Twisted Thoughts And Thoughtful Truths On Thursday #016

Twisted Thoughts And Thoughtful Truths On Thursday #016 – The Atrium – Chapter 03 – Incremental Progress, Part I

As promised, I’m releasing some of my upcoming book bi-weekly as part of the Twisted Thoughts And Thoughtful Truths On Thursday series here at SBS.  I don’t expect it to make sense…at least, not at the moment…but that’s okay.  Putting it out here publicly is intended to be motivation to keep me writing it, and that’s all the purpose any of it needs to serve.  Hopefully, if I get lucky, you’ll enjoy it in the process…that’s the best case scenario.  At the moment, I’d predict that things will likely change with the order I put these things out in…and what reads as “chapters” now, might end up becoming pure prologue, if it even ends up making the final cut for the whole story at all.  Regardless, if you find yourself being one of the few that wanna follow along and see where this goes, I can at least promise you that reading what is posted up here at the homepage will provide you with extra insight, details, and ideas that probably won’t even end up being in the book…so perhaps, by reading these postings at the start of each month, you might very well know more about what I’m writing than the publisher will by the time things are all finished. 

I truly hope you enjoy, and thank you for reading.

– Jer @ SBS

The Atrium – Chapter 03 – Incremental Progress, Part I

June 5^th, 1988.

Derrick looked down at his patient on the hospital bed below him, and intensely scrutinized the frame of the man that had just come in.  “Can you hear me clearly?” he asked, looking directly into his eyes.

“Y-y-yes,” he stammered back.  “I can.”

“Okay, good.  Can you tell me your name?”

“Yes.  My name is…George Wright.”

“Okay, good.  My name is Derrick, George.  I’ll be the doctor operating on you shortly.  It’s nice to meet you – we’re going to get you on the right path to a new and better you in no time at all.  Comfortable?”  Derrick’s eyes scanned George’s for approval, which he saw beaming back as he nodded to confirm.  “Excellent.  As I understand it, you’ve had trouble remembering things since your concussion back in January.  You’re here today so that we can take a look under the hood & see about fixing you back up.”

Derrick smiled.  George smiled.  Keeping serious situations lighthearted was determined to be the best way to go.  Derrick continued.  “So…we’re going to start by shaving your head.  I’m afraid we’re going to have to remove your hair today so that we’re able to make the incision we need.”  George nodded in his understanding and approval combined.  “From there, we’ll make a cut clear around the top your skull, and basically take the lid right off the top of your head, which is called a craniotomy.  After that, once we’re inside, we’re able to take a much closer look at the brain tissue to see what we can see.  That could be potential damage of some kind that we’ll be able to repair, there could be a tumor that we’ll remove, it’s ultimately hard to say without getting right in there as a scan will only ever show us so much.  You’ll be put under general anesthesia and be happily asleep in dreamland throughout the whole procedure, so you won’t feel a thing of course.  That being said, if you have any questions, it’s probably better that you ask them now, because in about a half hour or so when the surgery officially begins, you’ll be a bit hard to get a hold of as you’ll be unconscious throughout the entire ordeal.  When you wake up, we’ll either have answers about the next steps to take, or you’ll already be right as rain.  How does that sound George?  Is there anything else we haven’t covered in our briefings that you want to know about?  I know you’re likely feeling overwhelmed and overloaded with information because our staff is very thorough on the journey for you to get this far already, but if there’s anything else at all that you want to know, I highly encourage you to ask.”  Derrick scanned George’s face closely for a reaction.

“N-n-no,” he stuttered back.  “I’m good.  I understand the risks, and I understand the potential benefits.  I’m g-good.  Or,” he reconsidered, “I’m as good as a p-person c-could be under circumstances like this.”

“That’s fantastic to hear George.  I understand where you’re coming from, and it sounds to me like you’ve got the right mindset and attitude to go through a major surgery like this.  I know it can be daunting to say the least, but I assure you that I’ve been as well-trained as anyone in the field could ever be for this type of procedure, and I’ve performed it successfully many times.  I think that…”

“Many times?” George interrupted and implored.  “Does that mean there are times where things didn’t work out?”  He clutched the thin blanket on the hospital bed below him & balled a wad of it into his fist.

