IN GOOD TIMES AND BAD
Summary: Kel and Joe’s friendship is tested.
Disclaimer: The story and characters of Emergency! belong to whoever now owns them – and that’s not me. This work of fan fiction 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.
Rating: PG for a handful of mild swear words.
Author: Greer L. email@example.com
Author’s Note: I like to set my stories in the time period in which Emergency! originally aired – in the mid-1970s. It’s hard to believe, but things such as MRI's and laparoscopic surgery were not part of medical practice at that time and therefore will not find their way into my story.
“That was brilliant work, Kel.” Dr. Joe Early nodded toward the patient being wheeled down the long hallway of Rampart General Hospital’s emergency department.
“Save your praises until we see if he makes it,” Dr. Kelly Brackett responded. He snatched the surgical cap from his head and let the door close softly behind him. Kel had to admit that the impromptu thoracotomy they’d just performed was pretty darn exceptional. It would have been tricky enough in the OR, but they’d done it in a treatment room. Days like this made it all worthwhile. He felt good about his own work but even better about how well he and Joe worked as a team. Kel might run the emergency department but he always did his best work with Joe by his side.
“Oh, he’ll make it,” Joe replied. “No doubt about it.”
“I appreciate your vote of confidence, but—“ Kel leaned gingerly against the wall outside of the treatment room. The moment the back of his head touched the wall, he closed his eyes and grimaced in pain.
“Headache?” Joe asked solicitously.
Kel tried to decide if it would hurt less to speak or to nod. “Yeah,” he finally grunted. He’d been able to push away the pain during the last emergency but, now that the adrenaline rush had worn off, it was back with a vengeance.
“Maybe you should try some aspirin,” Joe suggested.
Kel opened his eyes and immediately closed them again. The glare from the fluorescent hallway lights only intensified the pain. “Four years of medical school, six years of residency, and twenty years in practice and you tell me to take two aspirin and call you in the morning.”
“I didn’t say to call me,” Joe said with a smile. He looked at his wristwatch. “I’m officially off duty. Actually,” he yawned, “I was officially off about two hours ago. See you tomorrow, Kel?”
Kel watched Joe amble down the hallway and wondered not for the first time to whom Joe turned at the end of a long day. He was reminded how little he really knew about the personal life of his closest colleague beyond the fact that Joe lived alone, was pretty good on the piano, was widowed and had a daughter that lived far enough away that they rarely saw each other.
What Kel did know was that the man was a top neurosurgeon, an excellent emergency physician, a great teacher and, most importantly, the one doctor in his department who was never afraid to tell Dr. Kelly Brackett exactly what he thought. It had been Joe’s quiet persistence that helped change Kel’s mind about the paramedic program. Joe had been right – that time, and so many others. As Kel made his way toward the base station to dictate his surgical notes, he was reminded once again that his personal success, and the success of Rampart’s emergency department, were due in large part to Joe Early.
Some days were simply crazier than others, Kel thought to himself as he exited the treatment room and was greeted by the flashing light over the base station that indicated an incoming call. He’d come on duty six hours ago and had yet to sit down for one minute. He quickly crossed the corridor, on the way ditching the chart from his last patient.
He depressed the button that sent his voice over the airwaves and also started the machine that would record the entire transmission. “Squad calling in, please repeat.”
“Rampart, this is Squad 51.”
Kel recognized the voice of paramedic Roy DeSoto.
“Go ahead, 51.” Kel pulled a pen out of his lab coat pocket and grabbed a nearby pad of paper.
“Rampart, we have a male victim, approximately 70 years old. Victim was doing yard work approximately thirty minutes ago when he started experiencing chest pains and difficulty breathing. Has history of hypertension, controlled with medication. Patient is currently awake and oriented. Skin is pale and dry. Pulse is 150 and faint, respirations are 32 and labored and BP is 98/64. We’ve started the patient on O2 and are patching him in now.”
Kel’s first thought was MI – myocardial infarction or heart attack. It was certainly the worst possibility at this point and, therefore, the one he had to rule out first. The whine of the EKG transmitter signaled an incoming transmission. Kel studied the paper readout for several seconds before again depressing the transmit button. “51, I read ventricular tachycardia. Continue the O2 at fifteen liters per minute. Start an IV, D5W. Administer a bolus of 150 mg lidocaine and start a lidocaine drip. Transport as soon as possible.”
“IV D5W, lidocaine bolus, lidocaine drip, O2 at fifteen liters,” Roy repeated back.
“Oh, and 51, get me updated vitals once you’ve got that lidocaine in.”
A few minutes later, Kel stepped out of the small room to find Joe at the base station sipping a mug of steaming coffee. A few feet away, head nurse Dixie McCall hunched over a small stack of papers. Kel suspected she was working on next month’s nursing schedule.
“Whatcha got?” Joe asked glancing at him over the rim of his cup.
“Chest pain, respiratory difficulties. Possible MI. Should be here in about five minutes.”
Dix lifted her head. “I’ll set up room one.” She swirled off of her stool and headed down the corridor.
“Busy day,” Kel said.
“You wouldn’t have it any other way,” Joe replied with a smile.
“Yeah, I guess not.”
Joe took another sip of coffee. “Speaking of busy, where are you going on vacation this summer?”
Not this again. It seemed that, for at least the past month, every conversation with Joe centered on vacation. Where people were going, when they were going, how long they were staying. He was tired of hearing about it and especially tired of talking about it. “Vacation? Who’s got time for vacation?”
“I do,” Joe said. “Heading to Napa at the end of August. Ten days of wine tasting.”
Kel had to admit that did sound interesting. He’d never been to the California vineyards and had heard great things about the tours, scenery and especially the tastings. Then he thought about the paperwork piling up on his desk. Chart review, assessments on residents and interns, revisions to the paramedic training syllabus, annual department budget, new equipment purchases, facilities improvements, . . . the list went on and on. Kel didn’t ignore the paperwork; in fact, he was better than most doctors at getting it done on time. It was just that the paperwork itself was nearly a full-time job. Add to that his regular job and there never seemed to be enough hours in the day.
“Yeah, well, I’ve got about ten days of paperwork to catch up on. That’ll be my vacation.”
Joe frowned. “I’d call that work, not vacation. Why don’t you go somewhere?”
Kel sighed. He was going to get dragged into the vacation conversation whether he liked it or not. “Where do you suggest?” he asked without enthusiasm.
“Anywhere that’s not here. Tahoe. Vegas. Yosemite. Acapulco.” Joe smiled. “Take Dix and make a real vacation of it. This place can survive without you, you know.”
“What’s that supposed to mean?”
“It means that sometimes you—“
A noise at the end of the corridor cut off further conversation. Roy and the ambulance attendant were wheeling the stretcher containing their cardiac patient at the swift yet seemingly unhurried pace that was the norm in the emergency department.
Kel turned to Joe. “Want to lend a hand?”
Joe set down his coffee. “Sure.”
Kel crushed the tennis ball over the net in what had to be the perfect down-the-line shot. No way would it be returned.
About two seconds later, a small yellow blip headed back toward him. Somehow, Mike Morton had not only chased down his perfect shot, but had actually managed to return it. Still, it was a weak return, and Kel was able to score a clean cross court winner. He jogged to the back of the court and picked up a couple of balls, tucking them in the pocket of his shorts. By the time he was at the service line, Mike stood ready in the opposite court.
Kel tossed the ball into the air and, at the same time, rotated his shoulder until the racket smoothly made contact with the ball. The serve flew straight and hard into the net. Kel scowled. He’d been having trouble with his first serves all day. Sweat trickled down his forehead, stinging his eyes. He wiped the wristband across his face and pulled another ball from his pocket. He bounced the ball several times on the court. This time, he concentrated less on positioning his serve and more on simply hitting the ball over the net.
Mike easily returned the softer serve. Kel sprinted across the court to track down the ball, and his return shot was not well placed. Luckily, Mike hit the ball beyond the end line.
Kel walked toward the net.
“Set point?” Mike called from the other side of the court.
