The Portable Veblen: Shortlisted for the Baileys Women’s Prize for Fiction 2016

“Traumatic brain injury in combat has become the number one killer of our troops,” Paul began, gazing down the table. “It was the signature injury of the Iraqi and Afghani campaigns. Warfighter brain injury studies to date include a lot of hopeful breakthroughs on tissue regeneration, but none addresses the need for intervention on the spot, before the cascade of damage begins.”

A few of them actually yawned. He responded passionately:

“Let me get to the point. For the past year and a half I have performed a rigorous study of decompressive craniectomies on lab animals with a tool of my own invention, and I’m ready to translate my results to a Phase III trial—”

“We’ve got a few ‘animals’ for you,” one seasoned bureaucrat broke in, with a bitter snort.

“We’re getting an extended Doberman,” Kornfink said, drumming his pencil on the table.

“What’s that?”

“That’s what I wanted to know, but we’re getting one.”

“How extended is it?”

“I’ve heard of those.”

“I’ll let you know,” said Kornfink. “I’m breeding them. Shelley’s idea for my retirement.”

Suddenly the inert committee appeared to remember why they were there, and returned to Paul, as if nothing had happened.

“Dr. Vreeland, the Department of Defense will consider cooperating with the VA and the licensor to fund this study. How do you propose testing in field conditions?”

Paul said, “The VA in Menlo Park has several vacant buildings which we’ve submitted petitions to use to create field conditions with all relevant noise, light deprivation, smoke, and so on.”

He added, “We’ll also want to invite trained medics to test the procedure in simulated conditions, rather than MDs.” He cleared his throat, and pulled on his collar.

“This is something like a field trach, is that what you’re thinking?” asked Bradley Richter, a sinewy man with dark eyes and a pronounced underbite, reminding Paul of a sea angler with skills adapted to life in the dark deep.

“Yes, sir. Medics easily master tracheotomies in emergency situations. For testing we’d move from cadavers to live volunteers in these aforementioned conditions.”

“By volunteers, are we talking scores less than eight on the Glasgow Scale?”

“We’re looking at a number like that,” Paul said, having been warned by Cloris to keep this vague.

Cloris Hutmacher spoke up. “I’ve already met with Planning at the VA in Menlo Park and they’re ready to lease us Building 301, which is a fifteen-thousand-square-foot structure currently in disuse. Any of the WOO simulator systems would fit there.”

Richter took notes.

Paul cleared his throat. “If we succeed, which I believe we will—”

“People, this is huge,” said Cloris.

“Cloris has an eye for the huge,” pronounced Richter.

Cloris said, “It’s a cusp moment for all of us.”

Paul gazed around the oblong slab, at men and women who’d served the military and had undoubtedly been the trendsetters and thugs of their grade schools.

“This is clearly an opportunity of the highest order,” he heard himself declare. “To serve. My country.” He made methodical eye contact with each person present. “My father’s brother, PFC Richard Vreeland, Company C, Second Battalion Fifth Cavalry, First Cavalry Division, died of blast wounds to his head, chest, both legs, abdomen, and right hand in the ambush at Phu Ninh.” He had never mentioned his uncle’s annihilation to anyone before, and the expediency of doing it now shocked him, yet made him feel like maybe he could be a player after all. The room fell silent. “As soon as this meeting is over, I’m going to visit his name on the Wall. I want this as much for our country as I want it for him.”

A round of backslapping ensued. Cloris told him he was spectacular, and invited him to join some of the committee members for drinks. “Well, I’d like to, but I need to go by the Wall. My uncle,” he added.

“You really meant that?” An admiring glint flashed in her eyes. She was as thin as a whip.

“Of course I did.”

“Come with us now,” Cloris said. “Visit the Wall later.”

“But my flight leaves at nine.”

She whispered, “I won’t tell anyone you didn’t go to the Wall. Come on!”

