by Barbara Ebel
-----
As soon as Danny walked out of an exam room, Cheryl stopped him.
“Matthew’s on line one,” she said. “He has more good news about David Bell.”
Handing Cheryl his last patient’s chart, he hurried to his office and picked up as Matthew was in charge of hospital rounds that morning for all their patients. “Matthew,” he said, “what’s going on?”
“We extubated him a little while ago like you were hoping. So far, he’s doing fine breathing on his own. He said to also thank you for helping him get rid of that breathing tube.”
“Perfect, thanks. Please order arterial blood gases. I’ll make evening rounds so I can see him myself.”
As he hung up, Cheryl walked in. “Want some lunch when you quit concentrating on your daughter’s boyfriend?”
“Glad you said that. Getting too close to any patient or treating David differently could cause me to lose my objectivity.
-----
The parking lot closest to the ER as well as the entrance itself looked unusually quiet as Danny stepped onto the curb alongside Casey’s ambulance. He’d gotten out of the office later than he wanted and walked briskly. With a gentle breeze in the air and fading sunlight, he wished he could stay outside longer before going into the ICU.
A waft of smoke blew out from behind the open door of the ambulance. As he came around, Toni sat on the bumper, cigarette in hand and Casey sat inside on the bench, writing on top of a clipboard.
“You both must be three-to-eleven,” Danny said. “What? Nothing to do?”
“Hey, Dr. Tilson,” Toni said. “Nothing official. Doesn’t mean I’m not amusing your friend, though.”
Casey looked up. “She may be a newbie partner but she has the lingo down.”
“Did you know,” she said to Danny, “that the beat for “Staying Alive” is the optimum speed for doing CPR?”
Danny laughed. “No, I didn’t. But believe it or not - as a neurosurgeon - I can’t remember the last time I had to do CPR. Probably as a resident and that was eons ago.”
“Casey will soon learn I need CPR every day.”
Danny shot a glance Casey’s way.
“Yeah,” she said, blowing out more smoke, “my CPR is how I function adequately. It stands for coffee, Pepsi and Redbull.” She flicked her cigarette and ground it out with her shoe.
“We know about energy drinks,” Danny said, wincing at her habit. “Especially ones that can get you into trouble.”
“I’m happy to report I’ve never touched the stuff … nor the cigarette habit,” Casey said.
“Wow,” Danny said. “You two sure seem like seasoned partners already.”
Toni glanced back at Casey and smiled. “Casey is such a cool partner; I can act like myself and speak my mind.”
Danny raised his eyebrows. “I hope that’s okay with him.”
Casey reached over for a bottle of water. “She has her own way of doing and saying things. But she has passion for the job and that’s what counts.”
Toni shrugged her shoulders. “I already have it figured out. I love the job but I’ll never let it weigh me down when I go home. There’s only so much we can do and, no matter how much that is, people will eventually die anyway.”
“I guess what the three of us usually do is prolong life,” Danny said.
“And as far as that goes, how is David doing?” Casey asked.
“Full of surprises,” Danny said.
“We both know there’s no such thing as a textbook case,” Casey said.
Danny laughed. “At this point, maybe he’s better than a textbook case.”
“I’ve heard it said around here that you work miracles,” Toni said, adjusting the clip in her hair.
“That’s a tall order to fill,” he said. “Nothing but preposterous rumors.”
A call came through from the front radio and Casey scrambled between the two front seats. “Time to break up this party,” he said.
“See you tomorrow,” Danny said. “Bye, Toni. I’m off to the ICU. Have a good ambulance run.”
“Thanks,” Toni said. “We’re off to another site where most bleeding stops no matter what we do … for better or for worse.”
Danny turned and went into the hospital thinking that Casey now shared eight-hour shifts with a polychromatic character.
-----
Besides David’s nurse, there were two more people in scrubs and a respiratory therapist in David’s ICU room as Danny came alongside the glass window. That was not the patient-health care ratio he expected to see and a worried look crossed his face as he rounded the corner.
“Dr. Tilson, I was just going to call you,” the head nurse in the ICU said. “Several of the staff have been busy with your patient who just had a terrible seizure.”
Danny slipped between them to stand at the bedside. Practically lifeless and somnolent, David had an ashen color and his limbs looked spent and exhausted.
“I monitored his airway,” the respiratory therapist said. “It remained patent the whole time.”
Danny glanced at the caretakers. “You all did a marvelous job. How long has it been?”
“Only about five minutes,” someone replied.
“David?” Danny said. The young man stirred but hardly let out a mumble in response.
Danny glanced at the monitor with David’s arterial-line blood pressure readings and noticed they were higher than normal. He grimaced, knowing the ramifications of a young man having new-onset seizures. The event wasn’t a total surprise as it was a possibility after a brain injury but, nevertheless, he had hoped David had been through enough.
Chapter 11
“There’s one more thing, Dr. Tilson,” the ICU nurse-in-charge said. “Just before David had the seizure, his parents showed up for a visit. We sent them to the waiting room.”
“Please tell them I’ll be out to talk to them as soon as possible.”
