Gravity

‘Anterior MI,’ he said to Anna.

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

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

Jack and two nurses ran outside.

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

‘Morphine?’ the nurse asked.

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

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

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

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

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

‘How long’s she been out?’

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

‘Did you get the CT scan done?’

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

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

‘Show me the films,’ he said.

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

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

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

The blood had to be drained at once.

‘Get her back to ER!’ he said.

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

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

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

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

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

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

‘Then get someone else!’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gazing at the audience of well-dressed men and women, Gordon felt as though he were staring at an alien culture. What was wrong with these politicians? How could they be so shortsighted? It bewildered him that they did not share his most passionate belief: What sets the human race apart from the beasts is man’s hunger for knowledge. Every child asks the universal question: Why? They are programmed from birth to be curious, to be explorers, to seek scientific truths.

Yet these elected officials had lost the curiosity that makes man unique. They’d come to Houston not to ask why, but why should we?

It was Cornell’s idea to woo them with what he cynically called ‘the Tom Hanks tour,’ a reference to the movie Apollo 13, which still ranked as the best PR NASA had ever known. Cornell had already presented the latest achievements aboard the orbiting International Space Station. He’d let them shake the hands of some real live astronauts. Wasn’t that what everyone wanted? To touch a golden boy, a hero? Next there’d be a tour of Johnson Space Center, starting with Building 30 and the Flight Control Room. Never mind the fact that this audience couldn’t tell the difference between a flight console and a Nintendo set; all that gleaming technology would surely dazzle them and make them true believers.

But it isn’t working, thought Gordon in dismay. These politicians aren’t buying it.

NASA faced powerful opponents, starting with Senator Phil Parish, sitting in the front row. Seventysix years old, an uncompromising hawk from South Carolina, Parish’s first priority was preserving the defense budget, NASA be damned. Now he hauled his three-hundred-pound frame out of his seat and stood up to address Cornell in a gentleman’s drawl.

‘Your agency is billions of dollars overbudget on that space station,’ he said. ‘Now, I don’t think the American people expected to sacrifice their defense capabilities just so you can tinker around up there with your nifty lab experiments. This is supposed to be an international effort, isn’t it? Well, far as I can see, we-all are picking up most of the tab. How am I supposed to justify this white elephant to the good folks of South Carolina?’