“Do you really think that’s necessary?” Mr. McLeod asked skeptically. “I’m sure I’ll be fine in a while.”
Simon frowned. “Yes, I do think this test is necessary,” he said firmly. Hailey lifted a brow but didn’t say anything as she slipped out of the room, no doubt to send their patient’s blood to the lab. He sharpened his gaze on his patient. “You may have appendicitis or something worse, like a pocket of infection or an aortic aneurysm.”
“Hank, please.” Mrs. McLeod was practically wringing her hands at the list of potential problems. “Don’t argue with the doctor. Have the CT scan, please.”
“All right, I’ll have the scan.” A mutinous expression darkened the patient’s eyes. “But I’m already feeling better. I’m sure there’s nothing seriously wrong with me.”
Simon wasn’t so sure, but since Hank McLeod had agreed to have the scan, he wasn’t going to waste any time in getting it ordered. “Someone will be in soon to take you to Radiology,” he promised.
While he was on the phone with the radiologist, he realized Hailey was standing beside him, chewing her lower lip anxiously, obviously waiting for him to get off the phone. When he finished his call, he glanced at her. “What’s wrong?”
She let out a sigh. “Do you think it’s possible Mr. McLeod has an abdominal aortic aneurysm? Everything about his presentation reminds me of a patient I had about six months ago back in Milwaukee. Same type of abdominal pain, same relatively stable vital signs, except for the high blood pressure, and even the same stubborn denial that anything was wrong.”
Simon was impressed by her gut instinct. “It’s one of my differential diagnoses, yes. And if he does have one, we’ll find it on the CT scan. They’re finishing another patient now, but they’ll be ready for him in about ten to fifteen minutes.”
“Sounds good. I’m going to give Jimmy and his mom discharge instructions and then I’ll be ready to go with Mr. McLeod. I just need you to write out his prescriptions.”
“Jimmy?” Simon had to think for a minute to figure out who she was talking about, and then he nodded. “Oh, yeah, the kid with the dogbite.” He logged on to the nearest computer and quickly pulled up the sixteen-year-old’s record. He entered in the medications and then printed the prescriptions. “Make sure he understands he has to finish all the antibiotics.”
She chuckled. “I will.”
Simon handed Hailey the scripts and then turned his attention to the other patients in their team. There was a twenty-two-year-old female patient with a severe headache that he was still waiting for Neurology to clear before he could consider sending her home. He figured she was suffering from migraines, since everything else had come back negative, but wanted the specialist to see her just in case.
Twenty minutes later, he got a call from the lab on Mr. McLeod’s blood count. The gentleman’s hemoglobin and hematocrit were on the low side, reinforcing Hailey’s suspicion that he might have a leaking abdominal aortic aneurysm.
As Simon was on the phone with the lab tech anyway, he took all the blood-work information, relieved that the cardiac injury panel was completely negative. The patient’s white blood cell count was negative too, which made the drop in his hemoglobin and hematocrit even more suspicious.
The minute he hung up the phone, his pager went off. He read the text message. McLeod’s BP is dropping, come to CT stat.
Simon didn’t waste any time heading over to the scanner, thankfully located right around the corner in the emergency department. When he arrived, Hailey glanced up at him, her expression grim.
“I told them to keep the IV in place. Do you want me to start a vasopressor to bring his blood pressure back up?” she asked.
“Yes, let’s start norepinephrine titrate to keep his blood pressure above 90 systolic.” He reached for the phone to stat page Leila Torres, the on-call surgeon working today. He quickly punched in the number for the CT scan, followed by a 911 so she’d know to come straight over. “How much of the scan were you able to complete?” he asked as he hung up the phone.
“Maybe half?” Hailey said as she pulled the IV medication out of the crash cart and hung it on the pump.
He crossed over to the reading room to look at the images. They hadn’t quite been able to get half the scan done, but he could still see there was the slightest hint of blood leaking near the guy’s descending aorta.
“What’s happening?” the patient asked Hailey. “Is the test over?”
“Your blood pressure dropped a little too low,” she explained. “We’re starting you on some medication to bring it back up.”
He caught Hailey’s hand. “Tell Myra I love her,” he said.
Simon caught the agonized look in Hailey’s eyes. “I will,” she assured him.
Leila strode into the room, glancing at Simon with an arched brow. “You rang?”
Simon pulled her into the reading room and indicated the worrisome spot on the CT scan. He kept his voice low so the patient couldn’t hear. “The only abnormal lab test he has is a low H/H. He just dropped his blood pressure so we couldn’t finish the scan. I think he has an aneurysm that’s about to rupture.”
“I think you’re right.” Leila was a petite woman with a hint of Asian heritage, and Simon had all the respect in the world for her skill as a surgeon. “I’ll take over from here.”
While Leila explained to Mr. McLeod what was going on, he called the OR to let them know an emergency case was on the way. Then he informed the radiology tech they needed a couple of transporters to run the patient up to surgery.
“We can’t forget his wife,” Hailey murmured, as they prepared to wheel Mr. McLeod down the hall.
“We’ve got it from here,” Leila told them. “Go back to the ED. Tell his wife I’ll talk to her when the surgery is over.”
“All right.” Simon stood next to Hailey as the team whisked the patient to the nearest elevator. This was the most difficult part of his job, giving bad news to families.
He turned and headed back to the arena. He was a little surprised when Hailey followed him into Mr. McLeod’s room. Some of the nurses left the bad news up to the doctor. He appreciated her support as Mrs. McLeod looked up at them questioningly.
“Where’s Hank? Have you finished his scan?” she asked, her gaze bouncing nervously between the two of them.
“Mrs. McLeod, your husband has an abdominal aortic aneurysm. What that means is that the biggest artery going from his heart down through his abdomen has a bulging section, where the artery wall is weakened.”
“A weak artery is causing his pain?” she asked, her brow wrinkled in a puzzled frown.
“It’s actually more than a weak artery, Mrs. McLeod,” Hailey said. “This is a very serious condition that needs immediate treatment.”
Simon nodded. “Your husband’s blood pressure dropped while he was getting his CT scan. We started him on some medication to bring it back up, but we think the weak spot of his artery has started to give way. I’m sorry to tell you this, but he was taken to the operating room for emergency surgery.”
“Emergency surgery?” Mrs. McLeod paled at the news. “But he’ll be all right, won’t he? I mean, you caught it in time, didn’t you?”
“We acted as quickly as we could, and he has an excellent surgeon taking care of him.” No matter how much he wanted to gloss over the risks, he knew she needed to hear the truth. “As Hailey said, this is a very serious condition. A life-threatening condition. He has a good chance of making it through this surgery alive, but there is a twenty-eight percent chance he might not make it.”
“No.