Angels on the Night Shift

by Robert D. Lesslie, M. D.

  She was used to the attention, and without seeming to notice it, she walked over to where I stood and plopped her bag on the floor beside me.

  “Anything exciting to tell me about, Robert?” she asked, glancing over to the patient ID board. It was almost completely filled in, with only a few empty beds in the department. Typical for this time of day.

  I was finishing up some prescriptions for the asthmatic truck driver in room 4.

  “Nope,” I answered. Then sliding the chart down the counter to Jeff Ryan, “This should just about do it for me, so there’s nothing to turn over.”

  “Good,” she replied, her voice animated with anticipation. “Looks like we’re going to have a busy evening.”

  I had first met Elizabeth—Liz, as she preferred—when she was a fourth-year medical student rotating through the emergency department of Charlotte Memorial Hospital. I was serving as chief resident, and found her to be quick, eager, and a good Password partner at three in the morning. Nobody could beat us. Her parents were both physicians, internal-medicine specialists in Asheville, and she had finished summa cum laude at Chapel Hill.

  After med school, she had completed an emergency-medicine residency in Atlanta, and then we had talked her into joining us in Rock Hill. After only three months, she had fit right in and was one of the “family.”

  “I guess no Password tonight,” I quipped, then turned and headed down the hallway to our office. Liz grabbed her bag and followed me.

  We were just outside the ortho room, about to turn the corner, when Jason Evans almost ran into me.

  “Whoa, Robert!” he exclaimed, stopping just in front of me. “Glad I caught you. I wanted to give you an update on the guy with the thoracic dissection.”

  “Mr. Shays,” I said. “Yeah, how is he doing? We haven’t heard anything.”

  He stood silent for a moment, shaking his head. It was then I noticed the blood spattered on his pant legs and surgical shoe covers. His scrub top was drenched with sweat, plastered against his body.

  “We just finished in the OR,” he said, glancing over at Liz and then back to me. “That was a really close one. It took us forever to get enough exposure to find out where he was bleeding, and then to put things back together. But he’s heading up to the ICU shortly, and he’s stable, for the moment. He’s not out of the woods, but he’s got a reasonably good chance of surviving this.”

  Relieved, I nodded my head, then asked, “Is his family still in the surgical waiting room?”

  “Just left them,” Evans replied. He glanced down at his wristwatch. “Gotta get going. Got several people to see upstairs. Just wanted to let you know about your patient.” Then he turned and was gone.

  “You had a dissection today?” Liz asked, wide-eyed and excited. “And did he say thoracic? I’ve never seen one. How did he present? Was it straightforward or…You know, according to the textbooks, only 25 percent of them present with classic symptoms, and only 50 percent survive an operation. In fact, most don’t make it to the OR.”

  She paused just long enough for me to wonder which question I was supposed to answer.

  “Wow! You were right, Robert,” she exclaimed. “You told me I’d see it all if I came to Rock Hill!”

  She paused again, and I had just enough time to say, “I need to go check on Mrs. Shays before I head home. And you’d better get out to the department and keep things moving.”

  Heading toward the surgical waiting room, I heard our office door open behind me and Liz call out, “I want to hear all about that case in the morning!”

  I shook my head, marveling at her enthusiasm and trying to remember if I had been that way when I first started out. Taking a deep breath, I walked down the hall toward the surgery waiting room.

  Mrs. Shays and her son were sitting on the lone sofa in the small but brightly decorated room. They glanced up as I entered, and the initial smile of recognition on Mrs. Shays’s face quickly faded into a look of concern.

  “Is something wrong?” she asked hesitantly. “Dr. Evans said…Is Ernest…”

  “No, no, Mrs. Shays,” I reassured her, quickly stepping over to the nearest chair and sitting down. “Ernest is fine. I just talked with Dr. Evans, and your husband is in recovery and doing okay. He’s gone through a lot today, and he’s still critical, but he’s alive. And we both know he’s in good hands.”

