White Sister (14 page)

"That guy's a purebred asshole," he muttered softly.

Chapter
19.

WHEN I GOT back to the trauma ward it was two P
. M
. and there were twice as many cops as when I left.

Pagers kept going off and people would get up and leave the room. Some didn't come back, but more kept arriving.

When a police officer is shot, it's standard for the chief to make an appearance. The one time I can remember when that didn't happen was when one of our guys got hit and then Chief Willie Williams was in Vegas on a junket and elected not to come home. The other time was now. Mike Ramsey stayed conspicuously absent.

Two network news teams were hovering in the corridor outside, drinking machine coffee. I pushed past their shouted questions and checked with the trauma desk. Still no word on Alexa.

I had been trying to get through to Chooch, but the Trojans were having afternoon practice and nobody had been picking up the phone at the football dorm. I sat down and tried again. This time I reached him.

"What's going on?" he asked quickly.

i 02

"I found her. It isn't good. She's been shot in the head. She's in the trauma ward at County-USC.

"No!" he said softly.

"Listen, Chooch, you should stay there."

"I'm coming!" he said, and hung up.

My head was throbbing, my palms sweating. I had a heavy feeling in my chest and I couldn't breathe. If Alexa died, I would never find my way out of this.

The next hour dragged by. My mind kept wandering off in search of some ray of hope
any slight sign that Alexa would be okay. I heard laughter from behind the glass. Would they laugh if someone were about to die? I wondered. People died every day in this place, so it might mean nothing.

I heard someone say, "She's not..." I couldn't hear the rest of the sentence so I moved closer to the bulletproof window dividing us. She's not what? I thought. Talking? Breathing? Alive? It was torture.

At that moment, the door opened and a tall, slender doctor with glasses and curly red hair came into the room. He looked way too young to be involved with my wife's near-fatal trauma, so I turned my gaze away.

"Scully?" he called out.

"Here!"

"Come on back."

"Is she . . . ?"

"Tell you in a minute." He led me through the door and down a trauma ward hallway.

"Is she in one of these rooms?"

"Just follow me," he said.

We entered a small, windowless office that had three desks jammed together and clipboards hanging on the walls.

He closed the door and introduced himself. "I'm Doctor John Romer, Chief Resident of Neurosurgery here."

"Is my wife okay?"

"Sit down," he said.

"Just tell me, damn it!" I almost shouted. "I've been waiting out there for hours!"

"No, she's not okay. When she arrived here she was technically dead. We managed to get her heart started. The good news is that the bullet missed the brain stem, which governs breathing, swallowing, and heartbeat. If it'd hit that, it would have been over. Her heartbeat is ragged and we had to give her electroshock to even it out. I've put her in a drug-induced coma to help reduce intracranial pressure and we're keeping her body temperature at thirty-three degrees Centigrade for the same reason. That's the good news. Here's the bad. She's probably not going to make it."

His words fell on me like slabs of concrete. "But her heart is beating, she's got a pulse, so she's alive," I said.

He nodded.

"Then what do you mean she's not going to make it? If she's alive, she has a chance."

"Are you familiar with the Glasgow Coma Scale?"

"The what?"

"We use GCS to measure head injuries. It goes from three to fifteen
three being worst. The prevailing judgment says anyone at four or below is a lost cause."

"What's hers?"

"Between four and five."

"That doesn't mean she can't survive," I pleaded.

"In that numeric range, something like under four percent make it, and if they do, their quality of life is usually pretty gruesome. We're talking about persistent vegetative states. Total life comas. People who never wake up and live out their days on life support."

"That's not Alexa," I said hotly.

He heaved a deep sigh. This was tough duty. As a cop, I'd offered up this kind of devastating information to family members and I knew he was desperately trying to get through it. He needed to communicate the rest of Alexa's condition, and plowed ahead.

"The bullet entered her skull at the right temporal lobe. It angled upward, and barely managed to stay to the right of the midline. It's what we call a marginal multi-lobar wound, which means it came close to crossing the midline, or midcoronal tract in her cranium. Fortunately, it didn't. It exited at the parietal lobe at the lower right side of her head. Had it crossed the midcoronal plane, both sides of her brain would have been affected and she'd already be dead. Even so, wounds of this nature have generally been associated with poor outcomes." He took a deep breath before continuing. "The temporal lobe deals with memory, hearing, language, organization, sequencing
that sort of thing. Your wife's functions in those areas have undoubtedly been traumatically affected by the path of the bullet. The parietal lobe deals with touch and visual senses, as well as spatial perception. These are her two main problem areas."

I was trying to take it in, but in truth, it was just a jumble. I was hearing what he said but panic and loss were scrambling his words, making it impossible for me to comprehend very much.

"The bullet fragmented, resulting in some collateral damage. We tried to get as much of that out as we could. The MRI showed there are still little pieces all over the place. Those might need to be dealt with later to repair normal blood flow. She's not responding to stimuli. Her motor reflexes are nil. There are several other poor prognostic neurological indicators, including fixed and dilated pupils and hypotension, which is low blood pressure. We've given her plasma in an attempt to bring her BP up and she seems to be responding." He took another breath, then added, "The bullet was a nine millimeter, which, as you know, is a pretty high velocity load. All in all, not a good prognosis. I don't foresee a favorable outcome. I'm sorry, but you need to know the truth."

"Damn it, you can't just give up on her," I said. Then I started to cry. I put my head down and tears ran. The young doctor finally put a hand on my shoulder.

"I suggest you get a second opinion from another neurosurgeon," he said.

"Can I stay here for a minute?" I pleaded.

