Glossary:
Decubitus ulcer: medical name for bedsores, wounds that develop when a patient is left in the same position for long periods of time.
Cincinnati (stroke scale): the face-arms-speech-time test used to determine if someone is having a stroke.
Satting/sats: refers to the amount of oxygen in the blood. Ideally above 94% on room air.
EMTALA: The Emergency Medical Treatment and Labor Act. Basically says that emergency rooms aren't allowed to turn people away.
Edema: medical name for swelling
ETOH: Alcohol, also refers to someone who has consumed it excessively.
"Hey, that's all we know," Elias said, as I signed his run report under transfer of care. He gestured at a face sheet and physician's notes that were left on the desk in room two. "The family didn't give a history when they dropped her off, and the nurse tried to call them back but the number they gave had been disconnected."
I thanked Elias, and he and his partner, a newcomer still wearing the stricken face of someone in her first month of emergency medicine, headed for the EMS room to finish their report and restock their ambulance. I turned and watched Katie taking vitals on my patient, a seventy-four-year-old woman whose family had seemingly abandoned her at an assisted living facility. She was confused, could not care for herself, and by the smell of her had an active shingles rash somewhere on her body. The facility had sent her here because they needed her medically evaluated, including tests to determine whether her confusion was caused by dementia, a past stroke, or something else entirely.
At least the patient seemed happy enough. She was trying to talk to Katie about the weather, and I noted that she was unable to follow a coherent train of thought, forgetting that she'd already said something and repeating herself. Probably I couldn't diagnose her in the ER. She'd need to be admitted, which was going to mean a long argument with the admitting hospitalist, since this was far from an emergent case, and then probably many more arguments with the various assisted living facilities in the area to try and find a place for her.
My vampirism was a curse; that much I knew. But I couldn't help but feel blessed that I would never end up like this woman, no matter how much time passed. I would never be warehoused in a nursing home, neglected by staff while decubitus ulcers ate through my skin. And my family would never abandon me, nor I them.
I put my orders into the computer and sat down to do some charting. Before I could begin, I heard the double doors to the ambulance bay open and Elias and his partner rolled in with a familiar face looking up from the stretcher. I looked away and tried to complete as much charting as I could before I was called to assist, which I inevitably would be. I'd made the mistake of learning Spanish several centuries ago, and I was the only person on the night shift with the fluency to take someone's medical history.
Half a page of notes later, Malik, the nurse, called my name. I stood and reluctantly made my way to room one, where Elias and his partner were still in the process of coaxing their patient off the stretcher and onto the bed.
"If you can't scoot, we can move you on the sheet," the partner was saying, with the exaggerated clarity people used when talking to non-native English speakers.
"Naw, he can scoot," Elias insisted. "C'mon, Pedro, vamanos." He motioned for Pedro to slide himself from the stretcher to the bed.
"Es muy dificil," Pedro protested, slurring badly. He stank of alcohol and human body odor.
"You weren't gone long," I commented to Elias, moving my shoulders to hide that I'd stopped breathing.
"Caught a call right out the door," he said. "This guy was outside the liquor store down the street."
Pedro, with a mighty groan, finally managed to haul his bulky frame onto the bed. Elias deftly moved the stretcher away and raised the bed rail. He headed for the EMS room, guiding the stretcher one-handed with practiced ease. His partner started to follow, but Malik stopped her with a glare.
"Report?" he asked, eyebrow raised.
"Oh. Yes." She stopped and stood up straighter. "Um, male, fifties, bystander found him lying on the grass outside a liquor store. Says he has been drinking but only two beers."
Malik snickered at this part. "That's what they all say."
"Negative cincinnati, glucose of 129, satting at 97, pulse of 88, resping at 14, b/p 144/78, lungs are clear, pupils are responsive, normal skin parameters," Elias's partner recited, sounding a little short of breath. "Um, don't know his history or allergies or meds because my Spanish kind of sucks. But I think he was, um, trying to flirt with me on the way here, so …" Her cheeks started turning the color of fresh tomatoes.
"Relax," I told her. "You did very well. What's your name?"
"Myra," she said, still looking mortified. "Do you need anything else?"
"No, that will be all." Myra scurried out of the room like something was chasing her. It was definitely her first week on the job.
"No te vayas! Tu es muy bonita," Pedro protested as she left.
"Well, Pedro," I said, turning to face him, "como estas hoy?"
"Tu es muy bonito tambien, Senor Doctor," he assured me.
After much coaxing, Pedro then proceeded to tell me how he was a little drunk right now, but had only imbibed two beers. ("Dos cervezas, es verdad!"). He'd been to the hospital many times before, and I was able to look up his medical records to find his history and allergies. This was the latest in a series of visits that began with him being picked up by EMS, and ended with him discharged once he was sober. I'd tried to get him a bed at an inpatient rehab facility a few times, but had come to realize that he wasn't an alcoholic, just a dedicated recreational drinker with exceptionally poor judgment and even worse hygiene. And there was nothing I could do about it except give him the standard alcoholic workup because EMTALA required it. It angered me, in my weaker moments.
