Los Gatos Weekly-Times

Photograph by George Sakkestad

Judy Dethlefs examines Jesslyn Whittel.

Daily Challenge

Emergency room staff must solve puzzles fast

By Clarence Cromwell

Scene one: A warm afternoon in June. A small break room at Los Gatos Community Hospital, where Dr. Judith Dethlefs and the reporter who's been following her this month are talking. The doctor has just finished saying that she loves working in the emergency room because she never knows what will happen next. Extreme closeup of Dethlefs: She has a kind face and keeps her sand-colored hair cut just above the collar. She doesn't look surprised when a nurse pops her head into the tiny break room: "I need you in C. This guy munched up his fingers pretty good."

Dethlefs exits with a swirl of her white coat while the reporter gathers up pens and notebooks in hopes of catching up.

Cut to a small treatment room.

Lonnie Woodlief lies on a bed and tells the doctor his right hand was bitten by the twin blades of an industrial table saw about an hour ago as he cut a notch in a sheet of plywood.

"It hurts, trust me," he says, grimacing.

Dethlefs, in a tone that's somehow both confident and soothing, promises Woodlief that he'll get a shot for the pain. The X-rays show that two fingers are broken and Woodlief may need an orthopedic surgeon for one of them.

She takes a few notes on her clipboard and unwinds the bandage without so much as a blink at the damaged hand. She prods the wound a little to assess the damage and asks Woodlief to wiggle each of his fingers (tendon injury in the index finger, she notes).

After taking a culture to check for infections, she wraps the hand back up and sends in a nurse with Woodlief's pain shot.

In the hall, the doctor's tag-along reporter asks how Dethlefs remains so cool when people are hurt so badly.

"You just learn how to efficiently get things done, and getting upset doesn't help that," Dethlefs says.

They keep walking.

Slow pan of the emergency room at Los Gatos Community Hospital: It is square, about 30 feet across, and two sides of the room--the north and south--are lined with doors to the tiny treatment rooms, including the one Dethlefs just exited.

We pass the entry door on the west side, lined with a row of chairs awaiting new patients, a scale, and rolling blood-pressure gauges. The eastern wall is mostly a window into the two-bed cardiac unit, which is full of equipment--very complicated equipment, judging by all the knobs, buttons and glowing screens.

The nurses and doctors work quietly at the workstation right in the middle of the emergency room.

Dethlefs is one of eight doctors who work 10-hour days and 14-hour nights in Emergency. This is where people come when they need fixing, and for two or three days a week, anyone passing through the doors here gets patched up by Dethlefs. This emergency room is noticeably uncrowded; it's one of the quieter emergency rooms in the Santa Clara Valley because life-threatening injuries--the shootings and the car wrecks--are treated at the trauma centers of Valley Medical Center and Stanford University Hospital.

Still, doctors never know what will come through the door next.

Making Saves

Back to Dethlefs in the break room.

One of the rewards of working here is that she gets to save lives, she says. It's especially rewarding when doctors bring patients back from the very brink.

"Saves" happen quite a lot nowadays, because doctors are better able to handle heart attacks. Patients with life-threatening heart problems can be treated easily with drugs that thin the blood and open clogged vessels feeding the heart. If they get to Emergency soon enough, Dethlefs just has to diagnose the heart problem and administer the drug as quickly as possible, preferably during the patient's first 30 minutes in Emergency.

Of course, some people can't be saved.

A man recently walked into the emergency room in the late stages of a heart attack and, after being swiftly admitted, collapsed just inside the Emergency door and died.

Death is very hard to live with, the doctor says, especially when the patient comes in chatting with doctors and looking just fine. A death is easier for doctors to forget when the patient comes through the door in critical condition, perhaps unconscious, and doctors already fear the worst.

John Holden

When Dethlefs walks into the cardiac unit, a nurse explains that John Holden's heart is racing and his chest hurts. Holden, a retired U.S. Army sergeant, says he is 72 "but good-looking."

A while ago he was at home waiting for the pain to subside. He's had three or four heart attacks, he says, and this doesn't seem as bad as the others. Finally, he called his daughter and asked for a ride to the hospital.

Now he is laid up on a hospital bed with his chest bared and jeans rolled up to the calf. Holden has an oxygen tube in his nostrils and electrodes wired to his chest and legs, connecting him to a machine that's tracking his heart rate. There's a needle in his left arm, in case intravenous drugs are needed.

"What I'm looking at here is a heart rate of 124," a nurse says to Dethlefs.

Dethlefs advises a nurse to give him digoxin, the drug that will slow his heart. She explains that she was able to get Holden's medical records within a few minutes, by way of a fax.

Holden cheerfully talks about his service in the Army and 34 years living in Naples, among other things.

A beeping alarm sounds at the emergency room's central desk: an ambulance is on the way.

Solving the Puzzle

Dethlefs leans forward in her chair.

It's not so easy to tell what's wrong with people, she explains. The cut hand was easy to diagnose, because Woodlief told her what happened and she could see most of the damage. It's not always so simple.

"Not everyone reads the books of what their classic symptoms should be," Dethlefs says.

Some people just come in with unexplained pains or weird symptoms and wait for the doctors to make it better.

