Diagnosis Death Read Free Page B

smell of alcohol or the fruity odor that signaled diabetic coma. So far, so good.
    Elena flexed the man's head forward. No neck stiffness. She looked for blood in the ear canals. Good, no sign of a basilar skull fracture.
    When she thumbed back his eyelids, her pulse quickened. The right pupil was significantly larger than the left. Elena pulled a penlight from the breast pocket of her white coat and shined it into the man's eyes. The right pupil remained unchanged, the left contracted sluggishly.
    "Hand me the ophthalmoscope," she said.
    Elena used the instrument to look through the pupils to the back of the man's eyeballs. Sure enough, the nerve head of the right optic nerve was already bulging.
    "Blown pupil on the right." she said. "Get the neurosurgeon on call down here stat. This patient's had an intracranial hemorrhage." The aide turned and hurried out. "Hang a gram of Mannitol IV. Run the oxygen at high flow. Did you get blood for labs?"
    "Did it while you were checking him." The nurse patted her uniform pocket, and Elena heard the muted clink of glass.
    "As soon as you get the Mannitol going, send those to the lab for a stat CBC and metabolic profile. When you get a chance, put in a Foley catheter. And he's going to need an MRI, so put radiology on standby."
    The aide hurried back in. The nurse paused long enough to hand her the blood samples and whisper instructions. "I'm on it," the aide said, and scurried away.
    Elena registered the faint bluish tint to the patient's lips. She checked his fingertips and saw the same coloration creeping into the nail beds. The man's respirations were now weak and shallow. He needed more oxygen.
    "Give me the laryngoscope and a tube."
    The nurse placed an L-shaped instrument in Elena's left hand, slapped a curved plastic endotracheal tube into her right. Elena pried the man's jaws open with the tip of the laryngoscope and slid the flat end down his tongue. A light at the tip of the instrument showed the opening between the vocal cords, barely visible in a sea of pooled saliva. Elena gritted her teeth and slid the plastic tube downward along the laryngoscope. When the tube disappeared through the cords into the airway, she breathed again. Made it through another intubation. Quickly, Elena inflated the soft rubber cuff that provided an airtight seal around the tube. The nurse hooked the patient to the respirator and looked at Elena with raised eyebrows.
    "Set it at sixteen," Elena said. Soon the rhythmic sound of the respirator was accompanied by a regular rise and fall in the patient's chest. She watched for half a dozen cycles before nodding. "There, he's starting to pink up."
    Elena ran down a mental checklist. What had she missed? ABC. Airway, Breathing, Circulation: the mantra for handling emergencies, one of the first lessons learned by any doctor. The first two were taken care of. The man's heartbeat was strong, but she'd better check for cardiac damage. "Let's hook him up to the EKG."
    A few moments later she scanned the tracing. No abnormalities. Good.
    Anything else? As a resident physician at Southwestern Medical Center, Elena was part of a top-notch medical team. Chances were that if she forgot something, someone else would remedy the omission. But when she was out on her own in private practice, it would be totally up to her. That time would be here soon. Better get ready.
    Elena looked at the clock on the wall. Sometimes in an emergency, time seemed to slow down. At other times it seemed to be rocket-powered. This was one of those times when the minutes fled by. Where was the neurosurgeon?
    At Southwestern there were three separate hospitals on the campus—four if you counted Children's Medical Center. Chances were that the doctor this patient needed had to travel from Zale Hospital, on the far south end of the campus, to where Elena waited with the patient at St. Paul Hospital, at the far north end of the campus. Whether the neurosurgeon came by car or on the campus