“What do you mean there’s no X ray?” Dr. Nawaz demanded. “You bloody well better have an X ray, or we’ll be wrapping up and going home! There’s no way I can do an intracranial implantation without an X ray.”
“What Majorie means is that these two operating rooms were not set up for X ray,” Dr. Newhouse explained. “They were designed primarily for infertility procedures, so they have state-of-the-art ultrasound available. Would that be of assistance?”
“Absolutely not!” Dr. Nawaz snapped. “Ultrasound would be no help whatsoever. I need a full size X ray to get accurate measurements. The frame’s three-dimensional reference grid has to be related to the patient’s brain. Otherwise, it would be like shooting in the dark. I need some bloody X rays! You mean to tell me you don’t even have a portable machine?”
“Unfortunately, no!” Dr. Newhouse said. He waved through the window for Paul Saunders to come into the room.
Paul poked his head through the door while holding a mask to his face. “Is there a problem?”
“You’d better believe there’s a bloody problem,” Dr. Nawaz complained angrily. “I’ve been informed belatedly that there is no X ray.”
“We have X ray,” Paul said. “We even have MRI.”
“Well, get the blasted X ray in here!” Dr. Nawaz commanded impatiently.
Paul stepped into the room and looked back out at the others through the window. He waved for them to come in, which they did, holding masks to their faces like he was.
“There is a problem no one thought of,” Paul said. “Rashid needs X ray, but the room is not set up for it, and we have no portable unit.”
“Oh, for Christ’s sake! After all this effort, is it going to come down to this?” Daniel asked rhetorically. Then, looking directly at the neurosurgeon, he said, “Why didn’t you mention you needed an X ray?”
“Why didn’t you tell me it wasn’t available?” Dr. Nawaz retorted. “I’ve never had the dubious honor of working in a modern OR that didn’t have access to X ray.”
“Let’s think about this a moment and let cooler minds prevail!” Paul suggested. “There has to be a solution here.”
“There’s nothing to think about,” Dr. Nawaz snapped. “I cannot localize an injection into the brain without X rays. It is as simple as that.”
Except for the metronomic beeping of the cardiac monitor, the room sank into a strained silence. Everyone avoided locking eyes with anyone else. No one moved.
“Why not take the patient to the X-ray room,” Spencer suggested suddenly. “It’s not that far.”
The others had thought of the idea but dismissed it. Now they reconsidered the suggestion. Taking a patient from the OR to the X-ray room in the middle of a procedure was hardly routine, yet it wasn’t out of the question in the current circumstance. The facility was brand-new and practically empty, so contamination was less of an issue than it would have been normally, especially since the craniotomy had not yet been made.
“I have to say it sounds reasonable to me,” Daniel said optimistically. “We’ve got enough hands. We can all help.”
“What’s your opinion, Rashid?” Paul asked.
Dr. Nawaz shrugged. “I suppose it would work, provided we keep the patient on the OR table. With him sitting up and the stereotaxic frame in place, it would be ill-advised to move him on and off a gurney.”
“The OR table is on wheels,” Dr. Newhouse reminded everyone.
“Let’s do it!” Paul said. “Marjorie, alert our imaging tech we’re on our way to X ray.”
It took a few minutes for Dr. Newhouse to detach Ashley from the cardiac monitor as well as untie his arms from the armboards. With them sticking out laterally, it would have been impossible to get out through the door. When all was ready and Ashley’s hands were safely in his lap, Dr. Newhouse released the wheel lock with his foot. Then, with Dr. Newhouse pushing and Marjorie and Paul pulling, they rolled the OR table into the hallway. Except for the scrub nurse, who remained in the OR, everyone else trooped behind. Ashley stayed asleep and completely oblivious to the unfolding drama, despite his being in a sitting position and being jostled. With his head locked into the futuristic-appearing stereotaxic frame, he could have been a slumbering actor in a science-fiction movie.
Once in the corridor, everyone but Dr. Nawaz lent a hand pushing, although it was hardly necessary. The OR table rolled easily across the composite flooring, with only a quiet rumble from its considerable weight. When the group arrived in X ray, a discussion ensued whether to move Ashley from the OR table to the X-ray table. After weighing the pros and cons, it was decided it was best to leave him on the OR table.
Dr. Nawaz donned a heavy lead apron, as he insisted on personally aligning and supporting Ashley’s head while the films were taken. Everyone else retreated back out into the hallway. Ashley never awoke.
“I want the films developed before we move him back,” Dr. Nawaz told the technician, when she came in to retrieve the exposed plates. “I want to be absolutely certain they are adequate.”
“I’ll have them back in a jiffy,” the technician said brightly.
Dr. Newhouse returned inside the X-ray room to check Ashley’s vital signs. Paul and Spencer accompanied the X-ray technician to await the emergence of the X-ray film from the developer. Daniel and Stephanie found themselves momentarily alone.
“This is like a comedy of errors that’s not at all funny,” Stephanie whispered, with a disgusted shake of her head.
“That’s not fair,” Daniel whispered back. “The X-ray misunderstanding was nobody’s fault. I can see both sides, and it’s already water under the bridge. The X rays have been taken, so the implantation is back on track.”
“It doesn’t matter if it’s anyone’s fault or not,” Stephanie retorted with a pshaw. “It’s still a screw-up, and it’s been one thing after another from that fateful, rainy night in Washington until now. I keep asking myself what else can go wrong.”
“Let’s try to be a bit more optimistic,” Daniel snapped. “The end is in sight.”
Paul and Spencer emerged from the processing room with the technician a few steps behind. Paul clutched the X rays in his hands. “They look good to me,” he remarked, as he passed Daniel and Stephanie and went into the X-ray room. The others followed. Paul snapped the films up on the viewing box, switched on the light, and stepped to the side. The images were of Ashley’s skull surmounted by the opaque image of the stereotaxic frame.
Dr. Nawaz moved over, and with his nose close to the films, he carefully examined each in turn, orienting himself mostly by the indistinct shadows of fluid-filled ventricles in Ashley’s brain. For a moment, no one spoke. The only sound was Ashley’s deep breathing briefly obscured by the noise of Dr. Newhouse inflating the blood-pressure cuff on Ashley’s arm.
“Well?” Paul questioned.
Dr. Nawaz nodded reluctant approval. “They look okay. They should work.” He took out a marking pen, a protractor, and a precision metal ruler. With great care, he located a specific location on each film and marked it with a small X. “That is our target: the pars compacta of the substantia nigra on the right side of the midbrain. Now I have to figure out the x, y, and z coordinates.” He set to work drawing lines on the X rays and measuring angles.
“Are you going to do that here?” Paul asked.
“This is a good light box,” Dr. Nawaz said. He was preoccupied.
“We should get the patient back to the OR,” Dr. Newhouse said. “I’ll feel more comfortable with him reattached to the cardiac monitor.”
“Good idea,” Paul said. He immediately went to the foot of the OR table to lend a hand. Dr. Newhouse released the brake on the wheels.