3
Monday, June 5, 2006 – 5:35 p.m.
Aspen Memorial Hospital – Room 505
Watching the green blip slowly cross the screen of the oscilloscope as it counted out the heartbeat, breathing and brainwaves of Benita Noveen, Dr. Ken Slaterbaugh stood scratching his head through thinning brown hair. His gentle blue eyes moved slowly and methodically from machine to human and back again. A deep concern wrinkled his brow and he absent-mindedly reached up and stroked his mustache while carefully rereading her chart. It didn’t make sense. There was nothing wrong with Benita, yet she had been comatose since Friday when she’d been brought into the hospital by ambulance. Her limp body had been found in a park not far from Aspen Memorial Hospital where she was currently resting. The paramedics who brought her in had no idea what was wrong, and now, standing before her, Dr. Slaterbaugh was coming to the same conclusion. Her vital signs were normal except for occasional changes in her breathing and heart rate, and her brainwave activity gave no cause for alarm. There were no injuries, bruises, broken bones or allergic reactions to medicines. She had an identification card, but no family. A call to her employer shed no light on her possible collapse, either. According to her boss, she was a good worker, though quiet, withdrawn and often depressed. She had a negative view of life and herself, but she managed to keep it separate from her job. She knew she needed work to stay alive, so because of that, she made a real effort to avoid negativity while working. She did her job every day without complaining and when she left, as far as he knew, she always went right home. When asked if there had been any recent changes in her attitude, job status, health or other related details, her boss indicated there was none. In fact, he told Dr. Slaterbaugh, he had been thinking of giving her a raise in the next week or so because of her conscientious and trustworthy work and in the hope that maybe, just maybe, it would help break some of the chains of her pessimistic and lonely life.
With those thoughts in mind, Ken’s perplexity grew. He’d run every test imaginable in the last two days, but could find nothing wrong. His 20 years as a neurologist were of no help, either, and his frustration seemed to grow exponentially. As he stood there in the low light of the overhead fixtures, his pager went off. Plucking it from his belt, he read the LCD readout. He immediately recognized it as the ER. Someone needed his expertise right away.
*****
Arriving in the Emergency Room, Dr. Slaterbaugh made his way through the hustle and bustle of a typical trauma room environment. Quickly making his way around gurneys, past harried nurses and interns, jumping out of the way of a crashing IV pole that had been knocked over by a drunk, Ken finally reached the admitting desk.
“You paged?” Ken asked the nurse.
Her glistening aqua blue eyes caught Ken’s stare as he stood and waited. “Yes, I did,” she said in a cute and lilting voice. Her small frame made her look almost child-like in the large rolling chair. Her petite nose and tiny body added to the picture of adolescence, but her use of medical jargon and expertise at organizing and categorizing all the ins and outs of the ER belied that image.
“A 33 year-old man came in a few minutes ago with a skull fracture sustained while riding his motorcycle. His condition is stable, but there is some concern about possible swelling of the brain. Dr. Johansen would like to have you take a look at him.”
“Thanks,” Ken said. “Do you have his chart?”
“No,” the kid-nurse said; “Dr. Johansen has it. He’ll fill you in when you talk to him. He’s in curtain two with the patient. And be careful. The patient is not very happy about being here.”
“Thanks for the warning, Cindy,” Ken said, nodding to her as he left.
Walking around a puddle of vomit near curtain three, Ken slipped into curtain two to talk with Henry Johansen. He’d known Henry for about three years now. Henry was a great ER doc, and Ken respected him greatly. Henry’s choice of a career, though, would never work for Ken. He couldn’t deal with the intense pressure and stress of the ER atmosphere. Ken liked being able to examine carefully and methodically his patients and their ailments and then to be able to take control of the situation, enabling him to come to some conclusion that was the result of intense research, examination and well-thought out scenarios. The idea of “emergencies” coming in at any second didn’t sit well with Ken. Just thinking about the possibilities he could end up facing left him shaky and stressed.
On the other hand, Henry loved this kind of intensity. The adrenaline rush, dealing with the unknown, making split-second decisions and to a small degree playing God gave Henry what one might call a “medical high.” He loved feeling needed, being in control, taking the horse by the reins so to speak and bringing order to chaos.
