AWLL 2 - Book 4 - Elyse

December 18, 1989, Chicago, Illinois

My head was spinning, and I realized that I'd blacked out. I was on my side, on the floor of my office. My temples were pounding, and I felt sick to my stomach. And I couldn't move.

"Let's get him to the couch," I heard a soft voice say.

"We need one of the guys," I heard another soft voice say.

A minute later, two sets of strong hands helped me from the floor to the couch and laid me flat on my back. Someone raised my legs and put throw pillows under my feet.

"Boss? Boss? You OK?" a male voice said.

"Somebody needs to call Al Barton at UofC hospital, Kara, and Jessica!" a female voice said.

"What happened?" the same male voice asked.

"He got shocking news," a soft voice said.

I groaned and opened my eyes.

"Steve, just stay there," Elyse said. "Kimmy went to call Doctor Barton and Jessica."

"You knew?" I asked, coughing slightly.

"Karl talked to me first because he was afraid this would happen. He wanted one of us with you."

"How long was I out?" I whispered.

"Maybe five minutes," Elyse said.

"Elyse," Kimmy said, coming back into the room, "I talked to Doctor Barton. He said that because Steve passed out, I should call 9-1-1. The paramedics are on their way. He'll be waiting at the hospital with Jessica."

"Hell no," I croaked. "No paramedics. I'm fine."

"Boss, listen to your doctor friend," Terry said.

"Steve, please," Kimmy pleaded.

I gave in. It wasn't as if I was in any shape to fight them or even stand up. A few minutes later, the paramedics arrived, and a few minutes after that, I was on a stretcher with oxygen through a nasal cannula. They loaded me into the ambulance and, less than five minutes later, pulled up at the ER. The paramedics reversed the process and rolled me inside.

"Twenty-six-year-old male; syncopal episode; five-minute LOC; BP 80 over 50; tachy at 110; good bilateral breath sounds; no reported medication; no reported or observed trauma."

"I have this one," Doctor Barton said. "Doctor Torres, please assist. Doctor Adams, you may observe."

The two doctors, a pair of nurses, the two paramedics, and my wife took me into Trauma 2, and everyone but my wife helped move me from the gurney to the treatment bed. They removed the nasal cannula and moved the gurney towards the door.

"Thanks, guys," I said to the paramedics as they left, then turned my head. "Hi, Babe."

"Quiet, Tiger," she said firmly.

Doctor Torres listened to my chest, "Heart and breath sounds are normal." She moved the stethoscope to my stomach. "Normal bowel sounds."

"CBC, Chem-20, five-lead," Doctor Barton said. "And IV D5 Ringers."

"PO₂ 99% on room air," one of the nurses said after attaching a pulse oximeter to my finger.

"No oxygen," Doctor Barton said.

The other nurse deftly inserted an IV needle into my arm and taped it down. She attached an IV bag of saline to the tube and started the drip.

"Pupils equal and reactive," Doctor Torres said after shining a light in my eyes.

A nurse unbuttoned my shirt and began attaching EKG leads. She hooked them up to the monitor and turned it on.

"How are you feeling, Steve?" Doctor Barton asked.

"Fine. You know how I react to shocks."

"And we're going to get to the bottom of it. I'm going to call Ted Kulczycki and get the results of your stress test."

"He didn't do one," I said. "He didn't think it was necessary."

"Well, it's necessary now. I'll have the Chief of Cardiology come down, and we'll do a cardiac echo. Your EKG looks fine at this point, but I want to keep you on a monitor. You're too old or too young, depending on how you look at it, to have these kinds of episodes without some kind of physiological cause. How much caffeine did you consume today?"

"A cup of tea at breakfast and two cups of coffee at the office."

"Sugar?"

"Just carbohydrates and juice, no candy or anything like that. Breakfast was my usual -- bacon, eggs, toast, orange juice, and tea."

"Did you run this morning?"

"Yes. My usual three miles with one of my karate students."

"Any chest pain or shortness of breath when you run?"

"No, never. Just the usual elevated heart rate and breathing from exercise."

"Any tinnitus -- ringing in your ears?"

"Since I was little, but it's never bad, and I more or less don't notice it unless I think about it."

"Hmm. Headaches?"

