Susan put her penlight back in her pocket and slung her stethoscope across her neck. “Great. You’re a normal almost-teenager, except you don’t sass your mother enough. If you’re going to develop into a proper teen, you have to practice your sarcasm, eye rolling, and door slamming.”
Susan thought she saw a ghost of a smile cross Monterey’s face, but the girl did not speak.
Susan waved a dismissive hand. “Ah, don’t worry. You’ll get it. We all do.” With that, she exited the room and headed to visit the second patient on her list.
She found Dallas Moore sitting in the common room with several other boys, watching a video on the enclosed screen. She recognized him at once, the only African-American in the group. He had close-cropped hair and pudgy cheeks. He looked younger than his ten years, notably short for his age, and as round as a basketball. Legs like tree trunks jutted from his shorts, the skin ashy dry and in need of lotion. He breathed loudly, almost snoring, though clearly wide-awake.
“Dallas Moore?” Susan asked.
The deep brown eyes darted toward her. “Call me Diesel.”
“Diesel, okay.” Susan remembered seeing the nickname on the sheet Stony Lipschitz had given her. “I’m Susan Calvin, your new doctor.”
The boy nodded, clearly more interested in the television screen than in her. “Hopefully, I’ll be out of here before you are.”
Susan smiled. “That is precisely my plan. You mind if I examine you?”
“Here?”
Susan chuckled. “In your room. I can wait until after the movie, if you prefer.”
“Thanks.” Diesel’s gaze went back to the screen.
Susan left him there and started looking for her other charges. She expected to find Sharicka first. The only preschooler in the mix, she ought to stand out jarringly. Instead, Susan found a girl standing in clear confusion, as if she had just awakened in an unfamiliar body in a strange location. She shuffled a few steps, stopped, and looked around with her brow furrowed. She went to take another step, staggered, and fell.
A nurse ran toward her, but Susan arrived first. “Here, let me help you.” She took the girl’s hands and gently helped her to her feet. “Are you all right?”
“I think so.” The girl clung to Susan’s arm, her fingers like ice cubes. “I get dizzy sometimes. And confused. But I’m all right now.”
The description sounded familiar. “Would you happen to be Starling Woodruff?”
“Yep, that’s me.” The girl sounded shaken. “Would you mind helping me to my room?”
“Not at all,” Susan said. “Which way?”
Starling pointed down the back corridor. Knowing the doors had patient names on the jambs, Susan headed in the indicated direction, reading as she went. She found Diesel’s room, then, two doors down, Starling’s.
“I’m Dr. Susan Calvin, Starling. I’m your new resident physician.”
“Of course,” Starling said. “First of the month.” Her eyes narrowed.
“Which month?”
“July.” Susan helped Starling to her bed. “And it’s the third. The first was a Sunday, and I got here too late to bother you yesterday.” As Starling let go, the frigidness of her touch remained, engrained on Susan’s flesh. “Your hands are really cold.”
“They always are.” Starling leaned her back against the wall. “Feet, too. I suppose you want to examine me?”
Susan closed the door. “If you don’t mind.”
Starling made a gesture to indicate she did not.
Susan performed a slightly more thorough exam on Starling, including a check of all four lower extremity pulses. She had just finished confirming Starling’s cold feet when someone knocked on the door. Susan made sure Starling’s body was appropriately covered before answering. “Yes?”
Kendall Stevens pushed the door open a crack. “Time for rounds, Calvin.”
“Excuse me,” Susan said to Starling. “Will you be all right now?”
“I’m fine.” Starling rose carefully, walked to her shelf, and pulled down a Nancy Drew book. “I’ll just sit here and read for a bit.”
Susan headed out the door. “Do you want it open or closed?”
Starling nestled back on the bed, book in hand. “Open, please.”
Susan left the door open, then trotted to the staffing room, where she could just see Kendall’s back disappearing. As she rounded the corner, she noticed all of the R-1s sitting in chairs along with Clayton, the R-2. Stony perched on the edge of a desk, and Dr. Bainbridge sat on another, looking around the clustered group. The nurses hovered on the fringes, working and listening simultaneously.
