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“Dr. Wayne, I’ve got one for you in AC24.”
Bruce immediately pushed his chair out from his desk and stood to follow the nurse. “What’s the patient?”
Donna passed over a tablet with the patient’s chart pulled up. “Sixteen-year-old Duke Thomas with a history of sickle cell disease. Foster parents brought him in with complaints of pain, fever, and increasing shortness of breath. So far, we’ve got blood cultures, a CBC, CMP, reticulocyte count, and a type and screen pending. Rocephin’s infusing now.”
“Good,” Bruce nodded. “How does he look?”
“Like he feels very shitty,” the nurse grimaced. “He initially rated his pain 9/10. We gave him intranasal fentanyl initially followed by 0.65mg of Dilaudid and fifteen of Toradol once we established IV access per his pain protocol. Beyond that, he sounds pretty coarse, and his sats were hovering around 89% in triage. We’ve started him on three liters via nasal cannula , which seems to be doing the trick for now. X-ray just came by and got a shot of his chest.”
Outside the room, Bruce rubbed some hand sanitizer between his palms then donned a pair of gloves.“Thank you, Donna. While I examine him, would you mind paging whoever’s on for pediatric hematology?”
She smiled. “Sure thing. I’ll be back in a minute.”
When Bruce entered the room, his eyes immediately locked onto his patient. Duke was alone, lying on the stretcher, his sweat glistening underneath the florescent lights. His jaw was tensed, and his hands balled into tight fists at his sides. It was clear he was very uncomfortable.
“Duke, my name is Dr. Wayne. I’m going to be treating you while you’re here with us in the ER. How are you feeling right now? Has your pain improved at all with the medications?”
The kid’s eyes fluttered towards him. When he spoke, his voice was raspy and labored. “F-feel like a million bucks, Doc.”
Bruce smiled a bit. If there was one thing he’d learned over the years, it was that chronically ill children were usually tough as nails—that, and they often had wickedly dark senses of humor. His own kids certainly did.
“How does ‘a million bucks’ translate on a pain scale of 0-10?”
“S-seven.”
“Okay, what hurts the most?”
Duke inhaled shakily. “My chest and my back.”
“When did you start feeling bad?”
“Last night, but I didn’t have a fever then. T-then I woke up this morning, and it was hard to breathe.”
Bruce took a few seconds to listen to the boy’s lungs. Sure enough, there were coarse crackles throughout. “Have you ever had something called acute chest syndrome before?”
“O-once… when I was a kid. Eight or nine-years-old, I think.”
“Well, I’ll need to look at your chest x-ray before I can say so officially, but I think that may be what you’ve got going on right now. You’ll need to be admitted for a few days so we can treat you with antibiotics and oxygen and keep your pain under control,” Bruce explained. He glanced around the room. “Your nurse mentioned your foster parents brought you in. Did they just step out?”
Duke grimaced. “Y-yeah, a few minutes ago. Said they had to make a phone call.”
Something felt off to Bruce, but he kept his face carefully neutral. “Alright, I’ll try to find them so I can explain the plan. While we wait on an inpatient bed, we’re going to continue following the pain protocol your hematologist has in your chart. Depending on what your labs say, we may go ahead and order a blood transfusion, too. Sound like a plan?”
“S-sure, Doc. I’m not goin’ anywhere.”
Bruce placed a gentle hand on the teen’s shoulder. “Hang in there, bud. Either myself or someone else on my team will come back to check on you again soon.”
When he left the room, he saw Donna and Selina whispering at the nurse’s station. Both women had deep frowns on their faces.
That was never a good sign.
“Bruce, we got a problem,” Selina said as she watched him approach.
“What kind of problem?”
“Duke Thomas’s foster parents left.”
Bruce furrowed his brows. “What do you mean, ‘left’?”
“They just walked out of the hospital,” Donna explained. “I tried calling them, but it won’t go through. It’s like our number’s been blocked.”
“Could the phone numbers just be outdated? We could ask–”
“Both the mother and father confirmed their phone numbers at registration,” the nurse countered.
A pit started forming in Bruce’s stomach. “Duke mentioned they just stepped out to make a phone call. Maybe they’re coming back. Do we have a number for his caseworker? We’ll have to call DCS anyway to let them know he’s being admitted.”
“Lois is his caseworker,” Selina offered. “I’ll call her and see if she’s heard from Duke’s foster parents.”
“Thank you, Selina,” Bruce nodded. “Donna, did you happen to figure out who’s on for peds hematology?”
“Dr. Isley. She’s on her way.”
“Perfect. Let me know when she gets down here, please. I’ve got to check on a couple of my other patients, but I’ll circle back in a bit.”
