Karthey lay still until the MRI technician told her, "We're all done, you can sit up now."

Karthey obediently sat up. She noticed through the window that the tech was the only one in the adjacent room.

"Where's Dr. Holt?" she asked the tech.

"Dr. Holt had to move on to other patients for the time being," the tech informed her, "he will be back to review your scans as soon as he is finished."

A knock sounded at the door, and Dr. Holt's receptionist and right-hand woman, Rita, entered the room.

"Hi there, Cathy," she said, "Dr. Holt got called away to some other patients, so I'm here to take you back to your room where you can wait for him."

"It's Karthey," the young woman corrected her, "but okay."

She followed Rita back to her room, and Mrs. Devanne helped reattach Karthey's IV and the heart rate monitor on her finger.

"Now you just sit tight till Dr. Holt comes," Rita instructed. "The IV drip should be finished in a few hours, and if he isn't here by then, I'll send a nurse in to remove it. Can I get you anything, Mrs. Devanne?"

The older woman shrugged, "A sandwich would be nice."

"Can I eat too?" Karthey begged, "I haven't eaten all day and I'm starving!"

"I'll check in with the café downstairs," Rita promised. "I'll tell them to send up sandwiches for you two."

"Thank you, Rita," Karthey called after her as she left the room.

Several hours passed until Michael finally had the time to return to Karthey with news of the results of her MRI. He entered the room to find the woman and her mother sitting at a table with café-vendor fare spread between them. Karthey was still dressed in her hospital gown, but she was smiling and laughing far more easily than he would have expected her to. Mrs. Devanne pushed the table out of the way when Dr. Holt approached.

"How did she do?" Mrs. Devanne asked, putting her arm around Karthey's shoulder.

"As well as can be expected," Michael tried to keep his voice optimistic. "When I looked at your scans, Karthey, and your ventricles look practically normal, though your shunt is indeed broken."

"Wait, I have ventricles in my brain?" Karthey asked. "I learned that the heart has ventricles in biology in high school, but the brain does, too?"

"Yeah," Michael pulled out a pen and picked up one of the paper napkins from the table. "See, so there's the two lobes of the brain, like this," he drew two hemispheres, "and within the brain, you have four ventricles, two in the lobes," he added two ovals within the hemispheres, "one in the middle, between them," another circle, "and a fourth just below that, which leads right to your spinal cord."

"Cool!" Karthey responded.

"The ventricles hold the cerebrospinal fluid, which acts as a buffer for the brain inside the skull," Michael explained. "It sort of gives the brain its shape, and keeps the spinal cord and the brain in alignment."

Karthey gazed at the diagram in enthusiastic wonder. "So what does the shunt do?"

"Well," Here comes the hard part, Michael thought, "the amount of fluid in the brain and spinal cord is regulated by two glands in the brain: one produces the fluid, and the other absorbs it. The scar on the back of your head and the presence of a shunt indicate that you may have had an encephalocele removed."

"A what?" Karthey asked. "Is that like a tumor?"

"Sort of," Michael answered, "but not really. An encephalocele is just a sac of fluid and often brain tissue that escapes from the skull, which in an infant is not all one piece like it becomes when you're older. An encephalocele usually means there is a problem with one of the glands, either the producer or the absorber. We're trying to track down the hospital that did your procedure now, to see if we can get any more information about which it might be in your case. Either way, the cerebral shunt helps the draining process, usually providing another 'escape route' for the fluid."

"Usually?" Mrs. Devanne asked, "Isn't that what Karthey's shunt is doing?"

"Oh, I get it," Karthey spoke up, "It was doing that, but now it's broken, so that's why I was having the headaches."

"Not necessarily," Michael disagreed. "Karthey, have you recently experienced any violent head trauma, like your head snapping back and forth in a car accident?"

Karthey shook her head, "No."

Michael sighed, "Short of that, there's really nothing that could actually break a shunt tube like this, other than a long stretching over time, like a particularly fast growth spurt."

