Miracles in the ER (13 page)

“Earl, tell me, how did this happen? How did you manage to get four nails in your foot?”

“You ever use a nail gun, Doc?”

“Yes, I—”

“Then you know how they can have a hair trigger.
Bam bam bam bam!
It happened just like that! Four nails in my foot before I could move my finger!”

Denton Roberts was still in the room, standing near the doorway. I glanced at him, caught his eye, and he shook his head.

“Just that fast?” I was about to reach down to his foot again, but thought better of it and stopped.

“Just like that, Doc.
Bam bam bam bam!
”

The door opened and one of the X-ray techs walked in. She turned to the view box and slipped one of the films in place, then flipped on the light.

“Is that my foot, Doc?”

“It is, Mr. Smothers.” I walked over to the view box and leaned close. Denton was right behind me, peering over one shoulder, with Lori hanging over the other.

There before us was his right foot, the outline of his work boot barely visible. Clearly visible, though, were the four nails, unevenly spaced and irregularly angled. They were penetrating his forefoot, the area of his toes and metatarsals.

I looked closely, trying to find any evidence of a fracture. Somehow, with injuries like this or with knives, the bones seem to slide out of the way and avoid being struck and broken. I couldn’t find any evidence of a break.

Lori handed me the other film and I took the first one down. Same thing—four nails in his foot, but no visible fracture.

“Hmm, hmm.”

“What’s the matter, Doc? Am I gonna lose my foot?”

Earl was straining to see the view box, still grabbing his right knee to keep his foot from moving.

“I don’t think so, but we need to get that boot off and take a look.”

“Arghh! That’s gonna kill me!”

“We’ll give you something for pain first.” I looked over at Lori. “How about some morphine. Start with five milligrams IV and we’ll titrate it till we get some relief.”

A few minutes and ten milligrams later, Earl was resting quietly on the stretcher. His hands were folded across his chest now, and he looked sleepily up at me and said, “It’s okay, Doc. Do what you gotta do.”

I looked over at Lori, raised my eyebrows, and shrugged. How were we going to get his boot off? We could unlace it, but the nails were stuck in his foot and we couldn’t slide it off. We would have to
cut
it off.

Lori turned around and began rummaging through one of the drawers under the counter. She pulled something out, turned to me, and held it up—a pair of bandage scissors. Flimsy at best, and I shook my head.

“Ahem.”

We both looked over to the corner of the room. Denton leaned casually against the wall. He slowly stood upright, reached into his back pocket, and took out a gigantic pair of scissors—more like pruning shears.

“We use these when we need to cut someone loose,” he drawled.

“Perfect. Bring them over here.”

I made room for him beside me at the stretcher, and began to carefully unlace Earl’s work boot. Sawdust freed from the cuff of his blue jeans scattered over the bed. His eyes didn’t open and he didn’t move.

“Keep the morphine handy,” I whispered to Lori. She held up a loaded syringe and waved it at me.

I loosened the top of the boot as much as possible, then motioned for Denton to start cutting. Together, with me holding leather and him carefully snipping, we began to remove his boot, one piece at a time.

The work went faster than I thought possible, and we soon reached the first nail. No blood, or at least none visible on the top of his foot.

“Hasn’t washed these socks in a while,” the paramedic whispered, frowning and wrinkling his nose.

I nodded and gingerly took hold of the top of the nail. Once freed from the boot, it was loose, and moved easily. Denton trimmed the odiferous sock away, and our eyes widened. The nail was snuggled up against Earl’s great toe, but there was no blood. It hadn’t penetrated the skin.

We kept working, trimming the leather away from the next nail. The
sock fell away, and we stared at each other. The nail had passed cleanly between the great and second toes, but again, there was no blood and no broken skin.

The third nail was the same—neatly wedged between two toes, having missed his foot entirely.

Lori shook her head, looked down at the sleeping Earl, and then at the morphine-filled syringe. Without a word, she turned and set it on the countertop.

The last nail was different. We freed it from leather and cotton, but it wouldn’t move. It was stuck firmly. This must be the one that was causing his pain.

Denton trimmed some more of the boot away and I leaned down, my face almost touching the stretcher.

There it was. I let out a loud sigh and shook my head. The nail was jammed in the bottom of his boot, slap up against his little toe. And here was the blood. Actually, it was a drop at most, just a little scratch. Somehow all four nails had missed his foot and toes.

Earl shifted on the stretcher, and his head rolled to one side and then lazily up to where he could see us.

“Doc, am I gonna lose my foot?”

“No, Earl—you’re going to be alright.”

His head flopped back down onto the stretcher.

“Well, thank the Lord.”

All Swole Up

“Dr. Lesslie, do you remember me?”

I was standing in line in the grocery store and the question caused me to tense, just like it always did.

The words had come from behind me and I slowly turned and stood face-to-face with a middle-aged woman. She was smiling. Yes! It was going to be something good.

