Internal Medicine: A Doctor's Stories (25 page)

I
T WAS MY PAGER
that went off as we were leaving Gero. I recognized the number as 1 North, Acute Women’s. I traded my earlier embarrassment for pique. They shouldn’t be paging me. Pages go to the intern. I showed him the numbers on the little screen. “I think this is for you.”

It wasn’t. They had called me because Carrie B was complaining. Shortness of breath. Tingling hands. Dizziness. Her respiratory rate was thirty-two.

“How does she look?”

This is usually a good question to ask of an experienced medical nurse, but here I could never be sure if the person I was talking to was more trained in restraint holds. I asked anyway.

The reply was clearly skeptical. “She
looks
okay. I mean, her color’s good and all. I think she’s just hyperventilating.”

It seemed a good call. Of course, she could also be harboring a massive blood clot in her lungs. I tried to thrust that thought aside, even though I knew we were doomed to go through the full workup. Unless.

“Have you got a paper bag there?” I said into the phone. “Like a lunch sack?”

A long pause. “There’s the one I brought my lunch in.”

“Could you let her breathe into it? Just hold it over her mouth and nose for a minute.”

Something not quite voiced that I couldn’t hear. Then, “Yeah. I can do that.”

“Thanks.” I was pleading again. “Let her do that for a couple of minutes and see what her respiratory rate does.”

Joe was looking at me, one dark eyebrow cocked.

“It might work,” I said, the defensiveness tumbling out before I was aware. I caught myself. “New admit I worked up earlier. Carrie something or other. Did you hear about her?”

He rifled his sheaf of papers. “Uh-uh.”

“Internal stimuli,” I said. Joe just nodded.

“She’s hyperventilating. Let’s go down to X-ray. I ordered chest films.”

Joe followed me silently toward a stairwell.

“Any idea what I’m worrying about?” I asked him, remembering that part of my role here was his instruction.

“PE?”

“Yeah,” I said dolefully. Pulmonary embolism is something that happens to people after sustained inactivity, to women who are pregnant or taking birth control pills, and to people with cancer or some kind of inborn clotting disorder. It’s a common cause of in-hospital deaths, and because its presentation is often subtle any suspicion usually requires a full workup. And the workup is famously mined with false results. I was not happy to be thinking about PE in the context of strange little Carrie B and her internal stimuli. There was enough I didn’t understand already.

The radiology reading room was (as they often are) in the basement, where we found an empty, darkened room, with darkened view boxes lining the walls.

“Who’s there?” a voice came from beyond the far end of the room. Light leaked around a corner. Reggie, the X-ray tech, appeared, and suddenly the room was flooded with light. “Hey, Doc,” he said, hastily putting down a magazine. His other hand held an overloaded sandwich, which shed shreds of lettuce as he waved it in our direction. “I was just about to page you. Those films you ordered? Carrie B? You gotta see this.”

An uneasiness was gathering in my chest.

Reggie whipped a set of dark transparencies from a cubby below the counter and slapped them onto the view boxes, which flickered. Light and shadows snapped into shape.

The pair of films revealed the thoracic skeleton of an individual, young by the density of the bones, evidently female. Automatically I began to scan, following the protocol: name and date first, then bones, then—

We all involuntarily drew breath.

In half a dozen places, between the cursive sweep of the ribs I saw bright, impossibly straight fine lines, each two or three inches long. They radiated outward from the center, as if deep within the body some source of radiation spat out infinitesimal projectiles of energy. Then my perspective shifted and I realized that the objects I was seeing were pointing inward.

“Oh, my God,” Joe murmured.

They were needles.

“Pretty wild, eh, Doc?” Reggie said. He waved his sandwich again. “I counted seven. There’s one”—he leaned in closer—“you can’t quite see. It’s just about dead-on to the source. Posterior, I think. See? Right there.” The sandwich indicated a distinct hyphen of light tucked under the curve of the seventh rib. “I figure she must’ve—” Reggie reached with his sandwich behind his back, miming a difficult stretch. “Don’t see how she could’ve done that with all those others in there. Maybe she did that one first? What do you think?”

“My God,” Joe breathed again. He was looking at the lateral projection, in which the curve of the spine stood silhouetted, the arms held up to clear the ribs.

We all stared. The image seemed to be holding itself up for us, holding its breath just as we were, all four of us in the grip of something that could not release: the shadowy substance pierced by those impossible bright spines.

“What on earth?” I heard myself slowly—carefully—let out a long breath.

“Wild,” Reggie said again.

“My God,” breathed Joe. “An iron maiden.”

W
E POUNDED DOWN
the hallway to 1 North and fumbled for what seemed minutes with the keys before passing through both sets of doors. The strangeness of Joe’s words was echoing in the tumult where I was unable to think: I could only feel them resonating, an unease that kept pace with me as I ran down the darkened hallway.
Iron maiden
, I kept saying to myself.
What a crazy thing to say.

The room was dark. On the bed within we saw a shape rigid as a crusader on a tomb. It made no movement as we hung in the doorway.

“Miss B?” Joe whispered.

Only the head moved, rotating slowly to face us. The eyes were open, wide and sharply focused, giving the impression that she had been lying there staring into the dark.

The eyes returned our gaze, their surface sleeked with light from the hallway. Something in the calm directness of her expression unnerved me again, stirring up once more the inward uneasiness that had been following me around all night.

“Miss B?” Joe whispered again.

The figure on the bed did not stir. She just held us in that steady, blank stare. Slowly, as if drawn, we moved closer.

Joe reached out a hand toward her. Almost imperceptibly, she shied away.

Silence gathered, pushing back at us.

