My smile held no humor. “Didn’t you hear? Tyranny is the newest and greatest teaching technique.”
“Yeah, right. Anyway, things have been relatively quiet around here the last few hours. Keep an eye on Mr. Mendall in room 510. He’s been complaining about pain in his incision site, so I upped his dosage of fentanyl as well as NSAIDs. He’s been stable throughout the day. Oxygen levels, heartrate, and blood pressure all within normal range. If his pain becomes unbearable even on Fentanyl, you might want to get a consult from an attending.”
We discussed Drew’s other patients before he clapped me on the back and left me to repeat the process with the remaining doctors. Soon I was alone with a hospital tablet and the soft chatter coming from the nurses’ station. Settling into a chair, I opened the first computerized file and perused the pertinent medical information on each patient. It took a while to get through, but when I was done, I felt I had a handle on the cases and could approach the shift more like an inverted day.
As I stood to grab a cup of coffee, my pager beeped. 510. Drew’s patient. Possibilities raced through my mind. Had his pain increased? Were there other complications? A lot of things could turn south after surgery, and I mentally recalled all I’d studied the last few years.
I entered the room where a nurse hovered near the head of Mr. Mendall’s bed, adjusting the bag of fluids hanging from a hook and attached into the back of the patient’s hand through an intravenous catheter.
“What have we got?” I squirted hand sanitizer in the middle of my palm and rubbed the alcohol-smelling liquid over my skin before grabbing a pair of nitrile gloves and pulling them onto my hands.
“He’s spiked a fever and his blood pressure has dropped.”
I read the monitors before turning to the patient. “Mr. Mendall, how are you feeling?”
The man looked up at me hovering over him, his face scrunched in obvious pain as his body shivered. Pain, fever, chills, and—I glanced again at the vitals monitor—rapid pulse. I pulled back his blanket and lifted his gown to inspect the incision site. The tender skin around the site appeared blistered and angry red. I schooled my features. The patient didn’t need to read the thoughts racing across my mind on my face.
“Mr. Mendall, can you describe the pain for me please?”
He licked his lips. “It’s crackling. Under my skin.”
My heart jumped to my throat. I gently lowered his gown and pulled the blanket back up, then moved to his feet and untucked the blanket. His feet and ankles were puffy. Fluid retention. Kidney failure.
If the diagnosis was what I thought it was, Mr. Mendall couldn’t wait for a biopsy or an MRI. Necrotizing fasciitis, or hospital-acquired flesh-eating disease, was a fast-acting superbug with fatal outcomes if not treated quickly, as one in three persons died from infection.
Not wanting to alarm Mr. Mendall, I motioned for the nurse to talk side-bar style. “In cases like this, always presume Methicillin-resistant Staphylococcus aureus. Get Mr. Mendall started on an antibiotic combination of meropenem, vancomycin, clindamycin while I draw blood cultures. And call Dr. Feinburg. Tell him we have a patient presenting with necrotizing fasciitis that has gone into kidney failure.”
I’d get Mr. Mendall into dialysis, but he’d also need another surgery to cut away the dead tissue the bacteria had eaten and insert a surgical drain to remove pus and other fluids from the area. “For now, let’s go through quarantine procedures on this room until we hear from Dr. Feinburg on shutting down the unit or restricting admission.” These things spread like a wildfire, and we needed to cut the problem off at the source.
I ripped the gloves from my hands, pushing down the anger rising to the surface. Now was not the time, and Mr. Mendall’s room was not the place. I had to remain the professional. Get Mr. Mendall the help that he needed.Thistime I had the knowledge to do so. The power to do so.Thistime an unsuspecting person wouldn’t come to the hospital thinking they’d receive the medical help they needed only to contract an infection in this petri dish of a building and succumb to an illness they hadn’t had upon admission.
I hadn’t been able to save Laura, but I could save Mr. Mendall.
* * *
Dr. Feinburg lowered the medical mask from across his mouth and nose to hang around his neck. We’d finished cutting away the dead flesh, and Mr. Mendall had been whisked away to quarantine. A nurse pushed a man prepped for surgery past us and through a bank of doors. “That was a good catch, Reed. Another hour or so undiagnosed and I think we’d be looking at a different outcome.”
I pulled the scrub cap from my head. “I’m just glad we were able to save him, sir. Although he’ll have a nasty scar.”
“Better that than the alternative. We’ll keep admissions restrictive and monitor the other patients. Mr. Mendall’s kidneys should return to normal function as well, thanks to you.” He studied me a moment. “These things happen, you know. We do all we can to prevent them, but nosocomial infections are an enemy we’re still battling in hospitals.”
One that claimed almost a hundred thousand lives a year in America.
One particular life four years ago.
Even scarred wounds could ache, and my heart throbbed at that moment.
Dr. Feinburg clapped me on the shoulder. “You did well, Dr. Reed. Go home. Get some sleep.”
The wash of adrenaline and its subsequent loss left me drained. I turned over the patients to the incoming physicians and walked to my car in a zombie-like state. Driving home occurred on autopilot, I realized, as I sat in my driveway having no recollection of pulling out of the hospital parking lot.
Time had a weird way of moving forward but standing still all at once. Of creating the sensation of a déjà vu moment when, in reality, nothing was the same.
I didn’t want to remember that day. Laura, yes, always. But never that day. I’d never felt as helpless as I did then, holding Laura’s hand. Eighteen months in medical school, but my mind had refused to come up with a diagnosis or a solution. Neither had her doctors. Not until it was too late.
I tilted my head back and blinked up at the ceiling of my car. Twin tears pooled in my eyes. I blinked again, and they trickled down my temples and into my hair. My eyes closed, and I brought an image of Laura to my mind.
We were in the halls of George Washington High. Even though she had a purple JanSport backpack hanging from her shoulders, she’d hugged her books to her chest. Something about the curve of her lips as she smiled at the girl beside her mesmerized me. It took a whole month to get her to go out with me, but after that we’d been inseparable. High school sweethearts who married right after graduation.