Dr. Bainbridge addressed Stony. “Are they all here?”
“Yes, sir.”
Bainbridge nodded briskly. “Let’s start with . . .” His gaze wandered over the group and landed back on the R-3. “Which one took call last night?”
Susan’s heart rate quickened.
“Susan Calvin.” Stony gestured at her.
“All right, let’s get to work.” Susan suspected she was about to meet the side of Bainbridge that Stony had warned them about, the one that asked difficult questions and expected quick and well-considered answers. “Susan Calvin, present your first patient.”
Chapter 4
Susan began with one of the patients she had actually examined. “Starling Woodruff is a thirteen-year-old white female with a history of odd behavior who has been on the Pediatric Inpatient Psychiatry Unit for almost two years.”
“Odd behavior,” Bainbridge interrupted. “Is that her diagnosis, Dr. Calvin? Odd Behavioral Disorder? Isn’t that akin to diagnosing a child with a specific chromosomal deletion as having Funny-Looking Kid Syndrome?”
Irritation seized Susan, but she held her tongue. “Starling’s official diagnosis is dementia, status post A-V fistula repair.” She did not add she did not agree with the diagnosis. It would sound arrogant and ridiculous to contradict the numerous physicians who had treated her over the last two years. “Her symptoms consist mostly of memory lapses, particularly short-term, aimless wandering, lack of concentration, and confusion.”
Nods suffused the group, residents and nurses included.
Susan continued, wanting to get out the entire history before letting the other shoe drop. Going first made things so much more difficult. She had to guess how much information Bainbridge wanted, enough so he fully understood the situation but not so much it made her look incapable of sifting out the pertinent from the history. The residents’ reports at rounds might be the only knowledge Bainbridge would have of their patients.
“Starling underwent repair of a cerebral arteriovenous fistula in September of 2033. In the nearly two years since, she has developed worsening psychiatric problems, treated with various cholinesterase inhibitors. She is currently taking rivastigmine, which seems to help with memory and confusion, as well as sertraline for agitation and depressive symptoms. In addition to her psychiatric symptoms, she fatigues easily and has grown poorly for age, currently in the tenth percentile. She had previously been growing along the seventy-fifth percentile curve. On physical examination, she was pale, with remarkably cold extremities. Her pulse was thready. I could feel the liver edge, implying possible hepatomegaly, and I could hear a soft S4 gallop.”
Susan looked at the nurses, several of whom had creased foreheads. Apparently, they had never noticed the extra heart sound, which did not surprise her. It was subtle, not something expected in psychiatry, and, even under normal circumstances, required significant training to hear.
Stony pursed his lips, head bobbing. “Nice catch.”
Bainbridge looked from Stony to Susan. “Are you sure?”
“After rounds, I’ll double-check it,” Stony promised.
Bainbridge studied Susan. “What do you make of your findings, Susan?”
“Well . . .” Susan hesitated to speak. If what she believed was true, it would change the entire approach to the patient. “I don’t believe Starling has dementia p
er se. I think she’s actually suffering from congestive heart failure, a feature of which can be altered consciousness, especially in children.”
The nurses murmured in the background. Bainbridge nodded slowly. “Does she have a history of some sort of congenital heart disease with reparative surgery? Hypoplastic left heart? Transposition?”
“No,” Susan admitted. “But a child can develop congestive heart failure without a major defect.”
Bainbridge tried another tack. “An ASD, perhaps? A suspicious murmur?”
“No,” Susan admitted. “Prior to the A-V fistula repair, she was, apparently, perfectly normal.”
Bainbridge continued to stare. “So, then, what would cause a child with a normal heart to develop congestive heart failure after a routine neurosurgical procedure?”
Susan found herself bridling under the scrutiny and stood up straighter to buoy her confidence. The child’s life might depend on it. “Only one thing, sir. If the A-V fistula was not properly or fully repaired, it could cause a shunt that results in CHD.”
