by Holley Trent
A final assessment of his muscled extremities completed the exam. She felt oddly flushed, like his skin radiated too much heat. Strange.
When she touched him, a vibration flowed through her gloved hands. She had never gotten a vision through gloves. Then again, she’d never gotten a warning signal, either. What the hell was going on here? The vibration jolted up her arms.
Oh God, not now. Please wait until I finish treating this man. Please.
“Do we have a set of vitals?” she asked.
Her patient breathed on his own, unlabored. An old, scratched watch with a dried leather band was fastened around his thick, tanned wrist. Despite the horrific bruises over his body, only his head injury needed intervention. Damn it, she had to examine his wound. She shook her hand, hesitated, then took a deep breath and braced herself. When she lifted the palm-sized flap of scalp, it bled into his dark hair until she taped the gauze back down. She could repair the wound after the CT scan. Jerking her hand away from the buzzing sensation, she pulled off her gloves and replaced them with a clean pair.
She stepped away from her patient and relaxed. Maybe this man’s injuries weren’t as life threatening as she had initially thought.
The EMT frowned. “Blood pressure is one thirty over ninety, pulse eighty, respiration sixteen, temperature … 107?”
“Okay.” She stared at the EMT. “Wait. What? Could you retake that temperature, please? That can’t be right.”
“Ma’am, I already rechecked it with a different machine. It’s 107.3 to be exact.”
With her heart thudding, she searched the unconscious man for obvious signs of infection or malignant hyperthermia from drug use, anything to explain the temperature reading.
“Start him on IV fluids and get a cooling blanket hooked up.”
Screw those visions, she had to touch him again. She needed to figure out what was wrong with this patient before his brain fried.
She eased his eyes open and flashed her penlight. Normal pupillary responses. The deep brown, almost black color of his eyes surprised her with their darkness. His open eye locked onto hers and focused, at the same time a blast of vibration drilled from his face through her hand.
The depth of that gaze pulled her like a particle into a black hole. Her heart expanded then contracted, and her breath caught. Vertigo washed over her. She grabbed the IV pole for balance. The rush of vision took hold, blocking out all sound, like voices obscured by a stiff wind. Faces swam too quickly to make out details. Far in the distance of her mind’s eye, the focus sharpened onto a man. She could see—
A radiology tech tapped her on the arm. “Doc? Doc?”
Allison moved her hand away. The patient’s eye fell closed, and the vortex sensation ebbed.
For the space of two breaths, she felt like a woman surfacing from under water. “Yes?”
“C-spine x-ray is here for your review, and CT is warmed up and ready if this guy’s okay to go.” The tech passed her a plastic film.
The nurses turned on the water-cooling blanket now draped over the man. Allison could run him through the scanner with the blanket on top of him. But damn it, why was his temperature so high? Broken neck? Head injury?
She lifted the film to the light. No obvious vertebral fracture, so it was safe to move the patient. “Sure thing. I’ll go with you.”
Once they arrived in the CT room, the staff transferred the man’s backboard into the scanner, handling the man with ease, though to look at him, he must have been 200 pounds of solid muscle. This guy gave Captain America a run for his money.
The machine whirred and hummed. Images of his head, thorax, and abdomen slowly downloaded onto the computer screen. Allison leaned forward. No obvious internal bleeding or spinal injuries. No chest or abdomen damage. The overview scan revealed callus formation on his skull, forearm, and ribs, no doubt from old, healed fractures. A few minutes later, the standard scan images appeared. Where she’d noted callus formations before, now there were none. These new scans belonged to a man with no previous fractures. But how?
She glanced between the crash victim and his inconsistent scans. How did a man crash at fifty-five miles per hour and destroy his vehicle without so much as a hairline fracture? And what would explain the hyperthermia?
Allison rubbed her tight neck muscles. “What do you think? I’m not a radiologist, but it looks good to me.”
The tech gave the okay sign and put a finger to his lips. “I’ll have the radiologist call in a few minutes with the official word. This guy was lucky.”
“Yeah, lucky.” She stared at the screen and then back to the enigma on the other side of the lead glass window.
When the staff moved him back to the trauma room, his feet hung over the end of the gurney. He had to be well over six feet tall, maybe mid-thirties, probably a healthy guy. So why the temperature? Why the ghosts on the CT scan?
She reviewed the labs. White cell count was normal. Okay, so no infection. Drug screen negative. And the CT was negative, so the hyperthermia wasn’t due to brain damage. Her pulse sped up as she called for the nurse to start cooled IV fluids. She had to try something to help this man, but damned if she knew what the hell she was treating. Shivers skittered up and down her neck, part frustration and part fear for this man’s life.
When things don’t add up in the ER, people end up dead.
Marcie poked her head into the doctor’s work area. “Teleradiology’s on the phone.” Allison picked up the line, ready for her colleague to shed light on the mystery of this patient.
“Hi, Al, it’s Becca Lawson in Baker City.”
“What do you see?”
“Nothing much. What was the mechanism of injury?”
“Car went down the bank off the interstate, rolled a couple times. Restrained passenger, stable in the ER, with a head lac that I’ll sew up in a few.” She paused. “Oh, and a temperature reading of 107. I can’t find any reason for that. He should at least be sweating and seizing by now, with markers of muscle breakdown. Yet there’s nothing on lab. You see anything to explain it on your side?”
“No, his head is fine. There’s some swelling near the head wound and some facial bruises. I presume he’s black and blue?”
“Uh-huh.”
“His neck and spine are clear, no swelling, no fracture. Abdomen and chest are clear.” She whistled low. “Are you sure you’ve got the right patient? I’d say this guy cheated death.”
“It’s the right guy. Anything to explain the hyperthermia? Maybe something in the midbrain?”
“Hmm.” Taps and mouse clicks transmitted through the phone. “Nothing. No blood, no swelling. Did you check your thermometer?”
Allison blew an exasperated breath. “Yes, it’s reading correctly.”
“Don’t know.” Dr. Lawson chuckled. “This is why I have the computer screen and not a stethoscope.”
“Ugh. Thanks, Becca.” She set down the phone and pressed her fingers to the bridge of her nose.
A nurse’s scream shattered the silence.