a hummingbird the previous week after he had found it stunned from hitting Sara and Danny’s glass front door. He placed the small item on his lap and opened the faded cover to the yellowish tinge of aged paper.
“Your sister will wear your mom’s jewelry,” Greg said, “but you? Someday you can bequeath what your mother gave you to your children or a museum. Or sell it.”
Danny whistled, knowing it’s price tag would have plenty of zeroes, with more added as time went on.
“I still remember when your mother purchased it. She drove a hard bargain and requested that the store manager in New Orleans have the book and the signature verified by an authenticator of such things.”
They both looked at the front page: Einstein’s 1920 Relativity: The Special and the General Theory. Many copies existed, but this was one of the few remaining from the early 1900’s. Two-thirds down on the page was the author’s signature: Albert Einstein. Which wasn’t the usual way the historical genius had autographed his books. Almost always, he had signed A. Einstein.
“It’s the real McCoy,” Greg said. “And with Einstein’s full signature, you’ve inherited a diamond in a trowel of white sand.” Danny slid it back in the bag. “Perhaps you should put it in a safe deposit box.”
“Perhaps. But occasionally I look at it, Dad. I think of Mom.” Danny paused, looking again to the summer’s day, tree shadows beginning their leftward crawl. “It’s inspiration for entering a field where I’ll surgically be in the very matter which spawns incredible ideas and discoveries like his.”
When Greg left, Danny packed the last shirts and shoes left in his closet, a few medical texts in the nightstand and a bottle of Sara’s shampoo from his bathroom. He opened it and smiled. Orange ginger. Sara’s hair.
Danny glumly endured his first postgraduate year, then six months of general surgery, a few months of neurology and one month of neuro ICU. He knew how important these rotations were for establishing his clinical knowledge and skills; but he couldn’t wait to focus on physical brains, the control panel of it all. As he tolerated these months, he tried to listen to Greg, who kept telling him, “It’s not the end result, but the journey that matters.”
Finally, late in his second year of residency, Danny was smack in the middle of his first true month of neurosurgery. He pushed through hospital health care providers in scrubs, police officers, and uniformed ambulance personnel in the ER hallway, to see three stretchers in the trauma room. Someone yanked at his arm.
“Dr. Tilson, the one in between. The anesthesiologist is intubating the difficult airway over there, the driver. The ER physician will probably declare that patient on the right, another driver who went off the road to avoid them.” The navy blue uniformed man, the same age as Danny, spoke quickly and sped Danny to the head of the middle stretcher.
Danny had already begun assessing the patient while gesturing for the young man to continue. “This patient. Right front seat, wasn’t wearing a seatbelt. A ten-pointer buck ran from the ditch, driver slammed the brakes, trophy rack came through the front window. Brown body and appendages followed. She was talking when I arrived, but became somnolent en route. To be on the safe side, I intubated her.”
Danny glanced at the monitors. Vital signs okay, but not great. Dirty, dark blood covered the sheet and neck brace behind the motionless woman’s head. He slipped on gloves and felt around the endotracheal tube protruding from the patient’s mouth, palpating facial bones for stability and orbital area for swelling. Danny checked her pupil size and reaction to light. A general surgeon had arrived and simultaneously examined her abdomen and chest. They assessed quietly despite the chaos around them.
Danny finished, stepped back to a tray covered with the patient’s ER paperwork and grabbed physician order and progress sheets. “I’m going to need a non-contrast CT scan of the brain,” he said to the general surgeon and nearby nurse.
The surgeon nodded. “Looks negative down here.” A gloved nurse waited for Danny’s other orders.
“Nice job, driver,” Danny said to the man who had given him report. He pressed ahead with his writing without looking at him.
“I’m not just an ambulance driver,” the man said sarcastically, “but a highly trained EMT. A paramedic. And unlike you, I’m launched in my career. You’ll be pussyfooting around for the next five years before getting yourself established.”
The female nurse didn’t move.
“Shut up, Casey,” Danny said with a small grin.
The nurse exhaled. “Phew. I thought you two were for real.” She untwisted a pretty ivory earring.
