In lieu of an abstract, here is a brief excerpt of the content:

ON MY OWN BUT NOT ALONE RAN D. ANBAR* I As soon as the signal was received, the wardmobile began moving toward city perimeter. I got the first inkling that duty called as the red light flashed at my bedside. The chronometer showed an ETA of 5 minutes, meaning that our destination was about 20 kilometers from mainward. I stood up and momentarily lost my balance as the wardmobile swayed slightly to the right. The computer terminal was located next to the microchem processor at the other end of the compartment, exactly 19 paces from my bed: 16 YEAR OLD, WHITE MALE, was typed on the paper, below the patient's name. CHIEF COMPLAINT: VOMITING, DETERIORATING MENTAL STATUS x 1 HR. INFORMANT: STEELE, MD. KNOWN HPI: PREV HEALTHY. GENERALIZED BRUISING x 3 WK. HEADACHE x 3 DY. 39 FEVER x 1 DY. PMH: NKA. NO MEDS. NO PREV HOSP. IUTD. FH: 38 YR MOTHER: MIGRAINES. 42 YR FATHER. 8 YR SISTER. END OF REPORT. The terminal activated as its heat-sensitive keyboard reacted to my touch. I requested the Diagnostics program and then touched "Differential Diagnosis" on the computer screen. In return, it began spewing possibilities based on the known patient information: 1) CENTRAL NERVOUS SYSTEM LESION. PROB: 0.62. 2) BLOOD DYSCRASIA. PROB: 0.34. 3) INFECTIOUS DISEASE. PROB: 0.30. 4) OTHER. COMBINED PROB: 0.33. Before I had a chance to ask for an elaboration , the wardmobile signaled its arrival at city perimeter by priming the compartment's emergency equipment. The compartment hatch slid open and my patient was wheeled in on a stretcher by a tall, thin woman, dressed completely in black. "I'm Dr. ?Children's Service, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.© 1988 by The University of Chicago. All rights reserved. 003 1-5982/88/3102-0568$01.00 194 J Ran D. Anbar ¦ On My Own but Not Ahne Steele," she announced. "This is Michael," she indicated the patient. "I'm afraid his condition is even worse than when I called for your help. His breathing has been growing shallower and shallower." The black covers accentuated his pallor but did not obscure Michael's handsome, athletic features. He showed little movement and his respirations were inadequate. Why someone so young? I thought. "I think we should intubate," I said, reaching for a laryngocomp. After intubation I applied the Phrenstim applicators around the base of his thorax and switched on the ventilator. I looked for an indwelling vitalometer in the supply drawer. "I haven't had a chance to speak with his parents," said Steele. "But they're being shown into your waiting room." What anguish Michael's parents must be going through, I thought, glancing at the wall that separated the waiting room from the acute care compartment. Why does disease have to strike someone who has just begun investing in life? With the pulse guide mode turned on, I rapidly inserted the vitalometer into Michael's right radial artery. After warm-up, the vitals monitor displayed Michael's vital signs. "Things under control?" asked Dr. Steele. "Yes. I think I'll be fine from here on." I offered a weak grin. The compartment hatch door slid closed behind her. Alone. Involuntarily, I glanced at the automated cardiac compressor in the corner. I would hate to be stuck by myself with a patient who was arresting . "Don't you dare," I muttered to Michael. Establishing two intravenous lines was technically the hardest procedure to accomplish. Finally, I placed the fluorosplasma into the stretcher drawers, and they began pumping the fluid into Michael's veins. "OK, back to mainward," I said, unnecessarily turning my head toward the computer terminal. From its sampling through the vitalometer, the microchem processor began to give blood test results. Diagnostics chimed, and the printer spewed out: PATIENT IS ANEMIC AND THROMBOCYTOPENIC. SUGGEST TWO UNITS OF PACKED RED CELLS AND TEN UNITS OF PLATELETS. I glanced at the computer output indicating a hematocrit of 15, white cell count of 35,000, and a platelet count of 10,000. Jesus, I thought. I wonder what kind of wrench this throws into Diagnostics. We are taught to try to reason...

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Additional Information

ISSN
1529-8795
Print ISSN
0031-5982
Pages
pp. 194-200
Launched on MUSE
2015-01-07
Open Access
No
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