“Yes, put him on the cardiac monitor,” Simon agreed. He turned toward the patient’s wife. “Sometimes chest pain can radiate to other parts of the body. We don’t want to miss anything, so we’re going to do a full work-up.”
“All right,” the wife agreed.
“I’ll be fine, Myra,” Mr. McLeod said, patting his wife’s hand. “I’ll be out of here in a jiffy. I’m sure this is nothing more than food poisoning.”
Simon suspected the gentleman was downplaying his symptoms for his wife’s sake. He took out his stethoscope to listen to his patient’s heart and lungs. Hailey came in close beside him, reaching around him in order to put the electrodes on Mr. McLeod’s chest and then reaching up to turn on the monitor. He’d picked the wrong side of the bed, since the monitor cables were on the same side he was standing. Hailey’s scent, something fresh, like the scent of the ocean, teased his senses. He eased away, as far as his stethoscope would allow.
When Hailey finished getting Mr. McLeod connected to the monitor, she went around to the other side of the bed, where the supply cart was located. Simon relaxed and finished his exam, verifying normal heart and lung sounds.
He moved his stethoscope to his patient’s abdomen, expecting hyperactive bowel sounds. Instead, the normal gurgling sounds were diminished.
“Tiny poke here,” Hailey warned. She deftly slid a needle into his vein, filling up her numerous blood tubes.
“I’m going to call Radiology to schedule you for a CT scan,” Simon told him. “You’re heart looks okay so far, but I think you may have something going on with your abdomen. A CT scan is the best thing to show us what’s going on.”
“Do you really think that’s necessary?” Mr. McLeod asked skeptically. “I’m sure I’ll be fine in a while.”
Simon frowned. “Yes, I do think this test is necessary,” he said firmly. Hailey lifted a brow but didn’t say anything as she slipped out of the room, no doubt to send their patient’s blood to the lab. He sharpened his gaze on his patient. “You may have appendicitis or something worse, like a pocket of infection or an aortic aneurysm.”
“Hank, please.” Mrs. McLeod was practically wringing her hands at the list of potential problems. “Don’t argue with the doctor. Have the CT scan, please.”
“All right, I’ll have the scan.” A mutinous expression darkened the patient’s eyes. “But I’m already feeling better. I’m sure there’s nothing seriously wrong with me.”
Simon wasn’t so sure, but since Hank McLeod had agreed to have the scan, he wasn’t going to waste any time in getting it ordered. “Someone will be in soon to take you to Radiology,” he promised.
While he was on the phone with the radiologist, he realized Hailey was standing beside him, chewing her lower lip anxiously, obviously waiting for him to get off the phone. When he finished his call, he glanced at her. “What’s wrong?”
She let out a sigh. “Do you think it’s possible Mr. McLeod has an abdominal aortic aneurysm? Everything about his presentation reminds me of a patient I had about six months ago back in Milwaukee. Same type of abdominal pain, same relatively stable vital signs, except for the high blood pressure, and even the same stubborn denial that anything was wrong.”
Simon was impressed by her gut instinct. “It’s one of my differential diagnoses, yes. And if he does have one, we’ll find it on the CT scan. They’re finishing another patient now, but they’ll be ready for him in about ten to fifteen minutes.”
“Sounds good. I’m going to give Jimmy and his mom discharge instructions and then I’ll be ready to go with Mr. McLeod. I just need you to write out his prescriptions.”
“Jimmy?” Simon had to think for a minute to figure out who she was talking about, and then he nodded. “Oh, yeah, the kid with the dogbite.” He logged on to the nearest computer and quickly pulled up the sixteen-year-old’s record. He entered in the medications and then printed the prescriptions. “Make sure he understands he has to finish all the antibiotics.”
She chuckled. “I will.”
Simon handed Hailey the scripts and then turned his attention to the other patients in their team. There was a twenty-two-year-old female patient with a severe headache that he was still waiting for Neurology to clear before he could consider sending her home. He figured she was suffering from migraines, since everything else had come back negative, but wanted the specialist to see her just in case.
Twenty minutes later, he got a call from the lab on Mr. McLeod’s blood count. The gentleman’s hemoglobin and hematocrit were on the low side, reinforcing Hailey’s suspicion that he might have a leaking abdominal aortic aneurysm.
As Simon was on the phone with the lab tech anyway, he took all the blood-work information, relieved that the cardiac injury panel was completely negative. The patient’s white blood cell count was negative too, which made the drop in his hemoglobin and hematocrit even more suspicious.
The minute he hung up the phone, his pager went off. He read the text message. McLeod’s BP is dropping, come to CT stat.
Simon didn’t waste any time heading over to the scanner, thankfully located right around the corner in the emergency department. When he arrived, Hailey glanced up at him, her expression grim.
“I told them to keep the IV in place. Do you want me to start a vasopressor to bring his blood pressure back up?” she asked.
“Yes, let’s start norepinephrine titrate to keep his blood pressure above 90 systolic.” He reached for the phone to stat page Leila Torres, the on-call surgeon working today. He quickly punched in the number for the CT scan, followed by a 911 so she’d know to come straight over. “How much of the scan were you able to complete?” he asked as he hung up the phone.
“Maybe half?” Hailey said as she pulled the IV medication out of the crash cart and hung it on the pump.
He crossed over to the reading room to look at the images. They hadn’t quite been able to get half the scan done, but he could still see there was the slightest hint of blood leaking near the guy’s descending aorta.
“What’s happening?” the patient asked Hailey. “Is the test over?”
“Your blood pressure dropped a little too low,” she explained. “We’re starting you on some medication to bring it back up.”
He caught Hailey’s hand. “Tell Myra I love her,” he said.
Simon caught the agonized look in Hailey’s eyes. “I will,” she assured him.
Leila strode into the room, glancing at Simon with an arched brow. “You rang?”
Simon pulled her into the reading room and indicated the worrisome spot on the CT scan. He kept his voice low so the patient couldn’t hear. “The only abnormal lab test he has is a low H/H. He just dropped his blood pressure so we couldn’t finish the scan. I think he has an aneurysm that’s about to rupture.”
“I think you’re right.” Leila was a petite woman with a hint of Asian heritage, and Simon had all the respect in the world for her skill as a surgeon. “I’ll take over from here.”
While
