by Barbara Ebel
Melody glanced at Annabel. “Your new patient is in Room 2. You can go in and say hello, but when Dr. Schott and I finish this discussion, come with me to the waiting room. The person who brought him to the ER is out there. We need to ask her more questions.”
Annabel waited a moment. “The ER doctor took a decent enough history,” Donn said, “mostly from the woman outside, and they are handing him over to us for an internal medicine admission.”
Annabel backtracked to Room 2 and pushed on the semi-open door. A man lay flat on the stretcher in a hospital gown, a hand towel draped across his upper face. The room was silent as she approached the side rail and stood inches away from his right bicep.
There it was again … a sight she had seen on an ER patient in the recent past: an impressive tattoo of a native American Indian and an American eagle and flag. It was him – the man she had rescued from the submarine sandwich shop and driven to the ER.
“Jae,” she said. “Remember me? I’m Annabel Tilson, the medical student.”
-----
“Jae Nixon is the man I told you about last week,” Annabel said to her senior residents at the ER desk. “The man I gave a ride to.”
Donn narrowed his eyes.
“You gave me grief about it because I drove a stranger to the hospital from the sub shop when we were on call and I picked up our sandwiches.”
“How about that.” Donn looked surprised. “You were justified bringing him in.”
“However, he vaguely remembers me.”
Melody nodded. “He’s confused.”
Donn slipped in behind the desk and began writing orders.
“Follow me,” Dr. Burg said to Annabel. “We’re going to talk to the woman who brought Mr. Nixon in … this time. She’s a park ranger and she’ll probably be leaving soon to go to work.”
“A park ranger?”
“Yes, a national park ranger, just like your patient.”
“Really?”
“That’s a fact.”
The two women strolled over to Patty Caye in the waiting room. She stood out like a red rose in crabgrass. The small woman got up from a chair. She held her hat in her hand and her crisp uniform made Annabel’s white, short jacket seem crimped.
“You must be Ms. Caye,” Melody said, extending her hand. “I am Dr. Burg and this is Annabel Tilson, one of the medical students. I wanted to ask you a few questions in case you’re leaving.”
“I’m going to hang around for a little while. I have work covered for the time being; perhaps you doctors will have some answers about Jae within an hour or two.”
“Then we’ll be sure to give you an update. He seems mixed-up right now, so the ER doctor and my chief resident didn’t get much of a history from him. We do have the information about his recent ER visit and that he was diagnosed with the flu, hydrated, and sent home. Can you tell me what’s happened with him since then?”
“Each day has been a slippery slide of him getting worse rather than better. Increasingly, he’s in his cabin with nausea, vomiting, and a headache. And having to nap, which isn’t like Jae at all. He scared the hell out of me this morning because his memory was foggy, and he had such light sensitivity, I had to put a towel over his head in the car.” Her look of concern intensified and she fiddled with the brim of her hat.
“Has he travelled anywhere lately or eaten anything unusual that you are aware of?”
Patty shook her head slowly. “No. He hasn’t been on vacation for a year. Just the usual days off, which he basically spends in Ohio. And nothing odd to eat. He has venison in his freezer, but he hasn’t eaten any recently. He didn’t have the taste for it because he feels so crappy.”
Melody contemplated the information. “Luckily, we have his medical and surgery history he reported when he was here last. No real problems in the past. As far as you know, that is correct?”
Patty shrugged. “He’s a fit guy leading a healthy lifestyle and is often outdoors. A way of life many people would trade for in a heartbeat.”
“Thank you for the information. Please give me your number so we can contact you when we learn something or when he gets transferred to a hospital bed.”
Patty told her while Melody plugged it into her cell phone.
“By the way,” Annabel asked, “where do both of you work?”
“The William Howard Taft National Historic Site.”
Puzzled, Annabel crinkled her forehead.
