Tess Gerritsen - Bloodstream

Claire knelt down, and her first concern was to prevent him from injuring himself or aspirating secretions into his lungs. She rolled the man onto his side, loosened his scarf, and wedged it under his cheek to protect it from the icy sidewalk. His skin was florid from the cold, not cyanotic; his pulse was rapid but strong.

“How long has he been seizing?” she called out.

Her question was met with silence. She glanced up at the bystanders and saw that they had backed away even farther, that their gazes were focused not on her, but on the man. The only sound was the wind, blowing in from the lake, whipping at coats and scarves.

“How long?” she repeated, her voice now sharp with impatience.

“Five, maybe ten minutes,” someone finally answered.

“Has an ambulance been called?”

There was a shaking of heads, a collective shrug of shoulders.

“It’s just old Warren,” said a woman whom Claire recognized as the cashier from the general store. “He never needed an ambulance before.”

“Well, he needs one now!” snapped Claire. “Call one!”

“Seizures are slowing down,” said the cashier. “It’ll be over in a minute.”

The man’s limbs were jerking only intermittently now, his brain firing off the final bursts of its electrical storm. At last he lay flaccid. Claire again checked his pulse and found it still strong, still steady.

“See, he’s okay,” said the cashier. “Always comes out of it fine.”

“He needs stitches. And he needs neurological evaluation,” said Claire. “Who’s his doctor?”

“It used to be Pomeroy.”

“Well, someone must be prescribing seizure meds for him now. What’s his medical history? Does anyone know?”

“Why don’t you ask Warren? He’s waking up.”

She looked down and saw Warren Emerson’s eyes slowly open. Though he was surrounded by people, he gazed straight up at the sky as though seeing it for the first time.

“Mr. Emerson,” she said. “Can you look at me?”

For a moment he didn’t respond; he seemed lost in wonder, his eyes following the slow drift of a cloud overhead.

“Warren?”

At last he focused on her, his brow wrinkling as though he was struggling to understand why this strange woman was talking to him.

“I had another one,” he murmured. “Didn’t I?”

“I’m Dr. Elliot. The ambulance is on its way, and we’ll be taking you to the hospital.”

“I want to go home…

“You’ve split open your scalp and you need stitches.”

“But my cat-my cat’s at home.”

“Your cat will be fine. Who’s your doctor, Warren?”

He seemed to be struggling to remember. “Dr. Pomeroy.”

“Dr. Pomeroy has passed away. Who is your doctor now?” He shook his head and closed his eyes. “Doesn’t matter. It doesn’t matter anymore.”

Claire heard the wail of the approaching ambulance. It pulled to a stop at the curb and two EMTs stepped out.

“Oh, it’s just Warren Emerson,” one of them said, as though he ran into the same patient every day. “He have another seizure?”

“And a pretty deep scalp wound.”

“Okay, Warren, ol’ buddy,” said the EMT “Looks like you’re going for a ride.”

By the time the ambulance drove away, Claire’s fury was boiling over. She looked down at the blood, solidified on the ice. “I can’t believe you people,” she said. “Did anyone try to help him? Does anyone give a damn?”

“They’re just scared,” said the cashier.

Claire turned to look at the woman. “At the very least you could have protected his head. A seizure’s nothing to be afraid of.”

“We’re not afraid of that. It’s him.”

She shook her head in disbelief. “You’re afraid of an old man? What possible threat could he be?”

Her question was met with silence. Claire looked around at the other faces, but no one returned her gaze.

No one said a thing.

By the time Claire arrived at the hospital, the ER physician had already sutured Warren Emerson’s lacerated scalp and was scribbling notes on a clipboard. “Needed eight stitches,” said McNally. “Plus he had some minor frostbite of the nose and ears. Must’ve been lying in the cold for a while.”

“At least twenty minutes,” said Claire. “You think he needs admission?”

“Well, the seizures are a chronic problem, and he seems to be neurologically intact. But he did hit his head. I can’t tell if the loss of consciousness was due to the seizure or the head bonk.”

“Does he have a primary care physician?”

“Not currently. According to our records, his last hospitalization was back in ‘89, when Dr. Pomeroy admitted him.” McNally signed off on the ER sheet and looked at Claire. “You want to take him?”

“I was about to suggest it,” she said.

McNally handed her Emerson’s old hospital chart. “Happy reading.” The file contained the record for Emerson’s 1989 hospitalization as well as the summaries from numerous ER visits over the years. She turned first to the 1989 admission history and physical and recognized Dr. Pomeroy’s spidery handwriting. It was a skimpy entry, recording only the essential facts:

History: 57-year-old white male, accidentally struck left foot with ax while chopping kindling five days ago. Wound has turned swollen and painful and patient now unable to bear weight.

Physical: Temperature 99 degrees. Left foot has two-inch laceration, skin edges closed. Surrounding skin is warm, red, tender Enlarged groin nodes on left Diagnosis: Cellulitis.

Rx:Intravenous antibiotics.

There was no past medical history no social history, nothing to indicate that a living, breathing human was attached to that infected foot.

She flipped to the ER records. There were twenty-five sheets for twenty-five visits going back thirty years, all the visits for the same reasons: “Chronic epileptic with seizure…““Seizure, scalp wound.. “Seizure, lacerated cheek..

.“ Seizure, seizure, seizure. In every case, Dr. Pomeroy had simply released him without further investigation. Nowhere did she find a record of any diagnostic workup.

Pomeroy may have been beloved by his patients, but in this case, he had clearly been negligent.

She stepped into the exam room.

Warren Emerson was lying on his back on the treatment table. Surrounded by all that gleaming equipment, his clothes seemed even more frayed, more shabby. A large patch of his hair had been shaved, and the newly sutured scalp laceration was now dressed with gauze. He heard Claire enter the room and slowly turned to look at her. He seemed to recognize her; a faint smile formed on his lips.

“Mr. Emerson,” she said. “I’m Dr. Effiot.”

“You were there.”

“Yes, when you had the seizure.”

“I wanted to thank you.”

“For what?”

“I don’t like waking up alone. I don’t like it when…“ He fell silent and stared at the ceiling. “Can I go home now?”

“That’s what we have to talk about. Since Dr. Pomeroy died, no one’s been following you. Would you like me to be your doctor?”

“Don’t much need a doctor anymore. Nothing anyone can do for me.”

Smiling, she squeezed his shoulder. He seemed buried, mummified beneath all those musty layers of clothes. “I think I can help you. The first thing we have to do is get your seizures controlled. How often do you have them?”

“I don’t know. Sometimes I wake up on the floor, and I figure that’s what happened.”

“There’s no one else at home? You live alone?”

“Yes, ma’am.” He gave her a sad wisp of a smile. “I mean, except for my cat, Mona.”

“How often do you think you’ve had seizures?”

He hesitated. “A few times a month.”