Angels in the ER (6 page)

“Frank?” Katie said, now worried. She reached over and touched his arm.

And then it was over. Just like that. It had been only half a minute, maybe a little less.

“Wha…” he stammered, shaking his head as if to clear it. “What did you say, Katie? Do I want you to drive? No, no, I’m fine,” he answered, now more relaxed.

She continued to search his face, relieved by what he had just said. But she was still concerned, and the uneasy feeling was only slowly beginning to fade.

“Whew, Frank. You had me worried there. You must have been daydreaming.” She put her magazine in the passenger-door pocket.

He straightened his arms out, pressing himself back in the seat.

“That was really weird,” he began. “I could hear you talking plain as day, and I could see everything going on around us. But I couldn’t say anything. I knew what I wanted to say but I couldn’t make myself say it. My mouth wouldn’t work. Darnedest thing that’s ever happened to me.”

“Frank, are you alright now?” Katie asked, her anxiety returning.

“I’m fine now,” he responded, realizing he needed to calm his wife. “I just couldn’t talk, just for a second. No headache, no nothing. I’m fine. Honest.” He patted his wife’s knee as they sped down the highway.

She looked intently at her husband of forty years. He seemed all right. He was his normal self now, making sense, and he seemed in control of his faculties. Yet something like that shouldn’t happen. She just knew it.

She was silent for a few miles and then said, “Frank, we need to stop and see a doctor.”

He jerked his head to look at her. “What? I’m fine, Katie. Honest. We don’t need to stop anywhere, and I don’t need to see a doctor.”

“No, we’re going to stop. It’s still several hours to Myrtle Beach and I won’t feel right unless we have you checked out.”

She was sitting bolt upright, her arms folded across her chest. He was very familiar with this posture and knew her mind was made up. They passed a mileage sign, and she said, “Look, Rock Hill is just ten miles away. We’ll stop there. That’s a good-sized town, and they’ll have a hospital. We’ll just follow the signs.”

And then she was silent. Frank knew this silence, and knew that it would do no good to try to dissuade her. They would stop in Rock Hill and find a hospital.

The process begins. Someone punches your ticket, hands it back to you, and then you’re on the train. There’s no stopping. And just as when you’ve boarded a train, you have no control over where the process is heading. It’s almost as if it has a mind of its own.

It’s often a simple thing—an innocent-appearing symptom, a seemingly meaningless change in the way you feel, an unexpected finding in a routine examination. You go to your doctor or to the ER to have this “new thing” checked out. One examination, one test leads to another. Something else turns up. “We need to look into this further.” Or the unwelcome words, “We’re going to need to have you see a specialist.”

When the pretense of self-determination and control is stripped away, when the flimsy, artificial layers we construct for our protection are gone, it is our mortality that stares us in the face. Almost daily, one of the staff members in the ER will utter the phrase, “I don’t know how they can stand that. What will they do?” It is posed as a rhetorical question, and goes unanswered. But the dark thought hangs in the air. It sobers us for a moment, strikes a chord that is both familiar and uncomfortable.
There but for fortune…
And then we move on.

Not so for the person holding the ticket.

Frank was sitting up in room 2. He was in a hospital gown and seemed embarrassed as he struggled with the tie strings behind him. Katie was trying to help. She clucked as she shook her head. “Why do they always make these things so short?”

“They do, don’t they?” I said, entering the room and pulling the curtain closed behind me. “Hi, I’m Dr. Lesslie. What can we do for you this morning?”

They both looked up. Katie had managed to knot the strings and secure Frank’s gown.

“Hello, Doctor,” Frank began. “I’m not sure I even need to be here, but my wife—”

Katie quickly interrupted. “His wife is concerned about him and wants him evaluated. We’re on vacation, and Frank had an unusual episode a little while ago while we were driving on the interstate. I just want him to be checked out.”

She went on to explain the brief problem her husband had experienced. Frank sat leaning forward on the stretcher, his arms folded and his head down.

