Silent Fear, a Medical Mystery Read online

  She whirled around. “Thanks Casey. Nice work, fellas.”

  Casey and Mark both left the room, but Casey stopped. “Meet you back outside in awhile,” Casey said, handing Mark their residual paperwork.

  “Remind me never to do that to myself,” Danny said.

  Casey nudged him away from the door. “He’s lucky. He could’ve shot himself in the head and then he’d have you taking care of him.” His smile broadened.

  “Shut up, Casey. You’re just an ambulance driver anyway.” Danny laughed softly.

  “Okay, so what’s the deal with Harold?” Casey pointed towards the next room.

  “I haven’t gone in there yet.”

  “He came in by another ambulance. Mark and I couldn’t take the call. We were out on this one.” He nodded towards room 6. “I can’t imagine he called an ambulance.”

  “He’s not married and I bet he didn’t want to disturb his parents. He should have called the office and one of us could have looked in on him or fetched him.”

  A spindly-legged woman in high heels slowed almost to a stop. “Excuse me,” she interrupted. “Hello, Casey, if you need any more help from the business office, don’t forget my name.” She emphasized the last four words and Danny felt like an intruder.

  “Thank you, Monica,” Casey said. “I think I’m all set.”

  The woman continued on her way, her heels drowned out by the sounds of the ER.

  Danny looked up from the floor. “If Mary ever saw the number of women at work who fall at your feet, she’d wonder about fighting off competition the rest of her life.”

  Casey shrugged. “But you know she doesn’t have to.”

  A trauma surgeon passed them both, nodded hello, and entered room 6. “The trauma docs are always so fast to get here,” Danny said. “Looks like your patient will need them as well as cardiology.”

  Casey reached over to Danny, tapping him on the arm as the door fully opened to room 5. “Looks like you can go in.” The ER doctor and a laboratory technician with blood samples both came out of Harold’s room.

  “Okay,” Danny said. “See you tonight.”

  ----------

  Danny approached the stretcher where Harold’s legs splayed apart as if the paramedics had dumped him there. He wore a pasty color like the ghostly looking sheets beneath him. As Danny stopped, an attack of shivering sieged Harold from head to toe. And along with Harold’s lack of affect, he wore bags under his eyes like a drugged-out insomniac. A dreadful worry passed through Danny as he examined his colleague, making him take a long, soulful breath.

  “Harold,” Danny whispered.

  Harold’s eyes fluttered open. They lacked moisture and after a few seconds, they registered recognition. “Danny?”

  “Yes, it’s me. You should have called one of us last night if you needed help.”

  Harold moved his head slightly to the side, but then gave up. “No. That’s okay. I called you today. I still have a headache.”

  “You’re being admitted, aren’t you?”

  “Yeah, you can come see me.” Danny waited patiently as Harold tried to find his words. He straightened the pulse oximeter probe clipped on Harold’s index finger, which registered 96% on the monitor. “I’m going to cause a strain on the practice,” Harold continued, “my being in here.”

  “You focus on getting rid of whatever you’ve got. They’re working you up already, and once you get admitted, we’ll get to the bottom of this.” Danny patted his arm. “I’ve got to run for my next case. I’ll check on you later.”

  While running up the stairs to the second floor, Danny’s pager beeped. He entered the doctor’s lounge, poured a half cup of coffee, and sat in front of a phone. He dialed the number of the nurses station on one of their neurosurgical wings.

  “Dr. Tilson,” Danny said, when someone answered.

  “Dr. Tilson, this is Rob. I’m taking care of Troy Neal this afternoon. His fever has spiked higher, he vomited a light lunch he had, and we also just discovered a nasty bed sore that he kept us from seeing.”

  “I’m headed into surgery, Rob. I’ll be by afterwards. In the meantime, call his internist who’s been following him peripherally. Ask her to come see him.”

  Danny got off the phone. When it rains, it pours, he thought. He pushed the morning’s developments to the back of his mind and looked at the recent CT scan report on the computer screen for his next patient.

