by Lyle, D. P.
“So what happens when they get swollen?”
“This one, the glossopharyngeal, supplies the throat, ear, and tongue as well as other areas. It helps you speak and swallow and control your tongue, and it also carries sensations from these areas back to the brain. When it becomes swollen or inflamed, as we see here on your MRI, it can cause the deep, aggravating pain you’ve been having.”
“Is that why I get it sometimes when I’m eating or talking on the phone?”
“Exactly. This nerve is involved in both of those activities, so when you eat or talk and the nerve is inflamed, pain can be the result.”
“That makes sense.” She took a swallow of lemonade. “Does this mean I have to stop eating and talking?”
“I don’t think that’ll be necessary,” I said.
“Good. I like to do both.”
“The other thing is that this nerve is also involved in the functioning of the heart, particularly the rhythm. Sometimes when people have these discomforts the heartbeat slows down. Sometimes dramatically. Sometimes enough to cause dizziness and even loss of consciousness.”
“That’s why I’ve been having these dizzy spells?”
“I suspect so. We call this condition glossopharyngeal neuralgia.” I smiled. “We have big words for everything, but basically it’s a pain in the neck.”
Felicia laughed. “You can say that again.” She took another sip of her lemonade. “So what do we do about it?”
“Your Holter monitor showed that at times your heart slows down, but not severely so. You had no episodes of long pauses in the rhythm. That means that the likelihood you might actually faint is small.”
“That’s a relief. A couple of times I thought I might.”
“It also means you don’t need a pacemaker.”
She parked a wayward strand of hair behind her ear. “Pacemaker?”
“That’s right,” Divya said. “Some people with this have such dramatic changes in their cardiac rhythm that they need the protection of a pacemaker.”
“Fortunately, you don’t,” I said. “We’ll start you on medication to help relieve the swelling and discomfort. It’s a medicine called gabapentin that’s typically used for seizures. It seems to work fairly well in this situation.”
“Will that relieve this pain?” She rubbed the side of her neck.
“Are you having discomfort now?” Divya asked.
“I don’t know. Maybe. Probably my imagination. Sometimes it feels like it’s coming on, but then it doesn’t. Other times it sort of zaps me. All of a sudden.”
“Let’s get the medication started,” I said. “In a couple weeks we’ll see how you’re doing.”
Chapter 16
The First Annual Hamptons Health and Fitness Fair opened at eight o’clock sharp with a bit of fanfare. The mayor showed up, as did the chief of police, members of the city council, and Principal Jerry Hyatt. Jill used the microphone and a small amplifier to welcome the crowd of more than two hundred that had gathered just outside the chain-link gate. She then handed the ceremonial scissors to the mayor and he cut through the bright yellow ribbon. The gates swung open. The fair had officially begun
Evan, Divya, and I watched from near the goalposts of the football field and moved out of the way as the crowd surged forward. Most were kids who danced and ran and pleaded with their parents to keep up. The bulk of the rowdy kids headed for the infield, where the obstacle course and other sports venues had been set up. Others flared to the left and right and began visiting the booths that lined either side of the field.
We retreated to the HankMed booth, where fresh coffee awaited. Evan had stopped by Bagel Shack for bagel sandwiches, what appeared to be a half-gallon carton of coffee, and a stack of cups. He grabbed some coffee and immediately headed out to schmooze. Divya began rearranging our supplies.
“Aren’t you finished yet?” I asked.
“Finished with what?” she said over her shoulder as she rummaged in one of the two boxes of supplies I had carried from the van.
“Reorganizing everything. You went through all that three times yesterday.”
She turned and scowled at me, a pack of four-by-four gauze in her hand. “There’s not as much room in here as it looks. I’m simply trying to make things accessible but out of the way.” She tossed the gauze to me. “You can help if you want.”
I placed the gauze on the edge of the desk. “I thought I was helping by staying out of the way.”
She nodded. “Good idea.”
I poured a cup of coffee and sat behind the desk. Nothing to do except wait for our first visitor. I suspected it would take a while for all the athletic events to get going, and after that we’d begin seeing bumps, bruises, scrapes, and strains. Turned out it didn’t take that long.
A young mother showed up with her five-year-old son who had fallen headlong while racing through the gate and bumped his head. A small bruise and abrasion and of course tears resulted, but it took only a few minutes to clean it up and put a bandage on it. By the time I finished, the bump was forgotten and the boy wanted to get on with the day. His mother thanked us as she was being yanked out of the booth.
Jill stopped by.
“Looks like a good start,” I said.
She gazed out toward the field, where the crowds continued to grow. “Better than I thought. Last night I lay there staring at the ceiling thinking that absolutely no one would show up.”
“You should’ve called me. I would’ve shown up.”
“Right. I’m sure you would have.”
“I mean, after all, you were already staring at the ceiling.”
She gave me a playful punch. “Sometimes you’re a pig, you know that?”
“Just trying to be helpful. Cure your insomnia.”
“Make yourself useful. Pour me some coffee.”
