Bainbridge studied Susan. “What do you make of your findings, Susan?”
“Well . . .” Susan hesitated to speak. If what she believed was true, it would change the entire approach to the patient. “I don’t believe Starling has dementia per se. I think she’s actually suffering from congestive heart failure, a feature of which can be altered consciousness, especially in children.”
The nurses murmured in the background. Bainbridge nodded slowly. “Does she have a history of some sort of congenital heart disease with reparative surgery? Hypoplastic left heart? Transposition?”
“No,” Susan admitted. “But a child can develop congestive heart failure without a major defect.”
Bainbridge tried another tack. “An ASD, perhaps? A suspicious murmur?”
“No,” Susan admitted. “Prior to the A-V fistula repair, she was, apparently, perfectly normal.”
Bainbridge continued to stare. “So, then, what would cause a child with a normal heart to develop congestive heart failure after a routine neurosurgical procedure?”
Susan found herself bridling under the scrutiny and stood up straighter to buoy her confidence. The child’s life might depend on it. “Only one thing, sir. If the A-V fistula was not properly or fully repaired, it could cause a shunt that results in CHD.”
The nurses responded with a collective drawing in of breath that added up to an actual gasp. The doctors turned to face them.
“What’s wrong?” Bainbridge demanded.
The head nurse came forward. “Well, sir, the surgeon on Starling’s case was none other than Dr. Sudhish Mandar. He’s one of the greatest neurosurgeons in the world, and he personally signed off on Starling.”
Bainbridge sucked in his lips, nodding. “Well, then.”
Susan waited for his orders. It seemed impossible he would side with a first-year resident over a neurosurgeon with such stellar credentials, and she was not surprised when he did not.
Bainbridge patted Susan’s shoulder. “It was a great theory, anyway. I like to see my charges thinking in new and different ways.”
The smirks on the nurses’ faces annoyed Susan. She supposed they saw the same thing the first of every month: fresh, new residents so convinced of their own brilliance, so eager to find the instant cure so many wiser heads had missed. She supposed nearly all came with the same familiar “brand-new” approaches and ideas. She could hardly blame them for doubting her. “Dr. Bainbridge, I don’t think it would hurt anything to have Neurosurgery come down and reevaluate Starling. As far as I can tell by her chart, they haven’t seen her in at least the last eighteen months.”
Over Dr. Bainbridge’s shoulder, Stony shook his head, an obvious warning to Susan not to pursue the matter further, at least not at the moment.
A tinge of purple rose to Bainbridge’s wrinkled face, but his voice gave no sign of building rage. “Susan, when Dr. Sudhish Mandar signs off on something, it is off, finished, perfect.”
Susan wondered why she had never even heard of this so-called best neurosurgeon in the world. They had neurosurgeons at Thomas Jefferson, in Philadelphia; and she had performed her neurosurgery rotation as a medical student. She had never once heard them mention Dr. Mandar. “Fine, sir. As I wasn’t inside Starling’s brain, I can’t guess what they saw. However, I know pediatric congestive heart failure when I see it. Can I, at least, have a Cardiology consult?” No matter the cause of Starling’s heart failure, the cardiology team ought to have the expertise to control it. Perhaps they could come up with a reason for the problem that did not reflect badly on the neurosurgery team.
Bainbridge looked at Stony, as if to say he pitied the R-3 having to deal with a difficult upstart.
Stony did not seem put out by Susan at all. “How about if I examine Starling after rounds? If I also see signs of CHD, then we’ll consult Cardiology.”
That seemed to satisfy Bainbridge, who flashed Susan a sincere smile and nodded broadly. Before he could call for information about the next patient, thunderous pounding echoed across the ward. It sounded as if an entire wall had collapsed. There followed a shout, then a loud string of the dirtiest swear words in the English language in the voice of a prepubescent male. Through the one-way glass, they could see Dallas “Diesel” Moore ripping children’s artwork from the hallway walls and throwing the mangled papers at two nurses at his heels. Blood poured from his nose, gushing down the front of his shirt, but he paid it no heed.
“I hate you!” he screamed before disappearing around the corner, the nurses in tow. “I’m going to kill you! I’m going to kill you all!” He flung something in his hand that one of the nurses dodged.
Stony and several of the nurses excused themselves, darting out of the office toward the retreating figures.
“Whose patient is that?” Bainbridge demanded, watching Stony go.
Panic sparked in a few eyes. The other residents had had even less time than Susan to review and meet their patients. They might not know.
Susan rescued them. “He’s mine, too, sir.”
Diesel’s shouts wafted to them, still mostly curses. The sound of objects hitting the walls rose over the din, as well as scuffling and the softer voices of the nurses, attempting to restrain and soothe him.
Susan tried to ignore the noise as she presented the boy. When she had met him earlier, he seemed so calm, so normal, she could scarcely believe she had seen the same child. “Dallas Moore, known as Diesel. He’s a ten-year-old black male with morbid obesity, ADHD, oppositional defiant disorder, severe depression, and obsessive-compulsive tendencies, particularly in regard to food.”
The thudding sounds ceased as someone apparently restrained Diesel, but the threats grew louder and more vicious. Susan heard someone say, “Get him into the Self-awareness Room.”
Susan told the group, “He seemed quite normal this morning. I’m not sure what happened to him.”
One of the nurses, a petite blonde, spoke up. “He broke into the med room and plundered the snack cart. Ashlynn confronted him, and he just went crazy.”
Most of the nurses disappeared to the other side of the staffing area to watch through the one-way windows.
Another string of swear words rent the hallway; then came the sound of a large door closing. Silence followed until most of the nurses returned with Stony Lipschitz. Blood covered the front of the R-3’s dress polo, the stethoscope around his neck, and the papers in his pocket.
Bainbridge looked alarmed. “What happened? You didn’t have to hurt him, did you?”
Stony looked himself over. “It’s nasal blood, sir. Apparently, when Diesel gets upset, the blood vessels in his nose burst. The more he fusses, the worse it gets, and he won’t let anyone stop the bleeding until he’s calmed down. In fact, he seems to delight in spreading it as far and wide as possible.” Stony kept his hands away from his body. “Do you mind if I clean up?”
“Please do.” Bainbridge flicked a hand dismissively. “In fact, why don’t we all take a short break?” He looked at his Vox. “We’ll reconvene in an hour, at nine fifteen. Does that work for everyone?”
A tangible wave of relief flooded through the residents as they realized they could continue studying and examining prior to presenting their patients. They scattered in an instant. Susan hesitated, watching a janitor appear to clean up the blood-splattered hallway and the torn hunks of paper scattered in Diesel’s wake. She wondered what had come over him. She could scarcely imagine the stout, quiet little boy becoming a terror in an instant, as though he had swallowed Dr. Jekyll’s potion. She wondered what it must be like to live with a child so volatile, to be his parents or, worse, his younger sibling.
Curious, Susan followed the blood trail to the massive white door reading SELF-AWARENESS ROOM in bold black letters. Two male nurses stood there, one peering through a small but thick polycarbonate window.