Angels in the ER (36 page)

Emma had fallen from bed one night and Sarah had brought her to the ER. After examining her carefully and determining that no serious damage had been done, Jack Young had asked Sarah to step out in the hallway with him. He wanted to speak privately with her about Emma.

“Ms. Gaithers,” he began. “Your sister is going to be alright tonight.”

“Well that’s a relief, Dr. Young,” Sarah responded. “I was so worried.”

“She’s alright
this
time,” he went on. “But what about the next time she falls? Or what if something worse happens?” he asked her.

Sarah was startled by the question, and for a moment didn’t know how to respond.

Jack Young misinterpreted the pause as an invitation to offer his guidance and wisdom. He proceeded to tell Sarah that it was time for Emma to be placed in a home of some sort. She should be in a place where she would be properly taken care of. In fact, this probably should have happened years ago.

Sarah’s face had flushed and her back had stiffened.

“Dr. Young, you don’t know me,” she had firmly declared. “And you don’t know my sister. We have been together for more than eighty years and nothing is going to change that now. I will take care of Emma for as long as the good Lord allows me to.”

She paused here and leaned close to his face. “And that, young man, will be His decision and not yours.”

She had collected herself, softened, and then said, “If we’re finished here, I suppose I should be getting Emma home now. Thank you for your help.”

Jack didn’t make that mistake again. And while I knew the time for such a move was rapidly approaching, I was not willing to tread there. Not just yet. Sarah would know when her ability to take care of Emma had come to its end.

Several months earlier, I thought we had reached that point. On this occasion Sarah had been the patient and Emma her companion. EMS had brought the two of them to the ER after Sarah had called complaining of cough, fever, and shortness of brief.

We had quickly determined she had a severe pneumonia and would need to be admitted to the hospital for IV antibiotics and supportive care. It would be dangerous to do otherwise.

“Dr. Lesslie, that will be impossible,” she had told me, shaking her
head. “I cannot stay in the hospital,” she stated emphatically. “Who will take care of Emma?”

I again explained the seriousness of her situation, and that should she die, there would be no one to take care of Emma. I got nowhere. She refused to be admitted, and I knew we could not force her.

Exasperated, I left her room and walked over to the nurses’ station. Virginia Granger was sitting behind the counter and listened as I voiced my predicament.

She stood up and straightened the starched, pleated skirt of her uniform. “Dr. Lesslie,” she said. “Give me a couple of minutes with Sarah.”

She walked over to Sarah’s room and pulled the curtain closed behind her. I waited. A few minutes later she walked out and around the nurses’ station. I caught her eye and was about to speak when her right index finger, pointing upward, silenced me. She went to her office and closed the door behind her.

For fifteen minutes she was on the phone, calling people in administration and on the medical floors. She was calling in every bargaining chip she had, and she had plenty.

When she walked out of her office she was smiling.

“Well, here’s the situation,” she began telling me. Amy Conners pressed close behind me, curious as to what wonders Virginia had been able to bring about. “The administration has agreed to let Emma stay on a cot in the room with Sarah. The staff on the medical floor will make sure she’s fed and taken care of. Sarah should be alright with that, don’t you think?”

I didn’t know what to say. This kind of thing just didn’t happen, not in this hospital.

“Virginia…” I started, and then paused.

“Well, are you going to tell Sarah, or do you want me to?”

Another slight hesitation on my part, and Virginia was on her way to Sarah’s room. She agreed to be admitted to the hospital under these terms, and after a week of aggressive therapy, she and Emma were once again at home.

This afternoon’s visit to the ER would be more straightforward. We would repair the laceration of Emma’s face and the two of them would be on their way.

“Okay, Emma, let’s get your forehead taken care of.” I spent the next forty-five minutes suturing her laceration. Sarah stood by her side holding her hand, and all the while Emma just stared at the ceiling, smiling. The only indication of any discomfort had been a slight furrowing of her eyebrows as I numbed the edges of the wound.

“There, that should do it,” I said, taking off my gloves and tossing them onto the surgical tray.

“Why, Emma,” Sarah said, leaning close to her sister, “your forehead looks fine. I think Dr. Lesslie should have been a seamstress.”

Emma just smiled. Lori was giving Sarah instructions for wound care as I left the room.

A few minutes later they came up the hall behind me, Sarah pushing the wheelchair and Emma once again in her sweater.

They stopped at the nurses’ station and Sarah said, “Thanks again for all your help.” She patted her sister’s shoulder and added, “And Emma thanks you too.”

“You’re welcome, Sarah,” I answered. “And you too, Emma,” I added, looking down at her upturned face. “You two take care of each other.”

Sarah nodded and smiled. Then she turned and began pushing the wheelchair again. She paused, confused as to which way she should go. I was about to speak, when Sarah leaned over her sister and said, “Here we go, Emma. This way.” They moved across the hall and disappeared through the triage door.

Truly here was a ministering spirit, an angel passing through this life and touching ours.

The ambulance doors opened and Willie James was wheeled into the ER by two thirty something women. They were his daughters, and
they were pushing his wheelchair toward the nurses’ station. One of them looked up at us and said, “It’s Daddy’s heart again. He’s havin’ trouble breathin’.”

