Plague

Chapter 6 Day 1: 9:45 PM

Chapter 6
Day 1
9:45 PM

Jacob saw Joan as soon as he got in the door to the Pediatric Unit. She was looking very worried while she was taking the blood pressure of a young boy lying quietly on the floor. Jacob walked over to check out the child’s pupils.
“Hi, Joan,” he said, as he knelt down next to her, “How old is this kid?”
“He’ll be twelve next month. What do you think?”
“I think I’d better borrow your bag and examine him,” Jacob said.
The boy’s eyes were open, with both pupils the same size and both reactive to light. So far so good, Jacob thought. He examined the boy’s retina, and saw the outlines of the optic nerves though his pupils, and found no signs of an increase in the pressure inside his skull. The boy’s muscle tone was the same in all his extremities- much greater than normal. Jacob pressed his knuckle into the boy’s breast bone to get some reaction to pain, but there was none. The child’s reflexes were decreased, but that could have been because of the boy’s increased muscle tone. Lastly, Jacob scratched the bottoms of the child’s feet, looking for the Babinski sign, the most common tip-off of a problem in the brain. It was absent.
Jacob went over to the nursing desk where Joan was writing a note and asked for a nurse to assist the nurse he had left with the child, and get him back to his bed.
“I need some water and a syringe to do some calorics on the boy,” Jacob told Joan. “I want to see if the back of his brain is working.”
Jacob was about to ask Joan to see the chart and look at the results of the laboratory studies, when one of the children who had been standing around let out a shriek. Turning, he saw the two nurses around the boy, whose name, according to the front of the chart, was Kenny Jackson. They were holding onto the boy’s arms and legs, which were vigorously moving.
Jacob grabbed the valium from the desk next to Joan and ran over to where the boy was lying. He asked the nurses to let go of the boy.
To treat a seizure is easy, he knew, but it’s necessary to first get a look at what you’re treating.
There were no typical tonic-clonic or to and fro movements that characterize a grand mal seizure. The boy’s arms and legs were moving, but indiscriminately, flailing around in a jerky, disjointed way. He tried to talk, but Jacob couldn’t understand anything he said.
The boy appeared awake, even though his limbs were still jerking around. Jacob put his arm under the child’s shoulders and tried to sit him up. The movements subsided as he and a nurse held him in a seated position. Jacob asked him if he was feeling better; then he asked the boy to tell him his name, mainly to see if he could comprehend what was asked and answer coherently. The boy looked at Jacob, but there were no signs of cognition. His stare was blank.
Kenny began to look around the room with both eyes moving together, and again tried to talk. Suddenly, his entire body jerked. His eye movements became disjointed, with the eyes looking in different directions.
Jacob called his name but there was no reaction. He pinched the flesh of the boy’s arm and Kenny ignored that, too.
The boy slowly raised himself from his seated position. His torso jerked harder and harder until finally he got his body to a kneeling position and then stood up.
Jacob backed off and watched to see how the boy moved.
One of the nurses still held on to an arm. Jacob waved her back and tried to position himself to catch the boy if he fell.
Kenny moved forward, with a staggering, swaying gait that didn’t fit any particular neurological syndrome. His legs jerked at the knees and his arms flung themselves up and down in no particular sequence.
Jacob stood in front of him, with his arms outstretched, and looked into the boy’s eyes. They were moving disconjugately, each eye independent of the other. Kenny held his arms out in front of him. His wrists and elbows moved up and down in fast, hard jerks. He was like a puppet being controlled by a novice who couldn’t make the doll move smoothly.
Kenny continued to lurch forward, arms flailing and feet jerking. His eyes made no contact with anyone or anything, but jumped around in his head, each eye in its own orbit. It was scary as hell, Jacob thought: he had no idea what was going on.
Suddenly, Kenny jerked his head up until his face was looking straight up at the ceiling. He seemed to stand suspended for several seconds before he collapsed and fell to the floor.
Jacob was able to grab him before he struck the floor. He gently laid the boy on the carpet and knelt by his side. Kenny’s pulse was weak but steady. His eyes were still disconjugate and each looked in a different direction. He started to shake, one arm and then the other, slowly and spastically.
