Periodic Tales: Oxygen Part Two:
Dioxygen- O(2), the most abundant form of oxygen in the earth's atmosphere
"Any inflammable substance in the form of a gas, a liquid, or a fine dust can explode when mixed with air. If smouldering wood is placed in pure oxygen, it will combine with the oxygen so fast that it will become hot enough to burst into flame again." Barbara Lowery had moved on in the book now to the element, oxygen. She'd never studied chemistry at school; she'd done biology. Despite the fact that the book seemed to be aimed at teenagers rather than a developmentally challenged boy, she was finding the book quite interesting. It was not just factual but it explained things that she wasn't sure she'd ever been taught. For example, helium was an inert gas- it didn't join with other elements. She laughed when she read the next bit: "Some people seem to think there is something aristocratic about this aloofness. For that reason, the group is sometimes called the noble gases."
Sherlock looked up at the sound of her laughter, curious. He was starting to accept her presence. No eye contact yet. She glanced down at her watch. Oops- it's nearly six o'clock; got to get going.
"Sherlock, I need to get back to work now. We'll have to pick this up later. Maybe one of the nurses on the next shift will read to you."
The boy just reached his hands up, not looking at her, but off over her shoulder. His face was impassive, but she knew what he wanted. She handed over the book, and he opened it. But, this time, instead of resuming where she left off, he flicked back through the pages to Hydrogen and began to read. "Why are you re-reading that bit, Sherlock?"
There was no reply, or even recognition that she had spoken. She sighed.
According to the junior doctor she handed over to each morning, the ten year old had been making considerable strides in communication skills before his mother's death, but the loss of the person to whom he had emotionally attached had derailed that progress completely. He had not spoken once in the entire four and half months that he'd been at the hospital.
Is there no other family then? Perhaps Dr Molhotra would know. It was a sad part of her role as a night nurse that she rarely ever met the patients' families or got to know their background.
The young doctor frowned. "A father who has never visited and I think an older brother, but I'm not aware that he's been to see the patient- I think he's away at university or something."
"Sherlock seemed very quiet tonight- in fact slept through until five o'clock, which he's not done since I've been here. Is he on a new drug regime?"
"No, nothing new in terms of drugs." He scanned down the chart. "Oh, he had an ECT session yesterday afternoon. That tends to put people to sleep for about ten to twelve hours minimum."
Her face must have betrayed her surprise. "I thought that ECT was no longer used with children."
"Yes, it's never been used much, but it was a bit more common a decade ago than it is now. I have to say it seems a pretty extreme therapy, but all the protocols have been followed. The patient can't make informed consent, but the parent actually asked for it."
One of Barbara's previous jobs had been in a psychiatric ward in York. Some of the adults with schizophrenia or severe depression had been treated with a course of ECT. She'd been surprised at its effects. Pulsing a high voltage electrical current through someone's brain had always seemed to her a rather drastic measure. She'd seen adults wake up from such sessions disorientated, confused and with significant memory loss. She wondered what effect it could be having on the ten year old. Perhaps that was why he was re-reading sections of his book. Maybe he's trying to remember what the ECT made him forget?
oOo
"Sherlock, you always say that you delete stuff that isn't important to…keep on your hard drive, but I really can't understand how you could forget that smoke inhalation is dangerous." He'd arrived at the scene about twenty minutes after Sherlock had texted him, but it still wasn't quick enough to stop the consulting detective from chasing the suspect into the burning building. When the Bulgarian car mechanic was overcome by the smoke, Sherlock dragged him out of the back door into the waiting arms of Lestrade's team. The firemen were now dousing the burning garage, which was full of odd barrels of industrial chemicals. They had been evacuated to a safe distance, and the suspect rushed off to hospital in the first ambulance on the scene. It had been Lestrade who called the second ambulance, worrying about Sherlock, but he gladly handed the task of getting the detective to accept medical treatment over to John, as soon as the doctor got there.
His flatmate was now sitting on the back of the second ambulance, not really wanting to be there, but not well enough to stand up and stalk away. The paramedic placed the oxygen mask onto Sherlock's mouth and nose, pulling the straps tight so the oxygen would maintain its pressure and high flow. The pulse oximeter was clipped to his finger, and Sherlock stared at it as if insulted by its presence.
He tried to speak but the mask muffled his words. "I'm fine."
John put his hands on his hips. "Sherlock, you don't know whether you're 'fine'; the effects of carbon monoxide poisoning are not at all clear at the start. We're going to the hospital to get you checked out. At the very least, you could have burned your throat, your bronchi- when they start to swell, you'll go into respiratory distress. Without proper level of oxygen in your blood, you could go into cardiac arrest." He snapped. "Knowing you, you'll be still saying you're fine when the paramedics say you're coding."
He literally shoved Sherlock into the back of the ambulance and the paramedic slammed the door shut before the brunet had a chance to recover his balance. When they got to the hospital, the doctor explained to the Emergency Department team what had happened. Sherlock pulled the mask off and said, "It's unlikely that I've been exposed, John. No sign of my skin turning pink."
"You know as well as I do that skin discoloration is only one symptom and it doesn't always appear. Carbon monoxide poisoning is serious."
"I know that. The brain and heart are damaged when carboxyhemoglobin (COHb) levels exceed 20%. That's because the affinity of haemoglobin for CO is over 210 times higher than for O2. CO easily displaces oxygen from haemoglobin and binds to intracellular myoglobin in the myocardium. This negatively affects the oxidative phosphorylation and consequently, the energy source of heart muscle."
The Emergency Department doctor listened to the chemistry lesson and smiled. "Well, there's no sign of hypoxia affecting either his lung capacity or his brain function if he can get through all that on one breath."
But just to be sure, he ordered that Sherlock should be tested for the COHb levels, and given a blood glucose test, a cardiac enzymes test plus an ECG to see that nothing was amiss. And, despite the consulting detective's protests, when the results came back showing evidence of mild exposure to carbon monoxide, he also ordered an overnight stay in the hospital, so Sherlock could be monitored should any headaches, nausea, arrhythmias or chest pain occur, due to myocardial ischemia. And he was to keep the oxygen mask on, too, to accelerate the removal of the CO.
John just told him to shut up and stop whinging. "So do as the doctor says, for once, Sherlock. You know that chemistry doesn't lie. Breathing is definitely NOT boring."