I did and handed it to her. She took a sip.
“Evan brought your favorite bagel sandwiches, too.” I nodded toward the bag sitting on one of the exam tables.
“Sometimes I just love him.” She opened the bag and took out a wrapped sandwich.
“And the other times?” Divya asked.
“I tolerate him.”
“Don’t we all?”
Jill unwrapped the sandwich and took a bite. “Mmm. Right now I love him.”
“Maybe I’ll have one, too,” I said.
Jill tossed one my way.
After a few bites, Jill rewrapped the remainder of her bagel and dropped it into her purse. “I’m out of here. Need to go make the rounds and make sure everything is running smoothly.”
As soon as Jill left, Evan showed up. Not alone. He had two women in tow. One looked concerned; the other clutched a hand to her chest.
“Dude,” Evan said, “you need to see Debbie.”
I looked at the woman in pain, who I assumed was Debbie, and asked, “What’s the matter?”
She took a breath and winced. “I don’t know. I just got this sharp pain. Right here.” She pressed her fingers against her chest just to the right of her sternum. “It just happened all of a sudden.”
Before I could ask any more questions, Evan launched into who the women were and how he knew them. As if that was relevant. I raised a hand to slow him down, but he ignored me and pressed on. I gave up and waited him out.
I learned that the one with chest pain was Debbie Feiner and her friend was Patricia Masters. They owned a candle, lotion, and potpourri shop in Southampton called Serendipity Scents. Apparently Evan knew them and had convinced them to buy a booth for the health fair. Their booth was just down the row.
With Evan’s dissertation out of the way, I directed Debbie to sit on one of the exam tables and adjusted a privacy screen around it while Divya checked her blood pressure. It was normal. I li
stened to her lungs. Clear. Heart, too. As I pressed my fingers against her chest, attempting to see if I could reproduce the pain, I detected the telltale signs of subcutaneous emphysema. Nothing else feels like that. It’s a crunchy sensation, as if someone had injected glass beads or Rice Krispies just beneath the skin. It’s actually trapped air bubbles.
“When did this happen?” I asked.
“Just a few minutes ago. We were blowing up some balloons to decorate our booth and I got this sudden pain.”
“So it happened while you were blowing up a balloon?”
She nodded. “Exactly.” She took another breath and winced again. “What is it?”
“Let’s get an X-ray and then we’ll know for sure.”
Divya and I rolled our portable unit out of the van and set it up in the middle booth. Having the van here was already proving to be a good idea and our day had just begun.
Debbie’s X-ray showed exactly what I expected.
In order for air to leak into the subcutaneous area, there must be a breach in the pulmonary system. It’s often seen in people with chronic lung disease, particularly emphysema, where a bleb, basically a blister in the lung, ruptures and the air leaks. This can gather beneath the skin and create subcutaneous emphysema. It’s also seen in asthmatics and in some situations that produce what we call barotrauma—lung damage due to pressure. Scuba divers can suffer this. Coughing and sneezing can sometimes make it happen. And blowing up balloons, which causes the pressure inside the chest to increase dramatically, can definitely do it.
The images I had transferred to my laptop revealed that Debbie had a pneumomediastinum. That’s a big word for the collection of air in the mediastinum, the area between the lungs where the heart sits. I explained this to her.
“That sounds bad,” Evan said.
I gave him a look. One that said he wasn’t helping the situation.
“Well, it does,” he said.
“So what do we do about it?” Debbie asked. “An operation or something?”
I smiled. “No, you don’t need an operation. Both of your lungs are inflated and working fine. This is simply a minor air leak caused by you blowing up the balloons. It’ll go away. Might take a few days, but your body will ultimately absorb and remove all the air.”
“I guess I should avoid the balloons?”
“Absolutely. For a few weeks anyway. And try not to sneeze.”
“Oh, my God, I can’t even imagine what that would feel like.”
“A little uncomfortable. Sort of like a knife.”
She sighed, which caused her to wince again. She brought her hand to her chest. “I guess I shouldn’t do that either.”
“You’re going to be uncomfortable for a few days. I’ll give you a prescription for pain meds that’ll help some.”
“Do I have to go home? Or stay in bed? Anything like that?”
“Not at all. In fact, it’s probably better that you stay here at the fair so I can keep an eye on you.”
She nodded. “Thank goodness. I’d hate to dump all this on Patricia right here when the weekend is just beginning.”
“Don’t worry,” Patricia said. “I can handle it.”
“I know. I’d just hate for that to happen.”
I interrupted. “Well, that’s a moot point. You can stay and work the booth—just no more balloons.”
Debbie stood. “No problem there.”
“Either Divya or I will stop by and see you in a while, but in the meantime if anything changes get back here.”
“Will do.”
“I’ll run and pick up your prescription,” Patricia said.
“I’ll do it,” Debbie said.
“No. You rest at the booth. It’ll only take me a few minutes.”
Debbie nodded and then looked at me. “Thanks for everything.”