“We’re throw backs to grade school. It’s just that he never grew up.” Danny glanced sideways at Casey. “And I still think you should’ve been a quarterback. Thick neck, muscular build and all.”
Before Casey could open his mouth, Danny continued, “I’m not touching a book tonight, so pop over. Sara and I could use some deck time.”
“Okay. For Sara. But don’t let that baby fall asleep until I see her awake. What do you two do, tranquilize her?”
“That’s what babies do, Casey, they sleep.”
Casey weaved out of the trauma room through the diminishing gawkers. As the patient’s stretcher rolled past, Danny paged his chief resident to give her a report.
“When the CT is finished, meet me in radiology,” Dr. Welch said.
Chief residents, in their final sixth year of neurological surgery, were in charge of lower residents and had an attending physician available for counsel. Danny had an appreciation for Dr. Welch, a thick waisted, fast talking female whose gender in her specialty made her rarer than lobster ice cream.
Karen Welch stood in the CT scanning office when Danny arrived. She had evaluated the patient before they had transported her to the ICU. She glanced up and down the CT images on the viewer, hands on her hips.
“Dr. Tilson, glad you could join me. So your college bound, buck startled patient has a high-density area on CT,” she said, pointing.
Danny carefully looked through the images, careful not to let Karen bait him into hurrying the probable diagnosis, or missing something else evident.
“A cerebral contusion from a sudden deceleration of the head.”
“Is there more to that story?”
Danny took a step off the imaging room’s platform to establish better eye contact. “The brain impacted on bony prominences. A coup injury occurred where the skull struck the brain. A contrecoup injury is an injury directly opposite the impact site.”
Karen Welch turned to her resident. “Surgical treatment is not indicated at this time. When will surgical decompression be warranted?”
“With threatening herniation. If she becomes refractory to medical management. With increased ICP.”
“Ah, yes. The magic three letters for increased intracranial pressure. You know what to do.” She winked at the radiologist sitting in front of his equipment.
She handed Danny the patient’s chart from the table and began walking out. “I’ll talk to the general surgery resident. Most of the patient’s scalp wounds are only a few inches. They can clean and suture them without bringing the patient to the OR.”
That evening, Danny left Vanderbilt University Hospital and traveled southeast to the wedding present Greg had given them almost two years ago. Greg had hired the builder, but Danny and Sara had approved the plans and construction, giving the builder lots of latitude with his work. Since they chose a lot in a newborn subdivision, their split-level ranch at the end of a cul-de-sac faced woods in the back. Danny and Sara liked the outdoor, natural environment and had a wooden deck built on the front and back of the single story side of the house.
Danny hit the remote and pulled his four-year old Toyota into the garage. “Hi girls,” he said, entering the door. Melissa sat in her high chair, her right hand swinging a red rattle, the other hand holding a small white stuffed dog with a ribbon collar. She shook with glee when she planted her eyes on Danny. Sara graded the sprawling papers in front of her but got up to meet Danny halfway.
Danny put his right arm around Sara, pressing his head into her blonde peppered hair. Her bob cut accentuated the contour of her cheeks and her silky hair made him linger and revel in its fragrance. He pulled back. Sometimes her hair stayed behind her ears, but sometimes she’d purposefully leave it up front and kink it softly around her face. Danny liked it either way.
“Good day, night and day?” Sara asked.
“Actually, yes. I got an entire eight hours of sleep,” Danny said. “Did you have a nice day?” He planted a kiss on Melissa’s forehead.
“Every day is fine with Melissa in it.” Sara sat back down, crossing her trim legs, exposed from a burgundy corduroy skirt. “I finished meiosis and mitosis at school today, so tomorrow I start high school biology’s version of human anatomy. Although for fourteen and fifteen year old boys, that may only mean this …” She waved an outline of a shapely female in the air.
Danny laughed. Sometimes he accentuated his laugh, and added some on at the end for effect. Sara liked it. Along with his wide, white smile, and his jovial manner, he entertained her.
“You eat yet?” Danny asked.
“Homemade soup. And the salad’s over there,” she said, pointing with her whole arm.
