“You did good.”
An awkward pause. I take a chance and raise my arms and she approaches. I fold them around her. She begins to cry.
“It’s all right,” I say and I run my hand over the top of her head. I look over her shoulder at Caleb. Dr. Levy has a blood pressure cuff on Caleb’s arm and seems lost in the procedure. Caleb looks to me, smiles. It clearly pleases him to see his mom in my arms.
“You okay, kiddo?” I ask Caleb.
“I’m okay now.”
“Scary, huh?”
He nods. Dr. Levy sighs audibly and straightens up. He catches my eye briefly as he moves to walk away. I disengage from True. He knows about our divorce and enmity and True and I are both uneasy after our display of affection.
“Thanks,” I say. I am grateful to everyone here, including every clerk and orderly for saving my son. I would like to hand each a box of chocolate.
“That’s all right,” he says as he exits quickly. I am surprised he doesn’t dally. Perhaps he has to get back to a dinner engagement. I see him walk quickly down the middle of the room, looking into each curtained bay as if trying to find someone.
I watch as he finds a thirtyish woman dressed in a white doctor’s coat who has the appearance of a bright young resident. They talk for a moment as she looks at a chart in her hand. At first she seems slightly combative in the exchange, then stricken. The two of them leave the room as if in search of another as True speaks, “What’s going on?”
“I don’t know,” I reply. Something is wrong.
“That’s the resident. I thought she was really good. She went to Berkeley.”
There is an awkward pause. I turn to Caleb to fill the space and smile comfortingly. “You gave everybody a big scare.”
True steps over to the head of the gurney, grabs his little hand tightly.
“Maybe it’s Halloween,” he grins and chuckles. “This is my costume. A big head.” He finds this irresistibly funny and starts to giggle. “I’ve got a big head for Halloween! I’ve got a big pumpkin head for Halloween!”
“Maybe that’s your new name—Pumpkinhead.”
He is in paroxysms of giggles. A man across the way who is prone on a gurney strapped up with a heart monitor and oxygen tube looks sadly across at us.
“Down a notch,” says True. “We are in a hospital.”
But Caleb can’t be stopped. He stretches his mouth jack-o-lantern style and cries out. “I’m a Pumpkinhead!”
“Sssshhh,” says True.
An orderly arrives and presents himself at the foot of the gurney, addresses Caleb.
“Caleb? I’m going to move you to another room now, okay?”
Caleb looks helplessly to his mother. She looks to me in surprise. I say to the orderly. “I thought he’d just be released.”
The orderly looks at the chart on the foot of the bed, replies, “Caleb Fourchette? I have an order to take him up to the ICU.”
I am stunned. True speaks first.
“Why are you doing that?”
“Did your doctor speak to you?”
“Nobody spoke to us,” says True firmly.
Dr. Levy appears at the edge of the curtained area. He’s a small, cherubic man in his forties in a rumpled suit. He has bad breath. Has no one ever told him? He is mild mannered and smart and I respect him for that and for his lack of pretense including the halitosis.
He looks to Caleb with a doctor’s smile.
“Caleb, do you mind if I talk to your folks for a minute.”
The orderly looks to Levy. “What about ICU?”
There is something grave in his response. “We can wait just a minute on that. Okay?”
Dr. Levy guides us to an empty curtained area and then speaks in a low voice so that we have to strain forward to hear.
“I noticed that Caleb’s heartbeat was unusually fast when I examined him.”
“Isn’t that normal if they give him epinephrine?” I say. I already know that epinephrine is a form of adrenaline and adrenaline makes your heart pound faster.
“It was a little high considering. I looked at his chart and checked the resident’s medication order. It was for an injection of 10cc of a .001 solution of epinephrine.” His voice lowers again and he looks pained. “It should have been a .0001 solution. It seems there may have been an error in the order.”
True gasps. “What are you saying?!”
“The resident made a decimal point error when she wrote it down. Caleb received ten times the recommended dose.”
