Noble Vision (20 page)

Trembling, David cast the penlight directly into one eye, then the other.

“I . . . I can’t . . . see . . . anything,” she whispered. Then her face fell to the side and her eyes closed once again.

Chapter 11

The Diagnosis

David Lang pushed his unconscious patient to Imaging at an alarming speed. He was oblivious to the curious looks of the people he passed and to the gurney wheels that squealed in protest around the corners. A brain scan in the ER had indicated a fracture at the base of Nicole’s skull. He urgently needed to run another kind of scan, one that would reveal soft tissue, to learn more about Nicole’s condition. Traveling with his precious cargo through a maze of pastel corridors streaked with a myriad of black-lettered signs, he considered the possible causes of his patient’s condition. With every hypothesis, the corrective measure that he would take flashed instantly in his mind, as if healing were synonymous with injury.

Having detected no direct trauma to Nicole’s eyes, David suspected that a behind-the-scenes culprit was responsible for Nicole’s blindness, the prime mover in the magnificent production called vision—the optic nerve. Although sight seems to occur in the eyes the way a play occurs onstage, it’s directed behind the scenes, as is any great performance. The optic nerve carries impulses from the eye to recesses at the back of the brain, transforming stimuli from the outside world into sensations grasped by our minds in the unique phenomenon called sight. By enabling humans and other animals to see, the optic nerve allows Earth’s creatures to discover the world outside of themselves. Fitting with its vital function, this nerve belongs to that elite corps of tissue comprising the central nervous system.

As if the brain were concerned with the disastrous effect of injury to its precious optic nerve, it produces two, one emanating from each eye, with each able to bear the entire burden of vision should its twin die unexpectedly. The two optic nerves are protected from simultaneous injury when separated, but in their travels from the front to the back of the brain, they intersect, charting a course that resembles a large X. This means that despite nature’s careful duplication, an injury at the crossing point could harm both visual fields. To make matters worse, the delicate nerves travel along a dangerous route right by their intersection. There they lie on top of something as thin as fine crystal, the delicate sinus bones that line the nasal cavity and form the base of the skull. Nicole had sustained a fracture in that area, and the gauze that David had just placed under her nose was already darkening with blood.

David had asked an ophthalmologist to meet him in Imaging to examine Nicole’s scans. The eye surgeon, a trim, handsome man in his fifties with a kind face and an engaging smile, was waiting when David arrived.

“What’ve you got there, David?”

“A fall on the forehead from a distance of about twelve feet. The patient momentarily regained consciousness, reporting a total loss of vision. Both pupils are
nonreactive
to light, and she has a skull-base fracture.”

The ophthalmologist shined his pocket light on the stagnant blue pools that were Nicole’s eyes. “Let’s take a look,” he said, his smile vanishing.

The imaging room was dark and bare, as if staged for a mystery. A spotlight on the ceiling beamed a cone of light on the room’s lone furnishing, a pale-gray machine with a narrow sliding table at its mouth. The sleeping Nicole was to take center stage. The two men lifted her onto the table and positioned her head by the arched opening. The white sheet draping her body hung from both sides of the table, concealing the support so that she seemed suspended in space. The only soft touch in the stark setting was eighteen inches of lustrous gold hair, disobediently tumbling off the table, despite David’s attempts to restrain the tresses for a ride into the machine.

A monitor hung by Nicole’s side, its wires attached to sensors on her skin. David frequently glanced at the electronic charts and numbers, reading her heart rate, pulse, and respirations. He mentally rehearsed the scene that he would direct should the metal box sound an alarm.

After positioning Nicole, the surgeons stepped into the adjoining control room to watch her through a large window. A technician sat in the darkened room by a computer console and monitor. The operator activated a command that sent Nicole’s head slowly into the mouth of the machine. The ophthalmic surgeon settled into a chair next to the technician. David, too troubled to sit, paced restlessly behind the men, his black hair blending with the dark walls, his face reflecting the ghastly gray of the monitor.

The scanner was an advanced model that would pass a harmless substance through Nicole’s lovely head, providing exquisitely detailed pictures of her brain to transform ignorance into knowledge and to rescue David from the worst fear of all—the unknown. The machine would endow him with a superhuman power, like the childhood legend who could see through walls. He was thankful that he could spare Nicole the ordeal of exploratory brain surgery in which her skull would be opened by a surgeon as blind, in a way, as she, not knowing in advance the nature, extent, or location of the injury. In a few minutes the remarkable block of metal, his oracle, would enlighten him.

The machine hummed its electronic tune, and the screen displayed its first picture, an overview of Nicole’s brain. David examined the
artistlike
rendering. The machine produced images that distinguished tissues, bones, and vessels with a fine precision.

“Let’s get cuts through the sinus and the
sella turcica
,” David directed the technician, “so we can see the pathway of the optic nerves.”

The technician played a sonatina on the keyboard. The machine hummed. A new image appeared. The two surgeons leaned over the screen, gray hair next to black. While Nicole lay unconscious, the doctors scrutinized an overhead view of her brain sliced horizontally at the floor of the skull. Nicole’s eyes were prominent white orbs. The trail of the optic nerves extended from each eye, tracing the familiar wide X across the brain. The fragile sinus bones that formed the cranial floor under the nerves were a contrasting hue. But the pattern of the bones and nerves was not a smooth one. An abnormality appeared just before the intersection of the nerves.

“Look, there’s a disruption of the nerves in the optic canal,” said the ophthalmologist.

“Magnify that,” David murmured almost inaudibly, too absorbed in thought to raise his voice.