"So the break happened a long time ago?" Mrs. Devanne wrinkled her brow as she tried to understand what the neurosurgeon was saying. "But what about the headaches?"

Michael kept a neutral expression as he tried to reconcile what he saw with his own eyes with what they were telling him. He looked at the young woman. "Karthey, are you in any pain right now?"

"Right now?" Karthey repeated, "No, but—"

"The pressure headaches you were describing before were most likely caused because of a temporary blockage," Michael reasoned, "and if you're not in any pain now, the blockage must have passed. When I looked at your scan, Karthey, I saw that the end of the shunt isn't even where it's supposed to be. Right now it's sitting just outside your right ventricle, not inside it, where it should be. It's basically an unused piece of plastic in your head. There's no way to tell when that happened, but I can tell you for sure, if Karthey still has at this point in her life the same problem that she had when she was born and they put this shunt in, she wouldn't be standing upright right now."

"What are you saying, Doctor?" Mrs. Devanne asked.

"I'm saying that every so often, in cases that require intubation, especially congenital," Michael tried to explain, "a patient may become shunt independent—whatever was causing the problem at birth is no longer an issue once the brain has fully developed. Now, according to this MRI, I'd say the shunt has been ineffective for a good long while, much longer than just a few weeks ago, when you said the headaches started."

"So, but—" Karthey objected, "will the headaches come back?"

Michael shrugged, "They might, but I'm pretty sure that after this you'll be able to handle them with over-the-counter meds. I don't think they should be anything to worry about." He smiled reassuringly at the pair.

Karthey only half-heartedly returned his smile. Clearly she was worried, but Michael laid a reassuring hand on her shoulder as he escorted them out the door.

"It will be fine, Karthey," he promised her, "just focus on living your life. You have nothing to worry about."

"Okay," Karthey responded as Mrs. Devanne took her hand and squeezed it hopefully. "Thank you, Dr. Holt."

"Hey, no problem," Michael was getting used to waving off thanks, especially from Clinic patients, who regularly received more treatment than they deserved, if Michael Holt was concerned for their welfare.

"So what was it?"

Michael smiled and turned to face Rita. She had this odd habit of coming up behind him unannounced and asking a question. "Well, her shunt is currently sitting useless in her brain."

Rita raised her eyebrows, "Should you be so cavalier? That sounds serious."

Michael shook his head, "Her neurological reflexes are totally normal, and by now the headaches are gone. I think if it was anything damaging, it would have shown up."

"Let's just hope she's not going to slip into a coma tonight," Rita grumbled as she walked with Michael back down the hall.

Michael paused, "Oh, speaking of a coma," he remarked, "did anybody check on Lianne Set's alarm?"

Rita shook her head, "I really don't know what you or Minnie are talking about, Michael," she said, "I had Sharon check it out after Minnie left for the day, but there wasn't a sound, and all the monitors were reading normally."

Michael shrugged, "I guess that's that, then."

Rita pressed her lips grimly, "When were you planning on telling her that Lianne may never come out of her coma?"

Michael pursed his lips in thought. "Minnie and her brothers nearly forgot about Lianne after their parents died. If they knew she was a vegetable, maybe they would stop visiting her again."

"It'd be a lot quieter around here if they did," Rita grumbled.

"But then what would we do with Lianne?" Michael objected, "Legally, Minnie is the one who decides when to take her off of life support. If she stopped coming, when would we know Lianne was no longer viable?"

"Who's to say she's not already too far gone?" Rita inquired, but waved away any answer. "Moving on to more important things: are you going back down to the Clinic?" Rita asked merely for clarity's sake; she already knew the answer.

Michael spread his arms. "I still owe Kate the time today."

"I'm stunned to see you so noble," Rita remarked wryly, and returned to her desk in the reception area. "See you tomorrow, Michael," she hollered over her shoulder. "You should know that you'll have holdovers from today when you come in tomorrow!"

"Good night, Rita!" Michael responded. "I'll see them then!"