"Yeah, sure . . . I'm sorry."

He walked out of the room.

Then, without asking permission, I walked down the hall looking for Alexa. I passed open doorways where trauma patients were leaking precious fluids onto sterile surfaces. Medical assistants stared at me as I passed. I obviously didn't belong. I didn't have a knowing frown. I wasn't wearing green scrubs and paper slippers.

Somewhere halfway down the hall I found the neuro-ICU. The only way I knew it was Alexa was that I recognized her blue
-
trimmed running shoes sitting on a table across from her. Her head was completely wrapped in gauze. Tubes ran out of her mouth and from behind her ear. Some sort of metal cone was placed over her head. Machines gurgled and hissed; the heart monitor beeped in a soft uneven rhythm.

This really has happened, I thought as I looked in horror at Alexa's gauze-wrapped head.

I felt a hand on my arm. "Sir?" a woman's voice said.

"I'm her husband," I offered numbly as I turned and looked at the woman. She was slender and in her fifties, with tight gray curls escaping from her hair cap. "What's all that stuff on her?" I asked.

"We're performing hypothermia," she said softly. "It lowers her brain temperature from thirty-seven to thirty-three degrees Centigrade."

"Oh . . . yes . . . hypothermia."

"It reduces the chance of swelling or of a secondary brain insult like a stroke or subdural hemotoma. The next forty-eight hours are critical. I think it would be better if you waited in the waiting room."

"Sure . . . okay ... if you think that's better."

I turned and walked with her back down the hall.

"She's my wife," I repeated numbly. "She isn't going to die."

"Yes, I know," the nurse said softly.

Chapter
20.

Is SHE GOING to make it?" Chooch asked. It was a few minutes after three in the afternoon, just four hours past when I'd found Alexa at Slade's house in Compton. Chooch's dark features were pinched. The fingers on his right hand were crossed as he waited for my answer.

"She's stable. The next forty-eight hours will tell." "But... is she? She got shot in the head. Is that. . . ?" "Serious," I said. "I won't lie to you, son. It's bad, but she's alive. Beyond that, I just don't know."

We sat on the vinyl sofa and played eye tag with the thirty or more cops waiting with us. As before, they kept getting calls and leaving, new officers taking their place. I opened my cell and scanned the contact numbers looking for Luther Lexington, a neurosurgeon at UCLA. I had worked on his daughter Levonda's murder two years earlier.

Levonda had been visiting her grandmother in South Central when she accidentally became an innocent victim in a senseles
s d
rive-by. I'd worked the case for almost two months before getting a ballistics match on a liquor store shooting. I finally put the case down, busting two members of the Grape Street Crips in Watts. Luther said he'd never be able to pay me back. We were friends, but whenever we talked, I could feel sadness coming off of him in waves. Levonda's ghost was standing between us. No matter how hard we tried, I was a reminder of that tragic day.

I dialed his office in Westwood and his receptionist put me right through. "Luther, it's Shane Scully," I said after he picked up.

"I saw it on TV. I tried to call you at the office and at home," he said. "Your Lieutenant took a message. How's she doing?"

"She's in an induced coma. You know what the Glasgow Coma Scale is?" I asked, knowing he must.

"What's her number?"

"Between four and five," I said. "She's stable, kind of, and her brain stem is functioning."

I got up and moved away from Chooch. I didn't want him to overhear any of this. I walked into the corridor, heading toward a small patio at the end of the hall. But some news crews were waiting there, so I turned and headed the other way.

"Did they also give you a GOS?" Luther asked.

"What the hell's that?"

"Glasgow Outcome Scale. It's determined by a lot of diagnostic stuff. If she's in an induced coma, it may still be too early to get an estimate. GOS measures ICP, pupil dilation, motor activity recovery. Regeneration of reflexes, stuff like that. It attempts to predict survival rates."

"They didn't say," I muttered. "The trauma ward doc is a neurosurgeon named Romer. He told me it's a right side transverse injury, temporal lobe to parietal lobe, but that it didn't cross some plane."

"The midcoronal plane," Luther said. "If the bullet didn't cross from the right side into the left, that's good. They'll probably line up a team. Neurologists, otolaryngologists, a vascular surgeon, some head and neck people."

"Luther, I want you to take the case. I want to transfer her to UCLA where you are."

"Let's not talk about that yet. Give me the doc's name again. I
didn't have a pencil before. But you need to know she's in a good place. USC is a level-one trauma center and an excellent neurosurgical facility."

After I gave him John Romer's name, there was a long pause. I filled the space and said, "He made it sound pretty bad, Luther."

"I won't kid you, Shane. A four or five GCS is hairy."

"The doc here said I shouldn't hope for too much. That I should start preparing for the worst."

"Okay, Shane. One thing you need to understand is the Glasgow Coma Scale is just a scale. It's not carved on stone tablets."

"Yeah, but
"

"Doctors use it to try and predict who will make it and who won't. If a case is deemed hopeless, then generally, treatment isn't advised. Obviously, if you don't treat a four or a five, you're gonna get a pretty shitty outcome. In other words, the scale itself can skew the results. You understand what I'm saying?"

"Yeah, I guess."

"A couple more things to remember. When it comes to head injuries, nobody knows anything. The brain is a damned complicated organ and we don't understand exactly how it works. We have to remember that a person with a brain injury is a person first, and a patient second. Alexa is precious, so we're never gonna quit on her, okay? And that could affect her survival and recovery rate."

"I understand. Thanks."

"I'm not through. The next thing I want you to remember is, no two brain injuries are exactly the same. The effects vary greatly from person to person."