Tentative Title: Dancing with the Devil
Rating: PG-13 for adult themes. No sex, no slash.
Summary: Kel struggles with a difficult patient.
Disclaimer: The story and characters of Emergency! Belong to whoever now owns them – and that’s not me. This work of fanfiction is for personal amusement only and is not intended to infringe on any of those rights. The writer seeks no profit or credit from this story.
Author: Greer L firstname.lastname@example.org
Author’s Note: This story is based on medical convention as it existed in the mid-1970s. No CAT scans, MRIs, laparoscopy, and all those other nifty things now available to the medical profession.
“Clear!” Mike Morton’s authoritative voice filled the treatment room. An instant later, electricity surged through the body on the examination table causing it to arch upward then fall back.
“No conversion.” Dixie McCall’s voice was quiet.
Morton looked across the table. “Another amp of epi?”
Kelly Brackett met his gaze. Mike was still only a resident. As Chief of Rampart’s Emergency Services, Kel was officially running this resuscitation effort. “How long’s he been down?”
Dixie glanced at the clock. “Forty-four minutes.”
Kel automatically reviewed his options. They could administer another round of medications and defibrillate again in an effort to restart the patient’s heart. But there was no evidence that one more round would help. And, given that the patient’s brain had been deprived of oxygen for nearly an hour, it was unlikely that he would have any quality of life. It took only an instant for these thoughts to pass through Kel’s mind; he’d been in this position many times and it was never easy. He shook his head. “Let’s call it.”
“Kel,” Mike looked down at his patient. “He’s just a boy.”
“I know. But we’ve done all we can.”
Mike stared at Kel, his hands intensifying their grip on the paddles. A moment later, he tossed them roughly aside. “Damn.”
Kel waited for nearly a minute, then rechecked the EKG and listened to the boy’s heart. Nothing. He looked up at the clock. “Time of death, seven forty-six.” He shoved his hands in the pockets of his lab coat while Dixie turned off the various machines that had been attached to his patient.
Her quiet voice interrupted the silence. “His parents are waiting outside.”
“I’ll talk to them,” Mike volunteered.
Kel shook his head. Mike had been here for nearly thirty-six hours. “No, it’s all right, Mike. I’ll do it. You go home and get some sleep.”
Mike gave him a long look but something in Kel’s features must have warned him that this wasn’t the time to push it. He nodded curt thanks and stepped out of the room.
Kel looked carefully at the young man lying on the exam table. He recalled what little he’d been told by the paramedics who’d brought him in. The boy was a high school swimmer. This morning, like every morning, he’d gone to swim practice. Less than an hour later, he’d climbed out of the pool complaining of feeling unusually tired then, without warning, had collapsed. All efforts to revive him, first by the swim coach, then the paramedics, and finally here at Rampart had failed. Except for the fact he was dead, the boy looked perfectly healthy. At this point, Kel wasn’t even sure why he’d died; they’d have to wait for the results of the autopsy.
Kel rubbed the bridge of his nose. It was well past the end of his twelve-hour night shift. He should have gone home over an hour ago. Instead, he’d be here at least another hour talking to the boy’s parents and dictating notes from his treatment. He sighed. He hated losing a patient. He especially hated losing a child. And more than anything, he hated losing a healthy child at the end of a long week of night shifts.
The second Kel turned the knob, a stream of water shot into the air. He jogged across the lawn, grabbed the garden hose and directed its flow toward his car, liberally splattering himself as he did so. It hadn’t rained in over a week, and dust, road dirt, and general grime had turned the color of his car from a soft gold to dusty beige. Dirt was literally pouring off the hood.
Kel wasn’t fanatic about his car’s appearance in the way that many men were. Nor was his ego wrapped up in what he drove. Over the years, he’d driven sports cars and luxury cars and everything in between. The car currently in his driveway was a Ford Crown Vic – definitely more luxury and less sport.
For Kel, washing the car had become a ritual at the end of a set of night shifts. “Mids” as these shifts were often called because they crossed midnight, were always tough, and Kel found it difficult to sleep during the day. It usually took until at least the third day for him to manage a decent day’s sleep.
“Decent” was the operative word, Kel thought as he poured a small amount of detergent into a bucket and filled it with water. He’d used blackout curtains to turn his bedroom into night at all hours. That didn’t stop the phone ringing, people knocking at the door, the trash truck and mailman – a constant stream of noise. Then there were those who actually believed that, if you worked all night, you had all day “free.” He often thought about calling them at 3:00 a.m. to ask how they were enjoying their “free time.”
He was more than ready for bed right now, Kel thought as he splashed the sponge into the bucket and lathered the passenger door. This set of nights had been brutal, and ending it by telling parents that their son had died hadn’t improved his mood. He was supposed to have three days off before beginning day shifts, but at least one of those days would be spent in the office catching up on paperwork.
“Good morning, Doctor Brackett!”
Kel looked up to find a young woman standing at the foot of his driveway. He put up his hand to shield his eyes from the glare of the sun and recognized Laura Sullivan, the teenager who lived down the street. Laura was petite, maybe an inch over five feet, although her long legs made her appear taller. She was dressed in the current fad of a long-sleeved tie-dyed shirt with bell-bottom jeans.
He smiled up at her. “Good morning.”
“Worked last night, huh?”
“Why do think that?”
She pushed a strand of shoulder-length strawberry-blond hair off her forehead. “Saw you leave when I came home from school and saw you come home when I was out running this morning. Plus, you always wash your car after you’ve been working nights.”
Kel hadn’t realized he’d become so predictable. “You’re right. I did work last night.”
“Did you do any surgery?”
He shook his head. “Not last night.”
“I might like to be a surgeon.”
“I’m sure you’d make a fine surgeon.” Kel tried to figure out the purpose of this conversation. It was more than the girl had said to him in the year since her family had moved into the neighborhood. Surely she had better things to do than watch him wash his car. He stepped over to the hose and began to rinse off the soap.
“Uh, Dr. Brackett, I was wondering. Uh, you know I’m in the ballet.”
Kel nodded even though he certainly didn’t know.
“Well, you see, my ballet company is performing this weekend at the Pavilion. We’re doing Giselle.”
“That’s great.” Kel tried to put some enthusiasm in his voice.
“I’m selling tickets. All of us are,” Laura added hastily. “In the ballet company, I mean. And I wondered if you might be willing to buy one. They’re only $3.00.”
Ah, the joys of suburbia. The thought of ballet made him crave sleep even more. Still, he didn’t want to be rude to the girl. “Laura, I appreciate the offer, and I know you’ll be great, but—“
“Dr. Brackett, you gotta come. I’m soloing as one of the Wili dancers. It’s my first solo. “Suddenly, she looked sheepish. “Besides, the person who sells the most tickets gets a free semester of dance classes.”
Kel had no idea who or what a Wili dancer was, had never heard of Giselle, had never seen any ballet, and wasn’t sure he wanted to. But Laura seemed so earnest and the tickets were ridiculously cheap. Maybe he could give it to someone at work. He fumbled for his wallet and pulled out three bills. “I’ll take one for Saturday night.”
“Only one?” Laura asked with a slightly mischievous tone. “Aren’t you going to take a date? Don’t you know how romantic the ballet is?”
Kel almost laughed aloud. “And what makes you think I need a romantic evening?”
“You’re not married, Doctor.”
He wasn’t sure how to answer that one. Maybe Laura was right, maybe he should get out this weekend. Dixie had fixed him dinner a week ago – it was his turn. She’d probably enjoy the ballet. “All right,” he said. “You’ve sold me. I’ll take two.” He exchanged the three bills he’d given her for a five and a one.
Her eyes widened. “You’ll really come?”
He tried to sound as upbeat as she did. “Yes, I’ll really come.”
Laura thanked him and excitedly ran down the street toward the next house as Kel picked up the hose and finished rinsing his car.
“Schedule’s posted,” Hank Stanley called out as he appended the single sheet to the station bulletin board. Almost immediately four men rushed toward it, all craning to see their work hours for the next month.
John Gage was the only one who hung back. Being single, it didn’t matter much when he worked. Sure, it was better to have Saturdays free for dates but, as a paramedic, having every weekend free simply wasn’t possible. In an average month, he’d have two or three free weekends and had plenty of free weekdays and weeknights. More than enough to entertain the chicks.
From the table where he was finishing breakfast, Johnny watched his co-workers jot down their schedules.
“This is great,” Marco exclaimed, pointing at one of the dates. “My brother’s coming down for a few days.”
“Hey, as long as we’re off on the 14th,” Chet said, “I don’t care if we work the rest of the month.”
“What’s happening on the 14th?” Mike asked.
“Date with Sally. Got tickets to the Ice Capades.”
“The Ice Capades?” Mike asked. “Who goes to the Ice Capades?”
“Girls dig the Ice Capades.”
Johnny tuned out the rest of the debate and continued eating his cereal. Suddenly, he heard a slam. When he looked up, the other men were staring at Roy.
Cap was the first to respond. “Is there a problem, Roy?”
“I thought we were supposed to be off the 19th though the 21st.”
“We were. But B shift has to do their OBA recert and that’s the week the department scheduled it.” Cap shrugged. “Sorry, Roy, it couldn’t be helped. You know how these things work.”
“Yeah, I know,” Roy responded. “And somehow we always seem to get the short end of the stick.” Without waiting for a reply, he stomped out of the day room.
“What’s got into him?” Chet asked.
“Maybe I should talk to him,” Captain Stanley volunteered starting to the door.
Johnny was instantly out of his seat. “No, let me talk to him.” It didn’t take long for Johnny to find his partner seated on the bench in the locker room staring at a small notepad.
“Go away.” Roy didn’t even look up as he spoke.
Johnny braced his foot on the bench beside Roy. “What’s got into you?”
“What’s got into me?” This time Roy did look up, eyes blazing. “I’m not the one who told everyone we’d have the weekend of the 19th off. I’m not the one who changes our schedule every five minutes so no one can ever plan anything.”
“Roy, calm down, man. You know Cap doesn’t change the schedule unless he has to. You heard what he said – it was a department thing.”
“There’s always some excuse. I’m tired of it.”
“What’s so special about that weekend?”
“My dad was flying in and he and Chris and I were going fishing together.”
Johnny shrugged. “Maybe he can come some other weekend. I’m sure the fish will still be there.”
“You don’t get it, do you? Of course you don’t. You don’t have a wife who expects you to pick up the kids from football or dance lessons. Or to take her to dinner for her anniversary. Or kids who want to see their dad at one game or one recital or one school play. You don’t know what it’s like to tell your family that you’ll be working on Christmas and Easter and the Fourth of July.”
Johnny almost interrupted, but then thought better of i
“And I could handle that,” Roy continued. “If it ended there. Take last month. Just when I tell Jennifer that I’ll finally be at her birthday party, I discover that, oh no, we have to work that day. Do you have any idea how hard it is to explain to a six-year-old why Daddy has to work on her birthday?”
you switch with someone? You know
Bellingham’s always looking to pull extra shifts.”
“Because the moment I switch, they’ll switch our schedule again. And then I’ll have to switch back. Back and forth, back and forth.”
Johnny simply shook his head but Roy wasn’t finished.
“We already work crazy hours. Is it so much to ask that we have some stability in our lives? Just one day that we can plan to be off? Just one time when we can promise our kids—“
Both men unconsciously jumped up at the sound of the tones. “Squad 51, probable electrocution, see the construction manager at 1327 Manor Hill Road, 1-3-2-7 Manor Hill Road, cross street Dixon. Time out nine-nineteen.”
By the time they’d reached the squad, Cap had written the address on a sheet of paper. Roy grabbed it out of his hand.
“Want me to drive?” Johnny asked softly.
Without answering, Roy climbed into the driver’s side of the squad. Johnny exchanged a shrug with Cap and scurried to the passenger door.
The construction manager was waiting for them. “It’s one of our electricians,” he said, heading toward a new single-level building. Got a flash from the electrical panel. Looks to be burned pretty bad.” He led them inside the building and through a series of unfinished rooms.
“Is the power off?” Johnny asked.
“Yep, got it turned off right away.”
Their victim was sitting on the hallway floor, back propped against the wall. Everything was covered in soot except for smudged footprints near the electrical panel, and it appeared that the victim had been thrown against the wall by the force of the electrical spark. Johnny began assessing their patient while Roy set up the equipment. He estimated that their victim was about his age, though the man’s grey, wrinkled face and saggy, melting skin made him look more than twice that.
“His name’s Dale Lawson,” the supervisor said.
The victim’s eyebrows were gone and the hair at his hairline was singed off. A quick check of the man’s pupils found them equal and reactive. “Dale,” Johnny asked. “Can you hear me?”
““Hurts.” The man’s voice was soft and hoarse.
“Where does it hurt?”
“What about your hands and your face?”
“Can’t feel ‘em.”
Johnny exchanged a glance with Roy. Third degree burns rarely caused immediate pain.
“Hurts,” Dale repeated.
“I know it does. We’re going to do something about that as soon as we call the hospital.” Johnny glanced at the man’s hands, which looked like his face; his shirt was scorched at the neckline and cuffs but otherwise intact.
Roy handed him the stethoscope and BP cuff and picked up the biophone. “Rampart, this is Rescue 51.”
“Go ahead, 51. It was Joe Early.
“Rampart, we have a male, approximately 30 years old, the victim of an electrical flash burn. Patient is conscious and oriented. Estimate second and third degree burns over 10% of his body, primarily face, neck and upper extremities. Patient is in severe pain.”
“51, can you give me vital signs?”
“Affirmative, Rampart. Pulse is 88, respirations 20, and BP—“ Roy glanced at him.
“146 over 86,” Johnny replied. Roy repeated the information into the phone.
“Start an IV, normal saline at 100 ml per hour. Give 10 mg MS IV push. Administer O2 at 15 liters per minute. Cover all burned areas with dry dressings.” There was a brief pause in the transmission. “Can you send me a strip?”
“10-4, Rampart.” Roy handed Johnny the IV equipment and started set up the EKG.
A few minutes later, they were ready to transport. “I’ll go in with him,” Johnny offered. As Roy collected their supplies, Johnny tried to assess whether his partner’s attitude had mellowed.
