Trauma, page 24
The Glasgow score provided neurologists with a way to gauge the severity of an acute brain injury. By measuring various functions, including eye opening, verbal response, and motor response, a patient’s prognosis could be predicted with surprising accuracy. Anything eight and above had a good chance for recovery, while a score between three and five was most likely fatal. A six was the nether world—not great, not dismal. Perfectly in between.
Sam Rockwell had suffered a massive hemorrhage that went below the arachnoid membrane and into the cerebrospinal fluid, according to what Dr. Smerling had told her. The hemorrhage had grown, too, in part because of a course of anticoagulant medication. The increased swelling from fluid collection around the hemorrhage site caused further pressure on the brain structure and additional neurological injury.
For Rockwell to have emerged from his coma and get a six on the Glasgow score was about as likely as Goodwin inviting Carrie on a girls’ weekend.
“So what’s driving the number?” Carrie asked.
“We’ve got a little more verbal response than before, but his speech is still incomprehensible. He’s a two there. His eyes have opened in response to pain, and he’s got the same decerebrate posture as before.”
Based on that alone, Carrie pictured Rockwell in his hospital bed, arms and legs held straight out, his toes pointed downward, and his head and neck arched back. The abnormal posture was a sign of severe brain damage and earned him a two on the widely used scale. The eye movement was the new development, having gone from a plus one to a plus two in under a day. It was encouraging progress.
While there was no real reason for Carrie to rush up to Maine, Rockwell’s scores were not low enough to keep her from making the drive. As Dr. Smerling confirmed, his scores could improve at any time, and perhaps the verbal could get up to a four. The conversation in that case might be confused, but he might be able to answer some simple questions.
Did you ever see palinacousis in the vets before?
Did you notice any side effects from the DBS surgery?
Did any of your patients ever go missing?
As long as there was hope for Rockwell’s further improvement, Carrie could stay a day or two before her next scheduled surgery.
“Well, I appreciate you keeping me in the loop,” Carrie said. “I’ll be up there in a few hours.”
Carrie ended the call and her foot got a little bit heavy on the gas. She noticed the helicopter high up in the sky, hovering like a dragonfly as it made several passes over the highway. You’re not going to find any traffic here either, she thought.
Twenty minutes later, Carrie made a pit stop at a roadside gas station, an oasis on a lonely stretch of road. She filled the tank and took a much-needed stretch. She got a chicken salad at an attached restaurant, and was back in her Subaru thirty minutes later, enjoying a glorious sunset.
Up ahead, Carrie noticed a red Ford F-150 truck pulled over to the side of the road. She checked for oncoming traffic, wanting to give the truck a wide berth as she passed. She was maybe fifteen feet away when the Ford’s engine revved, its taillights flashed, and the pickup spun out into the road in front of her.
Carrie shrieked and slammed on the brakes, burning rubber that left long black trails behind her. She had been going forty-five, and avoided a rear-bumper collision by inches. Carrie leaned hard on her car horn to let the pickup driver know exactly what she thought of that maneuver. The F-150 sped on ahead, and Carrie released her white-knuckled grip on the steering wheel. Her hands trembled slightly as the adrenaline rush lingered.
“What an asshole,” Carrie muttered under her breath.
The F-150’s brake lights lit up as if the driver had heard her and wanted to escalate the confrontation. Carrie tapped on her brakes to keep distance, but the truck had slowed to a crawl and the gap between them closed in a blink. Clenching her jaw tight enough to hurt, Carrie braked some more, but the truck had come to a near standstill; before she knew it, the bumpers were almost touching.
Carrie hit her horn again, but with a little less force. The beeps were meant to urge the driver to pick up speed, not show her anger. She noticed the license plate was from Maine. Probably some local kids who did not take kindly to tourists who dared use the horn on them.
The truck picked up speed, and Carrie did as well, but inexplicably the driver braked again. The next time it accelerated, Carrie kept some distance that she would use to try and pass on the left. She had no desire to play this obnoxious game for the remainder of her drive.