When she had finished, I asked Frank how he felt now and what he remembered of the incident.

“Doc, I feel fine now, completely normal,” he responded. “And about what happened on the road, it was just really unusual. I could hear Katie, and I knew what I wanted to say, but I couldn’t make my mouth work. It was strange. And then it passed and was gone.”

He seemed fine now, but the story was bothersome. He might have had a small stroke, or he might have an aneurysm that was beginning to leak. His heart could be throwing out tiny clots. This could represent a number of potentially serious things, or it could be just a passing problem, one that would never recur.

His physical examination was completely normal. His vital signs were also within normal limits, his neurological status was fine, and his cardiac exam was okay. But something just didn’t seem right, and the fact they were on the road, headed away from home, bothered me.

“Well, everything looks good now, but I think we should just check
things out a little more. What I would recommend is that we get a CT scan of your head and make sure there are no problems there,” I explained.

“Dr. Lesslie, I—” Frank began.

But Katie interrupted him again, patting him on the arm. “Dr. Lesslie, you go ahead and do what you think needs to be done. I want to be sure everything is alright before we head on to Myrtle Beach.”

Frank looked up at her, and an expression of mild consternation gave way to one of resignation.

I looked at him, seeking his approval.

“Well…okay, Doc. If that’s what you think is best.”

“I do, Mr. Giles. It should only take an hour or so, and when we get the results we should be able to send you on your way. I’ll just feel better about things if I know the scan is normal.”

“We’ll feel better too, Doctor. And thank you,” Katie responded, smiling.

The Radiology Department was adjacent to the ER, just around the corner. Fortunately the CT machines were not too busy this morning. They were able to get Mr. Giles in right away, and in thirty minutes to an hour or so I would get a faxed report from the radiologist. As I stood at the nurses’ station writing on his record, I didn’t anticipate a bad outcome. I knew I was being cautious, maybe overly so. But with people from out of town who are just passing through, you tended to be a little extra careful. Most of our patients are from Rock Hill, or from within the county. And most have family physicians they can see in the next day or two for follow-up if needed. And if they get worse, they can always come back to the ER. But for those who are traveling, you want to be sure you aren’t sending them down the road with a problem that has not been identified or resolved.

The department had gotten busier while I had been in room 2 with the Gileses. I had taken care of a sore throat, started the workup of an elderly man with abdominal pain, and taken a quick look at a lacerated finger, when I saw Frank Giles being wheeled back into the
department by two X-ray techs, his wife walking by his side. They were smiling at me as they were taken to his room.

I was talking to Amy, requesting some lab studies for the gentleman with abdominal pain. “We’ll need a CBC, electrolytes, amylase, lipase, and an obstructive series for room 3, if you can get that going. Oh, and see if you can find a family member. He’s not able to tell me too much.”

“Sure thing,” Amy responded. She’d anticipated this and had already notified the X-ray techs.

Frank Giles’s chart was on the counter, and I noticed there was no faxed report attached to it. Usually the report would beat the patient back to the department. I glanced at the fax machine that sat at Amy’s elbow. Nothing.

Then the phone rang.

Amy picked up the receiver while continuing to fill out the lab requests for the patient in room 3.

“ER,” she answered. “Ms. Conners speaking.”

There was a brief pause, and then, “Sure, he’s standin’ right here, Dr. Stringer. Let me give him the phone.”

“It’s for you,” she said, handing me the receiver without looking up from her paperwork. “Dr. Stringer in Radiology.”

Matt Stringer had joined the Radiology staff a little over two years ago. He had extensive training in neuroradiology and, just as important, he was easy to work with. He seemed to understand the pressures we were under in the ER, and he never tried to second-guess us when we ordered studies, especially requests made in the middle of the night. He would frequently walk over to our department with films he thought were especially noteworthy, and together we would go over them. He had taught me a lot about the rapidly changing technologies of scanning and the newer forms of imaging.