While the technician played the keyboard, David wondered what mystery the next frame would reveal. What was the cause of the disruption they were seeing? Would there be a hemorrhage in the optic nerves from blood vessels ruptured in the fall? He could stop the bleeding and restore vision. Would hematomas—blood clots—be pressing on the optic nerves, blocking their function? He could remove the clots and restore vision. Would he find that edema—swelling—of the nerves was impeding their work? He could reduce the swelling and restore vision. Would the fracture on the floor of the skull have caused bone to press against the taut nerves in the optic canal? He could decompress the fragile nerves and thereby restore vision. He could and he would because he most desperately had to restore vision.

He leaned closer to the monitor. The technician pressed buttons. The machine hummed and vibrated. The next picture flashing on the screen cast a dark shadow across David’s face. He gasped.

“Oh, no!” the ophthalmologist cried.

David’s body stiffened behind the two men. He stared through the window at Nicole suspended in space. He knew the diagnosis. The image on the screen told him everything that the ophthalmologist would now say. The older doctor remained deeply engrossed in the brain scan, unaware that David’s hands had left the table, just as his eyes had left the screen and his thoughts had left the room.

“Oh, the poor thing! What a pity!” exclaimed the eye surgeon.

David did not see an object of pity. Under the folds of the thin sheet, he saw the exciting vitality of Nicole’s body, the striking pattern of taut lines and graceful curves, the flesh that was firm and supple. He saw a figure carved by a loving sculptor who masterfully mixed strength with softness to create beauty.

He thought of an ancient statue that he had seen of a goddess with wings, a statue that had stood on the prow of a ship as a symbol of victory. The sculptor had captured the deity descending onto the ship, with one foot touching the prow, the other still in flight. The eight-foot-high marble lady moved against a gusting head wind palpable in the fullness of her wings, the zesty swing of her robe behind her, the thrust of her body forward. The flowing drapery of her robe revealed the vibrant sensuality of a woman’s body. Sea-soaked and windswept, the voluminous garment clung to the front of her body like a transparent film, encircling her breasts, stretching against her taut stomach, highlighting the long lines of her legs. The statue’s pose revealed her spirit. Her arrogant thrust forward and visible delight at the touch of the sea and wind was more than a call to victory—it was an exaltation of victory, a triumph not merely over an enemy at sea but the triumph of the human spirit celebrated in the soaring body of a goddess with wings. The graceful movement of the stone lady had reminded David of a dancer. The statue had no head; it had been lost in the rubble of centuries. At that moment in the imaging room, David envisioned the winged goddess with Nicole’s radiant face.

The ophthalmologist continued to study the scan. “The fracture of the sphenoid bone did the damage. It must have hit with some force, because it cut right through the dura.”

The
dura mater
, Latin for “
hard mother
,” is the outer membrane covering the spinal cord and brain. The dura forms sheaths around the optic nerves.

“With the dura cut,” the ophthalmologist continued, “you can see the injury to the nerves. What a tragedy!”

The eye surgeon’s final word was like a heavy weight on the goddess’s ship. David knew that such ballast would not sink the marble lady. One sweep of her giant wings would cast the unwanted load out to sea. Was tragedy to be Nicole’s fate, he wondered—and his own? Could he abandon her to defeat, pain, and misery? Or could he change her destiny to that of the stone goddess—to triumph?

The ophthalmologist rose from his chair and turned to face his younger colleague, pulling David’s thoughts back into the room.

“There’s nothing you can do, David. A fragment dislodged from the fractured bone on the cranial floor and transected the optic nerves. They’re both completely severed. The situation is hopeless. She’ll never see again.”

David did not reply.

“You know as well as I do, David, that the optic nerve is identical to the white matter of the brain; therefore, it’s incapable of regeneration.”

“Do I?”

*
  
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*
  
*
  
*

The floor, the walls, and the fluorescent-lighted ceiling of Nicole’s hospital room were devoid of color. Outside the window, David observed a lively blue jay fluttering in a willow-green tree, performing its early evening grooming. The little bird’s world was bright, but Nicole’s was dark, he thought absently, sitting on the bed, watching her. She was still unconscious but was stirring and about to awaken. He found it ironic to be bringing her news that her sight had vanished, when she had sparked his own existence with such a vibrant light. Although he sat right next to her, his still pose, his furrowed brow, and his pensive gaze distanced him, as if he were pulled away by an inner conflict.

She stretched her arms, tossed her head, and opened her eyes. She blinked, at first dazed, then with a growing sense of her new condition. The sublime tranquility of sleep vanished, and a cry of horror formed on her lips. She reached up to touch her eyes.

He gently pulled her hands down to her waist and held them in his own. He watched her sympathetically, his focus seeming to return to the room, as if he had resolved the matter tugging at him.

“Don’t rub your eyes, Nicole. I’m afraid it won’t help.”

“I . . . I can’t see! I can’t see!”

“I know.” He squeezed her hands. “You’re in a hospital. There was an explosion. Do you remember falling?”

“Yes, yes, I fell!”

She was trembling. She tossed restlessly, fighting off the grogginess, struggling to regain full awareness. She tried to sit up, but he gently pushed her shoulders back against the bed.

“Not so fast—you’ve had quite a fall.”

The muscles that moved her eyes were unaffected by the injury, so they continued to focus with an eerie vitality.

“I’m a neurosurgeon—David Lang.”

“What’s wrong with my eyes?”

“You’ve had an injury.”

“Why can’t I see, Doctor?” The voice—and the fear in it—were growing stronger.

He hesitated.

For the first time, David had to be coaxed by a patient. “If you want to be kind, you’ll just tell me straight.”

 
“You fell on your face and broke your nose. A bone fragment got loose and . . . pierced the optic nerves. I’m afraid they’re . . . severed, Nicole. That’s why you can’t see.”

“And . . . what does that mean?”

He felt her hands become wet and icy.

“In the past, that meant that you . . .”—his voice dropped—“would not see . . . again.”