"Rarely. I take Anacin when that happens."

"Did you take any today?"

"No. It's probably been six months since the last headache."

"Do you ever suffer from vertigo? Or motion sickness?"

"I had trouble reading in a car when I was younger. It would make me nauseated, so I quit doing it. It's like getting dizzy when I stood up too quickly. As I said at Thanksgiving a year ago, I'm just careful if I'm lying down not to stand too quickly. As for vertigo, I do get dizzy when I look over the side of a tall building or a cliff."

"But you used to skydive," Jessica said from the corner where she was standing.

"Planes aren't a problem," I responded. "And, as I said, my vertigo has to do with looking over the side of a building or cliff or something. Looking out the door of a Cessna isn't the same."

"Alcohol and tobacco use?" he asked with a smile.

I smirked, "The 'Dragon Lady' over there limits my cigars and pipe smoking more than you do!"

"Dragon Lady?" Jessica laughed. "Really?"

"You heard me!" I said with a weak smile. "And alcohol is limited to a glass of wine with dinner, a couple of glasses of bourbon during Guys' Nights and other social occasions."

"Are you drinking enough water?"

"I think so. Probably four to six tall glasses a day."

"OK, then. Doctor Torres, thank you. Let me know when those blood test results are back."

"Yes, Doctor," Doctor Torres said.

She left the room, followed by one of the two nurses. Jessica came to the side of the bed and took my hand.

"I assume Kimmy or Elyse told you what happened?" I asked.

"I didn't talk to Kimmy. Doctor Barton did. I was busy when she called."

"Karl called," I sighed. "Nick was shot, and they don't think he's going to make it."

"Oh no!" she recoiled. "How? Why?"

I sighed, "I have no clue at all. Elyse might know more. I guess Karl talked to her before he talked to me. She and Kimmy came to my office just as the phone rang. If she's here, I want to see her."

"Doctor Barton?" Jessica queried.

He nodded, "Steve's in no apparent danger at this time. But I want to solve the mystery of these severe syncopal episodes if we can. Nurse, there's probably a large gaggle of beautiful young women in the waiting room. I suspect Kara and Elyse are both among them. Would you find them and bring them in, please?"

"Yes, Doctor!"

She left. Two minutes later, she was back with Kara and Elyse.

"Snuggle Bear, are you OK?!" Kara asked, coming to the side of the bed.

"He's fine, Kara," Jessica said, taking her hand. "He passed out when Karl called him."

"Elyse told me!" she said, a tear forming in her eye. "It's horrible!"

"What do we know, Elyse?" I asked.

"Probably just what Karl told you. He didn't know much other than there had been a shooting incident. Two sailors were shot, but he doesn't know any details other than that Nick was one of them and that they don't think he's going to make it. He called and asked for me, told me what had happened, and asked me to go to your office before the call was put through."

"What exactly happened when you went to Steve's office?" Doctor Barton asked.

"He answered the phone, greeted Karl very happily, then gripped the handset until his knuckles turned white. He paled, moaned, and started to fall out of his chair. Kimmy and I grabbed him and helped him to the floor so he wouldn't hit his head. Terry and Dave came to help us, and we moved him to the couch. That's when Kimmy called you and the paramedics."

"Next time, call the paramedics first, please. Those two or three minutes can make all the difference in the world. I already told Kimmy that. Did you do anything to help him come to?"

"No. Just laid him on the couch and put two throw pillows under his feet."

"That actually probably helped. That was a smart move."

"That was Terry," Elyse said.

A black doctor with graying hair came into the trauma room.

"Hi, Malik," Doctor Barton said.

"Hi, Al. What do you have for me?"

"Doctor Adams' husband had a repeat syncopal episode with a reported five-minute LOC. There's a history of episodes going back to age fifteen. Also a history of vertigo and low blood pressure. Very active; runs several miles a day and practices karate four to six days a week. No known health issues. BP has stabilized but was 80/50 when he came in, and he was tachy at 110. Nothing abnormal on the monitor."

"Good morning, Jessica. Anything you can tell me?"

"No, Doctor Washington. It seems to be a response to external stress. Elyse," she indicated with her head, "has known him since High School."

"Miss?"

