Seeds of Destruction

By Gary Miller Proulx

Dr Jacob Miller, a world renowned radiation oncologist whose cancer patients are dying suspiciously from their cancers after treatment that should have cured them, suspects something sinister behind their deaths-- even murder. He also suffers further turmoil when his romantic relationship ends, and, when flash backs occur to his own painful childhood as an orphan--he is brought to the bleak edge.

Incredibly, he battles back to discover that terrorists are behind his patients being sent to early graves and are also plotting to explode a dirty bomb in Boston. When Millers girlfriend is kidnapped by the terrorists, he recruits his friends and co-workers to help him save her and stop the terrorist bombing. If he fails his mission, he will not only fail his patients, but also the lives of countless thousands, and his country.

• Language: English
• Publisher: Abbott Press
• Release date: Apr 10, 2015
• ISBN: 9781458218728

Gary Miller Proulx

Gary earned his medical degree from Harvard Medical School and had his residency and fellowship training in Radiation Oncology at the Massachusetts General Hospital (MGH). He is currently the Medical Director of Radiation Oncology at Exeter Hospital in NH, an affiliate of MGH. He has published extensively in journals on cancer and .enjoys spending time with his family, dabbling in stand-up comedy and strumming his guitar. He currently lives in NH with his wife and one of his three children.

Book preview

CHAPTER 1: PLANTING SEEDS

POISON HIM? CUT HIM? OR BURN HIM?

Everyone eventually agreed to burn him.

Dr. Jacob Miller and his medical team stood over the patient lying naked on the operating room table. They were dressed in lead-lined gear from head to toe to protect themselves from radiation exposure, which made them look more like a police SWAT team than doctors and nurses. Only a hint of blue scrubs sticking out beyond their vests and thyroid shields gave away their identity.

Behind Dr. Miller sat Buzz, his dosimetrist, peering at his laptop in front of him. His job was to design the radiation treatment plan per Dr. Miller’s specifications and prepare the radioactive seeds for each needle planned for the patient’s surgery. Miller turned around to take the trocar with its needle filled with radioactive seeds.

Buzz, hand me the next one.

Done incorrectly, radiation implants could kill the patient. But in the skillful hands of Dr. Miller, a world-renowned radiation surgeon, he had at least a chance for a cure. Patients came from around the world for treatment by Dr. Miller, whose reputation included his being a miracle worker.

Prior to inserting each seed-filled needle with the trocar into the patient, Miller stared at the prostate target on the ultrasound projection on the monitor, hanging just above the patient’s abdomen. It was like the prostate was the enemy he studied before he was about to attack. These are the last seeds, Buzz. What do you think?

Buzz reviewed his laptop screen and compared it to the overhead monitor. While waiting for Buzz’s reply, Dr. Miller looked around the operating room. Only the sounds of the respirator attached to the patient could be heard, with its rhythmically pulsing diaphragm pushing vital oxygen into the lungs on its way down and removing carbon dioxide and other waste products on its way up. The patient, sedated and intubated, was not aware of the ongoing violations of his body.

The operating room was cold and dark, except in the center where the overhead lights provided illumination and heat. Standing in the center of it all, his thoughts drifting, Miller pictured the operating room as his Carnegie Hall, where he conducted the music of ‘destroying cancer to create life’. He led his staff of musicians through the symphony, each working independently throughout the procedure, but in the end, collectively to create the ‘sound of life’.

About the needle placement, Buzz said. He peered into the laptop screen to view the patient’s three-dimensional plan showing where each seed was to be placed within the prostate to within millimeter accuracy. He then stared at the ultrasound projection above the patient. The location looks spot on to the plan we have here up on the computer.

