13.
EN ROUTE TO BOULDER MEMORIAL HOSPITAL, BOULDER, COLORADO
TUESDAY, APRIL 23, 2013, 12:55 P.M.
As the ambulance bumped its way down toward Boulder proper, Pia continued to try to communicate with the runner. While Pia distracted the man, the EMT riding with them in the back of the ambulance used the opportunity to take a blood-pressure reading, pulse, and body temperature.
“Do you work at Nano?” she asked the patient. She pointed to the logo on the man’s sweatshirt. “I work at Nano,” she continued, placing her hand flat on her chest. Unfortunately the charade got no verbal response whatsoever.
“Holy smokes,” the EMT said, looking down, raising his eyebrows in surprise at the gauge on the ear thermometer. “His temperature is almost a hundred five.” As if he didn’t believe the thermometer, he put his hand on the man’s forehead. “It must be right. He’s hotter than hell!”
“What about his blood pressure and pulse?” Pia asked. From feeling his skin earlier, she had assumed the man’s temperature was elevated.
“They are entirely normal,” the EMT technician said.
“What about heat stroke?” Pia said. “Maybe we should try to cool him down.”
The EMT communicated the vital signs to the driver, who in turn contacted the ER physicians. The EMT in the back got an ice pack and offered it to the runner. The man looked at it questioningly. The EMT put it on his own head as a demonstration, then handed it over. The runner held it to his head and seemed to appreciate it.
“I don’t get it,” Pia said to the EMT. “He must work at Nano like I do, but his English is nonexistent. “By the way, my name is Pia.”
“Mine is David. Bill is driving. Nice to meet you.”
“How long before we reach the hospital?”
“Ten minutes or so,” said David, and he confirmed it with Bill.
Pia undid the Velcro and took her phone from her arm. She made a call. As it went through she had to brace herself against the wall because of the lurching and swaying of the ambulance. The siren was not being used since there was no traffic and the patient appeared to be remarkably stable.
“Mariel. It’s Pia. I’m calling from my cell phone. I was on my run, and I came across a man dressed in Nano running gear collapsed on the road.”
“A man? Who is he? Is he conscious? Where is he now?” Mariel sounded surprisingly anxious.
“I don’t know his name. He’s conscious, but he doesn’t speak any English. He has no identification with him. We’re in an ambulance on the way to the hospital.”
There was silence on the other end of the phone. Pia checked the screen to see if they were still connected. It seemed they were, since there was a good signal.
“Mariel, are you still there?”
“Pia, listen to me, this is very important. Where are you going?”
“Hold on, Mariel. David, where are we going?”
“Boulder Memorial in Aurora,” said David.
“Boulder Mem—”
“Right, I heard. Boulder Memorial. What’s the man’s status right now? Is he conscious?”
“He’s conscious but confused and paranoid. The problem is, as I said, he doesn’t speak a word of English.”
“Okay! Here’s the plan: I’ll meet you at the hospital. I’ll try to be right behind you. Listen. Pia, don’t let the ER staff touch this man. They’re not qualified. I repeat, no one is to try to examine him, do you understand?”
“I heard you, Mariel, but, no, I don’t understand. When I came upon him he’d been in cardiac arrest for God knows how long. He wasn’t breathing with no pulse. He’s breathing now, but they’re going to have to examine him. It would be malpractice not to do so. What exactly do you want me to say?”
Mariel didn’t answer Pia’s question, so Pia again pulled her phone away from her ear and looked at the screen. The connection had been broken. Not sure why the call had been terminated, Pia tried to call back, but it went directly to voice mail. Mariel had apparently ended the call abruptly.
Pia strapped her phone back on her arm. Did Mariel really say that the man shouldn’t be examined? Pia looked at the runner, who was still acting fearful. While Pia had been on the phone with Mariel, David had tried to run an EKG, but the man had pulled off the EKG leads. The man wouldn’t even let David take off his sweatshirt or start an intravenous line. On the positive side, at least he wasn’t trying to get off the gurney or loosen the buckle across his abdomen.
David sat back down on the chair next to the man. For the moment he was content to complete the ride to the ER without trying to do anything else, as the man wasn’t in any obvious medical distress, other than his extreme anxiety. The ice pack must have felt good to him because at least that was still on his head.
The man’s agitation increased when the ambulance arrived at the hospital and backed up to the unloading bay. He began babbling to himself and looked around continually, as if he were a caged wild animal. The man barely allowed himself to be wheeled into the ER, where he was sequestered in a room separated from the main emergency area because his high fever suggested he might be infectious. But at that point the man had had enough, and he started to undo the buckle restraining him. When he was prevented from doing this, he let loose a rapid flow of angry Chinese. He wouldn’t let any of the nurses near him. It wasn’t until Pia stepped up to him from the periphery, where she had been standing, that the man calmed down a degree.
One of the nurses took pity on a shivering Pia and gave her a white coat to cover up her jogging outfit. The ER was air-conditioned to a temperature well below seventy degrees. The nurse also told Pia that a request for a Mandarin interpreter had been placed, but unfortunately the only one available was off duty and wouldn’t be arriving for perhaps an hour.
