Terminally Ill

by Melissa Yi

  I left the room door unlocked and almost closed but not latched. That way, no one could see inside if they made their way to the staff doctor’s room beside ours or, more likely, the conference room or mini-kitchen on the right side of the mini-hallway.

  I’d only be here for a few minutes, max, before I got paged again. It was a miracle that they’d left me alone for twenty whole minutes as it was. I stared longingly at the neatly-made single bed pushed against the left wall. I remember the first time I saw this room, I thought it was kind of small. Now I just saw the bed. With clean sheets. Inviting me to take off my shoes and lie down on it. Just for a minute.

  I felt my body leaning toward it like I was about to do a planking picture. Not good. This wasn’t my bed—it was for the resident who did the midnight to 8 a.m. shift—and I wasn’t Goldilocks. I shook myself and turned to my right to sit at the metal chair beside the bed. I rested my elbows on the desk in front of me, facing the opposite wall. I could take notes on Mr. Bérubé’s case, or I could review morphine dose equivalents for palliative care. I did not need to sleep.

  “Hope?”

  “Ryan?” I mumbled, and jerked myself awake to see Tucker’s startled face peering into my own.

  Double oops. “Sorry,” I said, right away. “I was—”

  “You were asleep,” said Tucker, but he didn’t sound too happy about it. He shoved a bun in my face. “Want one? I’m on my supper break.”

  The small, square, hard-looking bread bun didn’t appeal. “I just ate, thanks. So did you make it to morning rounds with Elvis’s team?”

  Tucker grinned at me, jaunty as usual. He didn’t seem to be carrying any grudge from our fight, or from me saying the wrong name just now. “Sure did. But that’s not the most important part. His memory’s coming back.”

  I gaped at him. No wonder Tucker was in a good mood. He could’ve solved the case already. “You mean Elvis remembers what happened?”

  “Not all of it, but bits and pieces. At first he only remembered waking up that morning and saying, ‘It’s D-Day.’ But now he remembers eating breakfast.”

  I stared at him. “You called me down to tell me that Elvis remembers breakfast?”

  “I called you down so you could admire my luscious physique, and to catch you up on the case. You want to hear it or not, Buffy?” He tore a corner off the bun and popped it in his mouth.

  “I want to hear it.”

  “Okay, then,” he mumbled around the bun. I had to wait for him to stop chewing. I checked my pager. Still silent. So far. It was just a matter of seconds before a patient fell or got chest pain or needed a laxative, though.

  Tucker swallowed. “He got up around 6 a.m. He had toast and an egg. He went for a run. He did a quick run-through, wearing his costume, with Archer and Lucia, just practicing with the chains and breaking out of the coffin.”

  “He remembers all that?”

  Tucker made a face. “He thinks he remembers the run, because a truck almost ran him over.”

  That reminded me of Dr. Laura Lee, who really did get run over. I shuddered and pushed it out of my mind. “And the, uh, dress rehearsal?”

  “Not so much. He thinks he remembers going back to the hotel after the run to get the costume, but then it gets fuzzy.”

  I couldn’t get too excited about it, but okay. “His doctors were happy about it, I guess.”

  “Yeah, definitely. He even has a psychologist, and she was, like, super stoked. I guess a lot of a patients don’t get their memories back at all.”

  “So he remembers the stunt?”

  Tucker broke open a bottle of water and shook his head. “Nope. Not yet. But we think it’s coming. His psychologist said that it’s really a good sign that his antereograde amnesia is improving.”

  “What about after the stunt?”

  Tucker grinned. “Get this. Now he remembers you from the resuscitation. He remembers you, and one of the paramedics, working on him. Pretty nifty, eh?”

  “Nifty,” I said. It explained why Elvis was originally so gung ho about seeing me, but my mind was clicking on to more important things. “I need to talk to him. Did you get anything else from his team, or from his chart?”

  “Not a whole lot. Elvis was pissed about that, too. He kept threatening to cut off his hospital ID and allergy bracelets and walk out the door.”

  “Hang on. I didn’t know he had allergies. What’s he allergic to?”

  Tucker smiled and shrugged. “Bananas.”

