Silent Fear, a Medical Mystery (8 page)

“I hope that turns out okay. Last night I talked to Dr. Talbot. She’s headachy, crampy and not eating well, and sounded lethargic. She did see a doctor the other day. Despite a z-pack and aspirin for a fever, she’s not shaking it. I told her she needs to get in here today if she’s not getting better. Have one of our hospital staff or the ER take a look at her.”

“She’s a tiny, healthy thing, and young. I can’t imagine her being ill.” Danny furrowed his brow. “Actually, Dr. Patogue said earlier that two of our OR staff are going to be seen soon, too.”

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As Casey stood under the hospital overhang outside the ER, he waved to Mark to back the ambulance further in so the back doors would stay dry when opened. Their three-to-eleven shift had started with a thunderstorm. Mark got out and darted to the curb next to Casey.

They opened the rear end and climbed in to run through their check list of supplies, oxygen, and housekeeping. Casey smiled his appreciation for the spotless, equipped vehicle. He took pride in their roving work place, and even cleaned and disinfected the small rubber floor mat practically next to the bumper.

“Lousy Saturday we have,” Mark commented.

Casey counted the IV fluid bags on one of the shelves. “I don’t mind it. Thunderstorms are smart precipitation. They take care of themselves.”

Mark registered a quizzical expression as he opened new emesis basins.

“You don’t have to scrape it off the driveway.” Casey said, and then jotted down his inventory on a sheet.

“But we don’t get enough snow or ice anyway,” Mark countered.

“Nevertheless,” Casey said, “it doesn’t damage vehicles like hail pellets either, which can grow to golf balls.”

“What about lightning?”

“That’s separate, like wind. Those aren’t precipitation.”

“You’ve got this all figured out. You should’ve been a weatherman.”

“No way. I can’t separate who I am from what I do. They’re one and the same.”

The automatic doors to the ER opened and a young brunette with a loud purple scrub top came straight to their ambulance. She pushed her long silky hair off her shoulders. “Hi, you all,” she said, smiling at Casey. “Did you just get here?”

“Pretty much,” Casey said. “We’re three-to-eleven.”

“I would be telling you the beds are full and we’re on diversion, but the hospital had two early afternoon discharges, so there are two beds available. The desk just got two calls. You better come in. The other ambulance drivers are picking up the slip for the first one as we speak.”

“Okay, we’re coming,” Mark said.

Casey’s eyes flickered with enthusiasm when he stepped onto the pavement. The young lady hesitated as her face blushed. She was so close to the paramedic heartthrob.

“Go ahead,” Casey said. “I’ll wait for the better half of my working relationship.” He winked at her and she left.

Mark stepped down. “What did you do, encourage her by winking like that?”

“Heck, Mark. What do you mean ‘encourage her’?”

“Even if they know you’re not available, they could care less. They’re going to try and lure you in anyway.”

“You make me sound like red snapper on the end of a line.” Casey shrugged his shoulders then hurried inside with Mark at his heels. Two ambulance workers passed heading out as Casey and Mark greeted them. Casey waited for the ER desk secretary to give them the information.

“You just missed going on a run for an anesthesiologist who works here,” the husky voiced woman said. “A Dr. Talbot,” she mumbled. “Looks like you’re going a few miles south to the mall. Man with chest pain.” She handed them her note.

Casey ran his hand over his crew cut and the both of them turned on their heels.

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Danny’s cases extended into the afternoon and he still hadn’t seen everyone on the floor. At least his back patient finally stabilized with Dean’s supportive care, especially in the recovery room. Finally, the call Danny anticipated came through. Dr. Patogue had the MRI and waited for Danny in the X-ray department. He bounded down the stairs to the first floor and cut through the emergency room. He hurried faster upon seeing Casey and his partner going down the hallway towards the back door.

“Are you two on an ambulance run?” Danny asked as he sidled alongside them.

“Danny, it’s not the time for ambulance wisecracks.” Casey kept heading straight. “We’ve got a guy with chest pain.”

“I’ve only got a minute myself. I’ll follow you to the back.”

“Actually, there are two runs.” Automatic doors opened as they neared. Casey pointed to the ambulance backing out. “They’re going for a staff doc.”

Danny put his hand on Casey’s upper arm. They didn’t slow but Casey’s eyes caught Danny’s concern.

