As she staggered back from the bed, gasping and pressing the back of her hand to her mouth, he inched his way over onto the clean sheets.
“You—you…” she gulped, glaring at him in fury.
“Don’t scold me, nurse,” he whimpered. “I needed that—and it didn’t hurt you none.”
She shook off her nausea and got back to work. After all, the poor kid was probably too sick to know what he was doing. But she’d see that he didn’t trick her like that again!
She hurried to finish the other side of the bed, but she still hadn’t cleaned the room when the whole procession came in, and in spite of her struggles with the bed, it looked far from neat.
She recognized Dr. Claibourne by his white mustache and bald head. She’d seen Dr. Matthews, chief of surgery, and guessed that the other familiar-looking doctor was Dr. Browne, the surgeon who, according to Arnold Crane’s chart, had performed the appendectomy. She knew Dr. Cole, the resident, too, and it was simple to identify the tall, lean, good-looking stranger as the new doctor she’d heard discussed in the dining room. Dr. Claibourne introduced him to Arnold as Dr. David Sterling.
Mrs. Andrews brought up the rear, her eyes sternly disapproving as she saw the unfinished state of the room.
“Whatever have you been doing with your time?” she scolded. “You should have attended to this patient first thing—and even if you left him till last you should be done before this! And do you call that bed properly made?”
“I—I’m not used to making a bed in that position,” Janet faltered.
“Then why in heaven’s name didn’t you roll it down flat? There are no orders against it now! Are you stupid? Or just lazy?”
Janet grabbed up the dirty linen and fled from the room. But even in her blind haste she couldn’t avoid the eyes of the new doctor who’d been standing near the foot of the bed. There was an unmistakable glow of compassion there as he watched her flight, and she found her heart pounding with embarrassment.
Chapter 4
David watched the little red-headed nurse rush out, her cheeks flaming. What sort of battle-axe was this head nurse, to bawl a student out in front of a patient and a group of doctors?
He turned his attention to the chart Dr. Browne handed him.
“I performed an emergency appendectomy here eight weeks ago,” Browne was saying. He was a small rotund man, excessively neat in his grooming, meticulous of manner, with a mouth like a button hole. “A gangrenous appendix lay behind the ascending colon. The pathology report is there.” He flicked over a thick sheaf of the chart pages.
“A drain was inserted temporarily,” Browne continued, “and we’ve controlled peritonitis with antibiotics. His progress has seemed satisfactory at times, yet each time he’s about ready for discharge, he flares up with chills and fever, and complains of pain again. We’ve used prontolyn, intravenous mercurochrome, and whole blood transfusions, but he continues to lose weight and run a low-grade fever. Poor appetite from inactivity might account for it. I’m about to write him off as psychosomatic at this stage.”
David cast a quick glance at the boy who was listening intently, his eyes wide and round as an owl’s in his skeletal face. Did Browne always speak as frankly as this before his patients? The kid probably didn’t dig the technical terms—but he was getting the gist of things.
David handed Browne the chart. “I’d like to study that a little further, outside. But first, may I palpitate the epigastrium?”
“I wish you would, doctor! Make any examination you like!”
Browne spoke cordially, yet there’d been a tenseness about his mouth ever since Matthews suggested that David join the consultation on Arnold Crane. David understood that Browne had asked for the consultation with Matthews and Claibourne because he was nonplussed over the case—but that didn’t mean he would welcome the opinion of a rank newcomer.
“Where does it hurt, son?” David asked, as Miss Andrews neatly folded covers and bed-jacket back to expose the emaciated young body.
“Right here,” Arnold whined, touching claw-like fingers to his abdomen. “I can’t get a good breath without hurting.” David pressed his hand against the liver and the boy bleated with pain.
“Has there been any jaundice?” he asked, looking up at Browne.
“No, and blood culture is still negative.
David finished his examination and the doctors went out to the hall. “What about the X-rays?” David asked. “May we see them?”