As he had done twenty-four times on the patient over the previous hour, Dr. Miller held up the trocar, the steel, hollowed-out needle that held the plastic needle inside it, loaded with radiation in the form of seeds, each the size of a grain of rice. Big and thick, heavy, lead-lined gloves enveloped his hands, and he leaned over the patient’s pelvis and placed the trocar over the entry point marked on the patient’s perineal skin. As with each of the needles placed before, he took in a slow, deep breath that pulled his face mask inward, and with both hands, he stabbed the skin to feel the needle tear through the epidermis, then into the thick gluteal muscles and connective tissue below it to reach inside the prostate, which was ground zero for the attack on the cancer. It felt like stabbing with an ice pick into a tightly fitted, leather-covered chair. Blood oozed out of the puncture wounds around each needle. The patient’s monitors immediately showed stress with a jump in his blood pressure and an increase in his heart and respiration rate.

To Miller’s immediate right stood Bridget, his recently hired physician assistant. Dr. Miller felt like a giant next to her with his six-foot-two, wide-shouldered frame and her five-foot-three, petite frame. It was her first case in the operating room with him, and he had planned only to instruct her on the procedure, so she would be an observer only and not directly involved. He looked over to see her riveted in her spot, leaning forward, her arms folded across her chest, watching intently everything going on with the procedure, like a sponge absorbing every drop of information. Bridget, see how clearly the radiation seeds on the ultrasound images are?

She nodded. Yes, I see them.

It shows just about another centimeter, according to the plan, before dropping these seeds into the prostate. This last one is a bit tricky because it’s close to his urethra. And even more dangerous, it’s close to that blood vessel behind it . Miller pointed to the ultrasound projection in front of them. See it?

Bridget studied the ultrasound image on the projector in front of her and nodded again with her eyes wide open. Yes, I see them. Each twinkling, like stars in the sky.

I have to be careful not to stick that vessel, said Miller.

Dr. Miller, what would happen if you did hit it with the needle? The blood vessel, that is? asked Bridget.

Don’t even think that. Because it’s an artery, it could be a real bleeder, requiring surgery to close it. Even worse, if just one of these seeds gets into the bloodstream, it could travel to his heart, or to his lungs, or even worse, to his brain, causing him injury—even killing him.

She nodded nervously, and above her mask covering her nose, her eyes again opened wide.

Miller turned to Buzz behind him. Buzz, are you positive that the needle location conforms to the plan we designed?

He looked at the screen on his laptop, then back to the projector over the patient. Looks spot on to the plan. Why? Something wrong, Doc?

Miller squinted and looked more closely to the screen in front of him. I’m not sure. It looks uncomfortably close to that vessel running behind the prostate, but it must be the two-dimensional view we’re seeing on the screen, making it look closer than it actually is.

He took a deep breath, then readied the needle and pushed it in a full centimeter. He looked up to the ultrasound projection, which showed the tip of the needle exactly where the seeds were to be dropped. He exhaled a deep breath, pushed the needle inward the last few millimeters, and the seeds exited the needle.

That’s it, said Miller, and pulled the empty needle out. Everything looked good on the screen, but then seconds later, blood shot out of the body where the needle had been, like a racehorse jumping out of the starting gate, coming straight at Miller, splattering his face shield.

Miller jumped backwards, quickly put his hand over his face shield to block the blood, and twisted around. Damn! I can’t see anything.

The blood was velvet-red and pulsing to the rhythm of the patient’s heartbeat, which told everyone that an artery had just been pierced. Miller then turned back around to the patient and placed one hand over the bloodstream, applying pressure on the hole the trocar created in the perineum.

The life support system showed the patient’s blood pressure first increasing and then rapidly dropping. The trauma of cutting through the artery had shocked the patient’s vascular supply.

The anesthesiologist popped his head above the screen at the head of the operating table with his raised eyebrows and wide-open eyes. Miller! Stop the bleeding!

Miller looked over at Bridget and wiped the blood off his mask. Quick, Bridget, take over and press on this bleeder.

Bridget’s eyes widened. Me? Are you sure?

Miller nodded. Yes, I’m sure.

She stepped forward with slow, timid, baby steps, and pressed her hand over the shooting stream of blood, then looked over at Dr. Miller.