The nurses responded with a collective drawing in of breath that added up to an actual gasp. The doctors turned to face them.
“What’s wrong?” Bainbridge demanded.
The head nurse came forward. “Well, sir, the surgeon on Starling’s case was none other than Dr. Sudhish Mandar. He’s one of the greatest neurosurgeons in the world, and he personally signed off on Starling.”
Bainbridge sucked in his lips, nodding. “Well, then.”
Susan waited for his orders. It seemed impossible he would side with a first-year resident over a neurosurgeon with such stellar credentials, and she was not surprised when he did not.
Bainbridge patted Susan’s shoulder. “It was a great theory, anyway. I like to see my charges thinking in new and different ways.”
The smirks on the nurses’ faces annoyed Susan. She supposed they saw the same thing the first of every month: fresh, new residents so convinced of their own brilliance, so eager to find the instant cure so many wiser heads had missed. She supposed nearly all came with the same familiar “brand-new” approaches and ideas. She could hardly blame them for doubting her. “Dr. Bainbridge, I don’t think it would hurt anything to have Neurosurgery come down and reevaluate Starling. As far as I can tell by her chart, they haven’t seen her in at least the last eighteen months.”
Over Dr. Bainbridge’s shoulder, Stony shook his head, an obvious warning to Susan not to pursue the matter further, at least not at the moment.
A tinge of purple rose to Bainbridge’s wrinkled face, but his voice gave no sign of building rage. “Susan, when Dr. Sudhish Mandar signs off on something, it is off, finished, perfect.”
Susan wondered why she had never even heard of this so-called best neurosurgeon in the world. They had neurosurgeons at Thomas Jefferson, in Philadelphia; and she had performed her neurosurgery rotation as a medical student. She had never once heard them mention Dr. Mandar. “Fine, sir. As I wasn’t inside Starling’s brain, I can’t guess what they saw. However, I know pediatric congestive heart failure when I see it. Can I, at least, have a Cardiology consult?” No matter the cause of Starling’s heart failure, the cardiology team ought to have the expertise to control it. Perhaps they could come up with a reason for the problem that did not reflect badly on the neurosurgery team.
Bainbridge looked at Stony, as if to say he pitied the R-3 having to deal with a difficult upstart.
Stony did not seem put out by Susan at all. “How about if I examine Starling after rounds? If I also see signs of CHD, then we’ll consult Cardiology.”
That seemed to satisfy Bainbridge, who flashed Susan a sincere smile and nodded broadly. Before he could call for information about the next patient, thunderous pounding echoed across the ward. It sounded as if an entire wall had collapsed. There followed a shout, then a loud string of the dirtiest swear words in the English language in the voice of a prepubescent male. Through the one-way glass, they could see Dallas “Diesel” Moore ripping children’s artwork from the hallway walls and throwing the mangled papers at two nurses at his heels. Blood poured from his nose, gushing down the front of his shirt, but he paid it no heed.
“I hate you!” he screamed before disappearing around the corner, the nurses in tow. “I’m going to kill you! I’m going to kill you all!” He flung something in his hand that one of the nurses dodged.
Stony and several of the nurses excused themselves, darting out of the office toward the retreating figures.
“Whose patient is that?” Bainbridge demanded, watching Stony go.
Panic sparked in a few eyes. The other residents had had even less time than Susan to review and meet their patients. They might not know.
Susan rescued them. “He’s mine, too, sir.”
Diesel’s shouts wafted to them, still mostly curses. The sound of objects hitting the walls rose over the din, as well as scuffling and the softer voices of the nurses, attempting to restrain and soothe him.
Susan tried to ignore the noise as she presented the boy. When she had met him earlier, he seemed so calm, so normal, she could scarcely believe she had seen the same child. “Dallas Moore, known as Diesel. He’s a ten-year-old black male with morbid obesity, ADHD, oppositional defiant disorder, severe depression, and obsessive-compulsive tendencies, particularly in regard to food.”