Pia was standing next to the man’s bed, keeping him relatively calm, when the head ER doctor on the shift entered. One of the nurses told Pia that he had been called in because of his standing order that he be notified whenever anything out of the ordinary occurred. In this case it was the communication problem. He had been briefed by the EMTs even before they made it to the hospital.
Pia did a double take. From her medical school experience back at Columbia in New York, she was accustomed to seeing harried ER doctors looking like something the cat dragged in. In her experience they were always beset with dark circles under their eyes, always dressed in soiled scrubs that looked as if they had been slept in, always sporting one or two days’ growth of a beard if they were male, and always with hair in a state suggesting they had just arrived in an open convertible if they were female. In the few minutes she’d been at the busy Boulder Memorial ER, Pia had already seen several doctors scurrying around who met this description.
This man was the absolute opposite. He was in his thirties, tall and trim and well proportioned, looking like the athlete she was later to learn he was. His grooming was impeccable, and he was tanned from outdoor mountain sports. Under his whiter-than-white doctor’s coat, he wore a clean, starched white shirt with a handsome silk tie done in a perfectly symmetrical knot. He wore cuff links that could be seen peeking out from his jacket’s sleeves. His stylish glasses gave him an intellectual air. His voice was calm and assured and projected confidence. He was in charge, and Pia was impressed. There weren’t many men whom Pia found attractive, but he was one of them.
“What do we have here? A bit of a conundrum, I hear. A patient who seemed to be dead and now can’t wait to get out of our ER.” His eyes scanned the ER chart, which was essentially blank. He turned to Pia. “I’m Dr. Paul Caldwell. You found him, I understand.”
“Yes, my name is Pia.”
“And you’re a physician, I’ve been told.”
“Sorta,” Pia said, not wanting to misrepresent herself. “I graduated from Columbia Medical School, but I put off my res
idency to do research.”
“Okay,” said Paul. “Tell me about the patient.”
“I found him while out jogging. Apparently he was running as well when he collapsed. When I came upon him, he wasn’t breathing, and I couldn’t feel a pulse. Not knowing how long he had been in that state, I did CPR. The only things I noticed were that his skin was very warm to the touch, and it looked like he had some urticaria on his forearms. After a few minutes of CPR he came to, and it was an extraordinarily rapid recovery. One minute he was unconscious and the next he was wide awake. He has been agitated ever since.”
“So there’s no history whatsoever?”
“None. He doesn’t speak English, and my Mandarin, which is what I think he is speaking, is nonexistent.”
Paul smiled. He found Pia intriguing, especially because she was one of the most exotically beautiful women he had ever seen. He tried to guess her genealogy but couldn’t. His best guess was a North African and French mixture.
“Columbia University. Interesting. I’m an East Coast transplant myself. I went to Harvard but came out here to the University of Colorado for my residency. I even did a rotation here at Boulder Memorial. So what do you think is going on here with our patient, Miss . . . Ms. . . . Mrs. . . . ?”
“Pia Grazdani,” Pia said, not willing to rise to the obvious bait. “Beats me what’s wrong with him, but I’m telling you, as far as I was able to see, he was in full cardiopulmonary arrest when I found him. I thought about heat stroke because he felt so hot, with no perspiration. There was also a question of a seizure. I also thought of septic shock. But none of those goes along with the other thing I noticed: he had hives on his forearms, so maybe it was an allergic reaction of some sort.”
“Well, the best part is he seems to be doing quite well,” Paul said. “Let’s just run some tests on this fellow if we can.”
Paul then tried to talk to the man, but he stayed silent, glaring at Paul as if to dare him to come closer. Paul took an ear thermometer out of his pocket and found a cover for the probe. The only positive finding on the nascent chart was the elevated temperature.
“I just want to . . . wow, easy there, friend!” As Paul had lent over the man to take his temperature, the man angrily swatted Caldwell’s hand away.
“Let me try,” said Pia. She took the thermometer from Paul, showed it to the man, and put it in her own ear. She then let the man look at the display. After switching out the probe cover, all the time smiling at the man, she took his temperature. She was surprised. Just like her own temperature, the man’s had fallen to normal: 98.7 degrees.
“That’s incredible,” Pia said. His temperature had been 105. Such a precipitous drop called into question the veracity of the initial reading.
“Can you do a quick basic neurological exam?” Paul asked. He was as surprised as Pia about the apparent sudden dramatic fall in the victim’s core body temperature.
“I can try,” Pia said, not too sure of herself. She took the flashlight he offered and shone it in each of the runner’s eyes. The pupils constricted equally. She proceeded with a neurological exam, and although it was difficult to perform many of the basic tests because of the lack of communication, it seemed to Pia that his general brain function was normal. She was able to get the man to touch her finger with his finger and then touch his nose while Pia moved her finger into various locations. That tested cerebellar function. Whether he was oriented to time, place, and person was just a guess, but he seemed to be.
“I’m impressed with your technique,” Paul said with a smile. He was enjoying Pia’s company as well as her help with the difficult patient. He was surprised she was doing as well as she was without any residency experience. “I think you have demonstrated that there doesn’t seem to be any apparent neurological deficit. What about trying to get an EKG?”