It lands like a rifle bullet. I don’t know what it portends, but I know on the face of it that it isn’t good and Dr. Levy’s somber expression confirms it. He continues.
“I’ve seen it happen that somebody puts a decimal point in the wrong place, but the pharmacy or the nurse always catches it. Somehow they both missed it. She’s a really good resident and she’s not careless. I talked to her and she feels terrible. She wanted to talk to you and apologize, but the hospital administrators have a rule on this and won’t let her.”
I blanch but True lashes out.
“Won’t let her?! What do you mean they won’t let her?!” says True.
I am thinking it’s not about the resident, True. I don’t care about the resident. It’s about Caleb. What about Caleb?!
“It’s a policy thing,” Levy replies, noting my annoyance at True’s outburst. “She’s a good doc and she feels bad. I’ve asked to move Caleb to a room upstairs so that we can keep him overnight. We’ll put in an IV and monitor him.”
“Monitor him for what?” I ask.
“The epinephrine elevates his heart rate and blood pressure. We need to be looking at it.”
“And what if it goes up?”
“It is elevated right now. The question is, where will it go next?”
“And what do we do if it goes up?”
“I’m about to talk to the cardiology resident here and there’s a senior pediatric vascular guy at UCLA I’m going to try to get a hold of. I do want to get your boy on the monitor ASAP and I want to set up an IV in case we have to medicate him.”
“With what?” asks True, ending the phrase with her jaw agape.
“That’s what I need to talk to the cardiologist about.”
A woman dressed like an office worker wearing a hospital badge approaches us with a clipboard and holds it forward with a pen in her other hand.
“Mr. and Mrs. Fourchette? I have some things here for one of you to sign,” she says.
I look at True whose excellent State of California employee insurance policy covers Caleb and say, “Maybe you should sign. It’s your insurance.”
“I don’t want to sign unless I know what I’m signing.”
Levy interrupts, “I’d like to get Caleb going. I’m going to have him moved up now.”
“Can we do this upstairs?” I ask.
“I’m sorry. I need a signature.”
“I want to go up with Caleb,” says True.
“Can I sign?” I ask, trying to nip this fight for primacy in the bud.
“I need the signature of the main insured,” she replies. I shrug and True simmers.
I see movement out of the corner of my eye. Caleb is being wheeled out to the hall. I start for it. She grabs the clipboard and the pen, scans the papers angrily.
“What room?” she asks.
The hospital lady answers, “I’ll find out and let you know.”
I follow the gurney without True through a hallway maze into an elevator. Levy follows, talking on his cell phone. I look at my watch. It’s quarter after ten.
The doors on the elevator close. It’s me, Levy and Caleb.
“Where are we going?” Caleb asks.
“The doctors need to keep an eye on you because you got some strong medicine.” It’s the truth, but I can’t help but feel a little dodgy for hiding my concern. He extends his hand off the gurney palm up and I grab it and hold it tightly. Too tightly. I fear I am transferring my anxiety.
&
nbsp; I try to listen to Levy on the phone, wondering if his cell signal will fade on the elevator, wondering if that means he will miss a crucial piece of information he needs to help my son. At the moment, however, he is just leaving messages, asking for them to call back.
“Would you see if you can page him and have him call back? It’s Dr. Jonas Levy.”
The doors open and we proceed into a room that looks part Catholic hospital (crucifix on the wall) and part NASA control (stacked computer screens). To my surprise we are to be the only occupants, and the nursing staff who greets us is clearly on a higher level of the profession than what I am used to. That simultaneously cheers and worries me.
“Hey there, handsome,” says a take-charge redheaded nurse with a name tag identifying her as Beverly O’Neill. She points out the stacks of electronics. “This is where we train all the astronauts.” Caleb, unnerved, manages a meek smile. “You are one of the astronauts going to the moon, aren’t you?” He gravitates to Beverly’s confidence and smile.
She and an orderly in green scrubs whisk Caleb off the gurney and put him on a bed/table near the middle of the room. Levy remains on the phone in the hallway. I take a moment and find him, wait for him to get off the line. Just then True arrives off the elevator.