Henry turned and saw Ken enter the curtained area. “Thanks for coming down doctor!”
“No problem,” Ken replied, nodding at Henry and staring in disbelief at the behemoth in the bed. A huge, hulk-of-a-man was spread across the mattress. He looked like he belonged with the Hell’s Angels. Long scraggly hair, an untrimmed beard, teeth that hadn’t seen a dentist in decades and skin that looked like leather were his trademarks. His sweaty, grease-splotched brow and face and his grimy clothes cried out “Don’t mess with me! I’ll do what I want and no one will tell me otherwise.” Looking back at Henry, Ken asked, “So, what’ve we got here?”
“Well, our patient’s name is Hank Maverick, 33 years-old, 365 pounds. He’s six-foot one, fair health, and loves to ride his motorcycle. He came in about 30 minutes ago with a fractured skull. Seems he forgot his helmet today.”
“I don’t need no stupid helmet!” Hank bellowed. “Helmets are for pussies! Little wimps can’t take a little knock on the head. And it’s a hog. It ain’t no motorcycle, Mr. Know-It-All. If you’re gonna talk about my bike, make sure you know what you’re talking about!”
“Sorry, Mr. Maverick. I didn’t mean to upset you. However, a helmet would have prevented you from being here. Your head’s not made out of steel, you know.”
“It’s tough enough. A few bumps and bruises over the years is good for you. Toughens you up, you know. Besides, you two look like a couple of neat Nicks; don’t want to get down and dirty. A little dirt’s good for you. In fact, you’ve probably never even seen the underside of your BMW’s hoods now, have you? Don’t even know what an engine is.”
“Well,” Ken said, “I have looked under my hood, and believe it or not, I have done a lot of work on my own car. And it’s a Ford for your information.”
“Hmmff. Whatever. So can I go now?”
“Not until we run some tests. I can’t in good conscience let you go with an injury like that. I need to be sure there are no complications.”
“There aren’t,” Hank grumbled. “Just a little headache. Now, if you don’t mind, I’m leaving.”
With that, Hank started to climb over the edge of the bed. Before he could sit up, he rolled backwards onto his pillow. “Just a little dizziness,” Hank said. “I’ll rest for a minute and then I’m outta here.”
“We’ll see about that,” Henry said. “Why don’t you tell Dr. Slaterbaugh here exactly what happened?”
“I already told you, it’s no big deal.”
“But it is. Dr. Slaterbaugh needs to make an accurate evaluation in order to get you out of here as quickly as possible.”
Hank grumbled, “I was just going to go riding for a while with my buddies, and when I pulled out of my driveway, I misjudged and dumped it when I drove over the curb. I fell off and thumped my melon on the pavement. Next thing I know, I’m looking into the face of two paramedics. They insist I come here even though I feel fine except for a little bruise on my head. They wouldn’t let me just sit for a few minutes. They insisted I could have a head injury and needed to see a doctor. So, here I am, but not of my own choice. I was forced to come in. Give me a few minutes and I’m gone.” Hank’s hands trembled a little and he appeared somewhat pale. When he moved to reposition himself in the bed, his body rippled and rolled as if he were the embodiment of a vat of thick chocolate. His dark, greasy skin added character to the effect.
“Well, let me take a look,” Ken said. “I’m a neurologist. These head injuries can sometimes really fool a person. You might think things are fine, and then a few hours or days later, internally you start having some real problems: bleeding, blood clots, swelling of the brain, things like that. It’s always best to have it checked out just in case.”
Hank rolled his eyes as if to say ‘whatever,’ and laid his head to the side on his pillow. A dark smudge remained on the pillow where his face had just been lying.
“I’ve got the x-rays here,” Henry said, motioning toward the X-ray Viewer hanging on the wall beside Hank’s bed.
Ken looked closely at the x-rays, noticing the three-inch line running down the right side of his head from the mid-parietal to the occipital plate. It was serious, but not life threatening. Usually, it wasn’t the fracture that there was concern over. It was what happened inside the head that caused the problems.
“Doesn’t look too bad,” Ken said. “What are his vitals like?”
