Sweeping the Floor

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Nurse Addison opened the door and waved a clipboard at Doctor Skaven.

“The patient in room C is ready for you, doctor. Here’s his chart.”

The physician leaned back from his desk and took the information proffered. He pulled his glasses down from his brow, did a quick read through and said, “This guy’s forty-four and checked himself in with the self-diagnosis of a heart attack? Where’d he get a medical license?”

“I know, doctor,” she replied with the sigh of an exasperated school teacher. “The man looks physically fit, but that’s what he complained of: chest pain.”

Skaven knocked politely with two taps before he pushed the door open. He extended his hand, introduced himself, said, “You are Evan Burgess?” When the response was affirmative, Dr. Skaven gave a hearty smile. “Good, Mr. Burgess. I always like to confirm that before we do anything. Wouldn’t want to be treating the wrong patient now, would we?”

Burgess had removed his shirt as the nurse requested and Skaven was aware of the man’s physique which was excellent for a middle aged adult male. His posture was good, his skin clear, his complexion ruddy which was to be expected from the outdoorsman type he appeared to be. Skaven had already convinced himself the man’s heart was not an issue here. However, before the patient could say anything in reply, Skaven continued: “You don’t smoke? Have diabetes? You look fit. What kind of work do you do?”

“Forest ranger is the best way to describe it,” Burgess said obviously brightening to the topic. “I mostly walk around the forests of Marin, Mount Tam. That’s where I was when I felt the pain in the center of my chest. I was hiking and at first I thought it was muscle strain, the backpack pulling, that sort of thing, but it didn’t go away. It was, like, different from muscle pain, I don’t quite know how to describe the difference, plus I couldn’t catch my breath.”

The doctor said, “The nurse took your blood pressure which is normal.” He worked at palpating the man’s chest and back, listened intently as Burgess talked. All the while Skaven was thinking, recalling symptoms he had learned and become familiar with over the years. “You aren’t taking any medication? Haven’t been sweating a lot, have you? Has the pain spread to any other extremity?”

“No. I’ve never smoked or been overweight and there is no history of heart attack or stroke in the family.”

The doctor considered other indicators such as stress. He asked, “How’s the family life? You filled out the form and checked ‘single.’ You didn’t check ‘unmarried.’”

“Me and the wife didn’t share the same things that made us happy,” Burgess said with a hint of wistfulness in his voice. “We broke up five years ago. She faked liking backpacking and camping out. No, I don’t think about her much a tall.” As an after thought, he added, “And I love my job.”

“Pulse is sixty and regular,” the doctor said dropping the wrist. “Typical for an athletic guy such as yourself. Let me listen to your chest.” He placed the stethoscope, said, “Good heart sounds. Take a deep breath. Exhale. Another. Exhale. Another,” all the while moving the chest piece. The doctor sat back and looked Burgess in the eyes. “I detect no abnormalities.” Then Skaven did a somewhat unorthodox thing: he pressed the spot between Burgess’ ribs and breastbone. “Do you feel any pain?”


The doctor placed his hand beneath the patient’s leg and lifted the calf. He examined, then touched the calf and thigh firmly, did the same with the other leg. “I see no evidence of swelling in your legs or ankles.”

Burgess could see where the examination was going and said in his own defense, “It still hurts, doc. It’s a dull, deep burning pain and it won’t go away.”

Dr. Skaven said, “Oh, I believe you, Mister Burgess, and I’m just sweeping the floor, trying to clear things out of the way so I can figure out where we stand. It’s just that everything I know that would tell me what I am looking for or what you are suffering from comes up negative.”

“Well, I waited long enough before coming in. But it seemed like an emergency to me, I’d waited three days.”

The doctor gave a condescending chuckle. “That’s why we call it an emergency room. We’re here for you when you have an emergency. But I don’t think this is one, Mr. Burgess, for which you may be thankful.”

The patient began to pull on his shirt, a thick red Pendleton that smelled of pine pitch. “I guess I can go?”

Dr. Skaven was busy making notes on the top sheet of the clipboard. He lifted it and glanced at the sheet below, made several marks with his pen on that piece of paper and finally said, “Well, not quite. We want to make sure I cover all the bases so I’m gonna order an electrocardiogram, a chest X-ray and blood tests to measure your cardiac enzymes. Can’t be too careful, can we?”

He winked at Burgess as if to say, “Don’t worry. It will all turn out fine. I already checked everything I could possibly check, these are just icing on top, additional but unnecessary. Get me?”

Skaven pulled a third slip of paper from the clipboard and handed it to Burgess. “Take this to the front desk, they’ll direct you to the proper departments. Then I want to see you again in,” he paused to check his watch, “labs and X-ray should be about four hours. My shift ends at eight, so I’ll ask them to expedite the tests, should be ready by seven. That okay with you?”

Burgess poked his shirt into his jeans, zipped the fly, buckled and said, “Like I have a choice, doc?”

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