Chapter 33: Wednesday, August 18, 2010

Wednesday, August 18, 2010

Only the calmness that Shannon had given him kept Jake from screaming out in horror.

Jake turned on Greenlee. “What happened to her mind?”

Jake watched as Greenlee recollected losing his temper when he couldn’t bring Ellen to consciousness for questioning. He had focused all his energy on her brain, dragging tracks across the surface, destroying swaths of brain cells.

Jake activated Greenlee’s testicle pain circuit. Greenlee screamed. Jake gloried in his agony. When the screams became annoying, Jake disconnected his vocal cords. Greenlee’s screams were reduced to voiceless gurgling noises. When Jake found that still too distracting, he woke up a servant and had him drag Greenlee out of the room.

Jake knelt down beside Ellen. Despite Shannon’s conditioning, he felt like his calm might fail him at any moment.

“What can we do?” he asked Jan.

“I don’t know,” she said. “He damaged her brain. You saw it. He gashed through it, right across her parietal and temporal lobes.”

“Do we take her to the hospital? Do we do handle it ourselves, like we did with Donna?”

“I just don’t know. It was different with Donna. She was dying. We were her last hope. Ellen’s brain damage isn’t life-threatening, but she’s going to be changed.”

“Changed how?”

“Those parts of the cerebral cortex perform cognitive and somatosensory functions, including many hearing and language functions.”

“What does that mean — somatosensory?” Boris asked.

“That’s her ability to sense her own body,” Jan said.

“But can doctors do something?” Boris asked.

“I just don’t know,” she said. “They can’t put back brain that’s not there anymore, but there may be some kind of therapy that would promote healing.”

“Then here’s what we do,” Jake said. “We’re going to take her to the hospital. We’ll let them tell us what they can do. If they can help, we’ll let them. We can always intervene if we decide we can do better. I need you, Jan. Kara, too. We three have the finest resolution.” He stood and looked around. “Boris, can I leave you here with Alice, Shannon, and Julie to clean this up?”

“Of course.”

“Okay. Then I’m taking Jan and Kara to the hospital in Ellen’s car.”

He looked around and found Alice standing at the doorway.

“Alice, sweetheart, let your driver know that he’s going to be at my disposal, please.”

“Right,” she said and ran out of the room.

“Boris, would you help me get Ellen to the car?”

“Let me get her, boss,” he said and picked her up in his arms with hardly any strain.

Jake followed him. Boris set her gently into the middle of the back seat. When he got out of the way, Jake sat next to her and held her. Jan got in on the other side. Kara got in the front.

The driver looked back and saw Ellen.

“Where to?” he asked nervously.

Jake looked over at Jan. She thought for a second.

“I know!” she said. “Driver, do you know where the Hospital of the University of Pennsylvania is?”

“Uh-huh.”

“Then get us there.”

“This is an emergency,” Jake said. “Don’t worry about getting stopped by the police.”

The driver pulled away and started driving. Jake read his mind and saw that the drive would take ten or 15 minutes.

“We got lucky,” Jan said. “We’re going to a great research hospital. They’ll have really good neurologists there.” She ran her hand over Ellen’s brow. “We’ve got to remove her controls, Jake. They would just throw the doctors off. They’re going to be confused enough as it is.”

Jake nodded and got to work. It only took a minute. When Jake removed the last one, Ellen’s eyes opened. She looked up at Jake and smiled.

“J-j-j-j” she started but stopped. She tried again but could get no further.

Ellen, darling, can you understand me?

“J-j-j-j” she said and then stopped confused.

Mind talk, love, Jake sent. Can you understand me?

Yes.

How do you feel?

Strange. Sit up.

Jake took his arm from her shoulder and she tried to sit up straight. She attempted to put her hands down on the seat but could not seem to bring them into contact with it.

Arms not work. Why me here? I, Greenlee, uh, uh, almost.

Ellen, look at me, Jan sent.

Ellen turned her face jerkily in Jan’s direction.

“What do you remember about Greenlee?”

Ellen looked confused.

“Can you understand me, Ellen?” Jan said.

Why talk, uh, uh, bad? Ellen sent.

Don’t worry, darling, Jan sent. You’ve been hurt. We’re almost to the hospital. They’ll take care of you.

Greenlee, uh, Greenlee...

Yes, Ellen, Greenlee did this to you, Jake sent. But don’t worry about him. We’ve taken care of him. Now let’s just worry about you.