“I make it a point of always being honest with my patients George.  Personally, I’ve never had a surgery like this go south on me – but that’s not to say that there isn’t unique risks to every single procedure.  All we can do is all we can do.  I can assure you that you’ll get the very best care I can provide, as all my patients do.  I’m awake, attentive, and aware.  Not much ever slips by me.  In the event that somehow something would, there are two nurses assisting during the process, Karen and Melanie, who will bring my attention to anything additional that pops up along the way.  You’re in the best hands I can think of.”

“O-okay,” said George as he instantly started to calm back down.  “I appreciate that, th-th-thank you.”

“Believe me George, I’d be a lot more worried about you if you weren’t worried at all,” said Derrick.  “A healthy amount of fear or trepidation is very natural in a situation like this, but we’re gonna sail right through this procedure together, even if you’re not awake for it, and you’ll come out better on the other side of it.  If we can’t outright fix everything, we’ll have a much better idea of how to manage your symptoms and be able to plan for the next steps ahead.  One way or the other, we’re here to help you.”  George nodded back towards Derrick again, more or less affirming his confidence on the matter at hand.  Derrick took it as a sign of good faith, and got up from the bedside to collect what he needed for the task ahead of him.  “Karen will be in momentarily to administer the anesthetic to you, and we’ll get started quickly after it’s kicked in.”  He got up, grabbed George’s medical chart, and then left the room.

In what seemed like only mere seconds later, a shapely slender brunette popped in through the door with a tray full of tools.  Sitting on the stool beside the long hospital bed containing George, Karen looked at him directly in the eyes and said with a calm, soothing voice, “we’re going to need to shave your head in order to perform this surgery Mr. Wright – I’m assuming you understand that part of the process already?”  George shook his head slowly in confirmation.  Lost in the exceptional blue of her eyes, he could have sworn that he had never encountered such a remarkable shade of the color at any point in his life.  It was like her eyes were completely alive with a radiant spark he’d only ever read about before, at least until now – and he was consumed by them.  He heard the click of the shaver, but paid nearly no attention to it at all as Karen started to remove George’s hair prior to surgery.  Gathering a large amount of shaving foam in one hand, she applied it liberally around his head, took a clean razor from the tray, and made a motion to start taking off the rest of his hair down to the skin and scalp.  “Now you hold still Mr. Wright.  This won’t take but a moment or two, and you’ll basically be all ready to go from there.”  George continued to stare deeply into her eyes, entranced by the luscious blue color and watching as her pupils darted back & forth as she shaved his head bare.  Karen had a naturally calming presence on just about everyone she’d ever encountered.  Brain surgery would be terrifying for most patients, but George felt so at peace within her hands that he was convinced everything would be fine.  Making sure his skin was as smooth and shiny as a bowling ball fresh in the alley, Karen rubbed a towel over him, felt the occasional tug of resistance from a stray piece of stubble, and promptly got rid of any last evidence of the hair he had.  “There we go,” she said.  “You’re all set for your procedure.”

He smiled back at her and appreciated the reassuring look she had in her demeanor.  While he knew it was carefully crafted and calculated to deliver maximum calm to any/all of his worries, it was still every bit appreciated & equally effective.  “Now the next part that you’re going to be in-store for Mr. Wright, I don’t think you’re going to want to be awake for.  I’m going to administer quite a powerful anesthetic, so that you’ll essentially be lights out for the entire operation and you won’t feel a thing.  You’ll be a bit sleepy, but it’s also crucial that you remain conscious throughout the process so that we can make any imperative adjustments and learn as much as we can about what ails you.”  George nodded his approval again, practically too shy in his admiration of her flawless beauty to even utter a word, almost as if he was afraid his constant stutter would startle her away.  “Excellent Mr. Wright, it sounds as if you’ve been well-prepared for what’s ahead.  With your permission, I’ll administer the anesthetic now so we can get started.”  George once again nodded his head in approval, in what would be the final time before he went under.  “Fantastic,” said nurse Karen, who then grabbed what appeared to be a significantly large needle, pushed the contents forward with its plunger until it was devoid of air, and then proceeded to administer his injection.  Even as a willing participant that understood how important the task at hand was, George felt his skin seem to toughen up and resist the piercing, to the point where he could see that Karen had to physically press a bit harder than he’d have assumed she’d need to in order to pierce the needle through him.  In any event, it went in soon enough, and right afterwards, he felt the numbing effect he was supposed to through the haze he was informed of.  It was a bit like being on the inside of a cloud, he thought, and drifted away in the bed while remaining conscious enough to still converse with.