“Hey, Matt,” I spoke into the phone. “What’s going on?”

“Robert, this Mr. Giles you sent over for a CT scan, what can you tell me about him?” The tone of Matt’s voice was all business, something unusual for him.

“Well, what do you mean? From a neurological standpoint he’s fine. He had a brief episode earlier this morning of expressive aphasia, but that resolved and he’s been fine since. Why, what do you see on his scan?” I asked, becoming concerned. This should have been straightforward, a normal and perfunctory report. Apparently it was not.

“You mean he hasn’t had any problems before today?” Matt questioned. “No headaches, imbalance, change in behavior?”

“No. Not that he or his wife told me about. Why?”

Matt paused and then said, “You’d better come over to the department and take a look at this scan with me.”

“I’ll be right there.”

I told Amy where I would be and glanced briefly at room 2, where the curtain was pulled open. The Gileses were quietly talking to each other and didn’t look in my direction. I turned and walked down the hall toward the back of the ER and then to Radiology.

Matt Stringer was in one of the viewing rooms, sitting in a black leather chair. He was studying a row of films attached to a light box. He pressed a button and with a soft mechanical groan, the row moved upward and an entirely new set of films came into view.

“Hey, Matt,” I greeted him, stepping into the dimly lighted cubicle. “What do you have?”

I stepped behind him, leaned over his right shoulder, and looked at the view box. He was reaching out his hand and pointing to one of the X-rays, but my eyes had already found his intended target. I was stunned.

“Take a look at that, Robert,” he said, gently tapping the film. In front of us was a CT scan, a cross section of Frank Giles’s skull and brain. And in the middle of what should have been normal brain matter was something that shouldn’t have been there. The size of a tennis ball, it was clearly demarcated, being a different shade of gray from the surrounding tissue. The ominous-appearing mass had extended its tentacles into Frank’s defenseless cerebrum.

I knew at once what it was, but I asked Matt anyway, hoping I was wrong. “What do you think that is?”

“It has to be a glioblastoma. And pretty aggressive, from the looks of it,” he answered. “And you say this guy hasn’t been having any symptoms? Look at the size of this thing. That would be hard to believe.”

I continued to stare at the X-ray, and my mind raced.
A brain tumor.
How was I going to break this to the Gileses? What was I going to tell them?

“No, Matt. I asked both of them repeatedly, and he has been doing great. No headaches, no visual changes, no weight loss, no gait disturbance. Nothing. Just that brief episode this morning,” I told him. It didn’t seem logical to me, either. This was a huge tumor and it occupied a lot of space. You would think from its size and location it would have announced itself by now.

“Hmm,” Matt mused. “Well, it doesn’t really matter, does it? This thing is going to kill him. It’s too big and too invasive to do anything with. It’s in a terrible location and it must be growing pretty fast. Does this guy live here in town?”

I told Matt of the circumstances in which the Gileses found themselves. He rubbed his chin and looked up at me. “Good luck, Robert. I don’t envy you having to tell them about this.”

I wasn’t feeling so good about it myself. “Well, thanks, Matt. I guess I’d better get back to the ER and sit down with these folks.”

“Okay, I’ll see you later. Let me know if I can do anything.” He turned back to his work and pressed the button on the desktop. With the same quiet mechanical groan, the films from Frank Giles’s CT scan disappeared from view, and the X-rays of someone else’s life took their place.

The walk back to the ER was long but not long enough. The fact that I didn’t know these people wouldn’t make this any easier. They were good folks, and they would immediately understand the implications of what I had to tell them.

Virginia Granger was standing at the nurses’ station as I approached. She looked up from the legal pad she had in her hand and took off her glasses. Tapping the pad with them, she said, “Dr. Lesslie, there are a couple of things we need to go over before we have our staff meeting
in the morning. Do you have a few minutes now, or would another time be better?”