Johnny approached the base station expecting to find Roy waiting for him. To his surprise, Dix was alone. “Where’s Roy?” he asked, looking around.
“Said he’d wait for you in the squad.” She gave him a curious look. “Something going on between the two of you?”
“Not exactly. Roy’s upset because he was planning to go fishing with his dad and Chris in a couple weeks and now he has to work.” He shrugged. “Last minute schedule change.”
Dixie nodded. “I know how that goes. So, why doesn’t he switch with someone?”
“That’s what I said.” He sighed loudly. “But I don’t think it’s just this fishing trip. Roy’s upset that he misses a lot of family things because of work. Says I don’t understand because I’m not married, don’t have kids.”
“Don’t get me started on that one,” Dixie replied. “I can’t count the number of Christmas shifts I’ve taken so that nurses with kids can be home. I know it’s tough. Shift work is tough on everyone.”
“Yeah, I know, I’m preaching to the choir.” He flipped his HT. “I just hope Roy comes around.”
Dix gave him a knowing smile. “He will; he always does.”
Kel sat in the darkened amphitheater watching costumed figures twirl, glide and leap across the stage. Groups of ballerinas performed the exact same steps at the exact same moment; bodies spun at the same time, legs lifted to the same height, jumps culminated at the same point. The result was to make the extraordinarily difficult look effortless.
He was doing his best to enjoy the ballet, with limited success. There was a subtle but significant difference between appreciating a good performance and becoming immersed in it. On either side of him, couples stared at the stage with rapt attention. Of course, he suspected that most were relatives of the dancers, which might have influenced their opinions a tiny bit. Kel sighed. Perhaps the problem was that he was alone. He’d bought the tickets assuming that Dixie would go with him. By the time he’d gotten around to asking her, she’d already promised to take a weekend shift for one of her nurses and it was too late to find a replacement. He’d been terribly disappointed and had thought more than once about staying home. But Kel was a man of his word. He’d promised to attend, and so here he was.
He wondered if Laura Sullivan was among the group of dancers on stage. At this distance, all of the dancers looked alike. The only way he’d be able to distinguish Laura from the others would be if she wore a huge sign across her forehead. And even then . . .
Laura had told him that she would be a principal dancer in one of the scenes, a fact Kel had confirmed in the printed program. But he’d forgotten which scene she was in and couldn’t read the program in the dark. He leaned back in his chair, and decided he should simply try to enjoy the performance. The music stopped as a group of ballerinas flittered into the wings, leaving the stage momentarily empty. Kel wondered if they were close to intermission. The silence continued and Kel almost started to rise from his chair to beat the crowd to the reception area during the break.
“Excuse me.” The voice came from just in front of the stage. The speaker was a thin, nervous-looking young man who paused as if waiting for silence even though there was no noise. “Is someone here a doctor or nurse?”
Almost by instinct, Kel stood up and worked his way toward the aisle over the knees of fellow patrons. He reached the stage and introduced himself to the man at the front of the room.
“Evan Thomas, director of the company,” the man replied quietly. “We have a small emergency backstage. Could you come with me?”
”What’s the problem?” Kel asked, never breaking stride as he followed the man around the side of the stage, through a door, and up several stairs. In the background, the orchestra began playing and dancers ran onto the stage.
“One of our dancers fainted. We didn’t know what to do.”
The darkened backstage area was littered with props and costume parts and dancers stretched along metal bars. The company director led him to within a few feet of the stage, where a small group of ballerinas in white tutus clustered nervously. Kel pushed his way through the dancers and knelt next to the unconscious ballerina lying face down on the floor. His felt for her carotid pulse and found it faint, thready, and slow. He glanced up at the small crowd. “Did anyone see what happened?”
A dancer spoke up. “We were waiting to go on when all of the sudden she fell.”
“Did she hit her head?”
“I don’t think so.” The ballerina shook her head. “One minute she was standing here and the next minute, she just keeled over.”
Kel gently turned the unconscious ballerina onto her back. It was Laura Sullivan.
Kel almost didn’t recognize his neighbor in her tight bun, theater makeup, and form-fitting costume. She seemed smaller than he remembered – or at least looked thinner without the loose-fitting jeans and bulky blouses she usually wore. Kel pulled off his jacket, rolled it into a bundle, and placed it under Laura’s feet. Satisfied, he gently pulled back her eyelids, but in the darkness it was difficult to make any meaningful assessment.
“Is she dead?” someone above him asked.
“No,” he answered brusquely, then he turned to the company director. “Get these people out of here. Call an ambulance and the paramedics.” Kel desperately wished for his penlight and a stethoscope and inwardly cursed himself for not bringing his medical bag in the car. “And find her parents.”
“Come on, folks,” Thomas urged in a strong whisper, “give the doctor room to work.” He sent one of his dancers to find the Sullivan’s and another to make the necessary calls, then he turned back to Kel. “Is there anything else you need? “
“I could use a blanket.”
The director ran a hand across his forehead. “Sure, be right back.” He paused a moment. “Is she going to be okay?”
Kel nodded. “I think so.” Thomas seemed to accept this response and departed with alacrity. Almost immediately, Laura started to stir. Kel gently shook her shoulder. “Laura, can you hear me? It’s Dr. Brackett.”
She blinked rapidly several times and finally focused on his features. “Dr. Brackett?” Her eyes darted around the limited view. “What are you--? What am I--?” She started to sit up until she met the resistance of his hand against her shoulder.
“Easy now. Lie still.” He gave her what he hoped was a reassuring smile. “Do you know where you are?”
“Of course. I’m at the Pavilion.” Her eyes took in her surroundings. “Backstage.” Her situation finally seemed to register. “Wait, I’m supposed to be on—“Again she tried to sit up and again Kel kept her on the ground. “Not yet, young lady. I need to check you first.” He held his hand in front of her face. “How many fingers do you see?”
“Two,” she answered easily.
“Good. Do you remember what happened?”
“I was ready to go on. I was warming up with Karen and then . . . I felt a little dizzy.” She furrowed her brow and looked around again. “What did happen?”
“It seems that you fainted.”
“You mean everyone saw me?” For the first time, she seemed to realize that the performance was still going on. A look of concern creased her face and she closed her eyes and sighed. “Oh, man.”
Kel tried to think of something reassuring to say. Bedside manner had never been his strong point and this moment was no exception. Luckily, Laura didn’t appear to be in immediate danger. He turned at the sound of heels clacking against the floorboards as Laura’s parents rushed toward him, eyes fixed on their daughter.
“Laura!” her mother cried out as she approached. “Oh, my God!”
Kel waited for someone to tell her to be quiet then realized that the music had stopped and the dancers had disappeared. He’d failed to notice that they’d reached intermission.
Jim Sullivan’s eyes found his. “Kel, when I saw you get up I never dreamed . . . Thank goodness you’re here.”
Laura’s mother knelt beside her daughter and gently stroked her hair. “Sweetheart, what happened?”
“I fainted, mom,” Laura answered. “I feel fine now, if Dr. Brackett here would just let me get up.” She gave him a pleading look and he gave her a tight smile in return.
“Nothing doing until the paramedics get here.”
“Now you listen to Dr. Brackett,” Jim told his daughter.
Moments later, paramedics Roy DeSoto and John Gage hurried across the room, equipment in hand.
“Dr. Brackett?” Johnny said obvious surprise in his voice.
“I was in the audience,” he replied curtly. “This is Laura Sullivan. She collapsed after warming up for her performance and was unconscious for maybe five minutes. Let’s get a set of vitals.” He stood to let Roy and Johnny take his place beside Laura.
“Pulse is 48 and thready, respirations 16,” Johnny said after a moment. “Pupils equal and reactive.” Roy reported the BP as 100/60.
Kel frowned and reached for the stethoscope. Through it, he could hear Laura’s heartbeat, slow and irregular. He looked up at the paramedics. “Let’s get an IV started, D5W, and get her on the monitor.”
The girl’s eyes widened as Roy prepared the necessary equipment. “What’s that?” she asked apprehensively.
Roy answered as he worked. “I’m going to use a small needle to put this tube in your arm.” He gave Laura a slight smile. “You’ve had blood drawn before, right?”
“Well, it’ll feel about the same.” He fingered the IV bag. “Once the IV is in, this flows right into your vein.”
Kel tried not to hover over his paramedics, certain that his mere presence was enough to make them nervous. He stepped aside and motioned Laura’s parents to follow him.
Jim was the first to speak. “Kel, what’s wrong with her?” He nodded back toward the paramedics. “Why all the equipment?”
Kel knew he had to deal with this situation cautiously until he had a better sense of what might be wrong with Laura. “She had a syncopal episode – she fainted.”
“You’re not doing all this,” Jim pointed to the scene behind them, “for a simple case of fainting.”
“She was slow regaining consciousness and her heart rate is irregular. “This,” he said, indicating Roy and Johnny, “is a precaution.”
“Her heart?” Carolyn Sullivan whispered the words. “Oh, Kel, Laura’s going to be all right, isn’t she?”
“I think she’s going to be fine,” he replied in a tone designed to placate her worry. “We’ll take her to Rampart and run some tests, see if we can’t find out what’s going on.”
“Dr. Brackett.” It was Roy’s voice. “Can you come here a minute?”
He was at the paramedic’s side in an instant. “What’s up?”
Roy shook his head. “Can’t get a vein. They keep collapsing on me.”
Kel knelt down beside them, noting the marks on the inside of Laura’s forearm where Roy had attempted to insert the needle. Another try in that arm would be pointless. He reached for her other arm. Roy was right; her veins had virtually disappeared, probably due to dehydration. Without an acceptable vein, the IV would have to wait until they got to Rampart to do a cutdown. Kel checked the back of Laura’s hands and reached for a fresh needle. “Let me give it a try.”
Laura was becoming agitated. “Please, not again. It hurts.”
Laura’s parents pressed closer. “Johnny, let me have 5 cc’s lidocaine.” Kel hoped to use a trick he’d learned from an anesthesiologist. Taking the syringe, he swabbed the back of Laura’s hand, and injected the anesthetic, then waited a minute for the drug to take effect. “Okay, now the IV.” He carefully threaded the needle under the skin. The lidocaine had numbed the area so that Laura no longer jerked at every sign of pain. Even so, the procedure was more difficult than he expected. The instant he got the flashback that signaled success, Roy was ready with tubing. As soon as he’d taped down the IV, he stood up and motioned to the ambulance attendants. “Let’s go.”
Mike Morton and Dixie McCall met the ambulance and Kel couldn’t decide who was more surprised to see him. As they rounded the corner, Kel recognized the normal state of organized chaos for a Saturday evening in his department. Morton was clearly needed elsewhere. “I’ve got this, Mike.” He turned to Dixie. “I’ll need a nurse to assist.”
“You’ve got one,” she answered with a smile. “Room six is open.”
As they pushed the gurney toward the treatment room, Laura’s mother ran up. She’d ridden in the front of the ambulance and was now anxious to stay with her daughter. Kel intercepted her at the door. “Carolyn, I need you to wait out here.”
“Kel, she’s my daughter, I want to be with her.”
“I know, but I need to examine her and run some tests.”
“You think it’s something serious.”
“I want to rule out anything serious,” he said pointedly. “When’s the last time she saw a doctor?”
furrowed her brow. “Let me think. I guess it was last summer, for her school
Kel nodded. “Any recent illnesses?”
Laura’s mother thought for a moment. “No, not really. She’s been a bit tired of late with all her rehearsing. And I suppose she’s had a cold or two. Nothing serious.”
“All right.” He pointed toward the end of the hallway. “You can wait down there. As soon as we’re finished, I’ll come find you.”
She grasped his arm. “Kel . . . ”
He gave her a smile. “I’ll take good care of her.”
Once inside the treatment room, he was pleased to see that Dixie had Laura in a gown and hooked up to the hospital’s EKG, though Dixie’s expression told him that it had been a struggle. The ballet slippers were gone and Laura’s crimped blond locks now hung to her shoulders.
“Pulse is 46, respirations 16 and BP 98/60,” Dixie reported, removing the stethoscope from her ears.
“Dr. Brackett,” Laura asked with a pained look on her face and a slight whine in her voice, “can’t I go home? I feel fine.”
experienced eye, Laura looked anything but fine. She looked pale, exhausted, and malnourished
and her vital signs were far from normal.
Nevertheless, he kept his tone light.
“Why don’t you let me be the judge of that?” Kel started to reach into his lab coat, then
he realized he wasn’t wearing one. Dix
must have read his mind because she immediately handed him a stethoscope. He took it from her with a knowing smile then
turned to Laura. “Lean forward
Kel forced himself not to react when Dixie opened the back of the gown. The skin across Laura’s back was stretched so tight that he could count her ribs. He exchanged a glance with Dix. She’d noticed too.
“Take a deep breath, through your mouth.” He adjusted the stethoscope. “Again. Once more.” Her lungs were clear. He helped Laura return her to a semi-reclining position and listened carefully to her heart. The arrhythmia was still present. His eyes were drawn to the EKG monitor, which confirmed what he’d heard through the stethoscope. “Dix, I want a CBC with differential, SMA-12, blood gas, and a UA. And let’s get a heterophile antibody as well. Chest and skull series. Then start an isoproterenol drip. See if you can get a line into her arm – I don’t want to infiltrate the one in her hand. Also, I’m going to want a cardiology consult as soon as possible. ”
“Oh, wow.” Laura rolled her eyes. “What’s all that for?”
He coiled the stethoscope in his hands. “I need to find out why you fainted.”
“I got a little dizzy, that’s all.”
“Has it happened before?”
“No.” This time she gave him a smile. “I promise you that I’m not a fainting female.”
“Glad to hear it.” He made a few notations in Laura’s chart, then turned back to face her. “So, tell me, did you have anything to eat before the performance?”
She seemed surprised by the question. “Come on, it was my first solo. I was way too nervous to eat.”
“What about breakfast?”
“I had some grapes.”
She shrugged defensively. “I had a lot of grapes.”
It was now well after eight in the evening. That meant Laura hadn’t eaten anything of substance in almost a full day. No wonder she’d fainted. “What did you have last night for dinner?”
