Angels on the Night Shift

by Robert D. Lesslie, M. D.

  “I’ll do that, Virginia,” I told her, dispirited by this development. “I hope it turns out to be something simple.”

  “I don’t believe it will, Robert.”

  Virginia left the department, and as the shift wore on, Darren Adler’s color improved and he seemed to be getting stronger. It looked like he would be fine.

  “Dr. Lesslie, the CT scan on the kid in room 4 is back,” the unit secretary told me, not looking up from her work.

  I had forgotten about the child. It had taken longer to get his scan done than Liz had anticipated. It was almost nine o’clock when I went into the room with the radiologist’s report in my hand.

  Glancing down quickly at the name on the chart I said, “This must be Clark.” I walked over to the stretcher where the three-year-old boy was quietly sitting. He looked up at me as I said his name, but didn’t smile. He gave a quick, furtive glance at his parents, and then he looked down again at his hands.

  Odd, I thought. And it was a little odd that he was sitting alone on the bed, his feet dangling over the edge, bare-chested.

  I looked over in the corner of the room. A young woman, his mother I presumed, was sitting on the lone stool. She looked over at me and smiled. The man beside her stood with his arms folded across his chest, scowling.

  “This has certainly taken long enough,” he muttered, looking down at the small child.

  “And you are…?” I questioned them.

  “We’re his parents, Lewis and Erica Springs,” he told me bluntly. “Tell us about the CT so we can get home.”

  He still hadn’t looked at me, and I studied him for a moment. He was probably in his mid-thirties, dressed in a starched shirt and bright red tie, and wearing expensive shoes. His wife, Erica, was neatly dressed as well, and sat with her hands politely folded in her lap. She had glanced up at her husband when he said this, and then turned her head away.

  I turned my attention back to Clark.

  “Tell me, son, what happened to you today?” I asked him, stepping over and sitting down beside him on the stretcher. Without looking up, he quickly slid a few inches away from me.

  “We’ve already gone over this,” Lewis Springs interjected. “With that other doctor, the woman.”

  “Lewis, please…” his wife implored. “Let him—”

  “She wrote everything down on that chart,” he cut her off, his voice now raised a little. “Just tell us about the scan.”

  “Before we go over that,” I said, looking over at the two of them, “I need to know exactly what happened.”

  Lewis exhaled loudly and turned a little, facing away from me.

  “He was just running through the house this evening,” Erica explained. “He must have tripped and fallen and hit his head. As I told Dr. Kennick—I believe that’s her name—he didn’t get knocked out, but he quickly got a big hematoma on the back of his head, and he vomited once. We were just concerned and wanted him checked out.”

  “I understand,” I told her, looking now at Clark. Gently, I felt the back of his head and the large swelling there. I couldn’t feel any bony defect, and there was no active bleeding. I knew the scan was negative, but I wanted to be sure he was okay.

  “Has he complained of pain anywhere else?” I asked her, now focusing my attention on his wrists and shoulders. Those areas were frequently injured when a child, or anyone else for that matter, took a tumble.

  “No, just the back of his head,” she answered. “Everything else seems fine. I took a good look at him too.”

  Lewis was tapping his foot now, becoming more impatient.

  Things weren’t quite right here. Nobody liked being in the ER and having to wait a long time. But this was their child, and they should want to be sure he was all right, no matter how long it took. Their behavior didn’t quite fit the circumstances, and Clark seemed sullen, almost withdrawn. Something was bothering me.

  Suddenly, there it was.

  “Mrs. Springs, you said he was running through the house this afternoon?” I asked her.

  “Yes, he was…just like he always does. He was running and must have tripped on something.”

  She had hesitated, just for a split second—but she had hesitated.

  That’s what didn’t make sense. Children his age lead with their faces when they fall. We see busted lips and chins and eyebrows. Not the backs of heads. Why would he have fallen backward? Maybe his feet had gone out from under him, but that didn’t happen very often.

