by Barbara Ebel
Rachel had been gone for hours when Leo cracked open his eyes. The tee-shirt and cotton bottom she wore to sleep were tossed on the bedspread, and a skirt and blouse still hung on the doorknob. He figured she’d left in scrubs; he also knew her baby was crying.
After a visit to the bathroom, he went to the kitchen where the bawling baby sounded a lot louder. On the counter, he found an elegantly written note from Rachel: Leo, I didn’t have time before I left. Would you please make Julia a bottle as soon as you get up? I would really appreciate that.
Hell, he thought. She doesn’t even take care of her own kid. Blood ran faster in his veins while he made coffee. He found a clean bottle near the sink and tapped it on the counter with annoyance, then ripped open a new pack of cigarettes. Julia’s crying picked up, slowed into sobbing while she caught her breath, and then pitched back into a frenzy.
Leo jerked open a cabinet, grabbed a mug, and substituted it under the dripping coffee instead of the pot. It diverted him from going in there and ripping the baby apart. He gulped down a second cup, which wasn’t hot enough for him since he was already hotter than hell. After he lit his first smoke, he tucked the pack between his ripped, bare abdomen and jockey short’s waistband. Several puffs later, he downed more coffee. Julia’s distress could be heard by deaf ears through most of the house.
The Columbian blend tasted rich and smooth. He deserved this. A day where he didn’t run off to read unintelligible doctor scrawls all day and count pills like a child. But what the hell was he doing putting up with a little human being who couldn’t talk, yet could scream like the backdrop for a horror movie? That’s what he had allowed to happen in his own place. The wailing from his guest bedroom was analogous to screeching from some species living on the forest floor.
“Crap,” he shouted. He stormed across the kitchen, threw the bedroom door further open, smashing it into the wall, and ended beside the crib. Shut up, he silently said as he grabbed Julia’s arm. But she didn’t. His temper swallowed his thoughts as he went for her arm. His hand encircled her soft puffy arm and he shook. But that wasn’t enough for him as her eyes registered shock. The veins around Leo’s temples bulged and his biceps stiffened as he jerked again and again on the arm of the baby that had done nothing wrong.
Chapter 6
On Saturday morning Danny arrived at the hospital with plenty of time to spare. Dakota had demanded bedside attention a half hour earlier than normal, making Danny think the dog needed to go out so he relented. And it wasn’t such a bad day to be on call after all. A late summer rain made for a dreary morning and clouds began stacking up with malicious intent.
To Danny’s pleasant surprise, he had only two surgeries booked as well as the group’s in-house patients to see. His first case was one of Harold’s back patients who couldn’t wait for his personal doctor’s return to work. Danny did the fewest in his group but he could put people back on their feet without sciatica as well as his colleagues. He sat in the physician’s lounge with a bowl of cereal and coffee. As he turned a page in The Tennessean, he heard a familiar voice.
“Danny, can I join you?”
He looked up at Bill Patogue’s wide grin and thick glasses. At forty-two and natty in a bow tie, the internist looked a decade younger.
“Sure, Bill,” Danny said. He pointed to the scarlet red tie. “You must be a Louisville Cardinals fan. You’re not wearing Tennessee orange.”
Bill shook his head. “My tie colors don’t make sport’s statements unless we’re in March madness or it’s a holiday.”
Danny laughed. “I could use some color, Bill. What color stands for ‘stay out of trouble’?”
Bill put down a small plate, waved off the comment dismissively, and pulled in his chair. “I’m rounding soon on Harold and my growing list of consults. Did you know that hospital bed admissions are almost full?”
“Really? That means I could have a quiet day on call. If they get full, they’d have to divert emergencies to other hospitals.”
“The growing admissions seem to be medical.” Bill buttered his toast and opened a packet of marmalade. “Anyway, I never got back to you about Harold.” He shook his head and leaned in closer to Danny so he could be heard over the blaring TV. “He’s unconscious. The blood and urine results aren’t conclusive and nothing’s amiss with x-rays of his chest. Blood and sputum cultures are pending. I don’t want to waste anytime, so what do you think about getting a brain MRI?”
