Clover

Also by R.A. Comunale

Requiem for the Bone Man

The Legend of Safehaven

Berto’s World

Dr. Galen’s Little Black Bag

Shoes: Tails from the Post

Clover: A Dr. Galen Novel

Copyright © 2011 R.A. Comunale

All Rights Reserved

ISBNs:

978-0-9846512-1-4 (EPUB)

978-1-4956003-7-1 (Mobi)

978-1-4956003-8-8 (PDF)

Published in the United States of America

By Safehaven Books

A division of
Mountain Lake Press

Ebook formatting by

eBookIt

Cover design by Studio 4 Squared

This is a work of fiction. Any resemblance of the characters to real persons living or dead is unintentional and purely coincidental.

No part of this book may be reproduced, stored in a data base or other retrieval system, or transmitted in any form, by any means, including mechanical, electronic, photo-copying, recording or otherwise, without the prior written permission of the author.

To our disabled veterans

Her time drew near.

The Bumble Bee Queen laid the special eggs that would become her successors. She flew on what would be her last journey.

Her wings beat rapidly as they hovered over the clover field.

The chill of impending frost was in the air but she was happy as only a Bumble Bee Queen could be.

The young ones were safe.

It was her duty.

It was her legacy unto the generations...

“What's your name, boy?”

“My name is Galen, Robert Anthony Galen.”

“Why are you here?”

“I want to be a doctor like you.”

“From now on, kid, your name is Dottore Berto.”

 

“What's your name, little brother?”

“Bobby Edison. What's your name, big brother?”

“I'm Galen, Bob Galen.”

“Well done, Edison.”

“Likewise, Galen.”

 

“Country Boy, what's your name?”

“David Allen Nash. What's yours, City Boy?”

“Galen. Bob Galen.”

“Congratulations, Dr. Nash.”

“Congratulations, Dr. Galen.”

 

“June Ross, will you marry me?”

The unspoken, “No, Bob Galen,” deafened his soul.

 

“Nancy Seligman, will you marry me?”

“Yes, Bob Edison.”

 

“Lenora, your name will always be ‘Leni' for me.”

“Bob Galen, your special name in my heart is Tony.”

“Will you marry me, Leni Jensen?”

“Yes, Tony.”

 

“Cathy, I don't deserve a second chance at happiness.”

“Bob Galen, Leni's spirit wants me to call you Tony.”

“Cathy Welton, will you marry me?”

“Yes, Tony.”

 

“Tony, I don't feel well.”

He knew its name: pancreatic cancer.

“Don't die, Cathy!”

“Leni is calling me, Tony.”

 

He knew their names: Despair and Loneliness.

 

¿Niños, cuáles son tus nombres?

“Carmelita Hidalgo.”

“Federico Hidalgo.”

“Antonio Hidalgo.”

 

“Tio Galen, will you come to live with us and Tia Nancy and Tio Edison?”

“Yes, children, if your Tia and Tio will have me.”

“Tio Galen?”

“Yes, Antonio?”

“What do we call our home?”

“Safehaven”

Death is simple.

The heart stops beating.

The River of Life ceases its flow through the miracle of the human body.

We die.

There is, however, another death, a living death, one which takes away our very being while the heart still beats.

“Hidalgo, get your team together. We’ve got a C-5 cord injury on the way.”

Jerry Fromm, the first-year resident, felt every bit as tired as the tall medical student who had worked with him for the past 12 hours in the emergency room. Now both seemed to shed the fatigue that had lain across their shoulders. They were needed.

Tony Hidalgo hit the instant message button on his cell phone, and three signals went out simultaneously to the other members of his ER team: Julius Petrie, aka JP, roommate and friend; Sarah Knowlton, friend and lover, and Judy Hicks, friend to all and beloved of JP.

This was a race against time, a battle of technology and teamwork against the second hand to save a life and prevent a living death.

Tony heard the running footsteps just before his three colleagues appeared.

He yelled out, “Neck injury, C-5!” and their running pace doubled.

They were the new lords of creation, one month from graduation and the title of Doctor of Medicine. The initial tremors and pit-of-the-stomach queasiness at the beginning of their clinical rotations two years earlier now became a focused algorithm of emergency care that blocked sweaty palms and loose bladders.

The team of five dashed to the special elevator and rode it to the roof heliport, their minds running through the protocols they were about to use to prevent their new patient from becoming permanently paralyzed.

They heard the rapid whacka-whacka-whacka of the approaching Medevac helicopter’s rotors even before they opened the outside door. As soon as the pilot brought the chopper in for a gentle landing the team raced crouching across the pad to its side door. The whoosh-whoosh-whoosh of the slowing blades surged through them as they took the spinal-trauma cart holding the patient from the two EMTs aboard. Then they wheeled it to the trauma emergency enclosure on the rooftop.

