beginning of their clinical rotations two years earlier now became a focused algorithm of emergency care that blocked sweaty palms and loose bladders.
The team of five dashed to the special elevator and rode it to the roof heliport, their minds running through the protocols they were about to use to prevent their new patient from becoming permanently paralyzed.
They heard the rapid whacka-whacka-whacka of the approaching Medevac helicopter’s rotors even before they opened the outside door. As soon as the pilot brought the chopper in for a gentle landing the team raced crouching across the pad to its side door. The whoosh-whoosh-whoosh of the slowing blades surged through them as they took the spinal-trauma cart holding the patient from the two EMTs aboard. Then they wheeled it to the trauma emergency enclosure on the rooftop.
Top priority: Be sure the patient’s breathing and heart functions are stable. Soon the detailed stuff would follow, the painstakingly precise, step-by-step stabilization of the injured spine. But first they needed to perform more critical preparation.
“Good, they’ve got the exoskeleton in the supply dock,” Petrie muttered, as he and Tony grabbed the grasshopper-shaped metal contraption from its container.
Fromm rapidly programmed the stimulator units built into the device’s pads that would apply pressure to specific sites above and below the injury.
Sarah and Judy prepared the injector dispensers with their life-sparing drugs.
“How did this happen, Ted?” Tony asked the EMT who had accompanied the boy on the copter, and who was struggling with his own fatigue from a long day.
“Six minutes from injury, Tony,” he replied. “It was pure luck. We were almost overhead, returning from another transport when we got the call. We landed in the kid’s front yard. Sammy Tignor here just got a skateboard for his fourteenth birthday and forgot to wear his safety helmet. He went ass over teakettle off a homemade ramp. He’s breathing well, and we’ve already cathed him and given him a starter dose of Methylprednisolone and Dexamethasone. We also got a signed release from his parents authorizing all treatment. They’re on the way by car.”
“I can’t feel anything! Why can’t I feel anything?”
“Easy, easy now,” Judy whispered. “We’re going to help you.”
They quickly enveloped the boy in the lightweight duralumin exoskeleton, which prevented motion. A specially programmed nerve-muscle stimulator sent timed electric impulses to maintain muscle tone below the cut in his spinal cord.
The team focused low-power lasers on the injury site that fired preset light pulsations to stimulate the growth of stem cells in the spinal cord. This would provide clusters of new stem cells to participate in the regeneration process.
Tony took the entry pad containing all of the accumulated patient data during the transport flight from the medtech.
“He’s able to talk and breathe,” JP noted, “but he can’t feel anything from the neck and shoulders down.”
Sammy’s spinal cord, the massive communications cable from the brain that travels down through the bony spinal canal, had been torn. The connecting wires carrying instructions from the brain—move here, feel this or that—no longer worked.
At the level of the fifth cervical vertebra, Sammy could breathe and talk but little else.
Sarah was performing a quick but systematic exam on the boy. She looked up at Tony and nodded.
“Yep, a lower C-5. Judy, get the neurosurgeon on call. We’ll get him prepped for OR.”
Judy smiled at Sammy. He looked so small, so vulnerable, so scared. He reminded her of the younger brother she had lost in an auto accident four years earlier. She wanted to cry—they all did—but that wouldn’t have helped the kid.
“Hey, big guy, you doing okay?”
Barely audible, the pubertal voice replied.
“No-o-o. Are my mom and dad here?”
“They’re on the way, Sammy. We’re going to see if we can glue you back together again. You hang in there.”
She pulled out her phone, touched the extension for neurosurgery, and began the arrangements for what would happen next.
It was called the Joshua Protocol. The team of four, under Fromm’s guidance, inserted entry ports into the boy’s veins. They had no time to ride him down the elevator into the main hospital so they worked in the specially outfitted enclosure.
“Judy, Sam here looks to be about 43 kilos,” Tony called out.
The special cart had its own built-in electronic scale and measuring devices.
“Give him 1500 milligrams of lazaroids and sialidin. Sarah, get 2200 milligrams of erythropoietin-neurotrophin mixture ready. JP, have we got the nanos?”
Fromm watched the students carefully, constantly on guard for errors in judgment. There were none.
“All set,” Judy called out.
“Okay,” Fromm said, “watch for anaphylaxis. Sarah, start the factor infusion. Tony, stay ready for problems.”
He kept his fingers crossed.
The death throes of a complex organism, like that of a single cell, follow their own protocol. There comes a steadily increasing cascade of deadly chemicals coursing through the body that must be stopped or neutralized if the individual is to be saved.
The lazaroids and sialidin streamed through the boy’s veins, blocking the lethal showers of destructive, tissue-necrosis factors that would prevent return of function. Neurotophins, nerve growth-stimulating proteins carried by microscopic nanoparticles, homed in on the site of the nerve destruction. Slowly they stimulated the nerve endings, while the erythropoietin and 810-nanometer laser pulses attempted to induce natural stem-cell production.
“He’s starting to seize!” Sarah yelled.
The boy’s eyes rolled upward and his jaw muscles tightened.
Tony reached for a prefilled syringe containing Lorazepam, a tranquilizer commonly used for anxiety and also used for rapid control of seizures, and stuck the needle into the IV port on Sammy’s right arm. Slowly, counting out, “one-thousand one, one-thousand two...” he administered the drug, and the young patient’s face slowly relaxed.
Next JP inserted a tongue guard into Sammy’s mouth and administered low-dose oxygen via mask.
“Okay, let’s get him to the OR.”
Two on each side and one behind, they wheeled the cart with the exoskeleton stabilizer and portable heart-rate and respiratory monitors to the special wide elevator doors.
As the elevator descended, Judy looked at Sammy’s peacefully sedated expression and surprised her teammates with a comment.
“I wonder what he’s dreaming.”
“Dr. Castro, Sam’s been given the Joshua Protocol. Are you going to do a Reeve Procedure on him?”
Tony
