Miracles in the ER (10 page)

On Holy Ground

Right upper-quadrant pain—weight loss—nausea—anemia.

John Richmond was lying on the stretcher looking up at me, his eyes asking for an answer, something he could deal with. I didn’t have one yet, but my gut told me that when I did, it wasn’t going to be anything good.

He was sixty-six years old, a retired banker, and had always been in good health. The abdominal pain had started a few weeks earlier, but it would come and go, and he put off getting it checked out. This morning he had nearly blacked out when he got up from his kitchen chair, and that was enough for his wife, Ellen. She had insisted on his coming to the ER, and here he was.

“We need to check on some more lab work, and I’m going to get an ultrasound of your gall bladder. It might be something as simple as that.” I picked up his chart and headed for the curtained entrance of room 4.

“Would that explain his anemia and almost passing out at home?” Ellen’s brow furrowed and her eyes narrowed, locking on mine. She must sense something bad was going on here.

I turned and held the clipboard to my chest. “Not necessarily, but let’s start there. We need to find out what’s causing all of this, and I’m not going to let your husband go home until we do.”

Her face softened and she smiled and nodded at her husband. I glanced down. Her hand still gripped the stretcher rail, her knuckles white and tense.

There were some troubling findings on the ultrasound, and the radiologist recommended a CT scan. That, along with the rest of his labs, confirmed the diagnosis and my worst fears. John Richmond had a large tumor in his colon and multiple metastases in his liver. There was not going to be an easy answer.

The Richmonds’ son Matthew had joined them in room 4, and I shook his hand before pulling up a stool and sitting down.

“John, Ellen—we need to talk about what we’ve found.”

His surgeon was able to remove the cancer in his colon. But the tumors in his liver didn’t respond to chemotherapy and continued to grow. Within a few months he was jaundiced, his skin turning a deep yellow because of the inability of his liver to function properly. And the pain was getting worse. That was what usually brought him to the ER—and episodes of severe and uncontrollable vomiting.

“We’ll get you something for the nausea in just a minute, Mr. Richmond, and something for the pain,” I overheard one of my partners, Jay Barton, tell him. He was taking care of John Richmond this morning.

A few minutes later, Jay came out of room 5, pulled the curtain behind him, and walked over to the nurses’ station.

“How’s he doing?” I looked up from the chart in front of me and over to Jay Barton.

“Not good.” Jay shook his head and slid Richmond’s chart across the counter to Amy Connors. “His jaundice is worse, and his blood pressure is low. No fever—that’s at least one good thing. But I can’t imagine he can go on much longer like this.”

“Hmm. Is his wife in there with him?”

“No, it’s his daughter—Rebecca, I think. I wanted to ask him about a living will, advanced directives, that sort of thing. But I felt awkward with his daughter there and all. I wonder if he’s thought about that.”

“Got ’em right here.” Amy held up a sheaf of papers. “He filled these out a couple of months ago and gave us a copy. Keep ’em here with his chart all the time.”

She put the forms back with the rest of his record.

“Well, that’s good.” Jay sighed and picked up the chart for his next patient in the ENT room. “Let’s see what we’ve got back there.”

He disappeared down the hallway, and Rebecca stepped out of room 5 and walked over beside me.

“Dr. Lesslie, I’m going out to the waiting room to make some phone calls. Dad would like to speak to you, if you have a moment.”

“Sure, I’ll do that right now.”

She didn’t move, just kept looking at me with reddened eyes. Her mouth opened, but there was only a quiet sigh. She turned and walked out through triage.

“John, your daughter said you wanted to see me.” I pulled the curtain closed and stepped over to his stretcher. He held out his hand—cool, damp, his handshake weak. Just that small amount of effort seemed to tire him.

“Thanks, Dr. Lesslie.” His words were mumbled, whispered, and I leaned closer.

“I want to talk with you about my living will, in case…
when
something happens. I’m worried about my wife and my children. You know what they’ve had to go through, with all the treatments and everything.”

He paused and took some deep breaths.
Worried about his wife and children.
I marveled at the strength of this man. He was dying, yet he was more concerned about his family than himself.

“I’m ready,” he continued. “And I’d like nothing better than to take my last breath at home, in my bed, with my family around me. But I’m not sure…when the time
does
come…if they’ll be able to…” His words drifted away. His eyes never left mine and for a moment we were both silent.

“John, I understand. And if your wife needs to have you brought here, that will be fine. We’ll take care of you. And we’ll take care of her.”

Tears welled in his eyes, his voice just barely a whisper. “Thanks, Doctor. I just worry that Ellen…”

“It’s okay, John. When the time comes, it will be okay.”

Two weeks passed, and the time came. Ellen Richmond called 9-1-1 when John’s breathing became labored and he started weaving in and out of consciousness. Lori Davidson directed the paramedics to the cardiac room, then walked over beside me.

“Denton Roberts said there’s a bunch of people out in the waiting room, and they all want to come back. I’m sure it’s his family.”

I glanced over at the cardiac door and then at Lori.

“His wife handed me his advanced directives—no code—just supportive measures.” She paused and shook her head. “I can’t believe he can live more than an hour or so.”

Lori had spent a lot of years in the ER with a lot of sick and dying patients. She knew what she was talking about.

“Sure. Let them come back.”