She checked the traffic, moved over a lane, and gunned the accelerator to pass. All four of the Subaru’s engine cylinders worked overdrive to build up some speed. Carrie glanced to her right as she passed the truck, but the driver was just a shadow. She drove on ahead and felt her blood pressure spike when a check in her rearview showed the truck gaining. The truck was flashing its lights and slamming the horn. Carrie had one chilling thought.
Road rage.
She accelerated, but the more powerful pickup easily kept pace. The truck’s horn blared and its headlights flashed. Carrie rolled down her window and waved her arm to encourage the pickup to pass. The truck gained speed, but did not change lanes. The driver got so close to her Subaru the bumpers nearly kissed. Carrie’s heartbeat accelerated. She brought her arm back inside her vehicle. If the driver was not going to pass, she might have to get to the side of the road and let him go by.
A flash of fear came over her. What if she stopped and he did as well? There were no other cars on this stretch of highway. She checked her phone: no signal. Carrie could not imagine being in a more vulnerable position.
She put her arm out the window and gave another urging wave. This time the truck veered left into the oncoming lane, and then right, then left again, weaving down the road. Before Carrie could make sense of it, the pickup switched lanes and accelerated again. Carrie punched the gas, but the F-150 easily kept pace. They were driving alongside each other, but only the Ford was at risk for a head-on collision. Carrie dared a glance to her left and saw a single broad-shouldered driver in the cab. His face was an empty shadow, or so she believed. For a second, Carrie thought he had on a black mask. She did not get a chance for a better look.
Panic gripped her. Carrie floored the accelerator around a sharp bend and her car shot forward like a rocket. Her tires skidded, but never lost grip of the road. The Ford stayed in the left lane and kept pace as it inched closer to her car. She would have to leave the road to get any distance. Ahead was a long, straight stretch of highway with no oncoming traffic. Again Carrie leaned on her horn, giving it a long and angry blast, and then intentionally let up on the accelerator, hoping the Ford would decide to pass. The pickup’s driver anticipated her plan somehow, and slowed as well.
The truck kept parallel to Carrie’s car as it maneuvered yet another inch closer. The distance between them was no greater than a hair’s width. Carrie heard a sudden and tremendous crack as the truck snapped off her side mirror. The piercing scrape of metal on metal followed.
Instinctively, Carrie turned the wheel hard right as the pickup swerved away. She straightened out her course just as the pickup came back again. This time, the truck slammed into the side of her car. Carrie gave a yell and swung the wheel right. Her only thought was to get away from danger. She did not contemplate the consequences of making such a violent and sudden turn. Once the skid started, it was not going to stop.
Carrie screamed as her car veered off the highway going forty and headed for a dense copse of trees. Everything was a blur of green. She heard tree branches snap violently and metal and glass shatter. There was a huge crash, and a crack of splitting wood louder than thunder. Carrie’s head snapped back and she heard another sickening crunch of metal and plinking glass as the car stopped abruptly. A gunshot sound followed as the airbag deployed. It happened so fast, Carrie could not even register what hit her, but it felt as if somebody had slapped her face as hard as they could. Chalky dust went into her eyes and up her nose as she choked on a pungent stench.
For a moment, Carrie could see nothing but the white of the airbag. But then the pain came and the whiteness of the bag gave way to black.
CHAPTER 42
Braxton Price and Curtis Gantry used the police scanner in the pickup to listen in on the aftermath of Carrie’s accident. The accident drew two fire trucks, two police cruisers, and an ambulance to the scene. The driver was conscious and reported that a red Ford F-150 with Maine plates had driven her off the road.
The APB included no plate number, so Carrie had not seen, or could not recall it. Either way, Braxton was not worried about the police pulling them over. They were driving Gantry’s blue Chevy pickup with Massachusetts plates. Braxton had ditched the Ford on a prearranged side street off Route 1 about ten miles from where the accident occurred. Gantry had picked him up there, per the plan, and together they resumed the drive north. The whole operation had been improvised when they got word Carrie was headed to Maine.