Although Mike was younger than Kel and more agile, he’d only recently taken up tennis. Mike was quickly improving his shots and his strategy. Even so, with years of experience under his belt, Kel usually had little difficulty in winning their matches.
Today seemed to require more effort. Kel hadn’t played for a couple of weeks and it showed. He was missing his serves, was late on his approaches, and was slow in covering the court. His headache wasn’t helping the matter. Neither was the fact that he was suffering terribly in the heat. Tennis wasn’t like riding a bike; it took constant practice to maintain one’s skill.
He took a deep breath as he lined up to serve. Whether it was concentration or desperation, Kel hit an ace to end the game.
“Congratulations. Again,” Mike said as he shook Kel’s hand across the net.
“You played a great game, Mike,” he replied. “Keep it up and you’ll be beating the pants off me next week.”
“Up for another set?”
“I don’t think so.” Kel squinted into the sun and rubbed the bridge of his nose. “I’ve got a headache that won’t quit.”
“I thought something might be bothering you. You seemed a little out of sorts today.”
Kel grinned. “Just getting old, Mike, just getting old.”
Mike returned the smile. “Okay, but this young man’s gonna spend a few minutes hitting balls off the backboard. One of these days, I am going to beat you.” With a small wave, Mike trotted off the court.
By the time Kel reached the locker room, his head felt like it would explode. He grabbed a cup of water from the cooler. When he pressed it against his forehead, he could feel his pulse throbbing at his temples. He’d been off the court for almost ten minutes. He should be cooling down and his heart rate slowing. Neither was happening. It was as if his body was out of sync, out of control.
Thankfully, the locker room was empty. Kel leaned against the nearest wall and carefully lowered himself onto the cool tile floor, wiping his face with a towel. He dropped his head into his hands, closed his eyes, and concentrated on slowing his heart rate. He didn’t know how many minutes had passed until, finally, he felt a measure of control. The palpitations had stopped. The headache was better. He opened his eyes.
“Hey, Kel.” Mike strode into the room, a towel wrapped around his mid-section. “Aren’t you on duty at six? You’d better get a move on it –“ Mike’s eyes appraised him carefully. “You okay?”
Kel pulled himself into a standing position. “A little winded. Payback for being off the court the past couple of weeks.”
Mike stepped closer and scrutinized him more intently. “You sure?”
“I’m fine.” He stepped away from the wall, surprised that he did actually feel rather well considering the last few minutes. “A cold shower and I’ll be good as new.”
“Okay.” Mike didn’t sound convinced but also didn’t appear willing to challenge his boss. “I’m headed home. See you at Rampart in the a.m.”
“Right.” Kel waited until Mike had left and then sat down on the nearest bench. He tried to analyze his situation objectively. Was something wrong with him or was today’s episode merely the culmination of long days at work, lack of exercise, and trying to make up for all of it by playing a younger man at tennis on a hot day? Perhaps he would discuss the matter with Joe the next shift they worked together. Hypothetically, of course.
Kel quickly scribbled the discharge orders for his most recent patient. Uncomplicated bronchitis. Short course of antibiotics. Out the door. Would that they were all that easy. Then again, if they were, his job wouldn’t be nearly as interesting.
He looked up as Joe approached the base station. “Hey, Joe. Want to grab lunch?”
Joe shook his head and glanced at the wall clock at the same time. “It’s lunchtime already? What happened to the morning?”
“Gone the way of the dinosaur,” he said. “So, how about it? I’ll even treat.”
“I’ve got about a half-hour. Is that enough?”
The hospital cafeteria was surprisingly uncrowded and they were able to find a table alone at the back of the room.
“So,” Joe said after he’d eaten several mouthfuls of pasta. “What’s up?”
“What do you mean, what’s up? Can’t I invite you to lunch without something being up?”
“You can. But you never do.”
“Touché.” Kel put down his fork. “Okay, I wanted your input on intern evaluations. Cranston, Rhodes and DeWitt. They’ve all applied to be emergency residents next year. With Mike staying on, you know I’ll be lucky to squeeze our budget folks for one slot, maybe two at the outside. Who would you go with?”
Joe took another bite before replying. “I think Cranston is technically the most proficient of the three. She put in a chest tube the other day, and I didn’t do much more than watch.” Joe sipped his water. “On the down side, she’s a plodder. Lacks imagination.”
“I agree that her procedures are first-rate. However, my concern is her reaction in crisis situations. At times I think she has only one speed, regardless of the situation.” Kel picked at his salad. “What about Rhodes?”
“He’s a tough one, Kel. Incredibly bright and great with patients. However, his attitude toward the staff . . . .”
“He seems afraid of me.”
“Kel, it that were a disqualifier, you wouldn’t have any residents working for you.”
Kel gave him a look of mock disbelief. “You didn’t have that problem when you were my intern.”
It was a standing joke between them. When Kel took over Rampart’s emergency department, he’d found it critically short of qualified physicians. For years, Rampart, like most hospitals, staffed its emergency room with the newest interns, most of whom did emergency duty in addition to their regular rotations. They barely knew the first thing about medicine let alone emergency medicine.
Kel realized that he had to build a team of experienced physicians to mentor the younger doctors. Dixie had immediately recommended Joe Early. Kel didn’t know Early well but had heard he was a first-rate diagnostician. He was also a surgeon, which was a real asset in modern emergency departments. Kel realized that he needed Early, needed him desperately if he was going to make his emergency department successful.
One day, Kel had made his pitch. He’d never forget Joe’s initial reaction – “Dr. Brackett, you’re crazy. How can you possibly expect me to teach something that I don’t know the first thing about?”
Kel was having none of it. “You’re a brain surgeon, for goodness sake. If you could learn neurosurgery, you can certainly learn emergency medicine. Besides, if I can’t teach you, how will I ever teach the interns? Think of it as being my intern. Temporarily, that is,” he’d added with a chuckle.
Joe had finally agreed to help Kel out for six months, until he could train someone else. Those six months had turned into more than five years, and Joe had become Kel’s alter ego within the department.
Joe’s laugh brought Kel back to the present. “I still wonder how I ever let you rope me into that one,” Joe said.
“My incredible powers of persuasion?”
Joe’s blue eyes twinkled. “Well, at least you didn’t make me wear the intern’s lab coat.”
“Only because I didn’t think of it,” Kel teased. “Honestly, Joe, I’m not sure I would have made it through those first years without you.”
“I’ll accept the compliment, even if it’s undeserved.” Joe pushed aside his plate. “Okay, enough about my intern days. What about DeWitt? Personally, I think he’s the best of the bunch . . . “
“Got a bleeder here.” Kel pointed with the hemostat.
“Got it,” Mike Morton replied from across the operating table as he clamped off the offending blood vessel.
Kel poked around the open abdominal wound. The patient was a thirty-year-old woman brought in by the paramedics an hour earlier. She’d been on the losing end of a car versus bicycle collision, and Brice and Bellingham had done a great job of stabilizing her at the scene. When the patient had arrived in the emergency department, he’d immediately recognized the symptoms of internal bleeding. Now, he and Mike were in the OR doing an exploratory laparoscopy to find the source of that bleeding and stop it.
The amount of blood leaking into the abdominal cavity made it nearly impossible to see any of the organs clearly and Kel called for more suction. Once the surgical field was clear, he again attempted to trace the bleeding. He wasn’t surprised when he located the culprit. “Spleen’s lacerated. See here?”
“Yeah.” Mike peered into the wound. “You gonna resect it?”
Kel grimaced under his mask. “Not much choice.” It was nearly impossible to repair the blood rich organ and the human body could easily function without a spleen. Even so, surgeons performed a splenectomy as a last resort due to the role the spleen played in the immune system.
He glanced at the anesthesiologist. “We’re going to be another couple hours at least. And better order up another four units of blood. I have the feeling we’re going to need it.” The first tinges of pain that signaled a tension headache crept through his temples. Right now, he didn’t have time for a headache and he couldn’t very well run out for aspirin. He turned back to the operating field and held out his hand. “Hemostat.”
