Sunday, March 10, 2013

Another Night Clinic


                    

Another full moon…another Night Clinic. At least they fixed the front door and Miss James is with me again.

I walked through the main entrance and saw the new sign “No Werewolves Allowed” handwritten in black and blue magic marker. I see Miss James hasn’t lost her sense of humor.

“Good Evening , Miss James,” I announced as I placed my backpack on the counter behind the nurse’s station. “Are you ready for another action packed full moon?”
“I’m ready, Dr. Barnes,” She replied. “I’ve got my garlic, a crucifix and a pack of silver bullets all right here in my pocket.” She looked up from her desk and displayed a wide grin.
“That’s just fine, nurse, but, the garlic and crucifix are only for vampires and the silver bullets aren’t much good unless they are used with a gun. No matter, I’m ready to get to work. Anything waiting?”
“Headache in room three.”
Good, something simple.
I glanced at the chart. Twenty three years old, male, no significant past medical history. I knocked as I opened the door.
“Good Evening, Mr. Dallas. I’m Dr. Barnes, what is the problem that brought you here tonight.”
The patient was clean shaven, with short brown hair and brown eyes; eyes which stared at me as I walked towards the exam table where my patient lay sprawled out. Those eyes looked up at me, filled with tears and fear.
“Oooh…uh…it’s going to explode…Oo…” and his voice trailed off and the eyes closed.
“Mr. Dallas, can you hear me?” No response. I grabbed his wrist and felt for a pulse…nothing. I punched the red emergency button on the wall as I felt for a femoral pulse, which was present, but weak. Miss James burst through the door, crash cart in tow. I pulled the ambu bag from the wall and connected it to oxygen as Miss James hooked up monitors and handed me an endotracheal tube and laryngoscope.
Something simple?
“Tube is in,” I exclaimed as I connected the ambu bag and began steady rhythmic squeezing.
“IV is in,” Miss James countered.
I glanced at the monitor. Sinus Bradycardia with a rate of thirty. Miss James took over “bagging” Mr. Dallas while I made a quick surveillance. Left pupil reactive, right pupil dilated. No reaction to any stimuli, painful or otherwise. No sign of trauma anywhere. I picked up the red phone and called for an ambulance. Miss James continued ventilating our now relatively stable patient. His blood pressure was holding steady at 110/40, heart rate was now 50 and oxygen saturation was 100%. Two minutes later the ambulance arrived and Mr. Dallas was whisked away to County General Hospital for more definitive care.
“Another full moon?” Miss James commented rhetorically.
I just shrugged my shoulders. We went back to the break room to collect ourselves. I washed my hands and doused my face with cold water. Miss James took a drink of some Mylanta.
“Things like that always give me heartburn,” she stated. “Give yourself a few minutes. All that’s waiting is a simple…I promise… sore throat.”
I sat at the table and fixed myself a cup of hot chocolate. Over the years I never could develop a taste for coffee. Tea was OK, but only after a fine meal, not at work. I perused the newspaper while I sipped on my cup and waited for my epinephrine level to fall.
Astros lost again, no surprise…government wants to raise taxes…gang wars threaten to erupt…everything’s depressing, nothing to give the average Joe hope. Oh well, time to get back to work.
I picked up the chart to Room 1. Fourteen year old boy, Michael Drubitz, sore throat for two days, Temp 101, everything else normal. I knocked on the door and walked in.
“Good Evening, Michael. I’m Dr. Barnes,” I began with my usual introduction. I turned to the woman who was seated next to my patient. “Good evening, Mrs Drubitz?” I asked, never assuming an adult with a child is the parent.
“I’m Sheila, Michael’s mother.”
“Pleased to meet you. What is the problem Michael is having?” I asked, turning to the young man.
“My throat hurts. I can barely swallow,” the boy answered. I noticed he was flushed and he looked a bit listless.
