Brain Worms Page 5

  Chapter 6

  Harry repeated his neurologic exam and was convinced of the progressive deterioration. If he did not operate, this patient would die. However, operating blindly could kill the patient, and operating without sterile conditions could cause sepsis and a brain infection. He remembered a lecture on the history of neurosurgery. At the time, operating on the basis of a simple physical exam and an educated guess regarding location of the hematoma seemed archaic at best. Now that he was faced with a similar situation, he realized how much personal fortitude a surgeon required to proceed in the face of uncertainty. No wonder neurosurgeons had egos.

  The site of the skull fracture remained indented, with normal soft tissue swelling. It just didn't feel like significant pressure was developing under the fracture. The hematoma must be on the opposite side. Harry thought about the forces applied when Sven had struck the attacker. Surely the brain had bounced back and forth inside the skull. The hematoma probably resulted from bridging veins in the sagittal or lateral sinuses tearing when this man’s brain bounced away from his skull. The skull fracture was on the left; it would be logical that the subdural was on the left. Harry wasn't able to put in words why he thought the hematoma was on the right - other than to say that it didn't feel like pressure was building up under the fracture. A simple CT scan would have given him the answer almost immediately.

  Harry interrupted Theodore to ask where his first-aid kit was. Theodore did not even look up. "Bathroom. Under the sink."

  Harry retrieved the first-aid kit. It was standard military issue with antiseptics and bandages, but no surgical instruments. Mary said she had a surgical kit at her house which was where the medicine was, too. Harry was about to insist that he needed the equipment and medicine, despite the risk, when they heard someone stepping onto the porch. John spoke up, "It's me, and I have the driver."

  Mary started to open the door. Theodore stopped her and handed Harry one of the semi automatic rifles. They stood against the wall and Theodore nodded to Mary to open the door. As the door opened, a stranger stepped in. John followed, holding his hunting rifle at the ready. As John stepped through, Theodore closed and secured the door behind him. John explained how he found the driver sitting in the running van ready to depart. When he tapped on the car window with his rifle the man had crouched down and gunned the engine. John had chosen to simply shoot the tires rather than the man. The tires stayed on the rim for a ways before the van lost all traction. The man tried to flee on foot but was overtaken quickly.

  Theodore did not recognize the man and asked John who he was. John replied with a nod and an Eskimo phrase. Harry had to ask what the phrase meant and Theodore explained, "It's a nice way for an Eskimo to describe a white man who is a schmuck."

  Theodore began to question the man in detail about how he became associated with the attackers. Harry interrupted to ask if Mary could get the medical and surgical supplies he needed. Theodore asked the driver again how many men he had brought. The driver insisted there were only four of them. Theodore agreed to let Mary retrieve the instruments and supplies, but insisted that John accompany her. When the driver became uncooperative, Harry said, "You know Theodore, I've never done a burr hole with a cordless drill before."

  Theodore added, "And you think if you practiced on this schmuck it would be better?"

  Harry said, "A little practice is always a good thing. Besides, ventilating his brain a little might help him remember."

  The driver was now looking very confused and asked, "What are you talking about, ventilating my brain?"

  Harry explained, "This one gentleman you brought to us has developed a blood clot over his brain. I have to drill a hole through his skull to drain the blood and relieve the pressure. I could use some practice."

  “Nobody’s drilling no holes in my head."

  Theodore suggested, "Maybe you should remember a little better why you drove these guys out here."

  The driver looked at Harry, who was practicing with a cordless drill, then at Theodore, who was holding an automatic rifle pointed at his head. He said, "You guys are crazy. They gave me a grand upfront and promised me another grand when we got back. They never said nothing about anyone getting hurt. They just wanted to bring some guy back with them. How was I supposed to know they were bad guys?"

  Theodore said, "I suppose it's every day someone offers you two grand to drive out to Council." Theodore continued, "Did they describe the guy they were looking for?"

  "They said he was a stranger who had just come in on the morning flight. They described him as being a really big man with reddish hair." The driver looked up at Harry who just smiled back at him.

  Theodore's small living room was now filled with prisoners. Harry decided to use the kitchen as his operating room. The two recovered attackers wanted to know what Harry was going to do to their leader. Harry did his best to explain the surgery and the risk. The confusion evident on their faces meant they either did not understand the proposed surgery or why someone would help their enemy. Harry decided it was irrelevant and proceeded to prepare for his surgery. He carried the unconscious man into the kitchen and placed him on the kitchen table. He used Theodore's barber set to clip the man's already short hair to stubble. He then used some dishwashing soap to scrub the right side of his patient’s skull, and followed by shaving it with one of Theodore's razors.