  She smiled and gently patted her son’s knee. Julius was staring silently at the floor, his shoulders hunched over.

  “You people in the ER were so good to him, and…and Dr. Evans is…”

  She stopped, choking back a sob, and looked away.

  “It’s okay, Mrs. Shays,” I said, reaching out and putting my hand on her surprisingly frail and delicate shoulder. “I’m just glad we got to him when we did.”

  There was nothing else for me to say, and the three of us sat in silence for a few moments. Then I stood and walked to the door.

  “I’ll be back in the ER tomorrow morning,” I told them. “When I get the chance, I’ll go up to the ICU and check on Ernest.”

  As I opened the door to leave, she nodded her head, looked up at me once more, and quietly said, “Thank you.”

  I walked down one of the back hallways and out through a staff entrance. A short sidewalk led to the parking area, and I was almost at my car when someone called my name.

  “Dr. Lesslie.”

  The voice was weak, almost muffled, and yet familiar. Whoever had called out to me was thirty, maybe forty feet away, and I turned in that direction.

  “Dr. Lesslie,” the call came again.

  This time, I recognized the voice and the middle-aged man sitting in his wheelchair. He was being pushed toward the ambulance entrance by a woman, who I also recognized. It was Blaine Anderson and his wife, Mary Ellen.

  “Blaine,” I called out, walking over to the couple. “What brings you to the hospital this evening? I thought we had you pretty well tuned up when you were in the ER a couple of weeks ago. What happened?”

  I reached down to shake his hand and almost recoiled in surprise. It was scorching hot, and terribly wasted. There was no strength in his grip at all.

  Leaning over and studying his face in the pale light of the parking-lot lamps, I could now see that he was drenched in sweat. And then he coughed. It was more of a rattle, a gasp really, than a cough. I held onto his hand, troubled by his rapid decline in such a short time.

  “Got some fever this evening, and this dang cough,” he said with great effort, barely mustering something more than a whisper. “I think it’s pneumonia again.”

  He was probably right, and I looked up at Mary Ellen. She stood behind her husband, and he didn’t see as she slowly shook her head. She knew.

  “Well, the two of you need to get into the ER.” I glanced at the ambulance entrance and pointed in that direction. “Mary Ellen, why don’t you take him through those doors? Just stand on the mat and press the button on the right side. Then just go on in and one of the nurses will show you where to take him.”

  I hoped there was still a bed open. Blaine couldn’t afford to spend any time in the waiting room or in triage.

  “Thanks, Dr. Lesslie,” he murmured. “Wish you were going to be here tonight.”

  There was a brief moment of guilt and anxiety as I realized that Liz Kennick would be taking care of Blaine. But she knew her stuff, and she would recognize a sick patient when she saw one.

  “Wish I could too, Blaine, but if I don’t get home pretty quickly, I’ll be in big trouble.”

  “Just kiddin’,” he said, smiling weakly. “We’ll be just fine.”

  They turned and headed to the ER. I watched them for a moment, remembering the first time I had met this courageous and doomed man.

  It had only been a little more than two years earlier. The chart sitting on the countertop had read, 48 yr old M—laceration of left thumb.

  It had been a cold November morning, a Saturday, and Blaine Anderson and his wife were the only ones
back in the minor trauma room. He was sitting on the stretcher in the back right corner and looked up sheepishly as I walked over.

  “Well, what’s going on here, Mr. Anderson?” I asked, sitting down on the rolling stool by his stretcher.

  It was the first time I had ever seen this man, but I immediately knew there was something special, something different about him. In his face was a kindness, a gentleness that put me completely at ease.

  He held up his bandaged and bloody hand, silently shook his head, and looked woefully up at his wife.

  Mary Ellen introduced herself and explained, “Blaine was a little careless this morning. We have some friends coming over to watch a football game this afternoon, and he was helping make the chili. He got in a hurry, and the onions got the better of him.”

  Blaine was dressed in khakis, now blood-spattered, and a much-worn orange-and-purple Clemson sweatshirt.

