21. David
21
DAVID
I breezed through the doors of the emergency department with my lab coat barely on and my hair still mussed from sleep. Lauren and I had a chat after midnight when I finally got ahold of her, but I was so uneasy about what was happening, I'd barely slept. She was a bit distant and emotional and told me it was something we'd have to discuss in person and not over a phone call. I didn't understand, but I wouldn't push. I thought it had to do with her brother again.
When I got the call this morning that we had a case and saw how early it was and what time we went to bed last night, I decided not to call her in. Doctors Cooper, Baine, and Holt stood near the entrance waiting for me and matched my pace as I moved toward the nurses’ station to grab my tablet and the information we had on this patient.
"Talk to me," I barked, wishing Lauren were here to give this rundown. She was much better with true emergency situations like this than any of my other interns, and I regretted the decision not to call her in but it was too late now.
"We can't tell what is causing them, but the EEG shows complex partial seizures and heightened brain activity in the temporal lobe." Dr. Holt was on top of things. He'd make an excellent emergency doctor if he wanted to be one. "Forty-two-year-old male with no history of epilepsy or other seizure disorders. He's intoxicated on alcohol, and we're running a tox screen to make sure he's not on anything else. Vitals are unstable, and he hasn’t regained consciousness since he was brought in."
"How did they find him?" I asked, hoping to rule out trauma. We continued to walk until we're at the nurses' station and I had my tablet. My eyes pored over the details as Dr. Cooper fed them to me audibly.
"Stranger found him on the street seizing." She stared at me, not her tablet, which meant she either thought she knew everything or she had it memorized.
"Blood sugar?" I snapped off, and Dr. Baine responded.
"Just over a hundred, so in good healthy range."
"Pulse?" I asked, expecting it to be high.
"Around one-twenty. We're controlling it with meds." Dr. Holt had his eyes on his tablet.
"What are we doing for the seizing?" I skimmed the report, but before my eyes got to the list of medications, Dr. Holt responded.
"Thousand milligrams of Depakote and one fifty of lacosamide stacked, but there was no response so we sedated him."
The definitive, quick response was what I'd have done too. These guys were really learning their stuff well. I was impressed. "Good, let's wake him up. We'll need a full workup. MRI, CT, the works. I want to see what he does when his brain is awake. We need to observe that. Maybe a functional EEG as well. Get the helmet ordered from Midtown, and let's meet back here when the tests are done.”
I didn't go to the patient's room. There was no need. Looking at a sedated man on a hospital bed wouldn't give me any more answers than the case file in my hands. The interns rushed off to get to work, and I headed up to my office. I'd done enough of these strange cases to know it was probably trauma-induced, but with a sedated patient who couldn't give simple answers to questions about his history, there was no diagnosing anything.
I sat at my desk for the next forty minutes and dug into his medical history. As much as had been recorded into his chart here at Our Lady, anyway. There was no sign of any cause for seizures except a history of drug abuse. In my experience, that pointed to physical trauma, though I had seen patients who were clean and off drugs relapse, and the sudden surge of chemicals into their system caused their brain to go haywire.
That thought brought my mind back to Lauren and her struggle with Jason. I wanted nothing more than to ease the stress her mind was under. I wondered if she would let me pay for the rehab now that we'd gotten to know each other more. I'd offered it to her as an advance on her salary a while back, but she refused. Then, I had thought of it as her fierce determination, and now, I just found her to be stubborn, in a good way. But she was carrying a weight she didn't need to.
The thought nagged at my conscience until my phone buzzed with an emergency text. The patient had awakened and begun seizing in the MRI machine. The message had me out of my seat and reaching toward radiology as fast as I could. We had to get a good reading on his brain while it was active like this.
By the time I got there, the Ativan was flowing and his seizure had stopped. The interns surrounded him, hooking up the leads on his scalp and forehead for the EEG.
"We just got him calm," Dr. Cooper said, but she continued working on lead placement.
"Tonic-clonic this time, Doc. They're getting worse." Dr. Baine had no clue, maybe because he hadn't encountered a seizure patient, or perhaps he'd ignored that part of his studies.
"Tonic-clonic seizures aren't necessarily worse or better than complex partial seizures. We need the EEG to understand what is happening in his neurons." I studied him. He looked so familiar, but I couldn't peg where I'd seen his face. "Let's get this done faster. If he seizes again soon, we'll be able to catch it on the scan and know exactly what's taking place. It will help us narrow down the cause."
Their hands worked quickly and the man stayed calm the entire time. When his eyes blinked open, everyone braced themselves for another episode, but nothing happened, nothing that they feared, anyway. The man lifted his head and looked up at me, sort of confused. Seizures could make a person forget things for days or weeks afterward, but as crisp as can be, he said, "I know you."
My heart stopped when I heard his voice. It was the man I slugged on the street corner that night Lauren came rushing up to me. I had hit him so hard, he fell and smacked his head on the brick behind him and then possibly the concrete, too. Was I the trauma? Did this happen because of me? Had he been having the seizures since then and only now just got brought in?
"We really need this test, guys…" The functional EEG would not only tell us what was going on during an active episode, but also if his seizures had been happening previously and an approximate amount of intensity.
"I know you. You’re that guy who hit me…" The man became combative and belligerent, swinging and shouting.
The interns looked at me with shock and confusion the angrier and louder he got. He hit Dr. Baine and nearly knocked Dr. Cooper over as they wrestled to sedate him again, but the ruckus drew the security officers into the room from out in the hallway where nurses had called them.
"What's going on here?" one of the security officers asked.
"That man… he hit me." The patient was beginning to feel the effects of the sedation and could hardly be understood, but that accusation was enough for the security guys to take action.
"Dr. Park, can you explain what he's talking about?" One of them had a hand on his pepper spray, and I felt my gut tighten into a knot.
"I think we should talk somewhere private." My whole world just came crashing in around me with no way to protect Lauren from this fallout. If this guy told them what happened, they'd ask who the woman was. If I told them, we were done for. Chances were, without someone to corroborate my story, I was going to go down for assault. And if the seizures really were caused by that blow, I was in a heap of trouble, maybe looking at jail time.
My God, why couldn't life just let up and give me a chance to breathe?