“He started feeling sick three days ago, at school. I kept him home yesterday and today. He had fever of 104 this morning. He’s had strep throat five times since January. He gets sicker each time.”
“Let me have a look. Open your mouth wide, Michael.”
I pushed on his tongue with the wooden tongue depressor and saw two huge tonsils, touching each other in the back of Michael’s throat, yellowish exudates coated each one and the surrounding mucosa looked red and angry. A simple case of strep throat.
“It doesn’t look too complicated, Mrs. Drubitz,” A few days of antibiotics and he’ll be up and around like nothing ever happened.
“Are you sure, Dr? We never had anything like this until we came here.” She observed. “At our old home, he never got sick.”
“Changes always affect us. And this Houston climate seems to predispose to things like this,” I responded, as I prepared the prescription for a Z-pack. He doesn’t have any allergies, does he, Mrs. Drubitz?”
“Just to water,” she answered.
“Excuse me, did you say water?” I asked, more than a touch of disbelief in my voice.
“Yes, water,” she answered in a matter of fact tone, as if it was a common condition.
“What happens if he is given water?” I asked with a bit of trepidation, wondering what I was getting myself into.
“Why the same thing which happens to all of us,” she replied.
“Which is…?”
“We get wet and then we melt,” she replied.
“You melt?” Why me?
“Of course. It happens to all of us. I know you’re thinking, she thinks she’s some sort of wicked witch, which I’m not, by the way. Let’s just say that back home any contact with plain water has dire consequences. Look at this scar” and she held up her hand to reveal a circular scar about two cms wide on her palm, “drop of water fell there three years ago. Almost burnt a hole right through my hand. Luckily Michael here was able to get it off before it caused permanent damage.”
“Just exactly where do you hail from, Mrs. Drubitz?”
She stared at her son for moment and then looked me in the eye.
“We’re from, uh, Poland,” she said.
“Uh huh,” I murmured. “Well, Mrs. Drubitz, take the medication as prescribed. Does Michael have a family doctor or pediatrician?”
“Not really,” she admitted.
“Here’s the number to the Clinic at the University and also one for an Ear Nose and Throat specialist. He’s had enough infections that he may benefit from consultation with an ENT to see if he needs his tonsils removed.”
“Thank you so much, Dr. Barnes,” she said effusively as she shook my hand, I noticed her hand was cold and felt a bit damp, like shaking the hand of a frog.
The two left, but as they were walking out I noticed that Michael had left what I thought was his cell phone on the exam table. I chased after them, but they were nowhere to be found.
Oh well, I guess they’ll be back if they really want it.
I looked up and saw a bright shooting star at that very moment, racing away from the earth. It looked like it had just been launched from the park a few blocks away.
I wonder, nah, that can’t be true.
I smelled my hand, the one that had shook Mrs. Drubitz’ hand. It smelled of alcohol.
“Anyone else waiting, Miss James?”
“URI in two and diarrhea in four, and the Goddess of the Night dropped these off for you.” She showed me a box of cookies thickly coated with powdered sugar.
“How is she doing anyway? She makes the best butter cookies.”
“She looked good. Finished her first round of chemo. She said her breast is already better.”
“That’s great,” I responded as I scarfed down four of the best cookies I’d ever had. I quickly dispatched the two waiting patients and sat down for a few moments to relax. My respite was short lived however as there were several loud shouts and I heard the door slam. We went out into the waiting room and found four teenagers lying prostrate in the waiting room. They were wearing gang colors and they were drenched in blood. Two were conscious and the other two were out, although both were still breathing.
“Just what we need,” I blurted out, making no attempt to hide my exasperation. “Better call an ambulance.”
“Right away, doctor,” Miss James replied.
At that moment there was a bright flash, followed by the loud boom of thunder and then another and another. The lights flashed on and off, came back on for a moment and then went out.
“The phones are dead, Dr. Barnes,” Miss James shouted, “and I can’t get a signal on my cell.”