Perfect, said Miller. He then twisted the ultrasound probe placed within the rectum to visualize the prostate area better. Keep pressing while I check the vessel. Miller then scanned up the vessel. Buzz, hand me the Geiger counter. Miller turned, grabbed it quickly, and turned back to lean down onto the patients exposed pelvic area. He scanned it to make sure no radiation was detected outside of the prostate target. Where the Geiger counter clicks became louder, he moved the ultrasound probe over to the spot to focus in on it. He moved the Geiger counter a half centimeter at a time so as to not miss any of the half-center-length radiation seeds. His own heart kicked his chest from within, and his mask continually fogged up and down mirroring his respiration rate and intensity. The on and off hissing of the ventilator echoed in his head, and the bright, hot overhead lights cooked his outsides, while his adrenal surge baked his insides. If not for the coldness of the operating room sucking heat from his body, he would surely have overheated and collapsed.

Dr. Miller, what are you looking for? asked Bridget gingerly.

The radioactive seed. He pointed to the bright signal given off from the seed within the blood vessel on the ultrasound projection. There. See it? We have to get that out. And pronto. He extended his right arm out and lowered his hand to the circulating nurse who stood patiently behind him and to his right. Hand me the fiber optic scope with the clamp attachment. Miller then passed the scope through the hole in the perineum left by the trocar, extended the tiny forceps attached to it over the vessel, and clamped it just above the seed. Miller then worked quickly to enter the clamped vessel with the other attached forceps to retrieve the radioactive seed. He slowly worked the scope into the vessel, being careful not to stretch it too much, which could tear it.

Patient is stressed. The anxious voice of the anesthesiologist sounded from behind the curtain that draped the patient’s head and upper thorax. Don’t want to give him any more meds with his bad heart, but I have no choice. His heart is too weak to compensate for the drop in blood pressure on its own.

Miller looked up at the head of the table. I understand, said Miller, as he began to rub his right arm like he had a bad itch that could not wait to be scratched. Do whatever you need to keep him stable while I work to get this seed out.

Okay then. Giving more anesthetic. He then injected more pressure medication and more anesthetic for pain control into the patient’s vein, as it was obvious from the vital sign readings that the patient felt the deep trauma from inserting the scope first into his soft tissues and then into his blood vessel.

Miller’s mind raced in several directions without his hands missing a beat to retrieve the lost seed. He never once took his sights off the patient and ultrasound image in front of him, and yet he was somehow able to picture the operating room around him simultaneously, while his thoughts began to drift in and out from his immediate surroundings and circumstances. When I look around me, I see a fortress of walls protecting my kingdom, inside of which I control everything, but not for evil purposes. Only for good. I save lives here. I cure people of the enemy within them, the cancer. I stand high above all others, looking down on those that I am to save today, and, from above, the overhead lights shine only on me as I direct my orchestra.

Miller slowly worked the optic scope up the vessel, being careful not to touch the inner lining along the way, deeper and deeper until the shiny seed came into view. There it is! he said. He moved the tiny forceps attached to the scope forward to grab the seed. Just a few more millimeters. The video camera on the scope showed the forceps opening ever so slowly around the seed, like the jaw of a great white shark about to swallow its prey. Miller held his breath and closed the forceps down on the seed. There. Got it. He looked at the ultrasound, which showed the forceps grasping the seed and slowly being pulled out of the vessel. Everything on the screen looked like it was occurring underwater, with any movement of the scope creating little ripples of sound waves. Okay, Bridget, take the forceps off the vessel to let the blood flow before he gets ischemic. Just … another … centimeter to go, said Miller.

Bridget did as he said. And just as she did, the seed slipped out of the other forceps, shot a centimeter downstream, and began swimming away again within the vessel.

Damn! shouted Miller. Bridget, quick, clamp the vessel above the seed again. Hurry! Before it gets to where the vessel branches above.