Danny went to the counter and came back to sit with her carrying a bowl. “Casey’s coming over later. He wants to see Melissa awake.”
“Did you tell him babies don’t keep single guy’s hours?”
Danny wolfed down two servings while Sara finished putting A to D on test papers. He grinned. “Come on,” he said.
Danny opened the back glass door while holding Melissa. Sara followed with Fluffy the dog and a light cotton baby blanket. Outside sat two oak porch rockers and one double, which Danny and Sara eased into. Melissa cooed and clutched Danny’s fingers as she sat on his lap, facing forward. The early evening hinted of summer. Tree buds were making their debut and a few sparrows flew limb to limb, singing to each other.
Empty hooks like horizontal question marks hung from the porch beams. “Time to put out the feeders,” Sara said, following her husband’s gaze. “The hummingbirds are depending on us.” She buttoned her camel sweater as Casey jauntily came around the side of the house.
“Not even a front door greeting,” Casey boomed, standing in front of the railing. “A bunch of rocking chair slackers.” He walked up the steps and handed Sara an elongated brown bag. “Home grown,” he said.
Sara pulled out a bottle of wine, the label from Stonehaus, a Tennessee winery. “Sweet Muscadine. Thanks, Casey. Have a seat after you go inside.” She swept her arm forward, pointing directly with her index finger. “Glasses upper right.”
Casey squatted in front of Melissa. “Wow. You’re beautiful, for a baby,” he said, bouncing his head for her amusement. Melissa sputtered gibberish, her diaper bound bottom squirming in Danny’s lap.
Casey brought three thick wine glasses. “So how’s Jane Doe?” he asked Danny. Danny eyed him wondering if he had meant to be facetious by using the name Doe, but Casey was being straight.
“Who’s Jane Doe?” Sara asked.
“Deer accident this morning on a side road off 40. College girl with a cerebral contusion,” Danny said. Sara crossed her legs the other way and Danny resumed slowly rocking. “I checked on her before I left and she’s showing progress. She opened her eyes, responded to commands. Cerebral edema is getting better, but I’ve ordered another CT in the morning.”
“That’s good,” Casey said, turning his head towards Sara “Her boyfriend driver got intubated and went for surgery, but another driver averting the accident got killed.” Danny clasped Melissa closer and Sara shook her head.
“Sara, Casey and I’ll put Melissa to bed tonight, if you’d like. I’ll change her diaper, put her pajamas on, skip a bath. That okay?”
“Sure. I’d appreciate that.”
Sara dripped a few more ounces of Muscadine into her glass then Danny resumed rocking. A hummingbird scout whizzed by, taking a momentary pause near the roof gutter to view them, determining if they had yet placed a plastic bulb with red nectar. Danny broke the silence, and poked Casey. “Anybody new?”
“Got a date with an x-ray tech on Saturday. We’re going to see John Mellencamp at the Ryman Auditorium.”
“Bet she’s a knockout,” Sara said. “You date the most beautiful and intelligent women. I don’t know where you find them.”
“He doesn’t find them,” Danny said. “They find him.”
“She’s a nice lady,” Casey shrugged. “I’ve taken her out a few times.”
“Come on, then,” Danny said. “Help me out. Get lessons for what comes after the wedding rings.” Danny got up, swung Melissa once in the air, the glee of the ride spreading across her face like sunshine on the horizon.
“Daddy’s little girl,” Sara said. “You three have fun.” She chuckled as they left, Casey’s gym bulk noticeable in blue jeans and a cotton shirt, and Danny’s tall height. Two grown men, all their attention centered on a little baby girl.
Upstairs, they went to the bedroom directly across from Sara and Danny’s. Casey took a back seat to the bedtime routine, but gave Melissa a kiss after his friend laid her down in her crib. Danny nestled a lightly frayed blanket around his daughter as her movements slowed and her eyes closed.
“That crazy bitch. She nailed me.”
Danny listened to a patient on an ER stretcher, intrigued by two inches of nail jutting out of the man’s head. Maybe a five-inch nail including the part imbedded in his brain. The hem of the man’s blue jeans were caked with mud and his olive Henley shirt had missing buttons. He wore a two-day five o’clock shadow and his offensive odor masked background smells of open wounds and vomiting.