"I guess the same answer. It happens when he is severely stressed, usually from shocking news."

"OK. We'll get an echo and take it from there."

"I'd like to admit him to your service for monitoring and get a stress test done tomorrow."

"Anything you say, Al!"

He extended his hand, "Doctor Malik Washington. So you're his star pupil's husband?"

I smiled, "Yes, Doctor. Steve Adams."

"I'm going to listen to your heart and lungs. The technician will be in with the echo unit in a moment."

He did his exam, listening to my chest, front and back, asking me to breathe at various points. He put the stethoscope to my neck and listened as well. He moved his hand to the inside of my right thigh, and then he felt my right ankle. Then did the same thing on the other side.

"Everything sounds good," he said to Al. "Excellent arterial blood flow in the neck. Strong distal pulses."

A technician wheeled in a cart that looked very much like the ultrasound unit that I'd seen used on my wives when they were pregnant. The technician spread the gel on my chest and was about to place the transducer when Doctor Washington took it from him.

"I'll do this one myself, Jerry. Thanks."

The tech nodded and stepped away. I couldn't see the monitor clearly, but I could tell that he could see the beating of my heart. He adjusted the controls, pressed several buttons, and moved the trackball, all the while tilting and adjusting the transducer. About five minutes later, he removed it.

"Nothing abnormal that I can see. I have the baseline for the stress test. Send him up when you're ready. I'll take him on my service."

"Thanks, Malik. We'll monitor him here for another hour or so and then send him up."

"See you upstairs, Mr. Adams," he said and left.

"Al, are you really going to make me stay here overnight?" I asked.

"Yes. And I won't take 'no' for an answer. You're not signing out AMA. Do you hear me?"

I sighed, "Fine. Somebody needs to call Karl and get an update."

"There's a phone in the Chief Resident's office," Doctor Barton said. "He's off today. Elyse or Kara may use that. I'll make sure that the nurses know it's OK."

"Do you know his number?" Elyse asked me.

"Call the office. It's in my Rolodex," I said. "Keri can get it for you."

Elyse nodded and left the room.

"Are you OK?" Kara asked. "Really OK?"

"He's not in any danger, Kara," Doctor Barton said. "I just want to find out why he's so prone to these syncopal episodes -- fainting spells. Maybe it's psychosomatic, but I want to be sure."

"Psychosomatic?" Kara asked. "So not real?"

"Oh, it's very real, but if we can't find a physical cause, then there very likely is a psychological and mental component to it. And honestly, it could just be his body's way of dealing with stress. If cardiology doesn't find anything, we'll look further -- adrenal glands, that kind of thing. I'm tempted to get a CT scan."

"A brain scan?" Kara asked.

"Yes. To rule out a tumor or some other abnormality."

Jessica giggled, "A scan of Steve's head will very possibly turn up negative. For brain matter, that is!"

I smiled, "I guess I deserved that after the 'Dragon Lady' comment."

"Dragon Lady?" Kara asked.

"I asked about tobacco use," Doctor Barton chuckled. "And it appears that Jessica keeps him on a tight leash."

"With soda, too," I said.

"I've warned you about that. In fact, until we get to the bottom of this problem, I'd like you to avoid anything with added sugar or high-fructose corn syrup and absolutely stay away from anything with artificial sweeteners. There's no general problem with those, but perhaps some chemical is responsible for your issues."

"About the only thing I eat or drink with added sugar is the occasional soda Jess allows me to have. Otherwise, I mostly drink water or black coffee or straight tea. And I don't eat much candy, really. What about carbohydrates?"

"They're complex sugars, but given your energy expenditure, general health and fitness, and your weight, I don't think you're having any issues. We'll see what the blood panel shows in terms of blood sugar."

"Are you thinking diabetes, Doctor Barton?" Jessica asked.

"I'm thinking I don't know what's wrong, so I'm checking everything," he said. "The differential diagnosis at this point is, sadly, pretty much everything."

The door opened, and a nurse stuck her head in, "Doctor Adams? Multiple MVA coming in. The paramedics are five minutes out."

"Thanks, Rose," Jessica said.

She kissed me on the forehead and went out to get ready.