The instrument was immediately pressed into his palm. Then another. And another. The surgery was uncomplicated; Kel had performed the procedure many times. Mike had a good sense of what was needed and they worked efficiently as a team.
“Kelly clamp.” As the instrument was placed into his open hand, a sudden pain crushed his skull. The intensity of it shocked him.
“Doctor?” It was the voice of the scrub nurse.
He closed his fingers around the clamp and felt it throbbing in his palm. He tried to bring his hand toward the open wound. The pain in his head was excruciating. His hand was throbbing. He closed his eyes.
Heard Mike’s voice. Felt the clamp in his hand. His head was trying to explode. He could feel his heart beating inside his chest.
“Kel, what’s wrong?” Mike again. “Are you all right?”
He had to get out of the operating room. Had to sit down. Had to do something to stop the pain. He let the clamp fall to the ground. Heard it clatter on the tile. Stepped back.
“Mike, take over.”
Tried to give Mike a look of encouragement. Told himself what to do. Turn. Step. Another step. The doors. Open automatically. Step. Step. The pain. Step.
Minutes later, Kel sat on one of the stark, metal benches in the doctor’s changing room. His elbows dug into his thighs, which allowed him to rest his head in his hands. It was the only position that gave him any relief, even though he could feel his pulse racing through his fingers and throbbing in his temples. He was still in his OR gear, minus the facemask, which hung loosely against his chest. The outfit was stifling outside of the heavily air-conditioned operating room.
He knew he should go back into the OR and supervise Morton or get on the phone and call someone to take over. Morton was only a resident and leaving him to finish the surgery was unprofessional and inexcusable. At the moment, though, there was no way he could stand, let alone supervise surgery.
He didn’t bother to look up when he heard someone push open the door to the room. He hoped whoever it was would leave him alone.
Damn. It was Joe. Mike must have had the circulating nurse call him.
“Go away, Joe.” He said it without conviction. He knew Joe had crossed the room and was now standing over him because he could see the man’s shoes on the floor below. “Help Mike.”
“Morgan’s already in there.”
He nodded slowly. Of course, Joe’s first concern would be the patient.
“Talk to me, Kel.” Joe’s voice was soft.
Kel noted that Joe didn’t criticize him for abandoning Mike in surgery and wasn’t sure he’d have been as considerate had their roles been reversed. He should answer Joe, he knew that. What could he say? A moment later, he felt Joe gently start to lift his chin and recognized the sharp click of a penlight.
Kel grabbed for Joe’s wrist. “Don’t.” He took a deep breath. “Give me a minute.”
Joe’s hand slid down to his carotid. Kel knew his pulse was racing; he could feel it pounding beneath Joe’s fingers.
“Kel, let’s get you downstairs so I can examine you.” Concern was evident in Joe’s voice. “Can you walk or should I call for a wheelchair?”
The thought of being pushed down the halls of Rampart General in a wheelchair helped the pain in his head ease a tiny bit. “I just have a headache. If you’ll let me sit here for a few minutes, I’ll be all right.”
“No, Kel. Right now.” Kel opened his eyes in time to see Joe turn toward the wall phone.
“Wait.” Kel relaxed his hands until he was able to lift his head. The movement brought more excruciating pain, and he had to squint up at his friend. “I’ll go, but not to emergency.” He’d been a patient in his own department before and had no desire to repeat that experience.
Joe turned back around. “I can’t examine you here.”
“One of the exam rooms . . . ?” Anywhere was better than emergency.
Joe seemed to consider the request for a moment before speaking. “There’s a room around the corner from my office that we use for clinic,” he said. “Should be free this late in the afternoon.”
“But,” Joe held up his hand. “You ride in a wheelchair.” Kel started to protest but Joe cut him off. “A wheelchair or a stretcher. Take your choice.”
“Tell me what happened in surgery.” Joe peered into his eye with an ophthalmoscope.
Kel felt like an idiot, sitting on the edge of the exam table with his bare feet dangling above the floor. At Joe’s insistence, he’d removed his OR gown and shirt and now wore only his scrub pants. He’d forgotten how miserable and demeaning it was to be a patient and the cramped, windowless exam room didn’t improve his mood.
“I’m not sure,” he replied at last. “Routine exploratory laparoscopy turned into splenectomy. About an hour in, I started to get a headache. Annoying, but you know it happens. All of the sudden, it got incredibly worse.”
“How would you rate it on a scale of ten?” Joe asked, stepping back and replacing the ophthalmoscope on the instrument table.
“A twelve,” Kel replied with a weak smile.
Joe didn’t return the smile. “What about now?”
“Better. Maybe a four.”
“Where was the pain centered?”.
“I honestly don’t know. All over.”
“Any head injuries of late?
Joe held up a finger. “Okay, you know the drill.”
Kel followed Joe’s finger and then responded to requests to smile and stick out his tongue. He touched his finger to his nose, counted backwards from 100 by sevens, held his arms level while closing his eyes, squeezed Joe’s hands, and performed various other tests that were Joe’s way of checking neurological responses. He was pretty sure from Joe’s lack of follow up that they were normal.
“Any symptoms of migraine?” Joe asked.
“Joe, I have a headache, that’s all.” It was all he could do to keep his frustration from seeping into his tone. “I need to take a couple of aspirin and lie down, in that order.”
Joe folded his arms across his chest. “How long have you had the headaches?”
He noted that Joe didn’t take the bait. As always, he remained calm
and soft-spoken. In fact, Kel didn’t think he’d ever heard Joe raise his voice. Not to the interns, the nurses, or the staff. No matter how bad the situation was, no matter how angry Joe might be, his demeanor never changed. Joe was the perfect complement to his own occasionally abrasive personality. However, at times like this, Joe’s unflappable calm was equally maddening.
“How long have you had the headaches?” Joe repeated.
Kel fought off an irrational urge to make a run for it – anything to get away from Joe’s persistent questioning. “A month or so, I guess.”
“Have they been getting worse?”
Joe inflated a blood pressure cuff around Kel’s upper arm. “Anything besides the headaches that I should know about?”
Kel was deciding how much to tell him when he noticed Joe’s expression of surprise at the reading he’d just taken. Joe gave him a quick glance and, without a word, reinflated the cuff.
“Something wrong?” Kel asked when he’d finished.
“Your BP’s 200/112. When’s the last time you had it checked?”
Even Kel was surprised at the reading. “I don’t remember.”
“Ever had hypertension?”
“You do now.” Joe pulled out the extension at the end of the exam table. “Lie down. I want you to rest for a few minutes and then I’ll take it again.” He smiled. “Try to relax.”
Kel lay back and, as ordered, tried to relax. He added up his symptoms. What was wrong with him? Had he ignored important warning signs? Sure, he’d had headaches. Everyone had headaches. And the palpitations when he’d played tennis. That was unusual but, then again, he hadn’t been working out much of late. He’d figured he was simply out of shape.
He watched Joe write notes in what must be his chart. He’d removed his watch before surgery and this room had no clock. He figured at least five minutes had elapsed. “Come on, Joe,” he said impatiently. “I’m a busy man.”
Joe raised an eyebrow and continued writing. After a few more agonizing minutes, Joe returned to his side and took his pulse. “Ninety-two,” he reported. Again he inflated the BP cuff and took a reading. He frowned.
“What is it
now?” Kel asked.
“174/98. Better, but still too high.” Joe put away the sphygmomanometer and leaned
against the nearby instrument table.
“Kel, when’s the last time you had a complete physical?”
“A few years ago, I guess.”
“It’s past time you had another.”
He sighed. “Okay, maybe you’re right. I’ll see about scheduling one in the next week or so.”
“Not next week. Now. And I want to admit you.”
Kel propped himself up on one elbow. “Forget it, Joe.”
“There are tests I want to run and it’ll be a lot easier if you’re an inpatient.”
“Tests? What tests?”
“EKG, 24-hour blood work, LP, skull series, EEG—“
His response was automatic. “No way.”
“With a little luck in scheduling,” Joe continued as if he hadn’t spoken, “we can get it all done in a day or two.”
