I was in the shower when I heard my phone ringing. This is not unusual for me, for surgeons, or for specialists in high demand in general. It seemed there was always sick or injured people in need of saving or repair. My most hated thing in the whole wide world was failure. I simply did not see it as an option.
I shut off the water, grabbed my ringing cell phone that said it wasn't even 7am. Yeah, definitely not a good sign. Pushing the green button on the screen, I put it to my ear, "hello?" I pulled it away after no answer and saw it was her. "Kynlee, you okay?" I asked, worried she would call this early. Part of me thought the worst and her brother did or was dying.
Finally after hearing motion on the other end, she apologized for calling me. I recall asking her to call this morning and now she apologizes, afraid she might have woke me? "No you didn't wake me. I was taking a shower." I just knew instinctively this wasn't a social call and asked again, "Kynlee, what's wrong?" I heard her breathing change on the other end of the line. What I wouldn't give to be there comforting her. Morals be damned!
Next thing I knew, I was dressing and promising to get there as soon as possible. I felt like a magnet being drawn to her. After a little more discussion, I said I'd see her soon and jumped in my SUV. I didn't even take time to shave and simply finger combed my wet hair. My main focus right now was Kynlee and Kedron.
The whole drive to the hospital I considered all the things that could be causing Kedron to spike and hold a temperature of 103.5. My biggest fear was one of the major nosocomial bacterial infections that are so hard to fight: Methicillin Resistant Staphylococcus Aureus (MRSA) or Vancomycin-resistant Enterococcus (VRE). Both bacteria were becoming more and more resistant to antibiotics, something that happened due to overuse of antibiotics for illnesses not treatable with antibiotics. Humans, I've learned over my years as a neurosurgeon, are rarely patient when it comes to injury or illness. They want it fixed yesterday and to return to their crazy, hectic, stressful ways. People don't seem to realize that illness and injury sometimes happen to slow them down, to make them take notice, and make them improve their habits or change their lives. Obviously that wasn't the case with Kedron, who had an honest work accident while trying to support himself and his sister. I could easily feel the weight of the situation Kedron was in, to try to better their plight in life. The sad truth now was that Kedron was in serious condition, and if we didn't figure it out and correct it, he could die. Kynlee was correct about people dying from pneumonia. If pneumonia wasn't treated quickly in someone who is respiratory compromised, it could turn to sepsis, and then his chances were not good. Kedron had a 50-75% chance of survival just with the pneumonia. If it turned to sepsis, his chances of survival would be cut in half.
I stepped off the elevator, deep in thought. I walked quickly to room 1112 to see what I could do. As I looked into the room though, I saw Kynlee and my feet moved in her direction. She looked so small..... so lost, sitting in the chair next to her brother. Instinctively I squatted down in front of her, met her gaze, and was hit by an almost overwhelming yearning to hold her. I knew I couldn't, not here in the hospital in view of everyone. To stay in control, I met her eyes and grabbed her fisted hand with my own. I noticed her hair was still mussed from sleep, her eyes were blood shot with wet eyelashes from crying, and when I asked, "are you okay?"
Kynlee responded, "thank you for coming Dr. Teton."
I wanted to ask why the hell she continued with the official "Dr. Teton," title when I've asked her not to. Then her eyes flicked from mine briefly to Nurse Nancy in the corner. Yes, Nancy was a stickler for rules, having worked ICU for decades. I winked at Kynlee before getting up to put distance between us and get the information I needed to help her twin brother.
The lab reports were back and showed a significantly elevated white blood cell count. That combined with the fever, increased secretions needed to be suctioned, and diminished lung sounds, pointed toward ventilator assisted pneumonia (VAP). All we needed was the X-ray to confirm it. Kedron's injuries made him a prime candidate for VAP. Wam went to find Dr. Hanson to make sure he had ordered cultures and to see what broad spectrum antibiotic he was prescribing while they awaited the culture and sensitivity results. The culture and sensitivity results would allow us to treat the specific bacteria, giving Kedron the best chances at survival.
Wam entered the employee lounge, and there sat Dr. Hanson with a stack of charts. He looked up from the chart he was working on and greeted Wam, "good morning Dr. Teton. To what do I owe the honor?"
I entered and sat across the table from him, but couldn't help but smile at the skepticism written all over his face. "As you know, I'm consulting on several cases right now. My immediate concern is Mr. Knutson. Do you have a plan yet?"
