Life Support Read Online Free PDF Page A

crumbling memory, the nocturnal wanderings. The personality fracturing, breaking off a piece at a time. Darkness was distressing for these patients. As daylight faded, so did their visual links to reality. Perhaps Harry Slotkin was a victim of sundowning�the nighttime psychosis so common to Alzheimer's patients.
    Toby picked up the ER clipboard and began to write, using the cryptic code of medical shorthand. VSS for vital signs stable. PERRL for pupils equal, round, and reactive to light.
    "Toby?" called Val through the curtain. "I've got Mr. Slotkin's son on the phone."
    "Coming," said Toby. She turned to pull aside the curtain. She didn't realize an instrument stand was right on the other side. She knocked against the tray, a steel emesis basin fell off and clanged loudly to the floor.
    As Toby bent down to pick it up, she heard another noise behind her�a strange, rhythmic rattling. She looked at the gurney.
    Harry Slotkin's right leg was jerking back and forth.
    Is he having a seizure?
    "Mr. Slotkin!" said Toby. "Look at me. Harry, look at me!"
    The man's gaze focused on her face. He was still conscious, still able to follow commands. Though his lips moved, silently forming words, no sound came out.
    The jerking suddenly stopped, and the leg lay still.
    "Harry?"
    "I'm so tired," he said.
    "What just happened, Harry? Were you trying to move your leg?"
    He closed his eyes and sighed. "Turn off the lights."
    Toby frowned at him. Had it been a seizure? Or merely an attempt to free his restrained ankle? He seemed calm enough now, both legs lying motionless.
    She stepped through the privacy curtain and went to the nurses' desk.
    "The son's on line three," said Val.
    Toby picked up the receiver. "Hello, Mr. Slotkin? This is Dr. Harper at Springer Hospital. Your father was brought to our ERa short time ago. He doesn't seem to be hurt, but he�"
    "What's wrong with him?"
    Toby paused, surprised by the sharpness of Daniel Slotkin's response.
    Was it irritation or fear that she heard in his voice? She answered calmly, "He was found in a park and brought here by the police. He's agitated and confused. I can't find any focal neurologic problems. Does your father have a history of Alzheimer's? Or any medical problems?"
    "No. No, he's never been sick."
    "And there's no history of dementia?"
    "My father is sharper than I am."
    "When did you last see him?"
    "I don't know. A few months ago, I guess."
    Toby absorbed that information in silence. If Daniel Slotkin resided in Boston, then he lived less than twenty miles away. Certainly not a distance that would explain such infrequent contact between father and son.
    As though sensing her unspoken question, Daniel Slotkin added, "My father leads a very busy life. Golf. Daily poker at the country club.
    It's not always easy for us to get together."
    "He was mentally sharp a few months ago?"
    "Let's put it this way. The last time I saw my father, he gave me a lecture on investment strategies. Everything from stock options to the price of soybeans. It went over my head."
    "Is he on any medications?"
    "Not that I know of."
    "Do you know the name of his doctor?"
    "He goes to a specialist in that private clinic at Brant Hill, where he lives. I think the doctor's name is Wallenberg. Look, just how confused is my father?"
    "The police found him on a park bench. He'd taken off his clothes."
    There was a long silence. "Jesus."
    "I can't find any injuries. Since you say there's no history of dementia, there must be something acute going on. Maybe a small stroke. Or a metabolic problem."
    "Metabolic?"
    "An abnormal blood sugar, for instance. Or a low sodium level. They can both cause confusion."
    She heard the man exhale deeply, a sound of weariness. And maybe frustration. It was five in the morning. To be awakened at such an hour, to face such a crisis, would exhaust anyone.
    "It would be helpful if you came in," said Toby. "He might find a familiar face comforting."
    The man was silent.
    "Mr.