“Is it Lucy Talbot?”

“Sure is.”

Mark headed to the driver’s seat and Casey opened the back as the skies rumbled above.

“Casey, I have a sneaky suspicion that something is going on because we have a rash of sickness.”

“That’s not so odd.”

“No, this is different. I’m glad to know you’re picking up the patient other than Dr. Talbot.”

“Danny, I’d pick up anybody who needs me.”

“I know that. That’s your job. However…look, I’m not being an alarmist. You know me better than anybody. I’m going to go look at Harold’s MRI with Bill Patogue. But right now, my instinct is alert and this is just between you and me.”

“Okay, Danny.” Casey slammed the doors shut while a bolt of lightning peeled across the skies and Danny rushed inside.

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Danny could tell the radiology department napped on weekends when he walked through the front room. Although they took films and advanced imaging for trauma and more emergent requests, a skeleton crew and one radiologist manned the place. Danny spotted Bill and the radiologist, John, in the first dimly lit room and walked in.

“Danny,” Bill said. “John was nice enough to walk me through this, especially with my limited expertise with head imaging.”

The MRI films went from left to right on the viewing boxes and slices went from top to bottom. Danny methodically examined the images starting with the outside – the skull. The meninges was the layer closest to the skull, the membranes between the skull and brain. Danny knew it consisted of three layers called the dura, arachnoid, and pia mater, but on film it wouldn’t be like they were huge delineated layers.

Danny shuddered. These were Harold’s images - someone he shared his practice and specialty with, someone who often looked up to him for advice, someone who knew the sweat and tears it took to earn a neurosurgery degree. He wished he saw differently. Harold’s meninges on his MRI were inflamed, suspicious for meningitis.

John tapped his finger right where Danny stared. “Significant inflammation,” he said, “but also look at these high signals in the temporal lobes.”

The men took a step to the right as Danny leaned forward, also scrutinizing the hippocampus and frontal lobes. He glanced at Bill, who swiped the back of his hand along his forehead.

The double whammy hit Danny just as Bill piped in. “Inflammation of the brain, too,” Bill said, taking his bow tie off and shoving it into his pocket.

“Encephalitis,” John said.

“Worse than that,” Danny said, “meningoencephalitis.”

Chapter 7

Danny tried to leave the radiology department quicker than he got there, but Bill lagged. He waved for Bill to follow him into the staircase, but Bill took a deep breath and hit the elevator button.

“We have to talk and make a plan,” Danny said, “but first I’m going to go do a stat spinal tap on Harold. It’ll give us more information. Although we should call in a neurologist as well, we don’t have time to wait for them to do it.”

“I agree, and James, the scrub nurse from this morning put on the vent, is in a coma.”

Both men stepped into the elevator and Bill leaned against the wall.

“Are you all right?” Danny asked.

“I’m feeling hot and sweaty, but never mind about me. I’ll go get whatever lab results are back on Dotty.”

“Why don’t we meet in the doctor’s lounge at about six o’clock?” Danny suggested. “And after the spinal tap, I better go track down Lucy Talbot.”

“Lucy Talbot?”

“Yes, an anesthesiologist who’s fallen prey to something, too.”

Bill got off on the third floor and Danny continued on to the ICU. He weaved past a group of family members in deep discussion about a loved one’s care which sidetracked his thoughts. He went into intensive care with only his ex-wife on his mind. He’d get his procedure done but he gave himself the liberty of thinking only of her.

Danny grinned as he visualized Sara’s habit of talking with her hands. His eyes twinkled as he thought about her peppered blonde hair dramatically stopping in the middle of her cheeks and her subtle smell of orange-ginger. But her mind was as powerful as her looks; and her wisdom and strength underscored the loving quality she possessed for everyone and everything. That is, unless she was betrayed, but Danny still hoped to gain her forgiveness.

Harold’s nurse was in his cubicle so Danny went straight in, thoughts of Sara ebbing away. He looked at the nurse’s badge. “Marsha,” he said. “I’ll need your help straight away, if that’s possible.”

She turned down the volume of the overhead monitor. “Sure, Dr. Tilson.”