“Where is he? Is he in there?” I nod. “What is happening?”
“They’re hooking him up to the monitor,” I reply.
“Do we know anything?” I look up to Dr. Levy who is impassive.
“Nothing more I don’t think.”
She goes into the room to see Caleb where they are pasting the electrodes for the monitors on his chest. I stay with Dr. Levy. “What now?” I ask.
“I’m trying to talk to a pediatric cardiologist, but I haven’t gotten a hold of one yet.”
“Why a cardiologist?”
“The concern with the epinephrine is about his blood pressure and what the effects might be on his circulatory system. It’s 160 over 110 now which is elevated, but not dangerous for a young person. The thing is we don’t know how high it’s going to go and what the effects of that might be. His pressure could spike suddenly.”
“What effects?” I wonder and am steeling myself to ask, but Dr. Levy intuits what would be a slippery conversational slope and cuts me off.
“I really want to answer your questions, Mr. Fourchette, but I need to get going on this cardio guy,” he says, placing a sympathetic hand on my shoulder. The funereal hand-on-shoulder has the opposite effect from easing my apprehension. Levy moves off and I return to mission control where I find True standing over Caleb, holding his hand, smiling false cheer.
“At least you aren’t having your appendix out. I had my appendix out when I was nine and that was no fun.”
“What’s an appendix?”
“It’s this thing in your stomach that you don’t really need, but it’s in there anyway and sometimes food gets stuck in there and it really hurts and they have to open you up and take it out.”
“The food?”
“No. The appendix, silly.”
“I know. Your food comes out when you poop.” He starts to giggle. She encourages him.
“Who poops?”
“You poop!”
“I do not. Mom’s never poop.”
It’s a sweet exchange but I suspect she’s also playing the part. You want people around you to know you are a communicative parent. It’s all right, True. I do it, too. Yes. I sometimes make a show of amusing conversations with Caleb in supermarket lines so that everyone can see what a good dad I am.
Meanwhile I can see Beverly in a corner, removing an IV catheter from its wrappings, her eye on Caleb. Seeing the panic in Caleb’s eyes, she speaks to me.
“Doctor said to put in an IV in case he wants to administer something quickly.”
“Is that a needle?!” Caleb yells out. “I already had a needle!!”
“It’ll be over in a second,” says True, with one of life’s least persuasive arguments.
“I don’t want it!” he screams.
“He’s really phobic about needles,” True explains to a quasi-sympathetic Beverly. True is right. Once, when he needed a flu shot at Dr. Levy’s office he just jumped off the examining table and ran out. We had to chase him into the hall, drag him back with tears streaming and threaten and cajole him to take the injection.
She turns to Caleb. “You were so good downstairs, before.”
“You said it wouldn’t hurt and it hurt!”
I suppose he’s right. These are the inevitable effects of being lied to. The nurse approaches him with the needle in hand and his eyes widen.
“No! Please!!!” begs Caleb.
“It’ll be over in a second!” True says, obviously starved for a better rejoinder. She looks to me for support, a look I have missed over the past year and despite the circumstances, it feels good.
Beverly addresses Caleb. “What if I rub something on your arm so you won’t feel the needle as much?”
Caleb is ahead of her. He knows lidocaine from previous visits to the doctor and the dentist.
“That doesn’t work!”
“What doesn’t work?” asks Beverly.
“The stuff you put on that’s supposed to make it not hurt.”
Beverly tries to grab Caleb’s arm, but he pulls it away and sits on his hand. She looks at me with exasperation. It’s my turn.
“This is going to happen, Caleb. Okay? There’s nothing you can do about it. It’s for your own good and you can give your arm to the nurse now or I can make you do it. You hear me?”
Caleb is taken aback by my sternness. It even surprises me a little. He hesitates. Tears are in his eyes.
“I’m afraid!”
I move toward him. The nurse follows my lead, IV in hand.
