LITMIR.BIZ

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      Lukas adjusted his stethoscope and did a quick auscultation of the man’s chest. He had mild tachycardia and slow respiration. His skin was pale and cool to the touch. A quick check of his head and upper body revealed no signs of injury. Lukas didn’t smell alcohol.

      “Lauren, let’s get a bedside glucose on him.”

      “Yes, Doctor. We have a new patient in room eight who needs you next.” She lowered her voice. “It’s cancer. She’s a DNR.”

      Lukas grimaced. Those were the hardest. “Okay, thank you, Lauren.” He checked Frankie’s eyes. The man had good papillary sparing. Lukas quickly but gently turned the patient’s head, holding his eyes open. The eyes remained fixed on the ceiling. Positive doll’s eyes told him that this was either drug related or that there was bilateral brain swelling.

      “Shelly, has he been ill recently? A cold? Flu?”

      “No. Yesterday he was fine. He always brags about never getting sick.”

      “Does he ever drink?”

      “You mean liquor? Never.” She held out two prescription bottles. “I brought these. I found them on the bureau in his bedroom. His bottle is almost full, but the other one is empty. It belonged to his wife. She died last year.”

      Lukas took the bottles from her and glanced at the names of the drugs. Both were benzodiazepines for sleep. He glanced at the patient and didn’t like what he was thinking.

      “Blood sugar’s 125, Dr. Bower,” Lauren said.

      “Thank you.” He glanced again at Shelly, hating to ask his next question. “These are tranquilizers. Is it possible he might have taken an overdose of his wife’s prescription?”

      Her eyes widened with alarm. “On purpose? No way! I don’t even want to consider it. He’s so good with the kids, and he never seems depressed. He was doing so well after his wife, Doris, died.”

      Lukas was also reluctant to believe this kindly looking older gentleman would do anything so drastic. He’d probably flushed his wife’s pills after her death. But what if he hadn’t?

      “He hasn’t talked about going to be with his wife lately?” he asked Shelly.

      “No.”

      “Has he displayed any changes in his normal habits, like changes in sleep time or amount? Changes in eating habits? Has he given any of his personal items, such as jewelry, to friends or neighbors?”

      “Nothing that I know about.”

      “How long ago did his wife die?”

      “About eight months ago. Long enough for him to show signs of depression if he’s going to, I would think.”

      “Not necessarily. A wedding anniversary could have set him off, or her birthday, anything of significance to him.” Lukas was well aware of this because his own father had gone through a similar depression after Mom’s death. So had Lukas, though not as severe as Dad’s.

      “But they had just celebrated their wedding anniversary before she died,” Shelly said. “And her birthday was two weeks before their anniversary. We celebrated it with them.”

      “Okay, thank you, Shelly. Lauren, set him up for a CBC, a comprehensive chemistry panel, a portable chest, and a drug screen. Then set up a heplock. I want him to have a milligram of Romazicon at 0.2 milligrams per minute. We’ll repeat the dose after twenty minutes.”

      “What’s that for, Doctor?” Shelly asked.

      “Romazicon is the antidote for benzodiazepine overdose, just in case.” At her blank look, he explained gently, “He may have taken too many of these tranquilizers. I don’t want to dismiss the possibility and take a chance on being wrong.”

      He glanced at Frankie’s prescription bottle again. Dr. Robert Simeon had prescribed the drug. “Lauren, also put a call in to Dr. Simeon’s office. He’s the family doc. I’m going to check on Cowboy, then look in on the cancer patient. Would you see if that permission to treat has come in for the track student? We’ll need a CT head scan on Frankie if our workup is negative.”

      Dr. Wong entered the E.R. and greeted Lukas with a cheery smile and warm handshake. “Lukas, I hear you have one of my favorite patients visiting with you this morning.”

      “Yes, and your patient is already asking for some clothes. Beverly will assist you.”

      As soon as Cowboy was settled with his new doctor, Lukas heard Beverly’s cajoling voice through the door.

      “Dr. Wong, you’re a kindhearted person,” she said. “What time do you get off?”

      “Um, excuse me? Hold it, Beverly, you know I’m married.”

      “I know that, silly. How would you like to help out a hungry house pet?”

      “Forget it. I know all about Cowboy’s house pets. He just happens to be here because that ‘pet’ mistook his thigh for a drumstick. Isn’t that right, Cowboy?”

      Lukas chuckled as he walked back to the central desk. Beverly wanted that Mustang.

      His laughter died when he entered exam room eight with a chart for Mrs. Jane Conn. The eighty-six-year-old woman lay moaning in pain in spite of the morphine Lauren had just injected at Lukas’s order. A smooth, shiny sheath of mottled scar tissue obliterated half of Mrs. Conn’s face and showed up plainly beneath the nonrebreather oxygen mask she had received upon arrival. She had been brought here from her daughter’s home about thirty minutes ago, her pain unresponsive to oral medication or morphine suppositories. Lauren had established an IV where dark bruises attested to the failure of the new paramedic to do so.

      Since Lauren and Beverly were both busy, Lukas checked the blood pressure himself. It was going down, and the heart rate was dropping, probably due to a decrease in pain—or Mrs. Conn was dying.

      Lukas found Lauren and gave instructions for blood tests and X-rays. “You did say Mrs. Conn had filled out a do-not-resuscitate form for her family, didn’t you?”

      “Yes, but we haven’t received it yet.” Lauren wrote his instructions down on a sheet. “Her daughter, Ivy Richmond, should have it.”

      “I’ll need to get it from her, or we’ll have to take measures to resuscitate if…” He shrugged, hoping they would have no trouble getting the DNR form. He’d been forced to run codes on late-stage cancer patients before, and it had been very painful for everyone, especially for the patient.

      As Lauren ran orders for the tests, Lukas listened once again to Mrs. Conn’s chest. He glanced up, and to his surprise, he saw her one unaffected eye watching him.

      He took her hand. “Mrs. Conn, we’re trying to reduce your pain. How does—”

      “Let me…” her damaged mouth twisted in an effort to form the hoarse words “…go.” Her eye held him a few seconds, then glazed over and closed.

      Sadness overwhelmed Lukas as he watched her. He hated to see the pain, had always hated to see suffering of any kind. It was one of the things that had driven him to be a doc in the first place, and ironically, it had been one of his worst hindrances in premed vertebrate physiology. He’d always been physically sick afterward, even though the animals were anesthetized and even though he reminded himself over and over again that human lives would be saved because of the sacrifice.

      Mrs. Conn’s moaning had stopped. Lukas placed a hand on her frail arm, then looked over to find the eye watching him again. He couldn’t read the expression, for there was little expression to be displayed on the harsh mask.

      She moved her mouth.

      Lukas leaned closer to hear her.

      “Ready.” The word wasn’t even a whisper, but a breath of sound that barely carried past the barrier of the transparent oxygen mask. “I’m…ready.”

      When

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