Top priority: Be sure the patient’s breathing and heart functions are stable. Soon the detailed stuff would follow, the painstakingly precise, step-by-step stabilization of the injured spine. But first they needed to perform more critical preparation.

“Good, they’ve got the exoskeleton in the supply dock,” Petrie muttered, as he and Tony grabbed the grasshopper-shaped metal contraption from its container.

Fromm rapidly programmed the stimulator units built into the device’s pads that would apply pressure to specific sites above and below the injury.

Sarah and Judy prepared the injector dispensers with their life-sparing drugs.

“How did this happen, Ted?” Tony asked the EMT who had accompanied the boy on the copter, and who was struggling with his own fatigue from a long day.

“Six minutes from injury, Tony,” he replied. “It was pure luck. We were almost overhead, returning from another transport when we got the call. We landed in the kid’s front yard. Sammy Tignor here just got a skateboard for his fourteenth birthday and forgot to wear his safety helmet. He went ass over teakettle off a homemade ramp. He’s breathing well, and we’ve already cathed him and given him a starter dose of Methylprednisolone and Dexamethasone. We also got a signed release from his parents authorizing all treatment. They’re on the way by car.”

“I can’t feel anything! Why can’t I feel anything?”

“Easy, easy now,” Judy whispered. “We’re going to help you.”

They quickly enveloped the boy in the lightweight duralumin exoskeleton, which prevented motion. A specially programmed nerve-muscle stimulator sent timed electric impulses to maintain muscle tone below the cut in his spinal cord.

The team focused low-power lasers on the injury site that fired preset light pulsations to stimulate the growth of stem cells in the spinal cord. This would provide clusters of new stem cells to participate in the regeneration process.

Tony took the entry pad containing all of the accumulated patient data during the transport flight from the medtech.

“He’s able to talk and breathe,” JP noted, “but he can’t feel anything from the neck and shoulders down.”

Sammy’s spinal cord, the massive communications cable from the brain that travels down through the bony spinal canal, had been torn. The connecting wires carrying instructions from the brain—move here, feel this or that—no longer worked.

At the level of the fifth cervical vertebra, Sammy could breathe and talk but little else.

Sarah was performing a quick but systematic exam on the boy. She looked up at Tony and nodded.

“Yep, a lower C-5. Judy, get the neurosurgeon on call. We’ll get him prepped for OR.”

Judy smiled at Sammy. He looked so small, so vulnerable, so scared. He reminded her of the younger brother she had lost in an auto accident four years earlier. She wanted to cry—they all did—but that wouldn’t have helped the kid.

“Hey, big guy, you doing okay?”

Barely audible, the pubertal voice replied.

“No-o-o. Are my mom and dad here?”

“They’re on the way, Sammy. We’re going to see if we can glue you back together again. You hang in there.”

She pulled out her phone, touched the extension for neurosurgery, and began the arrangements for what would happen next.

It was called the Joshua Protocol. The team of four, under Fromm’s guidance, inserted entry ports into the boy’s veins. They had no time to ride him down the elevator into the main hospital so they worked in the specially outfitted enclosure.

“Judy, Sam here looks to be about 43 kilos,” Tony called out.

The special cart had its own built-in electronic scale and measuring devices.

“Give him 1500 milligrams of lazaroids and sialidin. Sarah, get 2200 milligrams of erythropoietin-neurotrophin mixture ready. JP, have we got the nanos?”

Fromm watched the students carefully, constantly on guard for errors in judgment. There were none.

“All set,” Judy called out.

“Okay,” Fromm said, “watch for anaphylaxis. Sarah, start the factor infusion. Tony, stay ready for problems.”

He kept his fingers crossed.

The death throes of a complex organism, like that of a single cell, follow their own protocol. There comes a steadily increasing cascade of deadly chemicals coursing through the body that must be stopped or neutralized if the individual is to be saved.

The lazaroids and sialidin streamed through the boy’s veins, blocking the lethal showers of destructive, tissue-necrosis factors that would prevent return of function. Neurotophins, nerve growth-stimulating proteins carried by microscopic nanoparticles, homed in on the site of the nerve destruction. Slowly they stimulated the nerve endings, while the erythropoietin and 810-nanometer laser pulses attempted to induce natural stem-cell production.

“He’s starting to seize!” Sarah yelled.

The boy’s eyes rolled upward and his jaw muscles tightened.

Tony reached for a prefilled syringe containing Lorazepam, a tranquilizer commonly used for anxiety and also used for rapid control of seizures, and stuck the needle into the IV port on Sammy’s right arm. Slowly, counting out, “one-thousand one, one-thousand two...” he administered the drug, and the young patient’s face slowly relaxed.

Next JP inserted a tongue guard into Sammy’s mouth and administered low-dose oxygen via mask.

