Miracles in the ER (26 page)

One of the views of Dirk’s chest revealed most of his neck as well. There, lying neatly between two of the vertebrae, was a four-inch pointed object aimed directly at his spinal cord. A knife blade.

“That thing must have been sitting in his neck for five years,” Jason said, looking first at me and then down at Amy. “He didn’t even know it. Whoever slashed his arm must have meant business and stabbed him in the neck—and the blade broke off. Within a couple of hours, we had him in the OR having it taken out. It must have been moving, getting closer to his spinal cord. The neurosurgeon said it was one, maybe two millimeters away. A funny movement or simple fall and that knife blade could have pithed him, paralyzed him completely. He was one lucky guy.”

“He was lucky he fell over that chair,” I said. “And he was lucky he came to the ER and saw you.”

“See, it’s like I said,” Amy pronounced, rolling back in her chair. “In the ER, you’ve got to always expect the unexpected.”

All That Glitters

Wednesday, 2:35 a.m.
In the ER, we’re always happy—thankful—for a straightforward diagnosis. Give us something simple we can deal with, something uncomplicated we can treat. It doesn’t happen very often, but when it does, it is appreciated. Sometimes that simple, uncomplicated diagnosis is made the moment a patient walks into the department, but then…it’s the ER.

“We’re headed to ENT.” Jeff Ryan was leading a young woman through triage, and the two paused at the nurses’ station for a brief instant. But it was enough.

Maylee Strait was twenty-seven years old, probably five-foot-five, and weighed at least three hundred pounds. She was wearing a light-blue bathrobe that barely met in the front and large pink curlers adorning the top of her head. An older woman appeared behind her, and I assumed it was her mother.

Maylee looked over the counter and gave me a beaming smile. Suddenly her eyes widened and her mouth dropped open. She took in a huge breath, and I reached to cover my ears. Too late.

“Aaaahhh!”

The blood-curdling scream echoed off the walls of the ER and down the hall. Every head in the department turned in Maylee’s direction. Her hands flew up in the air, covered her ears, and she started to dance. Not really dance—it was more of a gyration, a spasmodic jerking and tilting from one side to the other. She spun around a few times, almost sending Jeff flying into the far wall, and finally came to a sudden halt, staring right into my eyes.

“Help me, Mister! Help me!”

Before Jeff could reach out and steady the young woman, she had completely calmed herself. Her hands dropped to her side, she vigorously shook her head a couple of times, and that huge smile spread once again over her face.

I looked up at Jeff and nodded. “ENT. One of us will be right there.”

Jeff led Maylee down the hall but her mother lingered a moment, watching her daughter as she shuffled down the hallway and disappeared into the ear, nose, and throat room.

She stepped over to the counter, smoothed her hair, cleared her throat, and—

“Aaaahhh!”

The scream reverberated again through the department and I couldn’t help but flinch.

“What do you think’s wrong with her? You don’t seem too worried.”

Frank Dixon was sitting beside me, looking a bit puzzled. He had been working in the ER as an MD for a little over three months and was well-trained, confident, easygoing, but still a little green. This would be a good teaching moment.

“When Jeff brings the chart back, why don’t you go take a look?” I leaned back in my chair, folded my hands behind my head, and added, “Let me know what you think.”

Frank didn’t wait for the chart. He bolted from his chair and headed for ENT.

“Excuse me, Doctor.” It was Maylee’s mother. She was leaning over the countertop, hands folded in front of her on the laminated surface.

“Yes, ma’am.” I looked up at the woman, dropped my hands to my lap, and rolled forward in the chair. “We’ll have her taken care of in no time.”

“It’s not that, Doctor. I know she’ll be fine.” She looked down at her hands and shook her head. “I’m just glad this happened and I could get her to the hospital. She doesn’t like medical folks—no offense—and won’t go see Dr. Jones, our family doctor. But she’s got this problem. I’m sure you noticed—it’s her weight. She’s gained more than a hundred pounds over the past year. I can’t be sure, ’cause she won’t weigh herself anymore. But she just gets bigger and bigger, and I don’t know what to do.”

Amy Connors, our unit secretary, glanced at me and then back down at her paperwork.

“Does she have any medical problems or is she on any medication?”
This was a common problem and a common complaint, and always difficult to deal with.

“Well, I think it’s all glandular.”

Amy cleared her throat and turned a little to one side.

“Glandular,” I repeated. “Have you ever tried keeping a log of what she eats? Sometimes that’s helpful. Most of us don’t realize—”

“She eats like a bird,” Maylee’s mother interrupted. “I’ve watched her. We’ve all watched her. I’ve seen those TV shows where people sneak candy bars under their clothes. Stuff like that. But she eats like a bird.”