“Why the twenty questions?”
He gave her a tight smile. “Humor me.”
“Mom fixed meatloaf with mashed potatoes and green beans.”
“Did you eat any?”
“Sure, I ate a lot.”
Kel considered the merits of that statement. His patient’s condition certainly suggested she’d missed more than one or two meals. “Laura, are you trying to lose weight?”
“A ballerina can’t be fat, Dr. Brackett.”
“How much do you weigh?”
He kept his eyes locked on hers. “You must have some idea.”
Laura turned away and shrugged her shoulders. “I said I don’t know. Okay?”
Kel decided that he’d pushed hard enough. “Okay. For now.” He opened up the chart but didn’t find the information he wanted. “Laura, when was your last menstrual period?”
“Dr. Brackett!” She turned away, flushed with embarrassment.
Kel bit his lip in frustration; he wasn’t handling this well. Whatever connection he’d established with Laura seemed to have disappeared. Then again, he wasn’t used to dealing with a teenage girl who happened to be his neighbor. Maybe the fact that Laura knew him made it difficult for her to accept him as her doctor. Maybe he should get Joe; for some reason, he seemed to do better with the younger crowd.
Kel touched Laura’s shoulder and spoke very gently. “I’m sorry that my questions are making you uncomfortable.” Out of the corner of his eye, he saw Dix give him a strange look. Attempts at bedside manner were rare for him. “Would you prefer another doctor?” he continued. “Someone you don’t know?”
Laura swallowed hard. “No, it’s okay,” she finally said. “It’s just that I’ve never had a man ask me that question.”
Kel grimaced. “Sorry. But if I’m going to be your doctor, it’s important for me to know.”
“So when was it?” Dixie asked as she worked on the IV.
Kel forced himself not to smile. Trust Dix to press the issue.
Laura’s voice was soft and she kept her focus on Dixie. “Couple of weeks ago.”
Dix caught his eye and motioned him to the side of the exam room. Kel patted Laura’s arm. “We’ll be right back.”
“Do you believe her?” Dix asked softly as soon as they were out of earshot.
“She’s emaciated, Kel. You didn’t see her fully undressed. She can’t weigh more than 90 pounds.”
“I know.” Kel stole a glance at his young patient. “Let’s get a weight on her.”
Dix nodded but she wasn’t finished. “All the while you’ve been talking; I’ve been trying to find a vein. There’s nothing to work with.”
“Roy had the same problem. I’ll have to do a cutdown.” He sighed. Nothing about this was going to be easy.
Leaving his patient in Dixie’s capable hands, Kel stepped into the hallway in search of Laura’s parents. He rolled down his sleeves and rebuttoned the cuffs. Laura had handled the cutdown better than he’d expected and he’d increased the rate of fluids pouring into her body. The results of her blood tests weren’t back, but he had little doubt what they’d reveal – anemia, hypoglycemia, and probably hypokalemia as well. He suspected that these were only the symptoms of a more sinister disease for which treatment would be much more difficult.
Right now, he needed some information from Laura’s parents. Although the Sullivans were his neighbors, he didn’t know them well. Jim Sullivan was an attorney at one of the big firms in the city and Carolyn was a homemaker. Their son Nick was a senior in high school and played football. Jim always joked that Nick was bound to end up in Kel’s emergency department. And then there was Laura. A little more than a year younger than her brother, the few times Kel had seen her, Laura had appeared quiet and introspective. He knew her least of all. And now she was his patient.
The waiting room was crowded, but Jim and Carolyn must have been watching for him because they were on their feet the moment he approached.
“How is she?” Carolyn asked.
“Laura’s resting comfortably right now.”
“Can we see her?”
“We’ll be moving her to a room in a few minutes and you can see her once she’s settled.”
“Room?” Jim asked. “Does this mean she has to stay overnight?”
“I’m afraid so.”
“Why?” Carolyn asked. “What’s wrong with her? I thought she only fainted.”
This was not a conversation for the middle of the waiting room. “Why don’t we go to my office?” Once inside, Kel wavered between the familiarity of perching on the side of his desk or the formality of sitting behind it and decided on the latter. Jim and Carolyn wore matched expressions of fear and anxiety as they awaited his verdict.
“As I said,” he began, “Laura’s resting comfortably. She doesn’t seem to have suffered any ill effects from her fainting spell.” He shifted slightly in his seat. “However, she has an arrhythmia – an irregular heart rate. In Laura’s case, the condition is called bradycardia, a rate that’s much slower than it should be. We have her on a cardiac monitor, and I’ve given her medicine to increase her heart rate. I’ve also asked a cardiologist to consult on her case.”
Carolyn’s hand flew to her face.
“Kel, Laura’s always been a healthy, active girl.” Jim remained outwardly calm, though Kel detected a slight tremor in his voice. “Are you sure this isn’t some sort of phase she’s going through, what with all the effort she’s put into her ballet?”
“The arrhythmia is my main, but not my only concern. I’m still waiting on the results of her blood tests, but I’m pretty sure she’s anemic and probably has a potassium deficiency as well. Once I have the results, I’ll--”
“Kel, what’s going on here?” Laura’s father interrupted. “My daughter faints and now you’re telling me she has heart problems. I don’t understand. What’s causing all of this?”
“Laura told me she hasn’t eaten in the past day. Is that normal?”
“Oh, that can’t be true,” Carolyn replied dismissively. “Why I know that this morning she ate . . . “She frowned. “Well, she usually eats a big breakfast before she goes to school.”
his point. “Has she been dieting
“Dieting? What does dieting have to do with this?” Jim asked in a loud voice. “I thought we were talking about her heart.”
Kel turned to the girl’s mother. “Carolyn?”
“She wants to stay thin, for the ballet, you know.” Carolyn slid her wedding ring up and down her finger.
Kel took a deep breath. “Severe dieting can throw off the body’s electrolyte balance, cause iron and potassium deficiencies, as well as affect the cardiovascular system.”
A nurse poked her head inside. “I’m sorry to interrupt, Doctor, but Miss McCall said you wanted to be notified when Laura Sullivan was in a room. And that her lab results are back.”
“Oh, and Dr. Morton said to tell you that victims of a bus accident are coming in and he could use some extra hands.”
So much for his night off. “Tell him I’ll be right there,” he replied before turning back to the Sullivans. “Why don’t you go see Laura; the nurse at the information desk will have her room number.” He stood up from the desk. “I’ll find you once I’ve reviewed her lab results and we can talk further.”
“How long is she going to have to stay in the hospital?” Jim asked.
“A day, maybe more. I’ll have a better idea once I see the lab report.”
Carolyn stepped out of his office and quickly crossed to the information desk. Her husband hung back. “Kel, I’m a lawyer and I know when someone’s not telling me the whole story. What aren’t you telling me about Laura?”
“Jim, when you put together a case, I know you want all the facts. So do I. And I don’t have them yet.”
“Jim.” Carolyn impatiently hailed her husband. “Let’s go.”
Jim Sullivan gave him a long look and hurried after his wife.
An hour later, Kel was in one of the treatment rooms putting a final suture into the bus driver’s arm when he heard the page over the loudspeaker. “Dr. Brackett, Room 211, STAT; Dr. Brackett, Room 211, STAT.” He turned to the nurse assisting him. “Can you finish up here?”
“Of course, Doctor.”
Kel stripped off his gloves. “Get Dr. Morton or Dr. Jackson if you need help,” he called over his shoulder as he hurried out the door. Kel had learned a long time ago never to run through the hospital. It was dangerous, panicked patients, and usually didn’t get you where you wanted to be any faster than a brisk walk. His brisk walk was brisker than most, and he approached Laura Sullivan’s room less than a minute after the page. Sounds of the girl shrieking echoed halfway down the hall.
Inside, he found pandemonium. Laura was seated on the side of the bed surrounded in blood. She’d pulled out one of her IV lines and was working on the second. EKG leads had been tossed onto the floor causing the cardiac monitor to sound a shrill warning. A nurse huddled in the corner, a bag of yellow potassium IV solution in her hand, and shattered glass at her feet. A few feet away, Laura’s parents were pleading with their daughter.
“What’s going on in here?” Kel demanded.
The nurse spoke up. “I came in to start the IV you ordered and she freaked out.”
He nodded toward Laura’s parents. “Get them out of here, and then get me 5 mg diazepam IM and some help.” The nurse skirted around the bed and almost pushed the Sullivans out of the room. Kel grabbed Laura’s shoulders and tried to get her to lie down. She struggled against him, flailing her arms and kicking her bare feet against his shins.
“Laura, stop this! You’ll only hurt yourself.”
”No! Let me go. I want to go home.”
Blood continued to pour out of her arm and onto the sheets. The cuffs of his sleeves were nearly soaked. He tried to ascertain the extent of the damage, but it took most of his energy to hold her still. She began to weary from the struggle at the same time reinforcements arrived in the form of two nurses and two orderlies. The men took over from him, pressing Laura onto the bed and restraining her arms and legs. One of the nurses handed him a syringe, which he injected into her thigh. The combination of the sedative and exhaustion took their toll and, within a minute, Laura again fell unconscious.
Kel immediately began barking out orders to the nurses. “Cathy, get restraints on her and get me a set of vitals. Ellen, see if you can get that IV restarted. Try the arm but I may need to do another cutdown. Cathy, I’m going to want a new set of labs – CBC, SMA, and blood gasses.”
As soon as the restraints were in place, he dismissed the orderlies and began assessing the damage Laura had done to her arms. The area where he’d performed the cutdown was bloody and inflamed; it would need stitches. He was also worried about infection in the site; he’d have to start her on IV antibiotics.
“Doctor,” Cathy said from across the bed. “Pulse is 60, BP is 100/60 and respirations are 18.”
He pulled a stethoscope from his pocket. “I’ll need a suture kit.” He nodded at the wires dangling over the side of the bed. “And let’s get the EKG hooked back up.” Kel shook his head. This was going to be a very long night.
Once he was convinced Laura was stable, Kel again went in search of her parents. Jim and Carolyn huddled alone in the lounge at the end of the hall. At this time of night, visitors had long since gone home. They didn’t rise when he entered the room.
“She’s okay for now,” he said, sitting down in the chair across from them, and gingerly stretching his legs and back.
“I don’t understand what happened,” Carolyn said wearily. “One minute she seemed fine and the next . . . .”
“Look,” Kel said kindly, “we have a lot to talk about, but not tonight. You both could use some sleep.”
“We want to see her,” Carolyn protested.
Kel shook his head. “Not tonight. I’ve given her something to help her sleep. You can see her in the morning.”
“Will you be here?” the mother asked anxiously.
He stood up in the hope they would do the same. “No, but a nurse will be in the room with her all night. There’ll be a doctor on duty, and they’ll call me at home if there’s any change in her condition.”
Jim stood up and reached out his arm to his wife. “Kel’s right, Carolyn. We’ll come back first thing in the morning.”
“What if she wakes up in the middle of the night and is scared?”
“Carolyn, she’s not a baby,” her husband replied, and Kel winced at the tone. The situation was already taking its toll on Laura’s parents and the real stresses had yet to come.
It took several more minutes for him to convince the Sullivans to head home. The moment the elevator door closed, he leaned heavily against the wall and massaged his temples. It was hard to believe this evening had started nearly five hours ago with a few young girls twirling on the stage in tutus and ballet slippers.
“Good morning, Laura,” Kel greeted his patient not long after sunrise the next day. “How are you feeling?”
Laura’s expression and the reports he’d received from the night nurses made clear that his patient was in a foul mood. She tugged at the restraints on her arms. “Get these off me!”
Kel hated restraints and wished they hadn’t been necessary here. “Laura, do you know why we had to use those?”
“I don’t care. Just get them off.”
“You pulled out your IV last night.” Kel kept his voice calm and unemotional. “You made quite a mess not to mention the six sutures I had to put in your arm.”
Laura only glared at him.
“If I remove the restraints, how do I know you won’t pull the same stunt again?”
“I guess you don’t.”
“Then I guess you don’t leave me much choice.”
She stared at him with a sullen expression. He held her gaze for a moment, then he turned his attention to her chart. At least a full minute passed in silence.
Kel glanced over at the nurse. “I’ll take over for a while. Why don’t you get some breakfast.” She nodded gratefully as Kel took her place in the chair beside the bed. Psychiatry had never been his strong point, and his limited skills were about to be tested. “I heard you gave Nurse Mendez a hard time this morning,” he said.
“She was mean to me.”
He leaned back in the chair and crossed his arms. “Why’d you pull out your IV?”
“I don’t know.”
“Laura,” he said disapprovingly. “We played that game yesterday.”
She was silent for a moment. “I know what you’re doing with this stuff.” Laura turned her head to stare at the IV pole with the bags of fluid running into her veins.
“I’m trying to make you well.”
“You’re trying to make me fat.”
That fit with what the nurse had told him. It was also something he should have anticipated. “Would you like me to explain what’s in each of those bags?”
“Like I’d believe you.”
“The large bag of clear liquid,” he began as if Laura hadn’t spoken, “is D5W, which stands for dextrose 5% in water. It’s used to keep the IV line open and keep you hydrated. The small bag with the clear liquid is an antibiotic.” There was still no reaction from his patient. “The yellow liquid is potassium. The blood tests we ran showed you’re hypokalemic, which is the medical term for low potassium. It’s a common side effect of weight loss.”
Laura didn’t say anything, but Kel was certain she was listening to his every word.
“You may remember that last night you had a different bag of clear liquid.” Laura nodded. “That was isoproteronol, which we used to increase your heart rate.”
“And what about the shot you gave me last night?”
Kel smiled to himself. He did have her attention. “That was a sedative called diazepam, to calm you down.”
She almost laughed. “It sure did that.”
Kel clasped his hands together and considered his next statement very carefully. “They tell me you didn’t touch your breakfast this morning.”
“I wasn’t hungry.”
“As a ballerina, it must be important to stay thin.”
She looked away. “I guess so.”
“When I was at your performance, I didn’t see too many overweight dancers.”
“You have to be light to do the jumps,” she replied. “And the guys don’t want to lift you if you’re fat.”