Sweat bubbled off Bridget’s brow. She grabbed the clamp from the nurse, but as she opened it, using only her forefinger and thumb, gravity pulled down on it, and it slipped out of her hand and fell to the floor. Bridget’s head snapped back and over to look at Dr. Miller with horror on her face.

Dr. Miller looked sternly at her, and fog built up on his mask from his rapid breathing. Nurse, give her a new one, he said.

Bridget took the new clamp, placed it inside the hole, pushed it to the vessel, and quickly reached above where Dr. Miller had the scope in the vessel. Where do I clamp it now?

Bridget, look at the ultrasound monitor, said Miller. Now, I will slide the ultrasound forward so you can see the branch point. There! See the seed just below the branch point?

She nodded nervously. Yes! I see it.

Good, now clamp it just before where it divides.

The ultrasound showed the seed migrating upward, wiggling along as the current from the blood flow pushed on it, causing it to bump into the sides of the vessel wall and spin out of control when caught in areas of turbulence. It was like watching an object tossing and turning while being dragged helplessly through white-water rapids.

Bridget struggled to keep her forceps steady with her body appearing tense as she adjusted her position over the body. Here? she said, placing the forceps over the exposed vessel just below the branch point, where it formed the shape of the letter Y.

Yes, there. Steady. Steady. Now! Quickly! It’s just a few centimeters away.

Bridget grabbed the vessel just below the division and squeezed it shut, just as the seed reached the beginning of the division. The ultrasound showed that the seed again had been stopped just before the branch point.

Thank God, said Miller. Good job, Bridget. If that had gotten away, we may have had to open up his chest where the seed was likely to travel.

Miller grabbed the forceps, pulled the seed out of the vessel, then through the soft tissues of muscle and fat, and turned to give it to Buzz behind him. Put that bad boy away, said Miller.

Yes, sir. Buzz placed the seed into the lead radiation seed container (aka, the Pig) next to him. Now you stay in there and behave. He shook his forefinger at the lead pig. You have been a naughty boy, Mr Seed, said Buzz.

From behind the curtain, again came the anxious voice of the anesthesiologist. Come on. Come on, everyone. Let’s hurry it up. Another sixty seconds, and we may have a code on our hands. His heart rate is now tachycardic with occasional atrial fibrillations.

Bridget, I need you to move the clamp back down to just before the tear in the vessel and then step away so I can stitch this sucker up, said Dr. Miller.

Bridget stared at Dr. Miller like she had just been told to jump off the Empire State Building.

Miller lowered his head and gave a penetrating look. Got it?

Bridget looked directly into Miller’s eyes. Yes. I got it. With beads of sweat coming down her temples, she slowly let go of the clamp. Immediately, blood shot back out of the trocar-needle hole in the perineum, but for only the few seconds it took for her to clamp above the tear in the vessel.

Good job, said Miller. Now, Carol, hand me that suture.

Carol, one of the scrub nurses, slapped it into his outstretched hand.

Ow! Damn! It stuck me, said Miller. He transferred the suture to the other hand and and shook the one just stuck as if to send the pain away.

The nurse put her hand up to her mouth. Oh, my—I am so sorry, Dr. Miller. Do you want to re-glove?

He looked closely at it under the light. No time for that. Just glove over it. Within seconds, he had a new sterile glove over the old one to cover the hole in it. Immediately, he brought a new needle and thread into the hole with the scope and began to suture the tear in the vessel using the scope with forceps.

Thirty seconds. I’m not kidding. This guy is not tolerating this, said the anesthesiologist.

Miller worked quickly, placing three stitches as fast as anyone in the operating room had ever seen.

In an even higher octave this time, Ten seconds, said the anesthesiologist.

Miller did not look up from where his hands worked furiously. Not to worry … got everything under … control. There. Stopped! said Miller as the pulsing jet stream of blood became only a slight trickle, like that of a garden hose being shut off from full force to a slow trickle before it emptied itself out.

