The exhilaration of the cold, crisp air and the views of the frost-filled meadows cleared David’s mind. For a few minutes he was relieved of his anguish over his recent medical failures. Entering the hospital he felt better than he had for several days. The first patient he visited was Mary Ann Schiller.
Unfortunately Mary Ann was not bright and cheerful. David had to wake her up, and while he was examining her, she fell back asleep. Beginning to feel a little concerned, David woke her up again. He asked her how it felt when he tapped over her antral sinuses. With a sleep-slurred voice she said she thought there was less discomfort, but she wasn’t sure.
David then listened to her chest with his stethoscope, and while he was concentrating on her breath sounds, she fell asleep again. David allowed her to fall back onto the pillows. He looked at her peaceful face; it was in sharp contrast to his state of mind. Her drowsiness was alarming him.
David went to the nurses’ station to go over Mary Ann’s chart. At first he felt a little better, seeing that the low-grade fever she had developed the day before had remained unchanged. But his apprehension grew when he read the nurses’ notes and learned that GI symptoms had appeared during the night. She’d suffered from nausea, vomiting, and diarrhea.
David couldn’t account for these symptoms. He wasn’t sure how to proceed. Since her sinusitis seemed to be slightly better, he did not alter her antibiotics even though there was a slight chance the antibiotics were causing the GI problems. But what about the drowsiness? As a precaution, he canceled her PRN sleep order as he’d done with John Tarlow.
Going on to Jonathan Eakins’ room, David’s relatively buoyant spirits returned. Jonathan was in an expansive mood. He was feeling chipper and reported that his cardiac monitor had been beeping as regularly as a metronome without the slightest suggestion of irregularity.
Taking out his stethoscope, David listened to Jonathan’s chest. He was pleased to hear that Jonathan’s lungs were perfectly clear. David wasn’t surprised with Jonathan’s rapidly improved status. He had spent several hours going over the case with the cardiologist the previous afternoon. The cardiologist had been certain there would be no problems with the heart.
The rest of David’s hospital patients were all doing as well as Jonathan. He was able to move from one to the other swiftly, even discharging a few. With his rounds finished, David headed to his office, happy to be early. After the experiences of the last few days, he’d made a vow to make every effort not to get behind again.
As the morning progressed, David remained acutely aware of the amount of time he spent with each patient. Knowing that his productivity was being monitored, he tried to keep each visit short. Although he didn’t feel good about it, he was afraid he didn’t have much choice. Kelley’s implied threat of firing him had left him shaken. With their debt, the family could not afford for him to be out of work.
Having gotten an early start, David was able to keep ahead all morning. When two second-floor nurses called and asked to be seen as semi-emergencies, David was able to take them the moment they came in the door.
Both had flu-like symptoms identical to the two previous nurses. David treated them the same way: recommending bed rest and symptomatic therapy for their GI complaints.
With ample time to attend to other matters, David even had an opportunity to slip over to Dr. Pilsner’s office. He told the pediatrician that he’d been seeing some flu already, and he asked him about Nikki’s flu shot.
“She’s already had it,” Dr. Pilsner said. “I haven’t seen any flu in my practice yet, but I don’t wait to see it before I give the shots, especially to my cystic fibrosis patients.”
David also asked Dr. Pilsner about his opinion regarding the use of prophylactic antibiotics for Nikki. Dr. Pilsner said he was not in favor of it. He thought it best to wait until Nikki’s condition suggested she needed them.
David finished his morning patients before noon and even had time to dictate some letters before meeting Angela in the hospital lobby.