“Oh my god, what is
that smell?” Miss James exclaimed as I walked into the clinic. She sniffed me
up and down.
“What did you do? Douse
yourself with old sweat and then put on a pair of forgotten scrubs from the
back of your gym locker?”
“It’s not that bad,” I
responded as she sprayed me down with FOE (Fecal Odor Eliminator).
“It’s worse than bad.
You’ll make our patient’s sick just by walking in the room,” she commented as
she continued to spray. “Why didn’t you clean yourself up?”
“Well…I was out running
and got back late and I’d forgotten I was scheduled to work tonight and then I
only had time to throw on some scrubs and I guess the ones I picked out were
already dirty and here I am.”
Miss James smiled and
then started to laugh. She sniffed me again.
“A little better,
almost tolerable. Hold on a minute; I think I know I have a solution.”
She left me alone and
then came back with some clean scrubs; scrubs which were hot pink and almost see through.
“Put these on,” she
commanded.
“I can’t wear these,” I
protested.
“Well you can’t take
care of sick people smelling like a sewer. Come on, at least they’re size large.
You’ll feel much better, I promise and you’ll look extra sexy.”
She gave me a leering
smile and I acquiesced. Actually I didn’t look half bad.
“Pink is definitely my
color,” I observed as I modeled my new couture for her.
“Enough of the runway
show,” she stated. “There’s a patient in room one. Diabetic, short of breath.”
“Work, work ,work,
that’s all anyone cares about around here. How can a few sick people compare to
the world of high fashion,” I murmured as I picked up the chart outside the
exam room.
“Darrell Preston, 23,
diabetic since age ten, takes a lot of insulin,” I read.
I opened the door and
began my introduction, “Good evening Mr. Preston, I’m Dr. Barnes, what is the
problem that brings you in here?”
He was thin, African
American, wearing a hot pink tank top and tight fitting blue jeans. He was
sitting on the exam table, no he was curled up in the corner of the exam table,
his arms folded across his legs which were pulled up against his chest. I was
greeted by the distinctly fruity scent of ketones.
He looked up at me with
a blank stare and groaned.
“Don’t say another
word, Mr. Preston. I’ll be back in a moment.”
I stepped out into the
hall and started to call for Miss James, but she appeared as if she had read my
mind.
“I’ve already called
for an ambulance. I just saw his blood sugar, 585.”
“As soon as I walked
into the room and noticed the odor I knew it was DKA; that unmistakable fruity
smell. Start an IV of normal saline and run in a liter wide open. Do we have
the rest of his BMP?”
“Potassium is 5.3,
everything else is normal.”
“Get an insulin drip
going at one unit per hour, also.”
She went to work while
I went on to the next patient, Shayla Bakerstreet, abdominal pain, nausea and
vomiting for one day, 44, previous hysterectomy. Blood pressure 110/45,
heartrate 120.
“Good evening, Miss
Bakerstreet. I’m Dr. Barnes, what brought you in here tonight?”
She looked “sick” with
flushed cheeks, long, matted brown hair, sunken eyes and a protuberant belly.
“I’m sick,” she
announced, stating the obvious. “I started vomiting yesterday, my stomach feels
like it’s about to explode, I can’t go potty; isn’t that enough?”
“It is,” I replied. I
moved a bit closer and the fetid scent of her breath almost drove me back. The
typical feculent odor of a small bowel obstruction filled the air.
“How long ago did you
have the hysterectomy? And, have you ever had a similar problem before?”
“Ten years ago and no.
I’ve never felt like this, ever,” she stated emphatically. “Can’t you do
something?”
I lightly touched her
abdomen and she winced in pain.
“I’m going to throw
up,” she announced as I started to back away and then moved to help her sit up.
I reached for the basin
by the sink and as I gave it to her she vomited, her emesis shooting out
several feet and drenching me from chest to knees in vile, sewer like vomit.
I
can’t get a break.
“Wait here, Miss
Bakerstreet. As you can see I need to see if I can find a change of clothing.”
“It’s OK, I feel better
after throwing up.”
I went back to the
break room and called for Miss James. She had just finished loading Mr. Preston
into the ambulance.
“Oh my god, what
happened?” she asked and then she began laughing, uncontrollably, again.
“Yes, yes, very funny.
Now is there anything else to wear?”
