Chapter Thirty-Seven

The one thing Trapper hated about his job, other than losing a patient, was the endless paperwork that came with the Chief of Surgery title. Any excuse to walk away from the piles of charts he had to review was always welcome. Today it came in the form of a phone call. “Trapper, I’m on speakerphone with Dr. Reyes from pediatrics. We’d like a consult on a unique case. Frankly, we have several options and none of them are great. Can you join us in the conference room up in pediatrics?”

“Pediatrics and gynecology is an odd combination. I can’t wait. I’m on my way.” Entering the room, he nodded to the two doctors sitting at the conference room table. Dr. Howard Davies, from Obstetrics and Gynecology stood, shook Trapper’s hand and introduced him to Dr. Angela Reyes from pediatrics. “Let me guess,” said Trapper. You have a female child with reproductive problems. Somehow, that just doesn’t sound right.”

Dr. Davies slid the child’s chart across the table. “Her name is Maria Sanchez. She’s six years of age, and her follicles are developing.”

“What?” said Trapper with some disbelief in his response. “We’ve seen some fairly young adolescents enter menarche, but not a six-year-old. “Did you check her pituitary?”

The two doctors looked at each other and smiled. “Dr. McIntyre, Dr. Davies said you were good, but I didn’t expect you to come up with the answer immediately,” said Dr. Reyes in a moderate Hispanic accent. “She has a gonadotrophic adenoma that’s causing the production of high levels of FSH, but normal levels of LH for a six-year-old.”

“Which means none,” said Trapper. “So if her follicle stimulating hormones are high, she’s producing eggs, but with a lower LH, the follicles don’t release them. Polycystic ovaries.” Dr. Reyes nodded. “How long has this been happening?”

“Her parents just brought her in early this week with symptoms of a kidney infection and abdominal pain. They said she’s been nauseated for the last week and thought she had a bug, but that was the first they had noticed any problems. What we found was hydronephrosis of her left kidney. Her ovary condition has been there for some time because the membrane that turns the follicles into cysts has made her ovaries grow to four times their normal size,” said Dr. Davies.

“The ovary is blocking the ureter?”

“That’s right, Dr. McIntyre,” said Dr. Reyes. “The reason we asked you for a consult is that we have to determine in what order to correct all the problems. Removing the tumor is the long term solution, but she’s in danger of the ureter rupturing. There’s also the possibility of irreversible kidney damage. And then, there are her ovaries. Can we save them or will she become infertile.”

Leaning back in his chair, Trapper took a deep breath. “Things never get easier around here, do they? Alright. She can live a productive life without a kidney, and she can still have children without one of her ovaries. Is there any sign of blockage on the right side?”

Dr. Davies took the chart that Trapper slid back over the table. “No. Not yet, but if the ovary continues to grow, there will be. We have to do something fairly quickly.”

“How close are we to the same problem on the other side?”

“We can slow the growth of the other ovary by puncturing the cysts and releasing the eggs. That should give her time to recover from surgery sufficiently before we remove the adenoma and allow the hormones to rebalance,” Davies answered.

Resting his clasped hands on his chin, Trapper thought a moment before he gave them his opinion. “Of course, it will depend on the condition of the kidney when you go in, but if it can be saved, I’d take the ovary.”

Dr. Reyes and Dr. Davies both let out a relieved breath. “Thank you, Trapper,” said Dr. Davies. “We wanted another opinion before we proceeded.”

“Howard, I wouldn’t mind seeing this first hand. Do you have an assistant yet?”

Dr. Davies smiled. “No, I don’t. I still have to discuss this with the parents before I schedule it. I’ll let you know when as soon as I can.”

“Sounds good.” Trapper leaned over the table, offering his hand to Dr. Reyes. “Doctor, it was nice to meet you.” Turning to Howard, he took his hand and clasped his arm. “Howard, it’s been awhile since I’ve assisted you. I’m looking forward to it.”

Trapper walked into his office in a sour mood, stopping to look at the two people on his sofa before he closed the door. His silence on his way to his desk and continuing after he took his seat, caused Gonzo and Leah to look warily at one another. “You want to ask him, or should I?” asked Leah, looking at Gonzo first, then cutting her eyes over to Trapper.

“We’ve got a six-year-old girl with polycystic ovaries,” he grumbled.

“You’re kidding,” said Gonzo. “Pituitary?”

Trapper nodded.

“What does that mean…polycystic ovaries?” asked Leah.

“It means she’s producing eggs, but she’s not ovulating, so the follicles become cysts that increase the size of the ovaries.” Moving his glasses from his head to his eyes, he added, “We have to take the ovary.”

“Poor kid,” lamented Leah. “That’s probably a restricted surgery. You need to make sure you get Slocum’s approval before you do the surgery.” Trapper kept his nose buried in a chart. “Trapper, did you hear me?”

“I heard,” he answered crankily.

Standing, Leah headed for the door. “Well, I was going to see if you were available for lunch, but considering your frame of mind, I think I’ll just go.”

Raising his head, Trapper hurried out of his chair and around his desk, grabbing her hand. “I’m sorry,” he apologized, covering her hand with his other hand and putting on a smile. “Lunch sounds wonderful; just the thing to take my mind off a child with reproductive issues.”

“I hope you don’t mind. I asked Gonzo to join us.”

Smiling sweetly at her, he turned to Gonzo with the same smile, but menacing eyes. “Why not?”

Going through the line, Gonzo carefully watched what Leah put on her tray; two boiled eggs, a bowl of cut melons and grapes, and a container of milk. “Is that all you’re eating?” he asked.

“I don’t have that many good choices here,” she said. “I don’t usually eat beef, and their chicken here is like jerky. The fish is overcooked because it sits under those hot lights, and their vegetables are hit and miss. And I don’t want a salad.”

Once they were all seated, Trapper looked at her tray. “What’s wrong with her food?”

“She’s anemic.”

Trapper looked skeptically at him. “She had fresh crab, fresh salmon, fresh lobster, and vegetables along with it last week. How can she be anemic?” Twisting her mouth and bowing her head, she wished she could disappear.

“Ask her what she ate before you took her fishing…and over the weekend.” Both men looked expectantly at her.

“I haven’t had an appetite with everything that’s been happening, that’s all,” she said, looking down at her plate. She grudgingly took a bite of fruit.

“You’re not going back to work until your blood work is normal.” Gonzo lifted his sandwich for a bite. “That’s three square meals a day,” he said with a mouthful.

“When’s your next appointment?” asked Trapper.

She frowned. “Friday. How am I going to change it by then?”

“Stick with me, kiddo,” said Trapper, grinning.