My own voice broke against it in a harsh croak.

“We’ve seen the X-ray,” I heard it say.

The moment I said it, the tableau we had unconsciously formed began to dissolve. It was the wavering of her gaze that did it, releasing us all from the postures we had been holding. Joe and I audibly exhaled. Joe completed his gesture, his hand reaching her shoulder. “Don’t move,” he said.

A strange guttural sound, rhythmic and rising in pitch, emerged from deep in her throat. She was laughing. The sound rose to a high, tense giggle before cutting off with a sharp cry I could only recoil from.

I held myself carefully, suppressing the recoil out of professional habit: We do not reveal our disgust. Or fear. I kept my face as empty as possible.

“What are they?” I asked. She was taking rapid, shallow breaths, each inhalation ending in a grimace.

She took her time in answering. When she did, her voice was almost comically matter-of-fact.

“Needles.”

I expected something in her expression would change, her eyes to lower, a confession of something. But nothing changed: I stood riveted in her gaze until I looked away. I focused on the movement of her ribs as she breathed. That was scary enough.

“What sort of needles?” Joe asked.

A quick giggle, quickly cut off. “I got them. Here.”

“Like what the nurses use? For blood draws?”

“And injections.” She nodded owlishly at Joe.

“What did you do with the hubs?” I asked.

Her gaze swept back to me, her expression annoyed.

“Why do you want to know?”

Why did I? I considered a moment.

“I’m trying to figure out how to remove them.”

A smile: “I clipped them off. And pushed them. Deeper.”

Joe let out a sigh and turned to me.
See?
his expression seemed to say. I wasn’t certain I knew what he was inviting me to observe. Or understand. He seemed to have gotten over his astonishment. I was not any surer I understood anything.

A
T A SAFE DISTANCE
down the hall, Joe stopped and turned to me. He didn’t need to ask the question.

“How the hell should I know?” I said irritably. “This isn’t something they teach in medical school.”

“Do you think she’s safe?”

“You mean will she drop a lung?” I shook my head. “It’s a miracle she hasn’t already.”

“Why do you suppose she’s flinching like that?”

I stared at him.

“Do you think they’re touching the pleura? Something like that?”

“How the hell should I know?” I repeated. “She just scares the daylights out of me.” I turned on down the hall. “Come on. I’m sending her out.”

I left it to Joe to complete the paperwork involved in the transfer. While he was working, I waited nervously for EMS.

T
HE THREE FIGURES OF
the EMTs filled her room. I watched over their shoulders as they gently helped her stand and guided her to the gurney in the hallway. They placed her on it and began to strap her in.

“Not tight,” she said. And then that uncanny giggle erupted out of her, her eyes glazing over with an inward look I could not interpret, could not even look at without disordering my thoughts.

When I looked back at her I found her gaze upon me again.

“Thank you, Doctor,” she said, her expression almost prim, then catching at another inward expression of surprise as they swooped her up and away.

When I got back to the workroom, Joe was standing expectantly, pager in his hand.

“It’s Gero again.”

“D
OC?
”
THE NURSE SAID.
“It’s Mr. Scatliff. He’s vomiting and can’t seem to bring it up.”

I sighed. Another set of films I hadn’t seen yet.

We could hear the retching all the way down the hall. There was a small crowd gathered around a bench; it parted as we approached.

Mr. Scatliff’s wasted form curled over a trash can. He was clutching his gown to his chest with one hand; the other waved in the air, making a series of fluid gestures that seemed unrelated to anything else that was going on. I watched it, fascinated by its apparently independent movements. Was he gesturing to us? Conducting some internal music? The retching rose to a crescendo, and suddenly a flood of incomprehensible objects erupted from his mouth and rattled in the can.

And just as suddenly I felt, with a mixture of cold fear and uncomprehending surprise, a wave of nausea rising in me, and before I knew it I had vomited, too, right on the floor, splashing my feet and those around me.

I looked up, embarrassed. The entire crowd had turned to look at me, each expression a different mask of surprise.

But the face I found most startling was Mr. Scatliff’s. He had turned from his retching to look at me, and for a moment, as his free hand wavered toward me, I imagined I caught a glimpse of something intelligent in his eyes. Whatever it was, at that moment I didn’t want to know about it, and turned away as another gush of fire erupted through my chest.

A
FTER AN INTERMINABLE PERIOD
marked in my memory by scattered flashes—Joe’s face, a mixture of concern for me and for his pager, which kept going off; the amusement on the faces of the staff; beyond them the frieze of patients caught in attitudes of surprise, incomprehension, or intense concentration on any number of objects in the area, including me; and the interminable business of cleaning up the mess I had made—I followed Joe the long distance of the hallway toward the locked doors at its end.

Radiology was dark again, Reggie by now gone home for the night; the room flickered into light as Joe palmed the switches. He stooped to the bins below the counter, and I heard the stiff film jackets falling back into their bins with a hollow knock as Joe lifted each in turn.

“Roberson, Rush, Rutledge,” he muttered. “Sandler, Saknussem, Scarne. Scatliff.” He stood, grunting, snapped a pair of view boxes on, and slipped the films under their clips.

A crown of ribs, translucent with age, floated above dim clouds of bowel; a few dark pools of gas, a scatter of phleboliths, the spine a gnarled tree, but no foreign body. Nothing disrupted the ordinary shadows of an old man’s belly. I let out a sigh. Joe stepped back from the view box and ran a hand through his hair.

“I don’t see anything,” I said.

He nodded.

“That’s good,” I said.

He gave me a sidelong glance. There was something in his expression I couldn’t read.

“How are you feeling?” he asked quietly.