FOREWORD: I’ve anonymized names and redacted locations to protect the privacy of patients and colleagues.
It had been three weeks since I started as an intern at [REDACTED] hospital in the emergency department. Finding myself with nothing to do at three in the morning, I jumped at the chance to examine the new patient I saw enter the triage room.
I grabbed his papers from the triage desk but the nurse manager Liz almost slammed her hand in a clenched fist against the clipboard, yet somehow forced a sweet smile as she said, “I’m going to get someone else to take this patient.”
There were only two other doctors in the ED at this point in time, another intern, Doctor Patricia Weinstein, who was busy dealing with a man who decided to lick a frozen can, and Doctor Moore, who was busy with a more serious drug overdose patient. I was a bit more than annoyed with the nurse.
“The other doctors are busy. I’ll take care of this.”
Liz let the papers go. “I just think you should let someone else take care of this, doctor.”
I had a look at the triage papers.
Name: Daniel. Age: 34. Presenting symptoms: Oral thrush.
Oral thrush? To an ED? To say I was confused was an understatement. Since I started, I always had the hunch that nurse Liz had an incredibly low opinion of me, she was always staring at me, giving me terse one-word responses, and seemed to go out of her way to help me as little as possible. But this is absurd.
He shouldn’t be presenting to an ED with oral thrush at three in the morning. And what the hell was that about someone else taking this case? As if I couldn’t deal with thrush of all things.
“Concern noted.”
When I entered the room, the patient was alone, sitting on the edge of the patient bed, hunched over almost into a ball. He’d been in better shape.
“Hi I’m Doctor Narrator. How can I help this evening.”
The patient didn’t even sit up. He was hunched over his shoulders, almost in a sitting foetal position. I had a better look at the triage sheet.
“Hello,” checked my notes again, “Daniel. What seems to be the problem?”
“Are you…a doctor?” Said Daniel hunched over and with heavy breaths. This was when I started to think this was a bit more than oral thrush, possible allergic bronchopulmonary mycoses. What the hell was Nurse Liz thinking with such an incorrect initial diagnosis?
“Yes, I’m Doctor Narrator. Could I get you to sit up please Daniel?”
I couldn’t rule out anything without making a proper visual inspection. Not to mention this would be a simple function test.
“Sure thing…doc.”
Daniel slowly, and with what seemed like strenuous physical effort, placed his right hand on his knee. He then took a small breather by taking large gulps of air. Then he did the same with his left hand and with what seemed like the intensity of an Olympic weightlifter, he pushed himself off his knees and slumped back against the wall.
There were one, two, three, four white fingernail-sized toadstools growing on the left side of his face. His eyes were darting back and forth, his eyelids sunk half way down, and he had little if any muscle tone on his face.
Yeah, not thrush.
I was still in the middle of the room at this point. I hadn’t even begun a proper examination but I could already tell I was going to have to wheel him off and give him intravenous antifungal medication.
But I was a professional. I had to do at least a rudimentary investigation before sending him off. To be honest, at that point, I was also more angry at Nurse Liz for her half-assed attempt at triage.
And to assume I wasn’t competent enough to take this case.
More out of curiosity than anything, I asked Daniel, “Are you here by yourself?”
“Yes.”
Strange, considering he could barely lift himself up. There wasn’t a wheelchair or anything in here. It was too difficult to believe he could walk in here unaided.
“Daniel, did the nurses use a wheelchair to move you here?”
“No. Doc…it’s getting harder…to…breathe.”
The chart said he’d only been here for five minutes. There was no way he had deteriorated that quickly. Nurse Liz had to be really bad at her job.
“Daniel, I’m just going to have to ask you to open wide just to see inside. Then we’ll get you into ICU. Okay?”
Daniel struggled to nod. If he felt pain, he didn’t have the ability to show it on his face. It looked like he had a permanent sad clown fish face look. And his breathing looked heavier and more strained. It started to get faster and deeper. As if he was driven to the point of exhaustion. It was wearing me out just looking at him.
