"Coup de Foudre" 76
By Gaedhal
Pittsburgh, July 2016
Dr. William Sun was the Chief Resident in Neurology at Allegheny General. This meant that he saw a lot of head injuries. Many of these were from motorcycle accidents, the victims young men. Many of them were dead before they reached the hospital, or died shortly afterwards, their heads smashed like eggs on hard roadways. This was especially the case when the unfortunate rider didn’t wear a helmet. Once Pennsylvania had laws that mandated the wearing of helmets, but those had been repealed, supposedly in the interests of voters who wanted to feel ‘free’ as they launched themselves down the public highways at speeds up to 70 MPH. But skulls hitting pavement at 70 MPH generally did not enjoy feeling free when they were dead. Those were the cases that Dr. Sun could not help.
Others were more fortunate.
“At least this one was wearing a helmet,” commented Dr. Hayes, the intern on his neurology rotation. “Is he going to live?”
Dr. Sun didn’t blink. “You’re a doctor. You tell me.” Dr. Sun enjoyed making the interns work for their supper.
Dr. Hayes looked at the chart, then at the patient, who was lying very still in the narrow bed, the monitor beeping softly - heartbeat, respiration, blood pressure. The intern didn’t want to make a mistake in front of the imperious Dr. Sun. “Male. Early to middle forties. Good general physical condition. Vital signs stable. No fracture of the skull. Dislocated left shoulder. Abrasions on the left hand and arm. Internal injuries? Um…” He hesitated. “Nothing indicated by the MRI and X-rays.”
“What about the brain?” Dr. Sun prodded.
“Evidence of swelling, I mean, edema causing possible ICP - Intracranial pressure,” said Dr. Hayes. “Patient still unconscious.”
“Condition?”
Dr. Hayes knew that one. That was easy. “Critical.”
“Indeed. And why is he ‘critical’?” Dr. Sun asked.
“Um…” Dr. Hayes groped for the answer. “Because it says so on his chart?”
“Because he’s still unconscious and his brain is swelling,” said Dr. Sun. “He’s in no immediately danger of death, but he’s far from stable.”
“Because of the swelling, right?” Dr. Hayes could hardly wait to finish his neurology rotation and move on to pediatrics. He’d rather face a room full of squalling babies than all this brain stuff. But, unfortunately, his stint with Dr. Sun was only beginning.
“Yes, because of the swelling,” Dr. Sun returned. He never lost his temper, that wasn’t his way, but sometimes these interns were exasperatingly dense. “And why is it dangerous to the patient?”
“Because… because the skull doesn’t get any bigger?” Dr. Hayes replied. That was it! He had it! “If the brain swells too much, there’s no room for it in the skull. And… and… it stops blood flowing back and forth and movement of oxygen to the brain. That damages the brain further. Or kills it.” Or something like that.
“Diagnosis?” Dr. Sun asked.
“TBI,” said Dr. Hayes, feeling proud that he got it right. “Traumatic Brain Injury.”
“Prognosis?” Dr. Sun continued.
“Um… permanent brain damage?” Dr. Hayes said hopefully.
“Is that what you’re going to tell this man’s family?” said Dr. Sun. “Permanent brain damage? Can you be sure about that?”
“No,” Dr. Hayes admitted.
“No,” said Dr. Sun. “We cannot be certain of that or of anything else. This patient could wake up tomorrow and walk out of here with only a slight headache - although I doubt it. He could have surgery to release pressure, or we could wait and see if the swelling abates. He could have an extended recovery and cognitive rehabilitation so that he can lead a relatively normal life. Or he could be wheeled out of here and into an extended care facility where he may spend the rest of his existence in a vegetative state. Or he could die. We don’t know and we can’t say which will be the outcome at this point. So what do we tell the family?”
Dr. Hayes gulped. “That he’s in critical condition and we’re doing everything we can for him?”
“Correct,” said Dr. Sun. “Now let us meet the loved ones.”
Standing in the hallway, their faces strained, were a blond-haired man and a teenaged boy. Dr. Sun glanced at the information on the chart gleaned from the EMT’s report. Partner and son, to follow later. And here they were.
“I’m Dr. Sun. And this is Dr. Hayes. You are here for Mr. Kinsey?”
“Kinney,” the blond man corrected. “It was chaotic at the accident scene and they must have misheard me when they took down the name. It’s Kinney - K-I-N-N-E-Y. Brian Kinney.”
“Thank you.” Dr. Sun made the correction on the chart. It was important to get these details right or else it caused trouble with the insurance company later. “And you are?”
“I’m Justin Taylor. I’m Brian’s partner.”