  “Tiger fan, I see.” I nodded at his jersey and carefully picked up his injured hand.

  He glanced down at his chest and then back up to me.

  “Yep. And how about you? Not a Gamecock fan, are you?” he answered. Then smiling mischievously, “Don’t want you to take out your troubles on me.”

  I chuckled while removing the hastily applied kitchen towel. “Nope. Went to Erskine, so I can pull for anyone I want.”

  “Good for you,” Mary Ellen quipped. “A fall Saturday afternoon at our house turns a bunch of grown-up men into fourth-graders.” She rolled her eyes down at her husband, then leaned closer and asked, “What do you think? Is he going to need stitches?”

  I studied the exposed hand, examining the two-inch laceration over the back of his left thumb. His tendons were fine, and he could feel everything I was doing.

  “He’s done a pretty good number on himself,” I answered. “Looks like a few stitches, but he’ll be fine. Tell me how it happened,” I asked, looking up at him.

  It was one of those things that just barely registers somewhere in the back of your mind. Something that doesn’t quite make it to the front of your consciousness.

  When Blaine Anderson had looked at me, his eyes had flickered. It was brief, just a few up-and-down movements of his pupils. But it had been there. And then it was gone.

  “Well, Dr. Lesslie,” he began. “Contrary to what Mary Ellen is saying, I was not in a hurry, but was carefully slicing some red onions. I’m an electrical engineer, and I value my fingers, though it might not look like it this morning. But I’m really not sure what happened. Nothing slipped, and I was watching carefully. I just seemed to lose control for an instant. I must have lost my grip on the handle or something.”

  “Dr. Lesslie, EMS 2 is bringing in a chest pain, blood pressure of 80 over 40.”

  It was Lori Davidson, standing in the doorway behind me.

  “They should be here in ten to twelve minutes,” she added, then disappeared up the hallway.

  “Let’s get this numbed up,” I told them. “And one of the nurses will start irrigating it while I check on that ambulance patient. Shouldn’t take but just a little while, and then we’ll get you back to your chili.”

  “Thanks, Doc,” he said. “Do what you need to do. We’ll be right here.”

  Blaine’s thumb laceration healed well, and I didn’t see him again for another five or six weeks. He and Mary Ellen came into the ER again, this time late one Wednesday night. He had been bothered with a right-sided headache all day, something he usually didn’t experience. And then the pain moved and seemed to be centered in the back of his right eye, especially when he looked around.

  “I wasn’t too worried about this, Dr. Lesslie, until my vision started to get blurry,” he explained. “It seems to have really gotten worse over the past couple of hours.”

  All of his vital signs were fine, his neck was supple, and he had no fever. A quick assessment of his neurological status didn’t show up anything unusual. But his vision was significantly reduced in that right eye. He was almost completely blind.

  “Have you had any trouble with your eyes?” I asked. “You’re forty-eight now, and that’s about the time things start to change.”

  “I’ve never had any problems,” he quickly answered. “Never needed reading glasses or anything. Right up until this morning. What do you think’s going on?”

  Mary Ellen stepped closer to her husband and gently put a hand on his shoulder.

  I walked over to the curtained opening of room 4 and switched off the light.

  “Let’s take a good look at that eye,” I told them, stepping back to his stretcher and taking the ophthalmoscope from its holder on the wall.

  First, I checked his “good eye,” the left one. Carefully focusing the light beam on the back of the eye, I examined his fundus. The lining of that part of the globe can give you a lot of information about blood vessels and the optic disc, where the optic nerve enters the eye from the brain. You can also see a retinal detachment, which was something I was concerned about. Yet that really didn’t fit his symptoms.

  “This eye looks fine,” I told him, leaning back and shifting over to examine his right eye. “Let’s take a look at this one.”

  It took a few seconds to adjust the light so I could see his retina. It looked fine, and his blood vessels were normal here as well. Then I found his optic disc, and there was the answer.

