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Sixteen years old, and mildly retarded, Katie Youmans had been living with her father when she was brought in to see Claire for a bladder infection. Claire had noticed at once the circumferential bruises on the girls wrists. Forty-five minutes of gentle questioning and a pelvic examination had confirmed Claires suspicions. Katie was removed from her fathers abusive household and placed in foster care.
Since then, the girl had thrived. Her bruises, both physical and emotional, finally faded. Claire had counted Katie as one of her triumphs. Why would the girl switch doctors?
She found Katie in X-ray. Through the small viewing window, Claire saw the girl lying on the table, her lower leg positioned beneath the X-ray tube.
Can I ask what the admitting diagnosis is? Claire asked the tech.
They told me cellulites of the right foot. Her charts over there, if you want to look at it.
Claire picked up the medical record and flipped to the admission note. It had been dictated by Adam DelRay at seven A.M. that morning.
Sixteen-year-old white female who stepped on a tack two days ago. This morning she awakened with fever chills, and swollen foot
Claire skimmed the history and physical, then turned the page and read the therapeutic plan.
Quickly she picked up the phone to page Adam DelRay.
A moment later, he walked into X-ray, looking crisply starched as Usual in his long white coat. Though he had always been cordial toward her, he had never displayed any real warmth, and she suspected that under his Yankee reserve burned a masculine sense of Competition, perhaps even resentment, that Claire had lured away two of his patients.
Now he had laid claim to one of hers, and she had to suppress her own feelings of competitiveness. Only the well-being of Katie Youmans should concern her now.
Ive been following Katie as an outpatient, she said. I know her pretty well, and-
Claire, its just one of those things. He lay a reassuring hand on her shoulder. I hope you dont take it personally.
Thats not why I paged you.
It was just more convenient for me to admit her. I was in the ER when she came in. And her guardian felt Katie needed an internist.
Im perfectly capable of treating cellulites, Adam.
What if it turns into osteomyelitis? It could get complicated.
Are you saying a family physician isnt qualified to take care of this patient?
The girls guardian made the decision. I just happened to be available.
By now Claire was too angry to respond. Turning, she stared through the window at her patient. At her ex-patient. Suddenly she focused on the girls N, and she noticed the handwritten label affixed to the bag of dextrose and water. Is she already getting antibiotics?
They just hung it, said the X-ray tech.
But shes allergic to penicillin! Thats why I paged you, Adam!
The girl never said anything about allergies.
Claire ran into the next room, snagged the IV line, and closed off the infusion.
Glancing down at Katie, she was alarmed to see the girls face was flushed. I need epinephrine! Claire called out to the X-ray tech. And IV Benadryl!
Katie was moving restlessly on the table. I feel funny, Dr. Elliot, she murmured. Im so hot. Wheals had swollen on her neck in bright blotches of red.
The tech took one look at the girl, muttered Oh, shit, and yanked open the drawer for the anaphylaxis kit.
She didnt tell me she was allergic, said DelRay, defensively.
Heres the epi, said the tech, handing Claire the syringe.
I cant breathe!
Its okay, Katie, soothed Claire, uncapping the needle. Youll feel better in just a few seconds She pierced the girls skin and injected a tenth of a cc of epinephrine.
I-cant-breathe!
Benadryl, twenty-five milligrams IV Claire snapped. Adam, give her the Benadryl!
DelRay stared down with stunned eyes at the syringe the X-ray tech had just slapped in his hand. In a daze, he injected the drug into the line.
Claire whipped out her stethoscope. Listening to the girls lungs, she heard tight wheezes on both sides. Whats the blood pressure? she asked the tech.
Im getting eighty over fifty. Pulse one-forty.
Lets move her to ER, STAT?
Three pairs of hands reached out to slide the girl onto the gurney.
Cant breathe-cant breathe-
Jesus, shes really swelling up!
Just keep moving! said Claire.
Together they propelled the gurney out of X-ray and ran it down the hallway.
Cant breathe-cant breathe-
Jesus, shes really swelling up!
Just keep moving! said Claire.
Together they propelled the gurney out of X-ray and ran it down the hallway.
They careened around the corner and banged through double doors into the ER. Dr.
McNally and two nurses looked up, startled, as Claire announced:
Shes going into anaphylactic shock!
The response was immediate. The ER staff swung the gurney into a treatment room.
An oxygen mask was pressed to the girls face and EKG leads clapped to her chest. Within minutes a hefty dose of cortisone was dripping into her IV
Her own heart was still pounding when Claire finally left the room to let McNally and his staff take over. She saw Adam DelRay standing at the nurses desk, furiously scribbling in Katies hospital record. As she approached, he quickly shut the chart.