“Liar,” the boy whispered.
“Don’t start this now,” the blond man snapped. “This isn’t the time or place. This is Brian’s son, Gus.”
“Is my father dead?” Gus asked bluntly.
Dr. Sun nodded to Dr. Hayes. The sooner he learned to deal with patients, the better.
“He’s in critical condition,” said Dr. Hayes. “But we’re doing everything we can.”
“Critical? What the fuck does that mean?” Gus retorted. “I want to know how he is!”
Dr. Hayes recoiled. “He’s very badly injured.” He didn’t know what else to say to the kid.
Dr. Sun stepped in. “He has what we call a closed-head injury. His head struck the road, but he was wearing a helmet, which absorbed much of the shock. But that does not mean he’s out of the woods, as they say. He’s still unconscious. This is a time for us to wait and see what will happen next.”
“But what are you doing?” Gus demanded. “You’re not doing anything!”
“Gus, please try to focus,” Justin said. “Remember what we talked about in the Jeep. You have to stay calm.”
The boy’s face was red with anger. “Yeah, while my dad dies!”
“Your father is not in immediate danger of death,” said Dr. Sun. “There is no need to panic.” Dealing with frantic family members was not his favorite part of being a doctor. But the brain - the brain never yelled at you. The brain, so delicate and yet so strong, the center of everything. That was what was important. “We are monitoring his brain function. The main thing we are concerned with is swelling. That’s the most serious complication.”
Justin nodded. “Is Dr. Rodziewicz still on staff? Or Dr. Mangat?”
Dr. Sun was surprised at the blond man’s mention those doctors. Rodziewizc had been his mentor when he first came to Allegheny General and Mangat had been a colleague. “Dr. Rodziewicz is retired. And Dr. Mangat is now in Philadelphia. How do you know them?”
“I was here with a fractured skull. Dr. Rodziewicz was my surgeon and Dr. Mangat was my neurologist.”
“When was this?”
Justin shuddered, remembering. “In 2001. I was attacked in a hate crime. I was in the ICU and later in the Rehab Unit here.”
“That was before my time,” said Dr. Sun. “That was a terrible thing. But you seem fully recovered. Dr. Rodziewicz was the top neurosurgeon in Western Pennsylvania, so you were in good hands.”
“It took a while,” Justin confided. “I lost the use of my right hand for a while. And I had seizures. Trouble dealing with my emotions. Headaches. Nightmares. Memory loss…”
“And you want to know if your partner will suffer such effects as well,” said Dr. Sun. “My answer is that we don’t know - yet. I’m sure you understand how individual each case is.”
“I know,” said Justin. “But I’m glad there isn’t a fracture. That’s a good thing, right?”
“We must wait and see,” said Dr. Sun. He never wanted to say anything he might later have to retract. “But any time the brain is not exposed to the air is a good thing.”
“And mine was a bad thing,” said Justin, clenching and unclenching his right hand as if to assure himself that it was still working. “A very bad thing. But I survived.”
“Indeed,” said Dr. Sun. “We are moving Mr. Kinney upstairs into the Neurological ICU in a few minutes. When he is settled, you may go up there and see him.”
“What about other visitors?” asked Justin. “Brian has a lot of friends who care about him.”
Dr. Sun looked at the man and the boy. It was good that they were not alone, because this was going to be a difficult road for them and for the patient. “The ICU waiting room is open 24 hours, unlike the regular areas of the hospital. But he may only have two visitors in his room at a time. We must be clear about that. Any more might interfere with his recovery. Peace and quiet are vital.”
“I understand,” said Justin. “Only two at a time. But more people can be in the waiting room.”
“Yes,” said Dr. Sun. He held out his hand. “I am pleased to know you, Mr…?” He would have to remember the names, since this patient would probably be under his care for a while. But at least this man knew a bit of what was to come.
“Taylor. Justin Taylor.” Justin shook the doctor’s hand. “And Gus.”
The doctor also shook the boy’s hand. It was obvious that he was terrified. And that he and his father’s boyfriend had a rocky relationship. Dr. Sun hoped that wouldn’t cause needless drama. “I will see you gentlemen upstairs when Mr. Kinney is transferred. Until then.”
The two doctors walked away.
“Too bad we have to deal with family members,” said Dr. Hayes. “They sure are a pain in the ass.”
“Patients have families,” said Dr. Sun. “They are not simply bodies in beds. Wait until you rotate into Pediatrics and have to interact with distraught parents.”
“Yeah,” said Dr. Hayes. “Maybe I should look into Anesthesiology. All the patients are unconscious. And you never see the families.”
Dr. Sun almost cracked a smile at that. “Indeed,” he said.