  Chapter 5

  At Bruce’s request, Danny headed to the office after his surgeries. As soon as he entered, Bruce signaled him and Matthew Jacob, their junior colleague, into his office and started tossing questions Danny’s way.

  “What’s wrong with Harold? Is there any chance of him working in the next few days?”

  “He’s admitted and it’s too early to tell. And I don’t think so, at least not until Monday.”

  Bruce shoved some folders to the side and leaned on his desk. “What’s the admitting diagnosis?”

  “I think they put flu or flu-like illness.”

  “It’s not exactly flu season,” Bruce said.

  A lengthy silence followed. Bruce looked square at Matthew. “Harold was on call this weekend. One of you must cover. Matthew, are you game?”

  Matthew shifted his gaze from Bruce, which wasn’t an aversion to the question. Their newest colleague avoided most eye contact yet listened well and never missed details.

  “Not practically speaking. My new brother-in-law is getting married and I’m one of the ushers. I have the tux, there will be pictures, the reception, etc.”

  Bruce eyed them both. Matthew turned to his side, facing Danny. His favorite pastime with his wife was running, which made his profile skinny as a dime. “Honestly,” he said, “I don’t know if I’ll even have time to run this weekend.”

  A frown etched across Danny’s forehead. “Bruce, you can count on me if you can’t do it.” Danny knew he’d pulled his weight and more since he’d returned and that he stood in Bruce’s good grace. “The reason I say ‘if you can’t do it’ is that I finally have visitation and I’m bringing my baby to the house this weekend.”

  “Danny, I can’t. My wife and I are headed out of town for a birthday celebration. And this old man can’t pull that kind of call too often anymore.”

  Danny shook his head. “I guess we don’t have a choice. I’ll cover.” A pang of despondency gripped over him as he struggled not to show it.

  “Danny, sorry about the timing,” Matthew said.

  “Danny, there will be hundreds of visits with your daughter,” Bruce added. “By the time she’s eighteen, you’ll be begging for an Ivy League school to take her off your hands.”

  “I wish that were true, Bruce. She’s not in my hands.”

  Bruce got up quickly from his chair. “Now, what about Harold?”

  “I’m going back over after I get paperwork and chart work done,” Danny said. “I’ll check on him.”

  ----------

  Rachel had snagged another perk by living with Leo – his finished basement. On one side against a white wall and full length mirror, he had an assortment of cardiac machines. Racks of dumbbells lined another wall and the back of the room had resistance equipment as good as any found in a major athletic center. A large mat covered the entire middle section of the floor.

  After lunch and Julia’s nap, Rachel brought her daughter, her cell phone, and a bottle of water downstairs. She placed Julia on the mat, grabbed the cardboard box she kept there, and sprinkled out an assortment of toys. Julia’s hand reached for a green plastic turtle on wheels. To Rachel’s satisfaction, her infant became amused and pushed it along with her fingers.

  Rachel turned on the overhead TV and spied on her new sweat suit in the mirror. The pale blue, light weight cotton suited her. She was proud of herself for using his gym three days a week. Some things had gotten so much easier. Before using Leo’s equipment, she had never rowed, but nowadays the rowing m
achine had become her favorite so she adjusted the settings first.

  At thirty minutes, Rachel wore a light sweat. She slowed the pace for two more minutes and got off. Guzzling from her water bottle, she pushed another animal toy towards Julia, who had kept pensive. It seemed like her infant had turned a milestone and was mostly quiet these days. Rachel contemplated the treadmill next as her cell phone rang. The incoming call registered from Danny Tilson. Rachel hesitated, wondering how to prepare her response to whatever he wanted.

  “Rachel,” Danny said when she answered. “I was looking forward to having Julia with me this weekend, but something uncontrollable has come up. Can we postpone my visitation to the following weekend?”

  “Danny,” she crooned, “after all your gallant claims about wanting to have Julia, now you’re saying she’s not your priority?”

  Danny gulped at her insidiousness. “Rachel, why are you so mean?”

  “Wow. Mean? You’re the one who stole my dog.”

  Danny almost blurted out that she had stolen his Einstein book, but he stopped. “Back to the original question,” he said. “If I have to call Mark Cunningham, then I will. But I thought you didn’t want me to have Julia, and you’d be pleased.”