Kel sat up on the table and swung around so that he was facing his colleague. The movement started his head pounding again. What was Joe thinking with all these tests? Was something seriously wrong or was Joe simply using this as an excuse to get him in for an overdue physical?
“I’m not going to let you go poking around my spine and reading my brainwaves just because I’ve had a couple of headaches.”
“Kel, you’ve had serious headaches for weeks, you’re severely hypertensive, and who knows what else that you’re not telling me. Your symptoms need to be evaluated.”
“I’ve been working too hard. You said so yourself.”
“I think there’s more to it.”
“Joe, I’m not going to let you turn me into a guinea pig.”
“You will let me run these tests.”
“And if I refuse?”
Joe took a step toward him. “Don’t push me on this one, Kel.” Joe’s tone had turned steely. “Your little stunt today could have cost a patient her life.”
“You’re playing dirty pool, Doctor.” Kel was furious and, at the same time, didn’t know why he was so angry. Joe was right. Whatever had caused today’s problems did need evaluating. If the situation were reversed, he’d be doing the exact same thing with Joe or any other doctor on his staff. The problem was that this time he was the one on the receiving end.
“I’m only doing what I think is necessary for you and your patients. Now, it will be a lot easier if you cooperate. But you are going to have those tests, even if I have to go to Harrington.
Bradley Harrington was the hospital chief of staff, a bureaucrat they both despised. Yet Kel had never heard Joe make an idle threat. “You wouldn’t—” Kel sputtered.
Joe only stared back at him.
“Joe, don’t push our friendship . . . .”
“Kel, I am your friend, but I’m also a neurosurgeon and a pretty good one at that. As your doctor and your friend, I’m telling you that your symptoms need to be evaluated sooner rather than later. Until they are, you can’t continue to work at this hospital.” Instead of raising his voice, Joe lowered it, almost to a whisper. “I don’t want to go to Harrington, but I will if I have to. It’s up to you.”
Joe would do
exactly that, Kel was sure of it. And Harrington
would back him up, if only out of spite.
He fixed Joe with a hard stare.
“You don’t give me much of a choice, do you?”
met his eyes. “I guess not.” He picked up the chart and crossed to the
doorway. “I’ll arrange for Abramson to take
over your case.”
Joe turned around and crossed his arms over his chest. “I think it would be better for both of us if you had another doctor from here on out.”
Kel took a deep breath. He was furious with Joe for backing him into a corner. If he only submitted to half of the tests that Joe mentioned, he’d be stuck in the hospital for days being poked and prodded. That thought irritated him beyond belief. The only thing worse would be to be poked and prodded by someone else. Joe was tenacious, not unreasonable. More importantly, Joe could keep his mouth shut, whereas Abramson would have every detail of Kel’s condition all over the hospital in an hour. Most of all, Kel needed a doctor he could trust. Maybe there was something seriously wrong with him. If things didn’t go well, he might just need a neurosurgeon and wouldn’t find a better one than Joe Early.
“I’d rather you stick with me,” Kel said tightly.
Joe slowly shook his head. “I don’t think so. I’m too old to have to fight you every step of the way on this. You can do battle with Abramson or whomever else you want.”
“Joe, please.” Kel had no choice but to beg. “You’re right; I was wrong. If you promise not to turn me over to Abramson, I’ll agree to whatever tests you want to do.” He could see that Joe remained skeptical. “I’ll behave. I promise.”
He held his breath as Joe gave him a long look, a very long look.
Joe looked down at him. “You can sit up now.”
Kel pulled himself into a sitting position on the exam table. “You’re actually done?” he asked.
Joe’s eyes smiled at him over his reading glasses as he made notes in the chart. “For now.”
“For now? What’s left?” When Joe had said “complete physical,” he’d meant every word.
Joe gave him a smile. “I’m sure I can think of a few things.”
Kel was relieved to see the smile. Still, he couldn’t help but wonder what Joe had found. He waited for Joe to say something, but his friend merely kept scribbling. Finally, he couldn’t stand it another minute. “Well?” he asked with what he thought was extreme patience.
Joe was toying with him, he just knew it. He hoped that meant good news. “What’d you find?”
Joe put down the chart and stowed his pen in his lab coat pocket. “It means that the exam didn’t tell me much I didn’t already know. You’re hypertensive. You have slight tenderness in the upper right quadrant that could be due to any number of things. We’ll just have to see what your test results show.”
“So, what else do you have in store for me?”
start with some lab work—“
“Are you going to tell me what you’ve ordered?”
Joe shrugged. “Sure. CBC, Lytes, Chem. panel, UA, glucose tolerance, catecholamine--“
Kel sighed loudly. “I can’t believe I agreed to this.”
“Kel—“ Joe started in warning.
Kel held up his hands. “I know, I know. I promised. But I didn’t promise not to complain just a little.”
“Good.” Joe smiled again. “Then we’ll do an EKG and get some x-rays. Chest, skull, maybe a GI series if I’m so inclined. Tomorrow, we’ll do the EEG.”
“Come on, it’s not that bad.”
“The tests or what you suspect I have?” He eyed his friend warily. “What are you thinking, Joe?”
Joe shook his head. “It’s way too soon for that. Let’s finish the tests and then maybe I’ll have an answer for you.”
“Lie as still as possible, Dr. Brackett,” the cardiac technician instructed.
Kel wanted to sigh, but that would qualify as movement and they’d have to start the EKG all over again. Joe had ordered a twelve-lead, so Kel had monitors attached to his chest, arms and legs. As many times as he’d performed this test, there was something about it that made him hate it as a patient. He hated being attached to a machine, hated the fact that he couldn’t read the EKG as it came out, hated—
“Dr. Brackett, you seem a bit tense. It helps if you try to relax.”
Hated the sickly sweet words of the technician.
“Now don’t move,” the x-ray tech said as she crossed the room and slipped behind the shield.
Kel forced himself to lie perfectly still, the lead apron weighing heavily on his chest. A few seconds later, he heard the soft click and hum of the x-ray machine.
“Good.” The technician was back. “Now, I need you to turn toward me.”
Kel repositioned himself on the table and allowed the tech to maneuver him into the correct position. He never minded having x-rays taken. They were quick, easy, and painless. However, he’d been here for almost an hour. They’d already taken a chest x-ray, skull series, and flat plates of the abdomen. How many more had Joe ordered? Kel thought about asking, then gave up. Whatever the number, he’d agreed to submit to them.
“Okay, Doctor. Take a deep breath and hold it . . .”
“You’ll feel a little stick,” Joe said.
It felt like more than a “little stick” when Joe injected the anesthetic into the small of his back. It hurt like hell. And Kel knew this was only the beginning.
Kel lay on the exam table curled up on his side, with Joe performing the all too familiar ritual on his back. Well, it was familiar from the perspective of performing the procedure, not undergoing it. The fact that he knew every step – and the fact that he trusted Joe implicitly – didn’t make his situation any easier. Someone was about to stick things into his spine. His only consolation was that Joe was performing the procedure himself when he could easily have delegated it to a resident.
Kel felt a light pat on his shoulder. “I’ll be back in a few minutes,” Joe said. “Give the lidocaine a chance to work. Can you stay put or do I need to send Dixie in to monitor you?”
That was all he needed. “I’ll stay put.” He heard Joe stand up. “Joe . . . “
Kel took as deep a breath as he could, given his current position. “Joe, I want to apologize. What I said the other day, you know I didn’t—“
“I know.” Joe’s hand again rested briefly on his shoulder. A few seconds later, the soft whoosh of the door told Kel Joe had left the room.
For years, Kel had told patients that lumbar punctures – LPs to doctors and spinal taps to patients – were only “slightly uncomfortable.” He said that because that’s what the doctors who’d taught him the procedure said. He’d said it so often that he actually believed it. Until today.
The “slight pressure,” as he’d been taught to describe it, was immense and was accompanied by shooting pains down his legs. What Joe was doing had to be the single most uncomfortable thing he’d ever experienced. The next time he performed an LP, he was definitely going to choose his words of comfort more carefully.