  I leaned back a little on the stretcher and looked again at the back of his head. Then I looked at his chest and lower back. There were subtle areas of bruising, and what looked like a few small welts.

  “Mrs. Springs,” I said, glancing over at her. “Tell me about these areas. Did he do this when he fell this evening?”

  Erica quickly glanced up at her husband before standing and moving toward the stretcher. She put a hand on her boy’s shoulder and looked at this back.

  “Yes…he must have….he must have done this at the same time,” she murmured. “I saw that too, but it doesn’t look too bad, does it?”

  I gently ran my fingers over a few of the bruises, and Clark winced a little and pulled away. But he didn’t say anything or cry out.

  “We need to take a look at this too, then,” I told them. “I’m going to send him around for a chest X-ray, just to be sure there’s no problem with his lungs or anything.”

  I wasn’t very worried about these bruises. I was more interested in finding out whether Clark had any old fractures anywhere. I was becoming increasingly concerned about his safety.

  “Just tell us about the CT scan,” Lewis said, stepping into the middle of the room. “We’ll take him to his pediatrician in the morning and have his back checked out.”

  I looked down at the radiology report and then up into the faces of Lewis and Erica Clark.

  “His CT scan is fine,” I told them. “There’s no skull fracture, and no bleeding or anything going on in his head.”

  “Good,” Lewis said with determination. “Then we’ll be on our way.”

  He reached out and took hold of his son’s right arm. The boy jerked away and looked up at his mother with wide and frightened eyes. She didn’t move.

  “I’m afraid we’re not quite ready to release him,” I told Lewis Springs, standing up and positioning myself in front of the boy.

  “Release him?” Lewis sneered. “And just who are you to release my son? Come on, Erica, we’re leaving.”

  He was beginning to pull on his son’s arm, and for the first time Clark whimpered.

  Leaning closer to the frightened child, I said, “Mr. Lewis, I can’t let you do that.”

  He dropped the boy’s arm and put his finger in my face. His own face had turned deep red and he was sputtering in anger.

  “Do you know who I am?” he demanded. “I will have your license, Dr. Lesslie. I am personal friends with the hospital administrator, and tomorrow morning, you will not have a job. Now get out of our way! We’re going home!”

  I didn’t move, surprised a little at my own composure. But this wasn’t about me. It was about Clark Springs.

  “Here’s what’s going to happen tonight, Mr. Springs,” I told him calmly, disregarding the finger just inches from my nose. “We’re going to get those X-rays, and then I’m going to get a stat consult from DSS. There are too many red flags here for me to feel comfortable with Clark’s safety.”

  Erica’s head slumped to her chest and she moved back a little from her husband.

  “You’re going to what!” he yelled. “I’m warning you, you—”

  “Just a second,” I interrupted him, stepping toward the entrance of the room and pulling aside the curtain.

  “Susan,” I called out to the unit secretary. She looked over in my direction and I said loudly, “Call the police. We need them right now.”

  I stepped back into the room and pulled the curtain closed.

  “Now, Mr. Springs, what happens at this po
int is completely up to you.”

  He glared at me, his fists clenched and his eyes mere slits. I knew at that moment anything could happen. And I just waited.

  “Lewis,” his wife whispered, reaching out and touching his arm.

  He jerked away from her, was about to say something to me, then stomped out of the room. Clark just sat there, seemingly oblivious to all that had just transpired.

  The radiologist and I looked carefully at Clark’s X-rays. It was awful. There were three healing rib fractures on the left side of his chest and two more on the right. Kids just don’t break their ribs unless there is some major form of trauma. Like their other bones, their ribs usually bend before snapping.

  “Take a look at this,” the radiologist said, pointing to Clark’s right upper arm. There was a healing fracture there as well, probably only three or four weeks old. “Takes a lot of force to do that,” he muttered angrily.

  I just stood there, looking over his shoulder and shaking my head.

  “I don’t know how you folks in the ER deal with this stuff,” he said quietly. “I’m just looking at the films here, but you’ve got the child right in front of you. It must be hard not getting upset and really angry.”

