by Harry Kraus
Claire reached forward and touched the boy’s hand. “Stevie? I won’t hurt you. Let me see.” She snapped on a pair of disposable examining gloves and touched the bottle which glistened with saliva. Through the green glass, she could see the boy’s tongue, which was dark purple, and swollen beyond a slight narrowing at the neck of the bottle. Left without treatment, the swelling would continue until the blood flow to the tongue ceased altogether, causing the superficial layers to die and slough. She gently pulled the bottle away from the boy’s mouth.
His head came forward with the bottle. “Aaaaah!”
It appeared that the vacuum had sucked the tongue deeply into the bottle.
“We need to break the vacuum in the bottle.” Claire sat on a rolling stool. “Do we have anything here to cut the glass?”
Lucy rubbed her chin. “I can ask Cyrus. I know he’s got a hammer. Maybe we can break it.” She disappeared through the doorway calling for the maintenance man.
The boy’s eye’s widened. “Ahhh!”
Edna shook her head. “It could cut him.”
Cyrus appeared, looming large in the doorway and holding a toolbox. He shook his head. “My drill is in the truck.” He hesitated. “There’s a glass cutter up in Carlisle.”
“Thirty minutes away,” Lucy responded.
Edna imposed herself between the exam table and Cyrus. “Is he a doctor?”
“Me?” Cyrus smiled. “I mow the grass.”
The boy screamed again and scooted to the far side of the exam table. Claire could see that the situation could quickly deteriorate into hysteria.
“Nine wah wah.”
Edna shook her head. “This doctor will help you.” She looked at Claire, her eyes pleading. “He wants me to call nine one one. You can help him, can’t you?”
Claire looked at Lucy. “Bring me the emergency drug box. We’ll need an IV for sedation.”
Lucy’s hand went to her mouth.
Claire motioned her to follow her into the hall, where she whispered, “We’ve got to do something here. The poor guy’s tongue is going to die if we wait for an ambulance to take him to Carlisle.” She looked at Cyrus. “Get your drill.”
Lucy wrinkled her forehead. “What are you going to do?”
Claire wasn’t sure. She was plunging ahead in uncharted waters. But she was Stoney Creek’s front line for medical care, and that meant she had to do something. She put up a steeled expression of confidence, knowing Lucy could read her true feelings like a book. “Just get the emergency drugs. I’ll do the rest.”
Back in the room, Claire faced the slobbering ten year old who had backed against the wall. He bared his front teeth like a trapped animal. The boy may have been in grade school, but he was already at least a hundred pounds. She wouldn’t be able to handle him alone. Suddenly, she found herself wishing for an equipped O.R. and an anesthesiologist to control the child’s airway. All of those things would have been available up in Boston where Claire did her surgical internship last year. But that was then, and Stoney Creek was a long way from Boston. And although she knew that a hospital was a thirty-minute ambulance ride away, she knew the best chance to get the bottle off without surgery would be now before too much swelling compromised any chances of removing the bottle without surgery.
Claire looked at Grandmother. She was large, but feeble, and her eyes were squinted in concern. The situation was deteriorating. The patient was on the verge of hysteria and Edna was losing trust in Claire. “You like baking, I see,” Claire began, hoping to inspire Grandma with a little confidence.
Edna looked down at her dress. “Oh, yes, but, uh, how did—”
“You have baker’s burns,” Claire responded, reaching out and gently touching the older woman’s forearms. “I noticed when you shook my hand. These are commonly seen in bakers. When they are loading the bottom rack of an oven, the forearms often contact the rack above,” she said, depressing the scars. “Right here.”
The older woman nodded. “That’s right, Doctor. Exactly right.”
Claire captured the woman’s eyes and spoke calmly. “I’m going to help your grandson, Edna, and I may need your help. We need to try to remove the bottle here before the swelling gets any worse and causes more problems.” Claire stayed intentionally vague and lowered her voice to a whisper, while leaning toward Edna’s face. She didn’t want the not-so-little Stevie hearing about his tongue dying. She wasn’t sure that if he made a break for it, she could do much to slow him down.
