Chapter 27
Chapter Twenty-Seven
Holly
“Dr. Carrington, your next patient is ready. Mr. Stratten, room four, drove himself to the ER. He said he passed out while working in the garden. He’s alert and oriented now; his only complaint is a significant headache that he says has been off and on for the last three weeks.
” I nod along to the tech as I take a swig of water, begging the nervous energy from my lunchtime meeting to wear off.
“What time did he pass out?”
“Around eleven this morning.” I check my watch to note it’s almost two o’clock.
“I’m sorry, did you say a headache for the last three weeks?” Poor guy must be miserable.
The tech nods. “He lives out in the boonies. Doesn’t have a primary care doctor anymore. Stopped taking meds for heart disease and hypertension a few years ago when his scripts ran out.”
I huff out a frustrated breath. Sadly, that seems to be the case with a lot of the older populations I’ve run into over the last few weeks.
I raise a hand to knock on the wall outside room four just as she finishes.
“Mr. Stratten?” I pull open the curtain, smiling at the elderly man sitting on the hospital gurney.
His silver hair is sticking up on the sides, his thin legs dangling over the edge of the cot.
His hands are clasped firmly in his lap, the sun-spotted skin and deep wrinkles showing a lifetime of hard work.
I’m Dr. Carrington.” I reach my hand out, noticing he returns it with a firm squeeze.
“You can call me Harry.”
“Alright, Harry, nice to meet you. So, tell me what brings you in today?”
“Well, my wife says I passed out,” he says. “I was picking some tomatoes so she could can salsa, and I suddenly got the worst headache. Came on like a son of a bitch.”
Taking my stethoscope, I raise it to his chest, placing it over his heart. “Do you know how long you were passed out for?”
“Just a few minutes; she called an ambulance, but by the time they came, I was fine. I still have a headache, though. That hasn’t gone away.”
I pause for a moment to listen to his heartbeat, which sounds to be in a normal rhythm. “If the ambulance was there, how come you didn’t get checked out sooner?”
“Like I said, Doc, I was fine.” He shoots me a cute smile, and I shake my head at him, garnering a laugh.
“Has this happened to you before? You get a terrible headache and pass out?”
“Last summer, the same thing happened.”
I move my stethoscope to his back to listen to his breath sounds. “Deep breath in,” I say softly, and he pulls one in before releasing it. “Did you wake up from that one fine?”
“Yup,” he says, before adding, “Well, except my left hand was pretty numb after that. Figured I fell on it.”
“How long did the numbness last?”
He shrugs. “I don’t remember. It was a long time ago.”
I move around to stand in front of him again, holding my arms out straight in front of me.
“Hold your arms out like this. Try to keep them as steady as possible.” He does as I ask, and his arms look even.
I have him do the same with his legs and test the weight of each by pushing down.
“Has your wife ever said you’re talking funny?
Slurring your words, having a hard time speaking?
Or has she said your smile looks crooked? ”
“No, not really. She’s said I’m funny looking though.” I catch the slight wink he sends to my tech as I stand up. “What medications are you taking?”
“None right now. My old Doc, before he retired, had me on some stuff for blood pressure. I took an orange pill every morning and a small white one at night.”
“But you don’t take them anymore?”
He shrugs. “Doc retired, they closed the clinic. I haven’t found a new one yet.”
“And how long ago was that?”
“About three years.”
“Three years?” I gasp, playfully propping my hands on my hips. “Harry, you’ve had plenty of time to find a new doctor.”
“I know. But I felt great, Doc. My energy is great, I sleep good. I don’t want to drive an hour into the city just to sit in the waiting room and have some doctor who looks like he’s still a kid tell me to take a bunch of pills.”
“Where do you live?”
“Eastridge, you heard of it?”
I shake my head no. “I’m learning some of the outside areas; I’m most familiar with Willow Creek and Copper Ridge.”
“Ah,” he says. “I’m about another ten miles past Copper Ridge.”
“Yikes. I’m sorry you had to drive all this way to be seen.”
He shrugs a shoulder nonchalantly.
“So, tell me about this headache. On a scale of one to ten, one being nothing and ten being the worst pain you’ve ever experienced, what would you rate it at?”
“Maybe a two.”
He came in with a significant headache, yet only rates his pain at a two. “Tell me, Harry, what did you do for work? A farmer?”