I had already removed
the soiled scrubs and had wrapped a towel around my waist.
“Wait here, I’ll see
what I can find.” And she left.
The TV was blaring as I
sat alone in my slightly damp underwear, debating whether to shed them also.
“...lavender killer
still at large. Victim number eight was discovered today in the posh Evergreen
Hills suburb. Similar to the previous seven murders, the victim’s throat was
cut with almost surgical precision. And, like the other victims, the scent of
lavender filled the air at the crime scene . Police have been unable to find
any bit of evidence which ties the victims together or demonstrates any sort of
pattern…”
Miss James reappeared
with a bright purple scrub top and some gray overalls.
“These are all I could
find. I don’t know if it’s a step up from hot pink, but it will have to do.”
I eyed my new attire up
and down.
“Beggars can’t be
choosers,” I murmured as I pulled the purple scrub shirt over my head, stripped
off the dirty underwear and donned the overalls.
“Let’s hope no one
looks too closely, nurse. I don’t think this outfit hides everything that is
supposed to be hidden. You don’t have a belt, do you?”
“I think I have something
in my locker, hold on and I’ll get I for you.”
She returned in a few
seconds with a bright yellow belt.
“I think you’re ready
for the circus, all you need is a big red nose and some floppy shoes,” she
commented.
“Fun-ny,” I remarked.
“I’ll put on this white coat and I’ll be fine.”
The coat was a bit
small for me. I gazed at my reflection in the mirror: my hair was a bit
tousled, the small lab coat made my stomach appear to stick out, I was a
kaleidoscope of color in my mismatched outfit. Miss James was correct, I was
ready for the circus.
Perhaps
my unusual look will bring a bit of lightheartedness to the clinic.
“There’s a sick baby in
room 4, tempo 103, diarrhea, runny nose. Could be Rotavirus, there’s been a lot
of that going around.”
“Thank you, nurse, I
guess it’s back to work.”
I picked up the chart. David
Thompson, 3 months old, otherwise healthy. Heartrate 130, temp 103.
“Good evening, I’m Dr.
Barnes,” I introduced myself. “This is David?”
The woman with him, his
mother, I presumed, nodded.
“What’s the problem
little David is having?”
“He’s been coughing and
vomiting and his bowels are running and running.”
“Is he usually healthy?
I mean has he been sick or in the hospital before?”
“Never even been in the
hospital. He was born at home and got all his shots at home. He started getting
like this yesterday. I gave him some Tylenol, but he’s still sick.”
“What have you tried to
feed him?”
“Why, breast milk, of
course; greatest thing god ever made, at least for babies.”
“Can’t argue with you
on that.”
I gave her a little
smile as I started to examine her child.
“Let me look at your
eyes, little David,” I whispered. He stared at my face, his eyes wide open. The
pupils looked normal and there were tears. I listened to his heart which was
racing along at about 130 and his lungs were clear, the only noise was a bit of
a rasp from his upper airway which went away after he coughed.
“I’m going to undo his
onesie and his diaper now, if that’s OK with you,” I asked softly.
His abdomen was soft
and there was no tenderness. As I started to check his genitalia he did what
all baby boys seemed to like to do to me and peed all over my purple shirt and
then on my face as I tried to avoid the yellow stream.
“He should be a
fireman,” I commented as I wiped urine form my face and chest. “I’m not having
much luck with my clothes today. At least it’s sterile.”
I turned him to inspect
his back and he passed a large, green diarrheal stool which ran onto his
diaper, the exam table and onto my shoes.
“Figures,” I muttered.
“Miss James,” I called out, “could you give me some help, please.”
In a few moments the
door opened and my nurse entered, took one look at me: my purple scrub top was
splattered with the spray of urine, there was baby poop on the table, floor and
my shoes as I held our small patient in one hand and tried to clean up with the
other. Miss James did what any conscientious nurse would do in such a situation:
she burst out in uncontrollable laughter, for the third time.
“Dr. Barnes, you really
should take greater care to control your bodily functions,” she remarked as she
took our young patient from my hands and handed him back to his mother, who
immediately diapered and dressed him.
“I’m sorry, Mrs.