Grandma eyed Stevie pensively. “The doctor here needs to take a look, Stevie.”
“Can you climb back up on the exam table?”
The boy pushed tighter against the wall and shook his head. “Ooo!”
“I won’t hurt you, son. I’m going to help you. I’ll give you some medicine to make you real sleepy.”
Grandma Edna tried coaxing of a different type. “If you let the doctor help you, I’ll give you some of those caramel brownies you love.”
Claire took a half-step forward and lifted her hand. The chubby youngster let out a muffled squeal and shook his head. To Claire he certainly didn’t look like he needed any more brownies. In fact, the thought of brownies in Stevie’s stomach brought a sudden chill to Claire’s spine. If this kid was halfway through his chocolate milk, what else might be lurking in the depths of his belly that he might need to vomit if he worked himself into a lather? And if she sedated him, could he protect his airway if he started to vomit? She knew there was an endotracheal tube in the office’s emergency box, but putting a tube into a child’s windpipe can be a treacherous procedure under the best of circumstances; it could be next to impossible with a bottle of chocolate milk in the way. What I wouldn’t give for an anesthesiologist right now.
She clenched her teeth. She needed to work quickly, to dispel the worries which challenged expedient thought. Help me, God. “Stevie, I need you to get up on the exam table. I won’t hurt you. If you want me to help you, you’ll have to trust me.”
Stevie’s eyes were wide open, wild with fear, and wet with fresh tears.
His grandma nodded. “Come on, Stevie.”
Lucy returned with the emergency box and pulled out the IV supplies.
Stevie took one look at the IV and made a break for the door. His grandmother lunged and missed. Claire managed a fleeting grasp of the boy’s shoulder, and watched as he shoved Lucy forward and came face to face with Cyrus. For a second, the little tyrant stared down the maintenance man before attempting to dive between his legs. In a blink of an eye, Cyrus spun, lifted the boy by the waist of his jeans, and pulled the twisting flail of limbs to his own body. In another second, Cyrus had entrapped Stevie’s arms, while holding him from behind in a firm hold. He pried open Stevie’s right arm, forcing his elbow straight. He looked at Lucy. “Think you can hit this vein?”
Claire looked on with amazement and concern. She wasn’t thrilled at the use of force to restrain him, but she didn’t see much choice. She traded glances with Lucy and whispered, “Go ahead.”
The boy screamed and tried to kick at Lucy, who was holding an IV catheter.
Cyrus responded by jumping back up on the exam table, carrying the youngster with him, pulling him onto his lap where he could wrap his own legs around the writhing patient. “There,” he said, showing a thin smile. “Better hurry. He’s slippery.”
Claire took a deep breath. In spite of Cyrus’s words, it didn’t look like the boy could go anywhere. She quickly painted the inside of Stevie’s elbow and punctured the vein with the IV catheter. Stevie strained against Cyrus’s hold as Lucy taped down the IV and Cyrus spoke softly in the boy’s ear. “Come on, Stevie. I’ll loosen up if you cooperate.”
Stevie yelled as Claire quickly stabbed the IV port with a needle and pushed in the Versed, a rapidly acting sedative. After two agonizing minutes, Stevie’s eyelids drooped and Cyrus loosened his grip. Claire injected two milligrams of morphine and waited until Cyrus placed the quieted patient on the exam table. “D
on’t leave us,” Claire cautioned. “He may wake up if he feels pain.” She lifted the bottle to make her first close exam of Stevie’s tongue. The tip was deep purple and tense like a grape. She looked at Cyrus’s toolbox. “Do you have anything to cut the glass?”
Edna paled. “His tongue is so swollen. You’ll hurt him.”
Claire avoided eye contact with the grandmother. “We need to release the vacuum in the bottle. We have to break the bottle somehow.”
Edna tugged the lapel of Claire’s white coat. “You do it. You’re the doctor.”
Claire shook her head. She had to fight the rising panic within her. Her patient was quiet, ready for her to do something, but she wasn’t sure what that something should be. She tried to twist the bottle but the tongue moved with it. She tugged it forward but quickly met resistance as the tongue was already protruding as far as Stevie could let it.
