Now That You Mention It. Kristan Higgins
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you the GI consult?” she asked, failing to recognize me. Again.
“Yes,” I said. “I’m Nora. We’ve met. Three times.” She still looked blank. “Bobby’s girlfriend?”
“Oh. Right. Anyway, I suspect appendicitis, but his pain is a little more midline. We’re waiting on labs. I was going to scan him, but the attending wanted the consult to see if we can avoid the CT.”
The patient looked young for twelve, his skin ashen, face drawn with pain. We didn’t want to expose him to radiation from the CT scan if we didn’t have to. “Hi, bud,” I said. “We’re gonna take good care of you, okay?” I smiled at the mother as I washed my hands. “I’m Dr. Stuart. Sorry your son is having trouble.” I glanced at the chart. Caden Lackley, no trauma, eating mostly normally until today, acute abdominal pain, fever, nausea and vomiting. “Any diarrhea or mushy poop, Caden?” Like I said, not the best party chatter.
“No,” he answered.
“Okay. Let’s take a look.”
I felt his stomach, which was tight, one of the signs for appendicitis. But the pain wasn’t in the expected place; in fact, it wasn’t anywhere near McBurney’s point in his lower right abdomen. “It’s not his appendix,” I said.
Jabrielle pursed her perfect lips, irritated that she’d been wrong. All the ER docs were this way, hating when we specialists disagreed with them.
The kid sucked in a sharp breath as I palpated just under his ribs on the right side. There was no pain on the left. I rolled him to his side and tapped on his back to check for kidney problems, but he didn’t react.
He was probably too young for gallstones. Pancreatitis, maybe, but again, given his age, it was a bit unlikely. It wouldn’t be Crohn’s disease without diarrhea. “How long has your stomach been hurting, Caden?”
“Since Sunday.”
That was a nice specific answer. Today was Thursday, so five days of stomach pain. “Has it stopped and started?”
“No. It’s been there the whole time.”
I thought a second. “Did you eat anything different over the weekend?”
“We went to a party at my sister’s,” the mom said. “There was a lot of food, but nothing he hasn’t had before.”
“Anything with small bones in it? Fish, chicken?”
They looked at each other. “No. Nothing with bones,” she said.
“How about a toothpick?” I asked.
“Yeah,” he said. “Those scallops wrapped in bacon.”
Bingo. “Did you maybe swallow a toothpick?” I asked.
“I don’t think so,” he said.
“He was eating them like popcorn,” his mother said.
“Well, they are fantastic.” I smiled. “Sometimes people can swallow things without noticing it, Caden, so I’m going to do an endoscopy. Basically, you get some nice relaxing medicine, I slip a tiny camera into your stomach and look around and maybe I’ll see a toothpick. Sound like fun?”
It did to me.
I told Jabrielle to give him some Versed to relax him, then sprayed his throat with lidocaine to numb it, so he wouldn’t gag. His mom sat next to him, holding his hand.
“This won’t hurt a bit,” I said, then I got to work, sliding the scope into his throat, talking quietly through it, looking up at the screen as Caden’s esophagus and stomach were revealed. Healthy tissue, the beautiful web of blood vessels, the grayish walls of the stomach pulsing and moving with life.
And there, in the lower part of the stomach, I saw the toothpick, now black from stomach acid, sticking out of his duodenal wall. Using the endoscopy forceps, I gently grabbed it and slowly pulled it out. “Ta-da,” I said, holding it up so my patient could see. “We got it, Caden. You’ll feel a lot better tomorrow.”
“Good call,” Jabrielle murmured.
“Thank you,” I said. “I’ll order up some antibiotics, but he should be right as rain. In the future, big guy, eat more carefully, okay? This could’ve done a lot of damage. It could’ve slipped through into your liver, and that would’ve been really bad.”
“Thank you so much, Doctor,” the mom said. “We had no idea!”
“My pleasure,” I said. “He seems like a great kid.”
I pulled off my gloves, shook her hand, tousled Caden’s hair and went out to write the prescription.
Felt a little heroic.
If left untreated, that toothpick could’ve caused sepsis. It could’ve been fatal. Though it didn’t happen too often, I think I could firmly say I’d saved a life tonight.
Just then the doors to the ambulance bay burst open, and a pack of people ran down the hall next to a gurney. “Drive-up gunshot to throat” barked someone—Bobby, it was my honey! “Extensive blood loss in vehicle, get the Level One infuser running with four units of O positive. Call the blood bank for a mass-transfusion pack, and call trauma code for Room One, now! Stop sitting on your asses, people! Move!”
The place exploded with action, people running in every direction, doing as their lord commanded. I inched toward the room where the action was, hypnotized. Good God. It looked like half the man’s throat was missing, a meaty hole about the size of a fist, Bobby’s hand inside it.
“I’m clamping his carotid with my fucking fingers!” Bobby yelled. “Where the hell is the surgeon?”
Indeed, Bobby’s arm was drenched in blood, his scrubs sprayed with arterial spatter. The rest of the team buzzed around the patient, cutting off his clothes, inserting lines.
“No, you can’t intubate, idiot!” Bobby barked at an intern. “Can you not see my hand in his throat? Bag him, you moron!”
I sure didn’t miss residency. The ER doctors had been brutal.
Dr. McKnight from Surgery burst in, pulling on her gloves, a face shield already in place to protect her from blood-borne diseases. Someone draped her in a gown. “Clamp,” she snapped. “Now!” If there was anyone more, ah, self-confident than an ER doc, it was a surgeon. “Keep your hand there, Bobby, and don’t even breathe. You lose your grip, he bleeds out in five seconds. How the hell did he make it here with a pulse?”
Then a nurse saw me gaping and closed the door. I wasn’t ER staff, after all.
I snapped out of my awestruck stupor and closed my mouth. Janitorial was already mopping up the trail of blood, and half the residents—including Jabrielle, who shot me a dirty look, since I made her miss the good stuff with my boring endoscopy—hovered at the exam room window to see if the guy would make it.
The other patients in the unit were quiet in their exam stalls out of respect, it seemed—a TV-worthy trauma had just passed through their midst.
I wandered back to the triage desk. “Hi again, Ellen,” I said. “That’s some—”
“You done with that consult?” Ellen asked.
“Oh, yeah. Um...he swallowed a toothpick. I did an endoscopy and—”
She gave me the stink eye and picked up her phone. Right. She was busy, and I was an irritating doctor who made her life harder...which was true for a lot of nurses, especially in the ER. All the more reason I bent over backward to make sure they knew I appreciated them. But Ellen wasn’t the type to drink in the milk of human kindness, so I slunk to the computer and entered the report.
Just as I finished, the door to Bobby’s exam room opened, and out came the team again, heading for the elevator up to the surgical floor. I could hear the beeping that indicated a regular heartbeat.