Touhey needle without problems. There was no reaction to 2 cc’s of Lido- caine utilized to facilitate the epidural stick. Confirmation of the epidural location was made with 2 cc’s of sterile water with epinephrine.
A small-bore epidural catheter was threaded through the Touhey needle. The patient was returned to a supine position. A test dose of.5% Marcaine with a small amount of epinephrine was then prepared from a 30 ml vial. This test dose was injected. As soon as the test dose was injected the patient complained of what he )described as dizziness, followed by severe intestinal cramping. The heart rate began to increase but not to the extent expected if the test dose had inadvertently been injected intravenously.
Generalized muscular fasciculations then appeared, suggesting a hyperesthesia state. Massive salivation intervened, suggesting a parasympathetic reaction. Atropine was given intravenously. Miotic pupils were noted. The patient then had a grand mal seizure which was treated with succiny1choline and Valium intravenously. The patient was intubated and maintained on oxygen. The patient then had a cardiac arrest. The heart proved to be extremely resistant to drugs, but finally a sinus rhythm was achieved. The patient was stabilized but did not return to consciousness.
The patient was moved to the surgical intensive care unit, where he remained comatose for one week, suffering multiple cardiac arrests. It was also documented that the patient had a total paralysis following his anesthetic complication that involved not only the spinal cord but cranial nerves as well. At the end of the week, the patient had a final cardiac arrest from which the heart could not be started.
Jeffrey looked up from the notes. Reading Chris’s terse history of his complication recreated the terror that Jeffrey had felt when he’d desperately fought to save Patty Owen. The memory was so poignant that it brought perspiration to Jeffrey’s hands. What made it so poignant were the striking similarities in the two cases, and it wasn’t just -the dramatic seizures and cardiac
arrests. Jeffrey could remember with startling clarity the moment he’d seen salivation and lacrimation that Patty had had. And besides that there was the abdominal pain and the small pupils. None of these responses were usual side effects of local anesthetics, although local anesthetics were capable of causing an extraordinarily wide range of adverse neurological and cardiac effects in a few unfortunate individuals.
Jeffrey studied the next page of the notes. There were a number of words printed in bold letters. Two of them were “muscarinic” and “nicotinic.”
Jeffrey recognized them, mostly from his medical school days. They had to do with autonomic nervous system function. Then there was the phrase
“irreversible high spinal blockade with cranial nerve involvement,” followed by a series of exclamation points.
Jeffrey heard Kelly’s car pull up the drive and enter the garage. He glanced at his watch. She was a fast shopper.
The next item in Chris’s pile was an NMR-nuclear magnetic resonance-report on Henry Noble during the time he was paralyzed and comatose. The results recorded were normal.
“Hi,” Kelly called brightly as she came through the door. “Miss me?” She laughed as she dumped a parcel on the kitchen countertop. Then she stepped up to the back of the couch and looked over Jeffrey’s shoulder. “What does all this stuff mean?” She pointed to the words and phrases Jeffrey had been reading.
“I don’t know,” Jeffrey admitted. “But these notes are fascinating. There are so- many similarities between Chris’s case and mine. I don’t know what to make of it.”
“Well, I’m glad someone’s getting some use out of that stuff,” Kelly said as she went back into the kitchen. “It makes me feel less weird for having saved it all.”
‘.1 don’t think your saving it was weird at all,” Jeffrey said, turning to the next page. It was a typed summary of Henry Noble’s autopsy, which had been performed by the medical examiner. Chris had underlined the phrase
“axonal degeneration seen on microscopic sections” and had followed it up with a series of question marks. Then he’d underlined the phrase “toxi- cology negative” and capped it off by an emphatic exclamation point.
Jeffrey was mystified.
The rest of the notes were outlines of articles taken mostly from the