“Perfect. Go get one and let’s do this.”
As Eugene and his friend run to get the truck, Jex surveys the scene, hopeful to find the lost limb, though she thought to herself that the likelihood of successful reattachment was low, but never give up hope. The morbid search is in vain though, and by the time Eugene has returned with the surfboard, she has given up. Eugene and his friend move Marcus clumsily to a surfboard. and they begin to move, Eugene walking backwards and Jex guiding them through the busy crowd. Within two minutes, they have Marcus to the truck and they gently lay him in the truck bed. Jex and Molly jump in the back. Molly just curls up. Jex holds the surfboard steady.
The trip to the hospital is bumpier than Jex would like but it is quick. They pull into emergency as an ambulance pulls away. Two nurses are standing there and quickly run to the truck. Jex jumps out to greet them. One of them looks over the side and into the truck bed and looks at Jex. “Severed limb. Did you preserve it?”
“No,” Jex says softly. “We couldn’t find it.”
The nurse shakes his head. “OK, we’ll get him checked out and into the ER as soon as we can. There’s a long line.”
“Wait,” Jex says. “There’s more than just the leg to worry about. He needs an ER immediately. Right now. If it’s not already too late.”
The nurse turns to Jex in irritated resignation. “What more is there?”
[What is the emergency issue that Jex identified in Marcus? Will the young injured drummer be OK, or is it too late to help him? Turn to Ana Gnorisis Diagnosis to read Jex’s diagnosis and the conclusion of the story.]
Diagnoses
Free-styling
“Betsy,” Jex says firmly. “I don’t think there’s really much doubt about it. Ben has bacterial meningitis.”
Betsy turns pale, seems weaker than before, maybe about to fall over. “Oh, holy shit. What does that mean?”
Jex puts her hand up. “It’s OK – it’s only been about twelve hours, I think you said, since he began to show symptoms. There’s time. He’s going to be fine. But, right now, for sure, we have to get Ben to a hospital to diagnose it and start treatment if I’m right. They need …”
“Oh, man, I just can’t do hospitals. Q, I thought you said your friend could fix Ben?”
Jex interjects. “I definitely do not have the ability to fix Ben. He needs a doctor; a real doctor. And a hospital and all its resources. I …”
“See, Q, why do I even want to listen to some punk kid about this? Look at that ratty sweatshirt, and you know what, she stinks. I can’t be going to a hospital right now. With all respect, I am not taking this kid’s advice,” Betsy continues nervously. “I am sure it’s just a cold or flu or what have you.”
Q protests. “No, Betsy, you’re wrong. Come on, don’t be like that. Jex is the real deal, I’m telling you, if she says you should be going to a hospital, I think …”
“Betsy, listen to me,” Jex says firmly.“There is only one thing to do here. And that one thing is to bring Ben to a hospital immediately.” Her tone leaves no doubt to consider. “There is no other choice.”
Loudly, but with an assurance that seems slightly diminished, Betsy rebuts. “There is a choice. There is always a choice. I am his mama and I am the one who gets to choose what’s good for him and what’s not.”
Jex does not back down, knowing there is no time for a delicate bedside manner. “You may be the one who chooses who makes the decisions for him, but you don’t get to choose what’s good for him. What’s good for him is treating his meningitis. There is no doubt about that. It will save his life. The layers of his brain have become inflamed by a bacteria and if he doesn’t get antibiotic treatment, things are guaranteed to get much worse – and fast.”
Q butts in, having watched the exchange with growing despair. “We could call child protection. I bet they would demand Ben be taken . . ”
Jex interrupts her before Betsy can. “I am not calling child protection on anyone. Period, Betsy. Period.”
Q looks startled but shuts her mouth. Jex continues, looking directly into Betsy’s eyes, whose emotions Jex reads as a roller coaster of anger, fear, confusion and helplessness.
“Betsy, no one is calling child protection. The decision is yours. You’re his mama. But as his mama, please, please just listen to me for three minutes. Literally three minutes.”
Betsy squints her eyes in doubt and cynicism, but there is fear behind those eyes, too, and she mutters quietly. “What you got to say?”
Jex doesn’t hesitate. “There are pretty straightforward symptoms of bacterial meningitis. Fever, sluggishness, lots of crying – those are some of them, but those could be a thousand things.”