Now was not one of those moments. Despite my earlier resolution to stop worrying about it, I couldn't stop thinking of Esme. I wondered if there'd been signs of illness that I'd missed before last night. She'd never been as fast a runner or as vicious a hunter I was, which was odd, since male and female vampires of didn't differ physiologically. My best theory was that it was because I'd turned her so soon after she'd given birth, before her body had been able to recover. Since the human body was "frozen" at the time of transformation, she might have been frozen in that weakened state. But it was only a theory. Not much was known about vampire physiology. We healed from any injury within a day, and so few pathogens affected us, so there was little use for vampire doctors. Most of the literature about us was theory and speculation, if not outright legend.
A few vampires who worked in the scientific fields had done some studying. A colleague at Cornell had quietly figured out how much venom it took to transform someone—roughly two and a half milliliters, any less would simply scar and cause pain, but not a transformation. She was very interested in the transformation process itself, and most of the hard science on humans transforming into vampires came from her, though I tried hard not to think about her methods.
Another researcher I knew, this one based in England, was more interested in special abilities. She agreed with my theory that a human's talents can become amplified, like Jasper's empathy and Edward's knack for reading people. There was the question, too, of what counted as an ability. Did everyone have some kind of ability, with some more subtle than others? For instance, I managed to work around human blood every day without much temptation. I'd always attributed it to years of practice, but Dr. Sutcliffe wondered if I had my own gift.
But no one had really studied disease and illness in vampires, because the consensus was that it simply didn't exist. There were a couple of mildly toxic substances that would give us a rash, and we could get intestinal blockages from eating solid foods, but the substances were rare, and human food was about as appealing as steamed compost after someone turned.
If I got stumped treating a human patient, there was always UpToDate. The Mayo Clinic website if I was desperate, which was not often. If something was wrong with Esme, I didn't have a lot of resources I could pull from.
I finished the orders for Pedro's workup and went to check on the old lady in two. She was resting comfortably. On a lark, I added one more test to the orders, just in case. I was the first to admit that it was a zebra hunt, but there was a smell about her that I couldn't quite place, and it never hurt to check.
Katie came up behind me, so quietly that I barely heard her. She was snapping on a pair of gloves, the way she did when we had a trauma incoming. We were only a level two trauma center, so we never got the truly gruesome cases, but the broken bones and concussions and minor car accidents still got Katie a little excited.
"What is it this time?" I asked, following her into room nine, the larger room we used for traumas and arrests.
"Probable broken arm, self-inflicted. EMS picked him up at the police lockup. I just want to use the big room in case he's under guard." She began checking all the supplies in the room, making sure the monitor had batteries and we had all the proper supplies.
"This should be interesting," I murmured. Patients who came from a police facility always were.
I smelled the diesel and heard the backup alarm as the ambulance slid into its parking space. Through the antiseptic odors of the ER came the piercing scent of human blood, and the fresh plastic smell of splint boards. A second later, Elias and Myra rolled in again, dragging their stretcher between them. A mustachioed police officer, the chief if I wasn't mistaken, walked beside the stretcher, keeping an eye on the handcuffed patient. They stopped by registration, where the clerk took a few notes and pointed them to us.
Their patient was a middle-aged man with a dark suntan who smelled similar to Pedro. He had a hematoma and some swelling on his left hand, and his left arm was encased in splint boards and bandages and tape, no doubt Myra's doing. The young were always so overzealous with their splinting. His other hand was cuffed to the stretcher rail.
"Man, why does my arm hurt so much?" he asked, shifting uncomfortably and pulling at his cuffs.
"Because you punched a locked door very hard," Myra explained, her tone making it evident that this was not the first time they'd had this exchange. She turned to me and said, "Forty-two-year-old male, cops picked him up for ETOH, punched the door of his cell very hard. He is unable to move his fingers, and his hand and arm are very swollen, but no abnormal movement or crepitus. Um, splinted, as you can see. He's alert and oriented to person and time, not combative but confused and seems to have some memory loss. No meds, history of hypertension, no allergies. Lungs are clear, pupils responsive, normal skin parameters, blood pressure 156/94, pulse of 70, resping at 18, satting at 99, with a glucose of 88. Um, anything else?"
"Thank you, Myra," I said, as I helped her and Elias slide their patient over onto the hospital bed. The police chief quickly refastened the handcuff around the bedrail. I turned to him and asked, "Is this gentleman under arrest?"