Phew, two seconds to spare, said the anesthesiologist, now in his normal baritone voice, poking his head out above the drapes. Heart rate and pressure stabilizing. You know, Miller, you put a scare, something fierce, in me. For a few seconds there, I thought we might lose him.

Miller quietly sucked in a deep breath, like he had just surfaced from being underwater longer than he should have. Sorry about that. The patient is doing fine now, so let’s all take a deep breath and get the patient to recovery. Miller glanced around at his team and saw nods all around. Great job, everyone. It was a bit more than we expected. But thanks to all of you, the patient will do well. Let’s get a quick X-ray for prostate-seed placement check and cystoscopy for bladder check and then get the patient cleaned up and to recovery. I’ll meet him there after I talk with his wife.

Buzz approached Miller, put his arm on his shoulder, and wiped the sweat off his brow with his other forearm. Doc, you never stop amazing me. And I don’t mean just your skill at placing the radiation seeds. If you could only stay so calm when I’m late for a case as you do with getting bleeding controlled.

Thanks, Buzz, but I’m lucky to have a great team with me. Dr. Miller turned to Bridget, who was helping the nurses prepare the patient for the recovery room. Bridget, you did terrific. I mean it.

Bridget rubbed her gloved hands together and raised her eyebrows. Really? You’re not just saying that to make me feel good?

No. I would never do that. This is serious business. We deal with life and death, so I would never sugarcoat things. That wouldn’t help you, me, or our patients.

Bridget sighed while rolling her shoulders. Dr. Miller, I can’t tell you how nervous I was in there.

Miller chuckled. Yes, I know. I could tell. And that’s a normal response. I would have been worried if you hadn’t been nervous. Someone who’s too cocky is likely too dangerous. A healthy degree of nervousness keeps you on your toes. Miller moved over to her and put his arm around her. So, I will say it again, for your first time in the operating room, you did pretty damn good.

Bridget moved her eyes over and up to look at him, smiled, and said, Thank you, Dr. Miller. That means a lot to me.

When we have more time, perhaps later today, I’d like to go over today’s case with you to help you better understand it and prepare you for your next case with me. I just want you to know that what you just went through is something you have to go through. I didn’t leave you hanging there to torture you. It’s the only way you’ll learn to think on your feet under stress. He looked at his watch. Right now, I need to talk with my patient and his family. He turned to walk away.

Dr. Miller?

He stopped and looked back. Yes, Bridget?

May I go with you to see the patient?

He hesitated and stared at her for a moment, then nodded. Of course. Glad you asked.

They left the operating room, removed their sterile protective paper coverings and the radiation shielding, and walked down the hall to the patients’ waiting room. As soon as they entered it, Henry’s wife and family stood up with anxious looks on their faces.

She stepped forward. Dr. Miller, how is my husband doing? Did everything go all right? We heard from one of the nurses that there were a few problems, she said, all in one breath.

Miller walked right up to her. Your husband is doing fine. We had a few challenges, but everything came out well. He’ll be in the recovery room for a few hours before we have him go to the floor overnight for observations.

She looked up at Dr. Miller. I want to thank you for what you did for us.

Miller put a hand onto her shoulder and smiled. There is no need. This is what I do. I’m glad I could help.

Dr. Miller, I’m not talking only about your treating my husband for his cancer.

Miller removed his hand from her shoulder and leaned back while placing his hands on his hips. I’m sorry, but I’m not following you. What do you mean then?

I’m talking about your paying his—our—medical bills.

He looked down and askance at her. Who told you that?

When I went down to talk with the billing people at the hospital because he was laid off from his job and lost our insurance, the lady said we didn’t need to worry about the bills. I didn’t believe her, and I guess I started to make a scene, so she broke down to shut me up and told me you had paid them after you found out he lost his insurance. She began to cry and stepped forward to hug him. She was such a diminutive woman that when she hugged Dr. Miller, her head barely reached his chest.

Miller hesitated but then bent over to hug back. They weren’t supposed to tell you that.

