Angels in the ER (33 page)

It wasn’t unusual for one of the paramedics to ask to speak to the doctor on duty in the ER. Usually they would be requesting clinical advice for a difficult situation. Sometimes it would be a touchy circumstance, maybe a domestic problem or someone who really didn’t need to be transported to the ER by ambulance. I continued to write on the chart, anticipating a straightforward response.

“Doc, Denton Roberts here. We’ve…” He paused, his voice unsure and troubled.

The puzzling response by the paramedic piqued my interest. I stopped writing and put the chart down.

“Go ahead, Denton. What’s going on?”

“It’s, uh, a little unusual.” He paused again. And then, “We’re bringing in a forty-seven-year-old male. Stable, vital signs are okay,
but, uh…could you meet us outside, at the ambulance entrance? Our ETA is about five.”

Now this
was
an unusual request. The last time I had been asked to meet an ambulance outside the doors of the ER I’d found myself delivering a screaming, full-term little girl. That wasn’t going to happen this time, though. There was no panic, no sense of urgency in Denton’s voice. Yet something out of the ordinary was going on.

Amy Conners was the unit secretary tonight, and she had been listening to this communication. She pivoted in her chair and looked at me, her lips pursed in puzzlement.

“Uh, sure, Denton. If that’s what you need,” I responded.

“I would really appreciate it, Doc. We’ll be there in four to five. Thanks.”

Amy reached over and hit the speaker button on the scanner, ending the call.

“Now what do you think’s up with Denton?” she asked me. “He sounded sorta upset.”

“He did, didn’t he? I guess we’ll find out in a minute.”

I finished the last notations on the record of our two-year-old, placed the chart in the discharge basket, and walked to the ambulance doors. As I stepped on the activating mat, the doors slowly opened inward. I was buffeted by a blast of cold air, a reminder that it was winter and I was not dressed for lingering very long outdoors.

The lights of the approaching ambulance played over the few cars in the Emergency Department parking area. I glanced up, remarking to myself the clearness of the night sky. I found the new moon, which had just edged past the treeline beyond the parking lot. Just down and to the right…that would be Venus. Bright, stately. And Jupiter would be—

Medic 2 pulled to a stop in front of me, ending my all-too-brief reverie. Glancing through the driver’s window, I saw Seth Jones at the wheel. He waved and nodded, then killed the engine. Seth, an EMT, had been Denton’s partner for the past five years.

My attention was drawn to the back of the ambulance, where
Denton had opened the double doors from the inside. He stepped down and greeted me as I walked to the rear of the vehicle.

“Thanks for meeting us out here, Doc,” he said. “I just thought it would be better if we talked a minute before we bring the patient inside. You might not want us to bring him in at all when you, uh…”

“No problem, Denton,” I responded, moving toward the open doors.

He grabbed my arm and I stopped, looking directly in his face.

“Before you step in there, Doc, you need to know something,” he told me, his eyes meeting mine.

“What’s going on here?” I asked, shivering in the cold night air. I was beginning to lose my patience.

“We got a call to Oak Park from a neighbor of this guy,” he began, tilting his head in the direction of the ambulance. “The neighbor said we needed to pick this guy up, that he needed some help. Nothing more specific than that. Then he hung up. So we went over and found this fella in a trailer. No electricity. No heat. Just a kerosene space heater that was out of fuel. Said it had just run out. Maybe he was telling the truth, ’cause the place was cool, but not freezing.”

He paused and stamped his feet in the cold air. I shivered again.

“The trailer was in a vacant lot,” Denton continued, “surrounded by nothing but trash.”

Oak Park was an area well known to EMS and the staff of the ER. It was an unfortunate neighborhood, run down and left behind by a city that was expanding in different and more affluent directions. EMS runs to Oak Park were frequently dangerous, with an inordinate number of gunshots, seizures, and stabbings.