“It’s the usual thing,” Patty said. “Unless you’re a tourist, you aren’t aware of the sights in your own backyard. We oversee the 27th president’s birthplace, education center, and a park only a few miles north of here. Come on over. Volunteers, Jae, and I love to give tours and there are hiking trails as well.”
“Thanks. I’ll try.”
Annabel and Dr. Burg went back into the ER. Now that Jae Nixon was being admitted, he should recover quickly.
CHAPTER 12
Annabel stood poised over Jae with her stethoscope, his heart thumping regularly as an orderly came in to wheel him to the CT room. Hopefully, imaging of the young ranger’s head would shed light on the origin of his problem.
Jae’s vital signs were normal except for a low grade fever. He did indicate a stiff neck, but otherwise, his physical exam was unremarkable and he showed no focal neurologic signs.
A spark of recognition came over Jae’s face. “You look familiar, which makes sense, because I was here before.”
“Yes, you were. I met you, and then drove you here last time. We’re trying to get to the bottom of your illness, starting with a CT of your head. You’ll have to be still while the loud machine snaps pictures.”
The orderly threw a blanket over the sheet and placed his chart next to his legs. Jae closed his eyes and Annabel took a moment to examine his face; good-looking facial features with full lips and eyebrows, a tan skin color, and more important, no asymmetry between the right and left side.
She followed the stretcher out of the room and then wrote her H&P, a more difficult chore than normal because Dr. Burg’s and Dr. Schott’s H&Ps were on the transported chart and she couldn’t peek at theirs. She had to write an “assessment” and “plan,” but so far Jae Nixon remained a mystery. And, obviously, the “flu” diagnosis was as erroneous as false answers on a test.
Her iPhone, sitting next to her paperwork, dinged an alert. She opened up text messages and sighed with relief upon seeing Dustin’s name. Even if he answered with a negative remark, it would be better than not hearing from him at all. She scrolled through their conversation, starting with his from the night before:
I'm assuming you got home fine. Please let me know.
I am so sorry. Yes, I arrived home just fine but had an unexpected problem with my sister. I really enjoyed our date and hope to meet you again soon.
She narrowed her eyes at his new, longer message:
Apology accepted. Okay then, what night should we see each other “soon?” And … this time, You pick the type of food and how about a movie afterwards?
She smiled at the concept; a date which would fill up a whole evening. She didn’t know what that felt like anymore, although that would be a big chunk of time away from studying at night.
For me, that is like going on two dates! Thai food. And you pick the movie (which is not of an epic length!).
Thai place over by your end of town is superb. If need be, we can decide on skipping a movie.
Thank you! What night? Tuesday or next Saturday would work for me.
Tuesday then. What time?
Can we text each other? See what time I get sprung from the hospital, etc.?
Sure. I’ll be working day shift so we’ll have a similar schedule.
Annabel leaned back. She felt like a kid planning a birthday party.
I’ll poke you a line in the interim. I’m starting my day on call with a challenging case.
Glad to hear it. I bet your patient is lucky to have you. Edgar and I are working a domestic abuse cas
e.
Those must be sad situations to see. TTYL?
Looking forward!
Annabel went back to her home screen as Dr. Burg stopped in front of her.
“We have a room for Mr. Nixon. He’s being admitted to the medical floor once they finish with his CT. Perhaps you can start hunting up his lab work.”
“I’m on it,” she said, getting up. “Can’t wait to see what shows up.”
-----
Jordan Maldonado carried his lunch tray through the cafeteria towards the back end where tables were not occupied. It was the peak time for the lunch crowd, and an aisle over, a woman in a light brown uniform also walked with a plastic tray. He made a right to the last three or four tables. The woman ahead of him sat as he put down his food on the table behind her.
It was smart that he grabbed lunch now, he thought, because Annabel and Stuart had already gained a new patient each, so he was up next. Dr. Schott could call him any minute or any hour from now. He hated the anticipation that caused nothing but suspense and dread when any phone message came in. Sometimes he felt so uptight on call days that he developed a small skin rash on his arms. Luckily, it was hidden by his white jacket and no one else knew of his childish physical reaction.
