"No. It's been there the whole time."
I thought a second. "Did you eat anything different over the weekend?"
"We went to a party at my sister's," the mom said. "There was a lot of food, but nothing he hasn't had before."
"Anything with small bones in it? Fish, chicken?"
They looked at each other. "No. Nothing with bones," she said. "How about a toothpick?" I asked.
"Yeah," he said. "Those scallops wrapped in bacon."
Bingo. "Did you maybe swallow a toothpick?" I asked.
"I don't think so," he said.
"He was eating them like popcorn," his mother said.
"Well, they are fantastic." I smiled. "Sometimes people can swallow things without noticing it, Caden, so I'm going to do an endoscopy. Basically, you get some nice relaxing medicine, I slip a tiny camera into your stomach and look around and maybe I'll see a toothpick. Sound like fun?"
It did to me.
I told Jabrielle to give him some Versed to relax him, then sprayed his throat with lidocaine to numb it, so he wouldn't gag. His mom sat next to him, holding his hand.
"This won't hurt a bit," I said, then I got to work, sliding the scope into his throat, talking quietly through it, looking up at the screen as Caden's esophagus and stomach were revealed. Healthy tissue, the beautiful web of blood vessels, the grayish walls of the stomach pulsing and moving with life.
And there, in the lower part of the stomach, I saw the toothpick, now black from stomach acid, sticking out of his duodenal wall. Using the endoscopy forceps, I gently grabbed it and slowly pulled it out. "Ta-da," I said, holding it up so my patient could see. "We got it, Caden. You'll feel a lot better tomorrow."
"Good call," Jabrielle murmured.
"Thank you," I said. "I'll order up some antibiotics, but he should be right as rain. In the future, big guy, eat more carefully, okay? This could've done a lot of damage. It could've slipped through into your liver, and that would've been really bad."
"Thank you so much, Doctor," the mom said. "We had no idea!"
"My pleasure," I said. "He seems like a great kid."
I pulled off my gloves, shook her hand, tousled Caden's hair and went out to write the prescription.
Felt a little heroic.
If left untreated, that toothpick could've caused sepsis. It could've been fatal. Though it didn't happen too often, I think I could firmly say I'd saved a life tonight.
Just then the doors to the ambulance bay burst open, and a pack of people ran down the hall next to a gurney. "Drive-up gunshot to throat" barked someone—Bobby, it was my honey! "Extensive blood loss in vehicle, get the Level One infuser running with four units of O positive. Call the blood bank for a mass-transfusion pack, and call trauma code for Room One, now! Stop sitting on your asses, people! Move!"
The place exploded with action, people running in every direction, doing as their lord commanded. I inched toward the room where the action was, hypnotized. Good God. It looked like half the man's throat was missing, a meaty hole about the size of a fist, Bobby's hand inside it.
"I'm clamping his carotid with my fucking fingers!" Bobby yelled. "Where the hell is the surgeon?"
Indeed, Bobby's arm was drenched in blood, his scrubs sprayed with arterial spatter. The rest of the team buzzed around the patient, cutting off his clothes, inserting lines.
"No, you can't intubate, idiot!" Bobby barked at an intern. "Can you not see my hand in his throat? Bag him, you moron!"
I sure didn't miss residency. The ER doctors had been brutal.
Dr. McKnight from Surgery burst in, pulling on her gloves, a face shield already in place to protect her from blood-borne diseases. Someone draped her in a gown. "Clamp," she snapped. "Now!" If there was anyone more, ah, self-confident than an ER doc, it was a surgeon. "Keep your hand there, Bobby, and don't even breathe. You lose your grip, he bleeds out in five seconds. How the hell did he make it here with a pulse?"
Then a nurse saw me gaping and closed the door. I wasn't ER staff, after all.