“I was not gone long,” Angela said. “I’m fully aware of my responsibilities and carry them out to the letter. I was not responsible for surgical specimens which would have been the only true emergency. Besides, my errand involved a visit to the chief medical examiner.”
“You saw Walt Dunsmore?” Wadley asked.
“You can call him if you doubt me,” Angela said. She could tell that Wadley was partially mollified. She was suddenly glad she’d made the spur-of-the-moment visit.
“I’m too busy to be checking on your whereabouts,” Wadley said. “The point is that I’m concerned about your behavior of late. I should remind you that you are still on probationary status. I can assure you that you will be terminated if you prove to be unreliable.”
With that, Wadley stepped back through the connecting door and slammed it shut.
For a moment Angela stared at the door. She detested this open hostility with Wadley. Still, she preferred it to the previous sexual harassment. She wondered if they would ever be able to develop a normal professional relationship.
After the last office patient had been seen, David reluctantly headed over to the hospital to make his afternoon rounds. He was beginning to dread the experience for fear of what he might face.
Before seeing his own patients David went to the ICU to check on Caroline. The child was doing poorly and was clearly moribund. David found Dr. Pilsner sitting at the ICU desk in a hopeless vigil. The man was despondent. David could relate all too well.
Leaving the ICU, David started seeing his own patients. Each time he went into another room he felt anxious, only to be relieved when he discovered the patient was doing well. But when he went into Sandra’s room the anxiety remained. Sandra’s mental status had deteriorated.
David was appalled. The change was dramatic to him even though the nurses weren’t impressed. When David had visited her early that morning she’d been bright and aware. Now she was apathetic to her surroundings and was drooling. Her eyes had lost their luster. Her temperature, which had fallen, had now crept back up over one hundred degrees.
When David tried to talk to her, she was vague. The only specific complaint he could elicit was abdominal cramps, a symptom that reminded him of other patients he’d been trying to forget. David felt his pulse quicken. He didn’t think he could tolerate losing another patient.
Back at the nurses’ station, David pored over Sandra’s chart. The only new fact was that she’d apparently lost her appetite as evidenced by an entry in the nurses’ notes that recorded she’d not eaten her lunch. David checked all the IV fluids she’d had; they were all appropriate. Then he went over all the laboratory tests; they were all normal. He was desperate for some clue to explain the change in her mental status, but there were no clues in the chart. The only idea that came to his mind was the possibility of early meningitis, or inflammation of the coverings of her brain. It was the fear of her developing meningitis that had moved him to admit her in the first place.
David re-examined her, and although he could not elicit any signs of meningitis, he went ahead with the definitive test. He did a lumbar puncture to obtain cerebrospinal fluid. He knew immediately the fluid was normal because of its clarity, but he sent it to the lab for a stat reading to be certain. The result was normal. So was a stat blood sugar.
The only thing Sandra wasn’t apathetic about was pain when David palpated her abscess. Consequently, David added another antibiotic to her regimen. Beyond that he had no ideas. He felt lost. All he could do was hope.
Climbing on his bike, David cycled home. He knew he was depressed. He got no enjoyment from the ride. He felt heartsick about Caroline and concerned about Sandra. But as soon as he arrived he realized he could not wallow in self-pity. Nikki was slightly worse than she’d been at lunchtime when he’d brought home her oral antibiotic. Her congestion had increased and her temperature had reached one hundred degrees.