“Uh-huh,” I murmured, waiting for Amy to clear her throat again and hoping I would be able to maintain my composure. We had heard this story many times.

“It sounds to me like you need to get her in to see Dr. Jones. He might have some ideas about how to—”

“Robert, take a look at this!”

Frank Dixon was hurrying up the hall with a pair of forceps in his hand. He was holding it out in front of him, very much like an Olympic torchbearer. His eyes were focused on the object pinched between the teeth of the stainless-steel instrument.

Maylee’s mother spun around, and Amy looked up. Frank reached the counter and held the instrument so that all of us could see.

“It’s a…it’s a…” Frank was struggling, trying to remember his college entomology.

“It’s a candle fly,” I casually announced. “And it was in her right ear.”

“It’s a…How did you know?” Frank sputtered. “It
was
in her right ear. Jeff showed me how to flush it out, and here it is.” He raised the deceased insect a little higher.

“That should take care of it.” Jeff Ryan walked up behind Frank and laid the chart for ENT on the countertop. “You might want to take a look at this, though.” He slid the record toward me. “The vital signs.”

“That thing flushed right out.” Frank twisted the instrument in his hand, admiring his work. “As soon as I showed it to her, she—” His hand froze in midair and he looked down at me. “How did you know? She didn’t say anything about something being in her ear.”

“She didn’t have to,” Amy said, nodding. “It was the dance.”

“The dance? What dance?” Frank looked at the secretary, back over his shoulder down the hallway, and finally at me.

“The bug-in-the-ear dance,” I solemnly told him. “Usually this time of night. Can’t miss it.”

“The bug-in-the…” Frank studied the insect again and scratched his head.

I picked up Maylee’s chart and held it in front of me.

The vital signs.
That’s what Jeff had said.

Maylee Strait—27 yr old F. Bug in ear. Heart rate—46. Blood pressure—92/60. Respirations—10. Temperature—96.4.

“Are you sure about these?”

Jeff was looking at me, and he nodded his head. “I repeated them twice, but she looked okay. And she was jumpin’ all around with that bug in her ear. I thought we needed to get that taken care of first.”

“And her temperature? 96.4?”

“Took that twice too.”

“What’s the matter?” Frank Dixon turned in my direction, still holding the forceps in the air. “Did I miss something?”

“Come with me.” I was up from my chair and around the counter before he could respond.

Maylee was sitting on the stretcher in ENT, leaning back against the wall. Her eyes were closed when we entered the room and slowly opened, but only halfway. She smiled at us again and nodded. Then her eyes closed once more.

“What’s the matter?” Frank repeated from behind my right shoulder.

I held up Maylee’s clipboard and pointed to her vital signs.

“I didn’t take a close—”

“We need to move her into cardiac, Jeff,” I interrupted Frank. “Start a line with normal saline and get the lab down here stat. And get a blanket on her.”

“Got it.” Jeff leaned over, put a hand on the young woman’s shoulder, and gently shook her. “Maylee.”

Her eyes opened to mere slits again and she mustered a smile, this time more feeble.

“What’s going on?” Frank was at her side, helping Jeff get her down on the stretcher. The nurse shrugged and tilted his head in my direction.

“Let’s go talk with her mother.” I was out the door and hurrying up the hall.

Mrs. Strait was still standing at the nurses’ station. She saw her daughter
coming up the hall, lying flat on the stretcher and covered by a blanket. Her eyes widened and she clutched her purse to her chest.

She took a step toward Maylee as they wheeled her into cardiac.

I reached over and gently took hold of her elbow.

“Maylee will be fine. We need to start some things and she’ll need to come into the hospital. I think you might have been right all along.”

She looked up at me, her eyes still wide open. Her mouth was trembling. “What…do you mean?”

“If I’m right, her problem may
be
glandular, in a manner of speaking. All of these signs point to an underactive thyroid gland. Maybe one that’s not working at all.”

“Her thyroid.” Frank Dixon murmured behind me. “That explains her low temperature and heart rate—and her blood pressure.”

“That’s right.” I glanced at Frank and back to Maylee’s mother. “As well as her weight gain. How long has she been sleepy like this?”

We talked for a few minutes and it all came together. When her labs returned, the diagnosis was confirmed. Maylee was slipping dangerously close to becoming unresponsive—a coma induced by a nonfunctioning thyroid. If we hadn’t caught it and begun aggressive treatment, she would have died.

“I knew something was wrong.” Her mother shook her head, tears trailing down her cheeks. “I just couldn’t get her to go get help.”

Amy leaned over the desk and handed her some Kleenex.