“That’s right,” Betsy agrees, a bit more stridently. “A thousand things.”
Jex nods her head in agreement. “But Ben has more symptoms from that. He’s crying mostly when you hold him, or anyone even touches him. I tried. And he stops crying when you stop holding or stop touching him.”
Betsy winces at the thought, but it is obvious in her eyes that she knows this is true. Jex continues.
“That is what the doctors call paradoxical pain. That’s not so common, not like the other symptoms. But it is common in babies with bacterial meningitis.”
“That’s it?” Betsy whispers. “That’s why you think he has this. Because he won’t let me pick him up? What do you know? Babies go through their fits sometimes. You’re just a kid. That’s all you have?”
Without hesitating, Jex pulls from her backpack a tattered paperback book, littered with dog ears and folded over post-it notes, marking page after page in the book.
Jex flips immediately to a page in the book she seems to know from memory. “This is the Oxford Handbook of Clinical Medicine. It is in every doctor’s bag out there and it sets out the symptoms very clearly. You can look if you want,” Jex declares, waving the book around like a piece of evidence in a trial. “He has an aversion to light. The light hurts his eyes. That’s called photophobia and it is a key symptom of meningitis,” Jex declares, pointing at the dirty and tattered pages of the paperback. “And remember the fontanel I described. The soft spot on his head?”
“Yeah.”
“It’s bulging out. It’s swelling. That’s because the layers of his brain are inflamed. Like I said.”
Betsy’s eyes pop out. “His brain is inflamed? Bullshit.”
“No, it’s not bullshit. It happens in adults, too, with meningitis, but you can see it easier in babies because the four plates of their skull haven’t fully connected yet. See? There? It is clear as day. I am tracing it with my finger. See? You can see it with your own eyes. Just look. You can’t tell me he was like that two days ago.”
Betsy doesn’t look at Ben and she doesn’t look at Jex. She looks down at her own two feet and shakes her head slowly, barely, from side to side.
Jex is relentless. “And that seizure, the one you say you barely noticed. I hate to be the bearer of bad news, but those are just going to get worse. And fast. Like, anytime. Minutes, a couple of hours. Not more. Fever, sluggishness, crying, paradoxical pain, photophobia, a bulging of the brain, seizures. That is textbook bacterial meningitis and it needs to be treated right now. If we take Ben to a hospital, they can give him general antibiotics and it will begin to destroy the bacteria right away. Right away. They will take a quick culture and in two days they will know the precise antibiotic to switch to that is designed to destroy the specific bacteria that is causing this. He will be fine but he needs antibiotics right now. Right now.”
Jex pauses and both she and Q study Betsy carefully. She is just shaking her head from side to side. Tears drip from her eyes and her fists are clenched. “I can’t go to a hospital,” she says, barely audible. “I can’t.”
Q walks up to Betsy. Betsy grabs onto her and nearly collapses in her arms. “I can’t go the hospital, Boo. I just can’t.”
“Yes, you can, girl. You are strong and Ben needs you to do this.”
/>
“Q…”
“You can do this, Betsy. You can…”
“Q …”
“Betsy, you can…”
“Q, I’m on probation and I’m not clean, OK? If I go … If I go to a hospital, they are gonna make me pee and I am not clean. My PO is a son-of-a-bitch and he will lock me up and take Ben away. I can’t go to a hospital. I can’t let that happen. I am sorry. I am so, so sorry.”
Betsy collapses onto the couch and digs her head into the pillows, the force of her own revelation knocking her off her feet. “I am sorry,” she repeats, crying softly. Q sits next to her, holds her leg tightly. “No, Boo, no,” is all she can say.
Q looks over at Jex, desperate for answers. She is surprised to see Jex texting away furiously on her iPhone. “Jex, what you doing? We gotta help Betsy. This is some urgent shit. Get your nose out of your phone.”
Jex does not avert her eyes from the glowing screen, her brow furrowed in concentration. “Hold, please,” is all she says. Jex seems to be doing all kinds of finger acrobats on her phone, her face flush with light in the otherwise dark apartment. She does not seem to notice Q or Betsy at all, who are still collapsed on the couch, Q stroking Betsy’s leg as Betsy gazes out into nothingness, biting her fingernail and, here and there, shaking her head side to side in disbelief; but otherwise still.