With the runner far calmer than he had been since he’d awakened, Pia was able to attach the leads, and the patient left them in place. Paul turned on the machine, and it kicked out an entirely normal EKG.
“This is amazing,” Paul admitted. He studied the printout more closely. “Are you sure he was in total cardiac arrest when you came upon him? I don’t see any abnormalities.”
Pia shrugged. “I was reasonably sure he had no pulse, and he wasn’t breathing. So I’d have to say yes.”
“And you say you saw some hives on his arms?”
“I did.” She pointed to the man’s forearms.
“I don’t see any now,” Paul remarked, and Pia agreed. Whatever it was, it was now gone.
Paul motioned for the runner to take off his sweatshirt, but the man vociferously refused, shaking his head in the process.
“Okay,” Paul said. He wasn’t going to force the issue, at least not yet. He wanted, at a minimum, to listen to the man’s chest, but he decided to wait until the man was more amenable. “We need to take some blood,” said Paul. “Maybe I should do that.”
Pia glanced at him. The patient had not let Paul do anything. Why did he think he could draw blood, a far more invasive activity than taking a temperature or attaching EKG leads? “Maybe I should try.”
“But you’re not insured,” Paul said.
Pia looked at him questioningly. Paul’s comment seemed like such a non sequitur.
Paul laughed at Pia’s expression of confusion. “I’m just teasing. Obviously the guy’s not going to let me near him. For sure you’ll have to do it.”
Pia smiled. It seemed that Paul had a sense of humor, too. “I’ll give it a try, but I’m not very experienced. Although he does seem to trust me.”
“So I’ve noticed.” Paul handed Pia a needle used to take blood samples along with a vacuum tube. He held two more tubes in his hand. He wanted to do a whole battery of tests.
Pia made a point of showing the needle to the man and made a motion as if taking blood from herself. The man watched her but didn’t respond. Pia went ahead with the process of pushing up the man’s left sleeve. In plain sight were a number of other relatively recent puncture wounds over various veins. Pia looked over at Paul standing on the opposite side of the patient. “Do you see these?” she questioned, trying not to be too obvious about what she was referring to. The thought went through her mind that the man was probably a drug addict.
“I do indeed,” Paul said. He didn’t elaborate.
Pia applied the tourniquet and went ahead with the venipuncture. The man flinched but otherwise didn’t complain, as if he were accustomed to the process.
After filling the first vacuum tube, Pia pulled it out and pocketed it so she could take the next two from Paul. She was pleased with herself as the process was going smoothly. Of course it helped that the man was thin, with good veins that stood out like fat cigars.
“Good job,” Paul said as Pia slipped off the tourniquet and then withdrew the needle. She handed off the filled tubes and the blood-drawing paraphernalia to one of the male nurses standing by. They had remained in the room in case they were needed. It had quickly gotten around the ER that the patient might be a physical challenge.
Taking out his stethoscope, Paul was about to go back to trying to listen to the patient’s chest. He motioned to the man that he was going to pull up the man’s sweatshirt, but before the man could respond, the sounds of doors crashing open and raised voices could be heard just beyond their curtained-off area.
“What the . . . ?” Paul questioned. He pulled the stethoscope from his ears and reached out to pull back the curtain, but it was flung back sharply. The runner yelled in fear and grabbed Pia’s arm as two uniformed men stormed in and positioned themselves on either side of the bed. Pia could see that the men were carrying side arms. She recognized the uniforms. They were Nano security people.
“This him?” one of them called out to someone who had yet to arrive.
“Yes, it is,” a familiar vo
ice said.
Pia turned and saw Mariel Spallek come through the parted curtain. Behind her appeared two Chinese men in suits and dark glasses. One of them said something to the runner in Mandarin and the man cowered.
“Who’s in charge here?” Mariel demanded. She didn’t even bother to acknowledge Pia.
“I am,” said Paul. “My name is Dr. Caldwell. What the hell is going on? You can’t come in here like this. This man is a patient.” Paul reached out and pressed a red call button on the wall. A wall speaker crackled to life. “Nurse, we need security in here on the double!” Paul barked.
“Dr. Caldwell,” said Mariel, speaking authoritatively. “We’ve come here to take charge of this patient. Without even examining him, I can assure you he is fine. With whatever minor setback he had, he will be looked after properly. As you can see, he is very keen to leave.”
The runner had immediately heaved his legs over the side of the bed and was talking to the Chinese suit who’d addressed him, but in a way that suggested he was acknowledging a superior. The patient was still visibly agitated, but at the same time he seemed relieved to see people he apparently knew.
“Mariel,” said Pia. “What’s going on? This man works at Nano? Be that as it may, I don’t think he should leave here. He needs to be observed at the very least. We believe he had a cardiac arrest, Mariel, why are Nano security people here? And why are they armed?”
Mariel studiously ignored Pia. The Chinese man who hadn’t been talking to the runner reached out and snatched the two tubes of blood from the nurse’s hand before the nurse knew what was happening. The nurse stepped forward with the intent to grab them back, but Paul restrained him.