“Is it hard to keep your weight down?”
“How do you do it?”
She shrugged. “I dunno. I just do it.”
“Do you think you’re overweight right now?”
Laura considered the question for a moment. “I could stand to lose a few pounds.”
Kel let the answer sit in the air between them. Thoracic surgery was easy compared to this. He liked Laura and a part of him wanted to be the friend that she appeared so desperately to need. However, the physician in him took over, as it so often did. He hadn’t quite figured out how to balance the two. “Laura, have you ever taken laxatives to help you lose weight?”
“No,” she responded in a quiet voice.
“So what?” Her tone had changed to one of defiance. “Lots of girls do it.”
He almost started to lecture her on the dangers of laxative abuse but stopped before a word emerged from his mouth. Any progress in gaining Laura’s trust was the first step in getting her to accept the help that she needed. Even so, Kel felt out of his league, afraid he would ask the wrong question or say the wrong thing and commit the cardinal sin of doing more harm than good. He’d gone into surgery and emergency medicine because he liked the quick cure. This was foreign soil. Maybe it was time to take a break. “I think that’s enough for now.” He stood up, picked up Laura’s chart and started to walk out. Her voice stopped him at the door.
“Hey, what about these?” She held up her restrained hands. “You’re treating me like a crook.”
He sighed. “Laura, I’d like to get you out of those restraints. But I can’t have you pulling out your IVs.”
“What if I promise not to?” It was more of a statement than a question.
Kel leaned against the door. If he was going to earn her trust, he had to give back a little himself. “There’ll be a nurse in here with you at all times.”
“I said I wouldn’t do it.”
“Just a little insurance to make sure you keep your promise.” He set down her chart and began to release the restraints. “You know I can’t send you home until you eat something,” he said after a minute.
“The food here tastes terrible.”
“How would you know? You haven’t eaten any.”
“All hospital food is terrible.”
Kel remained silent.
By the time Kel finished removing the restraints, the nurse had returned. “Her parents are here,” she informed him.
“I want a nurse in here at all times,” he told her. “Even when she has visitors.”
“Of course, Doctor.”
“Even when she goes to the bathroom.” Again the nurse nodded her understanding. “And let me know how much she eats.” He couldn’t shake the feeling that he’d made a pact with the devil.
Kel was at the base station writing discharge orders when the buzzer sounded indicating an incoming call.
“Unit calling in, this is Rampart.” “Rampart, this is Squad 51.” It was the voice of Roy DeSoto. “We have two victims of an automobile accident. The first victim is a male, approximately 45 years of age.” Kel grabbed a nearby pad and began jotting down information as Roy’s recitation continued. “First victim impacted the steering column and windshield. The patient has a compound fracture of the right fibula and a possible fracture of the right radius. He has lacerations to his right thigh and head. Possible concussion. Stand by for vital signs.”
“51, what’s the status of the second victim?”
“Rampart, second victim is a female, approximately 25 years of age. Victim two is still being extricated. “
“Ten-four, 51.” Kel nervously tapped his foot as he waited for updated information from Roy. Johnny must be with the other victim.
A minute later, Roy was back. “Rampart, on victim one, pulse is 120, respirations 18, and BP is 106 over 86. Pupils are equal and reactive. Patient is conscious but disoriented and in severe pain. We have him on six liters of O2.”
Kel took down the information. Initially, he’d had trouble using the paramedics as his eyes, ears, and hands. Dictating orders from afar was a learned art. In the early days, the paramedics generally stepped through the procedures they’d learned in training. They reported on the patient’s condition, awaited orders, and then carried them out. Recently, however, he’d noticed that the best paramedics anticipated his questions and provided the information he needed without being asked. Some were even a step ahead of him in their requests to begin treatment. He occasionally wondered if the paramedics might be able to do much of their work without his input. But not today. He depressed the talk button. “51, start two large bore IVs with normal saline. Immobilize the fractures and use spinal precautions.”
“Ten-four, Rampart.” Roy repeated back the instructions.
“Is the ambulance at the scene?”
“Negative at this time, Rampart.”
“Give me updated vitals once you have those IVs in.”
The door to the room opened and Dixie poked her head inside. “Two victims from a motor vehicle accident,” he said. “One has fractures and possible internal injuries. They still don’t have the second one out.”
She nodded and ducked back out of the room.
Kel waited for word on the second victim. He glanced at his watch; he’d never been good at waiting. “51, do you have updated vitals on your first victim?”
“Uh, negative, Rampart.”
Kel frowned. Roy should have been able to start five IVs in the time he’d been waiting. “51, what’s the delay?”
“Rampart, we--, uh, I’m having trouble getting the IV started.”
Kel’s frown deepened at the anxiety in Roy’s voice. The patient needed those intravenous lines to combat shock. What was the holdup? Was there a problem with the patient that hadn’t been communicated? He rubbed the back of his neck. “51, we need those IVs in.”
“Ten-four, Rampart, stand by,” Roy responded.
Kel again glanced at his watch then for Joe or Dix or someone to whom to complain about the delay. He looked up at the clock.
“Rampart, this is Squad 51; we have extricated victim two.” It was John Gage. “Victim is female, 25 years of age, conscious but confused; pupils are equal and reactive. She has movement in all extremities. Patient has a small hematoma with abrasion on her left temple but no other external injuries noted. Rampart; be advised that the victim is pregnant. Stand by for vitals.”
Kel heard a muffled exchange, then, a few minutes later, Roy’s voice replaced Johnny’s. “Rampart, on the second victim, pulse is 100 and regular, respirations 24, and BP 110/72.”
Kel again scribbled on his pad. “Can you estimate how far along she is in the pregnancy?”
“Estimate six to seven months.”
“Ten-four. On victim two, give her O2 at 15 liters per minute. Start an IV with normal saline, TKO. Position the patient on her left side and transport as soon as possible. Monitor vital signs.”
Roy acknowledged the order. A moment later, Johnny’s voice crackled over the biophone. “Rampart, on victim one, both IVs are in.” He gave updated vitals. “And Rampart, ambulance is now on the scene.”
“Transport both victims immediately, 51.” He sighed as he flicked off the recorder. Something about this rescue struck him as odd and he couldn’t quite put his finger on it. He’d have to ask Roy what had gone wrong. First, however, he needed to find Joe Early and Mike Morton. With two trauma patients coming in, he’d need all the help he could get.
When Kel stepped out of the treatment room a short time later, he wasn’t surprised to find Johnny waiting for him at the base station.
“How’s she doing, Doc?”
“Well, the good news is that our mother-to-be seems no worse for wear. OB’s in with her now. I expect they’ll admit her overnight for observation, but I think she’s going to be fine.”
“That’s just great,” Johnny replied with a smile. “Doc Early sent the other guy to surgery but said it looks good.”
“You guys did a nice job out there.” Kel made a few notes in the patient chart, then flipped it closed and looked around. “Where’s Roy?”
“Getting a cup of coffee.”
Kel rubbed his chin. “Johnny, anything unusual about that last run?”
The paramedic shrugged. “Don’t think so. Pretty standard vehicle accident.”
“It took a while to get those IVs started on the first victim.” Kel kept his tone neutral.
“Yeah, it was a bit tough.” Johnny met his gaze. “Happens sometimes.”
Kel decided to press a tiny bit. “Then there’s nothing you think I should know? Nothing you want to talk to me about?”
Johnny gave him a look of surprise that wasn’t quite convincing. “Can’t think of a thing, Doc.”
Kel bit his lower lip. Maybe this was something best left for Johnny and Roy to work out. Still, as the physician supervising the paramedic program, it was his responsibility –
“Kel!” The voice of Jim Sullivan rang out from the vicinity of the elevator interrupting his thoughts. “Glad we found you.”
Out of the corner of his eye, Kel noticed that Johnny took advantage of the distraction to mumble something about retrieving Roy and scooted away.
“Are you familiar with the disease anorexia nervosa?” Kel asked. He sat at his desk, hands clasped together in front of him.
Carolyn and Jim Sullivan were seated across from him. Jim was a large man, solidly built. Now, as he leaned forward in the small chair, he almost overflowed Kel’s desk. By contrast, Carolyn was petite like her daughter and, at Kel’s question, seemed to sink even further into her chair. They couple looked at each other for a brief moment. Jim shook his head but Carolyn nodded tentatively.
“I think so,” she said with a frown. “I remember reading about something in a magazine at the beauty shop.”
“Nervosa?” Jim asked at almost the same time. “Is it something to do with the nervous system?”
“Not exactly.” Kel leaned back in his chair. He wasn’t surprised that the Sullivans weren’t familiar with the disease. Even he’d needed to review some medical literature on the subject. The disease was relatively rare, although being diagnosed with increasing frequency. “Anorexia, as it’s commonly known, is an eating disorder that tends to occur in girls Laura’s age. Patients with anorexia see themselves as fat when, in fact, they’re severely underweight. They are obsessed with dieting and terrified of gaining weight.”
Jim scoffed at his explanation. “So Laura’s a little thin,” he said with a dismissive wave of his hand. “That doesn’t mean she has this anorexia thing.”
Carolyn also spoke up. “Kel, I know she’s thin, but that’s normal for ballet dancers.”
“Did you know she only weighs 88 pounds?”
“Oh my God—“The words came out in a whisper from Carolyn’s lips. “I didn’t . . . I just thought . . .”
“No one’s blaming you,” Jim reassured his wife. “Isn’t that right, Kel?”
“This isn’t about blame, it’s about helping Laura.”
“So, we get her to eat more,” Jim replied.
“I’m afraid it’s not that simple,” Kel said, his expression grim. He picked up Laura’s chart and set it back down on his desk. “She’s nearly 20 percent below her ideal body weight. She’s stopped menstruating. And, she’s starting to have dangerous complications such as cardiac arrhythmia and severe dehydration.”
“What causes it?” Carolyn asked.
Kel sighed. “We don’t know. The best theory is that the disease has a psychological origin.”
Jim was out of his chair. “You’re saying my daughter is a nut case!”
“Jim,” Kel fought to keep his voice calm. “I’m not saying anything of the kind.” He nodded at the empty chair. “Why don’t you sit down and let me finish.”
Laura’s father leaned against the window. “I’m fine here,” he responded tightly.
Kel tried to decide whether to direct his comments to Jim or to Carolyn. “Patients with anorexia can starve themselves to the point of serious health problems and even death. There doesn’t appear to be a physical cause but there are obviously serious physical symptoms. The situation is complicated by the fact that most patients won’t accept that they have a problem. That makes treatment very difficult.”
This time Carolyn spoke up. “I’m sorry, Kel. I just don’t understand.”
“For reasons even we doctors don’t completely understand, patients with anorexia see themselves as overweight. They perceive any attempt to make them eat as trying to make them obese. They come up with all sorts of ways to lose weight, like binging.”
“What’s that?” Carolyn asked.
Kel pressed his lips together. “Binging is when someone eats a large amount of food and then forces herself to vomit.” Carolyn had paled at his explanation. “In theory,” he continued, “this allows the person to enjoy eating without gaining weight. In reality, it causes severe intestinal problems.” He took a deep breath. “Another technique is the use of laxatives.”
“Has Laura . . .?” Carolyn asked in a soft voice.
Laura’s mother put her hand to her mouth. “Oh my God.”
“So,” Jim’s voice came from across the room. “Why don’t you just fill her up with liquid food and get her weight back up.”
Kel wished the man would sit down. “IV feeding carries its own risks. The amount of nourishment isn’t adequate, and we can only keep it up so long. Ultimately, Laura must want to eat and keep down what she does eat.”
For nearly a minute, there was silence in the room.
“Kel,” Jim finally broke the silence. “No disrespect, but you’re not a psychiatrist; you’re not even a GP. What if you’re wrong?”
“Jim!” Carolyn said in despair.
“It’s all right, Carolyn,” Kel replied then turned to face her husband. “You’re right; I’m not a psychiatrist. That’s why I’ve asked Dr. Adams, one of our staff psychiatrists, to consult on Laura’s case.”
“You did what?” Jim cried out.
Kel took another deep breath. “Laura’s condition has to be managed both physically and psychologically. There’s only so much we can do to deal with the symptoms of her disease. We also have to figure out why she’s doing this to herself. That’s where Dr. Adams comes in.”
Jim turned on him as if they were the only two people in the room. “My daughter does not need to see a psychiatrist.”
Kel stood up from his desk. “I think she does.”
“Look, Doctor Brackett,” Jim said, emphasizing each syllable. “I’ve known my daughter for nearly sixteen years. You’ve been treating her for just over 24 hours. I think I know what’s best for her.” The veins in his neck bulged. “Now, when will she be ready to leave this hospital?”
“I wouldn’t recommend you take her home at this time.”
“That’s not what I asked.”
Kel clasped his hands together in a not too successful effort to control his frustration. “She can go home later today.” His jaw was tight. “But if you take her, you do so against medical advice.”
“I understand.” Jim Sullivan pushed himself away from the wall. “I appreciate what you’ve done for Laura up to now, but I also think it’s time we found someone else to take care of her.” Without waiting for a response, he strode from the room.
“I’m sorry, Kel.” Carolyn’s voice was soft. “He’s upset.”
“I’m the one who’s sorry, Carolyn. Sorry that I couldn’t make him see how serious Laura’s condition is.”
“What could happen to her?”
“That’s hard to predict. It’s possible that I’m wrong and that she’ll start eating again on her own.”
“And if you’re not – wrong, that is?”
“She’ll continue to find ways to starve herself. Without proper help, she could die.”
Captain Stanley wiped his napkin across his mouth and set it on the table. “Roy, John, I think you’ve got cleanup.”
Johnny chewed the last piece of hamburger. “I know, I know.” He turned to Roy. “What’d you say, I wash, and you dry?”
Roy didn’t look up. “Whatever.”
Johnny shook his head. It had been several days since the new schedule had come out and Roy was still in a funk. It was starting to get on his nerves. As the others slowly drifted away from the table, Johnny took up his place at the sink. He set the plug in the drain, dropped in a large blob of liquid soap and started the warm water running. By the time he got the temperature just right, Roy had joined him, towel in hand.”
