When Michael Holt reported to his office at eight o'clock the next morning, Rita waltzed in with the day's agenda.
"The Chung brothers and the Tanners will be here at nine," she informed the neurosurgeon, "They would have been here by now, but I thought you might need time to gird your loins before facing the onslaught."
Michael hung his head and laughed to himself at Rita's unabashed use of the most outrageous yet appropriate metaphors.
"Have either of the Devannes called yet?" he asked.
Rita shook her head, "No, but remember you have the Clinica at ten."
Michael waved his hand dismissively. Just then, the phone rang. Rita dutifully checked the caller-ID.
"That would be the call," she announced. "I'll just go back to my desk."
"Thanks Rita." Michael picked up the receiver, "Hello," he said, "this is Dr. Holt."
"Dr. Holt?" Karthey's voice was furtive, and strained. Michael knew she was worried, so he opened the e-mail from Dr. Medino and tried to keep his voice light and cheerful.
"Karthey," he said with a smile, "How was your appointment? Dr. Medino sent me the scans; I see the MRI told us what we needed to know."
"Yeah, I guess so," Karthey was still unconvinced.
"How is the recovery from the lumbar puncture? I hear your pressures were really high."
"The recovery has been fine. I'm lying down right now. I don't know if they were high; all I know is that it was the first time that the pain was completely gone without the use of painkillers. I could literally feel the fluid just rushing from my head." The young woman sighed, "He gave us two options for surgery; I wanted to ask you about them."
Michael pulled up the e-mail, "Yes, he notified me of the results. I must say, I thought I'd seen everything but your case looks particularly—unique."
Karthey sighed, "I know! I never thought I could find relief, but when they tapped in and drew off the fluid I could literally feel the pressure leaving my head."
Michael chuckled, "And now?"
"Pain-free; well, except for the spinal headaches, of course, but those were nothing compared to the last month!"
"So what about the surgery options?"
Karthey's tone dropped considerably. "I didn't really like either odds, Dr. Holt. It seems like I'm committing to either a deficient quality of life or a slow but certain death."
Michael frowned, "What did Dr. Medino tell you?"
"Well, for starters, he showed us where the aqua-something—"
"Aqueduct?"
"Yeah, where it was pinched off—only he didn't quite use that word…"
"Okay, yeah, I saw that too."
"And when he was talking about the surgery options, he said that the endoscopy would be the best to solve the problem, but at the risk of my short-term memory…" Karthey sighed again, "Dr. Holt, I'm going to college this fall; I need to be able to learn new things and remember them!"
"What is your concern about the revision?"
"The failure rate, mostly, that's what scared me. The margin just seems too big; a twenty-five percent failure rate sounds just big enough for me to fall in it."
"Twenty-five?" Michael echoed, his voice communicating the concern he felt; where were these numbers coming from? Perhaps in owning his own practice so amply equipped had placed him a world apart from the "normal" surgeons. His own average of failed revisions (as the operation was called) was below ten percent; nationally, the failure rate hovered just above that. He frowned. "Karthey, why don't you and Martha come in to Holt Neuro, and I'll see what I can do."
"Really?" she gasped.
Rita had returned to the office to catch the last part of his conversation. She immediately flipped open his schedule and laid it on the desk, pointing to a blank. She smiled as Michael informed Karthey, "It appears I have an opening at 11 this morning. Can you make it?"
"We'll try!" Karthey promised, "Thank you, Dr. Holt!"
"My pleasure," Michael replied, and hung up the phone.
"Well, sounds like you have a full day now, Michael," Rita remarked as she updated his schedule with Karthey's appointment. "Weren't the doctors at Manhattan Memorial able to assess the problem?"
Michael frowned and stroked his chin. He pulled up the MRI scan. "This is what her brain looks like," he told Rita. "Abel informed me that the lumbar puncture revealed pressures of 53 cm H2O in her spinal cord." He highlighted the area between the third and fourth ventricles, the one that Medino had said appeared too narrow to afford adequate flow of fluid. "This may be our problem here."
Rita blinked, "Now, Michael," her voice carried that patronizing tone she used whenever she thought he was missing something, "I keep a garden behind my house, and I water that garden with a hose."
Michael grinned, "I knew it!" he cried. "Somehow, you always struck me as the gardening type.
Rita forged ahead, "When I'm watering with the hose, and I pinch it off in a certain point, it stands to reason that one side will receive less pressure—"
Michael nodded, "The side in front of the kink."
"—While the pressure increases on the other side."
"The side receiving flow from the faucet, but the water has nowhere to go." He stopped as the effect she was describing played out in his mind.
Rita saw the connection coming, so she merely mused, "I wonder how the pressure could be so high lower in her spine, when it's been pinched off up near the brain stem." She left the office.
As soon as she exited, the Tanners descended upon Rita.
"Ms. Rita," Ben complained, "This arrangement is not working for us."
Rita steeled herself for what was to come. "What arrangement?"
"Lianne's communication in Morse code," Ethan answered, "It's too slow. We need to find out what she wants done with her stuff; she has a will, but it's not very specific. We are trying to clean out her living quarters, but she has a lot of old junk that is not mentioned in her will. We need to go faster. You need to tell Minnie to go faster!"
"Where is Minnie?" Rita asked.
Ethan pointed her to the waiting area near the comatose wing.
Minnie sat upon a couch, crying softly into a tissue.
"Minnie," Rita said gently, taking a seat next to her.
"Oh Ms. Rita!" Minnie sobbed, "I'm trying to do what my brothers ask! They say they want answers right now, and I am trying to translate the letters as quickly as I can, but Grandma Lianne, you know, she only goes at one pace, and there's nothing we can do about it! I'm trying! I want to honor her. But she forgets a lot of things, and she gets confused when everyone talks at once, and it makes her communicate even slower!"
Rita put a comforting arm around her as she sobbed. She looked around at the four men gathered in the room.
"Now, you all listen well," she broke out sternly. "You know that what you have is a gift. Not many people can communicate with a loved one beyond the reach of medicine, just waiting to die. You're lucky she didn't pass away before you all got here! Tell me this, if she had died suddenly, what would you have done with all those things?"
The younger men stared down at their hands. George Tanner spoke up, "Probably tossed a lot of it; it just looks like a bunch of junk to us."
Minnie's head flew up, "No!" she cried. "I am sure there are many things of value, from her heritage!" she turned to Rita, "That is what we are finding out from Grandma Lianne; the things she remembers are the most valuable to her. I want to keep those things. But George and my brothers don't want to wait for an answer!" She glared at them.
Rita nodded and stood, bringing Minnie with her. "This is your chance to communicate with your heritage before it is lost forever. Just give it time," she looked meaningfully around until all met her gaze, "be patient. You may never have this chance again."
They all nodded.
"Thank you, Ms. Rita," Ben said as she moved to resume her post at the front desk.