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.