  Mary returned with their medical kit. She had a reasonable selection of bandages and a few scalpels. Harry asked her to boil some water and placed the largest drill bit from Theodore's tool collection into the pot. He was wondering about a cautery unit and interrupted Theodore again. Theodore responded, "In the middle drawer under my workbench are a couple soldering guns."

  Harry had Mary retrieve the tools and selected the smaller pencil type. There was no logical way to sterilize the tool, though he had Mary wash it with soap and water. They covered the table with sheets and Harry used some of the local anesthetic to numb up the skull and scalp. He washed his hands and dried them with a clean towel. Harry considered for just a second his choice of surgical sites. Then he used the scalpel to cut through the man’s scalp, down to the bone above his right ear. He picked up the now hot soldering gun and used it to sear the bleeding edge of the scalp. When he had controlled the bleeding, Harry took a deep breath and picked up the cordless drill. With a half-inch bit Harry begin drilling into the skull. The bone drilled harder than wood, but the drill gradually ate into the man’s skull which was about 1/4" thick. As Harry's drilling reached through the hard outer cortex, the drilling speeded up and Harry relaxed the pressure. As the bit began biting into the inner layer, Harry needed to again increase his pressure. Too much pressure and the drill would fracture the inner table of the skull and damage the brain even further. Not enough pressure just generated heat from the drill without cutting away the bone.

  As Harry reached the expected depth, he relaxed the pressure again and kept removing the drill bit and cleaning the bottom of his hole. The bone itself was bleeding, but Harry was looking for a change in color as the tip of the drill bit penetrated through the man’s skull. When he finally saw a point of redness, he knew the real danger was beginning. Harry began to sweat profusely. He needed one of the diamond burrs from his neurosurgical kit. Unfortunately, it was 2,000 miles away. He would slowly drill for a few seconds; then wipe the hole clean with linen strips Mary had boiled for him. The center area of redness continued to grow from a small dot, and dark blood oozed into his drill hole. His surgical hunch had been right. Now he needed to enlarge the hole enough to evacuate all of the accumulated blood.

  The oozing blood obscured his view completely. He used the smooth end of a forceps to feel the bony edge of the hole he was creating. It seemed to take forever to gradually wear down the edge without driving fragments of bone into the patient's brain. After about 20 minutes, Harry was satisfied with his hole. He figured that at least 50 cc of b
lood had oozed out of the hole. Some of the blood was already clotted. He wished he had a suction device to draw out the remaining clots. He thought about drilling another hole, but decided the risk outweighed the benefit. He used the forceps and the linen strips to remove as much of the clotted blood as he could. There was a small amount of fresh bleeding, but without a full surgical exposure he would be unable to stop the bleeding. The vessels would have to seal off themselves. It was highly unlikely the patient would bleed to death from the slow bleeding but the buildup of pressure between the skull and the brain would have most certainly herniated the brainstem out of the skull and killed the patient.

  Harry used one of the linen strips to loosely pack the drain hole he had created and then added more strips as a surgical dressing over the top. He then used gauze to create a skull dressing to absorb the bleeding and protect the wound from further contamination. He had done his best and now they would have to wait to see whether it was good enough. He interrupted Theodore again to ask, "How long until we can medevac this guy out to a hospital?"

  Theodore called out from the adjacent room, "Snow should let up enough for a helicopter in ten to 12 hours. Is the guy going to make it?"

  "He should. Probably lose a couple more units of blood. But he should be able to tolerate that."

  Harry had Mary help him move the patient into Theodore's bed. He remained unconscious, but his pupils seemed less dilated. Harry doubted the man would regain consciousness soon, but he tied his hands together anyway. No use taking any chances. Mary, who had not said anything during the surgery, stated, "You do good work. I was imagining primitive peoples doing this with bone scrapers. Do you think they knew what they were doing?"

  Harry replied, "I've read some of the reports. Hard to say if they were letting out evil spirits or relieving pressure. People survived the treatment and their skulls healed, so they must have known something."

  Harry asked Mary to watch over their patient/prisoner and he went to talk to Theodore. Theodore had a stack of papers waiting for him. The papers were medical and scientific articles regarding neurotransmitters. One of the papers had Harry's name on it from when he was a resident in neurosurgery. They had treated a patient with a frontal tumor who had suffered from periodic episodes of rage that ended when they removed the tumor. The tumor cells had been secreting a neurotransmitter which seemed to be involved in the loss of control the patient suffered from. Most of the other papers had to do with either genetics or with neuroendocrine function in parasites. Several of the papers were written by a Dr. Ahmad.