“I’m going to write some orders, hopefully get the neurologist, Timothy Paltrow, to consult on Dr. Harold Jackowitz. In the meantime, please get me a spinal tap tray and gloves. Get respiratory therapy, too, so we have an extra pair of hands for positioning him on his side and watching his endotracheal tube and ventilator connections.”

Marsha almost made it to the door when Danny added, “In addition, I’d like you to put a sign on the door for infection precautions. Please have someone roll the shelf underneath it with masks and gloves for anyone that enters this room. Be sure to don up yourself.”

She scurried off and when she returned with a respiratory therapist, they rolled Harold onto his side and Danny prepped his back with a bactericidal agent. With sterile gloves, he felt Harold’s lumbar intervertebral discs and slid a thin spinal needle between two of them. Harold’s cerebrospinal fluid drained easily and Danny allowed it to drip into the kit’s sterile vials. The humdrum of the ventilator drowned out the silence.

“Thanks everyone,” Danny said when they rolled Harold flat on the bed again. Danny stood quietly for a second. His colleague already showed signs of ICU breakdown with IV marks on his arms and a pasty color.

“Marsha, I’m taking this straight to the lab myself,” Danny said, snapping back to his task at hand. He ran down several flights of stairs to the first floor laboratory and went straight back, ignoring the boxes where samples were delivered like mail.

A college-aged man stood at a centrifuge and looked over at Danny. “Can I help you?”

“I’m Dr. Tilson. Can you do me a stat analysis on CSF?”

“I’ll take care of it before anything else Dr. Tilson, but it still takes time for the results.”

“Thanks, I understand,” Danny said and left with urgency.

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Coffee and Casey would have to wait. Dr. Lucy Talbot now took priority. Danny scoured the ER board looking for her name. He twisted his hands hoping at least she wasn’t in room 5 like Harold had been. She wasn’t, but he scowled at himself thinking a room could harbor bad luck.

No one was in room 7 with Lucy.
It’s down time
, Danny thought, between being seen, poked and prodded upon, and the results of what they thought and where they’d send her. He shook his head because he was one of them. However, the way hospital employees were dropping in as patients, he could soon also find himself on the other side of medical care.

A crumpled sheet covered Lucy from her waist down, the stretcher at a forty-five degree angle. The little woman’s arms hung from her shoulders like they barely belonged and her eyes protruded like a frog’s. Although they were open, she didn’t seem to register Danny’s entrance.

“Lucy,” Danny whispered up close.

A guttural sound came from her throat, but most of what came next was juicy saliva. How could someone who appeared dry be that wet in their mouth, Danny wondered. He walked to the counter for a wash cloth. He dabbed Lucy’s mouth and chin and then pulled the moisture into the towel. Dr. Talbot closed her eyes and sunk further into the pillow.

When Danny returned to the desk, the two ER docs were both seeing patients. Since he couldn’t talk to them, he took Lucy’s chart and scribbled a quick note inserting his name into the case. He wrote consults for Bill Patogue and Timothy Paltrow to also come on board with her care, and wrote for an MRI ASAP of her head.

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Danny didn’t have much time before meeting Bill. He dodged down the hall to the coffee room, but what remained at the bottom of the pot resembled silt. After rummaging below, he stuck a filter in the pot and scooped his choice of French roast into the top. While the water did its magic, Danny poked his head outside, and glanced up and down the hallway. Casey’s ambulance was out back.

The hot coffee charged his senses as he went outside and rapped on the ambulance door. Casey opened one side. “Hey, come on in. We’re fixing to leave in a little bit because you all are on diversion. We’re going to another hospital.”

Towards the front, where the ambulance wasn’t covered by the overhang, the rain made a pinging sound in the cab. Mark gave Danny a wave. “This is quite a carwash,” he said and went back to his paperwork.

“I don’t think we’ve ever sat and talked in your ambulance before,” Danny said.

“And I’ve been doing this since you were in training and green as avocados.”

Danny rolled out a laugh. “I knew I needed to see you. That’s the first time I’ve been able to laugh all day.”

“Glad to be of service.”

“You didn’t go near Lucy Talbot then, did you?”

“No, Mark and I brought in a store owner with angina.”

“Start taking more precautions around here. We think Harold’s got meningoencephalitis. We can’t get results or be sure about the diagnosis, or source, or transmission yet. I’m making sure I give you two the inside scoop.”