“What did you do to her?” Danny asked, urging him to talk. Danny wanted to assess the man’s reasoning and appropriateness, look for mental deficits due to his injury. On second, thought, however, Danny figured his baseline might be someone else’s deficit.
“Are you stupider than my wife?” the man asked, wiggling his body all over the sheet. “What the fuck difference does that make?”
“Whether or not you walk around the rest of your life as a coat rack depends on me. Maybe you’ll talk to me nicely.”
The man’s eyes opened wider and he grinned in disgust.
“You need to tell me what happened and if you passed out,” Danny said, putting on gloves to examine the injured man’s scalp.
“I was drinkin last night. But I fished yesteday. Drinkin then, too. All I know’s is she was mad when I got home. I must’ta passed out in the garage, where I got a little workbench and tools there. I dunno.”
“So you were in a drunken stupor before you got nailed in the head?”
“Yeah. I reckon.”
Danny assessed his patient’s pupils, which were equal and reactive to his penlight and obtained a negative previous medical history from him. Danny went to the desk to sit down and write orders, but first stopped to tell the secretary to call radiology for a CT scan.
Danny was in his fourth year of residency, a PGY4. He’d been thrown into the trauma month because a resident was out on medical leave, and Vanderbilt needed the coverage. Otherwise, he would have finished his sixth month at the VA. The beginning of the year, he had done six months of pediatric neurosurgery, but found it depressing. It made him more appreciative of Melissa, now two and a half, and his second daughter, Annabel, six months old, who were both the picture of health. His little girls could undo the pediatric neurosurgery blues any day.
Danny slid into a rolling chair and scooted around Casey, who half sat on the desk, legs extended and crossed at the bottom.
“I’m working a graveyard this week,” Casey said. “He was my last run. His wife called it in. When we got there, she waved an automatic nail gun and asked me if I wanted the weapon. I told her I wasn’t the police.” Casey leaned backwards and selected a glazed Krispy Kreme from the donut maker’s box of twelve on the counter top. “You going to do the surgery?”
“Probably. I’m hoping Mr. Rhine’s blood alcohol level is low enough that anesthesia clears him. I’m the highest-ranking resident on this service right now besides the chief, so I think he’ll let me do it if he supervises.”
Casey took a napkin to hold the uneaten end of donut and nodded. “How are Sara and the girls?” A nurse stalled while grabbing a chart behind him. She opened a tab and glanced alternately between the page and Casey.
“They’re fine. You’re welcome to meet us all at Downtown Italy tonight,” Danny said, referring to his parents’ original Italian restaurant on Broadway.
“I’m going to the gym. Then I have to get back here for another tour of duty. I’ll take a rain check.” Casey got up, smiled at the nurse and left after pitching the wadded napkin into the trash.
Danny called his chief resident, Dr. Vince Aaron, and shortly later met the group rounding on patients in the CT room. After the other residents saw Mr. Rhine, the gaping mouths of junior residents closed and they congregated around his CT results.
“Clean penetrating injury,” Vince said, waving his pen at the scan and addressing the PGY2. “Do you see the bleed inside the skull?”
“No, sir, I don’t see any evidence of that.”
“Very nice. Correct. So we suspect the nail avoided major blood vessels. Now, Dr. Tilson and I must be careful not to cause bleeding while surgically removing it.” Dr. Aaron spun around, sat on the desk, and continued. “What about the nail’s location?”
“Lucky guy,” the PGY3 said. “The right frontal lobe. Probably forgiving.”
“What if it had been his temporal lobe?”
“The dominant hemisphere of the temporal lobe houses Wernicke’s speech area. But no telling if a penetrating injury there to this Tennizzee hunter would have enhanced or deteriorated his speech.”
“Fisherman,” Danny corrected him.
“Whose name is probably Bucky,” the PGY3 said.
Laughter erupted from the residents in the back.