Cyrus clanked through his tool box, lifting first a hammer, then a pair of pliers and a screwdriver.
“I don’t have a drill bit that will work for glass. Maybe you could break it with this,” he said, weighing the hammer in his hand.
Claire shook her head and tapped the bottle with her knuckles. “The tongue could be lacerated if the glass shattered.”
“Perhaps I could just tap the edge of the bottle,” Cyrus offered.
“No.” She couldn’t very well let Cyrus take over responsibility for the patient. She had to do something. Not that I have a clue. I’ve never seen anyone with their tongue stuck in a bottle before. How can I introduce air into the bottle without breaking it?
“Wait. I’ve got an idea.” She motioned to Lucy. “Bring me a spinal needle.”
Lucy shrugged and left the room, returning in a moment with a small box.
“Give me the twenty-two gauge.”
Claire snapped on a pair of sterile gloves and bent the needle into a sharp angle after removing the stylet. She drew up a local anesthetic into a syringe and attached it to the bent needle. She pulled the bottle aside. “Hold it here, Lucy, so I can see the base of his tongue.”
Claire pushed the needle into the exposed flesh at the base of Stevie’s tongue and injected a cc of the numbing medicine. She watched Stevie’s eyes, which opened briefly during the injection. Then, Claire twisted the needle so she could manipulate it through the muscle of the tongue and out through the swollen tip and into the bottle. Immediately the plunger of the syringe slid forward as the clear anesthetic fluid was pulled into the bottle, mixing with the brown contents. Claire pulled the syringe free from the needle, allowing a hiss of air to suck into the bottle through the spinal needle.
Claire pulled back the plunger to fill the syringe with air, then reattached it to the needle and forced additional air into the bottle before sliding the needle out. She twisted the bottle again, noticing a slight movement. She gently pulled the bottle away from Stevie’s face. Slowly, she added force, lifting her patient’s head from the table. Then, she laid her opposite hand on Stevie’s forehead and trapped it against the padded exam table before giving the bottle a forceful clockwise torque.
Stevie screamed as the bottle broke free in a spray of milk. Claire looked for the gush of blood. She was sure she’d sheared off the boy’s tongue.
Edna and Lucy gasped.
Stevie’s head landed against the table with a thud. In the silent moment that followed, Claire examined his tongue. It was swollen and purple, and had a rim indentation from the bottle neck. She took a deep breath. The tongue oozed blood from the needle stick, but was otherwise intact.
Relief and exhilaration flooded Claire’s veins as her lungs exploded in a laugh that broke the silence. She turned and slapped Cyrus on the shoulder. “We did it!”
He smiled and backed up to let Claire pass.
She handed a white gauze to Lucy. “Pinch his tongue to stop the bleeding. Then get him an appointment to see me in two days.” She looked at Edna and smiled. “Keep him sitting up most of the day once he’s awake. And give him some ice or a popsicle. It will help with the swelling.”
Claire was pumped, thrilled with the success of her innovative treatment. For her, this was the immediate gratification that fueled her surgical personality: see a problem; fix a problem; go on to the next problem.
She watched as Cyrus dropped his hammer into his toolbox and walked down the hall toward the back door and the parking lot beyond. She hadn’t liked having to get him involved, especially to physically control a patient, but she had to admit, without his help, they’d have never been able to restrain “little” Stevie. She dismissed her anxiety about the use of force, and reminded herself of what an answer to prayer Cyrus had been.
Claire reassured Edna, then hurried from the room, excited to face the challenges the next patient would offer. Best of all, she mused, when she was busy with a difficult patient, she couldn’t think about the cloud. I can do this. I don’t have to know the future. I have enough to keep my thoughts busy just concentrating on the here and now.
She nodded, opened the chart of her next patient, and began to read.
Chapter Six
Lena Chisholm listened as the back screen door slapped against its frame. Billy Ray was home early. She looked at herself in the mirror L and pushed a blond strand of hair behind her ear. It was a reflex. Billy always wanted her to look her best when he arrived. But today, he’d have to put up with things just as they were. She didn’t feel well enough to make the effort. She’d slept until ten, a fitful slumber interrupted by pain and her husband’s restless trips to the bathroom to empty his bladder of yesterday’s beer enthusiasm.