“Roy,” he said quietly, “you still stewing over the schedule change?”
“I don’t want to talk about it.”
“Why don’t you just switch with Dwyer or Bellingham?”
“I said I don’t want to talk about it.”
“Well, maybe you should.” Johnny dumped a set of plates into the sudsy water. “You’re driving everyone nuts.”
“Look,” Roy hissed, “just because you’re my partner doesn’t give you permission to run my life.”
“I’m just trying to help out. I know how much you want to go fishing with Chris—“
“You don’t know anything!” Roy tossed his rag on the counter and strode out of the dayroom. Five sets of eyes followed him.
Captain Stanley sauntered up. “Is there a problem I should know about?” he asked softly.
Johnny switched his gaze from the door Roy had just exited to his captain’s face. “Yeah, Cap, you probably should.” He shrugged. “But I’m not the one who should be telling you.”
“Tell me anyway. In my office, now.”
Johnny knew it wasn’t a request.
“Chet, Marco,” Stanley called over his shoulder. “Finish up the dishes.”
Chet started to argue but one look at his Captain’s face silenced any protest.
As they walked toward Stanley’s office, Johnny looked for some sign of Roy. This was Roy’s problem; he should be talking to Cap. Johnny had no interest in being the fink. On the other hand, Cap needed to know about any issue that could compromise the effectiveness of his men.
Johnny was two steps inside Stanley’s office when the tones went off. “Station 51, child injured at Rockaway Amusement Park.” Johnny turned on his heel and jogged toward the squad, Captain Stanley on his heels. “400 Rockaway Boulevard,” the dispatcher’s voice droned over the loudspeaker. “Four-zero-zero Rockaway Boulevard, cross street Harrison. Time out, twelve fifty-nine.”
Johnny always felt a certain thrill riding down the road, sirens blazing, cars veering out of their way. He knew where they were headed. Rockaway was a small amusement park on the outskirts of the city. Nothing to compare with Disneyland or Knott’s Berry Farm, Rockaway was geared to very young children; once they graduated to the scary rides, they moved on. He glanced over at his partner and started to ask if Roy had ever taken his kids there. One look at the stony expression on Roy’s face silenced him.
A security guard flagged them down at the park entrance. “Follow me!” They followed him his car along a winding path past a series of rides with names such as Flying Elephant, Cherry Choo-Choo, Apple Dumpler, and Wild Water River Boats. A glance in the rear view mirror confirmed that somehow Mike had managed to navigate the engine through this tortuous path. The park had only opened an hour earlier and was relatively uncrowded; the few families who were strolling the grounds seemed more interested in the fire engine than the
The security car stopped at a ride called “Rocket Ship to the Stars.” Despite its name, the ride was no different than a dozen others in the park, all of which consisted of a contraption that moved up and down while slowly circling. In this case, it was six rocket ships. The ones near ground level were empty. Two, frozen approximately fifteen feet in the air, were occupied. As he and Roy stepped out of the squad, they could hear shouts.
“Up here! We need help up here.”
Looking up, Johnny saw a woman standing in one of the rocket ships waving her arms. At the same time, a uniformed park employee ran up to them.
“Darn thing is stuck,” he said, pointing to the ride. “Everything was okay – we were working on getting it fixed, getting them down. Then, the lady in that one up there,” he pointed in the direction of the woman who had just been screaming, “she starts yelling that her kid’s having some sort of attack.”
Captain Stanley joined the group. At this last comment, he motioned toward his men. “Marco, Chet, bring a ladder.” He pointed toward the ride. “Roy, John, that thing has some weird angles. I’d rather set you up against the middle there and let you climb on out. Whaddya say?”
“Help!” Again the woman screamed from the top of the ride. “You have to help us!”
Roy started to jog back to the squad. “I’ll get the gear.”
Johnny turned toward the screaming woman. “Ma’am, we’re on our way,” he called up. “You need to stay calm and sit down until we get there.” He turned to Captain Stanley. “Cap, we need to try to keep her calm.”
“I’ll do my best, pal.”
By the time Chet and Marco ran past him with the ladder and propped it against the base of the ride, Roy had returned with their gear.
“I’ll go up,” Johnny volunteered. After securing the ropes, he quickly made his way up the ladder and began to scoot across the pole extending out to the rocket ships. As he neared the scene, the woman continued to shout.
Johnny heard Captain Stanley’s voice from the ground. “Ma’am, our paramedic is on the way. You need to stay calm. He’ll be right there.”
“I’m almost there, ma’am.” Johnny added. “Please sit down. We don’t want you falling out.” He pulled himself a few feet closer until he hovered directly outside of the rocket. Peering inside, he saw a small girl gasping for breath.
“Oh, thank God,” the mother said to him. “Please help her, she can’t breathe.”
“That’s exactly what I’m here to do.” Johnny tried to reach into the capsule to assess the girl’s condition. “What’s her name?”
“Naomi. Naomi Hartman. She’s only six.”
“Okay, I’m going to take good care of her. I need you to stay calm for me, okay?” The small size of the capsule made any meaningful assessment nearly impossible. “Ma’am, does you daughter have asthma?”
“Has she ever had anything like this happen before?”
“Cap!” he called down. “We have a child with difficulty breathing. There’s no room to work up here. I’m going to send her down.”
“Okay,” was the reply. As Johnny manipulated the ropes around the girl’s body, he was vaguely aware of Chet and Marco setting up to receive his lines. He had no doubt that Roy was already on the phone to Rampart advising them of the situation.
“What are you going to do?” the mother asked nervously.
“I can’t treat her up here. I’m going to get lower both of us to the ground. Don’t worry, someone will be back to get you right away.” He looked down at the girl as his fingers nimbly fingered the ropes and pulley. “Okay, Naomi, I’m going to put some of these ropes on you and then we’re going to take a little ride together. How’s that sound?”
“Hey, Johnny?” It was Roy’s voice. “Got any vitals on the girl?”
“Pulse 112 and weak, respirations 28,” he shouted down. He tossed his line to the ground below. “Ready?” he called to Chet and Marco.
Johnny carefully lifted the girl out of the capsule and hugged her to his chest. “Okay, Naomi. Here we go.” He could feel her wheezing and struggling to get enough air into her lungs. Once she was secure, he carefully swung his leg so that he was sitting on the edge of the bar. Then, as slowly and gently as possible, he lowered himself over the edge, bracing himself for the sudden impact of her dead weight in his arms. As he was lowered to the ground, he got his first good look at his small patient. He imagined she was quite cute when she wasn’t gasping for air. Right now, though, her face was contorted and her eyes pained. “Hold on, Naomi, we’re almost there.”
An instant later, his feet touched the ground and Cap immediately grabbed the girl from his arms and carried her over to a waiting Roy. By the time Johnny had unhooked himself and crossed over to his patient, Roy was on the phone with Rampart.
“—is 116 over 76. Breathing is labored. Lungs have wheezes in all lobes.”
“51,” Dr. Early’s voice came across the biophone, “is there any history of asthma?”
Johnny couldn’t help but smile – Dr. Early always seemed to draw the little kids which was good because, among all the docs in the emergency department, Early had the best rapport with them. Johnny shook his head in response to Early’s question.
“Negative, Rampart,” Roy replied.
“Sounds like an allergic reaction. Check for signs of insect bite.”
Johnny dropped to his knees as he and Roy simultaneously searched the girl’s limbs.
“Roy, here.” Johnny pointed to a small, inflamed spot near the girl’s ankle.
Roy grabbed the biophone. “Rampart, patient has a small wheal near the ankle.”
“Ten-four, 51. Start an IV, normal saline. Give 0.3 cc of 1 to 10,000 epinephrine IV push.”
Roy repeated the orders as he grabbed for the needed supplies with his free hand. “Johnny, you wanna start the IV; I’ll get the epi ready.”
Johnny noted that Roy was as professional as always. That was the problem. He and Roy had always approached their job with passion. Now, within a space of a few days, all of that seemed to have drained out of Roy. Now he functioned as an automaton other than for starting IVs. Without thinking, Johnny murmured soothing words to Naomi as he slid the IV needle into her vein. How many IV’s had he done in his career? How many had he done in the past several days? He paused as he taped the line into place. He knew the answer to that one. He’d done them all. The thought stayed with him as he climbed into the ambulance. He’d done them all.
“Well, young lady, you’re set to go home.” Kel smiled down at Laura as he made some final notations in her chart. “You have to continue with the antibiotics.” He looked away from his notes. “It’s important to take all of them.”
“And if your arm starts to hurt or swell, make sure you come back to the hospital right away. Got it?”
“Or, if you just want to talk.”
“It’s okay,” Laura responded with a smile. “I know where you live.”
“Well, I’d best get your parents so you can get out of here.” He turned to leave.
“Dr. Brackett?” Her voice stopped him. “Is my dad mad at you?”
Kel laid Laura’s chart on the bedside table. “Let’s just say that we have a difference of opinion on how best to take care of you.”
“You’re the doctor, aren’t you?”
Kel couldn’t help but smile. “Yes, but the patient doesn’t always have to follow her doctor’s advice.”
“Well, if I’m the patient, how come nobody asked me?”
“You’re also a minor.”
“So my dad gets to decide what happens. I don’t get a vote?”
“Laura, at the end of the day, you’re probably the only one who will decide what happens to you.”
“My mom says I have to eat more.”
“It’s a little more complicated than that.” Kel paused. There was so much more he wanted to say but Jim Sullivan had warned against mentioning anorexia to his daughter.
“Well, I’m glad to get out of here, whatever the reason.” She sat on the side of the bed, her long legs dangling over the edge. “I can’t wait to get back to rehearsing. Next month it’s the audition for the city ballet. Mr. Thomas thinks I have a good chance of getting a spot as a primary dancer.”
“Next month,” Kel replied carefully. “Don’t you think that’s a little soon?”
“They only hold auditions once a year. If I don’t make it now, I’ll have to wait ‘til next year. And if I make it, even as an understudy, it’ll really help my chances of getting into Julliard.”
“Laura, I know this audition is important, but –“
“No, you don’t know, Doctor Brackett. I’ve worked my entire life for this. My dance company is good but it won’t get me anywhere. I just have to make it into the city ballet.”
“I’m not sure you’ll be ready, medically.”
“I feel fine.” As if to prove her point, Laura jumped off the bed and twirled around the room. “See. No dizziness, nothing.”
Kel shoved his hands into the deep pockets of his lab coat. “I don’t need to tell you that dancing around a hospital room isn’t the same as auditioning for a major production. And it’s not just the physical stress I’m worried about.”
“Well don’t. Worry, that is.”
Kel grimaced. “Occupational hazard.”
Before he could say more, Carolyn poked her head into the room. “All ready to go?”
It took only minutes to get Laura situated in a wheel chair. As she rolled down the hall, Kel’s eyes reflected his concern.
Kel arched a kink out of his neck as he stepped out of the treatment room. After twelve hours and he didn’t know how many patients, he was calling it a day. He glanced at his watch. He could finish writing orders on this last patient, change clothes, and still make it to his tennis match on time. The thought brought a smile to his face. There was nothing like pounding a tennis ball for an hour to relieve stress.
At the base station, Johnny and Roy were in their normal positions surrounding Dix. Johnny looked animated, Dixie tolerant, and Roy – Roy looked distracted.
Kel nodded at his paramedics. “Morning, folks.”
“Hey, Doc,” Johnny replied with a hint of impatience.
“Don’t let me interrupt your story, Johnny,” Kel said giving Dix a sly grin.
“Yeah,” Johnny said, returning his attention to the head nurse. “So, you see, it’s her birthday on Monday. I want to get her something that says I like her and that I didn’t forget. But we’ve only gone out once, so it can’t be something that says I like her too much because it might turn out that I don’t like her as much as I think I do.”
Kel shook his head. He couldn’t begin to figure out that comment and only hoped Dix had some clue what the young paramedic was trying to say. Meanwhile, this was his best opportunity to talk to Roy. He flipped the chart closed and put away his pen. “Roy,” he said softly. “Got a minute?”
Roy looked up sharply. “Sure, Doc. What’s up?”
“I’m thinking of making some changes to the paramedic training program and wanted to run them by you.”
Roy shrugged. ”Yeah, sure.” The lack of enthusiasm in Roy’s voice was palpable.
“Do you want my input, too, Doc?” Johnny asked suddenly.
Kel wondered how Johnny could tell his own story and listen in on their conversation at the same time. “That’s okay, Johnny. I think Roy and I can handle it.” It was unclear whether Johnny got the implicit message or was more interested in Dix’s views on his girlfriend’s birthday but, whatever the reason, made no move to follow.
Kel led Roy to his office and shut the door behind them. “Have a seat, Roy.” Kel leaned gently against a bookcase. “Want to tell me what’s going on?”
Roy looked confused. “With what?”
“Cap called you, didn’t he?”
“Should he have?”
Roy didn’t answer. Kel waited patiently until Roy finally broke the silence. “I’m just struggling with a few things right now.”
Kel continued to wait.
“You know, Doc, it’s funny that you mentioned training, because I’ve been thinking that maybe that’s what I should be doing.”
Kel leaned further into the wall. “Why do you think that?”
Roy nervously rubbed his fingers together. “You know, Doc, that I’ve always been an ace at starting IVs.”
Kel gave him an encouraging smile. “As I recall, you were the best in your class.”
“Well, lately, it seems that I can’t start any. I’ve gone over the technique in my head a thousand times. Johnny’s even let me practice on him. But I can’t do it. I miss the vein, don’t go in far enough, go too far, all sorts of things.” The words were coming out in a rush. “Johnny’s had to cover for me every time for the last week now. I thought it was just – you know – one of those phases you go through. But it’s not getting any better.”
Kel crossed one arm over his chest and gently rubbed his chin with his free hand. He’d suspected something like this from the calls he’d taken from Squad 51. Roy was right – this sort of thing happened and not just to paramedics. Hospitals were filled with tales of interns who suddenly couldn’t draw blood, nurses who couldn’t find the right mark for injections. And, in most cases, all that took to right the situation was a bit of time. And in those other cases, it was only the symptom of a bigger problem.
“When did it start?” he asked gently.
