“Well, don’t blame us,” Janet said. “Talk to maintenance.”
Feeling irritated for his patient’s sake, David took Janet’s suggestion and marched down to maintenance. He knocked on the jamb of the maintenance/engineering office. Inside and bent over a desk was a man close to David’s age. He was dressed in rumpled, medium-green cotton twill work shirt and pants. His face was textured with a two-day growth of whiskers.
“What?” Van Slyke asked as he looked up from his scheduling book. His voice was flat and his expression was emotionless.
“One of my patients was moved from his room,” David said. “I want to know why.”
“If you are talking about room 216, it’s being painted,” Van Slyke said in a monotone.
“It’s obvious it’s being painted,” David said. “What isn’t obvious is why it’s being painted.”
“We have a schedule,” Van Slyke said.
“Schedule or no schedule,” David said, “I hardly think patients should be inconvenienced, especially patients who are ill, and patients in the hospital are invariably ill.”
“Talk to Beaton if you have a problem,” Van Slyke said. He went back to his book.
Taken aback by Van Slyke’s insolence, David stood stunned in the doorway for a moment. Van Slyke ignored him with ease. David shook his head, then turned to go. On his way back to the patient floor, he was seriously considering taking Van Slyke’s advice to discuss the situation with the hospital administrator until he walked into John Tarlow’s new room. Suddenly David was presented with a more pressing problem: John Tarlow’s condition was worse.
John’s diarrhea and vomiting, which initially had been controlled, had returned with a vengeance. On top of that, John was obtunded, and when aroused, apathetic. David could not understand these symptoms since John had been on IVs since his admission and was clearly not dehydrated.
David examined his patient carefully but couldn’t find an explanation for the marked change in his clinical state, particularly his depressed mental status. The only thing David could think of was the possibility John could have been overly sensitive to the sleeping medication that David had prescribed as a PRN order, meaning it was to be given if the patient requested it.
Hurrying back to the nurses’ station, David pulled John’s chart from the rack. He desperately pored over the data that had returned overnight from the lab in an attempt to understand what was going on and to try to decide what to do next. As a result of the run-in with Kelley the day before he was reluctant to request any consults since neither of the two he wanted–oncology and infectious disease–were CMV doctors.
David closed his eyes and rubbed his temples. He did not feel he was making much progress. Unfortunately, a key piece of information was lacking: the results of the stool cultures plated the day before were not yet available. Consequently David still didn’t know if he was dealing with a bacteria or not, and if he was, what kind of bacteria it was. On the positive side was the fact that John was still afebrile.
Redirecting his attention to the chart, David ascertained that John had been given the PRN sleeping medication. Thinking that it might have contributed to John’s lethargy, David canceled it. He also ordered another stool culture and another blood count. As a final request, he asked for John’s temperature to be taken every hour along with the express order for David to be called if it rose above normal.
After completing the last scheduled biopsy, Angela tidied up the small pathology lab in the OR suite, and headed for her office. Her morning had been productive and pleasant; she’d managed to avoid Wadley entirely. Unfortunately, she knew she’d eventually have to see him, and she worried about his behavior. Although she considered herself an optimistic person, she was fearful that the problem with Wadley would not spontaneously resolve.
Entering the office, Angela immediately noticed the connecting door from her office into Wadley’s was ajar. As silently as possible she moved over to the door and began to close it.
“Angela!” Wadley called out, making Angela flinch. She hadn’t realized how tense she was. “Come in here. I want to show you something fascinating.”