Thompson, it’s been one of those nights,” I apologized. “Little David has all
the symptoms of Rotavirus, which has been going around recently. Be sure to
give him plenty of fluids. We have some samples of Pedialyte here and I think
that would be good for him. He should start to get better in a day or two. If
he is unable to hold anything down, take him to the Pediatric Clinic at the
University Hospital or bring him back here. Do you have any questions?”
I’m sure the look on my
face was enough to deter any attempt at questioning my medical judgment or
instructions. Miss James gave them a twelve pack of Pedialyte and some
information on caring for babies with Rotavirus while I cleaned my shoes and
rinsed my shirt.
I returned to work and
was greeted by Miss James emerging from exam room one looking white as a ghost
and holding her hand over her mouth. As the door closed an overpowering stench
wafted through my nostrils and almost caused me to join my nurse who was now
violently retching in the sink. The smell of fetid stool was filling our
clinic, threatening to send all of us out into the street.
“I’ll open the side
door, you get all the windows,” I shouted as Miss James composed herself. The
cool night breeze helped to carry away some of the foul odor while my intrepid
nurse attacked it with a steady stream of F.O.E.
“Perirectal Abscess is
draining in room one,” Miss James announced.
“I could have guessed,
you know. Now all the mystery is gone,” I replied. “It’s things like this which
make me glad I broke my nose in the fourth grade.
I looked at the chart
outside exam room one. Eric Miller, twenty nine, complaining of pain in the
butt, otherwise healthy.
“OK, wish me luck. I’m
going in,” I informed Miss James.
“Wait,” she said,
putting her hands on my shoulders. She reached up and gave me a kiss on my
cheek. “For luck, in case you don’t return.”
I smiled and then
answered her kiss, “If I should fall in combat, please remember me; remember
that I gave my life to the neverending battle against pus.”
I took a deep breath
and opened the door.
“Good evening, Mr.
Miller,” I greeted my patient by extending my hand. “What’s the problem you are
having.”
Even though I was making
a conscious effort to breathe only through my mouth, the powerful odor still
managed to find its way into the olfactory centers of my brain. I summoned all
my will power, commanding my dinner to stay put as I faced Mr. Miller.
“I’ve got this terrible
pain in my rectum, for five days,” he reported. “It started draining a little
bit two days ago.”
“Is that when this
powerful smell started?” I inquired.
“I guess so, although I
don’t really notice it much,” he stated, although I couldn’t see how he could not
notice it.
“Well, let me look at
your bottom, although I’m sure you should be at the hospital. You’re going to
need surgery, at least an I&D.”
“I&D?”
“Incision and drainage
of the abscess I’m sure you have. It will make you feel better right away,” I
explained as I examined his perianal area and confirmed my diagnosis, all the
time struggling to breathe.
The entire posterior
and left side of the perianal area was red and hard, except for a black area in
the middle. And, I was sure I felt some crepitance suggesting a particularly
nasty infection.
“Are you diabetic, Mr.
Miller?”
“Not that I’ve ever been
told. But, I haven’t been to a doctor in years.”
“Did the nurse take any
blood for testing?”
“No, but she didn’t
stay in the room very long. She sort of looked sick.”
“Yes, she’s not feeling
all that well for some reason, maybe it was your special cologne. Anyway, I’ll
draw some blood for testing, but we need to get you to the hospital. Should I
call an ambulance?”
“I’ll drive myself,” he
decided.
“Good idea, you’ll get
there faster. I’ll call the surgeon on call and have a crew standing by to take
care of you. Good luck.”
Miss James had
recovered and we managed to get Mr. Miller off to University Hospital with
minimal fuss. Steve Johnson was on call and he told me he’d have his residents
standing by to tackle what I was sure was a case of Fournier’s gangrene, although
Mr. Miller didn’t really look very sick. We did do a fingerstick glucose before
he left and found it was 350.
A
tough way to find out you’re diabetic.
The powerful scent of
infected necrotic tissue lingered in my nose as Miss James I had a brief respite
from our duties.
“Vomit, poop, piss and
pus; I’d say it’s been a very fragrant shift, don’t you agree, Nurse?”
Miss James was only
barely recovering from the ordeal and gave a faint smile. The pungent scent of
Mr. Miller still lingered in the air and my feeble attempt at consolation only
made things worse.
“It’s not that bad
anymore. Maybe there’s something else making you sick?” I queried.
“I’ll be OK. I think
I’ll lie down for a few minutes. At least until another patient shows up.”
