“Looks generally about the same as yesterday,” Michael commented. Lynn nodded, restraining herself from reaching out to touch Carl’s face. She noticed that his beard had darkened, and as her eyes traveled down his body, she observed that both arms were now relaxed. Apparently the decorticate posturing was gone. Whether that was a good sign or not, Lynn had no idea. The myoclonic jerks of his free leg had also stopped.
In order to look as if he were on a legitimate mission, Michael took out his penlight and tried Carl’s pupillary reflexes. While he was busy, Lynn glanced up at the monitor. She didn’t want to look into Carl’s unseeing eyes again, as doing so had unnerved her the day before. She saw that the blood pressure was normal as was the oxygen saturation. The ECG looked normal to her as well. It was then that she spotted the temperature graph. Carl had a fever of 103 degrees, and it had been as high as 105! She knew that wasn’t good news.
“Pupillary reflexes are better than yesterday,” Michael said, straightening up. “I wonder if that is a good sign.”
“His temperature is elevated,” Lynn said with concern, pointing up to the monitor.
“So it is,” Michael said after taking a look. “That can’t be good.”
“It’s not,” Lynn said. “Pneumonia is a big threat to people in a coma. I learned that last night.”
“You got that right. Sounds like you learned a lot in one night.”
“It is amazing what you can get done if you don’t eat or sleep.”
“Then let’s get you down to the cafeteria before you flatline.”
“Let’s check the chart first. I want to see the results of the MRI he was supposed to have had.”
Leaving Carl’s cubicle, the duo walked directly toward the central desk. As they traversed the room, Lynn made momentary eye contact with Gwen Murphy, who had moved on to cubicle 6, along with all the other nurses. Fortunately Murphy’s expression didn’t change. For Lynn, being an interloper was a nerve-racking experience. She was impressed that Michael seemed to be taking it in stride.
At the circular desk, Michael smiled at Peter, who smiled back. The clerk was on the phone with Clinical Chemistry, trying to get the latest lab values before they were even in the computer. The attending physician didn’t look up from her work. The stack of charts was still in front of her.
As he had done the previous day, Michael went directly to the circular chart rack and gave it a decisive spin. He stopped it at the slot for cubicle eight. There was no chart.
Tapping Peter’s shoulder, Michael silently mouthed, “Vandermeer,” and motioned toward the chart rack. Without interrupting his phone conversation, Peter pointed to the attending physician. Michael understood. The attending had Vandermeer’s chart, a new, potentially problematic complication.
With a shrug, Michael started toward the attending, only to have Lynn grab the sleeve of his white coat and restrain him.
“What are you going to say?” Lynn questioned in a whisper.
Michael shrugged again. “I’m going to wing it, as usual.”
“You can’t use the anesthesia ruse because she might be from anesthesia.”
“You are so right,” Michael said with a nod.
“Hold on,” Lynn said. She stepped over to Peter and scribbled on the notepad in front of the clerk: Who’s the attending, and what department is she from?
Without interrupting his conversation, Peter scribbled: Dr. Siri Erikson, hematology.
Lynn mouthed a “Thank you” to Peter and then took the note back to Michael.
“Hematology?” Michael questioned, still in a whisper. “What does that mean? Carl’s got a blood problem?”
“Who’s to know?” Lynn said. “I hope not. Maybe there is some association with the fever.”
“I would think a fever in a comatose patient would call for an infectious disease consult, not one from hematology.”
“I agree. Anyway, let’s see how friendly she is toward medical students.”
Both Lynn and Michael were well aware that some medical attendings savored the teaching role whereas others saw it as a burden and acted accordingly.
“The good news is that she’s not from anesthesia,” Michael said, “so our cover is okay if it comes to that.”
“You do the talking,” Lynn said. “You’re better at deception than I.”
“I’m going to pretend I didn’t hear that, girl.”
“That’s fine, boy!” Lynn responded.
Michael approached the hematologist. He cleared his throat to announce himself. “Excuse me, Dr. Erikson.”
The woman looked up from her work. She was attractive, somewhat heavyset mature woman in her late forties or early fifties. Consistent with her family name, she looked Scandinavian, with blond hair and a pale complexion. Her eyes were a clear cerulean blue. “Yes,” she said.
“My partner and I were wondering if we could take a quick look at Vandermeer’s chart if you are not using it at the moment.”
Dr. Erikson turned to the stack of charts in front of her and fished out Carl’s. She handed it up to Michael but maintained a hold on it. “I’m not finished with it,” she said. “So I need it back.”
“Of course,” Michael said. “We’ll just be a moment.”
“I assume you are medical students,” Dr. Erikson said, glancing briefly at Lynn. She had yet to let go of the chart. “What is your association with the case?”
“My name is Michael Pender and this is Lynn Peirce. We’ve been asked by anesthesia to follow the case.”
“I see,” Dr. Erikson said. She finally released her hold on the chart. “Is it because it is a case of delayed return to consciousness?”
“You got it,” Michael said. He smiled diplomatically, handed the chart to Lynn, and started to take a step away, hoping to end the conversation, but Dr. Erikson spoke up again: “Is it just Vandermeer you are interested in, or are you following Scarlett Morrison as well?”
“Should we be?” Michael asked.
“Not necessarily. But she is a similar case.”
“You mean she is another case of delayed recovery from anesthesia?” Michael asked. He shot a glance at Lynn, whose eyes had opened wider, despite her fatigue. She was obviously taken aback.
“Yes, she is,” Dr. Erikson said. “She was a Friday surgery. A very similar case, I’m afraid. I’m surprised someone in anesthesia didn’t tell you.”
“I’m surprised, too,” Michael said. “We certainly should be following her.” He glanced at Lynn, who looked as if someone had just slapped her.
“I’m using the Morrison chart at the moment,” Dr. Erikson said. “When you finish with Vandermeer’s, I’ll give it to you.”
“That’s a deal,” Michael said, grabbing Lynn by the arm and forcibly moving her away, over to a couple of empty chairs. The two of them sat down.
“If it is true there’s another case, this is worse than I thought,” Lynn said in an excited, horrified whisper. “If there was another case last week, then the incidence here at Mason-Dixon Medical Center is three in five thousand, meaning it is not eighty times the average, but one hundred twenty times!”
“Calm down!” Michael insisted, trying to keep his own voice low. He glanced over at Dr. Erikson in hopes she wasn’t paying any attention. Luckily she was again totally absorbed in her work. “Let’s take this one step at a time,” Michael said. “We came here to look at Carl’s chart. Let’s do it and get the hell out!”
Making an effort to follow Michael’s advice, Lynn opened the chart. The last entry was a short note by the neurology resident, Charles Stuart, who had been called during the night when Carl’s fever had spiked. Stuart had ordered an emergency portable chest X-ray, which was read as clear, so no pneumonia. He wrote that the operative site was not red or swollen. He sent away a urine sample for bacteriologic studies and drew blood for a blood count and for blood cultures. He concluded his note with the statement “Fever of unknown origin. Will follow. Consult requested.”