When he arrived at his office shortly after 8 a.m. on the following
Monday, there already was a message on the answering machine from Mrs.
Waxman, asking that Dr. Andrews call her immediately. Andrews suddenly
realized that he had forgotten to reach her the preceding week. He also
was surprised that she would have called him, since he couldn't imagine
Waxman remembering (or bothering) to tell his wife that his doctor wanted
to speak with her.
He had his receptionist place a call to her, but
there was no answer.
Less than ten
minutes later, the receptionist buzzed him. "There's a Dr. Jack
Tyler out here who says he needs to speak with you right away.
Something about Ralph Waxman."
you sure? Jack works at Memorial Hospital, across town. How would
he know Waxman?"
"I don't know, but he says it can't wait. I'll pull his chart."
into his office. "Bill, I hate to
add to your morning, but things are in a mess. I need some information
on a consult that I just saw at Memorial. I was coming by here
anyway for a committee meeting next door. I also think you need
to know what is going on. You remember your patient, Ralph Waxman?"
I just saw him maybe a week ago. Actually, his wife just called
"I'm not surprised. He just killed a woman."
"Get serious, Jack. He's obnoxious, but he's not an axe murderer."
"No, I don't mean that. He was driving one of his company's trucks, went left
of center, ran one car off the road and then hit the car behind it head-on, at
full speed. The woman driving it was killed instantly. Her six-year old daughter
is alive but in pretty bad shape at Childrens', from what I'm told. Did Waxman
have a history of cardiac conduction problems?"
"Not at all. His heart seemed fine. I think we even did a stress test on him
last year. How come?"
"It's pretty strange, Bill. Waxman was brought in by squad. His right kneecap
was shattered in the crash. The ER couldn't find much else physically wrong with
him--so sign at all of any head injury, even though they said he acted spaced
out and not quite with the program. Actually, he should have been having a good
amount of pain, but the ER doc said that he seemed lethargic, nonetheless."
"So what does all that have to do with his heart?"
"The ER doc did give him something for pain. Ten minutes later, a nurse who walking
past his stretcher glanced at the monitor they'd put on him. Waxman was in the
middle of a long asystole. Before she could react, he started having a convulsion.
They got that under control, but he kept dozing off and having asystoles."
"Didn't they they reverse the narcotic?"
"Sure they did. Trouble was that it didn't change anything. He kept dozing off
and having more asystoles. They put a temporary pacemaker in yesterday and are
planning on a permanent one later this morning, unless you can provide some information
that would get him out of it."
"No--not really. I didn't have him on much medication, I don't think. No indication
that he'd had an MI?"
"Not at all."
"So that was why he hit and killed the woman, I guess. He blacked out at the
"Sorry, Bill. It isn't that simple. The cops came in right after the squad arrived.
There was a good witness: the driver of the car in front of the woman; the guy
that Waxman ran off the road. His head was up."
"Just what I said. Waxman wasn't slumped over or anything. He was sitting up
behind the wheel of his truck and his head was up. There was still enough daylight
for the driver of that first car to get a good look at him. Said he looked like
a zombie that was looking straight through him, rather than at him. No attempt
to brake at all. Waxman just kept barreling along at full speed."
"So they did a tox screen?"
"Sure. Part of the reason that the police came was to make sure they didn't forget
to do it. Blood alcohol negative. No drugs of abuse detected. The lab at Memorial
sends out to a reference lab for more thorough assays. Results won't be back
for a bit. So I need to find out what on earth you might have given him."
here to continue..