Not that he was presenting to be any kind of challenge to begin with, but from that point forward, Karen knew her job in particular only became easier.  George was fully pliable now, and she could basically move him in whichever direction she needed to without having to ask him for permission or endure any potential complaints.  She stabilized his head with a specialized brace, then measured out a cutting line around the circumference of his skull for the upcoming procedure, and that was it for her.  She would remain in the room with Derrick as he operated, but there was precious little else she’d need to do aside from clean away the blood as they cut into him, or suck it up through the small mechanical vacuum if it got to be too much.  Karen never got squeamish even in the most extreme circumstances, which is why Derrick and every other doctor at the hospital constantly fought over who she’d be assisting for the day.  As much as her looks were appealing to everyone both male and female, her steady supply of soothing calm was even more sought after by one and all.  Once she finished tending to George, she simply sat in a chair in the corner of the room and waited quietly for Derrick to come back in and start the operation.

Within a couple of minutes, Derrick’s thin frame appeared in the doorway and he made his way towards the hospital bed that carried George.  Grabbing a light to look into his eyes and see where he was at in his newfound state of painless consciousness, he smiled as he watched him try to keep up with which direction the light was going as he moved it back & forth.  “You still with us George?” he asked coyly, already knowing that he could count on him to answer based on the test that he’d just applied to him.

“Y-y-yes,” he stammered sweetly back as he stared straight ahead.  “I’m here, and I’m as ready as I’ll ever b-b-be I think.  Let’s start the show.”  George smiled with a calm unusual for such an intense procedure, but he was fully convinced that he was in the right hands.  He was being cared for, carefully.

He wasn’t at all wrong.  Derrick knew that it was of the utmost importance to get the procedure right, and generally considered each operation he’d led to be a mission towards perfection, every time.  He made the first incision & circled his scalpel expertly all the way around George’s head with professional precision.  The skin seemed tougher than most he remembered operating on, and felt like he needed to press down hard in order to make the cutting as effective as it could be.  George felt the pressure and knew there was weight being applied to make the incision, but thankfully he felt nothing more than that.  Derrick then got out the radial bone saw – a crainotome – to make the deeper cut around his skull.  Essentially creating a flip-top lid at the top of his patient, Derrick warned him about being careful not to move, that he might smell a slight burning-like smell, and related that this part of the procedure would be over fairly soon.  Everything was on schedule, everything was calm, and all his vital signs were right where they should be.  Not like brain surgery is ever an easy thing, but so far this seemed like it could go on to be the smoothest sailing Derrick could recall having for this type of procedure in his twenty-plus years of being a doctor.  The thin saw revved up and whirred incessantly, and then cut directly into the skull below him with a bit of a shriek or a squeak as the bone scurried away beneath its force.  Karen kept a close eye on George as he lay there staring straightforward, aware of the procedure but quite seemingly unconcerned.  With impeccable precision, Derrick lifted off George’s newly created lid only about a minute or so later, and took a moment to admire how stunningly precise his cut was before even having his first glance at the naked brain now sitting there in the open air in the center of the skull.

