“How can we cool him?” Mitt demanded frantically. “He’s burning up.”
“We have ice,” Sheila said.
“Get it!” Mitt yelled. “Get as much as you can.”
Sheila disappeared, leaving Mitt alone with Mr. Ortiz, who was like a piece of glowing charcoal, cooking all his internal organs. Seeing the stethoscope that Sheila had dropped on the bed after taking the blood pressure, Mitt reached across, put the earpieces in his ears, and listened to Mr. Ortiz’s chest. The man was breathing fast and shallowly, and Mitt heard all sorts of additional sounds that he knew he wasn’t supposed to hear, all of which made sense if the man was not long for this world. He was frying his lungs, as well as his kidneys, liver, and brain.
Sheila was back in a flash along with a number of other nurses. Word traveled quickly around the ward that an unusual problem had developed, and everyone was curious and willing to help if they could. Sheila had brought back a bucket of ice as well as a bunch of towels. Soon everyone was putting ice cubes onto towels, folding them up, and then placing them all over Mr. Ortiz’s body. One of the nurses thought to bring a remote thermometer. When she used it, everyone was both shocked and horrified. It registered 111 degrees.
A few minutes later and to Mitt’s utter relief, Madison showed up. “Do you really think it’s a thyroid storm?” she demanded, out of breath, while pushing in against Mr. Ortiz’s bed across from Mitt.
“It has to be,” Mitt said. He described what he found when he first arrived. “The guy’s literally burning up. Even with the ice packs, his remote temperature was over 110 a minute or two ago!”
“Whoa,” Madison commented. “Yikes! That’s not good. Anyway, I took your word about the diagnosis and immediately called for an emergency Internal Medicine consult. They should be here momentarily. I’ve never handled a thyroid storm. Have you?”
“Are you joking?” Mitt asked. He looked across at Madison to see if she was being serious.
“No, I’m not joking. I’m impressed you made the diagnosis and so quickly.”
“When I saw him sweating and felt his temperature, I knew there weren’t too many medical explanations for what was going on. Besides, he’d had thyroid surgery today, which I suppose is a giveaway. But then again, his past history is of hypothyroidism rather than hyperthyroidism, which is what a thyroid storm is. Well, to be honest, I can’t explain it, but here we are. What are we going to do?”
“We’re waiting for the medical guys,” Madison said. “Handling a case of thyroid storm is out of my league. I’m assuming all is okay on the surgery end?”
“See for yourself,” Mitt said. He lifted the ice-filled towel draped over Mr. Ortiz’s neck to reveal the paper tape covering the incision.
“Well, at least that appears to be fine. What’s his blood pressure?”
As soon as Madison asked the question, Sheila nudged her out of the way and retook the blood pressure. As she was busy doing that, Mitt felt the pulse. Another nurse lifted an ice pack and again used the remote thermometer.
“His pulse is still way up there around 150,” Mitt said.
“Blood pressure about the same,” Sheila said. “I’m getting about 170 over 130.”
“Temperature still reads 108 despite the ice packs,” the nurse with the thermometer said.
“Good grief,” Madison said. “That’s not good. Such numbers are incompatible with life, at least in my book.”
At that moment a team of three on-call medical residents came rushing into the room out of breath. There were two males and one female, all dressed in whites. Many of the nurses who’d grouped around the bedside gave way to the newcomers.
“I’m Dr. Deion Phillips, senior medical resident on call,” the lead resident said breathlessly as he pressed in against the bed. He was a strapping young Black man with imposing but restrained dreadlocks. “I’ve been told you have a case of thyroid storm. Is that true?”
“That’s what we believe,” Madison said. “He’d had a thyroidectomy this morning.”
“Any idea of the BP, pulse, and temp?” the medical resident asked hurriedly as his eyes took in the entire scene, particularly noting the patient’s dramatically flushed color, his copious perspiration, and the vomit on the floor. He snatched up Mr. Ortiz’s wrist to feel the pulse.
Madison rattled off the results. “We’d just taken them before you arrived.”
Dr. Phillips whistled in appreciation at hearing the numbers. “Whoa, this is one sick dude.” Quickly pulling his stethoscope from around his neck, he listened briefly to Mr. Ortiz’s chest, first his heart for a couple of beats and then his lung fields for several breaths. “Shit, man!” he said, straightening up. “This does look like a thyroid storm! Amazing! He’s already got serious pulmonary edema! No wonder he’s breathing so rapidly. Not good! Let’s get an O2 monitor on him and get an idea of his saturation. I bet it’s in the toilet.” He then turned to his compatriots, and in keeping with Bellevue being a teaching hospital, he asked them what they thought the guy needed and needed stat.
“Methylprednisolone, metoprolol, methimazole, and propranolol,” the two more junior residents rattled off in unison.
“Right on!” Dr. Phillips said, flashing them a thumbs-up. Then he turned to Sheila Ferguson. “Do you have these meds here on the floor?”
“I’m sure we do,” Sheila said. She immediately left to head down to the floor’s pharmacy room.
Dr. Phillips stepped up to the head of the bed and checked what the IV bags contained. Only one had fluid remaining and it was saline. Grasping the tubing that snaked down into Mr. Ortiz’s arm, he called out: “Who put in this IV line?”
“Anesthesia did this morning at the beginning of his surgery,” Mitt responded.
“Okay, good,” Dr. Phillips said. “That means we can count on it. Now, let’s get more ice!” He handed off the empty bucket to one of the nurses, who quickly disappeared. At that moment, the patient’s rapid, rather noisy breathing came to a sudden stop. Immediately Dr. Phillips again snatched up Mr. Ortiz’s wrist to feel for a pulse. When he couldn’t feel one, he let go and then tried again. When he still didn’t feel one on the second attempt, he shouted: “Good God! We’ve got an arrest here! Someone call the resuscitation team and let’s start CPR!”
Dr. Phillips himself climbed up onto the bed, kneeled next to Mr. Ortiz, and started the closed-chest massage. He also called out for an Ambu bag, and another nurse ran to get it. Next he questioned loudly if the resuscitation team had been called. One of the nurses responded positively. Dr. Phillips then told one of his fellow medical residents to get a syringe and draw some blood for stat electrolytes.
“Looks like we have been appropriately preempted,” Madison said as she drew Mitt a few steps away from the bed to give everyone who was actively engaged more room. “This is another unique experience for me, and I have to give you credit for appropriately calling this one. Seems your diagnosis of a thyroid storm was right on. I’m impressed. I’m also impressed that you seem to be a magnet for what I’d call rather unique clinical cases, considering this thyroid storm and the aneurysm blowout on Monday night.”
“Maybe I am a magnet,” Mitt admitted. “This case is making me seriously paranoid.”
“What on earth do you mean? How can a case of thyroid storm make you paranoid?”
“It’s simple,” Mitt said, looking back at the frantic activity around Mr. Ortiz. “This is another of my assigned cases. I assisted on his surgery this morning.”
“Okay! A couple of cases of bad luck, but you certainly didn’t have any role in causing the thyroid storm or the abdominal aorta bursting.”
“It makes me paranoid because I’m getting the distinct feeling he’s not going to make it. And if he doesn’t, I’m batting a thousand.”