“Have you prescribed anything?”
“No, of course not. Not that I haven’t been tempted.”
“And now he’s reporting pain?”
“At the amputation site. Whenever he tries to walk on his prosthetics. I don’t know if he’s really having a problem or if it’s an excuse to not do his exercises at home. I’ll take him back down to D.C. and get him refitted if it’s necessary, but what if it’s not?” She blew her nose.
Trip slid the tissue box toward her. “Let me take a look at him.”
“Oh, God. Thank you, Trip. I know you’ve done a couple of tours of duty. I’m hoping he’ll listen to another soldier where he won’t listen to me.”
He pushed back from his desk. “I don’t know if two ninety-day stints will qualify me as a fellow soldier to a marine, but I’ll do what I can.” He opened his office door, ushering Anne into the wide corridor that led to the waiting room. Trip had to admit, her tears and jitters shook him. Anne was the very definition of an emergency department jockey-cool under pressure, calm when everything around her fell apart, able to process rapid-fire information and turn it into a rational diagnosis and a measured treatment plan. He had consulted with her half a hundred times before she left the Washington County Hospital for Glens Falls. He had never seen her lose it. Never.
Will was slouching in his wheelchair as they entered the waiting room. He sat up immediately. He would have been a big kid before-all the Ellis boys took after their dad-and his five months post-trauma hadn’t entirely wasted his natural youthful muscle, although he looked way too pale and had clearly lost weight.
“Hi, Will. I’m Dr. Stillman.” They shook hands. “We’ve met before, haven’t we? You were in Catrin’s class.” Trip’s middle daughter was a sophomore at Smith. No wonder Anne was so overwrought. A nineteen-year-old ought to be in college, his worst problems hangovers and getting girls to go out with him.
Will nodded. His light brown hair was growing out of its baldy sour, giving him the appearance of a hedgehog. “Catrin and I were on the cross-country and track team together.”
Behind Will, his mother made frantic no-no-no gestures. Talking about running was off-limits? That wasn’t a good sign. “Your mom says you’ve been experiencing some difficulties with the prosthetics.” He gestured to the hall. “Why don’t you come on in and we’ll take a look?”
Anne swooped behind Will and grabbed the handles of his chair just as the boy laid hold of the wheels. “I can do it, Mom.” He sounded like a nice son trying not to be annoyed with his mother.
“Of course. Of course you can.” Anne’s voice was unnaturally perky. Trip led them down the hall, opening the door to his largest examining room. Will back-and-forthed a couple of times before getting the chair lined up with the entryway. He rolled through, Anne right behind him.
Trip made a hold-up gesture. “Will? Do you want your mother to wait while we talk?” Anne’s frown almost made him miss the boy’s expression. It clearly hadn’t occurred to either of them that Will could see a doctor without his mother tagging along.
Will looked at Trip. Looked at his mother. “No, it’s fine.” He smiled weakly at Anne. “After all, she’s the expert.”
“Okay.” Trip took his usual seat, the rolling stool tucked under the counter. He flopped open the fresh case file and clicked his pen. Ask if P. wants alone
Anne hovered behind and to the side of the wheelchair.
“Why don’t you tell me what’s up?” Trip said.
“He’s been complaining of pain-”
He held up one hand. “Let me hear it from him, Anne. You know a history isn’t complete without the patient’s own words.”
She made a disparaging sound and clamped her lips together. Trip looked at Will. “Well?”
Will shrugged. “It’s not a big deal. It hurts some when I practice standing.”
His mother took a quick breath.
“I haven’t been working on my mobility as much as I should,” he added quickly.
“Why’s that?”
Will shrugged. “The wheelchair’s actually more convenient. With the crutches, my arms and hands are all tied up. It’s like… it’s like I’ve got four prosthetics instead of two. In the chair my upper body is completely free. And it’s hard. Walking, I mean. Just a couple steps and I’m sweating.” He spread his hands. “Why not use the wheels?”
Trip rolled toward him. “How about I take a look?” Will pulled his loose khakis up and unstrapped his prosthetics one at a time. Trip took them and examined their cups, running his fingers inside and pressing into the pads. They were very high quality work, suggesting made-to-measure. There shouldn’t be any mechanical irritation involved. Will pulled off his socks-the close-fitting coverings that went over his stumps-and Trip cradled the amputation sites in his hands.
It was a classic traumatic transtibial amputation, neatly finished off and well healed. The left leg was a little rawer than the right. “This is the one that was an attempted tarsal resection?”
“Yes,” Anne said. “They tried to save his entire tibia, but his vascular network was too compromised.”
“My foot got blown off, and then they had to chop the rest of it off up to my knee,” Will translated.
Trip rolled back to his bench and scribbled a note on the stump condition. “Are you experiencing pain at any other times?”
“Not in my… not there. I get phantom pain sometimes, especially at the end of the day, before I go to bed. Tingly, crampy sensations, like I’m getting a charley horse in my calves.” Will’s mouth screwed up. “In what used to be my calves. They told me I could expect that, once the real pain from the operations went away.”
Trip nodded. “Phantom pain may be your brain’s way of trying to create input from nerves that ought to be there, but aren’t. Practicing your walking could help that, by giving your brain real nerve information to deal with.” He pulled an X-ray request from a tray and jotted down the series he wanted. “I want to get a few X-rays while you’re here, just to make sure you aren’t developing bone spurs or stress fractures. Once we rule those out, I’d like to get you into physical therapy.” He glanced up at Will. “Have you seen anyone since you were released from Walter Reed?”
Anne frowned. “I told you. He has a once-a-week appointment at the Stratton VA Medical Center.”
Trip’s hand involuntarily went to the scar half hidden by his hair. “Sorry. Since I got back, I’ve been more scatterbrained than usual. Will, I’d like you to do another two sessions each week at our PT facility. We have an excellent therapist who has a lot of experience with diabetes-related amputees. In the meantime, if you don’t have a weight set at home, I suggest you get one.” Trip smiled at Will. “I’m betting you were used to working out hard in the Corps. Let’s get you back into that routine.” He stood. “You can head over to the waiting room until the radiology tech calls you.” He ripped the PT request off its pad and handed it to Will.
He walked them to the waiting room before heading over to radiology to drop off his request form. Parker Weyer, one of his partners, spotted him in the hall. “Trip. Can I have a quick consult with you?” It turned out to be a C4 fracture that wasn’t responding to immobilization. Trip and Parker debated fusion versus screws and eventually decided on the former, given the age of the patient. On his way back to his office, their practice manager snagged him. One of the radiology techs was pregnant and being pulled off duty. Did the partners want to make up her absence by offering the other techs overtime? Or did they want to hire a sub for the length of her maternity leave? He took the printout of cost comparisons and promised to confer with Parker and Madeline.