A few choice words crossed my mind. How a doctor could send a patient in for a procedure without an explanation was beyond me, and how a patient couldn’t ask wasn’t something I understood, either.
“I’ll take a few X-rays of your abdomen, and then fetch the doctor. I’ll come back, make the table vertical, and you’ll stand and drink that cup of barium,” I said, pointing to the cup behind me on the counter, “a sip at a time, at the doctor’s discretion. He’ll use fluoroscopy to watch the barium travel down your esophagus and into your stomach. Fluoro is basically an X-ray, but instead of a picture, we get a video in real time. When that’s done, we’ll start the small bowel follow through. You’ll drink the rest of the barium, and we’ll take X-rays as it flows through your small bowel.”
Dana eyed the cup. “Does it taste bad? I’ve been vomiting a lot. I can’t keep anything down.”
The requisition page with Christy’s scribbles was lying on the counter next to the empty cups. I picked it up, looking for the answer to my next question. Dana had only been ill for two days. I glanced up at her, noting her appearance.
“Have you been sick like this before?” She shook her head in answer. “Traveled recently?” She shook her head again. “Any history of Crohn’s disease? Anorexia? Bulimia?” I asked.
She held out her arm, palm up. There was a perfect bite mark in the middle of her forearm. Each tooth had broken the skin. Deep, red perforations dotted her arm in mirrored half-moons, but the bruised skin around the bites was still intact.
I met her eyes. “Dog?”
“A drunk,” she said with a weak laugh. “I was at a party Tuesday night. We had just left, and some asshole wandering around outside just grabbed my arm and took a bite. He might have pulled a whole chunk off if my boyfriend hadn’t hit him. Knocked him out long enough for us to find the car and leave. I saw on the news yesterday that he’d attacked other people, too. It was the same night, and the same apartment complex. Had to be him.” She let her arm fall to her side, seeming exhausted. “Joey’s in the waiting room . . . scared to death I have rabies. He just got back from his last tour in Afghanistan. He’s seen everything, but he can’t stand to hear me throw up.” She laughed quietly to herself.
I offered a comforting smile. “Sounds like a keeper. Just hop up on the table there, and lay on your back.”
Dana did as I asked, but needed assistance. Her bony hands were like ice.
“How much weight did you say you’ve lost?” I asked while situating her on the table, sure I had read Christy’s history report wrong on the requisition.
Dana winced from the cold, hard table pressing against her pelvic bone and spine.
“Blanket?” I asked, already pulling the thick, white cotton from the warmer.
“Please.” Dana hummed as I draped the blanket over her. “Thank you so much. I just can’t seem to get warm.”
“Abdominal pain?”
“Yes. A lot.”
“Pounds lost?”
“Almost twenty.”
“Since Tuesday?”
Dana raised her brows. “Believe me, I know. Especially since I was thin to begin with. You . . . don’t think it’s rabies . . . do you?” She tried to laugh off her remark, but I could hear the worry in her voice.
I smiled. “They don’t send you in for an upper GI if they think it’s rabies.”
Dana sighed and looked at the ceiling. “Thank God.”
Once I positioned Dana, centered the X-ray tube, and set my technique, I pressed the button and then took the film to the reader. My eyes were glued to the monitor, curious if she had a bowel obstruction, or if a foreign body was present.
“Whatcha got there, buddy?” David asked, standing behind me.
“Not sure. She’s lost twenty pounds in two days.”
“No way.”
“Way.”
“Poor kid,” he said, genuine sympathy in his voice.
David watched with me as the image illuminated the screen. When Dana’s abdomen film filled the screen, David and I both stared at it in shock.
David touched his fingers to his mouth. “No way.”
I nodded slowly. “Way.”
David shook his head. “I’ve never seen that. I mean, in a textbook, yes, but . . . man. Bad deal.”
The image on the monitor was hypnotizing. I’d never seen someone present with that gas pattern, either. I couldn’t even remember seeing it in a textbook.