“Okay, very funny, Mr. New Englander,” Vince said. “Now, everybody get down to business. Danny, I’ll meet you in the OR after the case is booked, you’ve got consent and labs, and the anesthesiologist gets the ball rolling.” Vince pocketed his pen. “In the interim, I’ll be the photographer.”
Danny scrubbed while watching the attending anesthesiologist and resident say goodnight to and intubate his patient. The anesthesiologist probably didn’t bother to ask him to count backwards. When Danny walked through the double doors, the OR table had been turned ninety degrees from the ventilator, the anesthesia circuit carefully secured; one arm of the patient was wrapped on an accessible arm board for IV access and the other arm tucked alongside his body. A blue warming blanket covered the patient and draped over the sides of the table.
A nurse unfolded Danny’s surgical gown allowing Danny to slide into it. The circulating nurse tied it from the back as he stepped to the patient’s head. The area around the nail had been prepped and shaved. Danny affixed a bolt-like contraption to hold the head and put a sterile drape with a hole to expose the surgical site.
The scrub nurse stood closest to him, her instruments laid out neatly on moveable tray tables. Danny incised a wide circular margin, cutting down to skull. “Drill. Suction,” he said. The nurse handed him both, and he started to drill, applying pressure to bone. Danny knew his chief resident had scrubbed and readied after him, and he now looked closely over Danny’s right shoulder.
Vince dripped saline over Danny’s drill bit and surgical area. Danny continued drilling firmly, then eased up when he felt no resistance, which meant he was inside the skull and near the brain.
“Dr. Tilson, you scattering bone dust around here?” the anesthesiologist quipped.
“I’ll be sure to glue it all back together before we leave,” Danny said, smiling under his mask.
Danny suctioned. He slowly pulled out the incised skull bone. Perfect. The major venous sinuses weren’t anywhere close and the nail wasn’t too far in. Vince kept quiet; Danny had the situation under control. The small defect in the pulsating brain wasn’t bleeding, so Danny and Vince turned their attention to pushing the nail out of the bone from where it had entered.
“Fine job,” Vince said. He stepped back and took off his gown. The scrub nurse took the suction tip from Danny. He appreciated her methodical style and her respectful treatment of residents, who often weren’t assisted with the same professionalism as senior staff.
Minus the nail, Danny inserted Mr. Rhine’s skull piece back into the hole like a single cardboard piece into a puzzle, and stapled the scalp flap back onto the adjoining skin. He was grateful that the case had been straightforward and that a good senior resident had done the anesthesia. He’d get out at a reasonable time to spend the evening with Sara, Greg and the girls.
Greg’s chef, Gianni, eyed his pesto sauce for color and texture. He sampled it and nodded his approval. He slid chopped onion and garlic to Greg from a butcher block, for Greg’s customary part in preparing the appetizer while Sara and Danny were on their way. Greg sautéed them, added browned eggplant, and stirred in tomatoes. He mixed capers, anchovy paste and olives in the pan drippings, spooned it over the eggplant and covered it. “Sara’s favorite,” Greg said.
Greg and Donna had foreseen Nashville’s potential for a fine, pricey Northern Italian restaurant. While entrepreneurs concentrated on pulled pork and ribs, Greg and Donna figured the country superstars and entertainment folks had a ton of cash, and there was only so much barbecue people could eat. So when downtown Nashville was in its infancy, springing more and more café’s, buffalo wing restaurants and sports bars, Greg and Donna had bought a large, old bookstore and renovated it. Sending for Gianni from Italy sealed the deal. Later, when they opened a second and third restaurant, they sent for two more chefs, but remained attached to their original Downtown Italy.
Greg went to the dining area as Danny and Sara arrived. Melissa ran to him with outstretched arms, plowing into his legs and hugging tightly. Two fancy rubber bands held her fine hair in short ponytails off the side of her head, and long eyelashes swept almost to her eyebrows.
“Pop-Pop, guess what I did today?”
“What did you do today, sunshine?” Greg said, crouching down to her.
“I gave Annabel a carriage ride up and down Mrs. Emily’s driveway!”
“You are something else,” Greg said.