  It was hard. And it was heartbreaking. I thought of the quote Lori Davidson had taped to the inside of her locker. I had seen it only once, but I would never forget it:

  Let my heart be broken with the things that break the heart of God.

  Something like this would always break our hearts.

  “Do you know who this guy is?” he asked me, spinning around in his chair and taking off his bifocals.

  “No,” I answered. “And I don’t really care.”

  “He’s a big shot in town,” he informed me. “Works with some financial group in Charlotte, I think. And he used to be on the board of the hospital.”

  “Well, that should be interesting,” I remarked. “Thanks for your help here,” I added, walking toward the doorway.

  “Good luck, Robert,” he said quietly.

  I stopped and turned to face him. “It’s the little boy who needs the good luck. So far, he hasn’t had very much.”

  Hopefully that would be changing for Clark Springs. And hopefully Lewis Springs’s troubles were just beginning.

  When I got back to the ER, two police officers were stepping into room 4.

  I was physically and emotionally drained when the ambulance doors opened and my relief walked through them. And I was more than happy to see Ted Nivens, one of my partners, as he walked over to me, smiling.

  “Let’s get you out of here, Robert,” he said, looking around the department. “Anything I can do?”

  We had somehow managed to empty it out, and I had no one to turn over to him.

  Darren Adler sat on the other side of the counter, exhausted as well, but managing somehow to nod his head in agreement.

  “Nope, Ted,” I said to him. “Everything’s done. It’s all yours.”

  Then looking down at my nurse: “Darren, you did a great job tonight. I’m not sure I could have done it, looking the way you did when you came in. But good job.”

  “Thanks, Doc,” he said weakly, smiling up at me. “And thanks for giving me the chance.”

  7

  The Witching Hour

  8:40 p.m. This was my last night for a while, and I was looking forward to a couple of days off. It was Thursday, one of our quieter days, and the department was reasonably under control. That could always change quickly, but for the moment, we were enjoying the relative calm.

  Jeff Ryan walked through the triage door leading a young woman. He gave me his “I don’t have a clue!” look as he passed the nurses’ station and took her to room 5. I caught a glimpse of her face as she came by, as did our secretary, Susan Everett.

  “What in the world!” she whispered, her eyes glued on the patient until she disappeared behind the curtain. “Did you see that, Dr. Lesslie?”

  “I did,” I answered, wondering what was going on. “Pretty impressive.”

  The woman’s face was a glowing, brightly colored beet-red. No, it was more of a fire-engine red. She didn’t seem to be in any distress, and I waited curiously for Jeff to come out of the room and give us her story.

  He pulled the curtain closed behind him, then walked over. Sliding the chart of room 5 over in front of me, he said, “This beats all, Doc. She looks like a lobster, a boiled one, and she’s giving off heat like one too.”

  I looked down at the chart.

  Dakota Flanders—22 yr old F—hot flashes

  It was a descriptive complaint, but it didn’t help me very much.

  “Odd name,” I remarked to Jeff.

  “Yeah, she’s a student at Winthrop, from out West somewhere. Says she and a couple of her friends went out to dinner, and when she got back to the dorm, she felt a little flushed. One of her friends checked on her and got all excited. They almost called an ambulance but decided to drive over here instead. All of her vital signs are fine, and she’s breathing okay. Just looks like she’s been cooked.”

  “That’s interesting,” I said thoughtfully, picking up the chart and walking over to Dakota’s room.

  She was sitting on the stretcher, her legs hanging over the edge, and she looked up and smiled when I entered the room.

  “Miss Flanders,” I said, walking over to a stool and sitting down. “I’m Dr. Lesslie. Tell me what’s going on tonight.”

  She calmly repeated what she had told Jeff in triage, then asked me what I thought was happening to her.

  “Where did you have dinner?” I questioned her.

  “Captain’s Quarters,” she answered, naming a chain seafood restaurant on Cherry Road. “We go there every once in a while but have never had any problems. And I’m not allergic to anything, no shellfish or stuff like that.”