Danny sighed. In reflective thought, he stayed quiet for a moment and stared at his cereal. This seemed so unreal. Harold had been fine and he had no health issues which would have made him susceptible to a unique malady. Danny snapped out of his pensive look. “Sure. Let’s do it. When it’s done, I’ll take a look with you.”
“Alright. Even though it’s a Saturday, I’m going to stick around a bit. I’ll call you when it’s finished; it may be this afternoon.”
Danny fiddled with the spoon in his raisin bran and glanced at his watch. “It’s discomforting that one of our own is sick. As we know, medical people have the worst luck and outcomes.”
“I hear you. My consult to see this morning works here in the OR. She’s apparently confused, with a headache and muscle weakness. It’s not even flu season.”
“What’s her name?”
“Dotty Jackson. Do you know her?”
“She’s one of the OR nurses. I haven’t seen her most of the week. It may have been Monday or last week when I had cases with her.”
On the table, Bill’s pager vibrated, causing it to slightly scurry along as Danny and Bill watched. “Let me get this,” Bill said, pushing away from the table.
Danny reheated his coffee in the microwave while Bill answered his page. When he made it back to the table, Bill patted him on the shoulder. “Guess I’ll go downstairs to the ER first. The doc says it’s a hospital scrub nurse they just intubated and put on a ventilator. His mother found him unresponsive after he ran a fever all night. I’ll call you later.”
As the internist turned, Danny hurriedly asked, “What’s his name?”
“James something.”
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The patient on the operating room table was prone so Danny had good exposure into the man’s back to work around the lumbar nerve roots and musculature. Considering every surgery Danny had seen through residency or knew about, back surgery most reminded him of butcher’s work … like splayed cattle meat on a table, red and raw. Things weren’t going so well, either. The man had a platelet disorder which made him bleed more profusely.
Getting good visualization of his landmarks became increasingly difficult. At least he had Dean in the room, who had more of a challenge with the patient’s hematologic disorder than giving him anesthesia. Dean asked for two bags of platelets from the blood bank while he infused more IV fluids to compensate for the blood loss. Danny slowed down his pace so that the platelets could arrive and be transfused. They had to make headway in stopping the oozing.
Danny kept the suction tip in the open gap while waiting. Slow, steady blood was sucked into the canister. He watched Dean, who stood so tall that the IV height was easily in reach.
“I’ve never worked with you on a back before,” Dean said, glancing at Danny.
“I do them, but rarely. The head cases pile up for me so I do backs less and less. Actually, this is Harold’s patient.”
“What’s going on with Harold? You were going to see him in the ER the other day.”
“He’s in a coma,” Danny said, concern buttering his words.
Under his mask, Dean’s expression registered alarm. His eyes widened. “No way.”
Danny moved the tip away from the patient’s back for a moment. “Dr. Patogue is taking care of him. We’re getting an MRI of his head today.”
“I hope that turns out okay. Last night, I talked to Dr. Talbot. She’s headachy, crampy and not eating well; sounded lethargic. She did see a doctor the other day. Despite a z-pack and aspirin for a fever, she�
�s not shaking it. I told her she needs to get in here today if she’s not getting better. Have one of our hospital staff or the ER take a look at her.”
“She’s a tiny, healthy thing, and young. I can’t imagine her being ill.” Danny furrowed his brow. “Actually, Dr. Patogue said earlier that two of our OR staff are going to be seen soon, too.”
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As Casey stood under the hospital overhang outside the ER, he waved to Mark to back the ambulance further in so the back doors would stay dry when opened. Their three-to-eleven shift had started with a thunderstorm. Mark got out and darted to the curb next to Casey.
They opened the rear end and climbed in to run through their check list of supplies, oxygen, and housekeeping. Casey smiled his appreciation for the spotless, equipped vehicle. He took pride in their roving work place, and even cleaned and disinfected the small rubber floor mat practically next to the bumper.
“Lousy Saturday we have,” Mark commented.
Casey counted the IV fluid bags on one of the shelves. “I don’t mind it. Thunderstorms are smart precipitation. They take care of themselves.”