I looked at my cell phone and saw the same thing: no signal. All of this transpired over a period of thirty seconds at the most. It was now pouring rain and we had only emergency lighting.
“We’ve got to do something fast for these two boys,” I said, stating the obvious. I looked at the two conscious boys. One was holding his leg with a dirty towel which was drenched with blood, while the other had a handkerchief tie around his head and another around his left arm.
“You with the bandana,” I screamed at the least injured of the four, “help me get your buddies into the exam rooms.
“I ain’t doin nothing for those ugly 57’s,” he hissed with hatred in his voice. He jumped up and bounded out the door into the teeth of the torrential downpour.
One less bit of trouble I thought, although I silently scolded myself for having such a thought. I turned my attention back to the other three problems at hand.
“Miss James, do you think we can get them into the exam room, at least.”
I was down on the floor with one of them, feeling a very thready pulse, while my shapely companion was attending to the other, doing her best to check his blood pressure in the dim light.
“I think it’s 70 over…”
At that moment there was a flash of blue light, short bang and a cloud of smoke, followed by the appearance of a man, dressed in tight black Spandex with a red “S” on the chest outlined by a hexagon of silver scalpels, wearing a tight black skullcap and a black surgical mask. He was solidly built with broad shoulders, bulging biceps and pecs, a six pack abdomen and muscular thighs and legs. Miss James’ jaw almost hit the floor when she saw him.
He was accompanied by a petite woman wearing a loose robe and a headband. She also sported surgical mask, but hers was pulled down around her neck and she had a stethoscope around her neck and wide belt with many little compartments around her narrow waist.
“It’s Captain Surgery,” a booming disembodied voice announced.
“Da Da Da Daaaa…” an invisible band played.
“Stop with the music,” Captain Surgery commanded and the music trailed away. “OK,” he continued, “let’s get these guys patched up.”
 “I suppose you’re Lieutenant Flea?” I quipped.
“Cloud,” she stated in a flat, deadpan voice.
“Dr. Cloud,” the Captain added. “My trusted Anesthesiologist.”
He then hoisted the two unconscious victims up above his head, one with each arm, while Miss James, Dr. Cloud and I helped the third boy into one the exam rooms.
“Excuse me, uh…Captain, there isn’t any power and there is no OR here; no lights, no nothing,” I stated, trying to prevent starting up on something we couldn’t finish properly. “Are you really a surgeon?”
He looked at me with a look that was almost pity in his eyes.
“Have faith, Doctor, Captain Surgery (Da da da daaaa…, he glared and the music stopped) has been in much worse circumstances.”
I saw him lay the first lad on the exam table. His eyes glowed as Dr. Cloud descended upon the boys head. Captain Surgery started to glow with a purple light and when I looked back at the boy’s head he was intubated and being ventilated by Dr. Cloud. She had her finger on his temple and she began to speak loudly:
Heart Rate 140
BP 76/30
O2 sat 100%
Cardiac output 2 liters/minute.
CO2 45

The Captains eyes continued to glow as he murmured, “Lacerated Liver, transected right Renal vein, transected peripheral nerve, perforated duodenum, approximately two liters of blood in the belly. OK, here we go.”
I watched in awe as the black gloves he wore morphed from fingers to scalpel and clamps. A long incision was made. Sparks flew from the gloved fingers as each vessel was neatly cauterized and the incision carried deeper into the abdomen. Blood spewed forth and was expertly sucked up by a suction apparatus that had appeared from the belt around his waist. The blood was routed to the head of the table where it passed through a filter which was around Cloud’s waist and then returned to the patient. I also saw antibiotics infuse along with fluids and various anesthetic agents. All the time Cloud never took her finger off his temple and continued to rhythmically announce physiologic parameters.
Captain Surgery worked in mostly in silence, only a rare murmur escaped from his lips. His eyes glowed and emitted light which illuminated the field in the darkened room. As he ran his fingers over the abdominal structures he mumbled each by name.
“Liver segment four lacerated with bleeding branch of hepatic artery and portal vein.”
