Chapter Twenty-Seven

“Good morning, Mike,” said Trapper as he walked into Marcus Jones ICU room while looking at his chart.

“Dr. McIntyre, the nurses said something about an infection early this morning?”

Still reading the chart, Trapper said, “His temperature is elevated. Most likely an infection has started in his lungs since he’s been on his back for awhile. Nurse,” he said, addressing the young woman who was waiting at the door of the room, “get someone up here from respiratory therapy. I want to get culture through his tube.” Trapper wrote something in the chart, closed it and pushed his glasses up on top of his head. “Mike, this is most likely the beginning of pneumonia. It’s not unusual for patients confined on their backs to get pneumonia. Because they aren’t moving, small pockets of fluid can collect at the bottom of the lungs, and if it sits too long without adequate movement, it can harbor bacteria we normally breathe in from the air. We’ll go ahead and start him on a wide-spectrum antibiotic now, and when the culture comes back, we’ll adjust if necessary. After we take the culture, the top of the bed will be raised to a more upright angle, and I’ll have him turned every hour so that he’s laying more on his sides. That should clear it up.”

Mike gave him a worried, almost defeated look.

“Mike, with the injuries Marcus sustained, this doesn’t surprise me. The important thing is that the staff is keeping a close watch on him, so we can catch these kinds of things early enough to successfully treat them.” Slowly sitting down in the chair next to Marcus’ bed, Mike nodded solemnly. “Is there someone you can ask to spell you so you can get some rest and take care of your regular daily tasks?”

“Yes. Alan Jaeger is coming in for awhile today. I need to go home and pick up a change of clothes and the mail.”

“Good.” Trapper looked up when the respiratory therapist entered the room. He caught the nurse’s attention and nodded toward Mr. Jones. When Mike left the room, the therapist set the packages required for the culture on the bed next to Marcus and handed Trapper a bronchoscope. “Alright, we’re going to go right down the tube to collect a specimen. Go ahead and disconnect the ventilator. This shouldn’t take more than a minute.”

True to his word, Trapper made quick work of the culture, and by the time Mike came back into the room, the therapist was walking out the door with the cultures and the bronchoscope. “Mike, does Marcus have any drug allergies?” asked Trapper.

“He’s allergic to penicillin.”

Trapper wrote in Marcus’ chart as he spoke to the nurse. “Start him on a ten day course of erythromycin, one hundred milligrams by injection today, and fifty milligram injections starting tomorrow. And let me know as soon as the results of that culture come in tomorrow.” He turned back to Mike. “The culture will take at least twenty-four hours to grow. I’ll let you know the results tomorrow. In the meantime, try to relax. This is something we can take care of fairly easily,” he offered with a reassuring smile.

***

As Trapper walked down the hall toward his office, Gonzo fell in line next to him. “The oncologist is here to discuss Mr. Atchison’s chest x-rays. You interested?”

Both men changed direction. “Sure. Who’s the oncologist?”

“Bart Henry.”

“He’ll want to scrub, you know.”

“Is that bad?”

“Not at all. He’s one of the few who will scrub, and he’s pretty good at catching problems while the patient is open. Last time I performed surgery for one of Bart’s patients, we ended up doing eight biopsies.”

“Why is that good?”

“Because we avoided having to do additional needle biopsies or having to go back in. He can see the tissue first hand without having to wait for the perfect view on an x-ray.”

When they pushed open the door of the x-ray room, Dr. Henry was already there, looking at the x-rays. “Bart, how the hell are you?” asked Trapper, taking Dr. Henry’s offered hand with his other hand on the oncologist’s shoulder.

“Personally, John, just fine. But these x-rays worry me.”

“Bart, this is Dr. Gates. He’s the surgeon you’ll be scrubbing with.”

“Dr. Gates, John speaks very highly of you. As I understand it, you grew up in a MASH unit.”

“Yes sir, I did.”

“Well, if you can impress Trapper John, you have to be damn good.”

“Thank you, sir.”

“What do you think about Mr. Atchison’s lung?” asked Trapper.

The three men looked up at the x-rays on the light box. “The mass itself looks like it’s confined to just this lobe,” said Dr. Henry, pointing at an x-ray. And I don’t see any evidence of growth in the other two lobes, but I’ll want biopsies of both. But take a look at this one. Do you see the problem?”

“Mm hm,” grunted Gonzo. “The lymph nodes in the mediastinum are enlarged.”

“I’ll want biopsies from those as well. You might as well do it while you’re in there. There’s no point in waiting for a needle biopsy.”

“So we’re looking at a lobectomy and multiple biopsies,” said Gonzo.

“Yes, but be prepared for a pneumonectomy, just in case. Sometimes you can tell by the tissue color the cancer has spread before it shows up on an x-ray. In this case, the tumor will be a very dark red to almost black where the normal tissue will be a healthy pink. If we see the same colors as the tumor in the other lobes, it’s just a matter of time before the tissue will grow big enough to be seen in a picture. And with Mr. Atchison’s age, I’m not sure he’ll survive a second surgery so soon after the first if a biopsy comes back positive.”

“And what if we see similar coloration in the other lung?” asked Gonzo.

Turning, Dr. Henry walked just past Gonzo and reached back to put a hand on his shoulder. “You’ll close him up, and we’ll make him as comfortable as possible. John, will you be assisting?”

“That will depend on the schedule. I do have other surgeries scheduled for the next few days.”

“I’ll get it scheduled and let you know when, gentlemen,” said Gonzo as the two older doctors left the x-ray room. Gonzo took another moment to look at the x-rays, then pulled them down and turned off the lights.

“Bart, would you happen to have a patient named Carlotta Costa? She’s being treated for breast cancer,” asked Trapper.

“I do, but she’s not here. She’s over at Bay General. Why?” Dr. Henry asked as they boarded the elevator.

“I’m asking for Leah Haverty.”

Dr. Henry snorted. “That woman walked in from out of the blue, demanded a meeting with me, and asked what I intended to do about Carlotta. Well naturally, I told her there wasn’t much I could do but refer her to county. The Costa’s had no insurance. She asked what treatment would cost, and when I told her, she sat down at my desk and wrote out a check for the full amount. Then she said if I needed more to let her know at the number on the check.”

“What happened then?” said Trapper, chuckling. “I apologize. It’s not really funny, but…well…that’s Leah; sharp-tongued and to-the-point.”

“Well, I was speechless, and before I recovered my tongue, she had already marched out of my office and disappeared. But whether she was abrupt or not, she saved Carlotta’s life. Carlotta’s last test results were on my desk this morning. She’s completely clean. Of course, she’ll have to have follow-ups, but for right now, she’s off any restrictions. I’m not seeing her again for six months.”

With a wide grin, Trapper said, “That’s great news. Leah will be happy to hear it.”

“She will? I just assumed she paid because there was some reason she had to,” Bart said, stepping out of the elevator on the main floor and turning toward the front doors.

“Nope. When Leah introduced me to Leo Costa and told me about Carlotta, she said she did it for the Costa’s two children. She said they needed their mother. You’d be surprised just how gracious she can be.”

“I don’t understand. Why would she do that?”

“Because she lost two children of her own. Did you know John Lewis? He was killed in a car accident four years ago.”

“Yes, I did. John sent me several patients with synovial cell sarcoma. And I remember the accident. But what’s that got to do with Ms. Haverty?”

“Leah Haverty is Leah Lewis, John’s wife.”

“Oh. Well, that might explain it.” He shook John’s hand. “It’s good to see you, John. I’ll see you again in a few days.” Trapper waved as Dr. Henry walked into the parking lot.