Robin Cook - Fatal Cure

Angela looked as though she might burst into tears, but instead she lashed out. "I can't believe you let Nikki go in and visit her like you did," she said.

Stunned at the sharp rebuke, David came back. "At least I came home at lunch yesterday to be sure Nikki got her antibiotic." That said, he did feel guilty for having let Nikki spend time with Caroline.

David and Angela eyed each other, struggling with their irritation and fear.

"I'm sorry," Angela said finally. "I forgot about our truce. I'm just so worried."

"Dr. Pilsner wants to see Nikki in the ER right away," David said. "I think we better go."

They bundled Nikki up and went out to the car. David and Angela meticulously refrained from saying anything to provoke the other. They knew the other's weaknesses and vulnerabilities too well. Nikki didn't say anything either; she coughed most of the way.

Dr. Pilsner was waiting for them and immediately took Nikki into one of the examining stalls. David and Angela stood to the side while Dr. Pilsner examined Nikki. When he was finished he drew them aside.

"I want her in the hospital immediately," he said.

"Do you think she has pneumonia?" David asked.

"I'm not sure," Dr. Pilsner said. "But it's possible. I don't want to take any chances after what happened…" He didn't finish his sentence.

"I'll stay here with Nikki," Angela said to David. "You go do your rounds."

"All right," David said. "Page me if there's any problem." David was still feeling poorly himself; this latest development with Nikki only made him feel worse. He kissed his daughter goodbye, promising that he'd be by to see her all through the day. Nikki nodded. She'd been through this routine before.

David got several aspirins from an ER nurse, then headed upstairs.

"How is Mrs. Hascher?" David asked Janet Colburn as soon as he saw her. He sat down at the desk and pulled his patients' charts.

"Nothing much said at report," Janet said. "I don't think any of us have been in there yet this morning. We've been concentrating on getting the seven-thirty surgical cases down to the operating room."

David opened Sandra's chart hesitantly. First he looked at the temperature chart. There had been no spikes of fever. The last temperature taken was just over one hundred. Turning to the nurses' notes he read that Sandra had been sleeping each time a nurse had gone into her room.

David breathed a sigh of relief. So far so good. When he was finished with the charts he began seeing the patients. All were doing well except for Sandra.

When David entered her room he found her still asleep. Moving to the bedside, he glanced at the swelling on her jaw. It appeared unchanged. He gave her shoulder a gentle shake, calling her name softly. When she didn't respond, he shook her more vigorously and said her name more loudly.

Finally she stirred, lifting a trembling hand to her face. She could barely open her eyes. David shook her yet again. Her eyes opened a bit wider and she tried to speak, but all that came out was disconnected jabber. She was clearly disoriented.

Trying to remain calm, David drew some blood and sent it off for some stat lab work. Then he devoted himself to a careful examination, concentrating particularly on Sandra's lungs and the nervous system.

When David returned to the nurses' station a short time later he was handed Sandra's stat laboratory values. They were all normal, including the blood count. The white cells, which had been elevated from her abscessed tooth, had fallen with the antibiotics and were still low, ruling out infection as an explanation for her current clinical state. That said, the sound of her lungs suggested incipient pneumonia. David wondered again about a possible failure of her immune response.

Once again David was presented with the same trio of symptoms affecting the central nervous system, the GI system, and the blood or immune system. He was seeing a complex, but he had no idea what the underlying factor could be.

David agonized over what to do next. The life of a thirty-four-year-old woman hung in the balance. He was afraid to call any consults, partly because of Kelley and partly because the consults had not provided any help in the three similar cases. And calling in consults for Eakins had resulted in David's removal from the case. David was even reluctant to order further diagnostic or laboratory tests since nothing had proved to be of any value with the other patients. He was at a loss.

"We have a seizure in room 216," one of the nurses shouted from down the hall. David went running. Room 216 was Sandra's room.

Sandra was in the throes of a full-blown grand mal seizure. Her body was arched back as her limbs contracted rhythmically with such force that the whole bed was bouncing off the floor. David barked orders for a tranquilizer. In an instant it was slapped into his hand. He injected it into Sandra's IV. Within minutes the convulsions stopped, leaving Sandra's body spent and comatose.

David stared down at his patient's now peaceful face. He felt as if he was being mocked for his intellectual impotence. While he had been indecisively sitting at the desk puzzling over what to do, the seizure had taken over Sandra's body in a dramatic gesture.

David erupted in a whirlwind of activity. Anger replaced despair as he pulled out all the diagnostic stops. Once again he ordered everything: consults, lab tests, X rays, even an MRI of the skull. He was determined to figure out what was happening to Sandra Hascher.

Fearing a rapid downhill course, David also made immediate arrangements to transfer Sandra to the ICU. He wanted continuous monitoring of her vital signs. He did not want any more surprises.

The transfer occurred within half an hour. David helped push Sandra down the hall to the ICU. Once she was moved off the gurney, David started for the ICU desk to write new orders, but he stopped short of his goal. In a bed directly across from the central desk was Nikki.

David was stunned. He'd never expected to see Nikki in the ICU. Her presence there terrified him. What could it mean?

David felt a hand on his shoulder. He turned to see Dr. Pilsner. "I can see you're upset about your daughter being in here," he said. "Calm down. I just don't want to take any chances. There are some fabulously skilled nurses in here who are accustomed to taking care of patients with respiratory problems."

"Are you sure it's necessary?" David asked nervously. He knew how tough the ICU environment was on a patient's psyche.

"It's for her benefit," Dr. Pilsner said. "It's purely precautionary. I'll be moving her out of here just as soon as I can."

"Okay," David said. But he was still anxious about this latest turn of events.

Before writing the new orders on Sandra, David went over to talk with Nikki. She was far less concerned about the ICU than David was. David was relieved to see her taking it so well.

Returning his attention to Sandra Hascher, David sat down at the ICU desk and began writing her orders. He was nearly through when the unit clerk tapped his arm.

"There's a Mr. Kelley out in the patient lounge to see you," he said.

David felt his stomach tighten. He knew why Kelley was there, but he wasn't eager to see him and didn't go immediately. He finished writing the orders first and gave them to the head nurse. Only then did he go out to meet Kelley.

"I'm disappointed," Kelley said as David approached. "The utilization coordinator called me a few minutes ago…"

"Just a minute!" David snapped, cutting off Kelley. "I've got a sick patient in the ICU and I don't have time to waste with you. So for now stay out of my way. I'll talk to you later. Understand?"

For a second David glared up into Kelley's face. Then he spun around and started out of the room.