A ping from Jex’s phone fills the silence and Jex’s eyes scan it quickly. She does not smile but her eyes fill with triumphant satisfaction. She does not hesitate, walking with purpose to the couch where both Betsy and Q have turned their unflinching attention to Jex. Jex squats down next to the two and looks Betsy straight in the eye.
“Betsy, I know you don’t trust me but this is what I have to say. I just texted Dr. Stevens at County – you know, the hospital Chief Medical Officer I talked about earlier. She is a friend of mine. Dr. Stevens confirmed to me what I already knew: they are not going to pee test you or blood test you or anything test you – and they are not going to call your probation officer. You are safe at the hospital. It is a safe zone for you. I don’t know what to say to you to make you trust me, but it’s true.”
Betsy doesn’t respond but she stops shaking her head side-to-side. Her eyebrows curl up and it looks like she might cry again.
“Listen, Betsy. I know you’re scared. I know you’re confused. But Ben is not going to get better without treatment. He is going to get much, much worse. And treatment is just a couple of miles away. My car is outside and it fits a baby seat really easily. Dr. Stevens is expecting you, and no, I haven’t told her your name yet, I wouldn’t do that without you OKing it. But she is expecting you and I can drop you off at the hospital.”
Q chimes in. “Boo, come on now. If you don’t trust Jex, trust me. I know Jex and she has never done me wrong. If she says Ben has to go to the hospital, Ben’s gotta go. You know it’s right. You know it’s right.”
There is a long silence. Q opens her mouth, but Jex touches her on the shoulder and nods to her to give Betsy some time. The tension in the air is palpable. Another moment passes, and Jex is the one to break the silence this time.
“Betsy …”
Before she could continue, Betsy stops her. “Let’s go, OK, let’s go.”
Q puts her hand around Betsy’s arm. “Betsy, that’s the right cho. . .”
Betsy cuts her off, standing up quickly. ”OK, I said OK. Let’s go. Let’s go.” Q turns to Jex for direction and Jex is already heading towards the front door.
“Grab his baby seat. My car is out front. I will have the engine running and ready to go. Let’s go.” And just like that, she is out the door, as Q and Betsy scramble to collect Ben and his things. In a moment, they are off.
* * *
It is two hours later. Jex sits in her beat-up Ford Focus outside downtown County hospital and thumbs through her well-worn copy of the clinical medicine handbook. She has read it cover to cover a hundred times over; replicated every drawing in her sketchbook, memorizing every word. Its pages are barely legible under the dim glow of the streetlight. Dawn and its light is still some time away. She thumbs the cover and reads and re-reads the section on meningitis.
Ben is not the first case she had ever seen, but it was as close in physical proximity as she had ever been. She rubs her fingers together and recalls the shape and size of Ben’s fontanel, the soft-spot, closing her eyes and going through the texture and the curves, ensuring it is burnt into her memory. She remembers Betsy’s words; and her eyes; and her tears. The heat on Ben’s forehead; the piercing of his crying. With every thought, Jex yearns to learn more; to do more; to be more. Graffiti is awesome, and punk rock, too, she thinks to herself. But science and medicine. Man, Jex loves science and medicine. Since she could talk, she was learning about science and medicine. She loses herself in the words of the book, her dreams slipping in and out of each letter.
The sudden knock on the passenger window startles Jex. She looks up quickly and sees Dr. Stevens looking down expectantly. The two exchange smiles, and then there is a short, rather uncomfortable silence as the two look at one another. After a moment, Dr. Stevens points at the lock of the car door. Jex smacks her head with her hand and immediately unlocks the door. Dr. Stevens opens the door and gets in. “Sorry, Doc, I was distracted and didn’t think about the door being locked.”
“No worries, Jex. How’s it going?”
“Yeah, it’s going OK, you know. Not up to much.”
“Seems like you were up to quite a bit with Ben, no?”
Jex just shrugs. “I didn’t do anything. I happened to know some symptoms and told his mother about it. Q really was the one who talked her into going to the hospital.”
“Not surprised you knew the symptoms, with all you read in that book,” Dr. Stevens says with a sly smile. “You know that book better than I do.”