  “Out of the goodness of my heart, I will accommodate your schedule.” She eyed the treadmill as Danny ate into her time.

  “I appreciate that. Let’s keep the same arrangement for next week then.”

  “Bye, Danny,” she said nicely and ended the call.

  Rachel grinned. Now she was holding the short end of the stick with Leo. She hadn’t let Danny know about her Saturday predicament needing a baby sitter because Danny didn’t know about her part-time job. Leo, on the other hand, wouldn’t tolerate some baby sitter in the house, or most baby sitters in his house, and her instincts told her he wasn’t going to jump for joy to mind Julia again, either. She’d have to make it worth his while.

  ----------

  After finishing her work out, Rachel showered and changed, put Julia in the car seat and drove to a nearby restaurant for take-out. She took care of Julia’s needs back at the house and finally put her to bed. Rachel ate and waited for Leo, who didn’t walk in until 8 p.m. She untucked her legs from underneath and glanced back at him from the television with a sensual smile.

  “Hey, babe,” he said. He locked onto her eyes as he went over, the smell of beer on his lips as he kissed her.

  “I’ve got a flank steak and fries over there for you,” she said.

  “I’ll check it out. I had a meeting with a hospital administrator and then we had a few beers, but we didn’t eat.”

  “You don’t have to explain yourself to me.”

  “I won’t unless I want to.” He ambled over to the counter and opened the Styrofoam container. He dumped the contents onto a plate, zapped it in the microwave and pulled up a stool. Rachel poured them both a glass of wine.

  Rachel ran her finger around the rim of the glass when Leo pushed away his plate, the last piece of meat still remaining. “We should go to bed early,” she said.

  Leo eyed her - her aqua eyes, summer highlights, and open neck white blouse. He stood and came close, unbuttoning the top buttons of her shirt and running his hand down into her cleavage. When he brought his hand out, he undid his zipper, put his hand on her head and pushed her down. With his other hand, he greedily pushed himself into her mouth. When the pressure on her head abated, Rachel finally got up off her knees. Leo’s lust was becoming lecherous. She went to bed and after an hour, he came walking into the bedroom, his last cigarette of the day dangling from his lips.

  “Did you have fun playing Mommy today?” Leo asked, getting on the bed.

  Rachel felt the hair on her neck rise from annoyance, but perhaps she misread him and his gruff tone. “I did. I’m still working the day after tomorrow, though, and Julia is staying home after all. There was a change in plans. I know you’ll look after her just fine for me. Is that okay?”

  Leo propped his bare arm behind his head, leaned against the pillow, and sneered. “She’s not a problem. After all, it’s like having a part of you here with me.” He dragged what he could out of the end of his smoke and squashed it out on an adjacent ash tray.

  ----------

  The hallways of 4 East bustled with activity and it wasn’t even shift change. Another doc made rounds as a staff member followed her with a rolling cart stacked with bulky charts. It was mostly The Neurosurgery Group of Middle Tennessee’s hospital wing, but a few general surgery patients took up beds and other doctors came by for consults after their office hours. Danny nodded at the general surgeon as she passed and then settled at the nurses station to get the charts he needed. Before seeing Harold, his patients came first. He hoped the internist had been by to see Mr. Neal.

  “Hi, Linda,” Danny said, eyeing the name tag on the nurse’s scrubs. “Is Peggy here?”

  “No, Dr. Tilson. I’m one of the part-timers. She’s out sick.”

  “That’s too bad. I hope she gets better.”

  “Me too. I don’t want more hours if nursing gets more short of help.”

  “I understand. Do you know where Mr. Neal’s chart is?”

  She nodded and took a few arthritic steps away to a dictating desk. She came back and handed Danny the chart. “Dr. Patogue came by to see him.”

  “Thanks.” Danny sat and flipped to the newest progress note. He scanned the doc’s reiteration of Troy Neal’s admission diagnosis and hospital synopsis. The last few lines described a two by two inch broken down skin sore on the patient’s buttocks. Along with Mr. Neal’s recurrent fever and failing hospital course, Dr. Patogue thought he may be septic and had ordered a work up. He planned on starting him on new I.V. antibiotics.

