Critical Judgment (1996) Read Online Free PDF Page B

a cave. He comes into town every few weeks to sell his carvings and pick up supplies. Usually people leave him alone, but apparently this time someone didn’t.”
    Abby took two charts from the rack.
    “I’d better get a move on, then.”
    “It may not be a problem,” Perlow said. “Dr. Bartholomew’s on backup for surgery, and he’s in-house. I just saw him.”
    “Great.”
    The word came out more sarcastic than she had intended. Martin Bartholomew, one of four general surgeons on the staff, insisted on suturing every laceration that came in while he was on backup. Although Abby had yet to have a run-in with him, she had been warned by the other ER docs that it was only a matter of time. Bartholomew had an ego as bloated as his waistline, andunique requirements for even the most mundane procedures. It was sport for him to chastise a nurse in front of one of his carriage-trade patients for forgetting his special clamps or for opening a 6-0 instead of a 7-0 packet of suture.
    “Shall I call him now?”
    “Better let me at least check over Mr. Ives first.”
    Through the waiting room Abby could see another patient enter, this one a middle-aged woman, pale but ambulatory, supported by her husband. Probably a GI bug, she guessed. It was definitely time to get in gear.
    The patient in X ray had a straightforward, nondisplaced wrist fracture. Plaster splint, a few Tylenol number threes, and an orthopedic referral. But the two patients on stretchers were both enigmas. Neither was a true emergency, but their insurance probably didn’t charge them a penalty for using the ER instead of contacting their primary doctor. One complained of fatigue and a low-grade cough, the other, a flamboyant fifty-year-old redhead, of chronic severe itching with no noticeable skin rash. Physical exams on both were negative, as was the chest X ray Perlow had obtained on the cougher. Abby ordered some additional laboratory studies but suspected that they, too, would be unrevealing. Two more in what was beginning to feel like a series of ill-defined or unusual conditions.
    Was it her imagination, or had she been starting more and more of her discussions with patients by saying something like, “At this point I don’t really know what’s wrong with you, but …”? The challenge with cases like these, maybe the most difficult in ER medicine, was to be certain that no one was discharged feeling that his symptoms were being taken lightly. Patients like that were lawsuits waiting to happen. Abby was constantly reminding herself that although a particular problem might not have been the worst thing she had seen that day, it was certainly the worst thing the
patient
had had.
    While the two remaining patients from the waiting room were being evaluated by the nurses, Abby closed herself in the small doctor’s office and called home, expecting to get the answering machine.
    “Hello?”
    Not only was Josh home, but it sounded as if she’d awakened him. Lately it had been more and more like that. For the two years they had dated, before he’d moved to Patience, sleep had been something of an enemy to Josh. Even during his months of unemployment he had stayed upbeat and energetic. Maybe those ten months had taken more of a toll than she’d realized, though. Or perhaps the expectations and pressures of his job at Colstar had been more than
he
had bargained for.
    Over the five weeks they had been together in Patience, and even before she had moved up to join him, Josh had been irritable, distracted, easily fatigued, and bothered by headaches. A checkup with lab tests at the Colstar employees’ clinic, done at Abby’s insistence, had turned up nothing. But the disturbing changes in him had persisted. Recently, she had begun to wonder if she had wanted so badly for their relationship to work that she had never allowed herself to see Josh’s darker side.
    “Hi, honey,” she said. “Are you okay?”
    “What’s that supposed to