"The challenge," Dethlefs says, "is trying to figure out the puzzle of what's wrong. I've had two patients now with a ruptured aorta who complained of ear pain."

What looked like an oddball symptom the first time around could put her on her way to quickly discovering a weakened aorta next time, Dethlefs says.

"That's partly why I like emergency medicine--it's a challenge to figure out what's wrong."

Sally

When the ambulance arrives, paramedics hoist a gurney out of the back and roll "Sally" (not her real name) into an Emergency treatment room, an oxygen mask over her face. She's a living jigsaw puzzle.

"This is [Sally]," a paramedic says to Dethlefs. "She's 77. She was found by firefighters in her closet."

One of the paramedics, Carol Bentley, waits outside the room that is too small for more than three or four people. Sally, a paramedic and the doctor already fill it to capacity.

Sally was in the closet with a bowl of feces and her house was not well-kept, Bentley says. She only responds to her name.

The first piece of Sally's puzzle is easy. Bentley advises the doctor that Sally has a large, open wound on her chest.

"It looks like a gunshot wound, but it's not," Bentley says.

Dethlefs needs only a look.

"That is a breast cancer," she says, coming out of Sally's room. She explains that an untreated cancer can grow until it erodes the skin; to become so advanced, the cancer probably went untreated for years. It may not be life-threatening, Dethlefs said, because if a cancer has been around that long, it probably isn't spreading through the body very aggressively.

Fitting the rest of the puzzle into place has Dethlefs temporarily stumped. Sally's delirium is hard to figure out. It could mean a serious infection in the wound, the doctor speculates; it could mean she's not getting medication she needs; or it could be a condition related to her age.

In the meantime, Dethlefs examines Sally's physical condition and discovers numerous partly healed injuries, including a deformed wrist. A closer look shows that the wrist was broken and healed without setting properly. The injury is a few months old.

"I fell down once and hurt my wrist," Sally tells the doctor.

Now the doctor is sure that Sally just isn't capable of taking care of herself. Numerous bruises and scabs cover the woman's legs and knees; partially healed, yellowed bruises cover her back. She decides to admit Sally into the hospital.

Dethlefs orders some blood tests for Sally. Then an X-ray technician in aqua surgical scrubs rolls a portable X-ray machine into the room for a picture of the wrist. Dethlefs asks the tech to also roll Sally's bed up to the tomography department for a three-dimensional scan. Dethlefs wants to check for bleeding that would indicate a head injury and for tumors that could show up if her cancer has spread.

Officer Loney Turpin of the Campbell Police Department, who arrived just after Sally, still waits outside her room. The fire department reported Sally's condition as a possible case of elder abuse, Turpin says.

When Sally's son walks in to chat with Dethlefs, Sally doesn't recognize him. The son tells Dethlefs that Sally was fine about four days ago.

Jesslyn Whittell

A couple comes in with their two little girls after 10 p.m.

The tiny baby in the car seat is asleep. The two-year-old, Jesslyn Whittell, is wide awake and crying. She fell off a swing into the sand and might have something in her eye, explains her dad, Randy Whittell. The eye swelled up within a few minutes, and she's been rubbing it. Dethlefs quickly notes that Jesslyn's eye has a scratch.

The dad is a little anxious, too. He's a graying medical-equipment salesman from L.A., still wearing the shorts and sporty sweatshirt he put on for the family trip to the park.

Jesslyn has been to the hospital for a fever, the father says, and she doesn't like it here. Jesslyn agrees by turning up the volume a little.

"I can't tell you how much it kills me to hear this," Jesslyn's father says.

He squeezes Jesslyn's foot while Mom, Julie Whittell, holds Jesslyn in her lap to help the doctor apply medicine and an eye patch. Dethlefs, of course, doesn't bat a single lash.

Jesslyn's eye should be OK in a day or two, Dethlefs says, as long as the eye patch stays on.

Helping Kids

Dethlefs, leaning over paperwork at the doctors' workstation, says she enjoys working with kids, partly because they're more open with the doctor. Adults tend to not tell doctors about symptoms or to try to tell the doctor what they think is wrong.

Kids want to know if they have to have a shot, but after that, they're easy. What they usually have, by the way, are sprains and lacerations that don't call for shots.

Of course, there are less conventional maladies.

"I remember a little girl who came in who had inhaled a molly bolt," Dethlefs says. She took it out with a long pair of forceps.

Epilogue

Another slow pan of Emergency: The room is dim now. Sally is no longer in her room because she's been checked into the hospital (her next stop will probably be a nursing home, after she gets tuned up here). But John Holden has checked out and gone home. He'll be fine, for now.

Jesslyn and her stuffed cat have matching eye patches and they're on their way, along with Jesslyn's parents, out the door and back to a friend's home in Willow Glen. A young lady is in the room next to the one that was Sally's. She tells the nurse she was at a party when somebody hit her in the head with a bottle, and now she feels dizzy.

It's midnight. Dethlefs and the remaining nurses are bent over late-night paperwork at their workstation. Dethlefs will go home after the sun comes up.

Cut to the hospital parking lot: Los Gatos is asleep and the surrounding streets are nearly empty. Pull back until the floodlit hospital is just one of the zillions of twinkling lights in the Santa Clara Valley. Fade to black.

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