Taming the Telomeres, A Thriller

Doctors Explain

Each of the doctors in the conference room wears a poker face.

"My name is Dr. Wrightson, I'm a neurosurgeon here at the hospital. This is my colleague Dr. Bill Burge, a general surgeon. This is Dr. Peter Lucent, a neurologist-psychiatrist, and we have been consulting with several other doctors. But first I wanted you to know that we've completed a six-hour surgery on Amanda who I understand is your niece, correct?"

"Yes that's, that's correct," Barb answers.

"We are all so sorry for your family’s loss, but Amanda is quite the amazing patient. We did a lot of imaging when she first arrived here. Since she was not conscious when she entered, we obviously did MRIs of her brain and CT and MRI scans of all of her spinal areas. We have learned some troubling things.

“The MRIs of the brain showed that she has well, to put it very simply, bleeding in the frontal area of her brain lobes. Then, in the series of CT scans and MRIs of her spine we found that there is a fracture of the vertebrae at C2, which means her neck area. We stabilized her and reduced the swelling in her brain.”

Dr. Wrightson walks around the conference table and points to the scans that are clipped to a white board. Obviously, the doctors had been talking about these films before Barbara and Andy entered.

“With this type of fracture we have to be absolutely sure that there is no movement in her neck area. To do this we had to surgically attach what is called a halo. It actually encircles the skull and is attached with pins that we inserted into her head. Then we attach metal vertical rods to the halo ring and we custom-fit a plastic jacket around her upper torso. The idea is that between the plastic jacket and the rods connected to the halo, we prevent any movement of her neck. We see anywhere between 15 to 85 percent of the patients have success. Success meaning that the cervical fracture heals itself and the bone fuses back together. I know I just covered a lot, do you have any questions?"

"Not yet…" Andy says.

“I had an infectious control doctor at the surgery because she had so many lacerations and contusions. We took some cultures and the infectious disease doctor will follow up.

“Despite having multiple traumas all over, the rescue records reflect surprisingly little blood loss. I will need to reconfirm those figures. She did suffer a significant brain injury and as to that situation, I'll turn this over to Dr. Lucent for comment."

"I'm Peter Lucent. We can tell you Amanda has suffered what we call a mild to moderate brain injury but not a lot about her prognosis is known because she has not regained consciousness yet. The problem with Amanda’s type of injury is that the front lobe of the brain controls many executive functions. It controls our impulses, and it plays a significant part in our general cognitive reasoning. Frankly, we will need to carefully reduce her medications and hope for the best. Although we are currently assisting her breathing and providing her nutrition, she'll hopefully be breathing on her own soon. We're also hopeful she will come out of this coma soon and have a good recovery. But with the type of impact that she suffered it's just going to be a wait-and-see situation."

"When will we be able to see her?" Andy asks.

"Once we feel like she's completely stable and we get her into a room, we will allow the immediate family to see her. But she will be in intensive care for some time," Dr. Lucent says.

"Does this mean she's going to have permanent brain damage?" Barb bluntly asks.

"We can't tell at this point," says Dr. Lucent. "So the answer is possibly yes, possibly no."

"With this type of halo, does she need a wheelchair? And how long does she need to have that halo?" Barb asks.

Dr. Lucent looks a bit uncertain and turns to Dr. Wrightson for an answer.

"She’s definitely going to be in a wheelchair. How long will she be in the wheelchair and how long will the halo be on? It's too hard to tell at this moment. Until she's up and responsive to us we’ll be speculating as to whether she will have any paralysis. As for the halo, it can be 90 days or longer. Unlikely to be shorter, but maybe longer. We will conduct progress imaging to monitor the bone growth at the fracture site.

"Now, as you can appreciate the national media is pressing in every direction for information on your niece, given that she is the only known survivor of the crash. Do we have your approval to at least give general information to the media about your positive identification, our surgery techniques and her stable condition?"

Andy and Barb look at each other and ponder the question. Then, Andy answers.

"I see no problem with that."

"Do either of you want to attend the news briefing?"

"I don't think so," Barbara says, looking to Andy for his agreement. He nods affirmatively.

A hospital administrative-type person, who had not spoken yet, produces a piece of paper with a short paragraph permitting the disclosure, which Andy signs. With that, the doctors rise from their chairs and one by one shake the hands of Andy and Barb before leaving.

"We want to thank you so much for everything you are doing for her." Andy says sincerely.

"Sure. Again, we are sorry for your loss," Dr. Wrightson offers.

Barb and Andy then walk back to the family room to pass the news along to those anxiously waiting for an update.