Читать книгу Revenge - Sheldon Cohen - Страница 9

“Get me as soon as Spann’s wife comes in please.”

A mother with her three-year-old son sitting on her lap occupied room three. The nurse had cleansed a forehead laceration on the child and covered it with sterile gauze. As soon as the mother saw this impressive looking doctor, upright, confident, smiling, and warm walk into the room, she relaxed.

“Good morning, Mrs. Williams. I’m Dr. Pollard. What happened to Jimmy?”

“He fell down outside and cut his forehead.”

“Let’s get him up here on the table and we’ll take a good look,” said Pollard. “Do you mind if these doctors watch, Mrs. Williams?”

“Oh no, doctor.”

“Was Jimmy knocked out?”

“Oh, no, he cried right away.”

“He turned to the students, “Why did I ask if Jimmy was knocked out?”

Amanda answered, “Just to gauge the extent of the head injury. If someone is knocked out the head injury might be more severe?”

“Yes, and that would mandate a more careful neurological examination, which I’ll still do anyhow, just to be certain. Got it? You can’t be too careful in this business.”

He stood in front of the young man who looked up at him with bulging eyes. He reached down to hold the youngster’s hands in his. “Hi, Jimmy. We’re going to fix that head of yours. Would you lay Jimmy down on the table, Mrs. Williams? Stay there and hold his hand, please.”

He donned sterile gloves, while demonstrating proper technique for doing so to the medical students. He had the nurse take off the loose gauze covering the wound. He then showed them Jimmy’s one-inch laceration. “It’s certainly deep enough to warrant some sutures,” he told them. “Mrs. Williams, has Jimmy had all his childhood shots including tetanus?”

“Oh yes, doctor.”

The nurses had already set up a suture set, cleansed, and draped the wound. He applied a local anesthetic and in three minutes placed five sutures. At the same time, he lectured to the medical students about sterile and suture technique. He then removed his gloves, did his neurological examination, reassured the mother, gave her follow up instructions and was about to take his entourage into the next patient room when Gail told him that Mrs. Spann had just arrived and was waiting in his office.

When they arrived, they saw a somewhat disheveled appearing middle-aged woman sitting on the couch. She was leaning forward with her hands clasped under her chin, her body rocking back and forth. Her brown, highlighted hair suggested that it had not seen a comb or brush for some time. Her face was pale and gaunt. Her lips were quivering and her dark eyes were moist with tears. She had the appearance of a woman who lacked sleep and was paying no attention to her appearance. When she saw Pollard and the two students, she rose from the couch.

“Hello Mrs. Spann. Please sit down.” He sat next to her, turned to face her and said, “I saw your husband a few minutes ago. The paramedics brought him in. I was able to make a definite diagnosis.”

Mrs. Spann interrupted and said, “What doctor, what?”

“He has somehow developed meningitis. I did a spinal tap that confirmed the diagnosis.”

“Meningitis? What does it mean? Will he be all right?”

“I don’t know, Mrs. Spann. Meningitis is an infection of the meninges, or covering of the brain. He was in coma and that’s a cause for concern. He’s in Intensive Care now and on therapy. I got hold of Dr. Baehler and told him what happened. He was on his way to the hospital and may be in Intensive Care as we speak. Has your husband been ill lately?”

“No. He’s always been in great health. Why he can jog miles. I can’t understand what happened.”

“Has he seen a doctor in the last year or so?”

“Not that I know of except for a physical with Dr. Baehler. Just the routine studies done with a complete physical exam, and they were normal.”

“Do you know where he’s been these last few days?”

“He went out to the pharmacy two nights ago and he never returned home. The police found him in his car two days later.”

“Yes, I know. Would you like to see your husband now?”

“Oh yes, please.”

Dr. Johnson will you please take Mrs. Spann to Intensive Care and let the nurses know she’s there. If you see Dr. Baehler tell him Mrs. Spann has arrived. If he’s not there have the nurses page him. We’ll see you back down stairs whenever you get here. Goodbye, Mrs. Spann. We’ll pray for him.”

Barry led a distraught Mrs. Spann to the Intensive Care Unit.

Pollard, with Amanda trying to keep up, went to the next patient. He was an eighty-two year old man in severe congestive heart failure. As they were examining him, Barry returned and both students had an opportunity to observe the classical physical findings of congestive heart failure: the edema or swelling of the lower legs; the dullness to percussion over the lower lungs due to pleural cavity fluid; the cellophane like crackling in the lungs audible with a stethoscope due to lung congestion; the neck vein distention due to increased pressure in the veins as a result of a weakened heart; the shortness of breath; the increased respiratory rate; the inability to lie flat.

After the patient started therapy and Pollard admitted him to the hospital, he turned to Barry and asked, “Was Dr. Baehler in Intensive Care?”

“Yes, but he was busy at work with his patient. I told the nurses Mrs. Spann arrived and they told her to wait until Dr. Baehler would be able to speak with her.”

“Okay, good. You keep track of Dr. Spann upstairs. Before you come to work in the morning, I want you to visit him in Intensive Care and, if he’s still there, report to us on his progress. Amanda, you do the same for the patient that we just admitted for congestive heart failure. Let’s hope they’re both still around. When you work in the Emergency Department, you see acute disease and pass the patient off to other doctors. You’ll learn much more if you follow up on your admitted patients. This will give you the opportunity to see the results of your handiwork. The most important therapy for any patient may well be the initial therapy, and you’ll learn more if you don’t lose track of your treatment results.”

They spent the next two hours seeing patients of all ages and diagnosis. The students began to wonder if it would ever be possible for them to develop such a broad range of knowledge. Their mentor seemed to know everything. There was no problem that he didn’t have a reasonable answer for. The students now understood him when he said, “An emergency medicine physician has to speak the language of all the specialties. We see patients ranging in age from a few days to 104, and we see medical and surgical and traumatic problems crossing every area of specialization.”

The three of them were standing at the central nursing station while Pollard was dictating a clinical note on their last patient. Out of the corner of his eye he noted that John Baehler had entered the Emergency Department He completed his dictation and said, “John, what happened?”

A haggard looking Baehler with his tie askew and his white shirt sleeves rolled up to his elbows whispered, “Spann just expired. He went into shock and we couldn’t reverse it.”

Pollard struck his left palm with a closed fist right hand. “Oh Damn, but I’m not surprised. Meningitis with deep coma and four thousand white count. Could anyone survive that?”

Pollard could see the expressions on his student’s faces. They had just learned about the unexpected realities of clinical medicine. They learned about the frailties of human beings. Here was a healthy man succumbing to bacteria that all of us carry around on our bodies.

There but for the grace of God go I, thought Amanda, as she remembered her grandmother’s favorite saying.

“No, I don’t think anyone could survive that combination of clinical findings and laboratory results,” said Baehler. “Ann Nordstrom was there with me. I called her in consultation. She didn’t have much to add. Everything you ordered was perfect. It was clear from the start that we had an uphill battle.”

“How’d Mrs. Spann take it?” asked Pollard.

“Bad, but she did agree to an autopsy.”

“Oh, that’s good. Also unusual now a days; we don’t do much of those anymore.”

“She was very receptive. I told her how unusual her husband’s case was and our only hope of maybe coming up with an answer as to why this happened was the autopsy.”

“The hospital will no doubt hold some kind of service. After all he was a member of the Medical Executive Committee,” said Pollard. “First Harrison and now Spann. What the hell’s going on?”

“Beats me. Yes, I’m sure there’ll be a service. Thanks, Jason, for your help.”

Pollard nodded. Thanks for what, he thought.