Braxton took the chopper north, secured a car to use, and got behind Carrie’s Subaru with help of the chopper and Gantry, who had tailed Carrie all the way from Massachusetts. Braxton figured on taking her down near Bangor when she left the highway, but Carrie had opted for a scenic detour, so he and Gantry had arranged a different meeting place. It helped that Carrie had stopped for something to eat. Braxton was able to pull ahead and wait for her while Gantry got even farther down the road. The transition from one truck to the other took no time at all.
Gantry was acting like a boy at the skate park—all smiles and pumped full of adrenaline. He loved missions, any missions, but especially successful ones.
“So she didn’t die,” he said. “Does that mean we get a bonus?”
“No, it means we didn’t screw up,” Braxton said.
“What’s the worst thing that could have happened?”
“We’re about to permanently take out Rockwell. We don’t need two docs going dark on the same day from the same hospital who happen to work for the same program. It’s not the sort of coincidence our employers are interested in explaining away. What we did wasn’t optimal, but we had to do something. Besides, she’s still considered an asset to the program—at least, that’s the word from up high. I figured if Rockwell didn’t die after we ran him off a cliff, Carrie could survive a little action in the trees. Maybe we got lucky here, but we did all right.”
Gantry went silent. He seemed almost reflective, though Braxton knew his friend’s thoughts seldom strayed far from guns, sex, and money.
“Good thing we had the bird in the sky,” Gantry said. “I had lost her for a while there.”
“There are no helicopters where we’re headed next. No backup, either. We get caught, we’ve got to go dark ourselves. You carrying?”
From the pocket of his denim jacket Gantry fished out a white pill the size of a Tic Tac and popped it into his mouth.
“Hey, don’t screw around with that!” Braxton snapped.
Gantry hid his teeth and pressed the cyanide capsule between his lips. He flashed Braxton a toothless smile. “I t’ank you’re purty, Braxton. You like me?”
“Get that out of your mouth before you bite it and die.”
Gantry spit the pill into his hand and tucked it back inside his jacket pocket. “Who did you give the money to?” he asked.
“None of your damn business.”
“I’m guessing it’s Jesse.”
“Guess all you want.”
“How long since you’ve seen him?”
Braxton thought a beat. “Maybe five years. Maybe more.”
“So he’s what, fifteen now?”
“Something like that.”
Gantry gave a long, low whistle. “Imagine being that young and getting, what is it, half a million dollars? Just like that? Shit, if I had that kind of money at that age I’d have screwed myself into a coma deeper than Rockwell’s.”
“He’s not going to get the money, because we’re not going to get caught.”
“Maybe I won’t take the pill,” Gantry said.
“Who did you give the money to?”
“My mom,” Gantry said.
“So we get caught, you’re dead regardless, and instead of your mom winning the lottery, somebody other than you will be planning her funeral. Look, Gantry, the poor woman had it hard enough raising your sorry ass. Give her the peace of mind she deserves, man.”
Gantry nodded. He saw the logic in Braxton’s thinking. Always did.
“Speaking of piece, Carrie’s got a great ass,” Gantry said.
“That’s a different kind of piece,” Braxton said.
“Whatever. I’m just saying I followed her on a jog in Healey Park, and she has tremendous assets. I’d love to tag that.”
“That’s how you conduct surveillance?”
“Hey man, I’m just doing my job. Checked out her room, too. Nothing there, but I did have a nice time lying down on her bed and thinking dirty thoughts.”
“Nobody saw you?” Braxton asked.
“Nah, man. Her brother is a drone. He was watching TV and didn’t hear me come in. I think that guy could use the wires, if you get my drift.”
Braxton shook his head dismissively, turned on the radio, and eventually found the local NPR station.
Gantry listened for all of three minutes before he tired of hearing about the struggles of life in Libya and switched to a pop station. “You and your freakin’ NPR. I don’t know how you listen to that crap. We’re like the Odd Couple, man,” Gantry said.
