. The girl lay on her side on the gurney, a string of saliva from her slack lips puddling on the sheet and her dark hair splayed on the pillow. Her breathing so slow and shallow that her chest barely moved. Dr. Ben Allen felt her forehead: damp and cool. He turned to the ER nurse. “Temp?”
“Ninety-eight point six.”
No fever. A seven-year-old in a coma? He dug into his memory bank and the possibilities scrolled down: poisoning, cerebral hemorrhage, infection, brain tumor, diabetes.
The auburn-haired woman on a stool in the corner caught his eye. Her hands were wringing a small handkerchief in her lap. Her face had probably been attractive once, but now flabby cheeks crowded her eyes into slits. The seams of her slacks strained against her bulky thighs. She looked about thirty years old.
“Mrs. Harris, has Angela been sick?”
“Sick? You mean like a cold?”
“No. Anything serious?”
She shook her head. “No. Nothing like that.”
“Complain of anything—headache, stomach pains?
“She didn’t complain of nothing.”
Ben went through his history checklist: “Diarrhea? Any trouble passing her urine? A recent fall? Head injury?”
To each Mrs. Harris gave a negative response. Angela, an only child, had been born in North Lorain, outside of Cleveland. No problems in infancy. She’d had her immunization shots.
Dr. Carlo Rizzo, a member of Middleton’s Tubbs Hospital ER Physicians Medical Group, stood alongside the gurney. A swarthy, hawk-nosed man in his early thirties, a stethoscope draped around his neck, Rizzo said, “I call you, because Dr. Mayborough retires.”
The ER Medical Group consisted of mostly foreign-trained “docs in the box.” Drag in your bleeding, your gasping, your sniffling, bruised, swollen, whiplashed patients, and the ER bunch would do a passable job. They’d stitch the laceration, slap on a bandage or splint, and tell the patient to get in touch with their own doctor. But for anything more complicated, forget it. At least Rizzo knew when to ask for help. Bob Mayborough had retired and moved away six months ago, but apparently had not yet introduced Angela to another pediatrician. Now Angela’s care was Ben’s responsibility, since he, along with the other Tubbs Hospital attending staff pediatricians, rotated on call for emergencies
Rizzo held his stethoscope to Angela’s chest and listened.
Ben said, “Anything?”
Rizzo rested his hands on the gurney and shook his head. “Her pulse is slow, temperature is normal, respiratory rate is slow. Her belly is soft. Lungs are clear. The only thing, I can’t get any deep tendon reflexes.” He pressed with effort on the bony mastoid processes behind the girl’s ears.
Ben saw the frown on Mrs. Harris’s face. “He’s seeing if she’ll respond to the pressure. Gives us some idea of how deeply unconscious she is.”
Something was a little off. This mother, while concerned, seemed unusually composed for a parent who didn’t know whether her kid would live or die. And where was the father?
Angela moved her head slightly and the corners of her lips turned down, but her eyes remained closed. Her unblemished dark skin, long black eyelashes, and delicate features reminded Ben of a sleeping doll.
He put out his hand. “Let me use your percussion hammer.” Rizzo handed him the rubber hammer and Ben stroked the soles of Angela’s feet with the pointed end of its handle. Her toes curled down. “No Babinski reflex.” Out of the corner of his eye he saw the child’s mother press her hand to her mouth. Quickly he added, “That’s a good sign. Probably means she doesn’t have a brain hemorrhage. But to be sure, I’ll have to put a needle in her back and examine her spinal fluid.” He bent over the gurney, lifted the child’s eyelids and carefully inspected her eyes. “Pupils are constricted.” He shielded her eyes from the overhead light, again observed her pupils, and then took his hand away to let the light shine into her eyes. “Rizzo, have a look.” He repeated the procedure twice more. The child’s pupils remained constricted even when he shaded her eyes.
Rizzo nodded. “They don’t expand.”
Ben turned to the child’s mother. “Mrs. Harris, has she taken any medicine? Or could she have gotten into some drugs in the house?”
Mrs. Harris opened her mouth to answer, but suddenly a deep-throated moan came from the child. Her body twitched, face contorted, fingers fluttered rapidly, feet beat a rapid tattoo on the mattress. Her head and shoulders rose from the gurney, and with a violent retching, a stream of greenish liquid gushed from her mouth.
The nurse turned the child’s head to the side. Ben grabbed a towel from a nearby cart and wiped away liquid and solid food particles from the girl’s mouth and nostrils. Angela gasped as she made an effort to inhale, straining to suck air into her lungs, but she couldn’t. Her face turned blue, eyelids fluttered, and eyes rolled upward so that only the whites were visible.