As Danny wrote orders at the bedside, a tech rolled in the EEG machine. He attached the electrodes to David’s scalp, connected the wires to the electrical box, and then the box to the EEG machine. After turning it on, Danny stood and watched as his patient’s electrical activity traced across the paper in a series of squiggles. Not only had David’s rhythm slowed after his head trauma but, as expected, it now exhibited more slowing due to the seizure.
When Danny finished, he wrote an order for a consult. Although he had spoken informally with his neurologist friend Penny Banks about his patient, it was time to officially call her in on the case. Sharp and thorough, she’d be able to concur or disagree with his further choice of seizure medication for David.
An evening news show droned in the background as Danny entered the lounge and sat at the Bell’s table. Both parents rose but Danny signaled them to sit back down.
“Such good and bad news,” Tara said. “First, David wakes up and gets off the breathing machine but now he’s … he’s had a seizure. I don’t know if I can take the emotional roller coaster anymore.”
Floyd Bell put his hand behind his wife’s back and rubbed. “Dr. Tilson, tell us about the seizure and how he’s doing.”
“I arrived too late to see it myself. The staff did an excellent first-aid job and gave him the care and comfort needed. He’s very drowsy but right now he has no recall of the event. That’s not uncommon. His brain is recovering from the trauma of it.”
David’s parents exchanged soulful glances and Danny let them absorb what he had said. “Even though David’s been on medication which would stifle the occurrence of a seizure, chances are that he’ll have more. We can count on their unpredictability. I’ve now asked a neurologist to be more active in his care.”
Floyd glanced at his wife again. “We don’t know what to do, doc,” he said. He looked back at Danny, shrugging his lopsided shoulders. “We’ve been avoiding the decision but it looks like he won’t be able to finish the semester. Should we take him out of school and the dorm?”
“I’m sorry to
echo your concern. Yes, after the first and second head trauma, it would be too much for him to continue with school work. What his brain needs is rest. And, of course, sports are out of the question.”
“This is terrible,” Tara said. “It’s his first year of college. And all of this because of a stupid basketball game.” She closed her eyes as a tear slid down her cheek and her silver-blonde hair fell forward as she bent her head.
Floyd continued consoling her, his hand staying behind her. “Honey, they were accidents. You can’t stop a young man from being active.”
Danny leaned over the circular table. “Mrs. Bell, your son woke up from his coma. That in itself is spectacular, especially so soon.”
Her eyes stayed shut and she took a deep breath. “Thank you. I will try to take solace in that.”
“Dr. Tilson,” Floyd said, “how is your daughter? We don’t expect her to continue coming to the hospital to see David. She has her own life and education to worry about. Please let her know that.”
“She’s a big girl. Annabel isn’t talking to me much these days but she’ll figure out what to do. I hope you both will support her decisions.”
“Absolutely,” Floyd said. “She’s a sweet girl and we want what’s best for her.”
Tara took a tissue from her purse and dabbed at her eyes. “Do you … do you think we could go see him now?”
“Yes,” Danny said. “Please be very calm and comforting with him. And quiet. Also, I need to warn you. This is his postictal period. That refers to the time after an epileptic seizure when a patient has an altered state of consciousness. It can last up to thirty minutes so he may still be confused. He can have a host of symptoms such as a terrible headache like a migraine, or feel nauseous, or be disoriented.” Danny looked from one to the other. “Okay?”
Tara nodded affirmatively, moisture welling up in her eyes again.
“We understand,” Floyd said. “I think, based on what you’re saying, we may need a crash course in seizures by the time we’re finished with all of this.”
Danny rose slowly. “Me or my colleagues, or the hospital staff, will help you both with anything you need.”
-----
The next day, Danny barely had a break between his surgeries. Hospital staff seemed primed for a marathon. He wished all days could go so well and, by the end of this one, he smiled because it was over and he wasn’t on call.
Danny went straight to the office. He unlocked the front door with its classy group practice sign and turned on the lights; everyone had left for the day. He strolled into the kitchen to fetch a snack and began tidying up around the counter. Rinsing the dregs someone had left in the coffeepot, he refilled it to begin brewing French Roast when the office opened in the morning. He opened the refrigerator, slapped cheese and turkey slices on white bread, and sat down.
Danny wasn’t in a mood to rush home. Everyone right now had their own recent problems to think about and work through. The only two left unscathed seemed to be his sister and Nancy. Even though Dakota had the life, he had a dog’s problem; he had been made into a target, the victim of Julia’s newfound dislike of him. Danny frowned just thinking about it as Dakota adored that little girl.
After eating half a sandwich and gulping down a glass of water, his cell phone rang.
“Danny, it’s Penny Banks. You don’t happen to still be around the hospital?”
“Actually, I’m in the office.”
“It’s late for that but I have to drop by upstairs anyway. Can I come by to talk shop about David Bell?”
“Sure. Door’s unlocked and I’m in the kitchen.”
The proximity of other specialists in the same building, including Penny, was a perk Danny appreciated. Any of them could always meet quickly besides calling each other.
Within fifteen minutes, the silence broke when Danny heard a soft voice and the patter of high heels in the hallway. His eyes were fixed on the door.