Not wanting to see a repeat performance of the Frankenstein Waltz, Jacob injected five milligrams of Valium into a vein in Kenny’s arm and watched his small body relax.
With a nurse’s help, Jacob carried him into the examination room and placed him on the leather covered table. Jacob inserted an intravenous drip into his arm and left the nurse with him while he went to talk to Joan Armitridge.
She was standing by the floor desk, tearing a piece of blank paper into little bits. When she saw Jacob, she appeared to relax and asked him, “Well, what do you think?”
Jacob didn’t know what to think, so he just watched her rip up some more paper while he tried to make some sense of what he had seen.
“Joan, does Kenny have any psychiatric history?” he asked.
“Not that I’m aware of, anyway. He definitely doesn’t have a history of seizures. He’s been very healthy until now.”
“Well,” Jacob told her, “I’ve never seen a seizure like that one. Seizures originating from the temporal lobes on the sides of the brain can be very strange, but I don’t think that’s the answer here.
“Unfortunately, I don’t have a better answer.”
Joan and Jacob stared at each other in silence. He thought of the Mexican boy and the similarities in the description of his movements and what he had just witnessed. That didn’t make any sense to him either.
The phone rang at the nursing station.
Joan answered it and passed the phone to Jacob.
“Jake,” Tom Brighton said, “Stephan wants you to come down as soon as you can. He says it’s very important.”
“What did he find?”
“I don’t know. I was in the next room. I’ve hated autopsies since medical school. How are things up there?”
“Strange, to say the least,” Jacob said. “Would you believe another kid who walks like something out of monster movie? From what I’ve heard about the Mexican boy, he acted very much like the kid up here. Tom, I’d like you to do another CAT scan now, Okay? I’ll have the boy down there in five minutes.”
“No problem, Jacob, I didn’t shut down the machine, so that won’t be a problem. I’d rather do that than watch a post-mortem anyway. See you down here.”
Jacob told Joan about the test he’d scheduled and walked with her to the examining room. Mulvihill, the nurse he’d left with the boy, was gone.
“Where the hell is she?” Jacob asked.
“I don’t know, Jacob. Maybe she went to get his chart.”
“The chart was on the desk with us. I didn’t even see her leave the room. What’s with Kenny?”
The boy’s breathing had become irregular. Jacob peeled his eyelids up and saw two widely dilated pupils. They didn’t constrict when he shined his penlight into them, either. Jacob tried to lift his head up, off of the examination table, but it was too rigid; the boy’s shoulders came up off of the bed along with his head. Jacob had the sinking feeling that Stephan would have some more work that night.
“Joan,” Jake said, “Get me 100 milligrams of Decadron. Maybe we can help…Shit! He arrested- Joan, get a cart!”
Kenny had stopped breathing and was as good as dead if something wasn’t done quickly. While Joan called the hospital code that would bring six or eight doctors and nurses whose business was trying to cheat death by bringing back those who were just leaving a bit too early, Jacob started pushing down on the boy’s chest and breathing for him, blowing air from his lungs to the boys, inflating his small chest as much as he dared.
Three minutes later the room was overflowing with doctors and nurses putting more tubes into each of the boy’s arms, his bladder and trachea. Others worked an ambu-bag, pushing oxygen into his lungs. Nurses called out medication names and dosages and filled syringes, handing them to the doctors who proceeded to plunge them into the boy’s IV or directly into his heart, hoping to change the flat line seen on the EKG monitor to a series of rhythmic blips. The physician leading the arrest called for everyone to stand away from the bed, then placed two paddles on the child’s chest and sent several hundred volts of electricity into his heart, trying to give it a little help in starting back up. The scene was chaos, but controlled chaos; the best medicine has to offer.
Jacob was standing away from the table, over by the door, with Joan. She motioned for him to follow her out of the room.
“He’s not going to make it, Jacob. What the hell is going on? The kid comes in with tonsillitis, a mild case at that, has a funny seizure or something, and dies. His lungs stop working. This is right out of those hospital movies! Why did that kid die?”
