Royal Pains : Sick Rich (9781101559536) (13 page)

“Felicia?” I said as we crossed the yard toward her.

She turned, glanced over her shoulder, and then stood. “That didn't take long. I thought I'd get at least half of these in the ground before you got here.”

Her yard was small but immaculately cared for. Thick, healthy-looking shrubs lined the edge and a pair of shade trees anchored each rear corner. Flowers lined the walkway that led from the back porch to a small circular patio toward the rear of the property, where an umbrella-shaded table and chairs sat.

“It's magnificent,” Divya said. “You obviously have a green thumb.”

“Got it from my mother. She could grow anything.”

“I used to garden,” Divya said. “When I was a young girl.”

“Really?”

“Nothing like this, but I did like playing in the dirt and loved the fact that you could plant seeds and flowers would appear. I thought it was magic.”

Felicia laughed. “In a way it is.” She rubbed her hands together and then swatted dirt from the knees of her pants. She looked around her yard. “It's also what I do for therapy.” She smiled. “Helps preserve my sanity. And it's cheaper than a psychiatrist.”

“Playing in the dirt will do that,” I said.

“Would either of you care for some lemonade? I made some fresh about an hour ago and it's nice and cold.”

“That's not necessary.”

“I'm getting some for myself, so it's no problem.”

Felecia invited us to sit at the patio table while she washed her hands and face. Divya and I settled beneath the umbrella. I opened my briefcase, pulled out the reports that had been faxed over from the hospital, and spread them on the table. Felicia returned, freshly scrubbed and carrying three glasses of lemonade.

She flopped in the chair across from us. “So what did you find out?”

I turned the MRI image of her brain toward her so she could see.

“Is that my brain?”

“Part of it.”

“This is unbelievable. It's so clear.”

People who have never seen an MRI image are always shocked at the clarity and the minute details exposed by the image. It actually shows more than if you had the organ in your hand. The separation of the various tissues, nerves, and blood vessels is astounding. I remember the first time I saw one. Back in medical school. The difference between those images and the typical X-ray images that I had been used to dealing with was amazing.

“Medical progress,” I said. “The MRI has given us a view of the body like we never thought possible.”

“It looks very
Star Trek
to me.”

“In some ways it is,” Divya said.

“Okay, so we know I have a brain,” Felicia said. “I assume there's something wrong with it or you wouldn't have come over here to show me the pictures. Right?”

“You might not be able to see this,” I said as I used my ballpoint pen to indicate an area on the image, “but right here there is some swelling.”

She studied the image. “If you say so. All I see is something that looks like cauliflower.”

I laughed. “That cauliflower is your brain, and right here, this small area, is the origin of the glossopharyngeal nerve. It's one of the twelve cranial nerves. These are the nerves that come from the base of the brain and do things like allowing you to see, hear, smell, and move your facial muscles so you can smile and talk. One of these cranial nerves also controls your heartbeat and blood pressure.”

“So what happens when they get swollen?”

“This one, the glossopharyngeal, supplies the throat, ear, and tongue as well as other areas. It helps you speak and swallow and control your tongue, and it also carries sensations from these areas back to the brain. When it becomes swollen or inflamed, as we see here on your MRI, it can cause the deep, aggravating pain you've been having.”

“Is that why I get it sometimes when I'm eating or talking on the phone?”

“Exactly. This nerve is involved in both of those activities, so when you eat or talk and the nerve is inflamed, pain can be the result.”

“That makes sense.” She took a swallow of lemonade. “Does this mean I have to stop eating and talking?”

“I don't think that'll be necessary,” I said.

“Good. I like to do both.”

“The other thing is that this nerve is also involved in the functioning of the heart, particularly the rhythm. Sometimes when people have these discomforts the heartbeat slows down. Sometimes dramatically. Sometimes enough to cause dizziness and even loss of consciousness.”

“That's why I've been having these dizzy spells?”

“I suspect so. We call this condition glossopharyngeal neuralgia.” I smiled. “We have big words for everything, but basically it's a pain in the neck.”

Felicia laughed. “You can say that again.” She took another sip of her lemonade. “So what do we do about it?”

“Your Holter monitor showed that at times your heart slows down, but not severely so. You had no episodes of long pauses in the rhythm. That means that the likelihood you might actually faint is small.”