Virginia had just come out of her office carrying the beginnings of next month’s nursing schedule. When she saw Willie, she put her stack of papers on the countertop and walked straight over to him.

“Having some trouble tonight, Willie?” she asked, stepping between the two women and taking control of the wheelchair. “Let’s just head over this way,” she added. She looked at me and nodded in the direction of the Cardiac room.

Willie James was 63 years old. He had suffered a pretty significant heart attack three years ago, leaving him with a little less than half of his cardiac muscle. Since then he had teetered on the edge of heart failure, sometimes doing well, and sometimes slipping over into dangerous and deadly territory. Too much salt, too much stress, too much physical activity—any of a number of things would overload his heart, and fluid would back into his lungs. He would become more and more short of breath, unable to walk short distances or even lie down without gasping for air. Then a frothy foam would form on his lips. Patients sometimes describe this as a feeling of “drowning in your own secretions,” and it is understandably very frightening.

Tonight Willie had slipped over the edge, but he was calm, and he even managed to smile up at Virginia as she had walked over to him. He was too short of breath to answer her question and only nodded his head as he leaned forward in the wheelchair, tightly grasping the handles and gasping for breath. The telltale foam of congestive heart failure was evident on his lips.

Willie was wearing an old T-shirt and well-worn plaid trousers. His feet were covered with white athletic socks, one of which had fallen halfway off. Its tattered and dirty toe was dragging on the floor. I got up from behind the counter and followed him and Virginia into the Cardiac room.

Without being asked, Amy said, “I’ll get X-ray down here. And the lab and someone from Respiratory.”

“Thanks,” I responded, glancing at the clock on the wall.
10:35 p.m.

Willie was in bad shape. He had waited a little too long this time before asking for help. He wasn’t responding to our usual treatments, and his condition was deteriorating right before us. And he was getting tired. Virginia was setting up an airway tray, anticipating we would soon have to intubate him and put him on a ventilator. That would be the next step, but I wanted to avoid it if at all possible. Willie did as well. He glanced at the tray with its various equipment and tubes, and his eyes widened. He looked up at me. He couldn’t say anything, but his eyes spoke for him.

We were all thankful when he began to improve. His oxygen saturation began to move upward and his pulse slowed a little. We continued our treatments, and within forty-five minutes it was evident he was moving in the right direction. He would avoid the ventilator tonight but would obviously need to be admitted to the hospital.

“Willie, isn’t Angus Gaines your doctor?” I asked, making sure that only a movement of his head was required for a response. I was pretty certain that was correct.

He nodded in affirmation.

“Good. I’ll give him a call and tell him you’re here,” I went on. “You’ll need to come into the hospital tonight, alright?”

It wasn’t a question, and Willie again nodded his head.

A few minutes later, Amy had Dr. Gaines on the phone.

Angus Gaines was in his early seventies and was still practicing medicine full-time. He had been in Rock Hill for more than forty years, and while technically a GP (general practitioner), he took care of just about everything. He didn’t do any surgery now, but he had more patients than any other physician in the area, and he wanted to be involved in their care. I knew he would want to know Willie was in the ER. He would probably come in and see him, and then have one of the cardiologists on staff admit him to the CCU.

Angus always came in to see his patients. It didn’t matter what time of day or day of the week it might be. We’d give him a call, and within
a matter of minutes he would come walking into the department. That wasn’t necessarily the rule for other members of the medical staff. In fact, it was becoming the exception.

Only a few days earlier, a forty-year-old woman had come to the ER complaining of fever, chills, and chest pain. She had a history of worsening lupus—an inflammatory disease of the internal connective tissues—and had recently been diagnosed with kidney failure. We determined she had pericarditis complicating her lupus. This was an infection of the outer lining of her heart, and could prove fatal. She would need to be admitted to the hospital. She gave me the name of her family physician and I asked Amy get him on the phone.

A few minutes later she handed me the receiver and I talked with her doctor.

After explaining the circumstances of this patient, I was told, “Well, Robert, we do see this lady in the office, but she owes us money now, and…well…I just don’t think we’re going to take care of her anymore. Why don’t you have the person on call for ‘unassigned medicine’ admit her.”

I was incensed. His response was totally inappropriate. But I knew this was not the time to fight this battle.

I glanced over at our patient, glad she had not been able to hear this conversation. Trying to control my anger and my tongue, I looked at the on-call board, which was located on a column in the nurses’ station. It listed the physicians responsible for various specialties: surgery, ortho, pediatrics, medicine. These medical staff members were required to take care of patients who didn’t have a doctor.

Locating the “medicine” slot, I read—

“Yeah, Robert—just have the on-call doc—” he began, repeating himself.

“Well, just a minute, Jake,” I interrupted him, with not a small feeling of satisfaction and sense of divine justice. “That would be you. You’re on call tonight for unassigned medicine.”

“Wha…”

We would never get such a response from Angus Gaines. In fact, I
had never heard him utter a cross word or show any sign of frustration with his patients or with being called in to the hospital late at night.

This night was no different. I was standing in front of the counter, when Amy handed the phone to me. “It’s Dr. Gaines,” she told me.

“Angus, this is Robert Lesslie in the ER,” I said, wondering if we had waked him. “I’ve got one of your patients here, Willie James. He’s in congestive heart failure again, and he needs to come in.”