Pittsburgh, July 2016
Dr. William Sun was the Chief Resident in Neurology at Allegheny General. This meant that he saw a lot of head injuries. Many of these were from motorcycle accidents, the victims young men. Many of them were dead before they reached the hospital, or died shortly afterwards, their heads smashed like eggs on hard roadways. This was especially the case when the unfortunate rider didn’t wear a helmet. Once Pennsylvania had laws that mandated the wearing of helmets, but those had been repealed, supposedly in the interests of voters who wanted to feel ‘free’ as they launched themselves down the public highways at speeds up to 70 MPH. But skulls hitting pavement at 70 MPH generally did not enjoy feeling free when they were dead. Those were the cases that Dr. Sun could not help.
Others were more fortunate.
“At least this one was wearing a helmet,” commented Dr. Hayes, the intern on his neurology rotation. “Is he going to live?”
Dr. Sun didn’t blink. “You’re a doctor. You tell me.” Dr. Sun enjoyed making the interns work for their supper.
Dr. Hayes looked at the chart, then at the patient, who was lying very still in the narrow bed, the monitor beeping softly - heartbeat, respiration, blood pressure. The intern didn’t want to make a mistake in front of the imperious Dr. Sun. “Male. Early to middle forties. Good general physical condition. Vital signs stable. No fracture of the skull. Dislocated left shoulder. Abrasions on the left hand and arm. Internal injuries? Um…” He hesitated. “Nothing indicated by the MRI and X-rays.”
“What about the brain?” Dr. Sun prodded.
“Evidence of swelling, I mean, edema causing possible ICP - Intracranial pressure,” said Dr. Hayes. “Patient still unconscious.”
“Condition?”
Dr. Hayes knew that one. That was easy. “Critical.”
“Indeed. And why is he ‘critical’?” Dr. Sun asked.
“Um…” Dr. Hayes groped for the answer. “Because it says so on his chart?”
“Because he’s still unconscious and his brain is swelling,” said Dr. Sun. “He’s in no immediately danger of death, but he’s far from stable.”
“Because of the swelling, right?” Dr. Hayes could hardly wait to finish his neurology rotation and move on to pediatrics. He’d rather face a room full of squalling babies than all this brain stuff. But, unfortunately, his stint with Dr. Sun was only beginning.
“Yes, because of the swelling,” Dr. Sun returned. He never lost his temper, that wasn’t his way, but sometimes these interns were exasperatingly dense. “And why is it dangerous to the patient?”
“Because… because the skull doesn’t get any bigger?” Dr. Hayes replied. That was it! He had it! “If the brain swells too much, there’s no room for it in the skull. And… and… it stops blood flowing back and forth and movement of oxygen to the brain. That damages the brain further. Or kills it.” Or something like that.
“Diagnosis?” Dr. Sun asked.
“TBI,” said Dr. Hayes, feeling proud that he got it right. “Traumatic Brain Injury.”
“Prognosis?” Dr. Sun continued.
“Um… permanent brain damage?” Dr. Hayes said hopefully.
“Is that what you’re going to tell this man’s family?” said Dr. Sun. “Permanent brain damage? Can you be sure about that?”
“No,” Dr. Hayes admitted.
“No,” said Dr. Sun. “We cannot be certain of that or of anything else. This patient could wake up tomorrow and walk out of here with only a slight headache - although I doubt it. He could have surgery to release pressure, or we could wait and see if the swelling abates. He could have an extended recovery and cognitive rehabilitation so that he can lead a relatively normal life. Or he could be wheeled out of here and into an extended care facility where he may spend the rest of his existence in a vegetative state. Or he could die. We don’t know and we can’t say which will be the outcome at this point. So what do we tell the family?”
Dr. Hayes gulped. “That he’s in critical condition and we’re doing everything we can for him?”
“Correct,” said Dr. Sun. “Now let us meet the loved ones.”
Standing in the hallway, their faces strained, were a blond-haired man and a teenaged boy. Dr. Sun glanced at the information on the chart gleaned from the EMT’s report. Partner and son, to follow later. And here they were.
“I’m Dr. Sun. And this is Dr. Hayes. You are here for Mr. Kinsey?”
“Kinney,” the blond man corrected. “It was chaotic at the accident scene and they must have misheard me when they took down the name. It’s Kinney - K-I-N-N-E-Y. Brian Kinney.”
“Thank you.” Dr. Sun made the correction on the chart. It was important to get these details right or else it caused trouble with the insurance company later. “And you are?”
“I’m Justin Taylor. I’m Brian’s partner.”
“Liar,” the boy whispered.