“That's a relief. A couple of times I thought I might.”

“It also means you don't need a pacemaker.”

She parked a wayward strand of hair behind her ear. “Pacemaker?”

“That's right,” Divya said. “Some people with this have such dramatic changes in their cardiac rhythm that they need the protection of a pacemaker.”

“Fortunately, you don't,” I said. “We'll start you on medication to help relieve the swelling and discomfort. It's a medicine called gabapentin that's typically used for seizures. It seems to work fairly well in this situation.”

“Will that relieve this pain?” She rubbed the side of her neck.

“Are you having discomfort now?” Divya asked.

“I don't know. Maybe. Probably my imagination. Sometimes it feels like it's coming on, but then it doesn't. Other times it sort of zaps me. All of a sudden.”

“Let's get the medication started,” I said. “In a couple weeks we'll see how you're doing.”

Chapter 16

The First Annual Hamptons Health and Fitness Fair opened at eight o'clock sharp with a bit of fanfare. The mayor showed up, as did the chief of police, members of the city council, and Principal Jerry Hyatt. Jill used the microphone and a small amplifier to welcome the crowd of more than two hundred that had gathered just outside the chain-link gate. She then handed the ceremonial scissors to the mayor and he cut through the bright yellow ribbon. The gates swung open. The fair had officially begun

Evan, Divya, and I watched from near the goalposts of the football field and moved out of the way as the crowd surged forward. Most were kids who danced and ran and pleaded with their parents to keep up. The bulk of the rowdy kids headed for the infield, where the obstacle course and other sports venues had been set up. Others flared to the left and right and began visiting the booths that lined either side of the field.

We retreated to the HankMed booth, where fresh coffee awaited. Evan had stopped by Bagel Shack for bagel sandwiches, what appeared to be a half-gallon carton of coffee, and a stack of cups. He grabbed some coffee and immediately headed out to schmooze. Divya began rearranging our supplies.

“Aren't you finished yet?” I asked.

“Finished with what?” she said over her shoulder as she rummaged in one of the two boxes of supplies I had carried from the van.

“Reorganizing everything. You went through all that three times yesterday.”

She turned and scowled at me, a pack of four-by-four gauze in her hand. “There's not as much room in here as it looks. I'm simply trying to make things accessible but out of the way.” She tossed the gauze to me. “You can help if you want.”

I placed the gauze on the edge of the desk. “I thought I was helping by staying out of the way.”

She nodded. “Good idea.”

I poured a cup of coffee and sat behind the desk. Nothing to do except wait for our first visitor. I suspected it would take a while for all the athletic events to get going, and after that we'd begin seeing bumps, bruises, scrapes, and strains. Turned out it didn't take that long.

A young mother showed up with her five-year-old son who had fallen headlong while racing through the gate and bumped his head. A small bruise and abrasion and of course tears resulted, but it took only a few minutes to clean it up and put a bandage on it. By the time I finished, the bump was forgotten and the boy wanted to get on with the day. His mother thanked us as she was being yanked out of the booth.

Jill stopped by.

“Looks like a good start,” I said.

She gazed out toward the field, where the crowds continued to grow. “Better than I thought. Last night I lay there staring at the ceiling thinking that absolutely no one would show up.”

“You should've called me. I would've shown up.”

“Right. I'm sure you would have.”

“I mean, after all, you were already staring at the ceiling.”

She gave me a playful punch. “Sometimes you're a pig, you know that?”

“Just trying to be helpful. Cure your insomnia.”

“Make yourself useful. Pour me some coffee.”

I did and handed it to her. She took a sip.

“Evan brought your favorite bagel sandwiches, too.” I nodded toward the bag sitting on one of the exam tables.

“Sometimes I just love him.” She opened the bag and took out a wrapped sandwich.

“And the other times?” Divya asked.

“I tolerate him.”

“Don't we all?”

Jill unwrapped the sandwich and took a bite. “Mmm. Right now I love him.”

“Maybe I'll have one, too,” I said.

Jill tossed one my way.

After a few bites, Jill rewrapped the remainder of her bagel and dropped it into her purse. “I'm out of here. Need to go make the rounds and make sure everything is running smoothly.”

As soon as Jill left, Evan showed up. Not alone. He had two women in tow. One looked concerned; the other clutched a hand to her chest.