I quickly put on some gloves and grabbed a fresh tongue depressor (I’ll be honest, it’s an over-glorified popsicle stick) and told Daniel to open his mouth. His jaw dropped and mine did too.
I think I stressed the point that this wasn’t oral thrush before but in a normal case you’ll just see a white coat over the tongue. Daniel didn’t have a white coat over the tongue. It looked like a full-blown mushroom farm in there. Most of his mouth was bright green, and there were, and I will stake my medical reputation on what I saw, there were fluorescent, pulsating, mushrooms on his mouth’s roof.
This was a mycosis for the ages.
Before I could even turn around and call for an emergency transport, I watched as one of the purple mushrooms swelled…then popped.
Bright purple spores sprayed on me. I fell back on the floor, coughing, flailing, spluttering, crying out for help in between my gasps for air.
Then another pop. Then another. And another.
I couldn’t see. The entire room was covered in fluorescent purple light. Smothered in tiny spores.
I was choking. Struggling, I grasped at my throat, as if that would help. Couldn’t cough, couldn’t breathe, vision blurring. I tried to stand up, couldn’t stay up, staggered until I hit a wall. Clawing, grasping, reaching for the door handle.
It was funny in a way. A doctor dying in a hospital trying to help a patient. Ironic. The thoughts that float through your head as you struggle to survive.
A miracle. I found the doorknob and heard a voice on the other side.
“I hope I’m not too late. This one might be a doozy.”
I turned the knob and simply fell out of the room and collapsed on the floor. Gasping for fresh air, I barely noticed as someone started spraying me with a squirt bottle.
I heard a woman’s voice over me.
“Sorry doc. But it’s only mostly water! It’ll wash out.”
In between the coughing and spluttering I managed to groggily turn my head and look at the woman above me. She was wearing green surgeon’s scrubs, a surgeon’s hair-net and an N95 face mask. Her only distinguishing feature was her green eyes and a single strand of black hair down the right side of her face.
She looked into the patient room and audibly sighed.
“One of these days I’ll be on time.”
I didn’t even have time to say anything before she went into the patient room and closed the door. Next thing you know there was a small BANG noise. A few seconds later, a light-yellow mist seeped out from under the door. She came back out and stood at the doorway. I couldn’t see any of those purple spores in the room behind her.
“Really sorry doc. This is all my fault. Really. I just need to be on time for once.”
She reached underneath her coat and pulled out a small vial of yellow liquid and poured into a plastic cup from one of her pockets and handed it to me. She was a real walking apothecary.
“Drink up. It’s uh…Nystatin.”
Maybe it’s because I nearly died from oxygen deprivation that I took that medicine without question from somebody I’ve never met before. I swallowed and only stared at the ground for a moment before I looked up and she was gone.
Daniel survived. I found him asleep on the bed and after I woke him up, he didn’t even remember walking into the hospital. No signs of infection. Sent him home. There were no possible reasons to hold him back for observation, he didn’t want to be there and there was nothing wrong with him. I’d never seen anything like it before.
That only left me the problem of finding out who that woman was. Doctors don’t fumigate entire rooms with explosions. My attending physician Dr. Rutkowski hadn’t heard of her. I asked him about the case and if he’d ever seen a systemic infection of purple mushrooms before but he just thought I was dumb intern playing a prank on him by the other senior doctors in the hospital. He wouldn’t even check security footage, saying patients don’t miraculously recover from systemic infections in minutes. “My diagnosis,” he said, “get more sleep.”
And what about Nurse Liz? She was the one telling me not to see the patient. She was the one who wrote down that absurdly wrong diagnosis of oral thrush. I asked her straight away if she saw the woman in the surgeon’s scrubs walk through but she said, “I must’ve been busy and didn’t see her.”
If anybody knew about that woman it had to have been Nurse Liz.