“We haven’t had him to X-ray since the laparotomy,” Browne replied. “The films and fluoroscopy then showed only a suggestion of some infiltration at the right base, suggesting perinephric or subphrenic abscess. But as I told you—no abscess was found. We don’t want to go through all that again. I tell you, I think the boy’s neurotic—maybe psychotic.”
David set his jaw grimly. He’d thought that about a patient once—to his great dismay afterward. “I believe it’s a mistake,” he said, his voice a little sharper than he intended, “to ascribe illness to neurosis before every physical source is thoroughly checked. I noticed on the chart that the patient suffered one severe chill before entry for the appendectomy. Sometimes when there’s a chill like that during the onset of an attack of acute appendicitis—Well, have you considered pylephlebitis? It’s my opinion there may be an abscess at the portal vein. I’d suggest a new set of X-rays, another blood count, and a check of the icteric index.” He turned to Matthews. “What do you think, Doctor?”
Matthews took the chart and thumbed through the pages, stopping here and there to frown over an entry. He was a tall spare man about sixty, looking far too young and fit to retire, David reflected.
“I think Dr. Sterling may have something,” he told Elwood Browne. “At least his idea is worth checking through.”
“As you wish, Doctor,” Browne answered stiffly. “But it rather looks to me like another futile laparotomy coming up—and if we cut that boy open again, he may not survive!”
“That’s true,” David thought sharply as they went on to another patient. Remembering how terribly wrong he’d been about a case once, his self-confidence took a nose-dive. But he couldn’t back down now. He had expressed a diagnostic opinion based on his years of study and prior experience that told him he was absolutely right. If further tests didn’t bear him out, the boy was Browne’s patient—there was no compulsion to operate.
“But it’s pylephlebitis as sure as my name is David Sterling,” he told himself stubbornly. An inflamed condition of the portal vein, possibly originating, or extending into the liver. With that history, and those symptoms, it just had to be! They’d been looking for infection below the liver and kidney because the ruptured appendix had started it. X-ray might not reveal the exact location of the abscess this time, either—but if they didn’t operate, he was willing to wager anything that an autopsy would disclose one at the portal vein.
He said as much to Claibourne as they were discussing it later at the clinic. “But I can see,” he added, “that Browne disagrees radically.”
“Oh, I wouldn’t say that,” Dr. Claibourne replied with a placating smile. “I think Elwood simply hates to risk further surgery with the boy in such a weakened condition.”
“The longer he waits, the worse his condition will be. If he fools around with the idea it’s psychosomatic and takes time for a psychiatrist to work him over…”
“I think he has more basis for that idea than appears on the chart,” Claibourne broke in. “He’s been talking to the parents, and other relatives. The boy has always been a little off-beat, they say. There’s a good chance he’s subconsciously prolonging this illness because it’s a cover for the inadequacies that have plagued him.”
David shook his head. “That may be, but I wouldn’t want to depend on it. If the boy gets much worse, he’ll be beyond the help of surgery. I believe it’s justified right now. X-rays m
ay not be convincing, or lab tests either, no matter how sure I am in my own mind.”
“Well, in that case,” Claibourne said, “it will be up to Browne, of course. But when doctors disagree, it always presents a challenge, and however the case turns out, that boy will have received a much more complete examination than would have been likely without a dissenting opinion. Which definitely improves his chances for survival. That’s what I meant about a clinic set-up offering a safeguard for both doctors and patients. And of course,” his smile was friendly, “I’m hoping your diagnosis turns out to be correct. It will be good for your own self-confidence, as well as for Stan Matthews’ confidence in you.”
Had Claibourne engineered this as a test? David wondered. If he had, David told himself with a chuckle, I stuck my neck out, but good!
He looked around his newly renovated, intricately equipped treatment and consultation rooms, modern like the rest of the clinic—and so far advanced from the shabby little rooms where his grandfather used to practice.
He could have a fine career here, providing he didn’t ruin his chances by some fluke the very first thing.