"I'm going to go check on the trauma that's coming in," Doctor Barton said. "The nurse will move you to one of the treatment rooms until you go upstairs. I'll check on you once the lab results are back."

He left, and it was just Kara and me in the trauma room.

"What about Bethany?" she asked quietly.

"I might sound coldhearted, but the Navy has protocols for things like this. They'll take care of her one way or the other."

"He's going to die?" she asked.

I nodded soberly, "I'd say that's what Karl was trying to tell me."

"How can so many terrible things happen to that poor girl?" Kara asked.

"Hell if I know," I sighed.

"Did you think about going to Guam?"

"I didn't think about anything, Honey. I passed out. And by the time I was thinking about it, Al Barton had already taken charge. I have to let the Navy handle this just as I did when I let Red take care of Stephie."

"She's going to need you and Kathy. You're still her best friend."

"When she comes to me," I said. "I'll make sure she knows I'm there for her and Nicholas."

"What will she do?" Kara asked.

"I have no idea, really."

"I can't imagine what I'd do if something like that happened to you!" she said, grasping my hand tightly.

"I'm fine, Honey," I said.

"But you're in a hospital bed, hooked up to monitors!"

Two orderlies and a nurse came into the room with a gurney.

"We need to move you, Mr. Adams," the nurse said.

They helped me move to the gurney, and the nurse unhooked the leads from the monitors. I was wheeled out just seconds before the paramedics burst through the receiving doors of the ER. Jessica and the rest of the staff sprang into action while I was taken to 'Treatment 3'. The monitors were hooked up again, and the nurse said that she'd be back in a few minutes to check on me. Elyse came back into the room with a grim look.

"No more details," she said. "He's in the base hospital in extremely critical condition with two gunshot wounds. That's all Karl knows."

"Where was he shot?" I asked.

"Once in the chest," she paused, "and once in the head. As Karl said before, he's not expected to live."

"Son of a mother-fucking bitch," I swore. "This CAN NOT be happening! Who did it?"

"Wow, Snuggle Bear. I've never heard you actually swear like that."

"If this isn't a time, when would it be? Did Karl find out who did it?"

"No. Just that it was on base."

"On base? What the fuck?" I growled.

Doctor Torres and a nurse hurried into the room.

"Your blood pressure just spiked," Doctor Torres said.

"It's just the conversation," I said, taking a couple of deep breaths and willing myself to relax.

"Ladies, if you're going to excite him, we'll have to send you out," Doctor Torres said.

"Too late," I smirked. "That happened YEARS ago. This is my wife, Kara, and my girlfriend, Elyse. They can stay."

"But, you're married to Jessica!" Doctor Torres protested.

"He's the one," the nurse whispered.

"Those rumors are true?" Doctor Torres gasped.

"They aren't rumors," Kara said. "And Steve became agitated because of what happened to his good friend in Guam."

"OK. Please let him relax. I need to talk to Doctor Barton about the blood chemistry results, and then we'll get you upstairs to cardiology."

"What did they show?" I asked.

"Doctor Barton will tell you," Doctor Torres said.

"No, you'll tell me," I said firmly. "You have the results. What are they?"

"Everything is good across the board. Your blood sugar is a bit low, but your cholesterol numbers are fantastic."

"Thanks, Doctor Torres," I said.

They left the room, and I closed my eyes and relaxed. Doctor Barton came in about twenty minutes later.

"Your blood work looks good. And despite your love of soft drinks, your blood sugar is actually a bit low. Nothing to worry about, but something to check at your regular exams. I'll talk to Doctor Kulczycki so he can do a hemoglobin A1C panel in addition to the normal blood glucose levels we do during physicals. That will give us a 30-day view of your blood sugar levels."

"Is Jess still busy?" I asked.

"They got the tougher case. Near amputation of an arm, crushed chest, and two broken ankles. She has two trauma surgeons with her and orthopedics. They're trying to stabilize the patient so they can get him to surgery."

"Damn," I said.

"You wear a seat belt, right?"

"Yes. Always. I won't drive or ride in a car without one on. I never have."

"He didn't."

"Wonderful," I sighed.

"An orderly will come to take you upstairs. Doctor Torres will go with you and come back once you're transferred to cardiology. I'll come see you when my shift is over."

"Thanks, Al," I said.