The team was going downhill fast, he thought, and he couldn’t wait for internal medicine to be over. When his dream becomes a reality and he became a practicing interventional cardiologist, he would have little use for it anyway.
Today, the most undeserving, likeable male of the group, Bob, was absent, so that meant extra work. Sick or healthy, he would enjoy pulling a stunt like that someday, too. One entirely free day off would be like tuition money falling from the sky.
And Annabel. She was a bigger joke. He thanked his lucky stars that he had not rotated on the same psychiatry or surgery service with her, because apparently, she ended up stealing the show. He would surpass her in the future, however, because, like most women, she would probably only become a measly family practice doctor or a pathologist reading pap smears all day. Or better yet, she would end up as the only doctor staffing a small-town physician’s office in a shopping mall!
Jordan sampled the coleslaw next to his hamburger and realized it needed to be pushed through a strainer to remove the excess, watery mayonnaise. A phone rang behind him and he glanced to the side.
The woman in uniform fumbled on the empty chair beside her and picked up her cell phone. Now he recognized her outfit from magazine pictures. She was a law officer with the cushy job of monitoring peoples’ activities in government public parks.
The woman put down her fork with her other hand. “Hello? I am so glad you called,” she said after a pause. “I am worried sick about him, and my colleague, Jae, as well. I’m at the hospital because my partner’s being admitted. The two of them are both in different hospitals! But how is Twist and what did you find out?”
Jordan pushed the slaw away and cut his hamburger in half. He couldn’t believe the lady’s bad luck dealing with two people needing medical care at the same time.
A long pause ensued. “Lepto…spi…rosis?” the woman repeated slowly from the conversation. “I knew something was terribly wrong. That sounds awful. What is it anyway?”
Jordan kept eavesdropping. Nothing like passively learning about a unique disease over lunch; or at least he thought it was rare. He never heard of it.
“I feel blessed that I brought him in so soon and that you skillfully made the diagnosis. Yes, keep him there for IV antibiotics. Like you said, they need to be given early in the course of the disease.”
Jordan peered to the side and saw her swipe a forming tear off her eye.
He dug in his pocket for the “Handbook of Internal Medicine” and flipped to the index. Leptospirosis was not listed. He pulled his iPhone from his other pocket and googled the word. A screen full of sources pulled up. It was pretty bad, he thought, if he could find a disease online but not in a medical book.
He read all the signs and symptoms of Leptospirosis, which also mimicked other diseases - fever, headache, vomiting, etc. - and learned there are often two phases: a first phase with the more common symptoms and a second phase more severe, with kidney or liver failure or meningitis.
The culprit, he read, was a Gram-negative bacterium. One that can be carried by all sorts of wild and domestic animals: horses, cattle, dogs, and most commonly associated with rats and mice. The carriers may not even show symptoms of the disease, which would make the disease harder to track down.
He read on, wondering how a human could acquire it, and found out it was through contact with certain body fluids or with water or soil, particularly through broken skin from a cut or a scratch. Contaminated food could cause it as well.
Jordan scratched his head. He wore a moderate crew cut; he preferred the short cut to hide his hair, which would grow out too frizzy if he allowed it. The woman moved her dishes back on her tray and slid out from the table as he read that the risk of exposure for Leptospirosis was higher in people working or participating in outdoor activities.
Since he still had the information open, he wondered how doctors diagnosed it. It was complicated and over his head, but he read it anyway. Diagnosis was based on screening tests and serology at certain labs. He shook his head and gloated. Fortunately for him, he didn’t work in a hazardous occupational job related to Leptospirosis; like a farmer, or a vet, or like that woman, a ranger in a park.
-----
Donn clutched a Saran-wrapped pb&j sandwich over the office desk while Annabel pulled up a chair beside him.