Just then Graham Burns poked his head in at the door.
“You’ll have to ride home with me again tonight, Dave,” he said genially. “Your car hasn’t been delivered yet. But Coralee said they just phoned and promised it tomorrow for sure. You about ready to leave?”
“I’ll take a cab later,” David told him. “And I’ll postpone moving my gear to my own diggings until tomorrow, if that’s okay with you.”
“Sure, fine! You’ll be home to dinner, won’t you?”
“No, I’ll have a bite over at the hospital. I want to go over the Crane kid’s chart again, and check the lab and radiologist’s reports. I’ll see you later.”
No use postponing his extra study of the case until tomorrow, he reflected as he crossed the street to the hospital. Doing it tonight would serve two purposes. It would give him a jump on Browne and Matthews when they studied the reports together tomorrow. And it would keep him away from Coralee another evening. The less they saw of each other the better.
Chapter 5
Janet picked up her list of bed baths from the desk and scanned it anxiously. Thank heaven! Room 242 wasn’t included, nor any of the difficult patients she’d had yesterday. Karen Carruthers must be back on duty, and Janet could return to the type of patients she could handle more easily.
She was just leaving the desk, however, when Miss Andrews came up, frowning. “We’re short-handed again today, Miss Raleigh. I’ll have to divide your patients up among the other nurses, and you can take over treatments.”
“T-treatments?” Janet repeated. Her heart began to race. It wasn’t unheard of for a green student nurse to handle treatments and medication, but she hadn’t expected such an assignment from Miss Andrews. Usually it was saved for the senior students; and considered a high form of commendation when handed to a fledgling.
“Yes—treatments!” Miss Andrews snapped impatiently. “You’ve been taught to give medication, assemble trays, and attend doctors, haven’t you? Your list is posted in the treatment room.”
“Yes, thank you!” Janet hurried to the spotless white treatment room. A sterilizer was hissing in one corner, and she knew one of her first jobs would be to remove the instruments and lay them on sterile glass shelves ready for use, or wrap them in sterile towels as needed on the trays she was to assemble. There was a hopper on one wall, flanked with counters and a sink. Cabinets lined other walls, among a variety of portable machines. She removed the covering sheet on the treatment table in the middle of the room and replaced it with a clean one, then turned her attention to the list of trays to be set up.
There were to be two catheterization trays, three enemas, and one boric compress. Those were easy. There was also to be a tray each for several specific surgical dressings, and one for a spinal puncture.
In the big pocket of her blue-and-white-striped uniform she carried a small folder listing the items necessary for each tray. She checked the list as she worked, to be sure everything was set up exactly as she had been taught by the instructress. She took time out at eight o’clock to prepare a tray of medicines according to the list on the door of the medicine cabinet, and gave each patient the prescription ordered. Then she came back to finish setting up the trays before the doctors came in to make rounds.
The treatment room was in order, the trays set up ready for use and covered with clean or sterile towels, when the first doctors arrived. Miss Andrews accompanied them on their rounds, and was still busy with them a few minutes later when Dr. Burns came in with the new young doctor who had witnessed her mortification yesterday.
“Dr. Burns, Dr. Sterling,” she murmured breathlessly, hoping her cheeks weren’t flushing, “Miss Andrews is busy, but I’ll accompany you if…”
“Is the spinal ready for Mr. Gamer?” Dr. Burns asked.
“Yes, Doctor—it’s all ready,” she told him, selecting the spinal tray from the counter and setting it on a stand.
“Not here,” Dr. Burns said. “No use moving him. Just set screens around the bed and we’ll do it out in the ward. Dr. Sterling’s going to assist. You’ve met Dr. Sterling?”
Without waiting for either of them to answer, Dr. Burns started talking to Dr. Sterling about the case. Janet held sterile gloves and tied sterile gowns on each of them, then rolled the tray, on a wheel-based cart, down to the ward.