The thudding sounds ceased as someone apparently restrained Diesel, but the threats grew louder and more vicious. Susan heard someone say, “Get him into the Self-awareness Room.”
Susan told the group, “He seemed quite normal this morning. I’m not sure what happened to him.”
One of the nurses, a petite blonde, spoke up. “He broke into the med room and plundered the snack cart. Ashlynn confronted him, and he just went crazy.”
Most of the nurses disappeared to the other side of the staffing area to watch through the one-way windows.
Another string of swear words rent the hallway; then came the sound of a large door closing. Silence followed until most of the nurses returned with Stony Lipschitz. Blood covered the front of the R-3’s dress polo, the stethoscope around his neck, and the papers in his pocket.
Bainbridge looked alarmed. “What happened? You didn’t have to hurt him, did you?”
Stony looked himself over. “It’s nasal blood, sir. Apparently, when Diesel gets upset, the blood vessels in his nose burst. The more he fusses, the worse it gets, and he won’t let anyone stop the bleeding until he’s calmed down. In fact, he seems to delight in spreading it as far and wide as possible.” Stony kept his hands away from his body. “Do you mind if I clean up?”
“Please do.” Bainbridge flicked a hand dismissively. “In fact, why don’t we all take a short break?” He looked at his Vox. “We’ll reconvene in an hour, at nine fifteen. Does that work for everyone?”
A tangible wave of relief flooded through the residents as they realized they could continue studying and examining prior to presenting their patients. They scattered in an instant. Susan hesitated, watching a janitor appear to clean up the blood-splattered hallway and the torn hunks of paper scattered in Diesel’s wake. She wondered what had come over him. She could scarcely imagine the stout, quiet little boy becoming a terror in an instant, as though he had swallowed Dr. Jekyll’s potion. She wondered what it must be like to live with a child so volatile, to be his parents or, worse, his younger sibling.
Curious, Susan followed the blood trail to the massive white door reading SELF-AWARENESS ROOM in bold black letters. Two male nurses stood there, one peering through a small but thick polycarbonate window.
“May I see him?” Susan asked.
The nurse stepped aside wordlessly.
Susan leaned into the glass. Diesel stood near the door, bashing his head against the padded walls, leaving smears of blood and snot that betrayed his tears. He wore a T-shirt, cut in the latest triangular-sleeve style, and olive green sweats with the trendy T’chana label and its signature parrots. Short and round, h
e looked more like a bowling ball than a child, especially bouncing from wall to wall.
“I’m going in,” Susan said, her hand on the knob before anyone could stop her.
“You can’t — ,” one nurse started.
“It’s not allowed,” the other said simultaneously.
Susan pretended not to hear them, turning the handle and opening the door. It was heavy, thicker than she expected, and also covered with padding.
Diesel ignored Susan, banging his head repeatedly against the wall, nose blood splashing in surreal patterns each time he did so.
The door closed behind Susan. She could see one nurse watching them through the window, and she guessed it had less to do with curiosity and more with protocol. The rules, perhaps state or national law, demanded someone placed in isolation be watched every moment. Susan imagined the other nurse running for assistance. In the end, she doubted anyone would bother her. To do so would only agitate Diesel, and the purpose of the Self-awareness Room was to give him a safe place to vent and calm himself.
Susan approached the boy. “Diesel?”
“Leave me alone,” Diesel growled. He stopped banging, grinding his head into the padding.
“Okay.” Susan stepped back, then sat cross-legged on the floor. She retrieved a wad of tissues from her dress pants and laid them in a dense pile beside her. She also had some Slookies, hard sour candies; but she knew better than to offer them to an obese patient on a strict diet.
The blood from Diesel’s nose dripped onto the floor beneath him in a steady patter, no longer squirting. Apparently, he had calmed a bit, at least enough to drop his blood pressure to a more normal level. She took that as a positive sign.
“What do you want?” Diesel said into the padding.
“Nothing.” Susan tried to keep her voice absolutely neutral. She had no idea what might calm Diesel and what might provoke him into another wild tantrum. “What do you want?”
I, Robot To Protect Page 4