Silent Treatment Read Online Free PDF Page A

And I really don’t know why. Male menopause or something. I feel like maybe I need—I don’t know, some sort of windmill to charge.”
    The corridor, a shortcut from the room where their meeting was held to the amphitheater, was closed to the public but not to hospital staff. Today, the ER was humming. The rooms to either side of them were all occupied. Major surgery, minor surgery, orthopedics, ENT, pediatrics, minor medical, major medical, cardiac.
    “Each one a story,” Harry said as they walked through.
    “Yeah,” Steve mumbled. “Well, after today we better get used to having to read the Cliffs Notes.”
    A nurse rushed past them from behind and into one of the two cardiac rooms.
    “Give him another three of morphine,” they heard a resident say as they neared the room.
    “How much Lasix has he gotten?”
    “Eighty, Doctor …”
    “This is V. tach. I’m almost certain of it.”
    “His pressure’s dropping, Doctor.”
    “Dammit! Someone was supposed to have called cardiology.”
    “I put a page in for them. They haven’t answered.”
    The two GPs stopped at the doorway. The patient, a husky black man, probably in his early seventies, was in extremis, sitting nearly upright on the litter, gasping for breath. Loud gurgling welling up from within his chest accompanied each inhalation. His heart rate was nearly one hundred and seventy. The young resident managing the case was a decent enough doctor, but he had developed a reputation for losing his cool in difficult situations.
    “What is his pressure?” he asked.
    “Maybe seventy, Doctor. It’s quite hard to hear.”
    There was undisguised urgency in the nurse’s voice. Her repeated use of the resident’s title was a demand that he do something.
    “We can’t wait for cardiology,” he said. “Get ready to shock him. Someone please page cardiology again. Janice, I want three hundred joules.”
    Steve Josephson, his eyes wide, looked over at Harry.
    “Pulmonary edema,” Josephson said.
    “Right you are,” Harry replied.
    “But that’s not V. tach on the monitor.”
    “I agree. Plain old garden variety sinus tachycardia, I would say. Due to the stress of the situation.”
    “We can’t let him shock that.”
    Harry hesitated for just a moment, then nodded. The two of them moved to the bedside.
    “Sam, that’s sinus tach.” Harry whispered softly enough so that no one but the resident could hear. “Try to shock that and you might kill him.”
    The resident looked first at the monitor and then at the nurses and technicians surrounding his patient. In seconds his expression went from confusion to anger to embarrassment, and finally to relief.
    “You want to take over?” he asked suddenly. “Please, go ahead.”
    Without answering, Harry picked up a towel and dried the perspiration that was pouring off the patient’s brow. He glanced at the plastic identification bracelet.
    “Mr. Miller, I’m Dr. Corbett. Squeeze my hand if youunderstand. Good. You’re going to be okay, but you’ve got to try and breathe slower. I know it’s hard and I know you’re frightened right now, but you can do it. We’re going to help you. EKG, Steve?”
    “Maybe a small anterior MI,” Josephson said. “He’s beating too fast to tell for sure.”
    “Hematocrit?”
    “Fifty percent. If he’s not a smoker, his blood is concentrated big time.”
    They looked over at the resident, who shook his head.
    “Lifetime nonsmoker,” he said. “But what’s his red blood cell concentration got to do with all this?”
    Harry’s exam disclosed no ankle swelling and no other signs of excessive fluid. Heart failure, from whatever cause, was producing back pressure throughout the pulmonary circulation. Serum, the noncellular part of blood, was being forced through the blood vessel walls and into the man’s lungs. As a result of the serum shift, the red blood cells, too large to pass through the vessel walls, were becoming sludge. Harry checked the man’s pupils