“They’ve been talking a lot on the radio this morning about that virus in Germany. They say it’s spreading all over. It looks like war on the television. People panicking in the streets. Scary stuff.”
I frowned. “I heard that when I dropped off the girls this morning.”
“You don’t think the patient has it, do you? They’re not really saying exactly what it is, but that,” he said, gesturing to the monitor, “is impossible.”
“You know as well as I do that we see new stuff all the time.”
David stared at the image for a few seconds more, and then nodded, snapping out of his deep thought. “Hayes is ready when you are.”
I grabbed a lead apron, slid my arms through the armholes, and then fastened the tie behind my back as I walked to the reading room to fetch Dr. Hayes.
As expected, he was sitting in his chair in front of his monitor in the dark, speaking quietly into his dictation mic. I waited patiently just outside the doorway for him to finish, and then he looked up at me.
“Dana Marks, twenty-three years old, presenting with abdominal pain and significant weight loss since Wednesday. Some hair loss. No history of abdominal disease or heart problems, no previous abdominal surgeries, no previous abdominal exams.”
Dr. Hayes pulled up the image I’d just taken, and squinted his eyes for a moment. “How significant?”
“Nineteen pounds.”
He looked only slightly impressed until the image appeared on the screen. He blanched. “Oh my God.”
“I know.”
“Where has she been?”
“She hasn’t traveled recently, if that’s what you mean. She did mention being attacked by a drunk after a party Tuesday night.”
“This is profound. Do you see the ring of gas here?” he asked, pointing to the screen. His eyes brightened with recognition. “Portal venous gas. Look at the biliary tree outline. Remarkable.” Dr. Hayes went from animated to somber in less than a second. “You don’t see this very often, Scarlet. This patient isn’t going to do well.”
I swallowed back my heartbreak for Dana. She either had a severe infection or something else blocking or restricting the veins in her bowel. Her insides were basically dead and withering away. She might have four more days. They would probably attempt to take her to emergency surgery, but would likely just close her back up. “I know.”
“Who’s her doctor?”
“Vance.”
“I’ll call him. Cancel the UGI. She’ll need a CT.”
I nodded and then stood in the hall while Dr. Hayes spoke in a low voice, explaining his findings to Dr. Vance.
“All right. Let’s get to it,” the doctor said, standing from his chair. We both took a moment to separate ourselves from the grim future of the patient. Dr. Hayes followed me down the hall toward the exam room where Dana waited. “The girls doing okay?”
I nodded. “They’re at their dad’s this weekend. They’re going to meet the governor.”
“Oh,” the doctor said, pretending to be impressed. He’d met the governor several times. “My girls are coming home this weekend, too.”
I smiled, glad to hear it. Since Dr. Hayes’s divorce, Miranda and Ashley didn’t come home to visit nearly as much as he would have liked. They were both in college, both in serious relationships, and both mama’s girls. Much to the doctor’s dismay, any free time they had away from boyfriends and studying was usually spent with their mother.
He stopped, took a breath, held the exam-room door open, and then followed me inside. He hadn’t given me time to set up the room before he came back, so I was glad the upper GI was cancelled.
David was shaking the bottles of barium.
“Thanks, David. We won’t be needing those.”
David nodded. Having seen the images before, he already knew why.
I helped Dana to a sitting position, and she stared at both of us, clearly wondering what was going on.
“Dana,” Dr. Hayes began, “you say your problem began early Wednesday morning?”
“Yes,” she said, her voice strained with increasing discomfort.
Dr. Hayes abruptly stopped, and then smiled at Dana, putting his hand on hers. “We’re not going to do the upper GI today. Dr. Vance is going to schedule you a CT instead. We’re going to have you get dressed and go back to the waiting room. They should be calling you before long. Do you have someone with you today?”
“Joey, my boyfriend.”
“Good,” the doctor said, patting her hand.
“Am I going to be okay?” she said, struggling to sit on her bony backside.
