Mr. Darnay’s right leg begun to swell. He had missed his physical therapy because it was Saturday and the pain medications made him lazy. His right popliteal vein began to fill with clot, and slowly spread proximally. Mr. Darnay’s nurse, Janice Lorry, would never have gone in his room if she hadn’t had a hankering for a Snicker’s bar, which she took from the bowl he kept to encourage visitors. She was surprised to see him looking uncomfortable; he asked for more pain medication. Something seemed wrong. She checked his oxygen saturation, 88 on room air; it had been 94 earlier that shift. She paged the intern on call.
The radiology resident sat in his office. It was a Saturday, and now he had to call in his technician and hang around to read the CT image. He had tried to put PA Carton off, but she was persistent and played the VIP card. When it was negative he was going to give her an earful.
Intern Cruncher was smiling. He was ready to check out; his wife was waiting. Connubial bliss and deep REM was all he could think of. He reached for the phone as his pager went off. It was that nurse on 14 West that drove him crazy. She said Dr. Defarge’s patient was hypoxic. He looked at his watch. He told her to encourage the use of the incentive spirometer; that it was probably post-operative atelectasis. He rolled his pager over, checked out, and went home.
Transportation was notified that they were ready for Mr. Charles in radiology. Kurt Rorcher from transportation had another patient to bring to the whirlpool, and they were short staffed on the weekend. When he finished with this first patient he would head up to 14 West, although he might have to stop by admissions and check out Lucie on the way.
Jarvis Lorry glanced over the terminal where he was polishing up a complex discharge summary. He’d been a hospitalist for two years now and enjoyed the flexibility of hours—and especially being around his wife, Nurse Lorry. However he recognized the look on her face; she was angry about something. He toyed with idea of sneaking down the back stairs, but then she spotted him. She wanted him to take a look at a patient for her. He knew better then to say no.
It was one of Dr. Defarge’s orthopedic patients, Mr. Darnay. He was hypoxic with a swollen leg. In Dr. Lorry’s mind every ortho patient with hypoxia had a PE until proven otherwise. He called radiology immediately. As expected on the weekend the reception was cool, but the tech was already there. He noted the patient’s iodine allergy and ordered a dose of Solu-Medrol.
The transportation aide went to the nurses’ station. They were ready for Mr. Darnay to get a CT angio. Nurse Lorry was amazed at how quickly it happened; her husband could sure get some action going. She helped load Mr. Darnay onto the stretcher. As soon as the transportation aide Torcher got down there they told him there was another patient to get on 14 West. Too busy for a Sunday. He might have to call in sick tomorrow if this kept up.
As Darren Charles made his way down to radiology on the second stretcher, Charles Darnay was getting contrast for his CAT scan. When Mr. Charles arrived he was given a dose of Solu-Medrol, which had been meant for Mr. Darnay. It would not be long until his glucose started to skyrocket.