“Says his name is Charlie,” Denton informed me. “No last name. No ID. No nothin’. The trailer was a wreck. Just a few empty cans of beans on the floor. Oh, and there were two cats and a mangy dog inside. Didn’t even get up when we walked in. Just sorta looked at us.” He stopped and rubbed his hands together.

I was trying to decipher the importance of the dog, when Denton continued.

“Charlie’s got some kind of skin problem. Had it for a long time, and it’s really bothering him now. Itching somethin’ fierce, he says. That’s the main reason the neighbor called us. That, and the—”

He hadn’t finished this last sentence when I broke from his grasp and stepped up into the ambulance. I was cold, and it was time to get me and this patient inside.

The overhead battery-powered lights were on. They were dim, but I could make out the form of our patient lying under a blanket on the ambulance stretcher. The blanket was tucked under his scruffily bearded chin and his large dark eyes were agitated, glancing from side to side. His hair stood in shocks, interspersed with irregular bald areas. The scalp that was visible was a blotched, angry-red color. He was filthy, and had a peculiar odor—a combination of musk, sour clothes, decay, and something else I couldn’t quite identify.

My eyes were drawn to his blanketed torso, where I could make out the furious movement of his arms and hands. He was violently scratching himself. And now I could hear his faint moaning. It was a pitiful sight and sound.

“Charlie, I’m Dr. Lesslie,” I said to him. “I’m here to help you.”

I reached down and grabbed the edge of the blanket. Denton had stepped into the ambulance and was standing behind me. He whispered in my ear.

“I’d be careful with that, Doc,” he warned. “Like I said, it’s not just the itching that’s bothering him…”

I had stopped as Denton said this, but now I lifted the edge of the blanket, pulling it toward me and exposing Charlie’s scantily clad body. His dirty and tattered plaid shirt was open, revealing his chest and abdomen. The light was not very good, but I could see that his skin was wrinkled and scaling. That strange odor was stronger now, and I noted oozing from the deep furrows that seemed to be everywhere.

Then I froze and just stared. There was…movement. His skin was moving, writhing, somehow alive. And he was scratching himself everywhere. What was I looking at? I leaned closer. Were those—

“It’s the ants, Doc,” Denton said. “They’re everywhere. All through the trailer, and all over his body. They’re itching him to death.”

Reflexively I stepped back, dropping the blanket over his body. His eyes caught mine and correctly interpreted my revulsion. Yet his gaze didn’t waver.

“Help me,” he pleaded.

I collected myself and thought for a minute.

“Denton, ask Seth to take him to room 4. It’s empty and he’ll have some privacy. Then we’ll need to figure this out.”

“Sure thing, Doc.” He was obviously relieved to be passing the responsibility of this unfortunate man on to someone else. “Seth,” he called out. “Come on back here.”

Seth rolled Charlie through the ambulance entrance and toward the waiting bed of room 4. I glanced over and watched as Tina Abbott, a young nurse from one of the staffing agencies, followed them into the room. Denton and I stood just inside the automatic doors and he told me what he had learned from the neighbor who had placed the 9-1-1 call.

Charlie had been living in town for about two years. Apparently he moved around a lot, never staying long in any one place. The neighbor owned the lot and the trailer, and one day Charlie had knocked on his door, asking for work and food. He gave him some odd jobs to do and let him mow the grass. The run-down trailer wasn’t being used, and he let Charlie stay there for free.

“Not a bad guy,” Denton said of the neighbor. “Apparently he took pity on Charlie and would bring him meals every few days. That’s how he got to know about him and his problem.”

Charlie had been born somewhere in the Midwest, and from about six months of age his parents knew something was wrong. His skin began to wrinkle and then to crack and ooze. At first they were told their child just had a bad case of eczema. They tried various steroid creams, but nothing helped. His skin just got worse. Eventually the correct diagnosis was made. It was a condition called
ichthyosis. Ichthy
refers to fish, and their scales were descriptive of this disease. This
particular variety spared the face, palms, and soles of the feet. But the rest of the body was affected with varying degrees of scales, cracking, and furrows. There was no cure, and depending upon the severity it could be very difficult to endure. Skin infections were common, as was itching. Interminable itching.