She nodded and walked out to the waiting room.

“This is what we need on the man over in 1.” I slid the chart across the counter to Amy. “See if you can get the X-ray done first.”

The door of cardiac opened behind me and I turned to see Lori stepping into the hallway. She left the door cracked, looked over at me, and nodded. I had asked her to let me know when she had Mr. Richmond settled and as comfortable as we could make him.

She walked behind the nurses’ station and slumped into a chair beside Amy.

The door creaked faintly as I pulled it closed behind me and stepped into the room. No one looked up.

They were all there. Ellen stood at the head of the stretcher, one hand on John’s chest. Around the bed were his children—Matthew, Rebecca, and another son, Luke. With them were their spouses, and they all held hands.

If anyone was sobbing, I didn’t hear it. Their heads were bowed, and the only sound in the room was the quiet, irregular breathing of John Richmond.

It was his son Matthew who began to pray, his words measured, peaceful—words of hope and faith and love. And words of thanksgiving for this man, forever delivered from his pain and suffering. Then there was John’s last breath—a final
amen
.

We were silent. I knew we were standing on holy ground.

To Have and to Hold

Lori Davidson closed the curtain of room 4 and walked over to the nurses’ station.

“What’s the matter?” Amy Connors had twisted around in her chair and was looking up at the nurse. I glanced at her too, and saw the troubled look on her face.

Lori put an index finger to her pursed lips and shook her head. Once she was in the chair beside Amy and had put the chart of room 4 on the counter, she leaned close to the secretary and said, “This woman is in trouble.” She tapped the clipboard quietly and again shook her head.

Amy shifted in her chair, straining to read the information on the chart.

“‘Stephanie Evans, forty-two-year-old female. Headache and chest pain.’ Is she having a heart attack?” Amy looked up at the nurse and reached for her telephone.

“No, she’s not having a heart attack.” Lori’s voice was flat, distant. “She’s not even having any chest pain.”

This was unusual behavior for the nurse. I reached over the counter and she handed me the chart.

Vital signs were fine. No fever or rapid heart rate. I didn’t see any red flags on the info sheet.

Lori quietly stood, caught my eye, and motioned with her head to the medicine room. I followed her across the hall, the clipboard of room 4 still in my hand. She stood near the window, gazing out onto the ER parking lot. When she turned around, there were tears in her eyes.

“Sometimes it all comes back, and I…have a hard time handling it.”

I looked around for some Kleenex, couldn’t find any, and handed her some dressing gauze—and waited.

“You remember my sister, don’t you?” She dabbed at her eyes and sniffed.

“Angie? Sure, I remember her.” Lori had brought her sister to one of our Christmas parties a few years ago. “Does she still live in Charleston?”

“No, she left Charleston last summer and moved in with our parents in Virginia. She and her two children.”

That was odd. She was married, and Lori would have told us had anything happened to her sister’s husband.

“What about—”

“Angie left her husband. Finally.” Her face flushed and she tossed the gauze into a nearby trash can. “Finally.”

I leaned back against the counter and studied her knitted brow and narrowed eyes. This was the angriest I had ever seen her.

“Her husband beat her.” The words burst from her lips. “And she just took it. It went on for months before we knew about it. But she couldn’t hide a fractured cheekbone. When our father found out, I thought he was going to kill him. But it was textbook. Angie blamed herself, said she must have done something to deserve it. Angie of all people! She was a basketball and track star in high school, missed being valedictorian by half a point, and she was homecoming queen. She never had an issue with self-esteem. But when it came to this…I didn’t understand. None of us did.”

She sighed and stared down at the floor, silent.

After a moment, I asked, “What was the breaking point? What made her leave him?”

Lori looked at me, her eyes misting again. “He hurt one of the children—twisted Jake’s arm and almost broke it. Angie was in the car with the kids and on the road before her husband could turn around.”

“And you think…” I held up Stephanie Evans’s chart.

“Her husband is abusing her.” Lori’s words were measured, convicted. “I looked for an opportunity to ask her about it, but she kept deflecting me, changing the subject. You’ll see when you talk with her. You’ll know. You might want to ask her why she’s wearing a turtlenecked sweater in the middle of summer.”

All of the warning signs were there. Stephanie Evans never made eye contact with me. Her complaints were vague and ever-changing. Her answers to my direct questions were evasive, confused. There was no apparent reason for her being in the ER, except that beneath this façade, Stephanie knew she needed help. She just didn’t know how to ask for it.

“How did this happen?” As part of my exam, I was checking her thyroid gland and anterior neck. Lori was right. Why would she be wearing a turtlenecked sweater when it was ninety degrees outside? I had rolled it down and saw the bruises. They were clearly in the shape of fingers encircling her throat and were of different stages of resolution. This had been going on for a while.

“What are you talking about?” Stephanie’s hands flew to her neck and she pulled the sweater up to her chin.

“These bruises look like someone has choked you, Mrs. Evans. Is that how it happened?”

“I…I don’t know what you mean.”

Her eyes darted around the room, and then found mine. Her face softened and her lips parted, trembling. Maybe…

She turned her head and stared at the floor.

“We have a big dog, and she must have…She likes to jump up on people and she…A couple of days ago she—”

“Mrs. Evans, these bruises were made by someone’s fingers.”