He recognized from the clatter of instruments and Joe’s directions to the nurse that Joe was placing the needle in order to draw off spinal fluid. The only good thing in this living hell was that the nurse assisting Joe wasn’t Dixie. He hadn’t seen Dix since the incident in the OR which wasn’t altogether unusual given that he’d spent almost every waking hour undergoing one of Joe’s tests of torture. Today didn’t need to be the first time.
“Opening pressure is normal,” Joe said after a few moments.
So he probably didn’t have meningitis. No surprise there. He fervently prayed for Joe to work faster. He wanted to stretch out, anything to relieve the pressure in his spine.
“Kel.” Joe’s voice interrupted his thoughts. “I know it’s hard, but try not to tense up. We’re almost done.”
Kel tried to focus on his breathing. In. Out. In. Out. He counted his breaths. One. Two. Three. Four.
“Fluid’s clear – looks normal,” he heard Joe say.
Great. He’d gone through this misery for nothing. Five. Six. Seven. Eight. He was up to 174 when he suddenly felt the pressure ease.
“Dammit, Dix,” Kel said as the nurse entered his hospital room later that evening. “Did Joe tell the entire hospital that I’m in here?”
“And a good evening to you, too.”
Kel grimaced. “Sorry. Today has ruined any semblance of manners.”
Dix put her free hand on her hip. “And besides, I don’t think that I qualify as the ‘entire hospital.’ Joe thought you might rather have me here than one of the student nurses.”
“I’d rather I not be here myself. I don’t know why I ever let Joe—“
She gave him an exasperated look. “You know exactly why. Because he’s right.”
toward the bed. He watched as she
arranged the blood tray on his bedside table and began laying out the necessary
equipment. “Now what?” he asked.
“Need some more blood.” She smiled. “Then I get to check your vitals.”
Kel let his head fall back against the pillows. “Great. At this rate, I’m gonna need a transfusion.” He lay with his eyes closed as she went about her work. He’d lost track of the number of blood tests he’d had in the past twenty-four hours and had long ago stopped asking the purpose of each. At this point, he just wanted it to be over. He felt her tie the tourniquet on his upper arm, the needle gently slide into the crook of his elbow, the tourniquet being released. He had to admit that he’d barely felt the stick.
How much did Dix know? What had Joe told her? He felt guilty for not telling Dix himself what was going on. She had a right to know. He should have told her. Should have had Joe tell her. He kept his eyes closed while Dixie measured his BP and took his pulse.
“Will I live?” he asked when she was finished.
“To a ripe old age.”
Kel opened his eyes. “I hope you’re right.”
“Of course I’m right, Kelly Brackett. Whatever would make you think otherwise?”
“What did Joe tell you?”
“What he’s told everyone else who’s asked. That you had a couple of nasty headaches and that he, an overcautious and somewhat anal neurosurgeon, is bound and determined to find out why, even if it means running every test he can think of.”
Thank you, Joe, Kel thought to himself. “But I wish he’d tell me what he thinks is wrong.”
“Have you considered that he may not know anything?”
“I’ve considered it.”
“Look, Kel. I’ve known Joe longer than you have. If he says he doesn’t know, he doesn’t know.”
“You’re probably right. Still, it’s hard being on this side of the bed.”
“Yeah.” Dixie suddenly grinned. “Especially for you.”
Kel recognized her attempt to lighten the situation. He couldn’t help but respond in kind. “What’s that supposed to mean?”
“That you’re getting a reputation as an uncooperative patient.”
“No!” Kel faked surprise.
Dix smiled then again turned serious. “Kel, I can only imagine how you’re feeling. Joe knows. He’s been there. He wouldn’t keep you in suspense, you know that.”
“Yeah, I know.”
“When he knows something, he’ll tell you.”
“Of course. He’s a neurosurgeon. He’s used to giving bad news.”
“That’s not fair. He cares about you, a lot.”
“You’re right. But it’s still hard.”
For a moment there was silence between them. Kel suspected there was more Dix wanted to say but she, too, maintained the silence.
“Look, I’m supposed to be in emergency. I’d better get back before they put out an APB for me.” She packed up her supplies and turned to leave.
He reached for her arm. “Thanks.”
“For caring. For trying to calm my fears. For being you.”
The technician placed another electrode on his scalp. “Well, Dr. Brackett, I guess I don’t need to explain to you how an EEG is performed.”
“No.” Kel sighed. Another technician, another test, another cold, sterile room. The morning had started with more blood tests and now this. He hadn’t seen Joe since yesterday afternoon. When he’d asked the ward nurse about it, she’d told him that Joe had unexpected surgery and that, by the time he’d dropped by late in the evening, Kel was asleep. Nevertheless, he was starting to worry. Was Joe avoiding him because the news was bad?
“Now, Dr. Bracket, I need you to breathe deeply for me.” The technician’s smooth voice interrupted his thoughts. “Keep doing it until I tell you to stop but keep your head as still as possible. If you start to get lightheaded, let me know.”
Kel settled himself in his bed. The EEG hadn’t been as bad as he’d expected, probably because Joe hadn’t made him stay up the entire night before. He’d felt like an idiot with all those electrodes attached to his head but that was about it. He’d take an EEG over an LP any day.
EEG, LP, EKG, SMA. Enough with this alphabet soup of tests. When he’d promised Joe not to complain, he hadn’t realized what Joe had in store for him. And, other than the brief comments during the physical and LP, Joe had yet to give him any results. It was time he demanded them.
As if on cue, Joe stepped into his room. “How about we get some coffee?”
“Uh-oh. You’re actually allowing me to drink coffee. Must be bad news.”
“I didn’t say that. If you’d rather talk here . . . .”
“No, I’ve already spent far too much time in this miserable room.” He pulled his robe over his pajamas. At least he’d been spared the indignity of a hospital gown. “I’m more than ready to leave. Permanently.”
Kel didn’t miss the fact that Joe didn’t respond to his last comment. Warning bells started to go off in his head. He followed Joe down the hall to the doctors’
lounge, picking up a Styrofoam cup of coffee along the way. Thankfully, at this hour of the evening, the room was deserted. Kel sat at one of the tables and waited until Joe took the chair across from him.
He decided to dispense with the small talk. “So, lay it on me, Joe.”
Joe looked amused. “Like I said, the news to date is good. EKG, EEG, lumbar puncture, x-rays, fasting blood sugar – all normal.”
“Great. So I’m out of here.“ Kel put down his coffee and stood up from the chair.
“Not so fast.”
Kel sighed as he sat back down. “How did I know you were going to say that?”
Joe leaned forward in his chair and rested his arms on the table, holding his own coffee between his hands. “We still haven’t determined the cause of your hypertension and headaches.”
“I told you that I was tired. A couple of weeks of vacation and I’ll be good as new.”
Joe’s eyes found his. “I’m not so sure.”
“Look, Joe. I let you blackmail me into this battery of tests. I’ve undergone every one you’ve asked. Every single one. And you tell me the results are all normal. Okay. I’m finished. Done. Fertig. No more tests.”
If he’d expected a return outburst from Joe, he was disappointed. “I’m still not satisfied,” was all Joe said.
Kel again stood up from his chair. “What more do you want?”
“An adrenal biopsy.”
Kel opened his mouth to respond but no words came out. He sat back down.
“Your catecholamine levels are elevated,” Joe continued. “Urine and blood.”
Kel allowed the words to sink in. Suddenly, he understood exactly where this was headed and he didn’t like it. Didn’t like it all. He stared at Joe. “You think I have pheochromocytoma.”
Joe didn’t blink at the pronouncement. “I think it’s a distinct possibility. It would explain your symptoms.”
Kel sagged further into the chair. Pheochromocytoma. A fancy name for a tumor of the adrenal gland. A tumor. He mentally reviewed everything he knew about the disease. Rare. Generally strikes men and women in their middle adult years. Symptoms included orthostatic and paroxysmal hypertension, headaches, sweats, with symptoms commonly occurring after exercise or stress.
