“Just a port. Basically C-arm babysitting.”
The C-arm, named for its shape, showed the doctors where they were in the body in real time. Because the machine emitted radiation, it was our jobs as X-ray techs to stand there, push, pull, and push the button during surgery. That, and make sure the doctor didn’t over-radiate the patient. I didn’t mind running it, but the damn thing was heavy. Christy would have done the same for me, though, so I nodded. “Sure. Just give me the pager before you leave.”
Christy grabbed a lead apron, and then left me to go upstairs. “You’re awesome. I wrote Dana’s history on the requisition sheet. See you later! Get Chase’s number!”
Dana walked slowly from the bathroom, and I gestured for her to sit in a chair beside the table.
“Did your doctor explain this procedure to you?”
Dana shook her head. “Not really.”
A few choice words crossed my mind. How a doctor could send a patient in for a procedure without an explanation was beyond me, and how a patient couldn’t ask wasn’t something I understood, either.
“I’ll take a few X-rays of your abdomen, and then fetch the doctor. I’ll come back, make the table vertical, and you’ll stand and drink that cup of barium,” I said, pointing to the cup behind me on the counter, “a sip at a time, at the doctor’s discretion. He’ll use fluoroscopy to watch the barium travel down your esophagus and into your stomach. Fluoro is basically an X-ray, but instead of a picture, we get a video in real time. When that’s done, we’ll start the small bowel follow-through. You’ll drink the rest of the barium, and we’ll take X-rays as it flows through your small bowel.”
Dana eyed the cup. “Does it taste bad? I’ve been vomiting a lot. I can’t keep anything down.”
The requisition page with Christy’s scribbles was lying on the counter next to the empty cups. I picked it up, looking for the answer to my next question. Dana had only been ill for two days. I glanced up at her, noting her appearance.
“Have you been sick like this before?” She shook her head in answer. “Traveled recently?” She shook her head again. “Any history of Crohn’s disease? Anorexia? Bulimia?” I asked.
She held out her arm, palm up. There was a perfect bite mark in the middle of her forearm. Each tooth had broken the skin. Deep, red perforations dotted her arm in mirrored half-moons, but the bruised skin around the bites was still intact.
I met her eyes. “Dog?”
“A drunk,” she said with a weak laugh. “I was at a party Tuesday night. We had just left, and some asshole wandering around outside just grabbed my arm and took a bite. He might have pulled a whole chunk off if my boyfriend hadn’t hit him. Knocked him out long enough for us to find the car and leave. I saw on the news yesterday that he’d attacked other people, too. It was the same night, and the same apartment complex. Had to be him.” She let her arm fall to her side, seeming exhausted. “Joey’s in the waiting room . . . scared to death I have rabies. He just got back from his last tour in Afghanistan. He’s seen everything, but he can’t stand to hear me throw up.” She laughed quietly to herself.
I offered a comforting smile. “Sounds like a keeper. Just hop up on the table there, and lay on your back.”
Dana did as I asked, but needed assistance. Her bony hands were like ice.
“How much weight did you say you’ve lost?” I asked while situating her on the table, sure I had read Christy’s history report wrong on the requisition.
Dana winced from the cold, hard table pressing against her pelvic bone and spine.
“Blanket?” I asked, already pulling the thick, white cotton from the warmer.
“Please.” Dana hummed as I draped the blanket over her. “Thank you so much. I just can’t seem to get warm.”
“Abdominal pain?”
“Yes. A lot.”
“Pounds lost?”
“Almost twenty.”
“Since Tuesday?”
Dana raised her brows. “Believe me, I know. Especially since I was thin to begin with. You . . . don’t think it’s rabies . . . do you?” She tried to laugh off her remark, but I could hear the worry in her voice.
I smiled. “They don’t send you in for an upper GI if they think it’s rabies.”
Dana sighed and looked at the ceiling. “Thank God.”
Once I positioned Dana, centered the X-ray tube, and set my technique, I pressed the button and then took the film to the reader. My eyes were glued to the monitor, curious if she had a bowel obstruction, or if a foreign body was present.
“Whatcha got there, buddy?” David asked, standing behind me.
“Not sure. She’s lost twenty pounds in two days.”
“No way.”
“Way.”
“Poor kid,” he said, genuine sympathy in his voice.
David watched with me as the image illuminated the screen. When Dana’s abdomen film filled the screen, David and I both stared at it in shock.
David touched his fingers to his mouth. “No way.”
I nodded slowly. “Way.”
David shook his head. “I’ve never seen that. I mean, in a textbook, yes, but . . . man. Bad deal.”
The image on the monitor was hypnotizing. I’d never seen someone present with that gas pattern, either. I couldn’t even remember seeing it in a textbook.
“They’ve been talking a lot on the radio this morning about that virus in Germany. They say it’s spreading all over. It looks like war on the television. People panicking in the streets. Scary stuff.”
I frowned. “I heard that when I dropped off the girls this morning.”
“You don’t think the patient has it, do you? They’re not really saying exactly what it is, but that,” he said, gesturing to the monitor, “is impossible.”
“You know as well as I do that we see new stuff all the time.”
David stared at the image for a few seconds more, and then nodded, snapping out of his deep thought. “Hayes is ready when you are.”
I grabbed a lead apron, slid my arms through the armholes, and then fastened the tie behind my back as I walked to the reading room to fetch Dr. Hayes.
As expected, he was sitting in his chair in front of his monitor in the dark, speaking quietly into his dictation mic. I waited patiently just outside the doorway for him to finish, and then he looked up at me.
“Dana Marks, twenty-three years old, presenting with abdominal pain and significant weight loss since Wednesday. Some hair loss. No history of abdominal disease or heart problems, no previous abdominal surgeries, no previous abdominal exams.”
Dr. Hayes pulled up the image I’d just taken, and squinted his eyes for a moment. “How significant?”
“Nineteen pounds.”
He looked only slightly impressed until the image appeared on the screen. He blanched. “Oh my God.”
“I know.”
“Where has she been?”
“She hasn’t traveled recently, if that’s what you mean. She did mention being attacked by a drunk after a party Tuesday night.”
“This is profound. Do you see the ring of gas here?” he asked, pointing to the screen. His eyes brightened with recognition. “Portal venous gas. Look at the biliary tree outline. Remarkable.” Dr. Hayes went from animated to somber in less than a second. “You don’t see this very often, Scarlet. This patient isn’t going to do well.”
I swallowed back my heartbreak for Dana. She either had a severe infection or something else blocking or restricting the veins in her bowel. Her insides were basically dead and withering away. She might have four more days. They would probably attempt to take her to emergency surgery, but would likely just close her back up. “I know.”
“Who’s her doctor?”
“Vance.”
“I’ll call him. Cancel the UGI. She’ll need a CT.”