Thursday, August 11, 2011

The Best Revenge (Chapter 7)

I went to the stroke unit at 3, hoping to wrap up things so that I wouldn’t have to come back afterwards.  I was relieved that the unit seemed relatively quiet and I didn’t get bombarded with questions from nurses the second I walked through the door.  I read through Chloe’s notes in the charts and signed them.  I liked Chloe because she always knew what was going on.  I didn’t need to constantly be looking over her shoulder every minute to make sure she was getting things done.

I was signing the last of the notes when a nurse named Vicky approached me with a worried look on her face.  “Dr. Miller, there’s an issue,” she said.  As a resident, the nurses called me by my first name or at least Dr. Rachel, but now that I was an attending, I mysteriously commanded more respect.  Even if I corrected them, they all addressed me as Dr. Miller.

“Yes?” I asked.

“It’s Connors in room 11,” Vicky said.

Of course.  “What’s wrong?”

“His left leg is painful and swollen.”

I strode down the hall, instinctively reaching at the stethoscope that was around my neck.  Vicky followed at my heels, which I was grateful for.  She was one of the best nurses on the ward.

Sure enough, when I reached Alex’s room, he seemed like he was in a significant amount of pain.  He looked relieved to see me, which was a testament to how uncomfortable he must have been.  “Hi, Dr. Miller,” he said.  “Thanks for coming.”

“So your leg hurts, huh?” I said.

“It’s killing me,” he admitted, taking a shaky breath.  “I liked it better when I could barely feel it.”

“Did he fall?” I asked Vicky.

“No, Doctor,” she said.

“Any fever?”

“Vital signs stable,” she said, gesturing at the machine she had used to check his temperature, pulse, and blood pressure. 

The covers were pulled away from Alex’s left leg, which was looking red and tense.  I pressed my bare fingers against the skin of his calf and he winced.  “Ouch,” he said.

I looked at his face.  There was a line of sweat across his brow.  I wondered if he was breathing more rapidly than usual.  He flashed me a worried expression.  “So what’s wrong?” he said.  With a nervous laugh: “Am I dying?”

“I think you may have a blood clot,” I said to Alex.  I turned to Vicky: “But he’s got the IVC filter, right?”  Chloe told me Alex had had an IVC filter placed, which would keep any blood clots from going to his lungs.  Blood clots were not uncommon when you have legs that are barely moving at all, even with compression devices on the leg to help circulate the blood.  The key was to protect the lungs.

Vicky shook her head.  “No, he didn’t get the filter.”

I almost choked.  “What?  Chloe told me he got it on Monday.”

“Well, I can tell you he never got it.”

Alex was watching us talk, an alarmed expression on his face.  “What’s going on, Dr. Miller?”

“Just a little… shop talk,” I said.  I needed to get out of this room five minutes ago.  If I had thought there was any chance he hadn’t gotten the filter, I wouldn’t have mentioned it in front of him. 

“I’m not an idiot,” he said, managing to look peeved despite his pain.  “You can tell me what’s going on.”

I really couldn’t.  God, what a mess.  “I’ll be back in a minute,” I told him.  “I promise I’ll tell you everything.”

Before Alex could say another word, I hustled Vicky out of the room.  “We need Chloe to be paged right now,” I hissed.  “He was supposed to have that filter placed three days ago.  If he throws a pulmonary embolus, he could…”  I didn’t want to complete that sentence, but Vicky knew as well as I did that pulmonary emboli were often fatal.

Vicky paged Chloe while I flipped through Alex’s chart, hoping to find a procedure note that would prove Vicky wrong.  Alex’s apparent distress could have been from pain, but if he didn’t have that filter, it could also have been respiratory distress from a blood clot thrown to his lungs.  Shit, this was really bad.  I pressed my fingers into my temples, contemplating my next step. 

“Okay,” I said to Vicky, in my most calm but no-nonsense voice.  “Let’s get a continuous O2 monitor on him right now.  If his O2 saturation is anything less than high 90s, come get me immediately.  Otherwise, let’s give him two milligrams of IV morphine and see what he looks like when he’s more comfortable.”

Vicky nodded and ran down the hallway to carry out my orders.  She was a really good nurse to have around in a tight situation and I could tell she was as worried as I was.

About a minute later, I had Chloe on the phone.  “Chloe,” I said.  “Tell me that Connors had the IVC filter placed on Monday.”

“He did,” Chloe confirmed.

“Are you sure?” I pressed her.

Chloe hesitated and that was when I knew.  He never got the filter.  I cursed to myself.  “I’m so sorry,” she said quickly.  “I thought he got it, but… I guess I never saw a note.   Maybe they canceled it and never told me.”

I waved off Chloe’s apologies and raced down the hall back to Alex’s room, glad that I was dressed in comfortable shoes.  Vicky had given him an IV pain medication and he looked a lot better already.  I glanced at the monitor and saw that his pulse and oxygen saturation were perfect.  He almost definitely had a clot in his leg, but there was no sign the clot had reached his lungs. 

“You wanna tell me what’s going on, Dr. Miller?” Alex asked.  His brow was furrowed, although the pain medications had mellowed him out significantly. 

I offered him a falsely reassuring smile.  “It looks like you probably have a blood clot in your leg,” I said.  “But it’s not a big deal.  The only worry is if it goes up to your lungs, so we’re going to put in a filter now to keep that from happening.”

“Awesome,” Alex said with a sigh.  “They’re going to put in the filter right now?”


“What if they’re busy now?”

“Trust me, you’re getting that filter within the hour.”  I turned to Vicky.  “Could you please get interventional radiology on the phone right away?”

Vicky hurried out of the room.  Alex smiled at me.  “I think I get it now,” he said.

I frowned, my stomach in a knot.  “Get what?”

“Why everyone says you’re such a great doctor,” he said.  He winked at me.  “It was eluding me for a little while.”

I blushed.  For a moment, our eyes met and my breath caught in my throat.  He still had the same gray eyes he did when we were kids.  There was something very boyish and sweet about Alex Connors, which was what had attracted me to him all those years ago.  I wrung my hands together, unable to break eye contact. 

“My darling, are you all right?”

I whirled around and saw Eva standing behind me.  She was holding a brown paper bag and a coffee cup, and her eyes were filled with worry.  She ran to Alex and embraced him while I stood there awkwardly.  Thankfully, Vicky came to tell me that interventional radiology was on the phone, so I was able to escape.

After I explained the situation to the interventional radiology resident and made only one or two thinly veiled threats, Alex was bumped up to being next in line to have his IVC filter placed.  Chloe had arrived at the unit by that point, full of tearful apologies.  I could have handed her her ass on a plate for not following up to make sure her patient got his filter—it was only by the grace of god that Alex hadn’t dropped dead of a pulmonary embolus.  But I had about five minutes to make it across the city to my bridesmaid dress fitting appointment, so I made Chloe swear not to leave Alex’s side till that filter was in him, then took off for a cab.

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