Charlie had a severe case, the worst I had ever seen. When he was two years old, Denton told me his parents had had enough. The constant draining sores, the crying, and the stares and disgust of all who saw him became too much for them to bear. They tried to leave him at several orphanages, but none would accept him. Who would be willing to adopt this child? So finally they just abandoned him. Left him on a park bench and took off.

He had grown up in a series of foster homes, being home-schooled, if it could be called that. No public school would accept him because they thought his skin condition was contagious.

And then he had just wandered from town to town, working where he could find employment. The neighbor didn’t know much more than that.

“Just a pitiful creature,” he had told the EMTs. “I just finally had to call you guys.”

I thanked Denton for the information, and then I noticed a small black ant climbing up his right shirtsleeve. I pointed to it and he brushed it away.

“Aaaah!” The scream came from the direction of room 4. We both looked over in time to see the curtain fly open and Tina Abbott bolt from the room. She had both hands held to her mouth and ran bent over. Running blindly, she stumbled into the soiled-linen cart and knocked it over, spilling its contents.

“Aaaah!” she screamed again, and then began to vomit in the middle of the nurses’ station.

Lori had just walked back to the counter from triage, having sent our two-year-old with the ear infection on his way.

“Could you step into room 4?” I asked her. “Seth is in there, and he may need some help.”

Without asking any questions, she started in that direction. First she helped Tina sit down on one of the chairs at the desk.

I then turned to Amy Conners. “Would you check the cleaning closet and see if we have any insect spray?”

“What the—” she began.

I just shook my head and said, “Please, just see if we have any, and bring it to room 4.”

Lori was attempting to wipe some of the ants off Charlie as I entered the room.

“Hmm,” she murmured as I walked over.

The light here was better and now I could see just how severe Charlie’s skin condition had become. There were deep crevices everywhere, with no apparent area of healthy skin except on his face, hands, and feet. And the ants were everywhere as well. They were crawling in and out of these cracks and fissures, apparently having made their home there. All the while, Charlie was scratching and quietly moaning.

After ordering something for the itching, I left Lori with Charlie and walked over to the nurses’ station. I sat down and began to ponder my options. First, we needed to get these ants off him. But how? Enough insect spray to kill all of these ants would probably be toxic. We couldn’t scrub him down—the ants were buried in his skin. Alcohol? Betadine? That wouldn’t work.

“What about the Hubbard tank in PT?” This came from Amy, who had sensed my quandary and had come up with the obvious remedy. “You know,” she added. “The one over in physical therapy.”

This was the perfect solution. This large stainless-steel tank, when filled with warm water, was used to treat patients with burns and other skin injuries. You could suspend a person in the tank and gradually submerge them. In Charlie’s case, the ants would either drown or have to flee for survival.

“That’s a great idea!” I told her. “Thanks. Could you get the nursing supervisor on the phone and we’ll see if we can get this going?”

“That would be May Flanders,” she informed me with obvious skepticism in her voice.

“Hmm,” I muttered. “Well, get her on the phone, and we’ll see.”

May Flanders was sixty-two years old and had been a nursing supervisor for about seventy years, it seemed. I had never seen her touch a patient, much less offer any constructive help to our staff, even in the worst of circumstances. Most puzzling was that she always carried a ballpoint pen in one hand and a clipboard in the other. Yet never in all my encounters with her had I ever seen her make any sort of notation on that pad of paper.

Fifteen minutes later, Amy’s phone rang.

“ER, this is Amy,” she answered, followed by silence as she listened to the caller. “Yeah—well, okay. But why don’t you tell him that.”

She handed me the phone, shaking her head and silently mouthing, “May Flanders.”