I’m Dr. Bower.” Lukas placed the clipboard down on the counter and remained standing. “I hear you have a headache this morning.”
“Yeah, Dr. Bower.” The man continued to rub his forehead. “It’s the worst I’ve ever had.”
“Then you’ve had headaches like this before? Any nausea associated with them? Fever?”
“I’ve had some before, but not as bad as this. I’m puking my guts out.”
Lukas knew from checking the chart that the man’s temperature was normal. “Have you ever seen a doctor for headaches before, Mr. Little? Ever had a CT head scan?”
“Not yet.” The man leaned forward and pulled a card out of his back pocket. “Here. I’m supposed to go see a Dr. Pippin next week in Springfield. He’s a neurologist.”
Lukas took the card and glanced at it. It was a blank appointment card, one anybody could pick up from a front desk of a busy office. Lukas was not impressed.
“What time is your appointment? Maybe I can call for an earlier—”
“I don’t have an appointment yet, okay?” the man snapped. “Look, I’ve had this thing for two days, and it’s getting worse. Are you going to help me, or—”
Beverly rushed into the room. “Dr. Bower, we just put an asthma patient in six who sounds really tight. She’s not panicky or anything, but—”
“I’ll be there.” Lukas reached for the clipboard.
“Hey, hold it a minute!” Little came halfway off his stool. “What about me? I want to know about my headache.”
“Sorry, Mr. Little, I’ll be back,” Lukas soothed. “We have an emergency.” He knew the irony of his words would be lost on this guy.
In exam room six, a woman in her forties sat forward on the bed with her legs dangling over the side. She wore a clear face mask attached by six feet of tubing to an oxygen regulator on the wall at the head of the bed. Lukas saw that her oxygen was running at 12 liters. Good. Beverly knew her stuff. The patient wore a pulse ox gauge on her right forefinger. It looked like a plastic clothespin with a thin cable attached to a small box on the bed.
Lukas glanced over Beverly’s shoulder as she hurriedly took the woman’s vitals. The O2 sat had been 87 percent before the mask. Not good.
He stepped around to the other side of the exam table. “Good morning, Mrs. Knight.”
“Miss. I’m Darlene,” she said between breaths.
“Thank you, Darlene. I’m Dr. Bower. I’m going to listen to your lungs to get a better idea about what’s going on.” He pressed his stethoscope against her back and heard a soft, musical wheeze, both inspiratory and expiratory. She was moving very little air.
He straightened. “Beverly, do you have the vitals yet?”
“Yes, Doctor. BP 130 over 90, heart rate 120, respiration 36, temp 100.6.”
“Okay, thank you.” He gave orders for IV treatment and reassured Darlene. While Beverly carried out the orders, he went to the desk and ordered a stat respiratory therapy, blood tests and a chest X-ray.
Beverly had the IV established and was pushing the Solu-Medrol when he returned.
He glanced at the chart. “Darlene, we’ll have someone here in a few minutes to give you a breathing treatment. It’s going to help.”
She nodded, not looking at him, still fighting to breathe. “Thanks.”
Lukas frowned at her for a moment. Interesting. Her eyes were bloodshot, and dark circles shadowed them—not the typical signs of an asthmatic. She avoided eye contact. She acted as if she had other things on her mind. Other asthmatics watched every move he and the nurse made, desperate for help, needing their reassurance and attention.
He sat down in front of her. “After we get your breathing improved, then we’ll need to do some tests to check you out.” He glanced at the chart again. Beverly had only had time to do the vitals, not a complete assessment.
“Do you take any medicines, Darlene?”
She shook her head. “Supposed to take theophylline and two inhalers, but I haven’t lately. I ran out. Can’t afford refills.”
Lukas nodded. “Any drug allergies?”
She shook her head.
“Any chance of pregnancy?”
This got her attention. She shot him a very startled look, blushed, shook her head. “No.”
“Sorry, I had to ask. We’re doing an X-ray.”
She shot him another startled look. “Do you have to? I don’t have insurance.”
He considered it a moment. He’d like to see an X-ray, but with the other tests, it may not be necessary. “Okay, we’ll put a hold on that for now, but we still may need it, depending on what the other tests show.” That could be what was bothering her.
She looked slightly relieved.
“Hello.” There was a knock at the open door, and Kaye, the respiratory tech, walked in. “Are you Darlene Knight? I’ve got orders to make you start feeling better, or I lose my job. Got a few minutes?”
Lukas smiled at her. “Thanks for coming so quickly, Kaye. Darlene, I’ll be back after your treatment.” He braced himself to face the man with the migraine.
“Do you make a habit of abandoning your patients in this emergency room?” Mr. Little demanded as Lukas walked back in and laid the clipboard down on the counter.
“Not if we can avoid it,” Lukas said calmly. “Would you mind stepping to the bed?”
“Why?”
“If I’m going to treat you, I’m going to check you out. Please move to the bed. If you need some help, I can—”
“I don’t need help,” the man snapped, then grudgingly obeyed Lukas.
Lukas checked heart, lungs, reflexes. Normal. Then he lowered the lights and checked the eyes. Bingo. They were pinpoint, no dilation. In this dimly lit room, that didn’t fit.
He picked up the chart. “Mr. Little, it says here that you’re allergic to Imitrex and Reglan. Those are our drugs of choice for migraine. What medications have you taken before?”
“Demerol and morphine work best.”
“But I can’t in good conscience give you a narcotic without running some tests to make sure you’re not in danger. I need a CT and a urine—”
“What?” Little brought his hands down from his head and glared at Lukas. “What’re you trying to do to me? I just want some simple pain relief! No urine test.”
Lukas checked the time. Forty-five minutes until Camp took over. No problem with this patient; he was about to leave. Federal law