Kel mentally kicked himself. He was a doctor. He should have recognized his symptoms. Joe was right. He had all the signs of an adrenal tumor. Damn.
“Kel,” Joe was trying again. “Listen to me. I said you might have pheochromocytoma. Right now, I can’t prove that you do any more than I can prove that you don’t. That’s why I want to do the biopsy.”
“One of my med school professors called it the ‘ten percent disease.’ Something about ten percent of cases presenting with different symptoms from the textbooks. And ten percent being malignant.”
“Kel, you’re getting way ahead of yourself here--”
“When will you do the surgery?” Kel cut him off.
“I won’t,” Joe said. “If the biopsy’s positive, we’ll need to remove the entire gland. It’s tricky surgery, you know that. I haven’t done more than a couple in my career and those were more than a few years back. I want Collins.”
Kel smiled at the mention of the name. Tom Collins. Tom was constantly being ribbed about his name being the same as a popular alcoholic drink. Fact was that Tom Collins the surgeon didn’t drink. Ever. He was deeply religious, from the Bible belt. Didn’t smoke, drink, or swear. As much as Tom was out of his social element in California, he was in his element in the operating room. He took on the toughest cases and still had the best outcomes in the surgical department.
“We’ve got to get your BP stabilized first. I’m going to start you on IV propanolol and sodium nitroprusside and see if that brings it under control. I’d say a week of normal BP but, ultimately, it’s up to Tom.”
“So, I’m in here for the long haul.”
“’Fraid so,” Joe replied. “Not only are we running the IVs but, until the BP is under control, you’re still at risk for a hypertensive crisis.”
Kel nodded. He couldn’t argue with Joe’s logic. “Joe, is this what you suspected all along, why you didn’t show for the past day? You didn’t want to tell me.”
Joe shook his head. “Actually, no on all counts. Didn’t the nurses tell you why I wasn’t here?”
“Something about your being busy.”
“Yeah. In case you hadn’t noticed, the emergency department is short one pretty sharp physician. The patients, however, keep coming. Things have been pretty backed up. And—“ Joe held up his hand when Kel started to interrupt. “And, I was the neurosurgeon on call yesterday. So when a couple of teenagers plowed their car into the nearest embankment, and popped their heads into the windshield . . . “
Kel raised his hands in submission. “Okay, okay.”
“And to be honest,” Joe continued, “I’ve been considering pheochromocytoma for awhile now, but it wasn’t my first diagnosis.”
“I’m afraid to ask what was.”
Joe gave him a knowing smile. “As well you should be.”
Kel was bored. It had been one day since Joe’s “diagnosis” and Kel had nothing to do but sit in his bed or in the day room and allow the medication to do its work. He had little interest in the talk shows and soap operas that were the standard daytime TV fare. Yesterday, he’d read the backlog of his medical journals. He’d even thumbed through a couple of paperbacks without much interest.
He was beginning to realize that he never took vacation because, on a certain level, he preferred to work. Crazy as his life had become, it was his life and he rather liked it. He had no idea how much longer he could stand doing nothing.
This morning, he gave up on the novels and tried the newspaper. He flipped open the Los Angeles Times and started to read an article about new highway construction designed to improve traffic congestion in the city. As he tried to concentrate, he felt the first tentacles of a headache reaching into his skull. Kel sighed. He probably should call for the nurse.
“Morning, Doc.” John Gage bounced into the dayroom, followed closely by Roy DeSoto. “Dix told us we might find you here.”
“Morning, guys.” He waved them over. “Starting early or finishing late?”
“Starting early,” Roy responded. “Making a supply run. It’s Saturday – you know what that’s like.”
Kel smiled and held up his arm with the attached IV. “Wish I could help.”
“So, how long are you gonna be laid up?” Johnny asked.
Kel realized neither Joe nor Dix had divulged much about his condition. He figured he’d might as well tell them the truth. “Depends on what they find. Joe thinks I may have an adrenal tumor. If he’s right, they’ll remove the adrenal gland and, hopefully, I’ll be good as new within a few weeks.”
Johnny looked a little surprised. “Tumor? That’s pretty heavy stuff.”
“Luckily, this type of tumor is almost always benign which means that the surgery usually provides a complete cure.” He hoped he sounded more reassuring than he felt.
“That’s great,” Roy said.
“Dix said you had a little time on your hands,” Johnny chimed in. “Is there anything we can get you – you know, books, magazines, or something?”
“Thanks, but I think I have enough novels to—aah!” A wave of pain crashed down on his skull, causing him to grab his head.
“Doc?” Johnny asked. “Doc, you okay?”
Kel shook his head. “Get Joe.”
“Stay with him.” This time it was Roy. “I’ll get help.”
The pounding in his head continued and Kel could only guess that his BP was skyrocketing. He was vaguely aware of Johnny taking his pulse. Almost immediately, several people came into the room and there was a rush of activity. He felt himself lifted onto a gurney and wheeled down the hallway.
He was back in his room. The tightness in his arm meant that someone was taking his blood pressure.
“206 over 100,” someone said.
“We’ve got to lower it.”
“Pulse is 106 and bounding.” Was that Johnny?
“Doctor, what do you want to do?”
“Let me think. I, uh . . . “ Kel knew most of the doctors on staff and he didn’t recognize the voice. Must be one of the new interns. He carefully opened his eyes and confirmed his suspicion.
Diaz oxide, Kel thought to himself. Come on, give the order.
“Doctor, you’ve got to give him something to lower his BP right now!” That sounded like Roy.
“I know, I know. But he’s already on an alpha and beta blocker . . .”
“Johnny, get help!”
There was more commotion and the next voice he heard was that of Joe Early. “What’s his BP?” he called from the doorway.
“212 over 108 and climbing.”
“What have you given him?”
“Ah, nothing, Dr. Early.” It was the intern. “You see, I –“
“Diaz oxide,” Joe ordered. “100 mg IV bolus.” He leaned close. “Take it easy, Kel. We’ll get this under control.”
“Are you in pain?”
“Carol, give him 50 mg meperidine IM and get me another set of vitals.”
He felt the cool circle of Joe’s stethoscope press against his chest. After a moment, he heard Joe’s voice. “Let’s get him hooked up to a monitor.” Again Joe leaned over and spoke softly to him. “You heart sounds fine, Kel, the EKG is simply a precaution.”
Kel felt the stick of a needle, the repeated inflation of the BP cuff, the EKG pads being attached to his chest, and the calm that now permeated the room. He stopped paying attention to Joe’s soft-spoken orders, the vitals being called out by the nurses, the blip of the EKG monitor.
“Kel?” Joe asked. “Did you hear me?”
“I asked if you were feeling any better.”
Kel opened his eyes and immediately noted that only Joe and a nurse remained in his room. Either the crisis was over or Joe had simply ordered non-essential personnel to leave, or both. He took stock of his situation. His headache had receded, his pulse was no longer throbbing, and his heart rate had slowed. Yeah, he felt better and said as much to Joe.
“Good. Your BP’s almost back to normal. EKG looks good. As you probably guessed, you had a hypertensive crisis. Luckily, Johnny and Roy were there to get you immediate treatment. I’m going to change the dosing on your meds. With a little luck, it won’t happen again.”
“Thanks, Joe. And thank Roy and Johnny as well.”
“I will.” Joe’s hand rested briefly on his arm. “Now, get some rest. I’m going to go have a talk with that intern on proper handling of medical emergencies.”
Kel smiled to himself. Despite Joe’s outwardly relaxed demeanor, he did not tolerate fools and Kel had no doubt that this would be one conversation the young intern would never forget.
Kel used the remote control to flick through the channels on the TV. He passed two comedies and finally settled on Hawaii Five-O. He hoped this was an episode when Jack Lord would utter the infamous, “Book’em Danno.”
He gazed up at the IV bags that dripped fluid into his veins. He’d thought the tests were bad; this was worse. His entire day consisted of lying in bed while the combination of drugs did their work. These drugs were new – changed after his last crisis. Joe had also ordered BP checks every thirty minutes, twenty-four hours a day, which made it virtually impossible to sleep.