Greg greeted his son and daughter-in-law, then went to the kitchen and brought out his eggplant and toasted focaccia. “Chow down,” he said, placing the appetizers on the table. A waiter stepped over, bringing them ice water and a bottle of Pinot Grigio while Melissa handed Annabel a piece of Italian bread. Her baby sister sputtered with delight, legs wiggling from the highchair.
Sara took the vase with a sprig of flowers and placed it on the floor against the wall behind them, then put a napkin on Annabel’s tee shirt. She dipped into the herbed vegetable in the middle of the table. “Thanks, Dad,” she said.
“Come on, Dad, join us,” Danny said. Greg poured wine and sat. Danny and Sara ordered shrimp scampi since Gianni made fresh pasta from scratch every day. “And ravioli with fresh mozzarella on top for the girls,” Danny said to Angelo, the waiter.
“Angelo, my usual,” Greg said.
“Yes, sir,” Angelo said. He winked at Melissa and left.
“Danny,” Greg said, “that internist put me on a diuretic today and gave me my lab results. My good cholesterol’s high and my triglycerides aren’t elevated. Since I’m not diabetic and don’t have cardiac risk factors, we can’t figure out why my blood pressure is high.”
Sara leaned in closer to her father-in-law. “Dad, you certainly aren’t obese either,” she said, waving focaccia in her hand before taking a bite.
“No one in the family had premature heart disease from bad genes, did they?” Danny asked.
“Not that I’m aware of. Your grandfather died young, but as you know, he died swerving off the road in an automobile accident.”
Danny pondered that a moment while two small speakers piped in Pavarotti. His parents had a flare for atmosphere and interior decorating; a mural of a Mediterranean piazza and vineyards plastered one wall.
“Dad, maybe granddad had a heart attack.”
Angelo slid Greg’s pasta in front of him. Greg acknowledged it with a nod of approval and looked at Danny. “That would explain it,” Greg said, frowning.
“Dad, did you talk to that man interested in your restaurants again?” Sara leaned back as Angelo placed their scampi plates. She cut ravioli for Annabel while her hair fell forward, then she swiped it behind her ear.
“He’s offered me a mint for the two other restaurants. He asks only that I give him the first opportunity to buy Downtown Italy when I’m ready to sell.” Greg twirled some angel hair after dipping it into extra parmesan at the rim of his plate. “Managing all three has gotten to be too much, especially without your mom.”
Melissa squirmed out of her chair headed for her baby sister. She spooned a small piece of pasta and airplaned it towards Annabel’s mouth. Annabel banged her arm but quickly reached for her sister’s ponytail. Melissa jumped back and giggled. Greg and Danny laughed, too, and Sara leaned in smiling, putting her hand on Danny’s shoulder to give it a squeeze.
“Well, I think your slowing down is a good idea, Dad,” Danny said. “Although managing Downtown Italy is hardly slowing down.”
“Okay, I’ll make the deal. Let’s all toast to it.”
Sara raised her glass, pretending to clink it towards Melissa and Annabel.
“And let’s toast to only three more years of residency,” Danny said. “And to a great teacher and magnificent wife.”
Angelo placed a cream linen napkin over his arm and smiled at them. “More wine?” he asked.
“No,” Sara said, waving her hand. “But we’ll take Gianni’s prized sacripantini.”
“You know, Miss Sara,” Angelo said, tilting his head, “sponge cake made with rum is a Luciano Pavarotti favorite. But, of course, Gianni’s is the best.”
“Yes, we know,” Danny said. “And please, Angelo, a shot of espresso with a shot of liquor. Brandy will do. I can be festive today.”
“Something you’re going to tell us?” Sara asked, kneading his shoulder.
“Before and after surgery pictures of my patient today made it into the department’s photographic archive. Projectors will be showing those slides in lectures all over the country.”
Sara beamed and they both kissed. When their lips pressed, they lingered.
Sara held Annabel snuggly in her arms for a few minutes before leaving the porch and going inside. Annabel had fallen asleep on the drive across Murfreesboro Road and the winding gravel roads into the subdivision. Two motionless deer stood on the outskirts of the woods. They had lost their white spots, but weren’t fully grown either. The deer stared at Sara and Danny and realized they weren’t a threat, so started eating at the brush. A nearby whip-poor-will called loudly, listened, then emphatically spoke again after a distant response from a fellow bird.