As he adjusted the brace a bit to give him a little more room to operate, Derrick closely observed the tissue of George’s brain and assessed its functionality, or lack thereof.   There was some darker parts that were clearly damaged and potentially rotting on the inside of George’s skull, and though it wouldn’t guarantee it would fix things like his speech impediment, it was still crucial to remove any tissue that could possibly infect the rest.  With more surgical incisions and taking pieces out one slice at a time, Derrick took out the malfunctioning parts and placed them carefully on the tray beside him.  “Could I get a little suction here,” he said to Karen as he pointed towards a slight pooling of blood that was impeding his vision.  She readily complied, and with a quick mechanical slurping sound, the interfering red liquid was vanquished.  “Thank you,” said Derrick as he went back to work.  They did everything they could to check his reflexes & responses, and somewhat to his chagrin, everything about George’s functionality seemed to work the way it was supposed to.  He grabbed a microscope close by and looked even further for signs of trouble, but everything looked more normal than he assumed it would have.  George kept staring straight ahead into the plain white of the wall in front of him, grinning like he’d already gone through a lobotomy long ago, just waiting for some kind of stimulation to provoke a response.  He knew it was important to remain as still as possible, and though the brace around his head all but ensured that was continually the case, he concentrated hard on not moving at all so as to help assist his doctor and nurse as best he could.  While it seemed a little unusual to him that the staff would be as small as only two to perform one of the most major surgeries George could conceive of, both Derrick and Karen had put him so at ease he was completely sure that he’d come out of the procedure just fine in the end.  It would have been unnerving to anyone looking at the Cheshire grin on George’s face – you’d swear he was actually enjoying this experience if you were to judge him by his huge goofy hammock-wide smile.

While brain surgery itself traced back more than a hundred years, the many mysteries of this extreme type of operation still plagued the procedure in a variety of ways.  At the end of the day, Derrick was really only able to take a look for any obvious tumors or damaged tissue, remove those, check the scans again, remove anything that might be missed, and then patch George up as best he could; nothing more.  On the bright side for his patient, Derrick was confident that no doctor was ever more thorough than he was, and he scrutinized George’s brain until he was completely satisfied he had answered every single question he had on his mental checklist.  He squirted water over top of the tissue to rinse it off and take one last look at the recently carved out section & observe the gooey grey matter surrounding his cortex.  Everything seemed to be as right as it could possibly be, so he informed George it would be time to put him back together.  Sewing the lid on his patient tight as if George were a giant jar of pickles to be kept as fresh as possible in the fridge, what had appeared to be a simple version of this involved surgery still took the better part of three hours.  As to whether or not that would solve all of George’s problems, they would all have to wait through his recovery in order to have any sense of their success overall.  For now, they cleaned up the rest of the blood, the grey matter & the extraneous fluids from the surgery, and prepared a small dose of sedative to administer to George so he could get in a deep sleep to assist the healing process.  Karen took over after he was disconnected from the brace and medical equipment, and wheeled him into the recovery room next door while Derrick finished cleaning up the surgical area.

He took one last large look at the room as a whole, making damn sure it was spotlessly clean for the next time it would be used.  Notably, the powerful gleam of the bright white walls seemed to bounce light right back at his eyes, practically feeling like he was scorching his poor retinas if he stared at them for too long.  Musing to himself, he found it somewhat surprising that he’d never heard anyone complain about how extremely bright it was on the inside of these four walls, or at least, Derrick felt fairly certain he’d have remembered if they did.  In general, his memory was so strong it often seemed like it had been programmed into him permanently, to the point where if he closed his eyes tight enough, he could remember his entire childhood and all the details that came with it, day by day.  The three main white walls seemed to beam out light from them onto each other, and the fourth wall behind him definitely wasn’t helping the cause.  With a large piece of mirrored glass that ran the entire span of the width of the room, this particular space was always intended to be used for observation, so that the next generation to come would be able to see operations happen in real-time & learn from both the mistakes and successes in the procedures being performed.  Derrick thought about the fact that he’d been at this particular hospital for about twelve years now, and that they’d really only used the room behind the glass a couple of times that he could recall.  He thought about how he should probably get Karen to start arranging more classes of medical students to come through so that the future doctors of tomorrow would be able to gain a wealth of knowledge from those that came before them.  He thought about how beneficial that kind of learning would have been for his own career, way back when he was still just a student.  Back then, it was just a ton of textbooks and eventually learning on cadavers if you were lucky enough, but for the most part it was all just theory until you actually put it into practice.  Smiling as he realized how much he had accomplished over the course of his many years, he looked into the mirrored glass and blocked the glare with his hand as he took a long look at his own face looking back at him.  He had what appeared to be a little bit of green onion from his lunch wedged into a front tooth, which was unprofessional, but made him chuckle.  He turned out the lights, and left.