Flashes of light and wisps of smoke emanated from the surgical field as his fingers danced over the injured organs at lightning speed.
“Vessels sealed, hemostasis achieved,” he announced. “Renal vein repaired and the kidney remains well perfused and functional. Duodenum repaired and buttressed. Final scan, all injuries addressed.”
 A torrent of clear fluid flooded out of his left hand as the abdomen was irrigated.
“Time to close,” he announced.
 I watched as he ran his hand up and down the wound which left the fascia closed. He infused a blue fluid into the wound and then ran his hand along the wound again, closing the skin. Finally, a clear fluid was applied and then dried, sealing the wound closed. The entire surgery had lasted only about twelve minutes.
“He’ll be good as new in a few hours,” the Captain announced. ‘On to the next victim, I mean patient.”
He went to the next table, once again eyes glowing as he scanned the patient. Cloud had the patient asleep in seconds and began her litany of vital signs and physiologic parameters.
“Look bad, Captain?” I heard her ask. “BP is forty.”
“Two gunshots; colon, superior mesenteric artery, just missed the spinal cord, second bullet went through the small bowel and right kidney. But, Captain Surgery (Da, da, another glare from the Captain’s eyes and the music stopped abruptly)is on the case.”
Once again the violet light engulfed his body and he went to work, his eyes shining, his fingers dancing, blood splattering here and there and then…silence, a few flashes of light and he started to close.
“BP’s ninety, Captain, heart rate’s down to ninety five and oxygen delivery is normal. Great save.”
“Thank you, thank you,” the Captain said with a bit of humility. “now on to the final lad.”
This time Cloud ran her hand across the patient’s abdomen which numbed him from the waist down. Captain Surgery reached his hand towards the gunshot wound, made a clean incision which exposed the injured artery.  The index finger from his left hand deftly encircled the artery above the injury while his left fifth finger controlled the distal artery. His right index finger ran up and around the injured segment and, when he was finished, left the artery perfectly repaired with an excellent, bounding pulse. He ran his right hand up and down the open wound and then pulled it out. The swelling disappeared and the wound sealed itself up.
“All three of these fine young men should be up and around in a few hours, doctor. Have them follow-up at the University clinic next week. They’ve received antibiotics and have been infused with extended pain relief. Well, Cloud, our work here is done. Wherever there is injury and disease, Captain Surgery (Da, da, da , daaaaa) will be there.”
“Always the dramatics,” Cloud whispered to Miss James.
“Did you say something, Dr. Cloud?” the Captain asked.
“I said you’re a virtuoso,” she replied.
 “It’s a living, “ she remarked as she packed up all her equipment.
At that moment the lights came on, the three gang members were all up and walking around and I saw a white light emanate from the Captain, which left his black, spandex outfit spotless. Every speck of blood and fluid washed away.
“Uh, Captain,” I asked, “shouldn’t you have a cape.”
“No capes, no capes; nothing but a nuisance, getting caught in doors,  dragging on the floor, and picking up all sorts of loose debris and germs. And, do you know how expensive they are to clean?”
He paused for a moment.
“Now remember, if you suffer from serious injury, broken bones, ruptured colons, ulcers, gallstones, hemorrhoids, cataracts, ear wax build-up or, well you get the idea. Just whisper my name, Captain Surgery (Da, da, da ,daaaa) and I’ll be there.”
There was a flash of light, a puff of smoke and they were gone.
“Do you believe that, Miss James? Vampires, werewolves and now this. I don’t think they pay us enough. That Captain Surgery (Da, da,da, daaa) is quite remartkable. ”
Miss James let out a big sigh. “I hope he comes back.” And, she sighed again.
“Muscles, brains and superpowers are not everything, nurse,” I commented. Then again, maybe they are.
“Look at the time; this shift is almost over. Anyone else waiting?”
“No, Dr. Barnes.
“Good, I could use some breakfast.”
And we left together as the day shift arrived.