The story continues...

Chapter 12

Wednesday 11:30 p.m. 4 West

            Dr. Baker stared at Mrs. Rourke’s chart. He opened it and looked at his history and physical. There was nothing there that he didn’t remember. The operative report revealed nothing new. It was a normal vaginal hysterectomy. There was no reason for the old woman’s pain except her own dementia. That sounded good.

            Dr. Baker looked up at the nurse, Nancy Littleton. “Okay, let’s go see Mrs. Rourke.” Nancy walked side by side with Dr. Baker down the hall to the patient’s room. Nancy snapped on her flashlight and slipped over to the bed and pulled on the overhead bed light. Light flooded Mrs. Rourke. Curled in a fetal position, her eyes were closed tight. Her forehead furrowed, and her breaths escaped in gasps.

            “Mrs. Rourke, would you roll on your back, please?”

            Nancy bent down and placed her hand on Mrs. Rourke’s shoulder trying to break through the painful fog surrounding the patient. Nancy’s heart softened and so did her voice. “Edith?” Nancy paused.

            Mrs. Rourke’s eyes opened. “Christy?”

            “No. It’s Nancy, the nurse. Your daughter went home earlier.” Nancy turned to Dr. Baker. “The daughter was pretty upset about her mom.” In the meantime, Nancy pointed to the patient’s Foley bag, which didn’t have much urine in it and what was there was bloody.

            “She’s 82. What does the family expect?” Dr. Baker nodded to Nancy that he had noticed the bloody urine.

            “It’s hard for family’s to watch loved ones suffer.”

            “Well, this is the first I’ve heard of Mrs. Rourke having any family. Where were they when she signed up for the surgery?” Dr. Baker paused. “I guess she did mention a daughter. Is there any other family?”

            “Yes. She has five children. Her husband is deceased though.” Nancy felt defensive. How could he not know more accurately know about the patient’s family? “She was coherent when she was admitted and not confused at all.”

            “Well, I still need to exam the patient. Will you get out of my way?” Dr. Baker tried to push Mrs. Rourke onto her back.

            “Hey, that hurts,” said Mrs. Rourke. Her eyes were open wide now. “What do you want?” She didn’t seem to be impressed with Dr. Baker’s visit.

            “I’m here to check you over because you have been complaining so much about pain. What is wrong with you?” said Dr. Baker.

            “I don’t know, but I know that something isn’t right.” Mrs. Rourke didn’t live to 82 and raise 5 children to take any attitude from anyone. “My belly hurts. Can you do anything about that?”

            Dr. Baker was surprised at Mrs. Rourke’s response. No dementia here. “I need you to roll on your back so I can exam your abdomen.”

            Mrs. Rourke complied. The surgeon’s hands palpated her abdomen. When he pressed on her lower left  abdomen, Mrs. Rourke cried out in pain.

            “Okay, Mrs. Rourke. I’m going to increase your pain medication and have another surgeon check you out also.” Dr. Baker pulled her gown down and the bed covers back up. “I’ll leave you alone now.”

            Mrs. Rourke rolled back over on her side and stretched out with a sigh. Her demeanor calmer, feeling less pain in her abdomen. “Could I have a drink?”

            “Yes.” Nancy held the glass up to her lips.

            Mrs. Rourke took a few sips. “I guess it’s better when I stretch out. Did he increase my pain medication?”

            Dr. Baker had left the room. Nancy said, “Yes, and your last dose was the higher dosage. You have less pain?”

            “I guess I do. Maybe I’ll live after all.” Mrs. Rourke chuckled.

            “Well, I would hope.”

            “You just never know when you’re 82.”

            “You behave and don’t think that way, Mrs. Rourke.” Nancy flipped off the light and left the room.

            Nancy found Dr. Baker at the nurses’ station, writing on Mrs. Rourke’s chart. He looked up.

            “How is the pain medication holding her?” asked Dr. Baker.

            “She just indicated that she was feeling less than she has been.”

            “Good. I’ve ordered a consult with Urological Association to see her. Could you see to it that they are called first thing in the morning and tell them that it is urgent?”

            “Of course,” said Nancy.

            “Stop all oral feedings and medications until they give their okay. They may want to do a procedure requiring her to be fasting. I also noticed that she has a temperature of 101, so I ordered a urine culture and blood cultures times three. I’m also leaving an order for oxygen at 2 liters if she should need it. I’ll leave the ordering of an antibiotic to urology.”

            Dr. Baker returned to Mrs. Rourke’s chart. He checked the anesthesia record for the use of Narcan, a drug that would block the action of the pain medications, that anesthesia sometimes used to reverse the anesthesia. None had been used. So there was no other reason for the patient’s pain and bloody urine except for a nicked ureter or a tied off one.  

            A telephone appeared in Dr. Baker’s field of vision. “You’re being paged, Dr. Baker,” said Nancy.

            Puzzled, Dr. Baker took the phone wondering what disaster had crawled in. He is beginning to wonder if he is ever going to get home. With a deep sigh he said, “This is Dr. Baker.”

            “This is Peter Newton in the emergency room. Carol Turner is here and has delivered a baby. Dr. Martin has been called also.”

            “What…why?” Dr. Baker’s face became pinched when Peter notified him that the patient was awake and he wasn’t able to talk freely. Would he please come on in?

            Dr. Baker handed the phone back to Nancy. He turned dead white considering all the possibilities that could have occurred. He remembered that he had given Carol Turner the booster. Panicked, he had trouble thinking straight overwhelmed by the ER calling a neonatologist in for the baby. With a moment of terror, it dawned on him that not only Susan, but also Yvonne knew about the tablet found in Terri Shultz. Two more fires that he had to worry about. Nurses may seem dumb, but they always knew more than they were supposed to. They just weren’t allowed to show it. They could be hazardous to a doctor’s practice if they were allowed to answer all the patient’s questions instead of being forced to refer the patient to the doctor. Unsettled, Dr. Baker abandoned Mrs. Rourke’s chart and headed for the elevators.