Revenge. Sheldon Cohen

Dr. Baehler. Just the routine studies done with a complete physical exam, and they were normal.”

      “Do you know where he’s been these last few days?”

      “He went out to the pharmacy two nights ago and he never returned home. The police found him in his car two days later.”

      “Yes, I know. Would you like to see your husband now?”

      “Oh yes, please.”

      Dr. Johnson will you please take Mrs. Spann to Intensive Care and let the nurses know she’s there. If you see Dr. Baehler tell him Mrs. Spann has arrived. If he’s not there have the nurses page him. We’ll see you back down stairs whenever you get here. Goodbye, Mrs. Spann. We’ll pray for him.”

      Barry led a distraught Mrs. Spann to the Intensive Care Unit.

      Pollard, with Amanda trying to keep up, went to the next patient. He was an eighty-two year old man in severe congestive heart failure. As they were examining him, Barry returned and both students had an opportunity to observe the classical physical findings of congestive heart failure: the edema or swelling of the lower legs; the dullness to percussion over the lower lungs due to pleural cavity fluid; the cellophane like crackling in the lungs audible with a stethoscope due to lung congestion; the neck vein distention due to increased pressure in the veins as a result of a weakened heart; the shortness of breath; the increased respiratory rate; the inability to lie flat.

      After the patient started therapy and Pollard admitted him to the hospital, he turned to Barry and asked, “Was Dr. Baehler in Intensive Care?”

      “Yes, but he was busy at work with his patient. I told the nurses Mrs. Spann arrived and they told her to wait until Dr. Baehler would be able to speak with her.”

      “Okay, good. You keep track of Dr. Spann upstairs. Before you come to work in the morning, I want you to visit him in Intensive Care and, if he’s still there, report to us on his progress. Amanda, you do the same for the patient that we just admitted for congestive heart failure. Let’s hope they’re both still around. When you work in the Emergency Department, you see acute disease and pass the patient off to other doctors. You’ll learn much more if you follow up on your admitted patients. This will give you the opportunity to see the results of your handiwork. The most important therapy for any patient may well be the initial therapy, and you’ll learn more if you don’t lose track of your treatment results.”

      They spent the next two hours seeing patients of all ages and diagnosis. The students began to wonder if it would ever be possible for them to develop such a broad range of knowledge. Their mentor seemed to know everything. There was no problem that he didn’t have a reasonable answer for. The students now understood him when he said, “An emergency medicine physician has to speak the language of all the specialties. We see patients ranging in age from a few days to 104, and we see medical and surgical and traumatic problems crossing every area of specialization.”

      The three of them were standing at the central nursing station while Pollard was dictating a clinical note on their last patient. Out of the corner of his eye he noted that John Baehler had entered the Emergency Department He completed his dictation and said, “John, what happened?”

      A haggard looking Baehler with his tie askew and his white shirt sleeves rolled up to his elbows whispered, “Spann just expired. He went into shock and we couldn’t reverse it.”

      Pollard struck his left palm with a closed fist right hand. “Oh Damn, but I’m not surprised. Meningitis with deep coma and four thousand white count. Could anyone survive that?”

      Pollard could see the expressions on his student’s faces. They had just learned about the unexpected realities of clinical medicine. They learned about the frailties of human beings. Here was a healthy man succumbing to bacteria that all of us carry around on our bodies.

      There but for the grace of God go I, thought Amanda, as she remembered her grandmother’s favorite saying.

      “No, I don’t think anyone could survive that combination of clinical findings and laboratory results,” said Baehler. “Ann Nordstrom was there with me. I called her in consultation. She didn’t have much to add. Everything you ordered was perfect. It was clear from the start that we had an uphill battle.”

      “How’d Mrs. Spann take it?” asked Pollard.

      “Bad, but she did agree to an autopsy.”

      “Oh, that’s good. Also unusual now a days; we don’t do much of those anymore.”

      “She was very receptive. I told her how unusual her husband’s case was and our only hope of maybe coming up with an answer as to why this happened was the autopsy.”

      “The hospital will no doubt hold some kind of service. After all he was a member of the Medical Executive Committee,” said Pollard. “First Harrison and now Spann. What the hell’s going on?”

      “Beats me. Yes, I’m sure there’ll be a service. Thanks, Jason, for your help.”

      Pollard nodded. Thanks for what, he thought.

      CHAPTER 8

      Amanda who had been listening said, “Dr. Pollard, what do you think happened the days that Dr. Spann was missing?”

      Pollard’s forehead creased. He nodded his head. “That’s a very good question, Amanda. I thought of it, but in the heat of the battle, I didn’t factor that in as having any immediate relevance. His situation demanded absolute concentration on making a proper diagnosis to start immediate therapy, because his clinical picture was critical and every second counted. So let’s now think about the excellent question that you’ve asked, and now that the situation has been resolved—with an unfortunate outcome—I might add, we have the luxury and time for such thoughts, and since you asked the question about it you must have some ideas. What’s your interpretation?”

      “Well,” she said, “he was listed as a missing person. That fascinated me because I heard all kinds of talk like that growing up. My father is a police detective you see...”

      Pollard’s eyes opened wide. His mouth dropped. “Oh,” he interrupted. “I should have known. Your father is Richard Galinski.”

      Amanda flashed a beautiful smile and her pearly white teeth and bright eyes sparkled in unison. “Why yes, do you know him?”

      “Do I ever. We had an unusual case we both worked on once. One of these days, I’ll tell you all about it. Wow, you just brought back some great memories. So tell me, what do you think happened to this man from the time he left home one night in apparent good health to the time he came under our care in deep coma? We’d love to hear about this from the perspective of a detective’s daughter, don’t you think, Barry?”

      “Yes, great idea.”

      With her head nodding yes, she said, “Well, I have to wonder if he was beginning to feel somewhat ill the night he left to the pharmacy. Perhaps he had a slight headache with nausea, aches and pains...you know, the early symptoms of meningitis. But then his symptoms progressed. What confuses me is that if he got too sick why didn’t he go back home? Since he didn’t, maybe his symptoms progressed so fast that he passed out. Would that be possible with a staph meningitis?”

      “I believe so, but if he passed out on the off ramp of a busy expressway, there’s no way he’d sit there for two or more days without anyone noticing,” said Pollard.

      “Yes, that was going to be my next point,” said Amanda.”

      Listening with great fascination Barry interjected. “Could the meningitis have caused a mentally confused state which resulted in the patient wandering around…a sort of amnesia? He got confuse, disoriented, didn’t know where he was?”

      “Another bullseye,” said Amanda.

      Barry looked at Amanda and said, “You heard about that?”

      “I not only heard about it, I