She looked familiar, but I couldn’t quite place her. And I for sure couldn’t remember her name. That’s one skill I haven’t mastered—remembering names. Just ask my wife.
Her
name is…dang it! It’ll come to me.

“You saw my little girl in the ER about eight or nine years ago.” The woman was beaming now, and her eyes were dancing. “I’m just so glad I bumped into you. All these years, and I’ve been wanting to thank you.”

I waited, still not remembering this woman or her daughter.

She patted the head of the girl standing beside her. “Nobody could figure out what was wrong with Adele. Not until we came and saw you that night in the ER.”

It was my turn, and I had to say
something.
“I’m glad she’s better.”
How lame was that?

“Better? She’s
better
than better. She’s fine now. But for a couple of weeks there, we were really worried, what with her legs swelling up all the time. Could barely walk.”

It was starting to come back now, and I looked more closely at the woman’s face. Her daughter would have been a teenager eight or nine years ago—and with swollen legs that were bad enough to bring her to the ER. Then I remembered.

Jay Barton had been working the morning shift with me. He had finished his emergency-medicine residency a couple of years earlier. Jay knew his stuff, but the thirteen-year-old girl he was seeing in room 2 had him stumped.

We stood beside each other at the nurses’ station, and I watched as he drummed the girl’s record with the fingers of his right hand.

“This just doesn’t make sense.” He stopped his drumming and loudly slapped the chart. “Perfectly healthy up until a few weeks ago, then started having some swelling in her legs, mainly in the morning. It’s bad enough to keep her from putting on her shoes. Gets better during the day, when she’s up on her feet, and starts all over again the next morning.”

I glanced down at the girl’s record.

Adele Hoskins. Legs swole up.

“Descriptive.” I pointed at the word
swole
.

“The secretaries up front just type what the patient says. Or in this case, the mother. But it
is
descriptive. She
is
all swole up.”

He chuckled but then scratched his chin and frowned.

“Vital signs are fine.” I pointed to her blood pressure and pulse. “Any weight gain or shortness of breath?”

“No, none of that. My first thought was her kidneys—she’s a little old for nephrotic syndrome, but I guess it could happen. That would explain the edema. But like you said, her blood pressure is fine, and there’s no protein in her urine. I’m waiting on some lab work and a chest X-ray, but so far I’m drawing blanks. Other than the swelling, she’s completely normal.”

“Dr. Barton, Dr. James is on the phone.” Amy Connors held the receiver over the counter and Jay grabbed it. He placed a hand over the mouthpiece and whispered, “This is her family doctor, and her mother said Adele’s been in the office three or four times with this. I want to see what he—”

He put the phone to his ear. “Bradley, this is Jay Barton. Thanks for returning my call. We’ve got Adele Hoskins here in the ER with her legs swollen again. Any thoughts as to what might be causing this?”

I walked down the hallway to a waiting patient in the ENT room. Fifteen minutes later, Jay was still at the nurses’ station. He was no longer on the phone, and still scratching his chin.

“James has no clue either,” he said with a sigh. “He’s ruled out heart disease and kidney problems. Thinks it might be some strange auto-immune
disease, something that’s just not showing up in her blood work yet. He’s going to send her to Duke and see what they think about it.”

“Did he have any suggestions about what you need to do for her today?” I understood his predicament and frustration. The only bright spot here was that Adele was his patient and not mine.

“No. He says he’s looked under every rock he can think to look under and hasn’t found a thing. He’ll be glad to see her in the office, but I sense Mrs. Hoskins is not interested in going that route anymore. That’s why she’s here.”

Jay sighed and glanced at the closed curtain of room 2. “I guess I’ll go talk with her and explain what we’ve found. Or haven’t found.”

The next time I walked up to the nurses’ station, the curtain of room 2 was pulled open and the room was empty.

A week later, it was my turn.

“She’s back.” Amy slid the chart across the counter. “Same thing. Swole legs.”

I didn’t have to look at the record to know the name of the patient.

Adele was in room 2 again. I pulled the curtain closed behind me and walked over to the stretcher.

Her legs were indeed “swole.” From the knees down, they were both distended and tense. But there was no pain, no tenderness, and her pulses were completely normal.

“Dr. Lesslie, we need some help here.” Mrs. Hoskins was pleading, wringing her hands, and pacing the small room. “It’s just not getting any better.”

Her heart and lung exams were normal, and I told them we would check another urine specimen, just to be sure nothing had developed since her last visit. But there was no reason to repeat another lengthy workup.

Lori Davidson led Adele to a nearby bathroom and gave her instructions for collecting a urine specimen. After that, she walked her back to room 2, pulled the curtain closed behind her, and was in there for what I thought was a long time. When Lori finally came out, she looked at me, smiled, and shook her head as she walked over.