“At that ballet thing. That young girl. Remember that I couldn’t get the IV started and you finally had to do it.”
“Roy, the only reason I got that IV started was that I cheated a bit with the lidocaine.
Roy didn’t look convinced. “Yeah, okay. And what about the other dozen times?”
Kel started to answer when he thought of something Roy had said earlier. “Roy, why did you think Captain Stanley had called?” It was unlikely that Hank Stanley would have called him about the IV situation. There had to be something else at play.
“It’s nothing, no big deal.”
“Why don’t you just tell me and let me decide how big a deal it is.”
“Doc, it’s just station stuff. Stupid stuff. You really don’t want to hear this.”
Kel simply waited.
“It’s about a fishing trip and . . . .”
“I was supposed to have next weekend off. And then—“
“Dr. Brackett, to base station.” Kel instinctively looked up when he heard the page. “Dr. Brackett, to base station.”
“I’m sorry, Roy,” Kel said as he strode toward the door. “I want to finish this. When’s your next off day?”
“Come see me then. How about two o’clock?”
“Dr. Brackett, I appreciate this, but I really don’t think . . .”
“Roy, it wasn’t a suggestion. Two o’clock Friday.
“Yeah, two o’clock.”
“So, tell me Dix, what did I do wrong?” Kel peered at his colleague over the brim of his coffee cup.
“Kel, what makes you think you did anything wrong?”
“Well, I’m no longer her treating physician.”
The Laura Sullivan case had been festering for days. Kel had reviewed his actions and treatment decisions more times than he cared to count, trying to figure out where he’d made a mistake. Finally, in desperation, he’d solicited Dix’s opinion. As was often the case, the only time and place they could find to talk during the workday was the hospital cafeteria.
“I should have turned the case over to Joe or to Abramson,” Kel continued. “Someone who didn’t know Laura or her parents. I let myself get too close, lost my objectivity. I should know better.”
Dix put down his fork and leaned over the table. “Kel, the only thing that you did was care about Laura.”
Kel stared at his best nurse and one time girlfriend. Nurturing came naturally to her and she wasn’t ashamed to admit it. Yet, Dix could also be tough as nails when she needed to be. Somehow, she managed to achieve just the right balance – something he’d never been able to do.
“You’re right,” he admitted. “I do care about her, Dix. For some darn reason, that kid has gotten to me. Heaven knows why.”
“It’s not a crime, Kel. Doctors are allowed to care about their patients.”
“Yeah, well, maybe if I cared a little bit less about Laura I’d be a better doctor to her.”
haven’t done anything wrong. The fact
that her parents are too stubborn to accept her disease isn’t your fault.
Kel wasn’t surprised that Dix came to his defense. “Isn’t it my job to make them accept it?”
“I don’t need to tell you that patients – and especially parents of patients – don’t always act rationally. Especially where the disease involved is anorexia.”
He gave her one of his habitual half-grins. “You’re right about that, Dix. But I still can’t help feeling that I bungled it.”
“Bungled what?” came a familiar voice from behind them.
“Have a seat, Joe,” Kel said. “Dix and I were just discussing my mismanagement of the Laura Sullivan case.”
When Joe didn’t pick up on the patient name, Dix said, “the young woman with anorexia.”
“The one whose parents fired me,” Kel added and jabbed his fork into his salad.
“It happens, Kel. Need I remind you about that case last year where I wouldn’t order a GI series because I was convinced the young girl was pregnant. You may recall that her father fired me as her doctor and tried to move her out of this hospital.”
“But in the end you were proven right.”
“And you will be too.”
“I kind of hope I’m not,” Kel replied with a wry smile as he pushed his food around the plate. Suddenly, he banged his fist on the table. “Dammit, I’m worried about that kid. Worried about what’s going to happen to her. And I hate being powerless to do anything about it.”
Dix and Joe looked at each other. Joe was the first to speak. “I wish we had a magic answer for you. But you can’t force the girl’s parents to let you treat her. You’ve given them your best medical advice – advice, by the way, that is based on years of experience. What they’re doing may be misguided, but it’s not illegal. At some point, you have to accept that there’s nothing more you can do. You know that happens a lot more often than we’d like.”
Kel leaned back in his chair. “You’re right, Joe. Intellectually, I know you’re right. But that doesn’t make me feel better.”
“Unfortunately, at this point, nothing will. Except maybe time.”
Rays of sun warmed Kel’s face and shoulders as he strolled toward the end of his driveway to retrieve the morning paper. He reflexively glanced at his watch then up at the cloudless sky, reevaluating plans to go into work a few hours early to catch up on some paperwork in favor of a short tennis match. Of course, that’s exactly what he’d done for the past two days and the pile of charts and other paper in his inbox had only grown larger.
He unfolded the newspaper and scanned the headlines. Some former governor named Jimmy Carter was starting to pull ahead in the Democratic primary. Whoever won would have more than a fair shot to defeat Gerald Ford, who was still in trouble over his pardon of Nixon. But a governor of Georgia . . .
“Hey, Doctor Brackett!”
By the time Kel turned around, Laura Sullivan had pulled alongside his driveway on her bicycle. She came to a stop and rested her feet on the pavement. “Haven’t seen you in ages.”
No, Kel thought to himself, not since your father prohibited me from treating you. “I guess it has been awhile,” he said aloud. “How’s your arm?”
“Oh, it’s fine.” She waved it at him. “Got it checked like you said. Some doctor my dad likes.” She paused for a moment. “I wish you were still my doctor.”
Kel smiled. “I spoke to Dr. Entman personally, and I’m sure you’re receiving fine care.”
“I guess so. Well, you know that I’m still dancing. I started last week with this new instructor . . . “
While Laura prattled on about her latest adventures in the ballet, Kel took the opportunity to examine the young woman with his eyes, not liking what he saw. He would have sworn that she’d lost weight since she’d been discharged from the hospital. Her skin had an unhealthy pallor, her eyes were sunken, her skin lacked elasticity.
“. . . so hopefully it’ll all come together on the big day,” she finished.
“And what day is that?” Kel asked, trying to work his way back into the conversation.
“I just told you.” Laura sounded exasperated. “I have the audition for the city dance company on the 14th.”
“So soon? I’m not sure you’re up to that right now.”
“What do you mean? I’ve been working like a dog these last couple of weeks.”
“That’s exactly what I mean. You look tired, Laura.”
Laura’s hands clamped on her hips. “Is that all you ever think about, medical stuff?”
Kel tried a half smile. “Sorry.”
“Look, Dr. Brackett. I don’t think you know how important this audition is to me.”
“And I don’t think you know how dangerous it can be.”
“I’m not doing anything the other ballerinas aren’t doing.”
“I’m not worried about the other girls; I am worried about you.”
“Well, don’t be.”
The defiance written across Laura’s face warned Kel to back off. He forced himself to relax his muscles. “Laura, let me put it this way. I know sometimes I say things that you don’t want to hear. But I do want what’s best for you.”
“Then wish me luck on my audition.”
As if there was a choice. “I do. Be sure to let me know how it goes.”
“Oh, it’ll go great, Dr. Brackett. I’m sure of it.”
“So, Dix, got that schedule worked out?” Kel stepped around the base station to grab a cup of coffee.
Dix was huddled over the monthly nursing schedule, pencil in hand and a very large eraser on standby. “It’s harder than it looks,” she said irritably.
Kel raised his hands in mock surrender. “I’m not doubting you for a minute.”
“What’s so hard are the nurses with families. They want to be there for their kids’ recitals and softball games and birthdays. They want Christmas off and all the school holidays. And I tell you, Kel, I understand it. But it’s not fair to those of us who don’t have kids to take all the crappy schedules.”
He nodded in understanding. He faced the same juggle with the physician schedule, although he had the luxury of having a bunch of residents who could be counted on to work extraordinarily long days. “I know.”
Carol, one of the more senior emergency department nurses came around the corner, also headed for the coffee urn. “Am I going to be able to have next Saturday off?" she asked Dix. “It’s my son’s violin recital.”
“I’m trying, Carol, I promise.”
The base station wall phone rang.
“I’ll get it,” Carol said, grabbing the phone. “Rampart Emergency.”
Kel saw her frown.
“Uh-huh,” Carol said into the mouthpiece. “Right. Ah, just a minute. Stay on the phone with me.” She turned to Dix. “Hey, Dix, there’s a kid on the line. Says he was told to call this number if anything bad happened.”
Dix sighed as she pulled herself off of her stool and gave Kel a look of exasperation. “Oh, great.” She took the phone from Carol.
Kel grabbed a chart from the rack and scribbled his treatment notes, only half listening to Dixie’s part of the conversation. He’d barely finished the first entry when Dix called to him. “Kel, it’s Chris DeSoto. Roy’s son,” she explained. “Says his mom is sick. Roy must be on a run because Chris said he called the station and no one answered.”
Dix shook her head. “I’m not sure he’s sure.”
Kel motioned for the phone. “Chris?”
“Yeah,” answered a young voice that sounded scared. Kel tried to remember the child’s age. Must be seven or eight by now.
“This is Dr. Brackett. I understand that your mom is sick. Can you tell me what’s wrong with her?”
“She fell down.”
“Is she conscious—“Kel realized the boy might not understand the term. “Is she awake?”
“She is now.”
“How long was she – not awake?”
“She said her stomach hurt and then she went to bed but she fell and wouldn’t wake up. Then she woke up.”
Kel snatched the nearest scrap of paper and scribbled to Dix to send an ambulance and squad to the DeSoto home. “Chris, can I talk to your mother.”
“She’s in the other room.”
Kel sighed with exasperation. Discussions with young children were not his strong point. “Chris, listen to me very carefully. Whatever you do, don’t hang up the phone, okay?”
“Is there a phone in the room where your mom is?”
“Okay, now here’s what I want you to do. I don’t want you to hang up. I want you to put down the phone, go into your mom’s room and pick up the phone in there. Do you understand?”
Kel heard the sound of the phone being placed down and said a small prayer of thanks that the boy hadn’t hung up. As he waited, Dix handed him a note indicating the squad’s ETA was approximately five minutes. Finally, there was the sound of an extension being picked up.
“Someone on the phone wants to talk to you,” Chris said in the background. Then, into the phone, “Here’s my mom.”
“Hello,” came a weak voice that Kel recognized as Joanne. “Who is this?”
“It’s Dr. Brackett.”
“Dr. Brackett? What’s going on?”
Kel briefly explained that Chris had called the hospital.
“He shouldn’t have done that.”
“He did exactly the right thing,” Kel replied “The paramedics are on their way. You should send Chris to let them in.”
“Paramedics? Is Roy coming?”
Kel silently mouthed the question at Dix, who shook her head. “No, Roy’s on a call and we haven’t reached him yet. Another squad is responding. I need you to stay on the line with me until they arrive.”
“Okay,” she replied in a tired voice.
“Can you tell me what happened?”
“My stomach’s been hurting most of the day. I’d been fixing lunch for the kids and got a little lightheaded. I almost made it to the bed, when I think I passed out.”
The sound of an approaching siren could be heard in the background. “Do you know how long you were unconscious?”
“Just a couple of seconds, I think.”
“How are you feeling now?”
“Okay, maybe a little weak. And my stomach still hurts.”
Kel heard Chris screaming in the background and Joanne tell him to “let them in.” Less than a minute later, Paramedic Craig Brice was on the phone. He quickly provided vitals and a clinical assessment of Joanne’s condition. Although the terminology was more technical, Brice essentially provided the same information that Joanne herself had given him minutes earlier.
“Start an IV, normal saline, TKO and transport immediately.” Any real diagnosis would have to wait until Joanne arrived at Rampart.
Kel heard the surprise in Brice’s tone. It was against procedure for the doctors and paramedics to refer to each other by name during calls but right now Kel couldn’t care less. “See if you can find a neighbor to take care of Roy’s kids or, if you need to, bring them in.”
The minute the call ended, Kel turned to Dix. “Find Roy.”
“Ah the glamour of being a firefighter-paramedic,” Johnny thought to himself as he swiped at the sweat pouring off his forehead.
The station had responded to a single vehicle accident – tractor trailer meets abutment. The truck driver had not been injured, although the same could not be said for the concrete barrier. What would normally be a quick call to the wrecker had been complicated by the fact that the tractor-trailer was carrying gasoline, some of which had spilled across the highway. A foam truck had been called in.
Now, Johnny and the other members of Station 51 were assisting the foam crew in hosing down the roadway. Of course, turncoats were a must when dealing with hazardous material. On a hot day like this, heat radiated downward from the sun and upward from the scorched cement. The heat and humidity met at him. Again, he took one hand off the hose and wiped away the perspiration.
“Cap says another twenty minutes should do it,” Marco called from behind him.
“Seems like we’ve already been here twenty hours,” John replied, shouting to be heard over the sounds of the hose and foam. “Why do people always have to pick the hottest days to have hazmat accidents?”
A few minutes later, Marco nudged him in the back. “Better look sharp. Cap’s on his way over.”
Captain Stanley was indeed jogging toward them, a firefighter from the foam crew trailing him.
“Hey, Johnny!” Cap yelled. “Rosenberg will take over. I need you to come with me.”
What had earned him this reprieve? Maybe one of the firemen had been injured. He looked over his shoulder at Marco, who only shrugged.
Johnny exchanged responsibility for the hose with his replacement and quickly followed Cap. “What’s going on?” Johnny asked the moment they’d cleared the scene.
“Dispatch called. Joanne’s been taken to Rampart.”
“What happened?” Johnny picked up his pace.
Cap shook his head. “Didn’t get any details.”
They found Roy seated on the back of the engine, drinking deeply from a thermos. Roy’s eyes narrowed at their approach.
“Roy, you and Johnny need to get over to Rampart right away.”
“Cap?—“Roy started to stand, a quizzical expression on his face.
“Roy.” Cap put his hand on the paramedic’s shoulder. “Dispatch called and said that Joanne’s on her way to the hospital. That’s all we know right now.” He turned to Johnny. “I’ll call you guys out of service and Johnny’ll drive you over. Take as long as you need, pal.”
