“Bessie? Well, my, God. That’s a weird coincidence. I knew she’d had a relapse two weeks ago. The nurses on her floor notified my office that she was found comatose one morning at 4:00 A.M. I’d even dropped in for a long overdue visit the day before, and she was fine – well, you know how these things go. I just assumed she must have thrown another embolus. But it was her chart Mark asked about? This is really strange. Do they know what happened to her?”
“The CT shows no infarcts, so it’s probably metabolic, but-”
The sight of Lena hovering nearby interrupted him. “I need to talk with you in private,” he said instead.
“Sure. I’ve got rounds until five. How about we meet at my apartment? I can make us a pitcher of the best martinis you ever had, and we can discuss whatever you want with no interruptions.”
“Sounds good.”
She gave him the directions.
Back at his desk, he returned to what he’d been doing since morning – reexamining Bessie’s old records from 1974 to the present. The reason? Tanya Wozcek had gotten him thinking the worst. Yet he’d gone over everything a second time and still couldn’t find a single entry that suggested an error in her management back then. At least not the kind that gets written down.
So he’d gone searching through the rest of her old charts, checking subsequent admissions to see if she had any tendency to develop any transient metabolic states that might have spiked her digoxin level, yet been missed in ‘seventy-four because they came and went: things like renal failure from dehydration; side effects of other medications; interactions with those drugs – he looked for them all.
The result? Nothing.
That left only two other possibilities: the sort of accident that occurs in the syringe, a nurse drawing up too much digoxin – or what Janet had suggested, a deliberate overdose. Given that the same woman now lay in a coma, also unexplained, tilted him toward the latter.
However, the records here only went up to the admission under Melanie four years ago, the one Tanya had mentioned. The more recent entries would be in her active chart on the floor. Should he go back upstairs and poke through them too? He glanced at his watch and saw it was nearly 1:00 P.M. He might as well, to be complete. After all, he had the rest of the afternoon before Melanie got off duty. He could also try to reach the people whose resident numbers were on the old M and M reports, if the teaching office could track them down for him. Who knew what bizarre piece of information one of them might remember that would prove useful?
Before closing the chart, he took a final glance through the clinical notes Melanie had written at the time of the first embolus, refreshing his memory about what had been done so he could more easily pick up the threads of the patient’s story when he got to the floor.
Precise, to the point, and clear, they documented why she had thought McDonald’s symptoms were the result of a clot, not a bleed, and warranted immediate thrombolitic therapy. Earl was impressed. The symptoms and signs distinguishing one from the other were subtle. In his own ER he’d seen seasoned neurologists dither over similar cases, then not insist as authoritatively as they should have for an immediate CT, thereby wasting precious minutes. Not Melanie. “Eyeball to needle time” as the residents called it, or the duration from when they first saw the patient to the infusion of a clot buster, had taken three-quarters of an hour, which meant she hadn’t squandered a second in making her own diagnosis and getting radiology to prove it. “Well done, Melanie,” he said under his breath.
As he walked out the door, Lena gave him a frosty good-bye, making it clear she hadn’t appreciated his denying her a chance to eavesdrop.
Chapter 11
That same day, Tuesday, November 20, 1:15 P.M.
Hampton Junction
“I read your transcript today,” Mark said to Lucy, as they shared a late lunch of soup and salad at his kitchen table. “No wonder you handled yourself so well with my patients.”
She chuckled, with her mouth full of lettuce. “My past was no secret, if you’d read your mail lately. That’s quite a pile on your desk.”
“It’s a bad habit of mine, avoiding mail. All I seem to get is forms, bills, and professional questionnaires. I hate paper-maze stuff.”
“Join the paperless society and use e-mail.”
“I did. That gave me even more junk to deal with, so I canceled it.”
“I’m surprised. You being way out here yet not wired-”
“Oh, I’m on the net and have necessary passwords that let me access labs and X-ray departments to get test results.” He knew he sounded defensive, but he didn’t want this sophisticated, world-traveled lady to think he was a hick.
“It’s just that I never met anybody in America who doesn’t have e-mail,” she said.
He grinned and held out his arm. “Want to touch me to see if I’m real?”
She laughed, skewering what looked like half a head of Romaine with her fork and toasting him with it.
“Tell me about where you were stationed with Médecins du Globe,” he said, figuring he’d mangled the pronunciation.
Her smile vanished. “I’m afraid it was the grand misery tour, from Papua New Guinea tribal wars to refugee camps in Somalia, Rwanda, Bosnia, and Albania.”
There was hardness in her voice that told him she didn’t want to talk about it. “I can only imagine what you’ve seen,” he said, after casting about for something to say. It sounded lame.
She remained quiet for a few seconds, then asked, “You were never tempted to join? Obviously you have a taste for challenge, working out here.”
“No, never tempted.”
“Why? Most of the time we’re not getting shot at, if that’s what you mean. Much of the work is a lot like this morning. Sick people come in, tell you what’s the matter, and you treat them. Except we deal out of tents and the backs of trucks.”
He noticed how she talked about the work as if it were ongoing for her. As for her making it sound routine, “Yeah, right,” he said. “You guys are awesome. It sure explains how you seemed so comfortable handling my patients. This practice must seem like child’s play compared to what you’re used to.”
The corners of her mouth twitched upward like a pair of mischievous quotation marks. “Well, we did have distractions in the field that you don’t, like local warlords to keep happy, and creepy crawlies in our sleeping bags, which I can definitely say I do not miss.”
“Don’t sell the Adirondacks short in the creepy crawlies department.”
“What do you mean?”
“When I was in medical school I did a rotation through an ER in Lake Placid. A hiker came in with puncture marks on his leg claiming a rattler bit him.”
“I thought there weren’t any poisonous snakes in upstate New York.”
“That’s exactly what they told the hiker in ER. Wouldn’t give him antivenom.”
“So what did he do?”
Mark’s grin widened. “Went back to the trail where the damn thing attacked him, found it, and killed it with a tire iron. He returned to the hospital and threw it on the desk of the triage nurse. He got the shot.”
Lucy started to laugh. “No!”
“Saw it with my own eyes. It was even in the journals. Apparently the rattler escaped from a reptile zoo nearby. Taught me to always believe the patient.” He glanced at his watch and pushed away from the table. “We’ve got to get moving. House calls.”
Lucy followed Mark’s directions along an unplowed back road. A brilliant sky provided the perfect blue to contrast with the fresh snow, the sun cast a glitter over everything, and the mountainous contours in the distance seductively beckoned him to ski their curves.
“You know what I love about the first winter storm?” Lucy said as she navigated the coiling road much faster than Mark would have liked.