Love On Call

“Naomi Purcell,” Cindy recapped as Glenn read. “Thirty-five years old and healthy. Married, three kids. They have a small herd of dairy cows down on Route 4 by the river. She came in with a fever and an infection in her left lower leg. It seems she got tangled up in some old barbed wire pulling a calf out of the brush this morning. Now her leg is red and hot and tender.”

“Is she diabetic?”

“No—not that she knows of. I sent off bloods and don’t have them back yet. But her temp is a hundred and three and the wound looks nasty. Swollen and draining.”

On the surface it sounded like a virulent cellulitis, but Cindy wouldn’t have called her for a straightforward infection. She’d have called one of the medical doctors for antibiotics and possible admission.

“What else?” Glenn asked.

Cindy shook her head, her eyes troubled. “She just looks really sick, Glenn—a lot sicker than something like a fairly superficial trauma should account for. And there’s a lot of swelling. I was afraid something might’ve gotten in there that she didn’t realize, some kind of foreign body, so I sent her to X-ray.”

“You know,” Glenn said, impressed as always by Cindy’s clinical sense, “there’s an opening in the rotation for first-year PAs. You might consider—”

“No way. I’m done with school, even if I do have an in with the new program director.”

The title still felt like a too-tight shoe, and Glenn shrugged aside thoughts of her new job. “Where are the X-rays?”

“I put them on a box outside her room.”

“Okay, I’ll check her out. Let me know as soon as you get her labs back.”

“I’ll call now.” Just as Cindy reached for the phone, the red triage phone rang. Cindy gave a little shrug and picked that one up instead. “ACH—go ahead.”

Glenn walked down to cubicle seven and announced herself as she pulled the curtain aside. “Ms. Purcell? I’m Glenn Archer, one of the surgical PAs.”

Naomi Purcell sat propped up on several pillows, her eyes fever bright in a pale white face. Lank strands of medium brown hair framed her face. Sweat beaded on her forehead, and her chest beneath the shapeless cotton hospital gown fluttered with quick, shallow breaths. A tall, husky man in a faded T-shirt hanging over the top of baggy blue jeans stood to the left side of the bed, his hand on her shoulder and terror in his eyes.

“She seems to be getting sicker really fast, Doc,” he said in a low, tight voice.

“I’m fine, Todd.” Naomi Purcell’s voice was wispy and faint but she mustered a smile. “My leg feels like a nest of fire ants are having a picnic on it, though.”

“Let me take a look.” Glenn snapped on gloves and drew back the sheet, expecting to see the angry laceration Cindy had noted on the chart along with the bright red sheen of a superficial infection surrounding it. All the expected signs of infection were there, but nothing about Naomi Purcell’s leg was typical. An irregular inch-long gash just above her left ankle gaped open, and a thin milky fluid oozed from its edges, slowly trickling down onto the sheet. Her foot was swollen to twice its size, the skin thin and tight as if trying to prevent the flesh and fluid beneath from bursting out and close to losing the battle. She checked for the dorsal pulse and couldn’t find it. “Can you feel me touch you?”

“Yes, a little. My toes are numb, though.”

“Do they feel cold?”

“No. More like they’re just not there.”

The inflammation extended up her calf following the path of lymphatic drainage, spidery fingers spreading toxins and whatever bacteria had invaded the deeper tissues. Glenn felt for the artery behind Naomi’s knee and found the rapid beat that signaled Naomi’s system was working hard to combat the infection. “This might hurt a little bit.”

“Don’t worry about me,” Naomi said, as if Glenn had anything else to worry about.

Right now, Naomi Purcell was the only thing that mattered in her life. She gently probed at a distance from the laceration, and a faint crackle, like air popping in the plastic bubble things they wrapped around packages that come in the mail, crinkled beneath her fingertips. Her belly tightened and she straightened up. “I want to check your X-rays. I’ll be right back.”

“She should get some antibiotics, right, Doc?” Naomi’s husband Todd said.

“Yes, and we’ll get on that in just a minute.”

His eyes followed her out of the room. Eyes that said, Don’t leave us. Help us. Eyes she’d seen hundreds of times before. Three X-rays hung on the light box next to the curtained cubicle. The bones of the lower leg stood out like bleached driftwood, balloon-shaped shadows marking the surrounding muscles and fat. And there in the depths of the tissue, clear streaks like icing in a layer cake extended from the edges of the laceration. Air where there shouldn’t be any. She found Cindy drinking a cup of coffee and making notes in a stack of charts in the tiny staff lounge. “We need to start her on antibiotics—I’ll get cultures and call Flann.”

“It’s bad, isn’t it?”