Trauma (39 page)

Welcome back to the jungle; nice of you to come.

The morning hustle and bustle seemed so perfectly ordinary, which paradoxically made it all feel a little eerie. Although there was a heavier-than-usual VA Police presence, Carrie saw no crime scene tape, nothing cordoned off. The evidence, as Detective Kowalski indicated, had been gathered, documented, and photographed in the intervening hours. Life at the VA, for all intents and purposes, had returned to normal.

Carrie's plan for the day was a simple one. With no surgery on the docket, she would spend time examining Dr. Finley's case files, and start to gather evidence. David had the right instincts. Had other vets gone MIA like Abington or Fasciani? If Goodwin wanted to conceal a side effect such as palinacousis, the first step would be to get those patients off the neuro recovery floor, where residents were trained to look for cognitive issues.

Carrie showed up at Dr. Finley's office with two cups of coffee, but when she opened the closed door, she found three people inside. Sandra Goodwin and Evan Navarro sat on those uncomfortable metal chairs facing Dr. Finley.

Carrie's eyes turned to slits as she focused her attention on Goodwin. She fought back the urge to scream,
Did you try to have me killed?
The outburst might have been satisfying, but Carrie knew it would serve no purpose. All that mattered was obtaining proof of Goodwin's wrongdoing. That required tact, not brute force.

Goodwin and Navarro both acted irritated by Carrie's intrusion; no outward signs of empathy there. Dr. Finley's face, by contrast, revealed his deep concern, and it put a walnut-sized lump in Carrie's throat. He was effusive in expressing his utter relief.

Carrie presented Dr. Finley with the coffee she'd bought him. “I know it's not Starbucks, but it's the best we've got here,” she said.

“The fact that you could think about me at all is incredible,” Dr. Finley said. He took the beverage with a grateful smile. He remained standing beside Carrie, his hire.

Carrie looked over at Goodwin and Navarro. “I hope I'm not interrupting anything,” she said.

“Coincidentally enough,” Goodwin said, “you were the subject of our conversation.” The tone of her voice cooled the room a few degrees.

“Oh?”

“We're discussing the DBS program,” Navarro said.

Carrie could not help feeling amazed at the lack of empathy. “Well, in case you or Sandra were curious, I'm doing just fine,” she said. “Thank you very much for asking.”

“I'm glad to hear it,” Goodwin said, not sounding glad at all. “But my chief concern, as I was just explaining to Alistair, is the continuation of DBS surgeries in light of your incident.”

“By ‘incident,' I assume you mean my attempted murder.” Carrie felt her whole body heat up. It took great restraint not to go at Goodwin the way Adam had threatened David.

“It's my opinion that a trauma such as what you experienced makes you a danger to the patients and to the program.”

“Last I checked, I wasn't actually shot,” Carrie countered. She saw where this conversation was headed, and she did not like it one bit.

“While you aren't physically injured,” Goodwin said, “your mental status is questionable at best. Evan has been studying up on the DBS procedure, and I think he'll be fine to take over for you until a mental health professional clears you to operate.”

“Evan?” Carrie could not hide her incredulity. “Is that why he came to the OR? To watch me work? Nice bit of subterfuge there, Sandra. Well played.”

“I don't appreciate your innuendos, Carrie,” Navarro said.

“I don't appreciate you poaching my job,” Carrie snapped back.

“It would only be temporary,” Dr. Finley said in a conciliatory tone.

Carrie frowned. “You're not on their side here, are you, Alistair?”

“No,” Dr. Finley said. “I'm not. But we have another problem.”

Sandra flashed a frigid smile. “I told Alistair that if we don't replace you with Evan, I'll go to the board with a formal complaint about your violating my procedures by interfering with patient care. Given all the scrutiny the VA is under these days, I'm sure you can imagine how poorly that will be received.”

“They'll force me to let you go, Carrie,” Dr. Finley said in a defeated voice.

“And Evan will continue in your place regardless. So really, Carrie, you have no choice in the matter.”

“When is the next surgery?” Carrie asked.

“The day after tomorrow,” Navarro said.

Carrie shot Dr. Finley a panicked look. “Is it a PTSD case?” she asked.

“Yes, it is,” Navarro answered. “But don't worry, I'm ready, and it'll go just fine.”

Dr. Finley cleared his throat, and Carrie noticed how uncomfortable he seemed. “Carrie, Dr. Goodwin has requested that you take a leave of absence until you're medically cleared to operate.”

“I've seen how you like to interfere with my processes and procedures. I'm not one to give second chances, and I don't want to risk you inserting yourself where your services are not required.”

“Alistair, I can't believe you're letting this happen,” Carrie said. “Navarro doesn't know anything about DBS.”

“Look at it this way, Carrie,” Dr. Finley said. “I have no choice. That's the way it is in the VA. It's the military, and everyone has to take orders, including me. Navarro has a licensed M.D. after his name, and as far as the VA is concerned, that means he can do everything from heart surgery to delivering a baby if the VA says so.”

“I strongly disagree with this,” Carrie said. “How can you feel comfortable with someone who may be completely incompetent?”

“As I recall, Carrie,” Navarro said, “you had no experience when you came on board.”

“If you take some time away, I can get you back on the team,” Dr. Finley said. “On a permanent basis, if you like. If you don't, Sandra will go to the board, and if she does that, your status here will be entirely out of my hands.”

Carrie's arms fell to her sides. “What choice do I have?” she asked.

Goodwin stood. “None,” she said.