“Don’t start this now,” the blond man snapped. “This isn’t the time or place. This is Brian’s son, Gus.”
“Is my father dead?” Gus asked bluntly.
Dr. Sun nodded to Dr. Hayes. The sooner he learned to deal with patients, the better.
“He’s in critical condition,” said Dr. Hayes. “But we’re doing everything we can.”
“Critical? What the fuck does that mean?” Gus retorted. “I want to know how he is!”
Dr. Hayes recoiled. “He’s very badly injured.” He didn’t know what else to say to the kid.
Dr. Sun stepped in. “He has what we call a closed-head injury. His head struck the road, but he was wearing a helmet, which absorbed much of the shock. But that does not mean he’s out of the woods, as they say. He’s still unconscious. This is a time for us to wait and see what will happen next.”
“But what are you doing?” Gus demanded. “You’re not doing anything!”
“Gus, please try to focus,” Justin said. “Remember what we talked about in the Jeep. You have to stay calm.”
The boy’s face was red with anger. “Yeah, while my dad dies!”
“Your father is not in immediate danger of death,” said Dr. Sun. “There is no need to panic.” Dealing with frantic family members was not his favorite part of being a doctor. But the brain - the brain never yelled at you. The brain, so delicate and yet so strong, the center of everything. That was what was important. “We are monitoring his brain function. The main thing we are concerned with is swelling. That’s the most serious complication.”
Justin nodded. “Is Dr. Rodziewicz still on staff? Or Dr. Mangat?”
Dr. Sun was surprised at the blond man’s mention those doctors. Rodziewizc had been his mentor when he first came to Allegheny General and Mangat had been a colleague. “Dr. Rodziewicz is retired. And Dr. Mangat is now in Philadelphia. How do you know them?”
“I was here with a fractured skull. Dr. Rodziewicz was my surgeon and Dr. Mangat was my neurologist.”
“When was this?”
Justin shuddered, remembering. “In 2001. I was attacked in a hate crime. I was in the ICU and later in the Rehab Unit here.”
“That was before my time,” said Dr. Sun. “That was a terrible thing. But you seem fully recovered. Dr. Rodziewicz was the top neurosurgeon in Western Pennsylvania, so you were in good hands.”
“It took a while,” Justin confided. “I lost the use of my right hand for a while. And I had seizures. Trouble dealing with my emotions. Headaches. Nightmares. Memory loss…”
“And you want to know if your partner will suffer such effects as well,” said Dr. Sun. “My answer is that we don’t know - yet. I’m sure you understand how individual each case is.”
“I know,” said Justin. “But I’m glad there isn’t a fracture. That’s a good thing, right?”
“We must wait and see,” said Dr. Sun. He never wanted to say anything he might later have to retract. “But any time the brain is not exposed to the air is a good thing.”
“And mine was a bad thing,” said Justin, clenching and unclenching his right hand as if to assure himself that it was still working. “A very bad thing. But I survived.”
“Indeed,” said Dr. Sun. “We are moving Mr. Kinney upstairs into the Neurological ICU in a few minutes. When he is settled, you may go up there and see him.”
“What about other visitors?” asked Justin. “Brian has a lot of friends who care about him.”
Dr. Sun looked at the man and the boy. It was good that they were not alone, because this was going to be a difficult road for them and for the patient. “The ICU waiting room is open 24 hours, unlike the regular areas of the hospital. But he may only have two visitors in his room at a time. We must be clear about that. Any more might interfere with his recovery. Peace and quiet are vital.”
“I understand,” said Justin. “Only two at a time. But more people can be in the waiting room.”
“Yes,” said Dr. Sun. He held out his hand. “I am pleased to know you, Mr…?” He would have to remember the names, since this patient would probably be under his care for a while. But at least this man knew a bit of what was to come.
“Taylor. Justin Taylor.” Justin shook the doctor’s hand. “And Gus.”
The doctor also shook the boy’s hand. It was obvious that he was terrified. And that he and his father’s boyfriend had a rocky relationship. Dr. Sun hoped that wouldn’t cause needless drama. “I will see you gentlemen upstairs when Mr. Kinney is transferred. Until then.”
The two doctors walked away.
“Too bad we have to deal with family members,” said Dr. Hayes. “They sure are a pain in the ass.”
“Patients have families,” said Dr. Sun. “They are not simply bodies in beds. Wait until you rotate into Pediatrics and have to interact with distraught parents.”
“Yeah,” said Dr. Hayes. “Maybe I should look into Anesthesiology. All the patients are unconscious. And you never see the families.”
Dr. Sun almost cracked a smile at that. “Indeed,” he said.