“Oh, hey, Brian. What’s up, man?”
Brian was black, with two hypnotizing rows of the straightest, whitest teeth Spencer had ever seen. He liked Brian; but, as always when around him, Spencer experienced a twinge of envy as the two bumped fists. Brian was one of those guys who projected effortless, intelligent manliness. A man’s man. Women loved him; men wanted to be more like him. He was tall and lean, but strong. He and Spencer played in a rugby league, and routinely bought each other beers at their favorite brew pub after games.
“Thanks for coming down. Jeez, that was fast.”
Huh?
“What do you mean, ‘fast’?” Spencer said. “Were you expecting me, or something?”
“I just paged you guys for a consult. Aren’t you here about Rita Wu?”
With great effort, Spencer kept his face straight and his voice even, as he replied that no, he wasn’t, but how could he help?
“Do you know her? Dr. Wu?”
“Dr. Wu? Yeah. I know her. I mean, you know, not too well. I’ve seen her around. I happened to be in the OR today when she had a grand mal, so I helped the code team bring her down here. Scary stuff. She seemed okay after we got her down here, though.”
“Yeah, well, she had another grand mal after she got here. One of the nurses heard her talking and yelling, then found her on the floor next to her gurney, seizing in a typical tonic-clonic pattern.”
Spencer folded his arms and did his best imitation of professional (not personal, definitely not personal) concern. “Huh. How is she now? Is she awake? Is she … okay?”
“Yeah. Fine, actually. A little postictal, but otherwise okay. Resting comfortably. Vitals are stable. Alert and oriented times three. Dehydrated and a little acidotic, but her electrolytes otherwise look good. EKG was within normal limits. I hung some normal saline and was able to fast track her for a head MRI. We’re still waiting on the results. No hard indications for antiepileptics, so I’m not loading her up with Dilantin yet. We’re going to admit her for observation and a workup. I’ve called Neurology, but they’re crazy busy, and haven’t been able to make it down here yet to see her.”
“Why’d you call us?”
“Because I was worried she’d taken some head trauma when she fell off the gurney. I think she’s fine, but you know how it is.” He rolled his eyes. “Liability crap. Even with a fellow doctor.”
“I hear you, man. Did you get the MRI before or after the fall from the gurney?”
“After.”
“Good. Happy to have a look and leave a note in the chart.”
“Thanks, man. You’re a rock star. Listen. Spence.” Brian looked uncomfortable. “You should know that, uh, when you look over her labs, you’re going to see some, uh, well … sensitive stuff.”
Spencer’s stomach rolled over. “What do you mean?”
“The tox screen,” Brian said quietly. “Well, it’s … it’s pretty positive, man. She had some hard-core stuff on board.”
(Poker face, Spencer. Poker face.)
“Huh. Like what?”
Brian shrugged. “Coke. Meth. Some others, any of which on its own could have conceivably kicked off her seizures.”
DRUGS? RITA?
(Poker face, remember the poker face)
“Huh. You’re sure.”
“Absolutely.
Absolutely NO way.
Spencer nodded and said, with appropriate somberness and neutrality (because he was, after all, just a colleague discussing sensitive information with another colleague in a somber and neutral way): “Is that what you think happened?”
“She doesn’t have a history of seizures, or any risk factors for them, and her workup is otherwise negative, so—pending the results of the MRI, yeah. That’s at the top of my differential. Montgomery has already been down to see her. He was in there alone with her, talking. I, uh, don’t know what about.”
“I understand. I’ll have a look.”
“Thanks, Spencer. Oh, and one more thing: She keeps mentioning her left ear. Not sure why.” His gaze now wandered toward a harried-looking nurse waving at him from across the room. From the doorway of one of the patient rooms, an ancient woman in a stained hospital gown, towing a wheeled IV pole, was screaming racial slurs at the nurse, who was Filipino. All over the ER, heads were turning to see what the noise was about.
Brian made a face. “Ah, I see the lovely Mrs. Thorn is back in my ER. Delightful woman. An absolute pleasure. She adores me.”
Spencer appreciated Brian’s sense of humor, dry as a fine wine.
“I think I’m the reason she keeps coming back.” He clapped Spencer on the shoulder, flashed his gorgeous teeth, and winked. “Every day’s better than the last, my friend. Damn, how I love this job. Let me know how things go, Spencer. And thanks again.”
As Brian approached, the knobby Mrs. Thorn immediately redirected her venom and bigotry toward him, screaming insults and poking her gnarled, arthritic fingers into his chest. The grateful Filipino nurse turned her attention to more important matters.