  “Bananas.” I frowned at him. “I’ve never heard of anyone who’s allergic to bananas.”

  “I know. He said it’s the real deal, though. His mom fed him bananas when he was four months old and ended up taking him to the hospital. Big rash head to toe.”

  “And breathing problems?”

  Tucker shrugged. “Unfortunately, he doesn’t remember being an infant.”

  “But Archer would’ve been around ten years old, because of the age difference. Does he remember?”

  “He remembers the rash, because Elvis looked so funny.”

  Hmm. I shook my head like I was trying to shake my thoughts loose. Usually, I’m not to foggy after a two-second nap, but I was obviously tired. “I’m going to ask him about it.”

  Tucker shook his head. “There’s no way he ate bananas. He remembers breakfast. And you don’t accidentally eat a banana.”

  “I know that.” Bananas have a giveaway smell and texture. Someone would really have to be plotting against him to spike his coffee with a banana, but if I was going to take on this case, I couldn’t discount anything.

  Now that I thought about it, the red marks on Elvis’s neck when we pulled him out of the river might have been urticaria, an allergic rash. It was hard to tell, what with him being dead and all, but once his circulation had restarted, the rash might have gotten more obvious. We hadn’t given him Epinephrine because his pulse had come back with oxygen, but…wait a minute. They gave him Epi in the ambulance because of his wheezing.

  Epinephrine constricts the peripheral blood vessels, forcing circulation into the head and neck, which is why we use it when patients have no blood pressure, but it also opens up the airways, which is useful when an allergic patient can’t breathe. I was reaching with the anaphylaxis angle, but I’d have to check his records and maybe chat with the emerg docs and paramedics.

  Tucker shook his head. “Why are you so interested in bananas? I think they’re a red herring.” He laughed, I guess because a banana doesn’t look much like a fish.

  I didn’t laugh back. “Listen. I know this sounds nuts. But that’s what I do.” Everyone else is like, One plus one makes two, and I’m like, What if we were using a binary system instead of base ten math? “Anyway, I’ll start asking questions tomorrow, post-call. Thanks for the update. I’ll keep you posted.” I stood up and pushed the chair back against the desk before I wove around Tucker, heading for the door.

  That got his attention. “You’re not going to see Elvis without me.”

  “Sure I am. If I can get some sleep, I can investigate post-call while you’re still at your clinic.”

  “No way. I’m the primary on this case.”

  “Says who, Scooby?” That just slipped out of my mouth, but now we’d squared off, glaring at each other.

  He stood close enough to me that I could feel the waves of heat coming off his body. “You didn’t want to risk your life. Remember?”

  I nodded. “And so far, I haven’t. I’m going to the University College, which we’ve agreed is safe—I’ll be doing my trauma rotation there during my emerg year for a whole month. It’s not like I need a bodyguard every time I go to a hospital. Otherwise, I’d never get anything done.”

  “Yeah, but you’re a crap magnet. You could use a bodyguard anytime, but it’s mandatory when you’re on a case.”

  I blinked at him. First of all, I’ve never heard anyone say “crap magnet.” I’m sure it’s normal in, say, a church, but where I come from, we swear loudly and free
ly. Secondly…“Hello. I told you. I’ve been on a case all afternoon with my palliative patient. I’m still alive and kicking. Exhibit A.” I spread my arms.

  It was kind of entertaining how his eyes bugged out before he got his smooth operator mojo back on. “Hope. No way. You need to—”

  My pager went off. I checked it and sighed. “It’s the floor.”

  “Hope—”

  I reached past him to punch the extension into the phone on the desk. “Hi, this is Dr. Sze, the internal medicine resident.”

  “The patient in 5212 is satting at 89 percent and has crackles at both lung bases. She also has pitting edema in both legs.”

  “Uh oh. Is she known for CHF?” It sounded like pretty classic congestive heart failure.

  “They stopped her Lasix in the emergency room because her blood pressure was low. She’s usually on 40 mg BID.”

  Darn it. “Okay. If you do an EKG and a trop and give her 80 mg of Lasix IV and 160 mg of aspirin, I’ll come and check on her as soon as I can.”

  “Thank you.”