“Dude,” Evan said, “you need to see Debbie.”

I looked at the woman in pain, who I assumed was Debbie, and asked, “What's the matter?”

She took a breath and winced. “I don't know. I just got this sharp pain. Right here.” She pressed her fingers against her chest just to the right of her sternum. “It just happened all of a sudden.”

Before I could ask any more questions, Evan launched into who the women were and how he knew them. As if that was relevant. I raised a hand to slow him down, but he ignored me and pressed on. I gave up and waited him out.

I learned that the one with chest pain was Debbie Feiner and her friend was Patricia Masters. They owned a candle, lotion, and potpourri shop in Southampton called Serendipity Scents. Apparently Evan knew them and had convinced them to buy a booth for the health fair. Their booth was just down the row.

With Evan's dissertation out of the way, I directed Debbie to sit on one of the exam tables and adjusted a privacy screen around it while Divya checked her blood pressure. It was normal. I listened to her lungs. Clear. Heart, too. As I pressed my fingers against her chest, attempting to see if I could reproduce the pain, I detected the telltale signs of subcutaneous emphysema. Nothing else feels like that. It's a crunchy sensation, as if someone had injected glass beads or Rice Krispies just beneath the skin. It's actually trapped air bubbles.

“When did this happen?” I asked.

“Just a few minutes ago. We were blowing up some balloons to decorate our booth and I got this sudden pain.”

“So it happened while you were blowing up a balloon?”

She nodded. “Exactly.” She took another breath and winced again. “What is it?”

“Let's get an X-ray and then we'll know for sure.”

Divya and I rolled our portable unit out of the van and set it up in the middle booth. Having the van here was already proving to be a good idea and our day had just begun.

Debbie's X-ray showed exactly what I expected.

In order for air to leak into the subcutaneous area, there must be a breach in the pulmonary system. It's often seen in people with chronic lung disease, particularly emphysema, where a bleb, basically a blister in the lung, ruptures and the air leaks. This can gather beneath the skin and create subcutaneous emphysema. It's also seen in asthmatics and in some situations that produce what we call barotrauma—lung damage due to pressure. Scuba divers can suffer this. Coughing and sneezing can sometimes make it happen. And blowing up balloons, which causes the pressure inside the chest to increase dramatically, can definitely do it.

The images I had transferred to my laptop revealed that Debbie had a pneumomediastinum. That's a big word for the collection of air in the mediastinum, the area between the lungs where the heart sits. I explained this to her.

“That sounds bad,” Evan said.

I gave him a look. One that said he wasn't helping the situation.

“Well, it does,” he said.

“So what do we do about it?” Debbie asked. “An operation or something?”

I smiled. “No, you don't need an operation. Both of your lungs are inflated and working fine. This is simply a minor air leak caused by you blowing up the balloons. It'll go away. Might take a few days, but your body will ultimately absorb and remove all the air.”

“I guess I should avoid the balloons?”

“Absolutely. For a few weeks anyway. And try not to sneeze.”

“Oh, my God, I can't even imagine what that would feel like.”

“A little uncomfortable. Sort of like a knife.”

She sighed, which caused her to wince again. She brought her hand to her chest. “I guess I shouldn't do that either.”

“You're going to be uncomfortable for a few days. I'll give you a prescription for pain meds that'll help some.”

“Do I have to go home? Or stay in bed? Anything like that?”

“Not at all. In fact, it's probably better that you stay here at the fair so I can keep an eye on you.”

She nodded. “Thank goodness. I'd hate to dump all this on Patricia right here when the weekend is just beginning.”

“Don't worry,” Patricia said. “I can handle it.”

“I know. I'd just hate for that to happen.”

I interrupted. “Well, that's a moot point. You can stay and work the booth—just no more balloons.”

Debbie stood. “No problem there.”

“Either Divya or I will stop by and see you in a while, but in the meantime if anything changes get back here.”

“Will do.”

“I'll run and pick up your prescription,” Patricia said.

“I'll do it,” Debbie said.

“No. You rest at the booth. It'll only take me a few minutes.”

Debbie nodded and then looked at me. “Thanks for everything.”

“Glad we could help,” I said.

“I'll walk you guys back to your booth,” Evan said.

My brother the gentleman.