Braxton shot Gantry an annoyed look. “Have you ever even seen that show? I know for sure you didn’t read the play. Do you even know what you’re talking about?”
To Braxton’s surprise Gantry returned a broad, sloppy grin and hummed in perfect tune the opening bars to the show starring Tony Randall and Jack Klugman.
“The Internet has everything, asshole,” Gantry said, and he resumed humming. On they drove, speeding into the twilight on their way to Seacoast Memorial Hospital, with Gantry humming The Odd Couple theme as if it was his favorite show of all time.
* * *
GANTRY PULLED into the hospital parking lot a little after nine o’clock. The two-story, mostly brick structure appeared to be undergoing a major renovation, and Gantry drove around until he found a parking space out of the way, near a loading zone. He cut the engine only after making sure that no surveillance cameras were around to record them.
Meanwhile, Braxton maneuvered inside the cramped cab and pulled off his loose-fitting sweats and T-shirt to reveal the green custodial uniform he wore underneath. He had in his possession an employee badge from Seacoast Memorial with his picture on it, but Lee Taggart’s name. The uniform and badge were precautions taken a while back, as soon as they’d known Rockwell would be a patient at Seacoast Memorial for a while. In the shadows of some scaffolding he checked his supplies: a syringe and a vial of clear liquid.
“I’ll be out in ten minutes,” Braxton said as he filled the syringe with liquid to the last marked line.
Gantry winked and blew Braxton a kiss. “Careful, sweetheart. I’ll be thinking of you.”
Braxton ignored him and headed for the main entrance. Inside the hospital, he flashed security his ID and continued on his way. No problems there. Braxton’s badge opened all the doors, a modern miracle courtesy of some supremely competent computer types who worked for his employers. Deep pockets bought a lot more than aerial surveillance.
Braxton walked the halls until he found a janitor’s cart—complete with a broom, cleaning supplies, and a twenty-gallon vinyl bag for trash—tucked away in an unobtrusive nook. He wheeled the cart over to the long-term-care wing on the first floor. The diffused fluorescent lighting, powerful stench of cleansers, beeps of various machines, and unpleasant stale air reminded Braxton of the VA. All hospitals were essentially the same, and the people who came to them were the same as well: They got better, got worse, or got dead.
Braxton went in and out of several rooms, emptying the trash and wiping down furniture. The two duty nurses did not give him a second look. He was the help, one of the invisibles who worked behind the scenes to keep the place clean enough to cure.
“Good evening,” Braxton said to a stout nurse who sat behind a desk covered with monitors.
Same shit, different location.
“Evening,” the nurse said. She gave Braxton only a cursory glance before her focus returned to those monitors.
Braxton wheeled his cart into Sam Rockwell’s room. For a guy who had been in a coma for so long, Rockwell actually looked pretty good. The bruises and cuts had mostly healed, and he appeared to be sleeping peacefully.
With practiced skill, Braxton injected succinylcholine intravenously and titrated the flow to speed up induction. Beneath the skin, invisible to the eye, Rockwell’s muscles had begun to twitch and spasm. Almost immediately Rockwell’s heart rate accelerated to help get oxygen to the brain. But the neuromuscular blocker, widely used by anesthesiologists and easy for Braxton to procure, would stop that heart in short order.
A patient as injured as Rockwell would not be subjected to an autopsy, Braxton had been told, and there was little chance of discovering the breakdown product, succinic acid.
Braxton counted to thirty before he wheeled his cart out of Rockwell’s room and over to the nurses’ station. “I’m no doc,” he said, “but that guy in there looks like he’s having a real hard time breathing.”
As if on cue, an alarm sounded. The nurse leapt up from her chair as though it were on fire, and rushed into action. Braxton heard the code call come over the loudspeaker. A moment later, a crush of doctors and nurses headed for Rockwell’s room like galloping racehorses.
Braxton became invisible again as he wheeled the janitor’s cart nonchalantly down the hallway, whistling the tune from The Odd Couple as he went.
CHAPTER 43
“It looks a lot worse than it feels,” Carrie said.