Jex smiles. “Well, that is sure not true, but those symptoms are pretty simple, so I felt pretty confident. I’m right, aren’t I? It’s bacterial meningitis, right?”
“We did the initial culture and its gram positive diplococci. Blue as can be. So, yes, it’s bacterial meningitis. Probably streptococcus pneumoniae, though we have to get the culture back from the cerebral spinal fluid to know for sure. We’ve already started an intravenous broad spectrum general regimen of antibiotics.” She pauses and then continues. “And, again, as you surely know,” Dr. Stevens continued with a wink, “we’ll decide on a specific set of antibiotics once we have identified the specific bacteria after the culture comes back from the lumbar puncture.”
Jex thinks for a moment. “Yeah, heh-heh, I didn’t mention the lumbar puncture to Betsy when we were talking about coming to the hospital.”
Dr. Stevens laughs. “So I learned. Probably a smart idea, but Betsy was none too happy to hear about it.”
“Yeah, not looking forward to the drive home. I am sure I will catch hell from Betsy for leaving out telling her about the excruciatingly painful shot that was needed to get a culture.”
“Oh, well, you might get a little bit of a respite from that, Jex. I came out to tell you. We are going to have to keep the baby here for a bit, and one of Betsy’s roommates has agreed to pick her and Q up when we’re done. So, you’re free. And for the record, I think Betsy is pretty grateful to you for what you’ve done. And Ben surely is, too.”
Jex just shrugs. “It was nothing. I wish I could do more.”
“Someday, Jex, someday soon.”
She shrugs again. “I don’t know. We’ll see, I guess.”
Dr. Stephens pauses before continuing. “How about you come in and get some food? The café is open. A full, proper meal on me.”
Jex scrunches up her face and declines as politely as she can. “That food is grisly. I’d rather eat socks… .oh, but thank you for the invitation. I really do appreciate it.”
Dr. Stephens smiles that smile she saves mostly for Jex. “No worries, Jex. I hope you get some rest. It must have been a long night.”
Jex sha
kes her head. “Naw, I’m not tired. There’s a sunrise yoga class near Venice Pier. I think I’ll check that out. Oh, and there’s a food truck there that has vegan burritos. I’ll eat then.”
“Are you sure, Jex?” Dr. Stephens protests. “Come on in, and relax for a bit before going out again.”
“Thanks, Doc, but a yoga class on the beach seems about as relaxing a thing I could hope for. The hippies are annoying but I’m pretty good at ignoring them.” She winks. “I’ll sleep when I’m dead. Besides,” Jex continues, gesturing out into the Los Angeles horizon. “The sun is already starting to rise. Early morning is my favorite time here. It’s so quiet . . . calm.”
“Fair enough, Jex. Fair enough. Well, I won’t keep you,” she finishes up, rubbing Jex’s arm before reaching for the door handle. “Thanks again for stepping up for Ben. I don’t like to think what would have happened if you didn’t get him here.”
Jex shrugs a final time. “Anyways, it was nice seeing you. I’m sure you will see me soon – I can’t stay away from the hospital.”
“You’re always welcome, Jex, and whenever you want to talk about your next steps, just let me know how I can help. I don’t mean to be a cliché or a broken record, but you have gifts, Jex. There’s a next step for you out there, Jex. Do what you want to do, but don’t forget to take the next step.”
Jex smiles and says only, “Right now, I’m just free-styling.” A pause. “Anyways, it was good seeing you.” Dr. Stephens nods and smiles. After a moment, she gets out of the car and steps to the curb. “It was good seeing you, too, Jex.”
Jex turns on the car and pulls away. Dr. Stephens waves and smiles again as she sees the bumper sticker-ridden 2001 red Ford Focus pull away, battered and broken but plugging away strong as a heart. She shakes her head affectionately and watches as Jex drives down the road, away from her.
Jex doesn’t look back in the rear-view mirror as the sun begins to rise around her. She plugs her iPhone into the cassette adapter and switches to her favorite playlist. “In the Aeroplane Over the Sea” by Neutral Milk Hotel has been rattling around her head all night. As the sun rises and she vanishes westward into the empty L.A. streets, the song rings through her joyfully, echoing through the car window and into the crispy air, like freedom. She smiles to herself, and sings along, out of tune and for no one else to hear.
Jex Blackwell Saves the World Page 14