  I felt myself stiffen a little, and then focused more intensely on the small opening in the scope. Then I glanced away, paused, and looked back once more. I needed to be sure.

  There was no mistaking what I was seeing. The disc was grossly swollen and pale, clearly different from the other side.

  It all began to make sense now. I remembered the flickering of his eyes when he had come in with the lacerated thumb. And the momentary clumsiness he couldn’t quite explain. After asking him about any unusual episodes of numbness in various parts of his body, things that seemed to “come and go,” and getting a positive response from him, I was afraid I had the diagnosis. Or at least something that would have to be ruled out.

  “Blaine, we’re going to need to have one of the neurologists take a look at you. This might be the first signs of multiple sclerosis, and we need to find out.”

  The couple were stunned, and just looked at each other for a moment.

  “But Dr. Lesslie, this is just a headache and some blurred vision,” he stammered. “Isn’t there something I can take and just…” He fell silent and looked down at the floor. He knew this was nothing simple and straightforward.

  “I’m not saying that’s what you have,” I said, trying to reassure him, yet fearing that my instinct was correct. “You’ll need to see a specialist and have some testing done to find out for sure.”

  My hunch had been correct. Within the week, Blaine Anderson had been given the diagnosis of multiple sclerosis, and it seemed to be a very progressive and aggressive form of the disease. His neurologist sent him to Johns Hopkins and the Mellen Center at the Cleveland Clinic for any ideas and help they might have. Their answers were the same. This was one of the most rapidly advancing cases they had ever seen, and even though they tried some of the most cutting-edge therapies available, no one was able to halt the onslaught of this debilitating illness. Blaine and Mary Ellen were left with dealing with the finality of his disease, and with its inexorable outcome.

  But they weren’t alone. Their family members and friends stood with them, as well as members of their church. The two of them rarely came to the ER without a least a few of their supporters. And they came in more and more frequently.

  Yet their spirits remained positive, almost cheerful, and Blaine’s inner fire always inspired us. And as we watched while he physically disappeared before our eyes, his spirit seemed to soar, and to dominate and rise above the disease that was conquering his body. We all knew where this path was ending, but somehow there was no longer any sense of sadness when he came to the ER with shortness of breath, or weakness, or fever. Rather, his presence was uplifting, and somehow rea
ssuring. And we were glad he was still with us, if only for a little longer.

  As I watched the Andersons disappear into the ER, I wondered if this would be Blaine’s last visit.

  6:58 a.m. The next morning, I relieved a surprisingly fresh-looking Liz Kennick. She was standing at the nurses’ station, writing on the chart of the woman in room 5.

  She looked up as I came through the ambulance doors.

  “Good morning, Robert!” she greeted me. “Just finishing up this patient and I’ll turn things over to you.”

  “Great,” I answered, walking over and setting my briefcase down on the floor.

  “Tell me about Blaine Anderson,” I asked her. “The fella that came in just as I was leaving last night. Looked like he might have pneumonia.”

  Her brow furrowed briefly as she searched her memory, sorting out the dozens of patients she had seen during her shift.

  “Oh, you mean the guy with MS?” she answered. “Yes. Nice guy. He did have pneumonia, and crumped right after he got back from X-ray. I had to intubate him, and he’s on a ventilator up in the ICU. Pretty sick man,” she said matter-of-factly, with no emotion in her voice. This was the first time she had seen Blaine, and she didn’t know him. I could forgive her for not cherishing this man the way the rest of us did. “I’m not sure he’s going to make it.”

  It was what I had expected. But I felt a heaviness, a sadness now, hearing these words. I would try to get upstairs sometime today and check on him.

  3

  Sins of the Fathers

  8:25 a.m. “Dr. Lesslie, come into my office. We need to talk a minute.”

  It was Virginia Granger, standing just outside her office, and her request took me by surprise. I was at the nurses’ station, right in front of Amy Connors. Amy looked up and silently mouthed, “You’re in trouble now.” She snickered, then looked back down at the ER log.