Her voice was rising, the shrillness fueled by anger and frustration. Jacob was damned if he knew what was happening, but rather than tell that to Joan, he picked up a phone and called the Pathology lab. When Stephan answered, Jacob said, “Stephan, ready the next slab and start thinking what to call your research paper.”
Stephan started to bellow, and Jacob hung up the phone and walked back into the examination room in time to hear the cardiac arrest team leader order a halt to the proceedings. The boy was now officially dead. They covered his body and wearily filed out of the room, mumbling apologies to Joan for not being able to call Charon back, and then they left the Pediatric ward.
Jacob woke up to the frightened faces of some of the ambulatory children looking open-mouthed at the parade of medical people, sensing the sorrow in the air. It hurts to lose a child. He still felt like shit as well stupid. He still didn’t have any idea at all as to what had killed the boy.
He helped Joan and a couple of nurses put the children back in their rooms. Joan ordered mild sedatives for the most frightened children and then she and Jacob started out of the door to the ward. Before the door was closed one of the nurses called to Joan, motioning from one of the rooms.
“I think Mulvihill is sick,” the nurse told Joan. “Or maybe she’s drunk again. She’s just lying on a bed moving around like she’s having a nightmare or something.”
Jacob moved quickly to the door and pushed it wide open. There, appearing to be sleeping peacefully was Nurse Mulvihill. She was breathing stentoriously, occasionally twitching an arm or a leg. Jacob put his hand on her arm and nudged her gently. Nothing happened, so he pushed a bit harder. With a loud snort she opened her eyes and sat up. She looked confused for a moment, her eyes moving sluggishly around the room. She snorted again and opened her mouth, but closed it without saying a word. Joan walked up to her and asked if she was all right. Mulvihill shook her head from side to side and then up and down.
“Of course I’m all right. What are we doing in here?” Mulvihill asked.
Her speech was a bit slurred and her words were not very clear. Her eyes seemed to go in and out of focus as she looked around, her pupils alternately constricting and dilating.
Lurching slightly, she got to her feet. Mulvihill wobbled a little, but kept her balance. She started to walk to the door but seemed to trip over her feet. Her hand shot out to grab Jacob’s extended arm, but missed by several inches. He took her hand and supported her until she could stand straight.
“Are you sure everything is all right? Why did you leave the Jackson boy alone?” Joan asked her.
“I really don’t remember doing that,” Mulvihill said. “I just had to lie down for a few minutes. I guess I didn’t feel too well. Is the boy all right?”
“No. He died a few minutes ago,” Joan told her.
That didn’t seem to faze the nurse. Mulvihill looked around the room again and slowly moved towards the door. Her gait was better than what it had been before. Actually, she moved a lot better than when she first woke up, Jacob noticed.
“Nurse,” Joan said, anger in her voice, “I’m going to report this to the nursing supervisor in the morning. I hope this won’t happen again.”
Mulvihill stated to get wobbly again. She leaned up against the side of the door and turned her head to look at Jacob. Her eyes seemed to fasten onto his, but he had the feeling she was looking right through him. Without another word, she turned and left the room.
Joan looked at Jacob, puzzlement etched on her face.
“I don’t understand this,” she said. “Mulvihill has always been such a good, competent nurse. I can’t imagine why she’d do something as irresponsible as this.”
The two physicians walked out into the hall in time to see nurse Mulvihill turning the corner to an intersecting hallway. She still wasn’t navigating smoothly. She could have just been showing the effects of chronic alcoholism, with a wide based, ataxic, abnormal gait, Jacob knew.
Rumor had it that Mulvihill had tipped more than her fair share of bottles. She had thin, colorless hair that always seemed unkempt, a wide face with multitudes of broken capillaries, and an ever-present sorrowful expression. She was probably a drunk, Jacob thought.
Joan and Jacob placed Kenny Jackson’s body on a cart, covered it and set off for the Pathology lab. He hoped Stephan had some idea of what was going on, because he sure as hell didn’t.