“Yes?” Mitt managed scratchily but urgently. He could feel his pulse hammering away in his temples.
“Dr. Fuller, this is Sheila Ferguson. Your patient, Mr. Diego Ortiz, is acting strangely.”
“Oh?” Mitt questioned. Half expecting something significantly worse, his flight-or-fight reaction mellowed a few degrees. “Acting strangely” was a far cry from being informed his patient was having an arrest, like he’d been told about Latonya Walker and Elena Aguilar. “What exactly do you mean by ‘acting strangely’?”
“He’s agitated, speaking Spanish a million miles a minute, and waking up all his suite-mates. One of the nurses who speaks Spanish says he’s not making any sense, which is strange because he’d been so calm all afternoon and evening according to the report when I came on duty. And he’s been asleep the whole time I’ve been here.”
“Are you suggesting we give him something like a tranquilizer or just double down on his sleep medication?” Mitt asked. He was trying to think of something specific to offer. The last thing he wanted to do was go to the fifteenth floor just because someone was anxious. “Or do you have something else in mind?”
“I think you need to come and see him,” Sheila said. “My intuition tells me that his sudden change in attitude is worrisome. It’s bizarre in my experience, and I don’t like it.”
“What about his incision?” Mitt asked. He was still fighting against the need to pay a visit to the patient in person. Mr. Ortiz’s dressing was just a piece of paper tape, so any developing problems like bleeding or swelling would be immediately apparent.
“The incision looks fine. I don’t think you understand. The man is beside himself. You need to come!” With that final comment, the nurse disconnected the line.
Reaching over in the darkness, Mitt turned on the bedside lamp. Then, for a minute filled with a slew of barely audible curse words, he lay back against the pillow and lamented his fate, wondering why he hadn’t been attracted to a future in finance, following in his father’s footsteps, where you could at least sleep through the night. But then, recognizing the inevitability of the situation, he put his feet over the side of the bed, sat up, and slipped on his loafers. Getting to his feet, he waited a few beats for his circulation to catch up to the changing demands. When it did, he picked up his white jacket and slipped it on.
As he walked through the on-call lounge, he didn’t rush. It sounded to Mitt more like a behavioral problem than a medical problem, which the nurses should have been able to handle. At the same time, he did recognize that Diego Ortiz was his only living patient and that he should be inordinately thankful he wasn’t being called for a cardiac arrest or some other medical emergency. In comparison, handling a behavioral issue should be relatively easy.
When Mitt arrived at the elevator lobby, he found himself speculating whether or not he would be seeing a hallucination in the elevator. The thought made him smile ironically at his nonchalance, and he wondered if it was because he’d become numb from lack of sleep, or because the increasing frequency was just making him expect one. Whatever the reason, when the elevator arrived and the door slid open to reveal an empty car, he merely shrugged and boarded without giving it much thought.
He felt the same way when the elevator discharged him on the fifteenth floor, wondering if he’d have to endure the bad smell or see the blond girl in the darkened hallway on the way to the west side of the building. As it happened, he didn’t smell or see anything, but he did hear his patient screaming in Spanish while still in the hallway and not even abreast of the nurses’ station.
Picking up his speed, Mitt hurried the rest of the way down to Mr. Ortiz’s room. Inside, all the overhead lights were on. Mr. Ortiz’s bed was next to the window with the curtain pulled out. All five of the other beds were occupied and all the patients were awake and wide-eyed, with their covers pulled up around their necks. There were two nurses trying to deal with Mr. Ortiz, who was sitting cross-legged in the middle of his bed and loudly carrying on in Spanish. At that moment the nurses were trying to take his blood pressure, but he was resisting. He was totally naked with his short dark hair spiked up wildly like a cartoon character who’d stuck his fingers into an electrical outlet. Another woman dressed in a white coat over a dark pants suit was near the head of the bed. Mitt later learned she was a Spanish translator who’d been called to assist. Her expression was one of confused alarm.
Already wondering what the hell he was going to do as the supposed “savior” doctor, Mitt approached the foot of Mr. Ortiz’s bed, rapidly taking in the scene. The patient’s body was flushed a bright crimson, and he was sweating profusely as if he’d just run a marathon. Even more alarming, his bloodshot eyes were bulging like they were going to pop out of his head. His IV was still in place, running into his left arm.
“My God!” Mitt croaked under his breath. As green as he was, he knew instantly this was no simple behavioral problem and that once again he was in way over his head. Aware that the patient had had thyroid surgery, Mitt surmised he was seeing something he’d only read about, namely acute thyrotoxicosis, or worse yet, a thyroid storm, which could be fatal. “Somebody please get Dr. Baker here stat!” Mitt yelled as he pushed up alongside the bed so that he could slap his hand against the patient’s forehead. Mr. Ortiz fought back, but Mitt persisted, and when he got his hand against the man’s forehead, his fears were corroborated in spades. The man was burning up.
“Tell Dr. Baker we’ve got a patient in thyroid storm!” Mitt yelled after the nurse who’d broken away to call her. At that moment, Mr. Ortiz suddenly stilled with a confused expression, but then blew out his cheeks before exploding with a bout of projectile vomiting. The episode was so forceful that most of the vomitus cleared the foot of the bed and sprayed out onto the floor.
“Good Lord,” Sheila Ferguson, the other nurse, exclaimed. She’d just managed to dodge the icky deluge.
As if vomiting had exhausted him, Mr. Ortiz’s eyes suddenly rolled back as much as they were able, and he collapsed onto the bed unconscious.
“What’s the blood pressure?” Mitt demanded. Sheila already had a blood pressure cuff partially around the man’s right arm and a stethoscope in her ears, as she’d been struggling to take his blood pressure even before Mitt arrived.
While Sheila repositioned the blood pressure cuff and blew it up, Mitt felt the man’s pulse at the wrist and quickly guessed it was galloping along somewhere between 150 and 200 beats a minute. Concerned at the tachycardia, he looked across at Sheila as she removed the stethoscope’s earpieces. “It’s way up there,” she said urgently. “It’s in the neighborhood of 180 over 135!”
“Holy shit,” Mitt murmured with alarm. Despite being a newbie, he intuitively knew that kind of blood pressure and pulse had to be cardiotoxic and unsustainable. With a sense of desperation, he looked back down at the patient, trying to come up with something he might do before Madison arrived. Although he knew he was in way, way over his head, he was sure there had to be something that could start to reverse the process. Then his mind latched onto an idea that he knew had to be important: Try to get the man’s body temperature down. The sky-high body temperature had to be feeding both his pulse and his blood pressure and turning his body into a kind of pressure cooker.