Danny and Sara headed inside. Sara carefully changed Annabel and tenderly placed her in her crib. She kissed her baby girl on the cheek and pressed her small fingers into her own. While Sara peeled away to take a shower, Danny helped Melissa wash and change. Melissa wrapped her arms around Danny’s neck as she stood on her pink bedspread.
“Tonight you can dream about those graceful deer visiting you in your backyard,” Danny said, returning the hug. “Their eyes are as bright as yours.”
Danny turned off Melissa’s light. He went into the master bedroom, closed the fauxwood blinds facing the woods, then sat on the bed and took off his shoes. Sara’s gray tee and loose cotton briefs she wore to sleep lay crumpled in the middle of the bed, and the chocolate colored quilt with a popcorn texture looked like they had just crawled out from it in the morning. Danny liked Sara’s taste in decorating, a cross between country style and modern. He moved brown throws and gold shams toward the headboard, thought about lying down, but heard the shower water and imagined his wife sponging her curves.
Danny unbuttoned his shirt and slid it off as he walked into the steamy bathroom to slick tiles and a hazy mirror. “Would two be a crowd in there?” He opened the shower door and narrowed his eyes, taking in the view from top to bottom.
“No. It needs to be steamier,” Sara replied.
“I can fix that.” Danny took off his navy trousers and briefs and stepped in. He inhaled the aroma of the shower stall, saturated with orange ginger. Already the sight of water hastening down her silky hair and smooth skin aroused him.
Sara leaned into Danny, who was a good six inches taller. She pressed her hands into Danny’s back muscles. Her breasts sunk into his chest as she felt him embrace her with firm arms. She explored his lower back, gliding her hand around. She squeezed while their lips and tongues explored, all wet and moist from each other and the pounding shower head.
Danny inched his hand behind Sara and between her thighs. He pressed closer while Sara raised her leg onto the soap dish ledge.
The salon was wedged between two posh women boutiques. The chatter inside diminished as personnel snapped down bulky dryers and stashed away rinse colors in plastic bottles. The last hairdresser with a client combed and snipped the parched hair of a customer in her chair, the wife of a prestigious partner of a major law firm in Elvis’s hometown.
“You have the longest legs, my drape isn’t doing your cream silk pants any justice,” the hairdresser said. “Here.” She placed another cloth over the woman’s knees.
“Thank you darlin. I’ll be shedding them soon enough. I’m donning my most recent holiday splurge for tonight. And if my husband asks me about the gown’s price, I’ll just tell him it’s one of his Christmas presents to me.” She laughed over her shoulder. “That works for everything this time of year.”
The younger woman combed her client’s hair forward around her face, scrutinizing for any unevenly cut areas. “Mrs. Rose, in retrospect, what would you do differently? Regarding men, that is?”
“First off, you’ve used the correct term. Never stop with one.”
The hairdresser squirted a creamy product in her palms and massaged it into the woman’s hair, creating a silky sheen.
The older married woman didn’t offer any more advice. “Are you still taking that course you told me about?” She spied the study guide on the hairdresser’s busy counter.
“I am. I take it online. It’s so easy and it’s only for twelve months. I sit for the certified surgical technician test in a few months.”
“Wow. There’s good money in medicine.”
“Not as a tech.”
“You’re not after lawyers, then, are you?”
The young woman smiled.
“Smart girl. You strap on one of those masks they wear and you’ll knock them male surgeons dead with those eyes.”
“Thank you for the kind words, Mrs. Rose. And enjoy your holidays.”
Mrs. Rose squeezed a twenty-dollar tip into the woman’s hand, paid the bill at the front register and left. The beautician swept her space. The salon was quiet and almost empty.
The co-owner left the cash drawer open and pulled the window blinds. The pretty twenty-four year old picked up her study guide and gathered her purse from the bottom drawer of the front desk. With her eyes fixed on the inattentive co-owner, her hand smoothly slid a fifty-dollar bill from the register into her blouse pocket.
* * *