When she’d awakened that morning, her left eyebrow had been stuck fast to her pillowcase, the blood and fluid that oozed from the freshly sutured laceration forming a natural bond that had brought tears to her eyes as she’d torn her face away from the linens. Now, studying her reflection, she could just get her left eye open above the raised purple flesh of her cheek. She hopped to the TV, shutting off Oprah and collapsing onto a well-worn couch.
“Lena?”
“In here.” She listened to his footfalls and the squeak of the hall closet.
“Did you wash my bowling shirt?”
She leaned back to accept his kiss. He paused as their eyes met, before looking away and setting his bowling bag on the couch beside her.
“You’re home early.”
“Mr. Bowman left early. He likes to spend weekends at his cabin.”
“When the boss is away, the mice will play.”
“Yeah, yeah. What he doesn’t know won’t hurt him. What about you?”
“I called in sick. Couldn’t exactly work like this.”
He wouldn’t look up. “It won’t happen again.”
She didn’t reply. She’d heard it before.
He lifted his hand and gently touched her cheek. “Can I get you some aspirin or something?”
She shook her head. “I’m okay.”
He lifted a blue couch pillow and slid it under her foot. “You should keep this elevated.” He stroked the bottom of her bare feet and glanced over just in time to see her wipe her eyes.
He could be so sweet.
And so violent.
“Why don’t you have your ankle wrapped?”
“I took the bandage off so I could wash my feet.” She pointed toward their little bathroom. “It’s on the counter by the medicine cabinet.”
Billy Ray retrieved the ace wrap and rerolled it with slow precision, making sure the edges were even. “There,” he said. “Can you hold up your foot?”
She obeyed and studied his face as he focused on wrapping her foot and ankle. “You should have been a doctor.”
A smile broke his mask of concentration. “I used to dream of being a surgeon.”
She giggled. “You?”
“Shut up! My biology teacher in high school said I’d be good.” He clipped the ace wrap in place with a little more vigor.
Pain shot through Lena’s ankle. “Ow! I was onl
y kidding.” She paused. “I’m the one who said you should have been a doctor.” She paused and studied her husband for a moment. Billy Ray had a vulnerable side, like a little boy, insecure and searching, afraid to challenge the world. He lifted his chin and nodded quickly to himself, perhaps reassuring himself of the properness of his job. His brown eyes gave his hardened face a hint of tenderness.
His eyes met hers. “What are you staring at?”
“What happened, Billy Ray? Why’d you give up a dream?”
He shrugged. “I blew out my knee playing football. It was my only ticket to college.” He pulled his hand through his dark hair and shuffled his feet.
Lena knew he felt inadequate, but didn’t know why. He was strong and good-looking. “So, you’re a car surgeon now. I’ll bet that Dr. McCall can’t even change her own oil.”
He smirked and picked at the grease beneath his thumbnail. “She probably doesn’t even pump her own gas.” He picked up his bowling bag. “We’re bowling up in Carlisle. Eddie’s gonna drive.”
So you can drink. “Don’t go, Billy. Stay home with me. You could rent a video. We’ll eat popcorn.”
“The guys are counting on me.”
“Okay, I’ll come along. I can root for the gang.”
He shook his head. “Don’t start, Lena. You can’t show up like that.”
“I’ll tell them I fell down.”
“No!” He slammed his bag down on the kitchen table.
Lena winced.
Billy Ray dropped his head and took a deep breath. Then, with his voice softer, but on the frayed edge of control, he continued, “I mean, no, baby. You need your rest. You don’t like Lester and Eddie much anyway.”
That was an understatement. Lester drank too much and didn’t like to drink alone. Eddie knew only three adjectives, and she would only repeat one.
“Stay with me, Billy Ray. We’ll listen to Garth Brooks.”
He clinched his jaw. “Don’t nag me, Lena.” He walked away into the kitchen where she heard the refrigerator open. He returned holding a can of cheap beer and chewing cold cheese pizza with his mouth open. He dropped into the chair across from the couch. “Want some pizza?”