"Why Dr. Teton, I never knew you cared...."
Dr. Hanson exclaimed and returned to his chart. "Come on Hal, I'm serious. With the high white count, fever, and increased amount and change in color of secretions, it's obvious it's pneumonia. How bad was the X-ray?" I sat and watched Dr. Hal Hanson as he efficiently attempted to ignore me. What a prick, to ignore me as if I wasn't there... "Look Hal, you either give me the information, or I'll report you to Dr. Paul for withholding information on a patient I'm consulting on."
Not lifting his head or eyes, Dr. Hanson began to laugh. "Geez Wam... got your panties in a wad much? What the heck is your issue?" Hal then set his pen down, checked his texts and said, "I'm the hospitalist and not all the results are back yet. I have a suspicion, but I'm choosing to wait until we have all the results to treat. I did prescribe some neb treatments, increased oral cares from every two hours to hourly, and talked to Dr. Adams about possible surgery to stabilize the cervical injury now that the cerebral edema is declining."
"You think surgery is going to make this better?" I asked sarcastically.
Hal's phone beeped. He looked and said, "X-rays have been posted. Care to take a gander at them with me?"
I simply nodded in response and moved to his side of the table. Hal sifted through his pile of folders, pulled his tablet out, and loaded Kedron's file with all his results. As we suspected, there were infiltrates throughout the lower half of both lungs. These white patches on X-ray showed inflammation caused by infection. Without treatment, the infection would turn to sepsis, and Kedron would not wake up. After brief discussion, we walked down to the hospital room to update Kynlee and get her permission to treat Kedron.
Of course she willingly gave permission to use a broad spectrum antibiotic until the cultures came back with more specific results. We would increase nebulizer treatments, add an antibiotic to the nebulizer treatments, increase postural drainage and suction, attempt to back off on the sedatives since the cerebral edema was lessening, and continue to give IV fluids to keep Kedron well hydrated.
I may not be a pulmonologist, but I'd worked enough cases as part of a team with pulmonology that I knew well what the treatments would be. Catching the pneumonia early and treating it aggressively increased Kedron's chances of survival, but he was still not in the clear by any means.
More tears had slipped from Kynlee's eyes when I confirmed her fear that it was indeed ventilator-assisted pneumonia. I explained we needed to carefully change Kedron's position frequently to help mobilize the secretions, but reassess frequently to make sure there were no signs of increased intracranial pressure. This case was indeed quite complex, and it was common for a new complication to arise just as the last problem is getting back under control.
No doubt Kedron's youth and fit physical body before the accident should work in his favor. Within the next week or two, the inflammation should continue to resolve, and we should get a better idea of the severity and permanence of his injuries. For the sake of both the twins, I hoped Kedron improved dramatically and the spinal cord injury wasn't permanent. Sadly, I'd worked enough cases to know that only about one in seven cases recovers significantly after a serious spinal cord injury. For the other six of seven, the paralysis was permanent.
I considered myself a spiritual man and certainly believed in a power greater than myself. Any doctor that had been around any length of time and did not believe in divine intervention or miracles, in my opinion, didn't belong in medicine. We are simply
an extension of the powers that be. We are like the hand at the end of God's arm. We are given knowledge and abilities in some cases to allow miracles to take place.
Sadly, in other cases, it doesn't matter what we do. If someone's time is up, the Grim Reaper comes calling and no amount of effort or intervention will save them. Hopefully Kedron's time was nowhere near up, and he and Kynlee would continue to have each other to lean on. I would do everything in my power, to make that happen.
As Nurse Nancy started Kedron's new medications and respiratory treatments, I asked Kynlee to take a walk with me. We had many things to discuss, and it needed to be done where we had some semblance of privacy.
We walked down the stairs and took a seat in the atrium, so we could enjoy the flowers as we talked. I was always amazed at the beautiful trees and flowers in every vivid color under the rainbow. Vegetation and wildlife, all things nature, have been shown in studies to help decrease stress and depression. So of course this was where I brought Kynlee to discuss the immediate future and turn over all pertinent information and supplies she may need while I'm absent this week.
I had not suspected it would be so difficult for me to leave, knowing Kynlee would be under my roof while I was under another. I may just have to find a reason to come back before the weekend. I may not understand my attraction to Kynlee, but that certainly did nothing to decrease it.