Mrs. Harris screamed.
“Ninety-eight point six.”
No fever. A seven-year-old in a coma? He dug into his memory bank and the possibilities scrolled down: poisoning, cerebral hemorrhage, infection, brain tumor, diabetes.
The auburn-haired woman on a stool in the corner caught his eye. Her hands were wringing a small handkerchief in her lap. Her face had probably been attractive once, but now flabby cheeks crowded her eyes into slits. The seams of her slacks strained against her bulky thighs. She looked about thirty years old.
“Mrs. Harris, has Angela been sick?”
“Sick? You mean like a cold?”
“No. Anything serious?”
She shook her head. “No. Nothing like that.”
“Complain of anything—headache, stomach pains?
“She didn’t complain of nothing.”
Ben went through his history checklist: “Diarrhea? Any trouble passing her urine? A recent fall? Head injury?”
To each Mrs. Harris gave a negative response. Angela, an only child, had been born in North Lorain, outside of Cleveland. No problems in infancy. She’d had her immunization shots.
Dr. Carlo Rizzo, a member of Middleton’s Tubbs Hospital ER Physicians Medical Group, stood alongside the gurney. A swarthy, hawk-nosed man in his early thirties, a stethoscope draped around his neck, Rizzo said, “I call you, because Dr. Mayborough retires.”
The ER Medical Group consisted of mostly foreign-trained “docs in the box.” Drag in your bleeding, your gasping, your sniffling, bruised, swollen, whiplashed patients, and the ER bunch would do a passable job. They’d stitch the laceration, slap on a bandage or splint, and tell the patient to get in touch with their own doctor. But for anything more complicated, forget it. At least Rizzo knew when to ask for help. Bob Mayborough had retired and moved away six months ago, but apparently had not yet introduced Angela to another pediatrician. Now Angela’s care was Ben’s responsibility, since he, along with the other Tubbs Hospital attending staff pediatricians, rotated on call for emergencies
Rizzo held his stethoscope to Angela’s chest and listened.
Ben said, “Anything?”
Rizzo rested his hands on the gurney and shook his head. “Her pulse is slow, temperature is normal, respiratory rate is slow. Her belly is soft. Lungs are clear. The only thing, I can’t get any deep tendon reflexes.” He pressed with effort on the bony mastoid processes behind the girl’s ears.
Ben saw the frown on Mrs. Harris’s face. “He’s seeing if she’ll respond to the pressure. Gives us some idea of how deeply unconscious she is.”
Something was a little off. This mother, while concerned, seemed unusually composed for a parent who didn’t know whether her kid would live or die. And where was the father?
Angela moved her head slightly and the corners of her lips turned down, but her eyes remained closed. Her unblemished dark skin, long black eyelashes, and delicate features reminded Ben of a sleeping doll.
He put out his hand. “Let me use your percussion hammer.” Rizzo handed him the rubber hammer and Ben stroked the soles of Angela’s feet with the pointed end of its handle. Her toes curled down. “No Babinski reflex.” Out of the corner of his eye he saw the child’s mother press her hand to her mouth. Quickly he added, “That’s a good sign. Probably means she doesn’t have a brain hemorrhage. But to be sure, I’ll have to put a needle in her back and examine her spinal fluid.” He bent over the gurney, lifted the child’s eyelids and carefully inspected her eyes. “Pupils are constricted.” He shielded her eyes from the overhead light, again observed her pupils, and then took his hand away to let the light shine into her eyes. “Rizzo, have a look.” He repeated the procedure twice more. The child’s pupils remained constricted even when he shaded her eyes.
Rizzo nodded. “They don’t expand.”
Ben turned to the child’s mother. “Mrs. Harris, has she taken any medicine? Or could she have gotten into some drugs in the house?”
Mrs. Harris opened her mouth to answer, but suddenly a deep-throated moan came from the child. Her body twitched, face contorted, fingers fluttered rapidly, feet beat a rapid tattoo on the mattress. Her head and shoulders rose from the gurney, and with a violent retching, a stream of greenish liquid gushed from her mouth.
The nurse turned the child’s head to the side. Ben grabbed a towel from a nearby cart and wiped away liquid and solid food particles from the girl’s mouth and nostrils. Angela gasped as she made an effort to inhale, straining to suck air into her lungs, but she couldn’t. Her face turned blue, eyelids fluttered, and eyes rolled upward so that only the whites were visible.
Mrs. Harris screamed.