He nodded. "I was going to let him sober up in the lockup, but we ran his name and it turns out he's got some warrants over in Tacoma. They're sending a car, and they'll take custody of him when he's discharged. Me or one of the boys will wait with him until then."
"Pull up a chair," I invited, as Katie wrapped a blood pressure cuff around the patient's good arm and clipped a pulse oximeter to his finger. I got a pair of scissors and started cutting away Myra's splinting work so that I could see the arm for myself. The patient winced and pulled away.
"Man, why does my arm hurt so bad?" he asked. "Why's it hurt?"
"Do you remember punching a door?" I asked.
"Door?" This was news to him. I sniffed at his head discreetly and was rewarded with the sickly sweet smell of brain edema. I gave his head a cursory exam and found a slight dark spot on the left side, barely a bruise and hidden by his shaggy hair and deep tan, easily missed in the field.
"Chief, did this man fall at any point, or sustain any head trauma?"
The chief shook his head. "Not since he's been in our custody. Before then, I can't say."
I put in an order for a head CT. Head trauma plus the blood-thinning properties of alcohol were rarely a good combination.
"You thinking concussion?" Katie asked me, squinting at the almost-bruise on the patient's head.
"It's possible." I took out a penlight and checked his pupils. They were responsive, but a bit sluggish, something Myra could easily have missed with her inexperience. I showed Katie, who nodded worriedly. Without even asking, she picked the phone up off the wall and called radiology.
"Is he going to have to stay here long?" the chief asked, leaning forward in his chair.
"It depends on the results of the CT, but it's possible," I said. "Will you need to call someone to relieve you?"
He nodded. "I've got places to be tomorrow. A friend of mine on the reservation is going to sell me his truck, so there's that to take care of, and if I'm being honest with you, it's going to be prime fishing weather."
"Is that so." I hadn't caught a fish in a few centuries. They had very little blood, and were incredibly hard to catch, plus most of them had a briny taste that I'd never gotten used to. My daughter Alice loved them, though.
"Oh, yes. The trout will be jumping," he assured me.
Malik arrived with the portable x-ray, and we took a few pictures of our patient's arm. I glanced at the films and saw nothing except a fractured metacarpal and a greenstick fracture of the distal radius, consistent with the stated mechanism of injury. Not that I had any doubts. Unlike some cities I'd worked in, the police in Forks didn't seem terribly inclined to abuse people in their custody. As Katie finished getting him a splint and sling, a woman from transport arrived to take him up to CT.
As I watched them go, I felt the familiar sense of satisfaction that my unique nature had been instrumental in getting the man the care he needed. There'd been barely any sign of head trauma, and I would otherwise have been inclined to cast his arm and let him sleep it off until Tacoma's police arrived. I wondered if my father was wrong, and vampires weren't inherently good or evil. We were the sum of the choices we'd made and the effect we had on the world. And if that was true, perhaps I would find favor in the eyes of God after all. I hoped so, at least.
My test results had come back for the old lady in two. As I'd suspected, her altered mentation was at least partly due to tertiary syphilis. An untreated infection, probably from decades ago, had laid dormant inside her until one day, it began to eat away at her brain. The damage was irreversible, but at least I could stop it from getting any worse. I wrote the order to start her on a course of antibiotics.
After my replacement arrived, I gave the handoff report and headed home, eager to see how Esme was faring. I found her on the sofa in our room, an arm over her eyes, looking weak and limp. If she were human, I would have thought her asleep.
"What's wrong, my love?" I asked, touching her shoulder.
She sat up slowly and winced. "I don't know. When I was human I used to get the most awful migraines. Did I ever tell you that?"
"It's odd for you to be having them now," I said, perturbed. I sat down next to her. "The transformation should have gotten rid of any chronic pain disorders."
She shrugged and pinched the bridge of her nose. "Well, not in me, it seems. It's not as bad as it was before, but it's still a headache and it's worse when I move."
"Interesting," I murmured, putting an arm around her slender shoulders. I hadn't felt pain from an internal cause since I turned. I'd never heard of anyone else who had, either. We could feel pain from trauma, but our own bodies never betrayed.
"It'd explain why I've been off my game lately," she murmured, leaning her aching head against my chest. "I was trying to hunt this morning, just deer, and one got away from me. I—I just wasn't fast enough."
I lifted her chin and assessed the dark spots beneath her eyes. They were a deep purple, and her irises were dark.
"How long since you've had anything to drink, love?"
She shrugged. "A week, maybe ten days. But I'm not especially thirsty. I'll try to hunt again tomorrow; I'm sure it's nothing."
I held her close to me, felt her warmth, her breathing synchronized with mine. I'd loved Esme for nearly a hundred years, and they'd been the best of my life. She'd spent those years protecting me as much as she had her children, because Esme Cullen took care of her own. Now I only hoped I would be able to do the same for her.
You review me; I review you. Happy holidays!