“I don’t feel very good….”
It was early Saturday morning and I was hoping to sleep in after a long week, but her trembling voice woke me from a deep slumber and filled me with apprehension. Mary was up and standing by the side of the bed, looking down at me as she said once more, “I don’t feel very good…”
“What’s wrong, sweetie? Are you sick? What’s the matter?”
“I don’t know, David…I don’t feel very good….” She walked slowly down the hallway, hesitating with each step, and tried to open the door to the garage. She couldn’t seem to turn the doorknob. I got out of bed and asked her what she wanted from the garage. “I don’t know,” she answered. Her voice was filled with confusion and fear and the look in her eyes told me that something was very, very wrong. She began to cry.
“I don’t feel very good,” she sobbed. I hugged her for a moment and tried to reassure her that everything was all right, then I got her jacket and helped her walk to the car. I started the engine and drove to the emergency room as fast as I could.
This was not our first trip to the emergency room and it would not be our last. It was, however, a pivotal point in the long struggle to save Mary from the ravages of liver failure. This particular day was the watershed event that changed my perception and understanding of Mary’s health status. Prior to this moment, I knew Mary had a serious problem, but I was confident that it could be managed and corrected. The reaction of the doctors at the emergency room made me realize that we had begun a desperate battle to save her life. That battle proved to be the hardest effort and challenge I have ever faced.
The morning was cool and crisp; the winter sun was shining brightly and under any other circumstances that particular Saturday would have been a beautiful day. Instead, the short drive to the ER was filled with fear and anxiety for both of us. Mary knew something was wrong, but she did not know what. I didn’t know, either. What I did know was that I was just as frightened as Mary, if not more so.
The tires shrieked loudly as I made the sharp turn into the ER driveway. I left the motor running and ran into the entranceway where I grabbed a wheelchair and raced back to the car. Mary was still crying as I helped her into the chair and rolled her to the registration desk. The nurse immediately assessed the seriousness of the moment and we were in an examination room in short order. Within minutes another nurse was drawing blood samples from Mary and a doctor began to look her over and ask her questions. When it was evident that her level of confusion was very high, he turned his attention to me.
“How and when did all this start,” he asked. Mary was very upset and he placed his hand on hers and spoke in a reassuring voice, “It’s all right now. We’re going to take good care of you and you’re going to be all right.”
I tried to relate Mary’s history to him as calmly and factually as I could, but my concern was bubbling through and clouding my abilities to communicate with him as well as I wanted. I asked him what he thought the problem was and he said he did not know yet. I then asked if she should be admitted to the hospital and he agreed, but added that he was not going to do that until later. When I questioned his rationale for delaying the admission, he looked at me with a level of confidence and concern that revealed him to be one of the best physicians I had ever met.
“She needs to be in the hospital, but she is not leaving this room until I know what is wrong with her. Let the blood work come back and then we will know what we’re looking at.”
That was my first encounter with Wade Etheridge, MD; the first in a series of doctors to save Mary’s life at a time when things could have gone either way.
Almost an hour passed before the blood results came back. Dr. Etheridge explained it to me in English rather than medical jargon, a gesture for which I was very grateful. I guess he saw how close I was to the edge of my last raw nerve as he took me into the hallway directly outside the examination room.
“We have two problems. First, her ammonia level is very high. Way too high. Secondly, her hemoglobin count –-her red blood cells–is way too low. The ammonia is a result of her liver problems; I am not sure about what is causing the hemoglobin problem.”
“What do we need to do, Doctor?”
“We need to start her on a medication to reduce the ammonia level. It is very close to toxic and we have to fix that pretty quick. We also have to give her a blood transfusion to bring her red cell count back to a safe range. This is pretty serious and we need to move on these issues in a hurry.”
My mind was reeling. I looked back in the exam room where Mary was resting and asked him about the ammonia level. I had never heard of that term before and did not understand the implications.
“How high is the ammonia level and what does that mean? I don’t understand what that is.”
“Everybody produces ammonia in their blood. The liver ordinarily filters it out and also removes a lot of other toxins as well. Mary’s liver is not working very well, so she is not able to cleanse her blood like you or I can. The average ammonia level for a healthy person is between 15-30.”
“What is her level right now?”
The huge variance in the numbers rocked me backwards. “208,” I echoed.
“Mr. Blackburn, I have to be honest with you. I have never seen an ammonia level that high in any patient I have ever treated. Or any patient I have ever heard of. This is very serious and we have to bring that down as quickly as possible. I have already talked to the best hematologist I know and he will be addressing the red cell issue.””
