When David entered her room he found her still asleep. Moving to the bedside, he glanced at the swelling on her jaw. It appeared unchanged. He gave her shoulder a gentle shake, calling her name softly. When she didn’t respond, he shook her more vigorously and said her name more loudly.
Finally she stirred, lifting a trembling hand to her face. She could barely open her eyes. David shook her yet again. Her eyes opened a bit wider and she tried to speak, but all that came out was disconnected jabber. She was clearly disoriented.
Trying to remain calm, David drew some blood and sent it off for some stat lab work. Then he devoted himself to a careful examination, concentrating particularly on Sandra’s lungs and the nervous system.
When David returned to the nurses’ station a short time later he was handed Sandra’s stat laboratory values. They were all normal, including the blood count. The white cells, which had been elevated from her abscessed tooth, had fallen with the antibiotics and were still low, ruling out infection as an explanation for her current clinical state. That said, the sound of her lungs suggested incipient pneumonia. David wondered again about a possible failure of her immune response.
Once again David was presented with the same trio of symptoms affecting the central nervous system, the GI system, and the blood or immune system. He was seeing a complex, but he had no idea what the underlying factor could be.
David agonized over what to do next. The life of a thirty-four-year-old woman hung in the balance. He was afraid to call any consults, partly because of Kelley and partly because the consults had not provided any help in the three similar cases. And calling in consults for Eakins had resulted in David’s removal from the case. David was even reluctant to order further diagnostic or laboratory tests since nothing had proved to be of any value with the other patients. He was at a loss.
“We have a seizure in room 216,” one of the nurses shouted from down the hall. David went running. Room 216 was Sandra’s room.
Sandra was in the throes of a full-blown grand mal seizure. Her body was arched back as her limbs contracted rhythmically with such force that the whole bed was bouncing off the floor. David barked orders for a tranquilizer. In an instant it was slapped into his hand. He injected it into Sandra’s IV. Within minutes the convulsions stopped, leaving Sandra’s body spent and comatose.
David stared down at his patient’s now peaceful face. He felt as if he was being mocked for his intellectual impotence. While he had been indecisively sitting at the desk puzzling over what to do, the seizure had taken over Sandra’s body in a dramatic gesture.
David erupted in a whirlwind of activity. Anger replaced despair as he pulled out all the diagnostic stops. Once again he ordered everything: consults, lab tests, X rays, even an MRI of the skull. He was determined to figure out what was happening to Sandra Hascher.
Fearing a rapid downhill course, David also made immediate arrangements to transfer Sandra to the ICU. He wanted continuous monitoring of her vital signs. He did not want any more surprises.
The transfer occurred within half an hour. David helped push Sandra down the hall to the ICU. Once she was moved off the gurney, David started for the ICU desk to write new orders, but he stopped short of his goal. In a bed directly across from the central desk was Nikki.
David was stunned. He’d never expected to see Nikki in the ICU. Her presence there terrified him. What could it mean?
David felt a hand on his shoulder. He turned to see Dr. Pilsner. “I can see you’re upset about your daughter being in here,” he said. “Calm down. I just don’t want to take any chances. There are some fabulously skilled nurses in here who are accustomed to taking care of patients with respiratory problems.”
“Are you sure it’s necessary?” David asked nervously. He knew how tough the ICU environment was on a patient’s psyche.
“It’s for her benefit,” Dr. Pilsner said. “It’s purely precautionary. I’ll be moving her out of here just as soon as I can.”