“Don’t force him!” says True.
At least I’m not lying to him.
“Give the nurse your arm! Now!”
Helplessly he offers up his little wrist. Beverly grabs it and I grab his shoulders to make sure he doesn’t move. Beverly swabs him quickly with alcohol and senses that the best gambit is an assault now and skips the lidocaine swab. I put a firm hand on his arm in support of Beverly. She jabs in the catheter. Caleb winces and cries out. She tapes down the tube. It’s over.
I look to True and try to intuit her reaction. I think she is glad that I stepped in but she won’t give me the satisfaction of approval. She looks away from me to Caleb.
“It’s over, baby. You did good.”
Dr. Levy steps in. He looks quickly at the monitors, puts a stethoscope to Caleb’s chest. I wonder what the stethoscope tells him that all the electronics don’t.
The transparency of Levy’s distress is getting to me. I look at him questioningly and he motions with his hand to follow him to the hall. True is torn between staying with Caleb and following him, but when I move, she follows. In the hallway Levy speaks in a quiet tone.
“I wanted to bring you up to date. My sense is that everything is going to be okay and Caleb’s going to slowly come down, but there’s not a lot of clarity. There’s plenty in the literature about normal pediatric epinephrine dosage and side effects, but there’s not much on overdose. You can see the problem, which is they can’t just go out and overdose children in clinical trials so all we have are a few anecdotal accounts from previous accidents. I’ve talked to three cardiologists and they all agree that we’re doing the right thing, which is to monitor his heart rate and his blood pressure closely and have a catheter installed in case he spikes so we can give him something immediately to slow his heart rate.”
“Why can’t you just give him a small dose now?” True asks.
“It’s tricky.”
“Tricky how?”
“The cardiologist I talked to said that benzodiazepine would be the drug of choice for an adult but it can sometimes have a paradoxical effect on young kids. His heart rate could actually go up if we administer it. He thought we should probably watch him and give him IV nit
roprusside that is effective at bringing down the heart rate. The pluses are that it’s got a short half-life so if he gets too much it won’t last that long, but it’s hard to figure out a dosage and you really don’t want to overdose because then he can become hypertensive.”
“What happens then?” I ask.
“Then we worry about organ damage, especially the liver. That’s why we don’t want to create new problems, but just watch him and be ready. We’re going to admit him overnight and keep a monitor on him.”
Levy seems nervous and I feel like he’s talking too much.
“He’s going to be all right, Mr. Fourchette. It’s going to be a long night, but I’m pretty sure he’ll be fine.”
It is a small but rare satisfaction to know that you have a doctor’s sole attention. Levy is there for us. What I don’t know and I’m afraid to ask is what the odds are for something to go badly wrong. Or I should say badly wrong again.
“No!!” I hear from inside the room. I enter to see Caleb squirming petulantly and Beverly with a grip on his arm, trying to keep him from flailing as True exhorts him to calm down.
“It hurts!” he cries as he tries to dislodge the IV.
“Just a little bit, Sweetie,” says True impatiently to no discernible effect. She looks at me pleadingly, the failed good cop. It’s clear that Beverly also has exhausted her bag of tricks and they need a bad cop.
“Caleb,” I address him in an unyielding tone. He pointedly looks away from me.
“Caleb,” I reiterate, even more seriously. This time he looks up. “I need you to calm down.”
As I look at Beverly I sense that Caleb’s behavior with the IV is taking on new meaning. Will his wriggling become a displacement of the hospital’s guilt and responsibility for overdosing him? We did our best, but the kid wriggled too much. Too bad his dad couldn’t keep him still.
“It’s pinching me!” Caleb protests.
“How bad is it?” I ask, trying to sound both unyielding and concerned.
“It’s really bad.”
“What if you try to think about something else, Caleb? Will that help?”
“No.”
“Well, what will?”
At least he’s distracted for the moment while he considers. Beverly eases her grip. I may be wrong, but True now seems grateful for my presence.
Some Books Aren’t for Reading Page 22