  Harry finished his quick read of the material and asked, "You think this Dr. Ahmad is our man?"

  "It's by far our best match. His field of research is neurotransmitters in parasites. He is connected with a possible terrorist organization, and he is on the Board of Directors of a small cell phone company with Arab ownership. Oh, he also lives just outside of Minneapolis."

  Harry asked, "You think they have engineered these brain worms for a terrorist act?"

  Theodore did not look up from his computer screen for a minute or so before responding, "I have calculated an 87% chance that the genes which were inserted into your brain worms are responsible for producing the neurotransmitter you found in your patient suffering from periodic episodes of rage. I haven't figured out why, but I'm pretty sure of the connection."

  "What next?"

  Theodore punched some more keys and a weather map was displayed which showed the snowstorm moving inland. He punched some more keys and the map became a moving display. Theadore said, "I think the storm will moderate in Nome 0600 local. But as slow as it is moving, it'll be noon before anything can fly here. I have a military transport arriving from Elmendorf to pick you up in Nome at 0600. With refueling, you should be departing by 0630. Arrival in Minneapolis at 1400 local. Some Special Ops folks will meet you there and help set up the operation."

  "How do I get to Nome in this snowstorm?"

  "I'll have John take you in his dog sled to the roadhouse at Solomon. The road should be fairly clear from there to Nome and I'll have a driver waiting to pick you up. You'll need to leave by 0200."

  "A dog sled?"

  "About the only reasonable way to travel in a snowstorm. Between the dogs’ natural ability and my GPS headset, they'll get you there safely. The schedule gives you a couple more hours of sleep."

  Harry asked, "What about the guy with a head injury? He needs real medical care."

  Theodore looked up at Harry and said, "You've changed some. The mission comes first; the well-being of the enemy combatants must be kept secondary. I'll have him medevaced out as soon as a helicopter can get in here. Only room for one on the dog sled. By the way, here's your orders which are retroactive to the time you performed the surgery. You're entitled to $124 a day, plus per diem for hazardous duty."

  Harry asked, "You can do this?"

  "Not sure, but I did it anyway. Something significant is brewing and we need to get a handle on it. I think you should get some sleep while you can and let me finish my work."

  Harry lay in the spare bedroom trying to get some rest. He was trying to analyze the information Theodore had given him, but it wasn't making sense. His soldier’s ability to sleep took hold and he slipped into oblivion. He found himself watching Angie being tortured in a cell that looked like his torture site from many years ago. Dreams of the ordeal he had faced seemed tame, compared to watching his wife in anguish. Someone was grabbing him by the shoulder when all he wanted was to break into the room and rescue his wife. Gradually Theodore's voice entered his consciousness, "Harry, it's OK. Harry, time to wake up."

  Harry withdrew from the scene of torture and reentered reality. He looked up at Theodore and said, "Sorry. They had Angie in the torture cell."

  Theodore looked at the now twisted metal headboard and knew Harry had had a tough dream. He simply said, "Time to get going."

  Harry dressed and found breakfast waiting. Mary had cooked up a platter of hotcakes and moose sausage. John came in and said the dogs were ready. Mary told him to eat something first. John took off his heavy parka and ate while standing by the door to stay cool. Harry finished his stack of pancakes and sausage and began dressing in his outerwear. John asked if he had more clothes. Harry shook his head no and John said, "I'll drive careful, so you can stay warm."

  They walked out into darkness which was banished only from a small area in front of the house where light fell through window panes. The snowflakes were so small they didn't show up as individual flakes but rather as a general whiteness which quickly paled the yard light. The dogs were harnessed in two rows. There were at least a dozen of them hopping in their excitement. The back of the sled was chained to a post on Theodore's stoop. Harry followed John out to the sled. The dogs’ yelps increased exponentially as John approached the sled. He had Harry climb into the wooden sled which seemed a bit flimsy for someone of Harry’s size. Harry half sat and half laid on the foam cushion. John then covered him with a sleeping bag and a blue tarp. Harry felt even more like baggage when John used ratcheting straps in a crisscross fashion to secure him and the tarp to the sled. The sled itself was made of strips of wood locked together with what appeared to be rawhide. It seemed to sag way too much with Harry's weight.