You’re a caring and generous man. God bless you, she said, with tears rolling down her face.

Dr. Miller looked over at Bridget, who had been watching them the whole time. Miller smiled and raised his eyebrows with a what can I say look on his face.

Dr. Miller looked down again at Henry’s wife, and she looked straight up at him. I have to get back to check on your husband and write orders for him. The nurses will let you know when he’ll be transferred to the floor so you can visit him.

She went back to hugging him, only this time tighter. Bless you, Doctor. Bless you.

I’ll be back to see you and your family after he goes to the floor in a few hours. I promise.

She then let go of her hug, wiped her tears away, and looked up to Dr. Miller as he walked away. Bless you. God bless you, Doctor.

On the way out, he passed Bridget, standing in the doorway. Come on back to the operating room with me, and I’ll show how to write the orders for the patients.

They walked down the hallway leading back to the operating room. Dr. Miller, that was a very generous and wonderful thing you did for that family, said Bridget.

It’s no big deal. I like helping those that need it, but thank you for saying so.

When they got back to the operating room, only Buzz and a maintenance person cleaning the floor were there. Oh, Buzz, I’m glad you’re still here.

Hey, Doc. This case was a bit more challenging, so I wanted to take a bit more time checking the room for any stray radiation. Just to be sure, replied Buzz.

Good idea. Listen, I want to meet with you and Ahzid later today in my office.

Sure, no problem. Can you tell me what it’s about?

Buzz, I think you know.

Buzz raised his eyebrows with a slight tilt of his head. Let me guess, the patients who died unexpectedly? Am I right?

Exactly.

Okay. I’ll let Ahzid know when I go back downstairs to put the pig with the extra seeds away.

Dr. Miller and Bridget sat down at the paperwork area, and he proceeded to show her how to fill out the postoperative orders. Any questions? he said after they finished.

No. That seemed pretty straightforward.

Good, I’ll go back to—

The OR phone’s loud ringing startled them.

One of the scrub nurses who had come back to get the post-op orders from Dr. Miller answered it. OR 9, she said. Dr. Miller? Yes, he’s still here. She turned with the phone extended out toward Dr. Miller. Dr. Miller, it’s for you.

Who is it? Can I call them back?

Dr. Miller is busy right this minute. Can he can call you back? She listened intently and looked surprised. Okay. Hold on. I’ll tell him. She looked over to Dr. Miller. It’s Dr. Whittimore from the Radiology Department. He says that unless you have your hands inside someone’s abdomen trying to stop their bleeding, it’s important and I had to interrupt you.

Miller stood, walked over to the nurse, and looked at her with a half smile. He’s just a bit late on that, he said. He took the phone out of her hand. Hello, Miller here. Now what’s so urgent that you scared the nurse half to death? He listened and then said, Oh, I see. You want to go over the test results on my patients … and? Miller paused. The silence permeated the OR. Miller felt the force of gravity pull down on him. His jaw opened, and his shoulders sagged. A burning again in his right forearm caused him to rub it.

No. Not another patient? he said as he shook his head.

CHAPTER 2: THE GAUNTLET

BRIDGET SAT IN THE CORNER OF THE OPERATING ROOM AND WAITED QUIETLY FOR Dr. Miller to finish talking with Buzz. She felt closer to him after experiencing the intensity of the implant case they had just gone through together. She wondered if this is what soldiers feel when they go through battle together and survive. Up until that moment, she had looked at him only has her direct supervisor. Nothing beyond cerebral interactions.

Good looking, isn’t he? whispered one of the OR nurses from behind in Bridget’s ear.

Bridget turned quickly to her. What? Who?

Oh. Come on now. I saw you gawking at Dr. Miller over there.

I … I was just thinking about all that happened during the case. That’s all. Bridget picked up the notepad on her lap that she had taken notes on and began looking through it.

The nurse gave her a questioning look, raising her eyebrows. "Listen, honey. It’s okay. Not to worry, you’re not alone. All of us nurses—even some of