  “Do you remember what you had?” I persisted, beginning to think this might be the answer.

  “Sure,” she said without hesitation. “I had the special—grilled mahi-mahi. But I’ve had that before, and I’ve always been fine. Why? Could that have caused this?”

  “Maybe,” I told her. “Do you remember how it tasted? Was there something different about it?”

  “No, not different,” she answered, putting her index finger on the side of her face, thinking hard. “It was blackened this time, and pretty spicy. But not different.”

  That was it. I had been down this path myself once. Some blackened tuna from one of the local restaurants had done me in. The peppery flavor should have tipped me off, but I had been hungry and in a hurry, and had eaten the whole serving. Within twenty minutes, I was lighting up like a Christmas tree.

  It’s called scombroid poisoning, and it happens often enough that not only had I had it myself, but I had seen several cases of it in the ER. It’s caused by a bacterium that forms a toxin on improperly prepared and stored fish. The toxin resembles histamine, thus the allergic-type reaction we see. The extent of the reaction and flushing is dose-dependent, and by the looks of Dakota, she had gotten a pretty good dose. Just like me.

  “We’re going to give you some Benadryl,” I told her. “And if it’s what I think it is, you should be a lot better in fifteen or twenty minutes.”

  Jeff walked out of room 5, having given Dakota her injection of Benadryl fifteen minutes earlier.

  “She’s doing great, Doc,” he said, walking over to where I stood. “Almost back to normal and ready to go home.”

  I had explained the poisoning to Jeff and Susan and told them the young college student should do fine, with no further problems. I was about to tell them about my personal experience with this, when I suddenly remembered the rest of the story. At the time, I had looked up the condition in a medical textbook to make sure I wasn’t going to die. It sounded straightforward until I came upon a very troubling statement.

  One to two hours after the onset of symptoms, the patient will develop abdominal cramps and profuse diarrhea.

  It had been
uncanny. As I had closed the book, my stomach had begun to rumble, and then—

  “Hello, nurse?”

  It was Dakota Flanders, peering out from behind the curtain of room 5, her voice sounding strained.

  “Is there a bathroom nearby?”

  3:05 a.m.—the witching hour. We had made it to the time of night when anything might come through those ambulance doors or through triage. Clara Adams had been right the other day when she had said the patients who came to the ER in the middle of the night could be very “interesting.”

  Jeff had discharged our only remaining patient and we were sitting at the nurses’ station with Susan. The buzzer from the business office fired off, indicating there was a new patient out front.

  Having just sat down, Jeff grumbled something unintelligible, pushed back his chair, got up, and ambled out to triage.

  A few minutes later, the door to triage opened and he walked back into the department leading Lucinda Banks. When I saw who it was, my heart sank.

  Lucinda was a fifty-year-old accountant, and this morning she was dressed as usual, wearing a neatly tailored business suit and high heels. Jeff rolled his eyes at me as they passed the counter and headed toward room 4. Lucinda’s eyes remained intently focused on the back of her nurse’s head.

  Lucinda Banks would have made Baron Munchhausen proud. Of course, he should be proud of himself. After all, how many people had a “syndrome” named after them? Munchausen’s Syndrome (somebody dropped one of the H’s over the past century or so) describes those individuals who make up fantastic, exotic, and totally untrue stories about themselves. In the baron’s case, he was apparently trying to impress his friends and acquaintances with tales of daring and adventure. With those suffering from the syndrome, the intent is totally different. Their goal is to convince their health-care giver that they have a significant and sometimes life-threatening illness, their ultimate objective being admission to the hospital.

  Early in my career, I just didn’t believe this syndrome really existed. It seemed too far-fetched. These individuals were apparently willing to undergo all manner of testing, poking, and prodding—at times quite painful—just to be believed and admitted. It just didn’t make any sense to me, and I couldn’t comprehend it. I was convinced it was an illness concocted for a magazine article or a TV show—until I met Lucinda.