The Kowalski Scenario

In brain surgery, finishing second is not an option.

Sometimes, there are no good, or even reasonable, choices.

Sometimes, you do everything right and still cross the finish line in second place. But here’s the thing. In brain surgery, finishing second means somebody is going to suffer. More to the point, that somebody isn’t going to be you, but it may very well be because of a decision you made.

And that’s only one of many decisions you will make that day. That week. That month. Day in and day out, the lives you save, and the ones you don’t, will haunt you.

The Kowalski Scenario: a medical suspense.

In brain surgery, finishing second is not an option.

A Tale of the Bloody Scalpel.

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About the Book

Sometimes, there are no good, or even reasonable, choices.

Sometimes, you do everything right and still cross the finish line in second place. But here’s the thing. In brain surgery, finishing second means somebody is going to suffer. More to the point, that somebody isn’t going to be you, but it may very well be because of a decision you made.

And that’s only one of many decisions you will make that day. That week. That month. Day in and day out, the lives you save, and the ones you don’t, will haunt you.

The Kowalski Scenario

In brain surgery, finishing second is not an option.

A Tale of the Bloody Scalpel.

 

One Friday night early in my training as a brain surgeon, a teenager came to the emergency room with a burning fever. He had a toxic look about him, with skin the speckled russet color of spoiled potatoes, and just that smell too. He took in long, almost lackadaisical breaths and the best that could be said of him was how listless he seemed, as if living was an afterthought soon to be a distant memory.

‘That ain’t tiddlywinks,’ as my mom used to say, and they called me because the kid wasn’t talking and wouldn’t—or couldn’t—move his right side. I looked over his labs, saw his white count was off the charts, and discussed him with the peds resident on call. She had already seen him, had looked in his ears, and hadn’t liked what she’d seen.

“Cherry red,” she said, referring to his left ear drum. “A stiff neck and he’s hot too. Temp’s 106—the boy’s a damn fire hazard.”

His brain is boiling.

I thought how a fever of 106 is a black hole. Nothing escapes. If we didn’t do something—and fast—he’d never wake up. If he survived at all.

“I’m guessing he has meningitis,” the peds resident said in some far off land I was barely a part of. My mind had wandered.

“Like hell,” I said, thinking out loud. “Meningitis might cause a high fever, even seizures. But it doesn’t cause paralysis. Sounds more like a stroke.”

“Strokes don’t cause a fever, certainly not 106, and why would a thirteen year old have a stroke anyway?” she asked in her junior peds resident naiveté.

I could think of half a dozen reasons right off, like maybe he had hydrocephalus and he’d had a dozen operations and now he’d bled in his head. Or maybe he had moya moya, a ruptured aneurysm, a congenital heart defect, a brain tumor, or a hundred other obscure but scary as the day is long diagnoses.

But, of course, I was hearing hoofbeats and seeing zebras when what was right in front of me was a a regular old mutt.

My mind was off wandering again when I heard a woman scream. His mother. I nearly ran into her as I rushed into the room, the peds resident only a step behind. I looked past mom to the boy, felt the fire pouring off him like heat waves from a coal furnace. He looked possessed of a devil thing: deathly pale, shaking all hibidy gibidy, his arms and legs going up and down and every which way. His back spasmed taut and his head kept lifting off the bed and smacking back down again. His eyes were about the widest I had ever seen—and they were pupilless. They had rolled so far upward only the whites were visible. He wasn’t quite doing the Linda Blair thing with his head spinning 360, but hell was in session in that room all the same. Any moment he’d start spewing that green pea soup shit from his mouth.

“Ativan, 1 mg IV stat,” the peds resident said. “Seizure, we need a lumbar puncture tray.”

“Let me see his CT scan first.” She was thinking to do a spinal tap on the kid. I was thinking we needed to do something, but not a spinal tap. A spinal tap wouldn’t extinguish whatever fire was raging inside his head.

While the ER doc treated the seizure, the peds resident and I checked out the head CT. Sure enough,  a barely perceptible rim of fluid lay over the left side of his brain. The tell-tale smoke to the fire that was killing him.

“Empyema,” I said.

“Huh?”

“Subdural empyema. Pus over the surface of his brain. Needs his skull cracked right now. That crap’s poisoning him and inflaming the underlying brain, hence the stroke-like symptoms. He may have had meningitis yesterday, but it’s way beyond that now. What we got here’s a neurosurgical emergency.”

Details
Author:
Series: Tales of the Bloody Scalpel, Book 10
Genres: Fiction, Suspense
Tags: from the mind of Edison McDaniels, Tense medical drama
Format: eBook
Length: short story
ASIN: B01LWCPI1X
eBook Price: 0.99
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The Kowalski Scenario
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About the Author
Edison McDaniels

A brain surgeon with 20+ years and over 8,000 cases under his belt, Edison McDaniels spends as much time as possible writing fiction these days. He is the author of the acclaimed TALES OF THE BLOODY SCALPEL series of medical thrillers, as well as the THE GETTYSBURG TRILOGY, a series of intense novels depicting the battlefield surgeons at Gettysburg.
He lives in the upper midwest, does not have a dog, but can often be found at Minnesota Twins baseball games. He is not squeamish.

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