“So are you admitting her to the hospital soon?”
“We are starting her medications while she is here in the ER and we are also going to start a blood transfusion while she is still here. Then she is going to ICU. ”
Dr. Etheridge left me to get the ball rolling with the treatments he had outlined. I went back into the examination room and sat next to Mary as she lay sleeping. She looked so beautiful and yet so fragile. I had never been more afraid for her; I held her hand and wept.
As I waited for the nurses to hang the blood and administer the various medications, I thought back over the time that had passed since I first met Mary and tried to understand what had led us to this moment. I remembered the first time I ever saw her, twenty years before. I traveled quite a bit in my job and was having dinner with some of the folks I worked with at a restaurant in a small town on the west coast of Florida. I had heard that a new sales rep would be joining us; she was the girlfriend of another rep and she had been hired just a few days before. I was staring at the menu when someone said, “Hey, here she is….WOW!”
I looked up and locked eyes with the most stunning and striking woman I had ever seen. She was tall and blond, about twenty five years old, and drop-dead gorgeous. And she was glued to the arm of the biggest weasel in the office. She joined us at the table, the obligatory introductions were offered by everyone, and Mary was the immediate center of attention. She was charming, intelligent, well educated, and her radiance filled the room. Try as I might, I could not take my eyes off her; nor could anyone else. Every guy at our table was doing his utmost to get her attention and make a favorable impression; her boyfriend Joe was eating all this up like fresh made ice cream—he was taking great satisfaction in his Trophy Chick and he knew we were all very envious.
I turned to the person sitting next to me and asked, “Hey Ray, how did a dweeb like Joe find a great looking girl like that?”
“I dunno, but he has to be the luckiest guy on the planet. I heard she was a model before she landed here.”
That statement proved to be accurate. Mary had been a professional model in New York and Paris for quite a while and that experience was evident in her poise and demeanor. We only exchanged a few brief words that evening, but I was determined to get to know her better.
As time passed, Mary and I became good friends. She breathed fresh air into our office and brought a lot of levity and good humor to all of us. She was a smart kid, but green and inexperienced in our business while I was sixteen years older and had been doing the job for a long time. I liked her a lot and I helped her learn the finer points and nuances of our trade. She seemed to trust me; I suppose that was because I was the only guy in the office that didn’t hit on her constantly. I assumed I was too old for her, so I was content to be pals and just work together. Our platonic relationship became better and better over the next few years and I always looked forward to our lunches together and the times we would see customers together. We laughed and joked constantly and she brought some much needed sunshine into my life.
Eventually Mary broke up with her jerk boyfriend and left the company to go back to school and complete her degree. I was sad to see her go, but I made it a point to stay in touch with her and we still met for lunch on a regular basis. A promotion caused me to move out of the area and I did not get to see her as often as I wanted, but she was never far from my thoughts. I made a point of seeing her whenever I was back in town and one day, six years after we first met, she did something I never expected. She popped the question and suggested that we get married.
“Married? Honey, I am way too old for you and you deserve a much better catch than me. We have been friends for a long time, but we have never been out on a real date together. I have never been so flattered, but this would probably never work out….”
“But you are forgetting one thing,” she said to me.
“….I love you, David… I always have.”
I looked at her beautiful eyes and realized that every chance for happiness I had ever envisioned was turning into reality. Her smile entranced me and I said to myself, “One last gift from God….” And suddenly my world was changed forever.
Those wonderful moments seemed like a lifetime ago as I sat next to Mary in that tiny room in the ER. I watched the rhythm of her breathing while she slept and reflected over the long, long road between that joyous day and the crisis we faced on this winter morning. Two nurses came in with the blood and began the transfusion. They woke Mary up in order to give her an oral medication that would start bringing her ammonia level down. Dr. Etheridge came back to the room and took me out into the hallway, where he reiterated his diagnosis and the treatments he had ordered. He was friendly and very informative; I thanked him for his efforts and told him that I would always be grateful for his quick actions and good judgment.
“No need for that, Mr. Blackburn. That’s why I am here.”
“Doctor,” I said, “I have seen a lot of emergency rooms and met a lot of doctors in my lifetime. I want you to know how much I appreciate all you have done today. And one more thing—Mr. Blackburn passed away many years ago. I am Dave..”
He smiled and shook my hand. “Pleased to meet you, Dave. I’m Wade.” With that handshake I knew I had an ally for whatever the future held.