“That’s a weary smile,” Penny said with a soft voice and a Boston accent as she entered. She was in her thirties and doggedly committed to her field.
“Reflects how I feel. How’s life treating you?”
“Can’t complain at the moment,” she said.
“How about a non-gourmet sandwich?”
“I’ll pass. What else do you have in that fridg?”
“Fruit medley in a plastic tray. Help yourself.”
Penny placed down her leather bag, pulled out the container, and slid some cantaloupe onto a flat plate. “I just came from the ICU. Your partner, Jeffrey Foord, was making evening rounds so I told him I would fill you in.”
As she sat across from him straightening out her skirt, Danny noticed her crooked nose which gave her eyes the appearance of being slightly crossed.
“As you must be aware, David Bell had a seizure early today. However, he just had another one this evening. Dr. Foord and I were dismayed at the intensity and length of it, Danny. I would think anti-epileptics would have subdued or prevented them by now but I’m going to keep reaching into my armamentarium of older and freshly-marketed drugs.”
Danny felt a twinge in his stomach as a forlorn look of hopelessness registered across his face.
“The nurse said something about your daughter knowing this young man,” she said.
Danny nodded, realizing he’d written an order for Penny’s consult but that he had not filled her in on the personal nature of his patient.
“David is my daughter’s boyfriend. The one in college. You may have read my original history and physical on him. The first blow to his head occurred at a home basketball game. The second one happened while he was supposed to be on head and body rest.”
“So much for that,” Penny said, then speared a piece of cantaloupe and put it in her mouth.
“It’s a tricky age. They’re old enough to drink and drive and pick out their career choices for the rest of their lives but their common sense isn’t yet grounded. And advice from older adults is perceived as lecturing.”
Penny smiled. “I have yet to have one that old but there are exceptions, I’m sure.”
“Yes, there are. But my daughter is being sulky and partially blaming me for not being more forceful about David’s orders to rest with no physical activity.”
“Danny, in that respect, you can’t win. Take heart. This too shall pass.” She swung her long brown braid behind her shoulder and smiled. “So, being that David’s two seizure medications should have therapeutic blood levels by now and he’s still having them, it looks like this regimen is a failure. There is a new pharmaceutical release which I’ll start him on tomorrow. Let’s see how he does on it.”
“In the meantime,” Danny said, “I can’t consider moving him out of the ICU.”
“I understand. But statistics show that the majority of patients around the world who suffer from epilepsy can be treated by anticonvulsant drugs. And there are 50 million of them. Pessimistically, however, a handful of patients do not respond to standard treatments.”
Danny grimaced as the two of them locked eyes.
“And that’s where you’d come in,” Penny said.
“Yes, that is where I’d come in. And we both know what that means.”
-----
Having not been on call, it was late for Danny to arrive home. Only the dull light over the stove guided him through the hallway where he stopped outside the bedroom door, hearing the low volume of the television. A few steps later, there was only quiet from Julia’s room. Nancy’s door was slightly ajar; she faced the wall with a sheet strewn over her shoulders.
Danny went upstairs and stopped at the landing facing the closed door. Although he heard no voices on the other side of the door, he heard the low hum of the dishwasher. Turning it on was often the last thing Mary or Casey did before going to bed. In any case, he realized he wouldn’t have been in the mood to talk and he headed back downstairs.
At the bottom, the shrill of his cell phone on his belt startled him. Almost nine o�
��clock. He wondered if it was Annabel with a problem but, on unclamping his cell, Rachel’s name appeared.
“Hi, Danny. It’s Rachel.”
“Is everything all right? It’s late to speak to Julia. She’s fast asleep.”
“Then I wouldn’t think of having you disturb her. I bet she’s having the most angelic dreams.”
These days, Danny didn’t think so. He waited a moment during her silence. “Yes, then?”
“I rarely request extra visitation which I am entitled to. But can I pick up Julia Thursday night and bring her back Saturday night?”
“Do you have safe arrangements for her when you work on Friday?”
“Actually,” she said, “I have no commitments on Friday and I’ll be spending the day with her.”
“Sorry, I didn’t mean to imply …”
“Yes you did,” she snapped. “It will be a lovely day,” she added, softening her voice. “As you know, she’s growing so fast. We have to capture the memories while we can. They are but fleeting and must be savored.”
Danny blinked. Sounded like a bunch of malarkey since it came from her. “I don’t see a problem with that. You can come by Thursday evening.”
When he hung up, Danny entered the bedroom. The TV was now off and Sara seemed to be sleeping so he avoided turning on the overhead light. He took off his shirt and tossed it in the bathroom hamper and showered. Before getting under the light covers, he sat and leaned over with his head in his hands. A soft hand touched his shoulder.
“Are you okay?” Sara asked quietly.
He turned his head. “The question is are you?”
“I asked you first. I’m wondering if you’re the one being burdened with too much.”
“It’s not the first time.” He took her hand in his.
“But each scenario is different. It doesn’t mean you have to stand up like the Rock of Gibraltar every time you have multiple problems at the same time. You’re only human, Danny.”
“So what do I do about how I feel?”
“How do you feel?”
“Despondent.”