“Okay, let’s get him to the OR.”

Two on each side and one behind, they wheeled the cart with the exoskeleton stabilizer and portable heart-rate and respiratory monitors to the special wide elevator doors.

As the elevator descended, Judy looked at Sammy’s peacefully sedated expression and surprised her teammates with a comment.

“I wonder what he’s dreaming.”

“Dr. Castro, Sam’s been given the Joshua Protocol. Are you going to do a Reeve Procedure on him?”

Tony was glad Roxanna Castro was on call. She was a world leader in her field.

The neurosurgeon, an African-American in her late 50s, nodded. She was tired from a night of dealing with auto-accident trauma, but nothing mattered more now than the well-being of this kid the resident and his team had brought her.

Her mind went into overdrive and the fatigue vanished.

“We need to go in and restore neurilemma continuity.”

Neurilemma, the magic covering of the nerve axon, acts like a continually expanding tunnel through which the long finger of the neuron, the nerve fiber, travels to its destination. Disrupt that sheath and the nerve ending has no way of finding its path. It becomes effectively blind and wanders aimlessly, often forming an ineffective—though painful—tangled, ball-of-yarn nerve clump.

The four almost-doctors, now in OR sterility suits, clustered around the large, flat-screen monitor, watching Castro activate the surgical microscope field and micro-Waldo units.

The anesthesiologist had used a Ketamine derivative to put Sammy into a form of dissociative anesthesia that would not suppress his breathing. His mind would float in a netherworld of non-existence; his body would feel nothing.

The chief OR nurse activated the exoskeleton controls and rotated the patient’s carefully immobilized body to a face-down position.

Todd Baker, the assisting neurosurgery resident, activated the mini-MRI unit. A portion of the viewing screen showed the havoc within Sammy’s neck.

“We’ll make the initial incision 2 centimeters below the break,” Castro said, speaking slowly as she brought the ultrafine laser scalpel down on the patient’s skin. It parted, bloodlessly. She peered through the microscope as she penetrated, layer by layer, down to the muscles and ligaments surrounding the neck bones.

“There it is, ladies and gentlemen.”

Tony, JP, Judy and Sarah all stared in wonder at the thin-walled portions of the fifth cervical vertebra and the red, swollen nerve ending capped by a blood clot where it should have continued down the spine.

Castro adjusted the laser’s controls and the light beam vaporized the clot.

Baker, one month from entering the world as an attending, carefully handed her a vial of stem cells. Subconsciously he felt like an acolyte on the altar presenting an offering to the officiating priest. In turn, Castro used a special glass syringe to draw up the mixture of stem cells and neurilemma growth factor, and began to infiltrate the severed nerve ends. Then she activated the micro-Waldo operating hands. This computer-guided machine allowed her hand and finger movements to be imitated in miniature by tiny robotic appendages.

Peering through the operating microscope, every movement of Castro’s fingers was reduced to micrometer-fine motion that allowed her to rejoin the neurilemmal sheaths. Meanwhile the surgical resident applied neurotrophic factor/stem-cell mixture and nerve glue each step of the way.

Castro smiled in satisfaction then turned to the intense young man standing beside her.

“Okay, Petrie, now what?”

“Restoration of vertebral integrity.”

“That’s right! Hicks, how would you do that?”

“Synthetic bone graft and bone glue.”

“Good! Knowlton, what’s the risk?”

“Rejection of stem cell graft or adverse reaction to injected nanos.”

“If none of that happens, Hidalgo, what next?”

“Continual intense neuromuscular stimulation by both electrical pulsation and laser, and then physical therapy after primary nerve regeneration and wound closure. His limbs will need frequent motion, and his skin needs to be protected from pressure sores while recovery takes place. At the same time his neck must remain immobilized, and unwanted calcification in the wound area must be prevented from disrupting the regeneration process.”

“And…?”

Castro stared, remembering herself as a young medical student answering questions from an older doctor in a similar situation.

Hidalgo’s manner resembles that doctor’s. Could it be?

“His head and neck will need to remain in a halo unit until stability of the cervical spine is confirmed.”

Tony mentally pictured the unit they called the “crown of thorns,” which would keep Sammy’s head from a damaging involuntary muscle spasm.

Then Baker jumped in.

“What’s the anticipated recovery time?”

The neurosurgery resident added his two cents, practicing his attending’s voice.

Won’t be fun unless I can pimp the med students with my questions
.

“About one month.”

“Before the Joshua Protocol and the Reeve Procedure, what was the recovery time?”

The four students paused for a moment, watching the still-unconscious boy lying in his metal cocoon.

Tony whispered his answer.

“Never.”

Castro let the surgical resident do the wound closures. Then an orderly wheeled the surgery cart into recovery, the patient even more firmly restrained.