  Danny hurried into Troy’s room with Linda lagging behind. His patient’s scrawny hands lay over his abdomen. They didn’t move when Danny approached him.

  “I guess we’re still not unwrapping your head bandages,” Danny said, “until I get another CT of your head to make sure we’re cleared up in there. Now you’ve got another problem to contend with. Or perhaps it’s been the real culprit the last few days.” Danny grinned at him, but Mr. Neal only put a frown on his lips. His face was more drawn and he sputtered a few coughs.

  “What’s sep tic, Doc?” Troy asked between breaths. “That other doctor told me but hell if I knew what he was talking about.” He pointed at his abdomen like he was going to vomit, but then coughed and spit out phlegm into a tissue.

  “It means you have an infection in your blood stream.” It didn’t make an impression, so Danny added, “It can be a serious medical condition.”

  “Should’ve told someone my butt was in trouble, right?”

  “Yes, Mr. Troy. Now you get some sleep.” Danny dimmed the light as he left.

  After Danny saw a few more patients, he looked over Michael Johnson’s chart. A normal postop fever should be gone for him as well. He thumbed to the nurse’s notes, although no one had called him with any new developments. An entry from the last shift nurse mentioned Michael complaining of a headache again, or maybe it had never left. Danny shook his head - kids weren’t always the best historians. Another note mentioned copious mucous or expectorant and several entries said ‘patient sleeping.’

  Danny made his way to the room farthest down the hallway with Linda following. Inside the darkened room, the long teen stared hazily at the TV. Danny stood right beside him, but the teen seemed half asleep. Michael pushed his tongue out to his lips stirring the secretions all around his mouth. “Michael?” Danny said. He received no response. Danny picked up the bedside chart. Last temp recorded - 101.8 Fahrenheit.

  “Linda, have his parents been by today? I haven’t seen them in a day or two.”

  “No, Dr. Tilson. Actually, I was told they went on a two day trip. They should have been back, but the charge nurse couldn’t reach them this morning.”

  With Linda’s assistance, Danny remov
ed Michael’s head wrap and found nothing amiss. “Let’s get him to C.T. for head imaging, please, as soon as possible.”

  When Danny left, he ran up two steps at a time to the medical fifth floor to see Harold. He swung open the heavy door as three medical employees, a crash cart, and an anesthesiologist whizzed by. Danny made a right turn for room 525 down the hall. Visitors and a nurse putting pills into little patient cups from a cart cleared the way for all the commotion. A doc’s worried face poked out from room 525 and signaled to the group of personnel heading his way. It was Bill Patogue, the internist. “In here,” he said loudly.

  Danny ran. Harold must be in a single patient room. It had to be Harold who was getting all the attention. He carried up the rear of emergency medical workers as they swarmed on Harold. Through the hands and bodies putting on EKG patches and suctioning secretions, the anesthesiologist pushed himself between the wall and the head of the bed. Dr. Patogue threw him some rubber gloves. Harold’s lifeless-like body wasn’t dead when it came to an overabundance of wet, clear, sticky secretions over his mouth, down his chin, and flowing to his ears and hair.

  The anesthesiologist leaned over to the top of the red cart, grabbed a laryngoscope and an adult-sized endotracheal tube and then opened Harold’s mouth. With trembling hands, the respiratory therapist handed him the suction catheter. The anesthesiologist interrupted trying to intubate him, moved the tip all around Harold’s mouth, and advanced it further into the back of his throat. The continuous slurping sound made everyone’s heart quicken. He switched what he had in his hands again. As fast as possible using the laryngoscope, he made his way through the secretions with the tube and into Harold’s trachea. The endotracheal tube and the ventilator were now going to do Harold’s breathing for him.

  ----------

  The sun hadn’t sunk all the way down past the horizon when Danny pulled into the driveway. As Casey pumped insect repellant onto a small Japanese Maple on the front lawn, Dakota ran to the car and anxiously waited for the door to open. Danny stepped out and gave Dakota a spirited greeting.