 

CHAPTER 53

With a scowl across her face, Carrie leaned against a wall outside Dr. Finley's office, arms folded tightly across her chest, and waited for Goodwin and Navarro to depart. As he walked out, Navarro shot Carrie a smarmy, sidelong glance that made her blood boil once more. But her real anger was saved for Goodwin, who refused to look Carrie in the eyes.

Are you surprised I'm still alive?
Carrie wanted to shout.

Goodwin could not have been completely dissatisfied, though. She had played the same blackmail card twice, but this time to greater effect.

Carrie stormed back into Dr. Finley's office as soon as the other two were out of sight.

“I can't believe you let Goodwin do that to me,” Carrie snapped as she closed the door behind her.

Seated at his desk, Dr. Finley looked utterly besieged. He let go a loud sigh and ran his fingers through an unruly tangle of hair.

“We can retreat now and regroup later, or Goodwin will put a permanent end to your career,” he said. “She'll trash your reputation so that you'll never match for another residency, and I doubt you'll find a situation like this one at some other hospital. Think about what's best for your career here, Carrie. Take the time off. Let the dust settle and hope to allow cooler heads to prevail. The program has to be protected at all costs.”

Though it stung to hear, Carrie was not entirely surprised by Dr. Finley's stance. Any threat to the program, in his view, had to be neutralized. He had gone out of his way to hire Carrie in a rather unorthodox manner to avoid significant delays following Rockwell's accident. He would do what was necessary to keep the OR active.

“Speaking of the program, did you know Bob Richardson works for CerebroMed?”

Dr. Finley's brow creased and he looked a little puzzled. “I'd never met Richardson before your demo. But I'm not entirely surprised.”

“No? Why?”

“DARPA hired them.”

“DARPA contracted with CerebroMed?” Carrie was surprised. “We deal in DBS, Alistair, not neurological drugs.”

“I'm well aware,” Dr. Finley said. “Cal Trent told me that CerebroMed has been developing software for studying and re-creating traumatic events. DARPA has been partnering with them, but that's all I know. It's part of the VR program, and not really within my area of expertise. How did you learn this, by the way?”

Carrie shrugged off the question. There was no use debating. Carrie knew she had lost her greatest ally. This program was Dr. Finley's greatest love, and it meant more to him than the truth about Goodwin. That much was obvious. Until she could give him definitive proof, he would always find a logical explanation for any concern Carrie raised.

“Well, can I at least review the files I requested?” Carrie asked.

“Yes, of course,” Dr. Finley said, and he presented Carrie with a large stack of files. Carrie glanced at them briefly.

“These are neurological reports,” she said.

“Yes.”

“I'm looking specifically for postoperative complications.”

Dr. Finley grimaced a little. “I'm afraid that would require Dr. Goodwin's involvement.”

Carrie just smiled and clutched Dr. Finley's files to her chest.

“No worries then,” she said. “I'll just look over what I have.”

*   *   *

CARRIE RETREATED
to her office. She set Dr. Finley's files on her desk. From her purse, she dug out Evan Navarro's hospital ID and log-on credentials. They were written on the same piece of scratch paper as the main number for the VA, which Carrie had jotted down the night Eric Fasciani disappeared. Carrie might not be able to view the medical records of DBS patients who had spent time on the neuro recovery floor, but Navarro could.

The electronic medical records system, known as VistA (for Veterans Health Information Systems and Technology Architecture), offered a variety of specialized enterprise applications, including electronic health records. The system, one of the largest in the United States, contained the records of more than eight million veterans, and personal data for hundreds of thousands of medical personnel and operating staff. Carrie was interested in only a handful of patients, specifically vets like Abington and Fasciani who had DBS surgery to combat PTSD symptoms.

Carrie launched the VistA program and entered Navarro's ID into the log-on screen. It took her almost thirty minutes to figure out the system, but eventually Carrie got the hang of it. It was different from the electronic medical records system at BCH, but intuitive enough for her to search for Steve Abington's name. From there, Carrie was a few clicks away from the problem list detailed in the computerized patient record system, abbreviated on the graphical user interface as “CPRS.”

Steve Abington's arrhythmia was logged as “inactive,” but she could see the onset date, last update, and location of the incident, which was the neuro recovery floor. The application said nothing about Abington's transfer to the med ICU, probably because Navarro did not have access privileges to that part of his medical record. Navarro was a neurosurgeon, and it seemed the walls Goodwin had erected between her department and the rest of the VA applied to this software application as well. No matter. Using Abington's case file, Carrie retrieved the clinic-specific procedure code for DBS and used that to search all DBS patients in the past twelve months.

There they were. Some names Carrie recognized: Steve Abington, Eric Fasciani, Don McCall, Ram
ó
n Hernandez, Gerald Wright, and Terry Bushman. Some she did not. Based on the patients who were fully anesthetized during their operation, it was easy to distinguish between DBS patients treated for movement disorders, and those treated for PTSD.

On a piece of paper, Carrie made a two-column table and filled it with information from Abington's patient record. She ignored details such as clinical reminders, recent lab results, patient record flags, postings, and active medications to focus solely on significant problems that might have resulted in a patient being transferred to another unit.

She started with the patients she knew, and in a matter of minutes had a list of four names, with one medical complication post-DBS among them.

The next patient Carrie looked up was Jim Caldwell. According to the record, Sam Rockwell had done his surgery. Seven hours after the operation, Caldwell's blood sugar levels dropped. Carrie could not see in the VistA system whether he remained on the neuro recovery floor, but now she had another name for her expanding table.