  Tucker said, “We’re not done here.”

  “Yeah, but my patient’s just about done upstairs. I’ll talk to you post-call. Toodles.” I blew him a kiss and opened the door, careful not to brush his body with my own. Even so, my heart thumped in my throat while his laser eyes bored into my back.

  Chapter 24

  Around midnight, I ran into my internal medicine senior resident, Omar, waiting for the elevator. “Sixth floor?” he said, which is the floor where we get to sleep in our call rooms, should we be so lucky.

  I nodded and joined him in waiting for our doddering elevator. I usually take the stairs, but this felt like an elevator night. I had to conserve my energy. I shoved my hands in my lab coat pocket and accidentally found the syringe the nurse had given me in case I decided to do an arterial blood gas on the CHF patient. I try not to do those, partly because lots of doctors say ABG’s are outmoded and painful, and partly because I suck at them. Jabbing a patient’s wrist twenty times with a needle is not my idea of fun.

  My pager went off. I grabbed the hallway phone to answer it. The nurse said, “We have a patient who fell in 8334, but I’m calling about Mr. Shuttercock, a man in 8234B with chest pain.”

  “Okay, do an EKG and a trop now, repeat it in eight hours, and I’ll be there. You can give him 160 mg of ASA to chew if he’s not allergic.” I always call it an EKG, after electrokardiogram, the German version, because that’s what the Dubin textbook suggested in medical school.

  She paused. “You have to do the ECG.”

  “Excuse me?”

  “You have to do the electrocardiogram. We don’t do them.”

  I’d never heard of nurses who didn’t know how to do electrocardiograms. “You’re a nurse?”

  “Yes, but on the eighth floor, the resident or medical student does them, not the nurses.”

  “Oh, okay. I’ll be there as soon as possible.” I hung up and turned to Omar, who had politely let the elevator go by, in case I needed advice. He pressed the up button again while I said, “Have you heard of this? On the eighth floor, they don’t do EKG’s.”

  He nodded. “The nurses don’t know how.”

  Colour me confused. “They do them all the time here.” I gestured at the 5 South ward.

  He shook his head. “Not on the eighth floor.”

  I was starting to get a bad vibe about the eighth floor, but when the elevator made its way back to us, I pressed the button number eight.

  The nurse had already placed the EKG machine outside Mr. Shuttercock’s two-person room, waiting for me. It wasn’t that big a deal to do an EKG: put the stickers on the patient’s chest, attach the electrodes, boom. But since Mr. Shuttercock was in isolation, I had to don the yellow gown, mask, and gloves and worry that even with disinfection pre- and post-visit, my stethoscope would now transmit MRSA throughout the hospital.

  While I wrote a note in Mr. Shuttercock’s chart, an unsmiling nurse informed me, “We have a woman who says her leg hurts, too.”

  “Really,” I said. This was why I always tried to escape as soon as possible. If you showed your face, the work kept piling up. My friend Richard took the opposite approach and stayed on the ward in between calls to play his cello for everyone, which I admired tremendously, but I always needed to do other stuff when I was on call. Like go to the bathroom or, someday, sleep.

  “Yes. In 8666C.”

  I almost laughed. The number of the beast.

  “You still have to see Mrs. Webster, the woman who fell, in 8334A,” the other, cheery nurse called from the hallway.

  Damn it. I’d already forgotten her. “Okay, first the fall, then the sore leg,” I said.

  I checked on Mrs. Webster, who said she’d slipped on the way to the bathroom, even with her daughter helping her. Her daughter was long gone, but on the incident report, it said that Mrs. Walker refused to use her walker. A quick flip through her chart showed that she was always falling. She wasn’t sore anywhere except her “bottom,” which seemed okay when I pressed on it, but I listened to her heart and lungs and checked her pupils and everything before I gave her the okay.

  I wrote a quick note and signed the incident report, then headed to lady with knee pain. Maybe room 8666 had cursed her.

  She was an elderly, dark-skinned Asian woman who couldn’t really speak. I felt guilty, wondering if she’d understand if I’d ever managed to learn Cantonese. “Where are you hurting? When did it start?” in English and French elicited nothing. I didn’t want to speak too loudly because she had three other roommates, all presumably sleeping behind their drawn curtains.

