4:15 P.M.
'Do you want the Phenytoin?' Dr. Draper yelled at Dr. Sheila Miller. Dr. Draper was one of the senior residents in the emergency medicine program at the University Medical Center.
'No!' Sheila snapped. 'I don't want to take any chances on causing an arrhythmia. Give me ten milligrams of Valium IV now that we have the airway secured.'
The city ambulance had called earlier to report that they were bringing in a forty-two-year-old diabetic who was in the throes of a major seizure. Considering what had happened with the seizing, diabetic woman the day before, the whole ER team, including Dr. Sheila Miller, had turned out for this new emergency.
Upon arrival the man had been taken directly into one of the bays where his airway had been given top priority. Then stat blood work had been drawn. Concurrently monitors were attached followed by a bolus of IV glucose.
Since the seizing had continued, more medication was necessary. That was when Sheila decided on the Valium.
'Valium given,' Ron Severide said. Ron was one of the evening RNs.
Sheila was watching the monitor. Remembering what had happened with the woman the day before, she did not want this patient to arrest.
'What's the patient's name?' Sheila asked. By that time the patient had been in the ER for ten minutes.
'Louis Devereau,' Ron said.
'Any other medical history besides the diabetes?' Sheila asked. 'Any cardiac history?'
'None that we're aware of,' Dr. Draper said.
'Good,' Sheila said. She began to calm down. So did the patient. After a few more jerks, the seizing stopped.
'Looking good,' Ron said.
No sooner had this positive assessment escaped from Ron's lips than the patient starting convulsing again.
'That's amazing,' Dr. Draper said. 'He's seizing in the face of both the Valium and the glucose. What's going on here?'
Sheila didn't respond. She was too busy watching the cardiac monitor. There'd been a couple of ectopic beats. She was about to order some lidocaine when the patient arrested.
'Don't do this,' Sheila cried as she joined the others in a resuscitation effort.
In a fashion eerily similar to the experience with the woman the day before, Louis Devereau went from fibrillation to flatline no matter what the ER team did. To their great chagrin they had to admit defeat once again, and the patient was pronounced dead.
Feeling anger at the inadequacy of their effort, Sheila snapped her gloves off her hands and threw them forcibly into the appropriate container. Dr. Draper did the same. Together they walked back toward the main desk.
'Get on the phone with the medical examiner,' Sheila said. 'Make sure you convey to him the necessity of trying to figure out what caused this death. This can't go on. These were both relatively young patients.'
'They both were insulin-dependent,' Dr. Draper said. 'And both had had long-term diabetes.'
They reached the expansive ER desk. There was a lot of activity.
'So when has middle-aged diabetes become a fatal illness?' Sheila asked.
'Good point,' Dr. Draper said.
Sheila glanced into the waiting room, and her eyebrows lifted. There were so many patients that there was standing room only. Ten minutes previously there'd been the normal number for that time of day. She turned to ask one of the clerks sitting behind the desk if there was some explanation for the sudden crowd and found herself looking at Pitt Henderson.
'Don't you ever go home?' she asked. 'Cheryl Watkins told me you were back here hours after a twenty- four-hour shift.'
'I'm here to learn,' Pitt said. It was a planned retort. He'd seen her approach the desk.
'Well, good grief, don't burn out,' Sheila said. 'You haven't even started medical school yet.'
'I just heard that the diabetic who'd just come in passed away,' Pitt said. 'That must be very hard for you to deal with.'
Sheila looked down at this college senior. He was surprising her. Only the morning before he'd irritated her by sloshing her coffee all over her arm in a room where he had no business being. Now he was being uncharacteristically sensitive for a college-aged male. He was also attractive, with his coal-black hair and dark, liquid eyes. In a fleeting instant, she wondered how she would respond if he were twenty years older.
'I have something here that you will want to see,' Pitt said. He handed her a printout from the lab.
Sheila took the sheet and glanced at it. 'What is this?' she asked.
'It's the blood work on that diabetic who died yesterday' Pitt said. 'I thought you might be particularly interested because all the values are entirely normal. Even the blood sugar.'
Sheila scanned the list. Pitt was right.
'It will be interesting to see what today's patient's values are,' Pitt said. 'From the reading I've done, I can't think of any reason the first patient should have had a seizure.'
Sheila was now impressed. None of the other college students who'd come through on the clerking program had shown such a degree of interest. 'I'll count on you to get me the blood work on today's patient,' she said.
'My pleasure,' Pitt said.
'Meanwhile,' Sheila said, 'do you have any idea why there are so many people in the waiting room?'
'I think so,' Pitt said. 'It's probably because most of the people delayed coming in until after work. They're all complaining of the flu. Checking through the records from yesterday and today, we've been seeing more and more people with the same symptoms. I think it's something that you should look into.'
'But it's flu season,' Sheila said. She was even more impressed. Pitt was actually thinking.
'It might be flu season, but this outbreak seems unique,' Pitt said. 'I checked with the lab, and they have yet to have a positive test for influenza.'
'Sometimes they have to grow the influenza virus in tissue culture before they get a positive test. That can take a few days.'
'Yeah, I read that,' Pitt said. 'But in this instance I think it's strange because all these patients have had a lot of respiratory symptoms, so the virus should be there in a high liter. At least that's what it said in the text I was reading.'
'I have to say I'm impressed with your initiative,' Sheila said.
'Well, the situation worries me,' Pitt said. 'What if it is a new strain, maybe a new illness? My best friend got it a couple of days ago, and he was really sick, but only for a number of hours. That doesn't sound like regular old flu to me. Besides, after he'd recovered he hasn't been himself. I mean he's been healthy, but he's been acting strange.'
'How do you mean strange?' Sheila asked. She began to consider the possibility of viral encephalitis. It was a rare complication of influenza.
'Like a different person,' Pitt said. 'Well, not totally different, just a little different. The same thing seems to have happened to the principal of the high school.'
'You mean like a slight personality change?' Sheila asked.
'Yeah, I suppose you could say that,' Pitt said. He was afraid to tell her about Beau's apparent increase in strength and speed and the fact that Beau had occupied the room that had become distorted; Pitt was afraid he'd lose all credibility. He was nervous about talking to Dr. Miller as it was and wouldn't have approached her on his own accord.
'And one other thing,' Pitt said, thinking that he'd come this far and might as well let it all out. 'I checked the chart of the diabetic woman who died yesterday. She had had flu symptoms before she got her seizure.'
Sheila stared into Pitt's dark eyes while she pondered what he'd said. Suddenly she looked up and called out to Dr. Draper, asking him if Louis Devereau had had flu symptoms before he had his seizure.
'Yes, he did,' Dr. Draper said. 'Why do you ask?'
Sheila ignored Dr. Draper's question. Instead she looked down at Pitt. 'About how many patients have we seen with this flu and how many are waiting?'
