as such.”
He lifted one eyebrow. “You aren’t giving me much to go on. A diagnosis of ‘He doesn’t look right’ isn’t strong enough to justify a battery of tests.”
Her face warmed under his rebuke. Other physicians would have attributed her impression as that proverbial gut feeling no one could afford to ignore, but clearly Lincoln Maguire didn’t believe in intuition. He only wanted cold, hard evidence. As far as she was concerned, he’d answered her private question about what he thought of her nursing savvy.
“I realize that,” she said stiffly, her spine straight, “which is why I’ve been watching him. He doesn’t complain about pain as such, but he finally admitted he has a few twinges because I’ve caught him rubbing his chest. According to the nursing notes, he received an antacid for heartburn several times during the night.”
“You don’t think heartburn is a possibility?” he asked.
“No,” she said bluntly, “but only because I think his skin color is off.”
He retrieved the chart on the computer and began perusing the notes. “How are his oxygen sats?”
“On the low end of normal.”
“Shortness of breath?”
She shook her head. “He said his chest sometimes feels a little tight, but that’s all.”
He stared thoughtfully at the computer before meeting her gaze. “It could be anything and it could be nothing.”
“I know, which is why I wanted to ask you to check him thoroughly.”
He hesitated for a fraction of a second before he shrugged. “Okay. Duly noted. I’ll see what I can find.”
She’d been half-afraid he’d dismiss her concerns, so she was grateful to hear of his intentions to follow through. And because she was relieved to pass the burden onto his shoulders, she chose to make small talk as they strode toward the room. “Are you ready for tonight?”
“I am,” he said. “Do you need help taking anything over to Ty’s house?”
“Not now,” she said. “I’m only moving some clothes and a few books. What I don’t bring now, I can always get later.”
“Fair enough.” He strode into Lopez’s room and the subject was closed.
Christy watched and listened as Linc checked his patient, seeming much more congenial with Jose than with her, but, then, a lot of the nurses had said he was far more personable with his patients than with the staff. She took some comfort in that because she’d begun to wonder if he was only uncomfortable around her.
“I hear you’re having a few chest twinges,” Linc mentioned as he pulled out his stethoscope and listened to Jose’s heart and lung sounds.
“Some. It’s happening more often than it did yesterday, though. Sometimes I cough for no reason,” the forty-year-old replied. Jose was of average height, but between his wife’s reportedly fantastic cooking and his years as a stonemason, he was built like the bricks he laid for a living. “Do you think it’s the hospital food? Maybe it’s giving me the heartburn.” His tanned, leathery face broke into a smile.
Linc laughed. “If you’re hinting that you want me to give Francesca permission to bring you some of her famous enchiladas, you’ll be disappointed.”
“It was worth a try, Doc.”
Christy watched the friendly exchange, stunned by how Linc’s smile made him seem so … normal. Clearly, the man did have moments when he wasn’t completely focused on his work, but she’d gone on countless rounds with him over the past year and had never heard such a heartfelt sound. She would have remembered if she had. Somehow, she sensed the two of them had more than a simple doctor-patient relationship, which only made her curious as to what connection a blue-collar worker like Jose had with the highly successful general surgeon.
He flung the stethoscope around his neck. “A few more days and you can eat her cooking to your heart’s content. Meanwhile, though, I want to check out these little twinges and the cough you’re having. We’re going to run a few tests so be prepared for everything from X-rays and EKGs to blood work.”
Jose’s expression sobered. “You think it’s my heart?”
“Not necessarily. If your chest feels tight and you’re noticing a cough, pneumonia is a concern,” he said, “so I’m going to try and discover what’s going on. As you said, you may only have heartburn but, to be thorough, we’re going to check out everything. Okay?”
His confidence was reassuring because Jose’s face relaxed. It was obvious why Linc’s patients loved him, and why he was so very busy.
“Are you having any pain in your legs?” Linc asked.
Jose wrinkled his face in thought. “I had a charley horse earlier in my right calf, but it’s gone now.”
Linc immediately flung back the sheet and checked his legs. “We’ll look into that, too,” he said, sounding unconcerned, “and as soon as I get those results, we’ll let you know what we’ve found. Okay?” He patted Jose’s shoulder before he left.
Outside Lopez’s room, Christy immediately pounced. “Then I was right. You found something.”
“Not really,” he admitted.
“Oh.” Her good spirits deflated.
“Are you sure his condition has changed in the last twenty-four hours?”
She knew what her intuition was telling her and she wasn’t going to back down. “He said himself he has a cough and his chest feels tight,” she reminded him. “Now he has a muscle spasm in his leg. Those are new symptoms.”
He looked thoughtful for a moment. “Okay,” he said decisively. “I want a chest X-ray, a Doppler exam on his legs, and blood drawn for a blood count, a cardiac panel and a D-dimer test.”
She recognized the latter as one used to diagnose the presence of a blood clot. “Do you suspect a PE?” She used the shorthand for pulmonary embolism.
“I suspect a lot of things, but in the interest of ruling out as much as we can we’ll add that to the list of possibilities. I also want a CT scan of his lungs and if the results are inconclusive, I want a VQ scan.”
The CT scan was a quick way to detect a blood clot, but not every clot was detected using this procedure, which meant the next step was the VQ scan. The two-part ventilation-perfusion procedure used both injected and aerosolized radioactive material to show the amount of blood and air flowing through the lungs. Naturally, if the patterns were abnormal, intervention was required.
“I’ll get right on it,” she said.
“And call me ASAP with those results,” he ordered in the brisk tone she knew so well.
As Christy placed the various orders into the computer system, she was hoping the tests would show something to support her nagging intuition, although she hoped it would be something relatively uncomplicated.
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