11

Nikki did not have a good night, nor did her parents. Angela was particularly distressed. By the wee hours of morning it was clear that Nikki was becoming progressively more congested. Well before dawn Angela tried the usual postural drainage combined with percussion. When they were through, she listened to Nikki's chest with her stethoscope. She heard rales and rhonchi, sounds that meant Nikki's breathing tubes were becoming clogged with mucus.

Before 8:00 A.M., David and Angela called their respective offices to explain that they would be late. Bundling Nikki in multiple layers of clothing, they took her to see Dr. Pilsner. Initially their reception was not encouraging. The receptionist informed them that Dr. Pilsner had a full schedule. Nikki would have to return the following day.

Angela was not to be denied. She told the receptionist that she was Dr. Wilson from pathology and that she wanted to talk with Dr. Pilsner. The receptionist disappeared into the interior of the office. Dr. Pilsner himself appeared a moment later and apologized.

"My girl thought you folks were just the usual CMV subscriber," Dr. Pilsner explained. "What's the problem?"

Angela told the doctor how a sore throat had led to congestion overnight and that the congestion did not respond to the usual postural drainage. Dr. Pilsner took Nikki into one of the examining rooms and listened to her chest.

"Definitely clogged up," he said, removing the stethoscope from his ears. Then, giving Nikki's cheek a playful pinch, he asked her how she felt.

"I don't feel good," Nikki said. Her breathing was labored.

"She's been doing so well," Angela said.

"We'll have her back to normal in a wink," Dr. Pilsner said, stroking his white beard. "But I think we'd better admit her. I want to start intravenous antibiotics and some intensive respiratory therapy."

"Whatever it takes," David said. He stroked Nikki's hair. He felt guilty for having insisted on the New Hampshire weekend.

Janice Sperling in admissions recognized both David and Angela. She commiserated with them about their daughter.

"We've got a nice room for you," she said to Nikki. "It has a beautiful view of the mountains."

Nikki nodded and allowed Janice to slip on a plastic identification bracelet. David checked it. The room was 204, one that indeed had a particularly pleasant view.

Thanks to Janice, the admitting procedure went smoothly. In only a few minutes they were on their way upstairs. Janice led them to room 204 and opened the door.

"Excuse me," Janice said with confusion. Room 204 was already occupied; there was a patient in the bed.

"Mrs. Kleber," Nikki said with surprise.

"Marjorie?" David questioned. "What on earth are you doing in here?"

"Just my luck," Marjorie said. "The one weekend you go away, I have trouble. But Dr. Markham was very kind."

"I'm so sorry to bother you," Janice said to Marjorie. "I can't understand why the computer gave me room 204 when it was already occupied."

"No trouble," Marjorie said. "I like the company."

David told Marjorie he'd be back shortly. The Wilsons followed Janice to the nurses' station where she phoned admitting.

"I want to apologize for the mix-up," Janice said after the call. "We'll put Nikki in room 212."

Within minutes of their arrival in room 212, a team of nurses and technicians appeared and attended to Nikki. Antibiotics were started, and the respiratory therapist was paged.

When everything was under control, David told Nikki he'd be back to check on her periodically throughout the day. He also told her to do everything the nurses and the technicians asked her to do. He gave Angela a peck on the cheek, Nikki one on the forehead, and was on his way.

David returned directly to Marjorie's room and gazed down at his patient. She'd become one of his favorites over the months. She appeared tiny in the large orthopedic bed. David thought that Nikki would have been dwarfed.

"Okay," David said, feigning anger, "what's the story here?"

"It started on Friday afternoon," Marjorie said. "Problems always start on Friday when you are reluctant to call the doctor. I didn't feel well at all. By Saturday morning my right leg started to hurt. When I called your office they switched me to Dr. Markham. He saw me right away. He said I had phlebitis and that I had to go into the hospital to get antibiotics."

David examined Marjorie and confirmed the diagnosis.

"You think it was necessary for me to come into the hospital?" Marjorie asked.

"Absolutely," David assured her. "We don't like to take chances with phlebitis. Inflammation of veins goes hand in hand with blood clots. But it's looking good. I'd guess it's already improved."

"There's no doubt it's improved," Marjorie said. "It feels twenty times better than it did when I came in on Saturday."

Although he was already late getting to the office, David spent another ten minutes talking with Marjorie about her phlebitis to be sure she understood the problem. When he was finished he went to the nurses' station and read her chart. All was in order.

Next he called Dudley Markham to thank him for covering for him over the weekend and for seeing Marjorie.

"No problem," Dudley said. "I enjoyed Marjorie. We got to reminisce. She had my oldest in the second grade."

Before leaving the nurses' station David asked the head nurse, Janet Colburn, why Marjorie was in an orthopedic bed.

"No reason," Janet said. "It just happened to be in there. At the moment, it's not needed elsewhere. She's better off in that one, believe me. The electronic controls to raise and lower the head and feet never break down, something I can't say about our regular beds."

David wrote a short note in Marjorie's chart to make it official that he was assuming responsibility for her care; then he checked in on Nikki. She was already doing much better, even though the respiratory therapist had yet to arrive. Her improvement was probably due to hydration from her IV.

Finally, David headed over to the professional building to start seeing his patients. He was almost an hour late.

Susan was upset when David arrived. She had tried to juggle the patients' appointments and cancel those that she could, but there were still a number waiting. David calmed her as he slipped into his office to put on his white coat. She followed him like a hound, ticking off phone messages and consult requests.

With his white jacket half on, David abruptly stopped moving. Susan halted in mid-sentence, seeing David's face go pale.

"What's the matter?" Susan asked with alarm.

David didn't move or speak. He was staring at the wall behind his desk. To his tired, sleep-deprived eyes, the wall was covered with blood.

"Dr. Wilson!" Susan called. "What is it?"

David blinked and the disturbing image disappeared. Stepping over to the wall, he ran his hand over its smooth surface to reassure himself it had been a fleeting visual hallucination.

David sighed, marveling at how suggestible he'd become. He turned from the wall and apologized to Susan. "I think maybe I watched too many horror pictures when I was a kid," he said. "My imagination is working overtime."

"I think we better start seeing patients," Susan said.

"I agree."

Launching into work with gusto, David made up for lost time. By midmorning he was caught up. He took a brief time-out from seeing patients in order to return some of the phone calls. The first person he tried was Charles Kelley.

"I was wondering when you would call," Kelley said. His voice was unusually businesslike. "I have a visitor in my office. His name is Neal Harper. He's from CMV utilization in Burlington. I'm afraid there's something we have to go over with you."