Ellen looked confused. Kara looked back at them. Jake felt her concern.

You are safe now, Jan sent Ellen, each word enunciated slowly. The doctors will take care of you.

Ellen nodded and closed her eyes.

A minute later the car pulled up to the emergency room entrance.

“Wait here with Ellen,” Jan said. “I’m going to get help.”

She got out and pushed through a set of big swinging doors.

The driver turned back to Jake and Ellen.

“What do you want me to do?”

A glance told Jake that he was tired. He hoped that they would let him go home for the night.

“You’re done,” Jake said. “Go get some sleep.”

“Thanks, man.”

Jake glanced down at Ellen. She was looking up at him, the fear in her large eyes as plain as the fear in her mind.

Don’t worry, my little sub. I’ll take care of you.

Jake could see that she had not really followed what he was saying, but she took comfort in his presence.

The doors of the emergency room banged open. Jan appeared, followed by a man and a woman wearing scrubs. The man was pushing a gurney. They rushed to the car and opened the door. The man looked Ellen over briefly and then pulled her from the car. With the help of the woman, he manhandled her onto the gurney. They hurried inside.

“C’mon, Jake,” Kara said, getting out of the car. “Let’s go in.”

Jake followed her through the doors. There was a large waiting room, mostly deserted. Jan, Ellen, and the hospital workers in scrubs weren’t there. Jake cast around for Jan. He found her in an examining room with Ellen, answering questions for a doctor.

I noticed she seemed to be having a problem about two hours ago, Jan said. We hadn’t gone to bed yet. Then she started having trouble talking and moving around. She seemed to get confused, too.

The doctor, a first-year resident, Jake saw, examined Ellen’s eyes. Then he tried to talk to her. She made a grunting reply.

The doctor left the room. Jan cast out for Jake.

Get one of the nurses out front to bring you back, she sent him.

Jake took control of a nurse who was sitting at a desk writing in a file. She escorted Kara and him back to the examining room. Ellen looked up at him from the gurney when Jake appeared.

What wrong? she sent.

Jake sat in a chair next to her.

Greenlee attacked you, he sent slowly. He hurt your brain.

“She’s following mind talk,” Jan said, “at least when you use simple sentences and vocabulary. She’s reasoning okay, too. The problem seems to be language processing. I can follow her thoughts just fine. She’s just not understanding us well when we talk.” She looked down at Ellen. Read my mind. Look at what I found when I examined your brain.

As Jake watched, Jan replayed what had happened when she had gotten to Ellen at Greenlee’s house.

“Did you follow that?” Jan asked when she was done.

Ellen nodded her head jerkily. Jan turned to Jake.

“Did you watch Ellen while she was reading me?”

“She followed you okay.”

“So the problem is just getting the words in and out. Internally she’s processing information just fine.”

“What about her clumsiness?”

“That’s something the parietal lobe does. It integrates what you see with what you feel. She must have had damage in that region, too. Ellen is having trouble telling her limbs where to move. Other problems may become apparent, but I’m already stretching my basic neurophysiology classes to understand what we’re seeing.”

“At least we see more or less what we’re up against,” Jake said. “What are we going to do?”

“When the doctors have finished their exams and their testing, we’ll find out what they can do. Maybe they can fix her up. Since I don’t have any medical training, I don’t really know.”

“What if they do something that will hurt her?”

“We’ll keep a close eye on them. I lied to them when we got here. I told them that I’m Ellen’s sister. With her being unable to communicate her wishes for treatment, that means that I will be the one to give or withhold consent.

“We’ll manage the doctors and nurses carefully. We’ll adjust their attitudes to ensure that they explain everything to us and respect our wishes for treatment decisions. We’ll also make them let us stay close to her, regardless of the time or in your case, your age or for Kara, her relationship to Ellen.

“That will let us do our part. We three can do things the doctors can’t dream of. I don’t know if we can bring Ellen back completely, but we should be able to help her at least some.”

“Help her how?” Kara asked.

“You weren’t there when Donna was injured,” Jan said. “What we did was stimulate the neurons damaged by her accident. That caused them to regenerate their axons and create new synapses. We took advantage of the self-organizing capabilities of the brain. We coaxed it into regrowing itself. It’s very fine work, just the kind of thing we do well since we’ve been supercharged.”

“What exactly will we do?”

