you never know a good thing until its gone

“You never know a good thing until it’s gone.”

“One day, all the love you know will be gone”. Marcus Delorean read the passage out loud, alone, here with the gravestones. Once a year, he came to this graveyard to visit the graves of his wife and child. He said a prayer of remembrance. Then, he sat, inhaling the scent of fresh-cut grass next to the tombstones. Large oaks as wide around as a barrel and a hundred feet high gave him welcome shade this summer afternoon. Birdsong wafted soothingly from the limbs of the trees.

He knew that no ghosts were here, no happy or sad spirits, only the lifetime of memories alive in his head. Once a year, he came here and set those memories free.

His phone buzzed in his pants pocket. He took it out and looked at the screen ID.  Nathan, his fellowship resident

“You know not to bother me when I am off duty, Nathan,” Marcus said

“Sorry, Doctor D, but it couldn’t wait”

Marcus sighed. “Ok then, shoot”

“Mr. Adams just died”

“Go on,” Marcus said into shattered serenity.

Nathan continued, “Everything looked good until 4AM when he started runs of V-Tach, just short runs to start, and it seemed like no big deal, but at 7AM, his BP started dropping, and he started having seizures and developing a petechial rash. As you know, we started broad-spectrum antibiotics yesterday, so it was always possible that the rash was secondary to the medicine, but the lesions grew too fast until his skin started bleeding. I hit him with high-dose IV steroids, but that did not work. His BP kept dropping despite pressors, then he flatlined and died"

“OK, Nathan. I will come back in. Meanwhile, keep the body in isolation. Have you told the family yet? No? That’s okay; I will do it after I see him.” Marcus hung up. The day lost its lightness.

On the way back, Marcus reviewed the case in his head. When alone, Marcus liked to talk about the case out loud, like a baseball play-by-play announcer.” John Quincy Adams (really), age fifty-four, came to the ER two days ago with weakness, fever, headache, sore joints, and cough. He had the usual tests, which were all normal except his chest X-ray. That showed haziness that could be pneumonia or fluid.” Marcus paused, reviewing what the resident had told him to justify the admission. These days, most things are treated at home. Marcus could remember a time early in his career when the hospital wards would be overflowing with many things that could be treated at home these days. He continued his monologue.

“The patient's oxygen saturation was low at 89, so he was admitted, put on oxygen, an IV, and intravenous antibiotics after all the cultures were obtained. He initially started to improve, but today, “Marcus’ voice trailed off.” Ok, hotshot, what about today?” Marcus said no more and pulled into the staff parking lot close to the front entrance to the hospital. Going in, he said hello to the guard there, who waved him through.

“Thanks, Harold; how is Maggie?

Harold, who dwarfed Marcus, him being six foot nine and three hundred and fifty pounds, muscle, not fat, said,” She is doing great, Doc, on the new medicine you prescribed. I can’t thank you enough and I don’t have to keep the AC set at 60. No more hot flashes”

Marcus chuckled, “you are most welcome Harold” and he went on in. He breathed in deeply. "Ah, I love that new hospital smell," he thought.

He went up to the ICU, passing by the waiting room, occupied by several families, patiently waiting for news from the other side of the door. Two small children raced around the seats chasing each other. Wearied parents and relatives gave up and let the kids play.

 He would be back to give them what he called halftime updates. Their eyes, he thought, always such pleading in their eyes, waiting on the tiniest sliver of hope, the eyes would almost break him.

Nathan sat at the nurse’s desk dictating notes. Sitting down beside him, Marcus pulled up Mr. Adams's chart and reviewed everything from the time of admission until the time of death. He was most worried as to whether the cause of death was infectious or not.

“Let’s go look at the body."

“Sure, boss,” said Nathan, “I’ve got him in room ten on the corner”

The two men rose, went to room 10, and put on the protective gear. Then they went inside. Lying on the hospital bed, covered only in a sheet, lay the departed Mr. Adams. Marcus pulled off the sheet.

Marcus’s eyes grew wider as he got his first view of the corpse. Every bit of Mr. Adams's body was covered in huge purplish bruises. Mr. Adams looked like he had been beaten by 10 men all at once. “Where did the rash first become apparent, Nathan”

“Wrists and ankles first, then soon popping up everywhere”

“Purpura Fulminans,” said Marcus. “The signs were all there. What caused it? Let’s start over again, as most medical problems can be solved just by taking a good history, so go over the presentation with me again, Nathan.”

Nathan reviewed each detail gleaned from his first interview with Mr. Adams. Marcus closed his eyes and immersed himself in the story as if he were Mr. Adams. Nathan took his time asking the questions and giving Mr. Adams’ answers. They had used this technique before on puzzling cases, and Nathan was astonished at the insights Marcus found.

Finally, Marcus opened his eyes. “Let’s go look at the body again”

Donning the protective garb, the two doctors returned inside the room holding Mr. Adams. Marcus removed the sheet

“I will start at the feet, and you start at the head. When we find it, call out”

“Find what exactly,” Nathan said

“You will know when you see it”

Nathan reluctantly complied. They each began an in-depth examination of Mr. Adams skin. ‘Ten minutes later, Nathan called out. “

“Damn, would you look at that” Nathan picked up a mosquito forceps and tugged on something in Mr. Adams's thick, curly black hair, then held it up for Marcus to see.

“A tick” Marcus exclaimed. He started taking off his protective gear. Nathan looked at him with one, raised, questioning eyebrow.

“Don’t worry, Nathan, Mr. Adams is not contagious. He died from Rocky Mountain Spotted fever”

The two doctors sat back at the nurse’s desk. A sweet aroma of freshly brewed coffee came from the makeshift coffee and refrigerator nook behind them, the smell of the coffee piercing the ubiquitous disinfectant smell in the ICU. Each man dictated the notes to be added to the chart. As efficient as the electronic record undoubtedly was, Marcus missed the heft and touch of the paper charts he used early on in his career. He had the physical sensation of time passing him by. Sometimes, you never know a good thing until it’s gone. He sighed and got up, and went to deliver the bad news to the anxious, waiting family.