an African-American in her late 50s, nodded. She was tired from a night of dealing with auto-accident trauma, but nothing mattered more now than the well-being of this kid the resident and his team had brought her.
Her mind went into overdrive and the fatigue vanished.
“We need to go in and restore neurilemma continuity.”
Neurilemma, the magic covering of the nerve axon, acts like a continually expanding tunnel through which the long finger of the neuron, the nerve fiber, travels to its destination. Disrupt that sheath and the nerve ending has no way of finding its path. It becomes effectively blind and wanders aimlessly, often forming an ineffective—though painful—tangled, ball-of-yarn nerve clump.
The four almost-doctors, now in OR sterility suits, clustered around the large, flat-screen monitor, watching Castro activate the surgical microscope field and micro-Waldo units.
The anesthesiologist had used a Ketamine derivative to put Sammy into a form of dissociative anesthesia that would not suppress his breathing. His mind would float in a netherworld of non-existence; his body would feel nothing.
The chief OR nurse activated the exoskeleton controls and rotated the patient’s carefully immobilized body to a face-down position.
Todd Baker, the assisting neurosurgery resident, activated the mini-MRI unit. A portion of the viewing screen showed the havoc within Sammy’s neck.
“We’ll make the initial incision 2 centimeters below the break,” Castro said, speaking slowly as she brought the ultrafine laser scalpel down on the patient’s skin. It parted, bloodlessly. She peered through the microscope as she penetrated, layer by layer, down to the muscles and ligaments surrounding the neck bones.
“There it is, ladies and gentlemen.”
Tony, JP, Judy and Sarah all stared in wonder at the thin-walled portions of the fifth cervical vertebra and the red, swollen nerve ending capped by a blood clot where it should have continued down the spine.
Castro adjusted the laser’s controls and the light beam vaporized the clot.
Baker, one month from entering the world as an attending, carefully handed her a vial of stem cells. Subconsciously he felt like an acolyte on the altar presenting an offering to the officiating priest. In turn, Castro used a special glass syringe to draw up the mixture of stem cells and neurilemma growth factor, and began to infiltrate the severed nerve ends. Then she activated the micro-Waldo operating hands. This computer-guided machine allowed her hand and finger movements to be imitated in miniature by tiny robotic appendages.
Peering through the operating microscope, every movement of Castro’s fingers was reduced to micrometer-fine motion that allowed her to rejoin the neurilemmal sheaths. Meanwhile the surgical resident applied neurotrophic factor/stem-cell mixture and nerve glue each step of the way.
Castro smiled in satisfaction then turned to the intense young man standing beside her.
“Okay, Petrie, now what?”
“Restoration of vertebral integrity.”
“That’s right! Hicks, how would you do that?”
“Synthetic bone graft and bone glue.”
“Good! Knowlton, what’s the risk?”
“Rejection of stem cell graft or adverse reaction to injected nanos.”
“If none of that happens, Hidalgo, what next?”
“Continual intense neuromuscular stimulation by both electrical pulsation and laser, and then physical therapy after primary nerve regeneration and wound closure. His limbs will need frequent motion, and his skin needs to be protected from pressure sores while recovery takes place. At the same time his neck must remain immobilized, and unwanted calcification in the wound area must be prevented from disrupting the regeneration process.”
“And…?”
Castro stared, remembering herself as a young medical student answering questions from an older doctor in a similar situation.
Hidalgo’s manner resembles that doctor’s. Could it be?
“His head and neck will need to remain in a halo unit until stability of the cervical spine is confirmed.”
Tony mentally pictured the unit they called the “crown of thorns,” which would keep Sammy’s head from a damaging involuntary muscle spasm.
Then Baker jumped in.
“What’s the anticipated recovery time?”
The neurosurgery resident added his two cents, practicing his attending’s voice.
Won’t be fun unless I can pimp the med students with my questions.
“About one month.”
“Before the Joshua Protocol and the Reeve Procedure, what was the recovery time?”
The four students paused for a moment, watching the still-unconscious boy lying in his metal cocoon.
Tony whispered his answer.
“Never.”
Castro let the surgical resident do the wound closures. Then an orderly wheeled the surgery cart into recovery, the patient even more firmly restrained.
She summoned Tony outside the OR.
“Hidalgo, are you by any chance related to a Dr. Galen?”
“Robert Galen?”
“Yes.”
“He’s my guardian, Dr. Castro. I call him Tio. He and his two friends, my Tio Edison and Tia Nancy, adopted my sister and brother and me. We all live at a place we call Safehaven, in Pennsylvania.”
“Would you give him my best? I was a student of his … a long time ago.”
“You all did a great job, guys!
Jerry Fromm was one happy resident. His team had done well, and in doing so reflected on his ability to supervise. No doubt the other residents would recognize him as a good teacher.
He also knew he was lucky. He had heard the nurses gossiping about this group—they called the kids “the A-Team.”
“How’s it going, kiddo?”
“I can feel stuff now, Dr. Hicks.”
“That’s great, Sammy!”
“Uh ... Dr. Hicks, is Dr. Petrie your squeeze?”
She grinned at him and nodded.
“Good, I like him. He looks and talks funny.”
“What about Dr. Hidalgo and Dr. Knowlton?”
“Who’s been talking to you, kid?”
“Well,