“We will move along the edges of the injured parts,” Jan said, “energizing each damaged neuron. Her brain will try to reconnect the damaged parts. Functionality has been lost because some of the tissue has been destroyed, but axons in Ellen’s brain will try to recreate the lost connectivity. Our ability to work at the smallest scales has improved since we worked on Donna. That’s the good news. The bad news is that at that scale there are a lot of neurons to sense and energize. It will take a long time to get them all.”

“Jan, I know that a brain has billions of nerves,” Kara said. “There’s not enough time in the day.”

“Fortunately we are only concerned with the brain tissue that borders the injury. But that’s still an awful lot of nerves. Our resolution now goes down to the individual neuron. If we had to spend even a second on each one, we wouldn’t get very far.

“I think our best approach is to move deliberately along the lesions, energizing individual neurons as we sweep past them, trying to balance speed versus accuracy. We have to do the entire depth and length of each gouge. I’ll demonstrate to you exactly what I have in mind, but in principle, it’s the same as the treatments you gave Jake when you supercharged him.”

“Leanne can help us with this,” Jake said. He glanced at the time. “I’ll let her sleep for another hour or two first. Then I’ll get Carol to send the plane for her.”

“You do that. Meanwhile, I’m going to give Kara a lesson in how to treat Ellen,” Jan said.

“Should I call Ellen’s parents?” Jake asked.

“Of course you call them,” Kara said. “They’re family. It’s good for them and for Ellen to get them here.”

“Yes, ma’am,” Jake said. “Although I think I’ll let them sleep for a while, too, before I call.”

“You better have a good cover story in place,” Jan said. “The truth will hardly do.”

Ellen’s neurologist walked into the hospital room. This time he didn’t even blink at the four of them hovering over Ellen’s bed. Jan pulled back, stretched, and rose to meet the doctor.

“Would you like to step out and discuss Ellen’s condition, Mrs. Harrison?”

“No, it’s better for everybody to hear what you’ve found, Dr. Mitchell.”

“Very well. We find Ellen’s case very atypical. Inexplicable even. I’ve consulted with our chief of neurology, an esteemed physician, and he is as startled by our findings as I am.

“It’s clear from the neurological examination and the imagery that Ellen has suffered a series of lesions along the distal cerebral cortex within the bounds of the parietal and temporal lobes. We have no plausible theory for the cause of these lesions. Fortunately for Ellen, there has been no bleeding into the brain. In fact and strangely, the lesions look like they’ve been cauterized. They have an average depth of five millimeters and stretch 15 centimeters, about six inches. There are three of them, roughly parallel.

“Ellen’s symptoms are consistent with those injuries. If I were pushed to make a diagnosis, I would call it Gerstmann syndrome, which is the name given to a cluster of symptoms that results from damage to the parietal lobe, such as her aphasia.”

“Aphasia?” Leanne asked.

“That’s when a patient has difficulty speaking, understanding speech, and reading and writing. Gerstmann sufferers exhibit aphasia and cognitive deficits. That is they have problems with certain kinds of higher reasoning. In addition, the lesions have also caused Ellen loss of asterognosis and the ability to grasp spatial relationships.”

“Astro what?” Leanne asked.

“Sorry. Asterognosis — the ability to recognize objects by touch. That and the problems with auditory processing are common symptoms of parietal and temporal lobe damage.

“The long and short of it is that we have widespread damage to the cerebral cortex without any apparent cause. We have no theory at the moment for how this damage might have occurred. And, unfortunately, we can offer no treatment. Assuming no new lesions form, Ellen’s condition will likely improve somewhat on its own. Brains are often able to rewire themselves when they’ve been damaged, at least to some extent. And while we have no treatment that addresses the underlying condition, that’s not to say that we can’t help at all, just not medically or surgically. There are therapies that will help Ellen to make some progress. With symptoms this diverse, Ellen will benefit from a broad array of therapies — physical, occupational, and speech and language.”

“We’re visiting from Texas,” Jake said. “Can she have the therapy there?”

“You’ll need a wheelchair to transport her. But she should be able to tolerate air travel. Travel by car would probably be too taxing.” Dr. Mitchell looked down at Ellen. “Social support will be important for her. For the most part, Ellen’s cognitive abilities are intact. She knows what’s happening to her. She can reason just as well as she could before the onset of the injury or disease. But language has become a barrier for her. It will probably be very frustrating. Depression is not unlikely.”