Chapter 3

Around the beginning of my second year of residency, I was just getting off an all-nighter and ready to head home when Anita brought us a guy in the detox van. I was standing nearby as she was giving report to the triage nurse.

"We picked this guy up outside the shelter downtown. As we were helping him into the back of the van to take him to detox, he just collapsed. At first, I thought he just passed out from booze, but then I noticed his respirations were really fast and deep, like he couldn't catch his breath. I checked him over for injuries but I couldn't find any. I figured I better bring him here because his breath smelled like he might have been sipping Sterno. He acts like he's really acidotic."

The nurse assigned him to a treatment room in the back and I followed them to do a quick exam. As he was being undressed (not a pretty sight), I bent over to smell his breath. Aside from a case of terminal halitosis, there was a definite chemical smell. While the lab tech was drawing blood, I asked the nurse to start an IV, get an alcohol drip going and get an amp of bicarb ready just in case. As it happens, Anita hit it right on the head. The guy's blood gasses showed a pH of 6.7, very acidotic and very lethal if not corrected quickly.

We got him stabilized and transferred to the ICU.

Anita went back to the detox center to turn her van over to the day crew. I called and asked them to have her drop by the hospital on the way home. She was there in ten minutes.

"That was a smart pickup on that last patient you brought in. If you'd taken him to detox and dropped him in the tank, he wouldn't have lived through the morning. I think you can claim this one as a save. Congratulations and kudos, Anita. Good job!"

"Wow! Thanks, Dr. Butcher! That really makes my day."

"Yeah, mine too. Hey, I'm just getting off duty. Would you let me buy your breakfast? You know, as kind of a reward for a job well done?"

The smile she gave me would have melted steel. "I'd like that very much! Can I clean up a little bit in the lady's first?"

"Take your time. I have to finish up a couple of charts but I'll be ready in about fifteen minutes. How about I meet you in the hospital lobby?"

"Great! See you then."

Our conversation was about half and half, Spanish and English, as we had our breakfast at Denny's. She was still so charged up, she insisted I tell her all about why the guy was so acidotic and why I started an alcohol drip on him when he was already suffering from alcohol poisoning. I explained that the Sterno he was drinking was methyl alcohol and highly toxic to the system and that ethanol, the kind you find in booze, actually neutralizes the bad stuff.

As we were finishing our coffee, she said, "You know, next week will be a year since I got my EMT. I talked to Denise last week and she says my spot in the next paramedic course is a lock. It starts in two weeks."

"Hey! Congratulations again! That's great news, Anita. Does that mean our Spanish lessons are coming to an end and my apartment is going to devolve back into its usual disorganized state? You're going to be an awfully busy girl, once you start P-school."

She looked kind of sad and nodded her head. "I suppose there's no way around that. I'm sure going to miss spending time with you, Dr. Butcher."

"Do me a favor, will you? Stop calling me Dr. Butcher when we're not on the job. It's Ken, OK?"

"Ken. Um, Ken, can I ask you a very personal question?"

"I don't see why not."

Anita took a deep breath and locked her eyes on mine. "Do you remember when I got beat up, and we were joking about girls picking bad boys instead of nice guys like you? I said something about giving me a chance and you said something about it being an ethical violation. Is that still true? Would it still be an ethical violation if we were to get, um, you know, closer?"

I was caught totally flat-footed by that one. I had no idea she felt that way and I was at a loss for words. I just sat there looking at her and trying to think of something to say. I guess she mistook my silence as rejection because she blushed and said, "Forget I said that, OK? I think I was out of line."

She started to slide out of her seat but I reached over and held her wrist. "No! No, Anita, you weren't out of line at all. I just didn't know you felt that way. The ethical issue only existed for as long as we were in anything like a doctor-patient relationship. Believe me, there's nothing I would like better than to get closer to you. I never said anything because I didn't think you were interested in anything more than friendship."