  Then they were on their way. Harry hadn't even thanked his friend for the help nor apologized for the trouble he had brought. His thoughts were first of how ridiculous it was to be traveling by dog sled to meet a jet transport. As the dogs began climbing the hill, the sled tended to rock back and forth with significant creaking like an old rocking chair. The animals were working hard and started to put all of their energy into pulling. Their yelping was soon replaced by the silence of the snow and the soothing sound of the sled runners. The regular drumming of the dogs’ feet added a musical quality to the quiet sounds. As the hill steepened, Harry felt John step off the runners and heard his footsteps as he ran
along the sled, helping push it uphill. John would shout an occasional word to direct the dogs. Otherwise, he and the team worked together silently. Harry felt a change when they crested the hill. Despite wiping his goggles clean, he could see nothing. They were out of the valley with the trees, and snow now obliterated everything. He wasn't sure how John and the dogs could navigate in the whiteout.

  The rhythm of the sled and the quiet sounds of the sled runners and dog’s paws produced a soothing of Harry's distraught emotions. There was no reason for anyone to torture Angie. She was just a pawn being used to draw him in. She would be afraid, but there was no reason for her life to be endangered as long as her kidnappers felt she had value. If Theodore was right, they wanted him because of his knowledge of the brain worms. Someone must have told them that he had kept a couple of the worms or maybe the radio interference in the operating room was a transmitter which had relayed the info. The question was how were the brain worms connected with his paper on neurotransmitter induced rage. Rage in a terrorist would be a powerful weapon. Yet, how would they control the onset of a rage? His patient with the brain worms exhibited no signs of being able to control his rage.

  They had been traveling for a couple of hours when John called a halt to the dog team and took time to make sure Theodore's sensor had registered their passage. The dogs were panting from their exertion on the uphill run. As soon as John gave them the command to move though, they were off and running. Their speed improved significantly as they headed downhill to the coast of Norton Sound. The wind was also noticeably stronger and the snow packed more firmly. The rocking of the sled, especially on turns, was much more noticeable. At times Harry felt sure the sled was going to tip. He shifted his weight to the outside as much as his confinement allowed. John did not need his help and was distracted by Harry's weight shifting. He told Harry, "It would be better for you to sit still. The dogs and I will control the sled."

  Harry did as he was told and concentrated on trying to see something in the darkness. He would wipe his goggles but it changed nothing. He felt trapped, with only the sound of the dog's paws and the sled runners mixed with the creaking of the sled, connecting him with his mission. He tried to plan the next phase, but had no information to base his planning on. Instead, his anxieties would surface only to be soothed by the sounds. He lost track of time. A building suddenly appeared and John called a halt to the dogs. Lulled, Harry felt a sharp sense of disappointment that his ride was over. He now understood a little why this ancient mode of transportation persisted in a time of rocket ships.

  When Harry was released from the sled and stood, he realized his feet were numb from the cold. A car was waiting. With a simple handshake, he left John and his dogs behind. The falling snow did seem less dense, but the wind was much more noticeable, building the snow up against the left side of the car as they drove toward Nome. They arrived at the airport a little past six and a sergeant was waiting for him in the terminal. He asked to see Harry's orders. Harry produced the papers Theodore had given him. The sergeant examined them carefully before saluting Harry and saying, "Welcome aboard, Sir. Can I assist with your luggage?"

  "Thank you, Sergeant. No luggage. I appreciate the lift."

  Harry's feet were now burning and tingling from the warming in the overheated car. He walked across the tarmac gingerly to the Gulfstream jet painted in Air Force colors that was waiting for him. He climbed aboard and took the seat indicated by the sergeant. The pilot boarded the plane and said, "It'll be a few more minutes while they de-ice the plane. Flying up here keeps you on your toes. The storm has settled down some, but we still had to push minimums to get in here."

  Harry replied, "I appreciate your efforts. Sorry for the inconvenience."

  The young Air Force captain replied, "No problem. I'd much rather be flying than working on the report my CO wants done regarding the maintenance issues. We don't get many VIP trips to Nome."

  Harry ignored the hint for an explanation and looked out the window. The snow was still swirling around the streetlights and dawn had not yet come to this northland. He said, "Still looks pretty marginal to me."

  The young pilot sounded cocky as he reassured Harry, "With our new electronic guidance systems we can handle zero-zero conditions on takeoff without any problem."

  Harry was thinking back to some of the helicopter flights he had flown in conditions like these. It was just too easy to get disoriented. Better not to know what was going on. His thoughts were interrupted. The sergeant presented a secure briefcase and several forms for Harry to sign accepting these documents. Harry scanned the forms which authorized him access only while in transit. Theodore must have found something. Harry signed the forms and accepted the key with the sergeant's admonition not to open the file until they were airborne.