“Glad we could help,” I said.
“I’ll walk you guys back to your booth,” Evan said.
My brother the gentleman.
Chapter 17
Jill’s worries about rain proved to be unfounded. By noon the temperature had risen into the upper eighties and the sky was cloudless, the breeze timid. The best advice would have been to find a shady spot and avoid strenuous physical activity. Not so easy at a health and fitness fair where athletic events were stacked up one after the other. The heat was beginning to exact its price.
Besides the usual bumps and scrapes, Divya and I were now seeing cases of dehydration. Most people were simply sweaty, flushed, and fatigued, a couple slightly dizzy, but no true heat injuries. Most were rehydrated with glasses of water; only one, an elderly man who wobbled in on his wife’s arm, required IV fluids.
The athletic events were in full swing. From where I stood at the entrance of the HankMed booth, I could see the various age groups running the obstacle course, performing the long jump, and racing around the track. I suspected that with all this activity and without a cloud in the sky we would see more cases of dehydration before the day was over.
I decided to track Jill down and suggest that she get an easily accessible water dispenser out in the field for the participants. Divya stayed behind to cover the booth. My first stop was directly across from us at the Hamptons Heritage booth. That’s where I found Jill.
“We’ve been seeing several people with dehydration,” I said.
“Here, too.”
“Are the only water stations the two refreshment stands?”
“I think so.”
“We need more. The kids need to drink more water.”
“What’d you have in mind?”
“Let’s take a walk down to the obstacle course area.”
We waited for a break in the runners so we could cross the track and reach the infield. By the time we got to the obstacle course’s starting line, the interschool contests were under way. Each grade from each school had boy and girl teams that vied for ribbons and trophies. The grand prize, a large trophy that sat on a nearby table and gleamed in the sunlight, would go to the school with the best overall score.
School colors were the dress of the day. Right now a line of green-and-white-clad seventh-grade girls stood near the starting line anxiously awaiting their turn. They giggled and high-fived and encouraged each other, saying things like “We’re going to trash the competition” and “Keep your focus” and “Let’s go crush them.” And who said girls aren’t as competitive as boys?
“The coaches have been bringing water over,” Jill said. She indicated a tray that now held only two water-filled paper cups. The trash can next to it was filled with discarded cups. “But it looks like they might not be keeping up.”
“Maybe a couple of those big barrel water dispensers would help,” I suggested.
“Yes, they would.” She shook her head. “I should have thought of that.”
“I don’t think anyone predicted it would be this hot today.”
“Still . . .” She shrugged. “We have a couple of big orange ones in our booth. I’ll get someone to grab them and fill them up.” She looked around. “I’ll set up another table next to the trophy display and put them there.”
“Perfect,” I said.
“I’ll get the vendors to supply the cups,” Jill said. “I’m sure they won’t mind.”
There were two refreshment stands, one at each end of the field. We walked to the nearest one. It was busy, with four lines of people waiting to buy sodas, hot dogs, hamburgers, and ice cream. I guess even at a health fair you couldn’t keep dogs, burgers, and ice cream out.
Jill waved to a man behind the counter. He walked our way. He wore tan shorts, sandals, and a light blue golf shirt. Jill explained the situation and he readily agreed to donate all the cups she might need.
“I’ll run a bunch over there right now
,” he said. “And I’ll check back periodically to make sure you have plenty on hand.”
“Thanks,” Jill said. “That’s a big help.”
We then made our way back across the track and along the row of booths in the direction of the HankMed booth. About halfway down we ran into Evan, talking with George and Betsy Shanahan.
“Hank. Jill,” Betsy said.
“Are you enjoying yourselves?” Jill asked.
“Absolutely. You’ve done an incredible job.”
“Truly remarkable,” George said. “Everything is so well organized and seems to be running so smoothly it feels like this has been going on for years.”
Jill laughed. “It feels like I’ve been working on it for years.”
“You should be proud of what you’ve done.”
Jill looked around. “None of this could’ve happened without the support of people like you.”
“Next year we’ll give even more,” Betsy said. “Events like this are so good for the kids and for the entire community.”
Evan seemed distracted. He kept looking toward a booth two slots down from where we stood. I followed his gaze. The booth contained half a dozen high-tech massage chairs. Each was occupied and there were a few people loitering around, obviously waiting their turn. The three people working the booth were handing out brochures.
George glanced at his watch. “We’d better get going if we’re going to see all the booths before we have to leave.”
“We have a barbecue to go to,” Betsy said. “George is never late for barbecue.”
He laughed and patted his belly. “And I’ve had practically nothing to eat all day in anticipation.”
After they left, Evan headed directly toward the massage chairs. Jill and I followed. The owners of Good Vibrations were two young women. Fit and tanned and wearing white shorts and pink form-fitting Good Vibrations T-shirts, they looked like sisters. They also looked like they could work at Marcy’s Bodyworks. Who knows, maybe they had at one time. They greeted Evan with hugs and cheek kisses.
My brother the social butterfly.