I was in a room. The room was white. A woman, also in white, hovered above me. Behind her was a brilliant light that stung my eyes. I tried to turn my head away, but the woman wouldn’t allow it.
“Do you know who you are?” she asked.
“Where am I? Who are you?”
“My questions first.”
I tried to rise. The woman prevented it with the flat of her hand pressed against my chest. It didn’t take much effort on her part. The way I felt, a couple of kittens could have held me down.
“Do you know who you are?”
“Rushmore McKenzie,” I said.
“Are you sure?”
“I don’t know. What have you heard?”
“Where do you live?”
I told her. I gave her answers to a lot of questions—my address, phone number, Social Security number, and yes, I had health insurance, the card was in my wallet.
“Good,” the woman said. “No apparent memory loss, no confusion. Very good.”
“Who said I’m not confused? Where am I?”
“You are in the emergency room of the City of Libbie Medical Clinic. I’m Nancy Gustafson. You have a concussion.”
“Oh.”
“Do you remember what happened?”
“No.”
“That’s not unusual. People who have concussions almost always have no memory of the impact that caused the concussion.”
“I remember walking in an alley—two men in an alley. Saranne. Saranne Miller was with me. Where is she? Is she all right?”
I tried to rise again. Nancy kept me down, although this time she had to put her weight into it.
“She’s all right, she’s okay,” Nancy said. “She’s outside. She’s the one who brought you in. Rest easy.”
Nancy patted my chest. Her smile was warm—I was sure I had seen it before.
“I was careless,” I said. “I’ve been careless ever since I arrived in this burg. Big-city boy gonna show the local yokels how it’s done. Dammit. I know better than that. Are you sure Saranne is all right?”
“Yes. You can see her in a bit. We need to do some things first.”
“The cops.”
“We called the cops. There are other things—”
“What things?”
“Listen to me, McKenzie. Are you listening?”
I stopped struggling with her.
“I’m listening,” I said.
“The brain has the consistency of gelatin. All right? It floats in a cerebrospinal fluid inside your skull that cushions it from bumps and jolts. Now, a blow to your head can cause your brain to slap against the inner wall of your skull.” For emphasis, she punched the palm of her hand with her fist. “This collision, the impact from the collision, can result in bleeding in or around your brain and the tearing of nerve fibers.”
“I know all this. I’ve had concussions before.”
“Then you know the drill.”
“You’re going to give me a CAT scan.”
“Yes.”
“The CAT scan will determine whether the blow has caused potentially serious bleeding or swelling in my head.”
“Exactly.”
“Are you set up for that in metropolitan Libbie?”
Turned out they were.
It didn’t surprise me to learn that South Dakota was facing a physician shortage. Nancy said that at least eighteen counties didn’t even have a single doctor living within their borders. To deal with the shortage, clinics relied on nurse practitioners—registered nurses that complete advanced education and training in the diagnosis and management of common medical conditions, including chronic illnesses. When patients were taken to emergency rooms, the nurse practitioners determined how serious their condition was and whether to transfer them to larger hospitals. In many cases, they relied on a complex telecommunications system that linked them with physicians in the bigger hospitals who provided assistance.
With the help of a nurse, I lay down on a narrow examination table, and the table was rolled into the large, donut-shaped CT scanner. A gantry containing electronic X-ray equipment rotated around me, taking multiple cross-sectional X-rays and combining them into detailed, two-dimensional images of my skull and brain. These images were sent directly to a hospital in Rapid City, where they apparently caused a certain amount of consternation.
Nancy returned me to the emergency room, set me on a gurney, and began asking more questions designed to test my memory and concentration, vision, hearing, balance, coordination, and reflexes. She asked if I felt dizzy, if I heard ringing in my ears, if I felt nauseous, if I was sensitive to light and noise, and seemed genuinely mystified when I kept answering no. In between the questions, she spent a lot of time on the phone.
Finally she said, “You told me that you had a concussion before.”
“Not really a concussion,” I said.
“What then?”
“An epidural hematoma.”
“When?”
“A couple of years ago.”
“Aha,” she said and hurried from the room.
She was smiling when she returned.
