Brad. Let's get down to it. What site do we head to first?'
'Head to http://ConsciousnessStudies.org — three s's in the middle-and click on the private data link.'
Instants later, my Web site appeared. Tyrone brought up the account entry box when he clicked on the data link.
'My user name is bstone, password, jambalaya.'
'Those are way too obvious,' Tyrone said. 'I mean, my apologies, but anybody who wants into your private data would be deterred by like… seconds.'
'You're right,' I said as the scan files began downloading.
'You want me to change it for you?'
'Let's wait.'
Tyrone shook his head. 'What do you want first, the MRIs, the PET, or the EEG?' 'Let's do the EEG.'
If you want privacy, I can show you what to do and leave.'
I thought about this for a moment. 'I can walk you through things if you're interested,'
'Wow? Really?' He turned and looked up at me. The scar presented itself again.
He caught my glance.
'Drive-by shooting,' he said casually. 'My own damn fault. I fell in with some older gang members, hacked bank accounts and school grades for them. When the police caught me, the trails all led to the gang. I needed to be zeroed out… fourteen years old and sitting on my uncle's front porch in Balance Due when it happened.'
Balance Due had been the black section of Itta Bena. I had been a small child the last time I'd visited there, but I still remembered the smell of raw sewage, which raised sulfurous bubbles in the stagnant, scum-carpeted ditches alongside muddy, unpaved roads lined with weathered wood shacks, rusted corrugated metal roofs, and wood-fire smoke coming out of battered tin stovepipes.
'Killed my uncle and aunt,' Tyrone said. 'Left me with this souvenir.' He swept his index finger casually across the scar. 'Made me want to be a trauma surgeon.' 'I thought drive-bys were a big-city thing.'
He shook his head and returned to the keyboard and display, talking as he worked.
'Every small town in the Delta has got its Crips and Bloods, or a bunch of drug-thug wannabes who are half as smart and twice as dangerous.' He paused. 'That's why I live way out in the country, at the end of a dirt road.' He nodded to himself.
'What happened to the people who shot you?'
'Dead,' Tyrone said without emotion. 'They crossed somebody. Somebody zeroed them out. End of story.'
An instant later the EEG appeared on the screen.
'Okay, that's the new one,' I said. 'Can you display the reference file for comparison?'
An instant later, we had the two files on-screen.
'The reference EEG's been consistent for almost six years, consistent with a persistent vegetative state in this subject, a forty-four-year-old female suffering from profound brain damage resulting from a motor vehicle accident.' It felt odd to describe
Camilla in the dry, impersonal language of grand rounds, but it focused my objectivity and made me reach deeper for details than I might otherwise have.
'Okay, you can see the new EEG from yesterday differs significantly, indicating a substantial increase in higher brain function.'
'How do you know it's higher brain function from looking at this and not brain stem or something else?'
'Good question.' I traced the jagged-line patterns with the cursor. 'Notice the P15 peak absent on one side and markedly prolonged in latency on the other.' He nodded.
'And here, BAEPs show neither wave IV nor V on either side.'
'Meaning?'
'I have an idea, but let's see what the scans tell us,' I said uneasily. An increase in higher brain might mean an end to her coma.
'Why would things be the same for six years, then suddenly change?' Tyrone asked. 'I thought once you got this far into PVS, nothing ever improved.' I recalled my last conversation with Flowers.
'Well, the patient recently suffered from a severe, antibiotic-resistant bacterial infection resulting in temperature spikes over one hundred and five degrees. Sustained high fever can dramatically affect the brain.'
Tyrone nodded. 'PET or MRI now?'
'MRI.'
I grew increasingly uncomfortable as we went through the MRI and, later, PET scans.
'It looks familiar, the pattern here,' I told Freedman when we had gone over the scans for the third time.
When I finally recognized the pattern, the significance hit me like a hammer. 'Oh, Jesus,' I whispered. Freedman turned in his chair, his face full of startled concern. I grabbed the back of the chair for support.
CHAPTER 38
'Dr.-uh, Brad? You okay?'
I shook my head. Freedman got up quickly and helped me sag into his chair. We remained like that as I struggled to calm my breathing. Finally, I regained control, took a deep breath, and let it out slowly.
'Can you pull up the recent EEG and PET?'
'Sure.' Freedman leaned over the keyboard and brought the scans on-screen. 'Here.' I tapped at the monitor. 'And here… while higher brain functions are increasing, there's no change in the activity of the lower brain and brain stem. Remember that MRI of the ventral part of the rostral pons?' As my horror grew, I struggled to keep my focus on presenting Camilla like a grand rounds patient. 'Uh-huh.'
'Okay, now look over here, and there's clear evidence of recovery of higher brain function, especially in areas associated with awareness and consciousness.'
'So this patient is coming out of the coma?'
'It appears so.'
'Induced by the fever or the bacterial infection?'
I nodded dully at the implications.
'That's good.'
'Maybe,' I said.
Tyrone started to ask another question, I stopped him with a raised index finger as I grabbed my cell phone and hit Jeff Flowers's speed dial. I turned to Tyrone as the phone rang.
'The scan patterns are a variation on what is known as locked-in syndrome.'
'Locked in?'
'Usually from auto accident trauma and strokes, sometimes by pontine lesions, which damage specific portions of the lower brain and brain stem while leaving little or no damage to the upper brain.'
Flowers answered.
'Jeff, it's Brad Stone,' I said urgently. 'We may have a situation.'
'Let me get to a place where I can talk,' he replied.
As I waited, I pointed at the MRI image on the monitor display. 'Look closely at this area and the pattern of hypodensity where the tissue has been destroyed. The pattern of damage leads to quadriplegia and, depending on the extent of damage, easily leads to death without artificial ventilation. This patient's death-ah, case, I mean-did not require ventilation, but all voluntary muscle function was lost as well as higher brain functions- until yesterday.'
Flowers's voice came hack on the line. 'Sorry, Brad, I was in a staff meeting.
'Thanks for taking the call. Look, Jeff, I think we have a case of locked-in syndrome developing.'
'Dear God.'
'Yeah. Can you do some tests to make sure.'
'Anything you need.'