Mark registered a quizzical expression as he opened new emesis basins.
“You don’t have to scrape it off the driveway.” Casey said, and then jotted down his inventory on a sheet.
“But we don’t get enough snow or ice anyway,” Mark countered.
“Nevertheless,” Casey said, “it doesn’t damage vehicles like hail pellets either, which can grow to the size of golf balls.”
“What about lightning?”
“That’s separate, like wind. Those aren’t precipitation.”
“You’ve got this all figured out. You should’ve been a weatherman.”
“No way. I can’t separate who I am from what I do. They’re one and the same.”
The automatic doors to the ER opened and a young brunette with a loud purple scrub top came straight to their ambulance. She pushed her long silky hair off her shoulders. “Hi, you all,” she said, smiling at Casey. “Did you just get here?”
“Pretty much,” Casey said. “We’re three-to-eleven.”
“I would be telling you the beds are full and we’re on diversion, but the hospital had two early afternoon discharges so there are two beds available. The desk just got two calls. You better come in. The other ambulance drivers are picking up the slip for the first one as we speak.”
“Okay, we’re coming,” Mark said.
Casey’s eyes flickered with enthusiasm when he stepped onto the pavement. The young lady hesitated as her face blushed. She was so close to the paramedic heartthrob.
“Go ahead,” Casey said. “I’ll wait for the better half of my working relationship.” He winked at her and she left.
Mark stepped down. “What did you do, encourage her by winking like that?”
“Heck, Mark. What do you mean ‘encourage her’?”
“Even if they know you’re not available, they could care less. They’re going to try and lure you in anyway.”
“You make me sound like red snapper on the end of a line.” Casey shrugged his shoulders then hurried inside with Mark at his heels. Two ambulance workers passed, heading out, as Casey and Mark greeted them. Casey waited for the ER desk secretary to give them the information.
“You just missed going on a run for an anesthesiologist who works here,” the husky voiced woman said. “A Dr. Talbot,” she mumbled. “Looks like you’re going a few miles south to the mall. Man with chest pain.” She handed them her note.
Casey ran his hand over his crew cut and the both of them turned on their heels.
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Danny’s cases extended into the afternoon and he still hadn’t seen everyone on the floor. At least his back patient finally stabilized with Dean’s supportive care, especially in the recovery room. Finally, the call Danny anticipated came through. Dr. Patogue had the MRI and waited for Danny in the X-ray department. He bounded down the stairs to the first floor and cut through the emergency room. He hurried faster upon seeing Casey and his partner going down the hallway towards the back door.
“Are you two on an ambulance run?” Danny asked as he sidled alongside them.
“Danny, it’s not the time for ambulance wisecracks.” Casey kept heading straight. “We’ve got a guy with chest pain.”
“I’ve only got a minute myself. I’ll follow you to the back.”
“Actually, there are two runs.” Automatic doors opened as they neared and Casey pointed to the ambulance backing out. “They’re going for a staff doc.”
Danny put his hand on Casey’s upper arm. They didn’t slow but Casey’s eyes caught Danny’s concern.
“Is it Lucy Talbot?”
“Sure is.”
Mark headed to the driver’s seat and Casey opened the back as the skies rumbled above.
“Casey, I have a sneaky suspicion that something is going on because we have a rash of sickness.”
“That’s not so odd.”
“No, this is different. I’m glad to know you’re picking up the patient other than Dr. Talbot.”
“Danny, I’d pick up anybody who needs me.”
“I know. That’s your job. However … look, I’m not being an alarmist. You know me better than anybody. I’m going to go look at Harold’s MRI with Bill Patogue. But, right now, my instincts are on alert and this is just between you and me.”
“Okay, Danny.” Casey slammed the doors shut while a bolt of lightning peeled across the skies. Danny rushed back inside.
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Danny could tell the radiology department napped on weekends when he walked through the front room. Although they took films and advanced imaging for trauma and more emergent requests, a skeleton crew and one radiologist manned the place. He spotted Bill and the radiologist, John, in the first dimly lit room and walked in.