They went to a noisy bar in Georgetown. Cloris spent her energy speaking closely into the large, open ear of Bradley Richter. Paul perspired heavily and drank too much. He didn’t end up visiting the Wall, but planned to tell his father he had. Or maybe not—maybe he’d tell his father he couldn’t, as he’d said all along. Well, it would make his father happy to think he’d tried. Throw the old man a bone. A cab returned him to Dulles within the hour, and he received the offer the next day by noon.

PAUL RETURNED from his tour of the VA grounds by nine A.M. In the lobby, an elfin woman in a yellow checkered skirt and a white blouse with a pin of a Scottish terrier on the collar stepped out and waved at him like a crossing guard.

“Dr. Vreeland!”

Susan Hinks had soft blond hair and cornflower blue eyes, a fine fuzz of blond on her cheeks, and an expression not of an embryo but of something quite fresh. A voyeur would know how to describe it. “Welcome. It’s great to meet you, Dr. Vreeland!” Her voice was charmingly nasal, with a mild midwestern twang, and her teeth were notably large and clean. “I’m your clinical coordinator and I’ll be providing support in all responsibilities related to the NIH and the DOD and Hutmacher. I’ll conduct follow-up evaluations, watch compliance with protocol, take care of the case reports. I’ll be your liaison with the Investigational Review Board, the IRB. We’ve been completely overwhelmed with volunteer applications—we’ve still got people calling and going around the usual channels to get in.”

Paul felt a surge of pride. “Seriously? Is this trial especially attractive for some reason?”

“Any trial is attractive,” Susan Hinks said. “They have to wait so long for treatment in the system. If they get into a trial, they get a lot of attention.”

He gave her a skeptical look.

“Are you trying to tell me these veterans are willing to get a hole punched in their skulls just to get a checkup?”

Unruffled, she said, “That’s the way it is, Dr. Vreeland. Let me show you what we’ve organized so far. I think you’ll be pleased.”

He’d recently reviewed the latest iteration of the World Medical Association’s policy statement, the Declaration of Helsinki, concerning the ethical principles for medical research involving human studies. Now he wanted to know: Had they followed the declaration to a T? Yes, Hinks told him. Had they filed all the paperwork disclosing his financial interest with Hutmacher?

“Form 3455, done.”

“Well! Great.” He followed her to the elevator, up a floor, down a corridor through some security doors that she opened with a code. A stooped man in a thin flannel shirt and jeans caked with cement pushed the blue button on a water cooler in the hallway; a woman in a butterscotch-colored sweater stood behind him. They eyed him timidly, and retreated to a room with a TV screen. “That’s the family room,” Hinks explained. “Since the volunteers began to arrive, we have some of the families spending all day here, thrilled to take part. Patriots to the bone.”

He winced at her word choice, while she opened a cabinet stocked with sterile aprons, masks, and gloves. “Here you go,” she said, and together they suited up.

The swinging doors let them through.

A gritty light touched on the ward, beds lined up military style. The cold echo of machinery bounced off the walls, along with the rhythmic hiss of chest cavities rising and falling on ventilators. A sharp whiff of ammonia penetrated his mask. Across the room, a nurse changed an IV bag, while an attendant mopped around a bed, gathering a pile of sheets bundled at the foot.

Paul grabbed the chart off the first footboard he came to. Flores, Daniel R.Injured by landmine, north of Kabul. He saw before him a twenty-four-year-old with a youthful hairline and an unblemished brow, missing the eyes, nose, and mouth beneath it. The roots of teeth poked from a band of purple tissue, and a breathing tube disappeared through a hole the size of a Life Saver, secured by a gasket. Where the boy’s arms had once been sprouted two fleshy buds, stippled with splinters of bone.

Paul looked at the chart attached to the next bed. Baker, Jeremiah J. Wounds suffered near Kandahar when his vehicle encountered an improvised explosive device. The young man’s eyes were open, and Paul bent over to make contact. The pupils were nonreactive. The eyes didn’t see.

“And we have wonderful volunteers who work with the families, a lot of attention, a lot of hope. It’s very uplifting.”