“Jae Nixon’s CT scan is done,” she said. “It’s not read by the radiologist yet, but I put a medical student express result request on his desk.”
A puzzled look spread across Dr. Schott’s face and Annabel laughed.
“You almost had me believing that,” he said. “You’re filling in with humor since Bob isn’t here.”
“No one makes a situation light-hearted like him. Anyway, I’ll go check again. In the meantime, they wheeled Mr. Nixon straight up here. I also have some of his blood work results.” She pulled out her index card for him and turned it over.
“CBC, Chem 7, U/A, LFTs,” he mumbled while looking. “Nothing is glaringly abnormal.”
They frowned at each other and Donn shrugged his shoulders. He turned his attention to his sandwich and took a bite.
“I better snatch lunch as well,” she said softly. “I wish I brought something from home like you.”
Annabel stood up and approached the door. Jordan came around the corner and almost smashed into her. They stood facing each other, too close for comfort.
“Obstructing the doorway,” he said, thick with sarcasm. He stared her down and held his position.
Donn still huddled in the room, she contemplated, sitting straight behind her at the desk. She knew Jordan hadn’t seen him yet because she blocked his view. She tried to hold her temper and she hated to create a scene, but Jordan asked for it.
“That was a cheap trick you pulled on my sister last night.”
“A ‘cheap trick?’ I consider it pay-back for your trumped up allegation against me in the lecture hall the other day. In front of Stuart and Bob.”
“Nancy had nothing to do with our spat the other day. She drove six hours for a date with you, which didn’t materialize!”
“You lied about me in front of our teammates.”
“Ha! Lied to them? I won’t mention your proclivity to cheat on a test to anyone again since you will only take the aggressive posture and call me a liar.” Her tense muscles relaxed, knowing Donn must be listening.
“You even gloat about being a slanderer. You better stay away from me for the rest of the rotation.”
“And stay away from my sister.”
“That’s a no-brainer!”
Annabel tried to gain control over her heartbeat, which was running away like a racehorse. She inhaled a deep breath and stepped to the side, revealing Dr. Schott.
Don
n swiveled his chair around, dropped the sandwich plastic wrap in the waste basket, and stepped past them out the door.
The fury on Jordan’s face made Annabel duck and zip out the door like the room was on fire.
-----
Annabel tracked down the radiologist like a bloodhound on a scent. She was especially compulsive about hearing the specialist discuss a CT scan of the head, zeroing in on the snapshot slices of Jae’s brain. Even if her patient’s scan was normal, it proved fascinating. The ventricles, the sinuses, the sulci, the brainstem all came alive for their viewing pleasure as well as any lesions, hematomas, or shifting of tissue.
She snapped the gray, large envelope from the front desk, timidly knocked on the radiologist’s door, and entered the dimly lit space.
“Would you mind? This patient of mine was just admitted. We are perplexed over his diagnosis and my chief resident thinks it may be a central, I mean a brain, problem.”
The elderly radiologist beamed. “Come on over, young lady. Let’s take a gander. What are his symptoms? You share his medical background with me and I’ll share an imaging lesson with you.” He put the films up on the only empty viewfinder.
Annabel rattled off Jae’s history and added with a smile, “My dad’s a neurosurgeon in Nashville, so I’m making sure I don’t flunk out due to a lack of knowledge about the brain.”
The radiologist took a sip from the paper cup to the side. “We’ll make sure that doesn’t happen.” He wielded a pointer forward to the images. Annabel had a fine grasp of the textbook knowledge; making the connection to the images was more important.
“And here is CSF surrounding the medulla oblongata,” he added in the end.
She shook her head. The brain is like a well-oiled machine, she thought. A closed-compartment, the skull, was where the fluid, the blood vessels, and the tissue took up only the space allotted to them. If they went over and above their normal occupancy, dangerous things like increased pressure, began to happen. She again considered her dad - an expert when it came to dealing with those situations.
