“I can’t feel anything! Why can’t I feel anything?”
“Easy, easy now,” Judy whispered. “We’re going to help you.”
They quickly enveloped the boy in the lightweight duralumin exoskeleton, which prevented motion. A specially programmed nerve-muscle stimulator sent timed electric impulses to maintain muscle tone below the cut in his spinal cord.
The team focused low-power lasers on the injury site that fired preset light pulsations to stimulate the growth of stem cells in the spinal cord. This would provide clusters of new stem cells to participate in the regeneration process.
Tony took the entry pad containing all of the accumulated patient data during the transport flight from the medtech.
“He’s able to talk and breathe,” JP noted, “but he can’t feel anything from the neck and shoulders down.”
Sammy’s spinal cord, the massive communications cable from the brain that travels down through the bony spinal canal, had been torn. The connecting wires carrying instructions from the brain—move here, feel this or that—no longer worked.
At the level of the fifth cervical vertebra, Sammy could breathe and talk but little else.
Sarah was performing a quick but systematic exam on the boy. She looked up at Tony and nodded.
“Yep, a lower C-5. Judy, get the neurosurgeon on call. We’ll get him prepped for OR.”
Judy smiled at Sammy. He looked so small, so vulnerable, so scared. He reminded her of the younger brother she had lost in an auto accident four years earlier. She wanted to cry—they all did—but that wouldn’t have helped the kid.
“Hey, big guy, you doing okay?”
Barely audible, the pubertal voice replied.
“No-o-o. Are my mom and dad here?”
“They’re on the way, Sammy. We’re going to see if we can glue you back together again. You hang in there.”
She pulled out her phone, touched the extension for neurosurgery, and began the arrangements for what would happen next.
It was called the Joshua Protocol. The team of four, under Fromm’s guidance, inserted entry ports into the boy’s veins. They had no time to ride him down the elevator into the main hospital so they worked in the specially outfitted enclosure.
“Judy, Sam here looks to be about 43 kilos,” Tony called out.
The special cart had its own built-in electronic scale and measuring devices.
“Give him 1500 milligrams of lazaroids and sialidin. Sarah, get 2200 milligrams of erythropoietin-neurotrophin mixture ready. JP, have we got the nanos?”
Fromm watched the students carefully, constantly on guard for errors in judgment. There were none.
“All set,” Judy called out.
“Okay,” Fromm said, “watch for anaphylaxis. Sarah, start the factor infusion. Tony, stay ready for problems.”
He kept his fingers crossed.
The death throes of a complex organism, like that of a single cell, follow their own protocol. There comes a steadily increasing cascade of deadly chemicals coursing through the body that must be stopped or neutralized if the individual is to be saved.
The lazaroids and sialidin streamed through the boy’s veins, blocking the lethal showers of destructive, tissue-necrosis factors that would prevent return of function. Neurotophins, nerve growth-stimulating proteins carried by microscopic nanoparticles, homed in on the site of the nerve destruction. Slowly they stimulated the nerve endings, while the erythropoietin and 810-nanometer laser pulses attempted to induce natural stem-cell production.
“He’s starting to seize!” Sarah yelled.
The boy’s eyes rolled upward and his jaw muscles tightened.
Tony reached for a prefilled syringe containing Lorazepam, a tranquilizer commonly used for anxiety and also used for rapid control of seizures, and stuck the needle into the IV port on Sammy’s right arm. Slowly, counting out, “one-thousand one, one-thousand two...” he administered the drug, and the young patient’s face slowly relaxed.
Next JP inserted a tongue guard into Sammy’s mouth and administered low-dose oxygen via mask.
“Okay, let’s get him to the OR.”
Two on each side and one behind, they wheeled the cart with the exoskeleton stabilizer and portable heart-rate and respiratory monitors to the special wide elevator doors.
As the elevator descended, Judy looked at Sammy’s peacefully sedated expression and surprised her teammates with a comment.
“I wonder what he’s dreaming.”
“Dr. Castro, Sam’s been given the Joshua Protocol. Are you going to do a Reeve Procedure on him?”
Tony was glad Roxanna Castro was on call. She was a world leader in her field.
The neurosurgeon, an African-American in her late 50s, nodded. She was tired from a night of dealing with auto-accident trauma, but nothing mattered more now than the well-being of this kid the resident and his team had brought her.
Her mind went into overdrive and the fatigue vanished.
“We need to go in and restore neurilemma continuity.”
Neurilemma, the magic covering of the nerve axon, acts like a continually expanding tunnel through which the long finger of the neuron, the nerve fiber, travels to its destination. Disrupt that sheath and the nerve ending has no way of finding its path. It becomes effectively blind and wanders aimlessly, often forming an ineffective—though painful—tangled, ball-of-yarn nerve clump.
The four almost-doctors, now in OR sterility suits, clustered around the large, flat-screen monitor, watching Castro activate the surgical microscope field and micro-Waldo units.
The anesthesiologist had used a Ketamine derivative to put Sammy into a form of dissociative anesthesia that would not suppress his breathing. His mind would float in a netherworld of non-existence; his body would feel nothing.
The chief OR nurse activated the exoskeleton controls and rotated the patient’s carefully immobilized body to a face-down position.
Todd Baker, the assisting neurosurgery resident, activated the mini-MRI unit. A portion of the viewing screen showed the havoc within Sammy’s neck.
“We’ll make the initial incision 2 centimeters below the break,” Castro said, speaking slowly as she brought the ultrafine laser scalpel down on the patient’s skin. It parted, bloodlessly. She peered through the microscope as she penetrated, layer by layer, down to the muscles and ligaments surrounding the neck bones.
“There it is, ladies and gentlemen.”
Tony, JP, Judy and Sarah all stared in wonder at the thin-walled portions of the fifth cervical vertebra and the red, swollen nerve ending capped by a blood clot where it should have continued down the spine.
Castro adjusted the laser’s controls and the light beam vaporized the clot.
Baker, one month from entering the world as an attending, carefully handed her a vial of stem cells. Subconsciously he felt like an acolyte on the altar presenting an offering to the officiating priest. In turn, Castro used a special glass syringe to draw up the mixture of stem cells and neurilemma