“Fine, I’ll man the front.”
I sat at the reception
desk studying the latest treatments for stage four lung cancer when an older
man walked in. He looked familiar, perhaps he had been a patient in the past.
I glanced up from my
journal as he signed in: M. Adams, headache. The name struck a chord in my
brain, Maurice Adams as in Dr. Maurice Adams, Cardiothoracic surgeon who had
retired only a few years ago. His name still struck terror in the hearts and
minds of medical students and residents. He had been famous for grilling
underlings rotating through his service on the finer points of anatomy and
physiology.
“Just a few minutes,
Dr. Adams and,” I hesitated a bit, “these forms need to be filled out.”
“Of course, young man,”
he answered as he took the clipboard and sat down in the lobby.
From my vantage point
behind the reception desk something about him didn’t look right.
Of
course something’s not right, that’s why he came to the Clinic.
He looked gaunt and
old, not the vigorous surgeon I remembered. Miss James came up front at that
moment and took over. She looked much better, the usual color had returned to
her cheeks and she even managed a smile for me.
“That’s Dr. Adams. I
know him from University Hospital, he was their number one heart surgeon until
he retired a couple of years ago. There was some flack about him when he left,
but I don’t know any details.”
“Well, he certainly smells
better than all the other patients we’ve had today,” she observed her nose
capturing the fragrance I had missed, a flowery smell which was very appealing.
“I’m not sure what it
is, but it is very pleasant and soothing, like being at home” she said.
I must have looked
confused.
“Spring floral. You
should know it; it’s almost the same scent as those air fresheners I keep in
the bathroom.”
I nodded in agreement,
embarrassed because I had never noticed any air fresheners.
I took a short break
while Miss James ushered the eminent Dr. Adams into exam room one. I glanced at
his paperwork:
“Maurice Adams MD,
FACS, seventy two, no allergies, no meds, no previous surgery, smokes
occasional cigar, retired.”
I knocked on the door,
waited a few seconds then went in.
“Good evening Dr.
Adams. I’m Dr. Barnes. You probably don’t remember me, but I rotated through
your service five years ago. What can I do for you.”
He eyed me up and down
before answering, “Oh, yes, Dr. Barnes. I see you managed to graduate medical
school, even though you once cut out one of my knots and I had to start over.”
“You remember, sir?” I’m
sure I was turning red at the mention of my past misdeed. “I’m sorry about that
sir. I was just a third year student. But, what about you? What’s the problem
you are having?”
“I see you went into
Internal Medicine, good choice, you’ll cause less mayhem.”
I was beginning to grow
a little impatient. “What about you sir? It says you’re having headaches.”
“Oh, yeah,” and he
pressed his hands against each side of his head. “They’d almost stopped until
you reminded me. I couldn’t sleep, my head was pounding, like someone had
hammered a seven inch spike into each ear. I took Acetaminophen, Ibuprofen,
Tramadol, oxycodone and nothing helped. I was on my way to the hospital when I
saw your sign, so I thought I’d stop here instead. Thought it might be quicker.”
“Well, you are right
about that, sir. And, I have to say that after an endless stream of patients
reeking of poop and vomit, your cologne is a breath of fresh air. Now, besides
the headaches, any other medical problems?”
“That’s why I liked
cardiac surgery. Just blood, no encounters with the greasy shit pipe or mucus.
Just nice, clean blood.”
“Your health, sir,” I
tried to direct him back to his problem.
“Nothing, no meds, no
allergies, only rotator cuff surgery to fix
an old golf injury.”
“OK, let me take a look
at you.”
He winced and drew back
as I moved closer to examine him. He closed his eyes and wrinkled his nose and
then he took out a small vial, unscrewed
the lid and took a long sniff in each nostril. I recognized the scent as identical
to the one we had noticed in the lobby.
I took out my
flashlight to check his eyes. He kept them tightly closed.
“Does the light hurt
your eyes?” I asked.
“A little,” he replied.
“OK, I’ll just look at
them without the light.”
I put the flashlight
away and he opened his eyes. The first thing I noticed was that his pupils were
unequal. The right reacted briskly as I moved my hand away from it, while the
left was larger and only barely moved. As I looked more closely there was
slight asymmetry of the face with the right drooping.
