David put the car in gear, and they started for the hospital.
“I’m concerned about how my patient will be this morning,” he said. “Even though I haven’t gotten any calls I’m still worried.”
“And I’m worried about facing Wadley,” Angela said. “I don’t know if Cantor has spoken to him or not, but either way it won’t be pleasant.”
With a kiss for luck, David and Angela headed for their respective days.
David went directly to check on John Tarlow. Stepping into the room he immediately noticed that John’s breathing was labored. That was not a good sign. David pulled out his stethoscope and gave John’s shoulder a shake. David wanted him to sit up. John barely responded.
Panic gripped David. It was as if his worst fears were coming to pass. Rapidly David examined his patient and immediately discovered that John was developing extensive pneumonia.
Leaving the room, David raced down to the nurses’ station, barking orders that John should be transferred to the ICU immediately. The nurses were in the middle of their report; the day shift was taking over from the night shift.
“Can it wait until we finish report?” Janet Colburn asked.
“Hell, no!” David snapped. “I want him switched immediately. And I’d like to know why I haven’t been called. Mr. Tarlow has developed bilateral pneumonia.”
“He was sleeping comfortably the last time we took his temperature,” the night nurse said. “We were supposed to call if his temperature went up or if his GI symptoms got worse. Neither of those things happened.”
David grabbed the chart and flipped it open to the temperature graph. The temperature had edged up a little, but not the way David would have expected having heard the man’s chest.
“Let’s just get him to the ICU,” David said. “Plus I want some stat blood work and a chest film.”
With commendable efficiency John Tarlow was transferred into the ICU. While it was being done, David called the oncologist, Dr. Clark Mieslich, and the infectious disease specialist, Dr. Martin Hasselbaum, to ask them to come in immediately.
The lab responded quickly to lab work requested for the ICU, and David was soon looking at John’s results. His white count, which had been low, was even lower, indicating that John’s system was overwhelmed by the developing pneumonia. It was the kind of lack of response one might expect from a patient undergoing chemotherapy, but David knew that John hadn’t been on chemo for months. Most ominous of all was the chest X ray: it confirmed extensive, bilateral pneumonia.
The consults arrived in short order to examine the patient and go over the chart. When they were finished they moved away from the bed. Dr. Mieslich confirmed that John was not on any chemotherapy and hadn’t been for a long time.
“What do you make of the low white count?” David asked.
“I can’t say,” Dr. Mieslich admitted. “I suppose it is related to his leukemia. We’d have to do a bone marrow sample to find out, but I don’t recommend it now. Not with the infection he’s developing. Besides, it’s academic. I’m afraid he’s moribund.”
This was the last thing David wanted to hear although he had begun to expect it. He couldn’t believe he was about to lose a second patient in his brief Bartlet career.
David turned to Dr. Hasselbaum.
Dr. Hasselbaum was equally blunt and pessimistic. He thought that John was developing massive pneumonia with a particularly deadly type of bacteria and that, secondarily, he was suffering from shock. He pointed to the fact that John’s blood pressure was low and that his kidneys were failing. “It doesn’t look good. Mr. Tarlow seems to have very poor physiological defenses, undoubtedly due to his leukemia. If we treat, we’ll have to treat massively. I have access to some experimental agents created to help combat this type of endotoxin shock. What do you think?”
“Let’s do it,” David said.
“These drugs are expensive,” Dr. Hasselbaum said.
“A man’s life hangs in the balance,” David said.
An hour and fifteen minutes later, when John’s treatment had been instituted and there was nothing else to be done, David hurried to his office. Once again, every seat in the waiting room was occupied. Some patients were standing in the hall. Everyone was upset, even the receptionist.