“Good. He’s not complaining of any pain or loss of vision. He says he’s hearing fine and has no loss of memory. He says his head is a little sore, and he has a slight headache, but other than that, he says he’s feeling fine.”
“That’s right, I’m fine. And I can hear everything you’re saying. I’m not deaf, you know. Now, can I go?” roared Hank.
“Not just yet,” Henry said.
“How long are you planning on keeping him here?” Ken asked, a quiver of concern stretching across his face.
“Probably another few hours or so, and then we’ll let him go if there are no complications or post-traumatic symptoms.”
Ken stood stroking his mustache while looking at the x-ray and the monster on the bed. His look of concern prompted Henry to ask, “What are you thinking? You don’t seem convinced that he will be okay.”
“Something tells me to keep him overnight. I’ve seen too many of these cases over the years where the patient looks and feels fine, but then within a few hours has something go wrong internally. I’d like to have him admitted overnight for observation.”
“Come on!” Hank hollered. “I’m not staying in this stupid hospital all night! I’m checking out. You can’t make me stay!”
“You’re right Hank, I can’t. But it’s in your best interests to do so, just in case. You wouldn’t want to go home and then end up being brought back in, would you?”
Hank just muttered something obscene under his breath and looked back at the ceiling. After staring off into space for a few seconds, he said, “I’ll stay tonight, but that’s it, no longer. First thing tomorrow, I’m gone!”
“Fair enough,” Ken said. “Do you need anything else or have any other questions before I leave?”
“No,” Hank said, his ego deflating like an unknotted balloon.
Ken and Henry left Hank spread out on his bed like a kiddies pool that had been filled too full of water.
Stepping outside the curtain and out of earshot from Hank, Henry asked Ken, “Well, what do you think?”
“Hard to say,” Ken replied, his soft complexion and wrinkled brow showing signs of concern. “He’s one of those cases where his outer shell makes it hard to distinguish his real feelings and pains from the falsely projected ones. A fracture like that, though, is serious, more so than I wanted to let on to him in the room. Given the proximity of the fracture to the parietal, temporal and occipital lobes of the brain, serious damage both short and long-term can occur. Those areas of the brain control important functions such as feelings derived from impulses coming from the body, hearing, memory, senses of time and individuality, as well as sight. Damage to any one of those areas could, over a period of time, have devastating results.”
“Well, it seems then, that, stay he shall, based on your expert medical opinion.”
“I just don’t like taking chances. You’ve known me for too long, Henry, to know how I like to have things in order and under control. I can’t take this not knowing, these sudden emergencies that can crop up in a case like this.”
“And I thrive on the unknown,” Henry said, a gleam of delight twinkling in his eyes. “It keeps me young, energetic, sharp.”
“Well, you can have it,” Ken said, his voice confident, but kind.
“Will you be by in the morning then to see Hank?” Henry asked.
“I’ll squeeze him in somewhere before noon. I’ll let you know my recommendation after I check him out. For now, let’s get him moved to a room on the neurology floor where I can have him connected to some monitors to keep an eye on his brainwave activity and vital signs.”
“Will do,” Henry said. “I’ll have admitting page you when he’s settled in.”
“Thanks Dr. Johansen,” Ken said as he reached out and gave Henry a firm, but gentle shake on his shoulder.
A gurney rolled by carrying an unconscious woman who appeared to have been shot. A cacophony of voices, machines and clatter followed them down the hall and into curtain four.
“I’ll check with you tomorrow.”
Just then, a voice beckoned Dr. Johansen from behind curtain four that they needed his help stat.
“Duty calls,” Henry said, with a twinkle in his eye and an adrenaline rush as noticeable as a gravy stain on a white shirt.
With that, Henry bolted down the corridor, nearly knocking over a nurse and disappeared behind curtain four. Ken could hear him immediately begin giving orders and taking charge of the situation. He smiled, and turned to go back upstairs to his office when his pager went off again. Stepping to the nurses’ station, he picked up the phone and dialed. A deep furrow of concern and anxiety appeared on his forehead.
“I’ll be right there,” he said.
Half running, half-jogging, he headed for the elevators, wondering what was going on with Benita Noveen.
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