“Come on, Roy,” Johnny said, reaching for his arm. “We’re wasting time standing here.” Johnny headed for the squad, relieved that Roy was following. He approached the driver’s side. “Lemme have the keys.”
“I’m driving,” Roy said defiantly.
“Johnny’s driving.” Cap’s voice of finality came from behind them. Reluctantly, Roy handed him the keys. Within seconds, Johnny was ready to pull out.
“Hey, John,” Cap called out as they started to pull away. “Call me, pal.”
Kel was waiting when the ambulance bringing in Joanne DeSoto pulled up, starting his evaluation even as the stretcher rolled down the hall. “Room 2,” he said brusquely.
Once Joanne was settled in the exam room, she favored him with a stricken look. “Where’s Roy?”
Kel smiled reassuringly. “On his way.”
Joanne nodded and briefly closed her eyes.
“Now, let’s see about you. Tell me again when the pain started.”
“This morning, when I got up. At first, I thought I’d eaten the wrong thing.”
Kel went over what she’d eaten and confirmed no one else in the family was ill, his mind automatically running through the differential diagnosis for acute abdomen. Carol interrupted with new vitals, all of which were within normal limits. He carefully examined Joanne, noting tenderness in the lower right quadrant.
“Do you think it’s appendicitis?” Joanne asked when he’d finished.
Kel bit back a smile. She’d obviously learned a few things about medicine from being married to a paramedic. “Maybe,” he replied, gently rubbing his chin. He’d seen literally thousands of cases of appendicitis and Joanne’s symptoms just didn’t seem to fit the diagnosis. It was one of those gut instincts honed through years of practice – something difficult to explain to a resident. Luckily, today he didn’t have to. “Joanne,” he continued, “is there any chance you could be pregnant?”
“Pregnant?” His patient almost chuckled. “Well, Roy and I have been trying,” she added sheepishly. “I’m about a week late, but that’s not unusual for me.”
Kel turned to his nurse. “Carol, I want a CBC and beta-HCG. Tell them to put a rush on it.” He looked down at his patient. “Joanne, I’m going to get someone from OB/GYN down here to see you.”
Joanne sighed. “Okay, I’m not going anywhere.”
He gave her a wry grimace. “I’ll go check on the whereabouts of that husband of yours while Carol gets everything set up in here.” He turned at the door. “And Carol, let’s type and cross match for four units.”
Johnny, usually faster than his partner, found himself almost chasing Roy down the corridors of Rampart’s emergency department. “Roy, calm down, man.”
“You calm down,” Roy replied without turning around. “It’s not your wife in here.”
Dixie at the base station. To Johnny, it
seemed almost as if she was waiting for them.
“Where’s Joanne?” Roy asked, looking around wildly.
“Roy,” Dix said calmly, “why don’t we get some coffee and I’ll tell you what I know.”
“I don’t want coffee. I want to know what happened to my wife.”
“Joanne was brought in about a half-hour ago with abdominal pain,” Dix reported formally. “She was conscious and in good spirits, considering. Kel and Dr. Dawson from OB/GYN are with her now.”
“I want to see her.”
“They’re still examining her. Kel knows you were on your way. He should be out any minute to talk to you.”
“Dix, I want to see Joanne. I need to see her.”
“I know Roy, but not yet.”
“Come on, Roy,” Johnny said softly. His partner’s pain was almost palpable. “Let’s go wait in the lounge. You’ll tell Brackett where to find us, won’t you, Dix?”
She smiled. “Of course.”
Less than fifteen minutes had passed since they’d taken up station in the lounge, but, to Johnny, it seemed like ten times that long. He’d helped himself to a couple of cups of coffee. Roy had refused to eat or drink anything as he paced back and forth across the floor.
“Why don’t you sit down.”
“Why don’t you stop telling me what to do?” He spun around. “Where the hell is Brackett?”
As if on cue, Dr. Brackett entered the room.
Before the doctor could sit down, Roy peppered him with questions. “Doc, how is she? What’s wrong?”
Brackett headed for the nearest table and gestured for them to take a seat. Roy quickly sat down across from the doctor. Johnny remained standing in the background.
“Roy, Joanne is stable right now. She’s up in ultrasound.”
“Ultrasound? Dixie said she had abdominal pain. What’s wrong with her?”
Brackett leaned forward. “Based on my examination thus far, I’m pretty sure Joanne has an ectopic pregnancy.”
Roy sat back in his chair. “She’s pregnant?”
“Yes. But as you know, an ectopic pregnancy isn’t viable.”
Johnny mentally reviewed what he knew about the condition Brackett had just described. In an ectopic pregnancy, the egg implanted itself somewhere other than the uterus – usually in one of the fallopian tubes. As the egg grew, the tube would expand until it burst a serious medical emergency because the patient could quickly bleed out. He quickly refocused on Brackett.
“The beta-HCG confirmed pregnancy and I felt a mass in the right adnexal area,” the doctor continued. “Now, we’re just waiting for ultrasound confirmation.”
“Then what?” Ray asked.
“The treatment is surgical removal of the affected tube. Janet Dawson from OB is standing by to do the surgery.”
“I know this is a shock.” Brackett’s voice was kind. “It’s also very manageable.” He stood up. “Look, I need to get back. When Joanne finishes up in ultrasound, you can see her for a few minutes before she goes to surgery. I’ll have one of the nurses come find you.”
Roy only nodded.
Johnny moved to intercept Brackett at the door. “Is she really okay?” he asked softly.
“She will be, Johnny. Luckily, we got her in here in time. If that tube had perforated . . .”
Kel was waiting when Dawson emerged from the OR. As a surgeon, he recognized from the lack of tension in Dawson’s features that the surgery must have gone well, a fact Dawson herself confirmed seconds later. “Let’s tell Roy,” Kel said as the two physicians walked toward the waiting room.
Of course Johnny was waiting with Roy. Kel allowed the OB doctor to deliver the good news.
“The left tube looks good,” Dawson concluded, “so she shouldn’t have any problems getting pregnant in the future.” The doctor pulled off her surgical cap. “You should go home and get some sleep, Mr. DeSoto,” she said. “Your wife will sleep through the night.”
“Yeah,” Roy mumbled. “Thanks, Doc.”
Dawson nodded and excused herself. The minute she left, Roy dropped onto the room’s only sofa.
Johnny was the first to speak. “Roy, that sure sounds like good news to me.” He turned to Kel. “What’ya say, Doc?”
It was obvious that Roy was still worried. Kel allowed himself a smile. “I agree. The news couldn’t be better.”
“Come on, Roy, I’ll drive you home.”
“I’m staying here.”
“You heard what the doc said,” Johnny replied. “She’ll be asleep all night. And besides, the kids need you.”
“Joanne’s mother’s taking care of them,” Roy said tightly. “I need to be here with Joanne. Like I should have been today.”
Johnny turned to Kel with a “what can I do?” shrug.
Kel quickly assessed the situation. “Johnny, could you give us a couple of minutes?”
“Sure, Doc. I’ll go get some coffee.”
Kel signaled his gratitude with his eyes. The minute the door closed, he crossed the room in a few strides and took a seat in the chair across from Roy. “Roy,” he said, “your being at home today wouldn’t have made any difference in Joanne’s condition or the outcome.”
“I know that. But it would have made a difference to me.” He looked up with a pained expression. “You don’t understand, I’m never there! Not for her, not for the kids, not for anyone.”
Kel took a deep breath. “I do understand. It’s part of what I wanted to talk with you about. And we are still going to have that talk, but tonight isn’t the time.” He waited for a response from the paramedic. After a moment, he continued, “Would you like to see Joanne?”
For the first time that day, Kel saw a spark in Roy’s eyes. “Could I?”
Kel nodded. “For a minute. As Dr. Dawson said, she’s asleep.”
He remained at the back of the room while Roy stood next to the bed, holding his wife’s hand and speaking so softly that, only a few feet away, Kel couldn’t hear the words.
Finally, Roy turned toward him. “Thanks, Dr. Brackett.”
“No problem, Roy. She’s doing very well.”
“It just makes me feel better to, you know . . . “
“I know. Now how about you’re doing me a favor and going home. I’m on tonight and I promise to keep a close eye on her.”
“I don’t think so, Doc. I want to be here, in case—“
“Roy,” Kel said gently, “if I thought she were in any danger, I’d tell you. That said; if you want to stay, I’ll let you stay. You won’t do Joanne any good, though, and won’t do yourself any good either.”
Roy looked back over his shoulder at his wife.
“We’ll take good care of her.” Kel edged toward the door in the hopes that Roy would follow. He wasn’t surprised to find Johnny standing in the hallway outside the room. “Johnny will drive you home, right?”
Johnny gave him an encouraging look. “Course, Doc.” He subtly reached for Roy’s arm. “Come on, partner.”
Kel was somewhat surprised when Roy DeSoto showed up at his office two days later at precisely two in the afternoon. “Come in, Roy. Have a seat.” The tension in Roy’s body had clearly eased in the past 24 hours. “I take it you’ve seen Joanne this morning.”
“Just came from there. Dr. Dawson said they may let her go home tomorrow.”
Kel smiled. “That’s what I hear.” He stifled a yawn. “Now, that Joanne’s okay, let’s talk about you. What’s this about you joining the paramedic training program?”
“I’ve been considering it. The hours are definitely more regular and I’d have more time with Joanne and the kids.”
“I can’t argue with that. But is it what you really want to do?
“Doc, aren’t you the one who’s always saying how important it is for paramedics to get good training? I’ve been doing this longer than almost anyone. I think I could do okay as an instructor.”
“Roy, I have no doubt that you’d make an excellent instructor. Early on, I thought only doctors had the necessary expertise. And, I was probably right. But that’s no longer the case. More and more we’re relying on senior paramedics as instructors. If that’s what you really want, I’d recommend you in a heartbeat.”
“I appreciate that, Dr. Brackett.”
Kel held up his hand and gave a half smile. “I said ‘if’ that’s what you want.” He leaned back in his chair. “Roy, I spent most of my career as a thoracic surgeon. And, frankly, I was pretty good at it. Like to think I still am.” He smiled more broadly. “In any event, when the chance came to do emergency medicine, I jumped at it. I don’t know if was the newness, the fact that I could create something, or just my insatiable need to take on a challenge.”
He sighed. “And what did I get? A staff with no emergency training. An inadequate budget. Days begging in city hall and testifying at political hearings. Patients who filled my days with headaches, hangnails and hernias. And really, really long hours. I don’t how I would've handled it if I had a family.
“But in the midst of the chaos I discovered that I loved it. Loved the thrill of never knowing exactly what will come through that emergency room door. Loved training the first emergency residents. Loved watching the paramedic program – loved watching men like yourself become more and do more than I ever thought possible. Bottom line, Roy, is that I couldn’t ever go back to just doing surgery. I could, but I’d never be happy. So I trade the crazy schedule and everything that comes with it in order to do something I love.
“And that’s what you have to ask yourself – and Joanne. You’d be a great teacher, but would it make you happy? Would you come home from work every day at five satisfied, or would you always want to be out in the field?”
“I could try it for awhile, you know, see how it goes.”
Kel nodded. “You’re right, you could. But we both know that, if you decided to go back, it’s unlikely you’d be reassigned to Station 51. In fact, I’d probably recommend against it.”
Roy looked surprised.
“No, not out of spite,” Kel reassured him. “It’s just that there are so many new paramedics joining the program that I’d rather see you and Johnny paired with less experienced men.”
“I guess there’s a lot for me to think about.”
“Roy, I’d like to be able to tell you that you’ll go out on your next shift and be involved in some heroic rescue that will convince you to stay on as a field paramedic. But, unfortunately, that only happens in the movies.” He stood up. “Take a few days off. Take care of Joanne. Talk this over with her. Talk with Hank – he’s been doing this for a long time and he has a family. And I’m always here if you want to talk again.”
Roy also stood. “Thanks, Doc.”
Kel stayed in his office long after Roy had left, trying to decide if he’d done the right thing. Maybe he should have encouraged Roy to take the instructor position. He couldn’t really understand what it was like to have a family; the closest he’d ever come was his relationship with Dix and that hadn’t turned out well at all.
No, Roy belonged in the field as long as he wanted to be there. Kel suspected there would be burnout at some point – he’d already seen it with some of the emergency residents and even a few paramedics. But until that time came, until Roy wanted out because it was too much, he should stay. He should stay for the department, for the paramedic program and, most importantly, for the victims whose lives he’d save. And Kel would do what he could to make that happen.
The following morning Kel walked into Joanne DeSoto’s room.
“Dr. Brackett.” Joanne’s eyes widened in surprise. “I didn’t expect to see you making rounds on the GYN ward.”
He gave her a warm smile. “I’m not. But I can come as a visitor, can’t I?”
“I hear that you’re set to go home this afternoon.”
“Yeah, Dr. Dawson said she had some paperwork to finish up and that I’d be out of here after lunch.” She sat up slightly in the bed. “I haven’t had a chance to tell you how much Roy and I appreciate what you did.”
Kel held out his palms. “Just part of the job. You should thank your son, though. If he hadn’t had the sense to call us, things might not have turned out quite as well.”
“I know. He’s a good kid.”
Kel had come into the room without a patient chart and found himself fidgeting for lack of something to hold.
Joanne seemed not to notice. “Roy told me you all had a good talk yesterday.”
“Roy’s an excellent paramedic – maybe the best we’ve ever trained. Obviously, I’d hate to lose him.”
“It’s kind of ironic that the man who was dead set against the paramedic program is now doing his best to keep my husband in it.”
Her tone was light, but Kel didn’t miss the import of her words and, for a moment, didn’t answer. Joanne was right. He hadn’t forgotten the night at the birthday party when he and John Gage had exchanged harsh words about the future of paramedics.
With a brief incline of his head, he requested her permission to sit in the room’s only chair.
“Joanne,” he said when he was seated, “I was wrong about that, and I’m not ashamed to admit it.”
“I know, Doctor. And I also know that you’ve done more than anyone to make it a success. The men know it too.”
“As I said, your husband is one of the best paramedics we have. I’d hate to lose his talent and experience in the field. But—“he held up his hand to stop her from interrupting. “But, I also know that nothing is more important to Roy than his family.”
