Fatal Cure. Chapter 12, 13, 14
12
TUESDAY, OCTOBER 19
To David’s and Angela’s disappointment, it was still raining in the morning. In contrast to the gloomy weather, however, Nikki was in high spirits and doing marvelously. Even her color had returned. The sore throat, presaging an extended illness, had disappeared with the antibiotics, indicating that if it had been infectious, it had been bacterial rather than viral in origin. Thankfully there was still no fever.
“I want to go home,” Nikki repeated.
“We haven’t talked with Dr. Pilsner,” David reminded her. “But we will, sometime this morning. Be patient.”
After the visit with Nikki, Angela left for the lab while David went to the nurses’ station to pick up Marjorie’s chart. He’d been considering discharging her until he walked into her room. Her response to his greeting told him something was wrong.
“Marjorie, what’s the matter?” David asked as he felt his own pulse quicken. She was lethargic. He touched the back of his hand to her forehead and her arms. Her skin was warm to the touch. He guessed she had a fever.
Marjorie responded to David’s persistent questioning with barely intelligible mumbling. She acted drugged although not in any apparent pain.
Noticing Marjorie’s breathing was mildly labored, David listened carefully to her chest. He heard faint sounds of congestion. Next he checked the area of phlebitis and found it was all but resolved. With mounting anxiety David examined the rest of his patient. Finding nothing he hurried back to the nurses’ station and ordered a barrage of stat laboratory tests.
The first thing to come back from the lab was her blood count, but it only added to David’s puzzlement. Her white cell level, which had been appropriately falling with the resolution of the phlebitis, had continued to fall and was now in the lower percentile of normal.
David scratched his head. The low white count seemed contradictory to her clinical state, which suggested developing pneumonia. Getting up from the desk, David went back to Marjorie’s room and listened to her chest again. The incipient congestion was real.
Returning to the nurses’ station, David debated what to do. More lab tests came back, but they were all normal, even the portable chest X ray, and hence no help. David thought about calling in some consults, but after his poor utilization review the day before, he was reluctant. The problem was that the consults who might have been helpful were not part of the CMV organization.
Instead of requesting any consults, David took the Physicians’ Desk Reference off the bookshelf. Since his main concern was that a gram-negative bacteria might have appeared as a super-infection, he looked up an antibiotic that was specific for such an eventuality. When he found one he felt confident it would take care of the problem.
After the appropriate orders were written, including a request to be called immediately if there was any change in Marjorie’s status, David headed over to his office.
It was Angela’s turn to handle the day’s surgical frozen sections. She always found the task nerve-wracking since she knew that while she worked, the patient remained under anesthesia awaiting her verdict whether the biopsy was cancerous or benign.
The frozen sections were done in a small lab within the operating suite. The room was tucked off to the side and visited infrequently by the operating room staff. Angela worked with intense concentration, studying the patterns of cells in the specimen under the microscope.
She did not hear the door silently open behind her. She was unaware that anyone was in the room until he spoke.
“Well, honey, how’s it going?”
Startled, Angela’s head shot up as a bolus of adrenaline coursed through her body. With her pulse pounding in her temples, she found herself looking into Wadley’s smiling face. She hated to be called “honey” by anyone, except maybe David. And she didn’t appreciate being snuck up on.
“Any problems?” Wadley asked.
“No,” Angela said sharply.
“Let me take a look,” Wadley said, motioning toward the microscope. “What’s the case?”
Angela gave Wadley her seat. Succinctly she gave the history. He glanced at the slide, then stood up.
For a moment they talked about the slide in pathological jargon. It was apparent they agreed the growth was benign, happy news for the anesthetized patient.