  She grunted and leaned over her right leg, so I pushed up her gown and felt her leg.

  Her leg, below her knee, was stone cold.

  I paused. We’d only ever learned about arterial blockages in surgery. As you can imagine, if your artery stops carrying blood to your leg, it hurts like hell (“pain out of proportion”) with pins and needles (paraesthesias). The limb is pale and pulseless. Later on, you get paralysis and poikothermia (a fancy word for cold, just to make the 6 P’s easier to remember).

  I felt for the pulse behind the medial malleolus, the ankle bone that makes up the inside of the joint.

  Nothing.

  I felt for the dorsalis pedis, the pulse on the top side of the foot.

  Nothing.

  “Ma’am,” I said, with a sense of foreboding, “can you move your foot for me?”

  She groaned and shifted her right hip.

  “No, I mean, below the knee.” I touched her cold foot. “Can you move this?” I stood on my left foot and slowly plantarflexed and dorsiflexed my right foot in the air, which means pointing the toe and heel, so she’d get the idea.

  She moaned again and held her leg.

  Because of the language barrier, I wasn’t 100 percent sure if she understood me. But I knew what my gut said: her right lower limb was dead.

  This was a surgical emergency.

  I called locating. “Can you page surgery for me, stat?”

  “Okay,” said a man.

  I hung up still feeling uneasy. At night, the security guards double as operators, which makes paging even more of a roulette wheel. I walked back to the nursing station. “How long has Mrs. Tong’s leg been like this?”

  “She’s been complaining since I got here at 11. I gave her Tylenol, but it didn’t help.”

  That wasn’t too helpful. I started paging through her chart. She’d been here for months, which meant pages and pages of crab-like handwriting to decipher. I found one listing of right knee pain a month ago. The geriatrician had concluded it was osteoarthritis at the time. Hard to know if that was related or not. He didn’t mention checking her pulse, but I assumed he would have noticed if her leg had been cold and she’d been unable to move it.

  So probably this was an acute problem, a blood clot that had blocked the artery, rather than a chronic problem. You usually see the latter in smokers who end
up slowly blocking off the arteries in their legs, like a tunnel that’s getting narrower and narrower over time. But for Mrs. Tong, more likely, a clot blocked off the entire tunnel at once.

  I could write a Wikipedia entry about it, but it wasn’t helping Mrs. Tong. I called locating and asked him to page surgery again. “Are they in the OR?”

  “I don’t know,” he said.

  Geez. I hung up and remembered something else. I had a senior. I didn’t have to do this all by myself. I paged Omar directly.

  “Hello.” He sounded like he’d already managed to get to sleep.

  “Hi, Omar. Sorry to bother you, but I think a patient on the eighth floor has an arterial embolism in her leg. It’s cold, pulseless and probably paralyzed.”

  “What was that?” He sounded much more awake now.

  I repeated it. “I think she must have a blood clot in her leg. Everything below the knee is dead.”

  “Did you do a Doppler?”

  “No.” I felt a twinge. My first instinct was to call for help. But isn’t that what you do in an emergency? “I’ve been trying to page surgery, and then you. But I’ll ask them for a Doppler.” I glanced around the empty nursing station. I saw the lights on in a room down the hall, on the opposite side of the nursing station. Presumably they were busy with something else.

  “I’m coming down. Which room is it?”

  I told him. Now 8666 didn’t seem so funny.

  Omar showed up seven minutes later, which was before the nurses did. I ended up walking down the corridor and asking if they had a Doppler machine. They didn’t, but the smiley nurse would try and get me one after she helped an old man back in bed. “Don’t you have an app on that fancy phone of yours?” she asked, gesturing at me.

  “I wish,” I said, with feeling. I’ve seen EKG apps, but a Doppler app was a good idea. If I knew how to program at all, I’d consider it. Of course, I’d have to upgrade my POS phone first.

  I rejoined Omar in room 8666 and said, “They’re looking for a Doppler machine. When they have a minute. But we could probably call 5 South and ask them.” I was starting to clue in that 5 South was the active medical ward and the eighth floor was…not.