By the time the doctors followed her she had the screens set up around the bed for privacy, the patient curled up on his side, his back at the edge of the bed, the lumbar region painted with merthiolate, and she was rechecking the tray for all the necessary items. The spinal punctures were usually done in the treatment room, where extra items were easily available. Of course, there was also a table of supplies at the center of the ward, if the doctor should ask for something not on the tray. She supposed his decision to do the puncture here was because of poor old Mr. Garners arthritic condition—it was painful for him to move.
“You didn’t want him to sit up?” she asked Dr. Burns. That was usually the position for the beginning of the puncture where the treatment table was used, but it would hardly be practical in this case, she reasoned.
“That’s right,” Dr. Burns said, his smile approving her preparations. “This is fine. Look, Dave, at the deformity of this fourth lumbar.” He went on talking as he picked up the small hypodermic she had prepared to anesthetize the site of the puncture.
Suddenly Dr. Burns turned to the tray, gave it a quick glance and said, “Bring me the usual Hoffman’s, will you please? Stat!”
Janet gulped and hurried around the screen to the table in the center of the ward. Hoffman’s, she thought—Hoffman’s! What did he mean? What did he want? She should have asked him, but he’d taken it for granted she knew, he probably thought she was one of the more experienced nurses—so she took a chance on finding something labeled Hoffmann’s on the center table. There were bandages, gauze pledgets, sponges, instruments…
“What are you waiting for?” Dr. Burns had stepped out from behind the screen to call to her. Janet was about to ask him to explain more fully what he wanted, when Miss Andrews came stalking over leaving the two doctors she’d been attending at another patient’s bed.
“What is it, Doctor?” she asked solicitously.
“I wanted the usual dose of Hoffman’s anodyne,” he said apologetically. “I guess I should have been more specific, but I thought…”
Miss Andrews swung to Janet. “You won’t find it standing there,” she said crisply. “Go to the medicine cabinet in the treatment room, measure out 4cc’s and bring it back.”
She found the bottle quickly. Hoffman’s Anodyne—Compound Spirit of Ether. She was sure she had never heard of it before, but if Dr. Burns had said, “Spirit of Ether”, she would at least have known where to look. She wouldn’t
have been searching the center table for an instrument or dressing.
Miss Andrews was still with Dr. Burns when Janet returned. “I’ll take over here,” she told Janet coldly. “Go on with the rest of your work. And next time you don’t understand a request, have the common sense to ask what is meant; don’t just stand around like a dumbbell wasting the doctor’s time!”
Once again Janet caught the new doctor’s compassionate glance as she turned away, and her cheeks burned more hotly than ever. By now he must surely figure her for the dumbbell Miss Andrews had called her.
That won’t be the last I’ll hear of it from Andrews, either, she thought as she went back to the treatment room. She’d be lucky if she were allowed to remain on medication the rest of the day, and she’d probably never be treatment nurse on Second Annex again. Maybe Andrews just gave her the job today in hopes of showing her up as stupid. Well—she’d succeeded.
She blinked back the tears of frustration and did one of the scheduled catheterizations. It was the first one she’d ever attempted, but Miss Crenshaw’s instructions had been explicit, the patient was cooperative, and Janet had no trouble.
She was feeling better by the time she returned to the treatment room with her tray. But her spirits sank when she saw Miss Andrews there in a scowling conference with Karen Carruthers.
“Come here,” Miss Andrews said sternly. “I want Miss Carruthers to tell you something.”
The senior nurse looked embarrassed. She was a big-boned blonde who flushed easily.
“I don’t like to be a tattletale,” Miss Carruthers said, beginning to fidget, “but I just couldn’t believe—surely you wouldn’t—I mean…”
“Oh, come on, Miss Carruthers, out with it!” Miss Andrews snapped. “Tell her what your patient in 242 told you.”
Arnold Crane, Janet thought, beginning to feel a painful pounding under her ribs. What had that obnoxious, pitifully sick boy said about her?
The Nurse Novel Page 33