The only positive part of this entire experience was being able to finish some of his paperwork. He’d finished evaluations on his interns, reviewed new paramedic protocols, dictated his chart notes, and reviewed all of the charts for his department with a thoroughness that amazed even him. One thing that was certain, whenever he did return to work, he would be caught up on his paperwork and then some.
He watched as Steve McGarrett and Danno tried to save the citizens of the fiftieth state from some new criminal enterprise.
Tom Collins strode into the room carrying a patient chart. He still looked like the college quarterback he’d once been. Tall, blond, blue-eyed and muscular, he looked ten years younger than he was. Kel noted that the surgeon was still in his scrubs. Given that surgery usually started in the early morning, Kel knew this was the end of a very long day for Tom.
Kel flicked off the TV. “Only Hawaii Five-O.”
“My son loves that show,” Tom drawled. “When we let him stay up late enough. Unfortunately, I usually don’t get home in time to watch it with him.”
“And tonight’s no exception.”
Tom shook his head and sighed. “Goes with the territory.” He flipped open the chart and skimmed the pages. “Looks like your BP’s finally under control. The docsazin seems to have helped.”
“Do you think Joe’s right about it being pheochromocytoma?”
“Yeah, I do. The blood work he ordered during your last crisis is as close to confirmation as we’ll get.”
“So, it looks like you’ll be doing more than a simple biopsy.”
Tom nodded. “I’m prepared to do a full adrenalectomy.”
“How many have you done?”
“Twenty-four. Truth is, they’re pretty rare, as you well know, so I count each one.” Tom slid into the room’s only chair. “Any questions?”
“Lots. But none you can answer.”
“Look, I’m not gonna tell you that I know what you’re going through or how you’re feeling, because truth is I don’t. What I can tell you is that I’ve already done more of these surgeries than most surgeons have done in their entire career and I’ve yet to have a bad outcome.”
“That’s why Joe wanted you.”
“What Joe didn’t tell you is that, before I came on the scene, he got called upon to do more than his fair share of these.”
“Somehow,” Kel said, “that doesn’t surprise me.”
“I want him to assist. Any objections?”
“Not from me.”
“Okay, then,” Tom replied. “I’ll schedule you for first thing the day after tomorrow. In the meantime, we’re going to keep an even closer eye on your BP. I don’t need to tell you that uncontrolled hypertension is the biggest variable in the surgery. With all the restrictions and monitoring I’m gonna order, you’ll be ready to shoot me.”
Kel gave the surgeon a wry look. “I already promised Joe that I wouldn’t complain.”
Tom smiled broadly. “Great. I’ll check in on you again tomorrow night to make sure everything’s a go. In the meantime, if you’ve got any questions, give me a yell.”
“Kel, you still with us?” Joe asked.
Kel lay on the OR table, naked under the sterile drapes. It was as vulnerable as he’d ever felt in his life.
Joe was in his scrubs, not yet fully gowned.
“You— Scrub?” Kel was having trouble forming the words.
“Don’t worry, I will.” Joe smiled. “Before I operate.”
“’Member. Take.” Kel fought to get out the words. “Care. Dix.”
“You can take care of her yourself.”
“I promise. I won’t have to, Kel, we both know that. But I promise anyway.”
Joe nodded and a second later Kel felt the mask press over his nose and mouth. The last sight he had was Joe’s concerned face staring down at him.
Kel opened his eyes. For an instant, he couldn’t figure out where he was. Then it all came back to him. He’d had surgery. He had vague memories of waking up for brief periods. He thought he’d seen Dix, or was it a dream?
“Good morning, Dr. Brackett.”
Kel looked up into the smiling face of a nurse he didn’t recognize.
“It’s just after eight o’clock on Thursday morning,” she continued with a smile that looked pasted to her face. “You’ve been drifting in and out of consciousness for almost twenty-four hours now. I’m Nurse Sheila Emerson.”
Kel knew the drill. Orient patients as to time and status.
The nurse quickly checked the various monitors attached to his body.
“How am I?” Kel asked.
The nurse gave him another automatic smile. “Let me see if I can find Dr. Early. I think he’s still at the nurse’s station.”
The minute she left the room, Kel tried to assess his situation. He was in the ICU, hooked up to an EKG monitor. He glanced up. He had one IV line with two bags hanging. One was saline, the other sodium nitroprusside. No transfusions, which was good news. The Foley catheter was still in. Not so good news. He’d have to talk to Joe about that.
As if on cue, Joe entered the room. Kel couldn’t help but notice that the older man looked tired, almost as if he was the one who’d had the surgery.
“How are you feeling?” Joe asked as he approached the bed.
“Shouldn’t you be telling me?”
“Better than you have any right to be.”
Kel wasn’t sure he understood Joe’s answer. “What does that mean?”
“Well, it was pheochromocytoma. The good news is that the tumor was benign. Tom removed the entire gland. If all continues to go well, in a few weeks, you should be back to normal.”
It wasn’t malignant. Kel sighed inwardly with relief. He expected to see Joe’s familiar smile at the good news. But Joe wasn’t smiling. He looked concerned. Did they find something else?
“Joe . . .?” he asked tentatively. “What’s the bad news?”
“Let me check you over.” Joe’s tone was almost gruff. “Roll onto your side for me.”
“Kel, you’re nearly a day post-op. I need to check you. Then we’ll talk.”
With Joe’s help, Kel did as he was told and turned onto his side. The movement hurt.
Joe leaned over the bed, pushed away the blankets, and began to remove the dressing that covered the incision. “It’s healing nicely,” he commented. “How’s the pain?”
“Bearable,” Kel replied truthfully.
“I’d rather there’d be none at all. I’ll up the meperidine a bit.”
Kel waited until Joe had finished his inspection and pulled the covers back over his side. “Joe, what aren’t you telling me?”
Joe had his stethoscope out. “Take some deep breaths.”
“Sash. Breathe,” he added, not unkindly.
Kel realized he’d get nothing more out of Joe until he’d finished the exam. He endured the remainder in silence, growing more and more worried at Joe’s distant attitude. Finally, he’d had enough.
“Joe, what’s wrong? Did something go wrong? Something you’re not telling me?”
Joe replaced the stethoscope in his pocket. “It was close, Kel.” Joe’s eyes had a haunted look.
Kel’s eyes narrowed. “What do you mean?”
Joe sighed as he leaned against the bed rail. “In surgery. Your BP was fluctuating wildly,” he said slowly. “Tom had a hell of a time controlling it.”
Kel couldn’t remember Joe ever swearing. “How bad was it?” he asked, unsure if he wanted to hear the answer.
Kel let the statement hang between them. Joe wasn’t one to exaggerate, not about surgery. He’d been scared. That alone scared Kel. Scared him badly.
“But I’m okay now?”
“That’s not the point.”
“Then what is the point?”
Joe started to turn away. “Maybe we should talk tomorrow, when you’re stronger.”
“No, dammit. I want to hear what you have to say.”
“Okay.” Joe pulled up the room’s only chair. “You have no idea how close you came to dying on the table yesterday. If Tom weren’t such a terrific surgeon, we’d be preparing for your funeral.”
Kel took a moment to absorb that statement. Why was Joe telling him this, trying to scare him? “You make it sound like it’s my fault.”
“It is your fault.”
“How is it my fault?”
“It’s your fault because you were sick for weeks and didn’t do anything about it. It’s your fault because you didn’t have a physical for three years. It’s your fault because you fought me every step of the way on this. If you’d just taken proper care of yourself, we’d have caught this weeks, maybe months ago.”
Kel couldn’t remember the last time he’d seen Joe so angry and said as much.
“Kel, I almost lost my best friend on the table yesterday morning. I don’t ever want to go through that again.”
The utter despair in Joe’s voice stopped him cold. Joe was not a demonstrative man. For him to say this much, to call Kel his best friend . . . .
