Robin Cook - Fever

The elevator arrived at Anderson 6 and Cathryn struggled to reach the front of the car before the doors closed. She was impatient to get back to Michelle, because the child had been very reluctant to let Cathryn leave. Cathryn had talked Michelle into letting her go after lunch by promising she’d be back in half an hour. Unfortunately it was now closer to an hour.

Michelle had clung to Cathryn earlier that morning after Charles had left, insisting that Charles was angry with her. No matter what Cathryn had said, she’d not been able to change Michelle’s mind.

Now Cathryn pushed open Michelle’s door, hoping the child might be napping. At first she thought perhaps she was, because Michelle didn’t move. But then Cathryn noticed the child had kicked off the covers and slid down in the bed with one leg tucked under her. From the doorway Cathryn could see that Michelle’s chest was heaving violently and worst of all, her face had an alarmingly bluish cast with deep maroon-colored lips.

Rushing to the bedside, Cathryn grasped Michelle by the shoulders.

“Michelle,” she cried, shaking the child. “What’s wrong?”

Michelle’s lips moved and her lids fluttered open but only whites showed; her eyes were rolled up in their sockets.

“Help!” cried Cathryn, running for the corridor. “Help!”

The charge nurse came from behind the nurses’ station followed by an LPN. From a room beyond Michelle’s came another RN. They all rapidly converged on Michelle’s room, pushing past the panic-stricken Cathryn. One went to either side of the bed, another to the foot.

“Call a code,” barked the charge nurse.

The nurse at the foot of the bed sped over to the intercom and yelled for the clerk at the nurses’ station to call a code.

Meanwhile the charge nurse could feel a rapid, thready pulse. “Feels like V-tack,” she said. “Her heart’s beating so fast it’s hard to feel individual beats.”

“I agree,” said the other nurse, putting the blood pressure cuff around Michelle’s arm.

“She’s breathing but cyanotic,” said the charge nurse. “Should I give her mouth-to-mouth?”

“I don’t know,” said the second nurse, pumping up the blood pressure cuff. “Maybe it would help the cyanosis.”

The third nurse came back to the bed and straightened out Michelle’s leg while the charge nurse bent over and, squeezing Michelle’s nose shut, placed her mouth over Michelle’s and blew.

“I can get a blood pressure,” said the second nurse. “Sixty over forty, but it’s variable.”

The charge nurse continued to breathe for Michelle but Michelle’s own rapid respiration made it difficult. The nurse straightened up. “I think I’m hindering her more than helping her. I’d better hold off.”

Cathryn remained pressed against the wall, terrorized by the scene in front of her, afraid to move lest she be in the way. She had no idea what was happening although she knew it was bad. Where was Charles!

A woman resident was the first doctor to arrive. She came through from the hallway so quickly that she had to grab the edge of the door to keep from falling on the polished vinyl floor. She ran directly to the bedside, grasping Michelle’s wrist for a pulse.

“I think she has V-tack,” said the charge nurse. “She’s a leukemic. Myeloblastic. Day two of attempted induction.”

“Any cardiac history?” demanded the woman resident, as she leaned over and elevated Michelle’s eyelids. “At least the pupils are down.”

The three nurses looked at each other. “We don’t think she has any cardiac history. Nothing was said at report,” said the charge nurse.

“Blood pressure?” asked the resident.

“Last time it was sixty over forty but variable,” said the second nurse.

“V-tack,” confirmed the woman resident. “Stand back a second.”

The woman resident made a fist and brought it down on Michelle’s narrow thorax with a resounding thump that made Cathryn wince.

An extremely young-looking chief resident arrived followed by two others pushing a cart filled with all sorts of medical paraphernalia and crowned with electronic instrumentation.

The woman resident gave a terse explanation of Michelle’s condition while the nurses rapidly attached EKG leads to Michelle’s extremities.

The charge nurse leaned over to one of the other nurses and told her to page Dr. Keitzman.

The electronic box on the top of the cart began to spew forth an endless strip of narrow graph paper on which Cathryn could see the red squiggles of an EKG. The doctors grouped around the machine, momentarily forgetting Michelle.

“V-tack all right,” said the chief resident. “With the dyspnea and cyanosis she’s obviously hemodynamically compromised. What does that mean, George?”

One of the other residents looked up, startled. “Means we should cardiovert her immediately… I think.”

“You think right,” concurred the chief resident. “But let’s draw up some Lidocaine. Let’s see, the kid’s about fifty kilograms, no?”

“A little less,” said the woman resident.

“All right, fifty milligrams of Lidocaine. Also draw up a milligram of atropine in case she goes into bradycardia.”

The team functioned efficiently as one resident drew up the medications, another got out the electrode paddles, while the third helped position Michelle. One paddle went under Michelle’s back, the other anteriorly on her chest.

“All right, stand back,” said the chief resident. “We’ll use a fifty-watt second shock to start, programmed to be delivered at the R-wave. Here goes.”

He pressed a button and after a momentary delay Michelle’s body contracted, her arms and legs jumping off the surface of the bed.

Cathryn watched in horror as the doctors stayed bent over the machine, ignoring Michelle’s violent reaction. Cathryn could see the child’s eyes open in utter bewilderment and her head lift off the bed. Thankfully her color rapidly reverted to normal.

“Not bad!” yelled the chief resident, examining the EKG paper as it came out of the machine.

“John, you’re getting good at this stuff,” agreed the woman resident. “Maybe you should think about doing it for a living.”

All the doctors laughed and turned to Michelle.

Dr. Keitzman arrived breathless, hands jammed into the pockets of his long white coat. He went directly to the bed, his bespectacled eyes quickly scanning Michelle’s body. He snatched up her hand, feeling for a pulse.

“Are you okay, chicken?” he asked, getting out his stethoscope.

Michelle nodded but didn’t speak. She appeared dazed.

Cathryn watched as John, the chief resident, launched into a capsule summary of the event in what was to Cathryn incomprehensible medicalese.

Dr. Keitzman’s upper lip pulled back in a characteristic spasm as he bent over Michelle, listening to her chest. Satisfied, he checked a run of EKG paper offered by John. At that moment he caught sight of Cathryn pressed up against the wall. Keitzman glanced at the charge nurse with a questioning expression. The charge nurse, following his line of sight, shrugged.

“We didn’t know she was in here,” said the charge nurse defensively.

Dr. Keitzman walked over to Cathryn and put a hand on her shoulder.

“How about you, Mrs. Martel?” asked Dr. Keitzman. “Are you all right?”

Cathryn tried to talk but her voice wouldn’t cooperate, so she nodded like Michelle.

“I’m sorry you had to see this,” said Dr. Keitzman. “Michelle seems fine and she undoubtedly did not feel anything. But I know this kind of thing is shocking. Let’s go out in the hall for a moment. I’d like to talk to you.”

Cathryn strained upward to see Michelle over Dr. Keitzman’s shoulder.