A smile brightens his face. “How did you know?”
I reach over to the hand sanitizer, pumping out a handful before rubbing it in my palms. “I’ve been learning that farmers, especially ones that live way out in the country, are some of the toughest people there are.”
He beams at my sentiment, opening his mouth to ask me something else before a knock on the wall sounds.
I turn to see one of my fellow doctors, ushering with his head to a room down the hall.
I had been so caught up in chatting with Harry that I forgot how swamped we’ve been.
I hold up a finger, letting him know I’ll be just a minute, and I turn back to Harry.
“Well, Harry, it could be a few things. For one, I’d like to keep you here for a few hours for observation.
We’ll check all your labs and put you on telemetry so I can see if your heart is doing anything funny.
I’d also like to order a CT, as I’m wondering if you had a small stroke. ”
He scoffs at that. “Wouldn’t I know if I had a stroke, Doc?”
“Maybe,” I offer. “Sometimes they can be so small they don’t leave any lingering effects. Has anyone used the term ‘TIA’ with you before?”
He thinks for a moment, furrowing his thick gray brows together. “I’m not sure. Maybe. But my memory isn’t what it used to be.”
“Let’s get an EKG right away before he’s placed on telemetry,” I tell the tech. “CT has been pretty backed up today, but you can hang out here, take a rest, we will run some tests and let you know when we’re ready for the CT.”
I flip the vitals monitor so he can see the display.
“We’re going to work on lowering your blood pressure too.
This top number,” I say, pointing to the screen.
“It’s too high. We’d like it around one twenty; I’d even take one forty if you have a history of high blood pressure and haven’t been on medications lately.
I’ll put in orders to have the nurses give you some medications through your IV, and we’ll re-check it every fifteen minutes.
” I push out a breath, letting my hands fall to my hips.
“That was a lot of information. What questions do you have for me?”
His eyes are still fixated on the monitor, and I can hear the cuff inflating as it checks his blood pressure. The numbers blink on the monitor, and when he sees that the reading is fairly high, he cringes. “You’re not going to make me stay here overnight, are you?”
I hand him his call light and explain how to use it. “Let’s hope not. If all tests come back normal, I could send you home with medications and a promise that you’ll find a new doctor to follow up with, as long as you promise to hang out with us until we get some answers.”
He winks, taking the call light from my hand. “You got it, Doc.”
***
“Is the CT ready yet?” I look down at my watch and grimace.
Harry has been here for three hours already.
Most of his labs came back normal, with the exception of slight anemia and the start of kidney disease, but with his age and overall health history, I was impressed with his results.
We had him on telemetry for two hours without any report of a pause in rhythm or an irregularity.
He’s getting antsy and has been pacing in his room for the last hour, continually coming to the nurses’ station to see when he’s allowed to go home.
Savannah, the tech working with him, grimaces. “Not yet. They finally got it fixed, and now they’re working through the list of people waiting. It sounds like they bumped some non-emergent ones to get our patients through, but it’ll probably be another hour or so.”
I reach back, gripping my shoulder with my palm, pressing down and trying to work out the knot that’s been plaguing me all day.
What started out as a decent shift turned into a madhouse.
As soon as we discharged someone, the room was barely cleaned before it was full again, and the waiting room is packed with at least thirty people in need of care.
Each case I see bleeds into the next. Asthma exacerbation, bike accident with head laceration, teenage girl here for med clearance before going to a psychiatric ward.
“I don’t feel comfortable discharging him without a CT. We could probably discontinue telemetry at this point.”
She nods, leaving the station to head in the direction of his room just as the double doors to the ambulance bay swing open, slamming into the wall.
“Gurney coming through!” a paramedic shouts.
I’m up, racing around the nurses’ station and down the small hall, grabbing the end of the gurney and pulling it into trauma bay one.
Another doctor and a team of nurses and techs follow behind me.
“What do we have?”
The chaos ensues; with the amount of blood on the patient’s clothing and gurney, we start gowning up. A tech holds a gown open in front of me, and I shove my arms through, reaching to slip on a pair of gloves as they tie the strings together across my back.
“Nasty car accident on I-23. Driver fell asleep and ran head-on into a minivan of five. Sixteen-year-old woman with lacerations to her face and arms, complaints of abdominal pain.”