“And what’s most important to his family,” Joanne replied softly, “is that he’s happy. He took your advice and talked with Captain Stanley. The Captain explained a couple of things that they could try to make Roy’s schedule a bit more predictable. You know, Doctor, he really loves being a paramedic. I don’t want to be responsible for taking that away from him.”
“And I don’t want to be responsible for taking him away from you.”
“It’s not you. It’s this thing – this need – he has. I’m sure I can’t explain it and I’m not sure even Roy could, but it’s there and it always will be. So, I think we’ve decided to keep going – for a few months at least and see if things get better.”
Kel smiled broadly. “I must confess that I’m glad to hear it.”
“No guarantees, though.”
“There never are, Joanne, there never are.”
“Dr. Brackett to the base station. Dr. Brackett to the base station, STAT.”
Kel was evaluating an elderly man with chest pain when he heard the page over the loudspeaker. He pulled the stethoscope from his ears and glanced at the nurse assisting him. “Carol, can you stay with him? Get me another set of vitals, a CBC, ABG, SMA-12, UA and a chest x-ray.” He gave his patient an apologetic look. “I’ll be right back.”
As he approached the base station, he saw Joe Early through the window on the phone with one of the rescue squads. From Joe’s demeanor, Kel knew the situation on the other side of the line was serious and pushed his way through the door.
“Rampart.” It was Roy DeSoto. “Pulse is 100, respiration 15, and BP is 100 over 70. Patient is unresponsive to verbal stimuli. Has slight response to painful stimuli.”
Kel didn’t know why he’d been called – Joe could certainly handle this emergency. Whatever the reason, he knew better than to interrupt.
Joe nodded at him but maintained his focus on the rescue. “Any word on what she took?”
There was the slightest pause before Johnny responded. “Rampart, we found an empty bottle of secobarbitol.” Another pause. “Also, the victim may also have ingested alcohol.”
Joe shook his head, then again leaned forward into the microphone. “51, insert esophageal airway and administer 6 liters of O2. Then start a large bore IV with Ringers Lactate, TKO. Send me a strip as soon as possible.”
“Ten-four, Rampart. Airway, O2, IV with Ringer’s TKO, setting up EKG now.”
Kel took advantage of the break in transmission. “What’s up, Joe?”
“It’s the patient, Kel. Johnny and Roy say it’s the girl from the ballet – the one you’ve been so worried about.”
The speakerphone crackled. “Rampart, sending you a strip. This will be lead 2.”
The machine whined softly as it fed out a thin strip of paper. Kel stepped closer and studied the output over Joe’s shoulder. The screen showed an erratic rhythm, punctuated by PVCs.
“Can you give me updated vitals?” Joe asked.
“Stand by.” “Pulse is now 90, respirations 12, and BP is 95/60.”
Kel’s eyes remained on the EKG readout and he saw the rhythm change only an instant before John Gage’s voice rang out over the speakerphone. “V-fib.”
“Defibrillate,” Joe’s response was immediate. “200-watt seconds.”
Kel could hear Johnny counting as the defibrillator charged itself. “One, two.”
Then Roy’s voice came on. “Clear,” followed by the soft thump of the defibrillator shock. In the background, a woman screamed.
The EKG momentarily jumped off the screen then it righted itself. No conversion. Kel heard the whine of another charge as Joe gave the order to increase the wattage to 300 and defibrillate again. The machine reached its desired range but there was no sound indicating the paramedics had counter shocked. Instead, Kel heard what sounded like an argument on the other end of the line.
Joe had heard it too. “51, have you defibrillated a second time?” Joe’s voice had lost none of its soothing calmness – he could have been asking for a weather report.
Both doctors could now clearly hear the background discussion on the other end of the line. “Sir, you have to stand back and let us treat her,” Johnny said with obvious frustration in his voice.
“You’re not even doctors,” Jim Sullivan responded. “You’re killing her.”
“Sir, we’re on the phone with a doctor right now. If you don’t let us treat her, she will die. Do you understand?”
“Jim,” Carolyn begged, “don’t let her die. Let them help her. Please.”
Kel didn’t hear the response but, a few seconds later, Roy again called “clear” and the EKG transmission jumped in response.
“Sinus bradycardia, rate of 40,” Roy reported in a tired voice.
Joe glanced at the EKG to confirm the reading. “51, give .5 ml atropine IV. Transport and monitor vital signs en route.”
After the paramedics had acknowledged and signed off, Joe turned to Kel. “What’s going on?”
Kel briefly summarized Laura’s medical history. “I know that she had some sort of stressful audition right around this time. My guess is that something went very wrong.”
Kel was filling in notes in a patient chart when Johnny turned the corner with Laura Sullivan’s stretcher. Johnny’s expression made clear that her condition hadn’t improved. The stretcher quickly entered treatment room 2, met by Joe Early and a trauma team.
Not more than a minute later, Laura’s parents came running up to him.
“Where’s Laura?” Carolyn asked frantically. “What’s happening to her?”
Kel set down the chart. “She’s in there,” he said, pointing at the treatment room. Dr. Early is taking care of her. He’s one of our most experienced physicians.”
Carolyn pressed her hands against his shoulders. “Why aren’t you in there?”
Kel looked helplessly toward her husband. “You requested that I have nothing to do with Laura’s treatment,” he replied formally. “I promise you, Laura is in excellent hands.”
“But you’re the head of the department!” Carolyn cried. “You have to help her.” Her voice turned to a whimper. “Please help her.”
Kel looked at Jim. He looked like a statue, unable to comprehend the situation.
“Please, Jim, let Kel save Laura.”
Without a word, Kel crossed the hall toward the treatment room. Inside, Joe barked out orders. Kel might be Chief of Emergency Services, but Joe was still running this case.
“What can I do?” Kel asked.
Joe, bent over Laura’s still form listening to her heart, didn’t even glance his way. “She’s not getting enough air. We need to intubate.”
“Got it.” Kel ordered the correct size of laryngoscope from the nurse. With practiced precision, he tilted back Laura’s head, visualized the vocal cords, and inserted the airway that allowed her to breathe more easily.
“Do we have the barbiturate level back yet?” Joe asked to no one in particular.
“I’ll call the lab again,” the nurse replied.
Joe was watching the EKG. “She’s starting to fibrillate again,” he warned.
“Dammit,” Kel replied. “Get the paddles ready.”
“V-fib!” Joe called out.
Kel grabbed the paddles and pressed them against Laura’s chest.
“400 watt seconds,” Joe said.
Hearing the tone that signaled the requisite power was available, Kel cried “Clear!” and sent a shock wave through Laura’s body. It jerked convulsively on the table.
“Sinus rhythm at 60,” Joe reported. “Start a lidocaine drip.”
In the background, the phone rang and someone stepped over to answer it.
“It’s the lab,” the nurse reported. A moment later, she called out the drug level.
Kel and Joe exchanged a glance. The level confirmed that Laura had a high level of secobarbitol as well as alcohol in her system.
Two exhausting hours later, Laura Sullivan was in the ICU. They’d stabilized her heart rate and pumped her stomach. She was still on the vent but, if Laura’s condition continued to improve, they expected to wean her off it later that evening.
From what Kel had been able to learn, Laura’s audition hadn’t gone well. Despondent, a few days later she’d found the pills from her mother’s old secobarbitol prescription and swallowed them with her father’s gin. No one was home at the time and help was called only when her brother returned home from football practice and found her unconscious.
“She’s holding her own,” Joe commented, nodding at the monitors.
“Yeah,” Kel replied without enthusiasm. That was about all that could be said right now.
“Go home, Kel.”
“No, Joe. I’ll stay with her.”
“Look, she’s going to be out all night. I’m on anyway. Better you get some sleep so you can deal with it in the a.m.”
“I don’t know . . .”
“Kel, you’re dead on your feet. There’s nothing you can do here that I can’t. I’ll call you if anything changes.”
Joe was right. He was tired. “Want me to talk to the parents?” Joe offered.
“No. I’ll do that at least.” Kel shook his head. He handed Joe the chart and steeled himself to once again meet with the Sullivans.
This time, they were too numb to do more than listen while he explained what the combination of alcohol and drugs had done to their daughter’s already damaged heart and body. “So,” he concluded, “we’ll just have to wait. The next 48 hours will be critical.”
“She can’t die,” Carolyn murmured. “You can’t let her die.” Jim simply stroked his wife’s hair, begging Kel with his eyes to make this nightmare go away.
Kel wished he could. The hours he and Joe had spent trying to keep Laura Sullivan alive were taking their toll. During the emergency, he’d forced himself to remain objective, to treat Laura as any other patient. Now that the immediate crisis was over, he fought his own instincts to comfort her mother as a friend.
“You’re free to stay the night,” he said. “However, visiting hours are limited and you might be better off at home.” He rubbed the bridge of his nose. “Dr. Early is on tonight and will check on her. I’ll be back first thing in the morning.”
The Sullivans had more questions for which he had few answers. Laura’s hold on life was tenuous at best, despite all the treatment modern medicine could provide. After the parents had left, Kel was left to sort out his own thoughts. Why, why hadn’t Laura told someone, called for help? He knew when that stupid audition was -- why had he forgotten to check with her? Why hadn’t he done more to get Laura the psychological help she needed?
It wasn’t supposed to be like this. In emergency medicine, you treated the emergency and either sent the patients home or passed them on to some other doctor to deal with the long-term problems. They weren’t supposed to keep coming back.
He pictured Laura twirling so gracefully in her tutu and tried to reconcile that with the frail patient in the ICU with tubes coming out of every orifice. It didn’t seem possible that it could be the same person. What the hell had happened?
He briefly considered spending the night on his office couch. No, he had a full day tomorrow and his patients, including Laura, needed him fresh. Pulling a virtual all-nighter wouldn’t do any good. He forced himself out of the lounge chair before it became too comfortable. One last check on Laura and then he was headed home.
The piercing ring of his telephone jarred Kel out of his restless sleep. He rolled over to grab the offending instrument, noting the time was 3:29 a.m. He’d been asleep for less than three hours.
“Brackett,” he said into the mouthpiece. The instant he recognized the voice on the other end of the line, he didn’t need to hear another word.
“Dammit, Joe, what went wrong?” Kel banged his coffee cup onto his desk, causing a small amount to slosh over the edge. He didn’t even bother to try to clean it up.
“What makes you think something went wrong?” Joe Early sat across from him, sipping from his own cup of coffee.
“Maybe because Laura Sullivan died tonight.”
“And that’s your fault?”
“I’m her doctor. Or was her doctor.”
when did you decide that a doctor has to save every patient?”
“Don’t start that with me, Joe.”
“Kel, I’m not telling you anything you don’t already know or anything you haven’t said yourself to interns and nurses and paramedics.”
Kel relented a bit. “I know, I know. But this is different.”
“Why?” Joe asked. “Because the doctor involved is Dr. Kelly Brackett, Chief of Emergency Services and not intern Mike Morton or paramedic John Gage.”
Kel waved him off. “No, no, it’s not that. It’s just different this time.” He sighed and leaned back in his chair. “Maybe it’s because I knew her. That’s the thing about working in emergency; most of the time you don’t get to know your patients. They come in sick or injured, you take care of them, they get better or they don’t. Sure, it hurts to lose them . . .”
This time it was Joe who shook his head. “Nice try, Kel, but I’m not buying it.”
Kel looked up in surprise. “What do you mean?”
“This isn’t the first time you’ve treated patients you know. There was Dixie, the paramedics, even me. What’s special about Laura Sullivan?”
“I don’t know.”
“I think you do.”
“Let’s not play twenty questions, Joe. If you have something to say, say it.”
“All right, Kel. She got to you.”
“What do you mean?”
Joe shrugged. “I don’t know either of you well enough to know how or why, but something about that girl affected you more than maybe even you realized.”
Kel started to respond until he realized he had nothing to say.
“It’s not a sin, Kel, to care about your patients.”
“I care about all my patients,” he replied testily.
“And you cared about this one more than most.”
“I thought I’d reached her,” Kel said softly.
“Maybe you did.”
“Well, if I had, she wouldn’t be in the shape she’s in now, would she?”
“You don’t know that.” Joe took a sip of his coffee before continuing. “We both know that anorexia is a complicated illness. It’s not like surgery; you can’t simply excise the problem and move on to the next patient.”
“Joe, I’m good at what I do. But this time . . .” He shook his head. “This time, I got in over my head. I tried to be internist, psychiatrist, and emergency physician all at the same time and ended up doing a lousy job of all three.”
“Kel, what are the first two rules of medicine?”
“First, do no harm?”
“No, the real ones.” When Kel didn’t respond, he continued. “Rule number one is ‘patients die.’ And rule number two—“
“Doctors can’t change rule number one,” Kel answered in a tired voice.
“Even Kelly Brackett can’t change rule number one.”
“Hey, Doc,” Roy DeSoto greeted him at the base station a few hours later.
Having come in after Joe’s call about Laura, Kel was now running solely on adrenaline. “Hi, Roy.” He looked around. “Where’s Johnny?”
“Up on pediatrics.”
“Visiting one of the patients?”
“In theory. I think it has more to do with Nurse Jacobs.”
couldn’t help but smile. “I see.”
“Dix told me that young girl died this morning – the ballerina.”
Kel’s smile disappeared. “Yeah, her heart just couldn’t take it. The strain of the anorexia coupled with the overdose. I thought we’d done enough to bring her back, but it just didn’t happen.”
“I know she was your neighbor. I’m really sorry.”
“Me too.” He tried to lighten the mood. “How are things going with you?”
“Better. Finally got the IVs going again. Haven’t missed a stick since we talked.”
Kel nodded. “That doesn’t surprise me.”
“Just having talked about it with Joanne seems to have helped. You know, Doc, you were right that I didn’t have that big rescue to convince me it’s all worthwhile. But most days I feel really good when I go home. I feel like I made a difference. You know what I mean?”
“Yeah, Roy, I do.”
“Thanks again, Doc.” The paramedic gave him a slight smile and strolled down the hall.
Kel was left alone at the base station. “I know exactly what you mean,” he said aloud. “Just not today.”