“Danny,” Bill said. “John was nice enough to walk me through this, especially with my limited expertise with head imaging.”
The MRI films went from left to right on the viewing boxes and slices went from top to bottom. Danny methodically examined the images starting with the outside – the skull. The meninges was the layer closest to the skull; the membranes between the skull and brain. Danny knew it consisted of three layers called the dura, arachnoid, and pia mater but - on film - it wouldn’t appear like they were huge delineated layers.
Danny shuddered. These were Harold’s images … someone he shared his practice and specialty with, someone who often looked up to him for advice, someone who knew the sweat and tears it took to earn a neurosurgery degree. He wished he saw differently. Harold’s meninges on his MRI were inflamed, suspicious for meningitis.
John tapped his finger right where Danny stared. “Significant inflammation,” he said. “But also look at these high signals in the temporal lobes.”
The men took a step to the right as Danny leaned forward, also scrutinizing the hippocampus and frontal lobes. He glanced at Bill, who swiped the back of his hand along his forehead.
The double whammy hit Danny just as Bill piped in. “Inflammation of the brain, too,” he said, taking his bow tie off and shoving it into his pocket.
“Encephalitis,” John said.
“Worse than that,” Danny said. “Meningoencephalitis.”
Chapter 7
Danny tried to leave the radiology department quicker than he got there, but Bill lagged. He waved for the internist to follow him into the staircase, but Bill took a deep breath and hit the elevator button.
“We have to talk and make a plan,” Danny said, “but first I’m going to go do a stat spinal tap on Harold. It’ll give us more information. Although we should call in a neurologist as well, we don’t have time to wait for them to do it.”
“I agree. And James, the scrub nurse from this morning put on the vent, is in a coma.”
Both men stepped into the elevator and Bill leaned against the wall.
“Are you alright?” Danny asked.
>
“I’m feeling hot and sweaty, but never mind about me. I’ll go get whatever lab results are back on Dotty.”
“Why don’t we meet in the doctor’s lounge at about six o’clock?” Danny suggested. “And after the spinal tap, I better go track down Lucy Talbot.”
“Lucy Talbot?”
“Yes, an anesthesiologist who’s fallen prey to something, too.”
Bill got off on the third floor and Danny continued on to the ICU, weaving past a group of family members in deep discussion about a loved one’s care which sidetracked his thoughts. He went into the unit with only his ex-wife on his mind; he’d get his procedure done but he gave himself the liberty of thinking solely of her.
Danny grinned as he visualized Sara’s habit of talking with her hands. His eyes twinkled as he thought about her peppered blonde hair dramatically stopping in the middle of her cheeks and her subtle smell of orange-ginger. But her mind was as powerful as her looks; her wisdom and strength underscored the loving quality she possessed for everyone and everything. Unless she was betrayed yet Danny still hoped to gain her forgiveness.
Harold’s nurse was in his cubicle so Danny went straight in, thoughts of Sara ebbing away. He looked at the nurse’s badge.
“Marsha,” he said. “I’ll need your help right away, if that’s possible.”
She turned down the volume of the overhead monitor. “Sure, Dr. Tilson.”
“I’m going to write some orders and hopefully, get Timothy Paltrow – the neurologist - to consult on Dr. Harold Jackowitz. In the meantime, please get me a spinal tap tray and gloves. Get respiratory therapy, too, so we have an extra pair of hands for positioning him on his side and watching his endotracheal tube and ventilator connections.”
Marsha almost made it to the door when Danny added, “In addition, I’d like you to put a sign on the door for infection precautions. Please have someone roll the shelf underneath it with masks and gloves for anyone that enters this room. Be sure to don up yourself.”
She scurried off and when she returned with a respiratory therapist, they rolled Harold onto his side. Danny prepped his back with a bactericidal agent. With sterile gloves, he felt Harold’s lumbar intervertebral discs and slid a thin spinal needle between two of them. Harold’s cerebrospinal fluid drained easily and Danny allowed it to drip into the kit’s sterile vials. The humdrum of the ventilator drowned out the silence.