Dr. Hayes smiled in the way I imagined him smiling while speaking to his daughters. “We’re going to take good care of you. Don’t worry.”
I helped Dana step to the floor. “Leave your gown on,” I said, quickly grabbing another one and holding it behind her. “Slip this on behind you like a robe.” She slipped her tiny arms through the holes, and then I helped her to the chair beside the cabinet. “Go ahead and put on your shoes. I’ll be right back. Just try to relax.”
“Yep,” Dana said, trying to get comfortable.
I grabbed her requisition off the counter and followed the doctor to the workroom.
As soon as we were out of earshot, Dr. Hayes turned to me. “Try to talk to her some more. See if you can get something else out of her.”
“I can try. All she mentioned out of the ordinary was the bite.”
“You’re sure it wasn’t an animal?”
I shrugged. “She said it was some drunk guy. It looks infected.”
Dr. Hayes looked at Dana’s abnormal gas patterns on the monitor once more. “That’s too bad. She seems like a sweet kid.”
I nodded, somber. David and I traded glances, and then I took a breath, mentally preparing myself to carry such a heavy secret back into that room. Keeping her own death from her felt like a betrayal, even though we’d only just met.
My sneakers made a ripping noise as they pulled away from the floor. “Ready?” I asked with a bright smile.
Chapter Two
Scarlet
BY LUNCH, DANA HAD ALREADY BEEN IN AND OUT OF surgery. Christy told us they only opened her up long enough to see there was nothing they could do, before closing her back up. Now they were waiting for her to awaken so they could tell her she would never get better.
“Her boyfriend is still with her,” Christy said. “Her parents are visiting relatives. They’re not sure they’ll get back in time.”
“Oh, Jesus,” I said, wincing. I couldn’t imagine being away from either of my daughters in a situation like that, wondering if I would make it in time to see her alive one last time. I shook it off. Those of us in the medical field didn’t have the luxury of thinking about our patients’ personal lives. It became too close. Too real.
“Did you hear about that flu?” Christy said. “It’s all over the news.”
I shook my head. “I don’t think it’s a flu.”
“They’re saying it has to do with that scientist over in Europe. They say it’s highly contagious.”
“Who are they? They sound like troublemakers to me.”
Christy smiled and rolled her eyes. “They also said it’s breached our borders. California is reporting cases.”
“Really?”
“That’s what they say,” she said. Her pager buzzed. “Damn, it’s getting busy.” She pushed a button and called upstairs, and then she was gone again.
Within the hour, the hospital was crowded and frantic. The ER was admitting patients at a hectic pace, keeping everyone in radiology busy. David called in another tech so he and I could cover the ER while everyone else attended to outpatients and inpatients.
Whatever it was, the whole town seemed to be going crazy. Car accidents, fights, and a fast-spreading virus had hit at the same time. On my sixth trip to the ER, I passed the radiology waiting room and saw a group of people crowded around the flat-screen television on the wall.
“David?” I said, signaling for him to join me in front of the waiting room. He looked in through the wall of glass, noting the only seated person was a man in a wheelchair.
“Yeah?”
“I have a bad feeling about this.” I felt sick watching the updates on the screen. “They were talking about something like this on the radio this morning.”
“Yeah. They were reporting the first cases here about half an hour ago.”
I stared into his eyes. “I should leave to try to catch up to my girls. They’re halfway to Anderson by now.”
“As busy as we are, no way is Anita going to let you leave. Anyway, it’s highly contagious, but disease control maintains that it’s just a virus, Scarlet. I heard that those that got the flu shot are the ones affected.”
That one sentence, even unsubstantiated, immediately set my mind at ease. I hadn’t had a flu shot in three years because I always felt terrible afterward, and I’d never gotten one for the girls. Something about vaccinating for a virus that may or may not protect against whatever strain came through didn’t sit well with me. We had enough shit in our bodies with hormones and chemicals in our foods and everyday pollutants. It didn’t make sense to subject ourselves to more, even if the hospital encouraged it.
