"It would not be my recommendation," Claude repeated. "If the offending agent turns out to be one of the aberrant strains of E. coli. antibiotics can make the situation worse."
"Now, how can that be?" Kim said. "That's ridiculous."
"I'm afraid not," Claude said. "Antibiotics can decimate the normal flora and give the renegade E. coli more room to flourish."
"Will she be admitted to your care?" Tracy asked Claude.
"No, that's not possible," Claude said. "AmeriCare requires a gatekeeper. But I'll be happy to look in on her, especially if whoever handles the case requests an infectious-disease consult."
"Since Becky does not have a staff pediatrician, she'll be admitted under the care of Claire Stevens," David said. "It's her rotation. I can give her a call."
"You can't do much better than Claire," Claude remarked.
"You know her?" Tracy asked.
"Very well," Claude said. "You're lucky it's her rotation. She takes care of my kids."
"Finally something seems to be going right," Kim said.
EIGHT
Wednesday, January 21st
Kim turned into the hospital parking lot a little after six in the morning. He'd skipped stopping at his office, as he normally did. He was eager to look in on Becky and make sure everything was okay.
The previous night things had gone well after the unpleasant episode with David Washington. Dr. Claire Stevens had come into the ER within a half hour of being paged. In the interim, Kim had phoned George Turner for the second time that evening. This gave him a chance to ask George's opinion about the pediatrician. George had echoed Claude's sentiments, and both Kim and Tracy had felt relieved.
Claire was a tall, thin woman – nearly Kim's height. Her features were sharp but they were belied by her gentle, reassuring manner. Kim's personal impressions of her added to the professional testimonials. She was about his age, which suggested years of clinical experience under her belt. What's more, her competence was immediately apparent and reassuring. Of equal importance, she established immediate rapport with Becky.
Kim pushed into Becky's room. There was a night-light near the floor that reflected off the ceiling, casting a gentle glow over the entire room. Kim advanced silently to the bedside and looked down at his sleeping daughter. Her halo of dark hair made her face appear the color of ivory. Its translucency gave her a fragile look as if she were made of porcelain.
Kim knew that under the circumstances it was appropriate for Becky to be in the hospital. At the same time her being there gave him great anxiety. His vast experiences in hospitals reminded him that it was an environment where horror could lurk.
Becky's breathing was regular and deep. Her IV was running slowly. Happy to see her resting so well, Kim quietly backed out. He did not want to disturb her.
Back at the nurses' station, Kim withdrew Becky's chart. He glanced through the admitting notes that Claire had dictated, then turned to the nurses' notes. He noticed Becky had been up twice during the night with continued diarrhea. There had been some blood reported but only by Becky. None of the nurses had seen it.
Kim then turned to the order sheet and was pleased to see that Claire had followed up on her word: she'd requested a pediatric gastroenterology consult for that day.
"Now, that's one delightful child." a lilting voice said.
Kim looked up. Glancing over his shoulder was a plump nurse with a face red from exertion. Her blond hair was permed into a multitude of tight ringlets. Her cheeks were dimpled. Her name tag indicated she was Janet Emery.
"Have you been looking in on her?" Kim asked.
"Yup," Janet said. "Her room's in my area. Cute as a button, that one."
"How has she been doing?" Kim asked.
"Okay, I guess," Janet said without a lot of conviction.
"That doesn't sound too positive," Kim said. A minute sliver of fear eked its way up his spine, giving him an involuntary shiver.
"The last time she was up, she seemed weak," Janet said. "Of course, it might have been because she was sleeping. She rang for me to come help her back to bed."
"I understand from the chart that you didn't get to see how much blood she might have passed," Kim said.
"That's right," Janet said. "The poor thing is embarrassed to beat the band. I tried to tell her not to flush after she uses the toilet, but she does anyway. What can you do?"
Kim made a mental note to talk to Claire about that problem and to Becky as well. It would be important to know if the blood was mere spotting or worse.
"Are you a consult on the case?" Janet asked.
"No," Kim said. "I'm Dr. Reggis, Becky's father."
"Oh my goodness," Janet said. "I thought you were a consult. I hope I didn't say anything out of line."
"Not at all," Kim said. "I certainly got the feeling you care for her."
"Absolutely," Janet said. "I just adore children. That's why I work this floor."
Kim went off to see his inpatients and then attend the series of hospital conferences scheduled for that morning. Like Mondays, Wednesdays were particularly busy with respect to his administrative responsibilities. Consequently, he didn't get back to Becky's floor until almost ten. When he did, the ward clerk informed him that Becky was off to X-ray. He was also told that Tracy had come in and was with her.
"Can you tell me about the status of the gastroenterology consult?" Kim asked.
"It's been ordered," the clerk said. "If that's what you mean.
"Any idea when it will be?" Kim asked.
"Sometime this afternoon, I'd guess," the clerk said.
"Would you mind giving me a call when it does happen?" Kim asked. He handed the clerk one of his cards.
"Not at all," the clerk said.
Kim thanked him and hurried off to his office. He would have preferred to see Becky and talk to her, even if for a moment, but he didn't have the time. He was already behind schedule, a fact that he was philosophical about, since it tended to happen more often than not.
'Well, Mr. Amendola," Kim said, "do you have any questions?"
Mr. Amendola was a heavyset plumber in his early sixties. He was intimidated by modern medicine and horrified by Kim's verdict: he needed a valve in his heart replaced. A few weeks earlier, he'd been blissfully unaware he even had valves in his heart. Now, after experiencing some scary symptoms, he knew that one of them was bad and had the potential to kill him.
Kim ran a nervous hand through his hair as Mr. Amendola pondered the last question. Kim's eyes wandered out the window to the pale wintery sky. He had been preoccupied ever since Tracy had called an hour earlier to say she thought Becky didn't look good, that she was glassy-eyed and listless.
With a waiting-room full of patients, Kim's response had been to instruct Tracy to page Claire and to tell her Becky's status. He also told Tracy to remind the clerk to call him when the gastroenterology consult arrived.
"Maybe I should talk to my children," Mr. Amendola said.
"Excuse me?" Kim said. He'd forgotten what he'd asked the man.
"My children," Mr. Amendola said. "I got to ask them what they think the old man should do."
"Good idea," Kim said. He stood. "Discuss it with your family. If you have any questions, just call."
Kim walked Mr. Amendola to the door.
"You're sure the tests you've done are right?" Mr. Amendola asked. "Maybe my valve isn't so bad."
"It's bad," Kim said. "Remember, we got a second opinion."
"True," Mr. Amendola said with resignation. "Okay, I'll get back to you."
Kim waited in the corridor until it was certain Mr. Amendola was on his way to reception. Then Kim lifted the heavy chart of the next patient out of the chart rack on the back of the door to the second examining room.