Finally, Kel found his voice. “Joe, I’m sorry. But I don’t know what I could—“
“You’re the Chief of Emergency Services. Whether you like it or not, people look up to you. Attendings, residents, nurses, paramedics. When you don’t take care of your own health, you give them license to do the same. I did it with my heart condition. The paramedics are doing it all the time. You know what it takes to get one of them to admit they’re ill or injured.”
The last comment produced a smile on Kel’s face and even Joe came close to a grin. It was short-lived.
“I don’t know why we don’t take better care of ourselves,” Joe continued. “Whether it’s some god complex or because we hate being patients, or something else altogether. But I do know that eventually it’s going to get one of us killed. Or, maybe even worse, get one of our patients killed.”
“All right, all right, I’ll try to do better,” Kel said.
“You say that, but we both know that in a week or a month, you’ll revert to your old habits.”
“Then I guess you’ll have to keep me on the straight and narrow.”
For a moment Joe said nothing. When he did speak, his voice was again soft and measured. “I’m a neurosurgeon. By the time most patients get to me, there aren’t many options left. No matter how skilled I am, many times there’s simply nothing that I can do to save them. I’m lucky if I can give them a few more months of reasonably meaningful life.
“It gets to me sometimes. And then I look at you. You’re young, brilliant, exactly what this new field of emergency medicine needs. And you almost threw it all away. That’s why I’m angry, Kel. There are so many who can’t be helped. You could be and almost died because you refused to be.”
Joe stood up. “I can’t change you; I can’t make you change. Only you can do that. But I hope you will, if not for yourself for those of us who need you and care about you.”
Without another word, he strode to the door. “Dix is waiting to see you. Are you up to it?”
Joe paused at the door and turned around.
“I hear you, loud and clear,” Kel said.
“I hope so.”
I’ve been insufferable these past couple of weeks. I’ve taken my frustrations out on a lot of
folks who were only trying to help me, but no one more than you. And you of all people didn’t deserve it.”
“It’s okay, Kel,” Joe replied with a smile. “That’s what friends are for.”
It was good to be back at work, Kel thought to himself as he stepped out of the treatment room and headed for the base station. He’d been back for just over two weeks after being out for nearly two months following his surgery. The recovery itself had taken over a month and then Joe had insisted he take a couple of weeks of real vacation before returning to work. Kel had to admit that, for the first time in several years, he felt relaxed, refreshed and completely healthy.
He’d worried how his department would manage in his absence. It had, apparently flawlessly. He had asked Joe more than once how he’d done it. Joe had merely smiled and told him not to worry about it. Kel suspected that Joe and Mike and probably most of the other emergency department physicians had pulled extra shifts to cover him. A part of him felt guilty, but another part recognized that it was necessary and he had done and would do the same for any member of his staff.
“Hey, Doc,” John Gage greeted him at the base station with a smile. “How’s he doing?” he asked, referring to the possible MI he and Roy had just brought in.
“Doing well,” Kel replied. “My guess is that’s it’s just angina and not an MI, but we won’t know for sure until we do some more tests.”
“That’s great,” Johnny said. “His wife was really worried.”
“Well, Mike’s talking to her now. It’s always nice to be able to give good news.” Kel poured himself a cup of coffee. “Hey, speaking of good news, I hear Station 51 finished second in the city-wide competition last week. Congratulations.”
“Thanks,” Roy said. “Wish we’d been first, but . . . “
“Hey, second out of twenty-three is nothing to sneeze at.”
Roy’s response was cut off by Mike Morton’s arrival.
“Everything okay with the patient’s wife?” Kel asked his resident.
“Perfect. I told her we’d keep him for a few hours and that he’d need to follow up with a cardiologist.”
“Great. Thanks for taking care of it, Mike.”
Mike pointedly cleared his throat. “As long as I’m taking care of things, how about I take care of that arm of yours? I saw you grimacing when we transferred that last patient to the exam table.”
Kel absently rubbed his shoulder. It had been sore for a couple of days, but he was sure he’d strained a muscle playing tennis a couple of days ago. Now that he was back in shape, he’d been pushing himself on the court.
“It’s nothing, Mike.”
“What’s nothing?” Joe Early asked as he approached the base station.
Kel glanced at Roy and Johnny, who looked for the world as if they’d like to be elsewhere.
“I was just saying that Kel should have someone take a look at his shoulder.” Mike directed his comment to Joe.
“And I was just saying that it’s nothing.” Kel started to say more, but one look at Joe’s face stopped him cold. Joe managed to convey an abundance of concern, disappointment and betrayal without saying a single word.
Kel mentally kicked himself. He’d promised Joe that things would be different, that he’d set an example in taking care of his own health. Joe had doubted him at the time and Kel had just proven that doubt well founded. Darn. Joe was right again. He could either go back to his old ways and encourage everyone else to hide illness and injury or he could do as Joe had suggested.
And what if he was wrong? Maybe this was more than just a muscle strain. He didn’t think so but he’d ignored his last set of symptoms and look what had happened. These thoughts crossed his mind in an instant and the solution came even more quickly.
“But,” Kel continued, drawing out the word, “I suppose it wouldn’t hurt to have one of you look me over, just to be sure.” He looked between his two colleagues. “Does one of you have a few minutes?’
Kel repressed a smile at the looks of astonishment that crossed the faces of Mike and the two paramedics and the approval in Joe’s eyes.
“I-uh, think I can spare a minute,” Mike replied, unable to hide the surprise in his voice.
“Three’s open,” Kel said with more cheer than he felt. As he followed Mike down the corridor, he shot a glance over his shoulder at Joe. He suspected that Joe had intentionally deferred to Mike and the look he received back from his friend confirmed it.
Kel felt a sense of déjà vu as, not more than ten minutes later, he again exited the treatment room. He rebuttoned his cuffs and slipped into his lab coat as he followed Mike to the base station. He wasn’t surprised to see Joe and the paramedics waiting for him.
All three looked from him to Mike, unable to hide their anticipation and apprehension. It seemed no one wanted to be the first to speak.
“Well?” Joe finally asked.
“Kel was right,” Mike said with a shrug of his shoulders. “Nothing more than a slight strain. A little heat, a couple of aspirin, and some Ben-Gay and he’ll be hitting those cross-court winners in no time.”
“That’s great, Doc,” Johnny said. Roy echoed his partner’s comments.
Kel watched his friends visibly relax, much as he himself had relaxed when Mike had delivered his verdict in the exam room. Kel hadn’t realized how much tension built up worrying about a medical condition and the enormous sense of relief in finding out that nothing was seriously wrong. He couldn’t believe how much better he felt now than he had a half hour ago.
“Well, much as I hate being a patient,” Kel said, “I must say that it’s worth the agony to find out there’s nothing wrong.” He gave Joe a brief smile. “Sure beats worrying yourself and everyone around you.” He fixed his gaze directly at the paramedics. “You should try it sometime.”
Roy and Johnny were saved from replying by the sound of their HT going off. “Squad 51, are you available?” the dispatcher’s voice came over the line.
“Squad 51, that’s affirmative,” Roy answered.
“Stand by, 51.”
“Gotta go, Doc,” Johnny said, scooping up their supplies.
Kel gave them a slight wave. “Be safe, fellows.”
Mike also edged away. “I’m gonna finish this chart from Mr. Martinez before anyone else comes in,” he said. “At least give myself a shot of leaving before midnight.”
Joe waited until Mike was well down the hall before speaking. “I must admit that you surprised me back there. I really thought you might revert to your old ways.”
“I suppose I surprised myself a bit,” Kel replied, allowing his mouth to twist into a tight smile. “I was so used to automatically fighting any examination or treatment that I’d forgotten how much easier it is simply to say yes. And,” he looked pointedly at Joe, “I have to admit that, once again, I was wrong and you were absolutely right. I hope this doesn’t become a habit.” He gave Joe a mock frown.
“I’m doing my best to make it one.” Joe’s eyes twinkled. “Now, how about some aspirin for that shoulder of yours? If you promise to take two, I’ll even let you call me in the morning.”
Kel gave his friend a look of gratitude. “It’s a deal.”