“How long have you been
having headaches?”
“Off and on for years.”
“Have they gotten worse
recently?”
“I’m not sure. I know
it was bad today and nothing helped. That’s why I’m here. Can’t you just give
me a shot so I can get some relief? Then I promise I won’t trouble you again.”
“Just trying to be
thorough, sir, like you taught me.”
I smiled at him, but he
just stared straight ahead, as if I wasn’t even there, like his mind was off in
another world.
“I think you should
have an MRI, Dr. Adams, but, for now, I’ll get you a shot of Morphine…”
“No,” he interrupted, “Demerol,
that works better for me. Usually 75 IV does the trick.”
“OK, OK, but you really
need to see a Neurologist. I’ll call Dr. Joint and I’m sure he’ll see you
tomorrow, even if it is Sunday.”
“Thank you, young man.
Now…Demerol?”
It was more command
than request and his insistent attitude made me wonder just a little about the
circumstances of his “retirement.”
“The nurse will be back
shortly,” I responded, but as I said this I saw that he was back to staring
blankly into space.
I found Miss James
looking like her normal cheerful self and asked her to give Dr. Adams the shot
of Demerol and then went to the break room for a moment. As I rummaged around
in the fridge looking for something cold to drink I heard a loud crash. I ran
to the front and heard more noises coming from the exam room. I threw the door open
and found Miss James being held by Dr. Adams, a scalpel at her throat.
“Stop right there, Dr.
Barnes or I’ll finish what I’ve started.”
“Just don’t do anything
foolish, Dr. Adams. We’ll do what you want. Just let her go.”
“Oh, I will, I will let
her go, once I’ve put an end to her misery.”
I took a step towards
them, but he tightened his grip on her and held the blade against her neck. At
the same time I saw him wince and close his eyes for a moment. Before I could
respond, however, he saw me and I took a step back. He wrinkled his nose and
then he put the little vial to his nose and inhaled deeply. The floral scent
reached my nose and filled the room.
“What is it, doctor?
What is going on? You don’t know, do you, but I do. It’s the tumor, the one in
your head pushing on your brain, filling it with ugly, violent thoughts,
telling you to use your surgical skills for evil. You know I’m telling you the
truth. You’re a doctor, you’re a surgeon, you don’t kill people, you save them.”
“Kill people? I’ve
never killed anyone. I perform surgery on them, make them better.
Unfortunately, sometimes the patient doesn’t make it. He winced again and took
a sniff from the little vial.
“It’s unbearable,” he explained,
“the smell, like feces and rotting garbage, night and day filling my head,
sometimes all I can do is clench my fist and close my eyes until the worst
passes. Lavender helps, it reminds me of my wife.”
“Dr. Adams,” I
implored. “You can’t do this. You’re a doctor.”
“I was a doctor. Now I’m
famous, now I’m the Lavender killer.”
He started to cut Miss
James neck, a careful, deep, even stroke right over the anterior border of the
sternocleidomastoid muscle. Blood began to pour out.
“She’s pregnant, you
know; you’ll be killing her unborn child. Could you possibly live with that?” I
screamed and he stopped. Blood continued to squirt out of the wound as he
dropped the scalpel. I ran to Miss James, knocking the distraught Dr. Adams
aside. I grabbed a box of gauze sponges and ripped it open and applied pressure
to the open wound. Luckily, this seemed to staunch the bleeding.
“Quick thinking, Dr.
Barnes. It looks like you messed up another outfit,” Miss James whispered,
looking at my blood stained clothes.
The bleeding had
stopped and I taped the gauze dressing in place as I called 911 to report the
capture of the Lavender serial killer and to call for an ambulance.
Dr. Adams was crying
uncontrollably as the police cuffed him and led him away. It turned out that he
had a massive tumor which was pressing on the olfactory center of his brain. He
died two weeks later.
Miss James had not
suffered injury to any vital structures. She recovered uneventfully and was
back in work in a few weeks.
“It was quick thinking
to say that I was pregnant,” she commented after she was home.
“Well…I remembered that
Dr. Adams about how he loved children, he was always very vocal about this
during his operations. I figured that the conflict created by the thought of
him killing an unborn child would at least get him to stop and perhaps give me
the chance to intervene. I think it worked pretty well. I mean, you are still
here.”
“And still pregnant.”