It was about twenty minutes before he made it back around to Duke’s room. Dr. Pamela Isley was waiting outside with Selina and Donna.
“Dr. Isley, welcome to the party,” he greeted as he joined the group. “What do you think of our friend in there?”
“I agree it’s most likely acute chest syndrome,” she confirmed. “His x-ray came back with left-sided infiltrates. His hemoglobin also resulted at 6.8, so I went ahead and ordered a blood transfusion.”
“Thank you for doing that. I haven’t had a chance to look at any of his results yet. Any word from his foster parents or Lois?”
Selina sighed. “Yeah, and it’s not good. His foster parents are turning Duke back in to DCS custody effective immediately. Lois is coming over to sign consents and stay with him for now.”
Bruce’s eyes widened. “They’re just giving him up? Why?”
“Apparently, his sickle cell has just become ‘too much’ for them to handle. They told Lois they believed it was in Duke’s best interest to be placed with a different family.”
Anger bubbled up in Bruce’s chest. “How long has he been with these people?”
“About six months, I believe,” Dr. Isley supplied. “My team has been treating Duke for years. He’s been in and out of state custody for most of his life. His father died a long time ago, and his mother suffers from schizophrenia. She is currently in a long term psychiatric care facility.”
“Shit,” he cursed. The whole situation was a complete nightmare. “Poor kid. Has anyone told him yet?”
Selina shook her head. “Lois asked me to wait for her. We’ll go in together once she gets here.”
He swallowed thickly. “Right. Well, I put in the bed request, so Duke should hopefully have a room upstairs soon. In the meantime, keep me posted, please.”
As soon as he could get off the floor, Bruce invited Clark to grab some coffee in the ER’s break room so he could fill his best friend in on the entire situation.
“I’m telling you, Clark, it pisses me off,” he ranted. “They knew Duke had sickle cell when they took him in. So why would they agree to care for him only to dump him over something like this?”
Clark handed him a styrofoam cup full of coffee. “Sounds like they liked the idea of caring for a chronically ill child but weren’t actually ready for the reality of it.”
“And now they just get to change their minds and walk away with no consequences,” Bruce grumbled bitterly.
“If it helps, I imagine DCS will think twice before giving them another placement,” Clark offered.
“Whole lotta good that does Duke now.”
His best friend cocked his head. “You know, it’s been almost four years since you acquired a new child…”
Bruce rolled his eyes. “Absolutely not. Alfred would kill me.”
“I’m just saying—”
“Nope. Not listening. In fact, I think I was just paged.”
“Okay, okay, I'll drop it. How's the rest of your crew doing?"
"They're all good," he replied, letting his guard back down. "Jason's applying to grad school this semester, and Tim's enjoying his classes so far."
Clark shook his head fondly. "Yeah, Conner was telling me about the 'Surviving the Zombie Apocalypse' elective they're taking together."
Bruce chuckled lightly. "It's good to know I'm paying for such a high quality education."
"Hey, from what I hear, it's actually pretty intense. Conner said their first project is to develop a presentation on how they would govern their post-apocalyptic society."
"That must be why I overheard Tim outlining his plans for dictatorship to Stephanie the other night. I have to say, I'm more than a little relieved. I was afraid he was experiencing delusions of grandeur."
"Well, if Tim ever does decide to take over the world, we're definitely in trouble," the Child Life Specialist laughed. "But anyway, what about Cass? How's physical therapy going?"
"It's going very well. Cass even told me the other day she hadn't realized how much of her pain wasn't normal."
When Dr. Hall had performed her shoulder stabilization surgery around Christmas, the doctor had noticed some red flags and referred Cass to a rheumatologist. Shortly after that, she was officially diagnosed with hypermobile Ehlers-Danlos Syndrome. Bruce still felt a bit guilty that he had missed it for so long, even though many people had assured him that it wasn't his fault. All of his daughter's symptoms were so easily attributed to her recurrent childhood trauma that there had never been any reason for him to dig deeper. Still, now that he knew, it seemed blatantly obvious.
"She is one tough cookie," Clark marveled.
Pride welled up in Bruce's chest. "She sure is."
***
After finishing his coffee and catching up on his charting, Bruce decided to check in on Duke again. Donna happened to be coming out of the boy's room as he approached.
"How's he doing?"
"Better," the nurse reported. "His pain's down to a five. I'm about to give report to the floor. They'll start his blood once he gets up there."
"Good," he nodded. "Is Lois here yet?"
"Yes, she's in there now."
"So he knows about his foster parents?"
Donna cast her gaze downward. "Yeah, Selina left not too long ago. He was pretty upset, but he actually didn't seem too surprised. I don't think this is the first time something like this has happened to him."
"Damn," he cursed, "he seems like a good kid."
"They usually are. But you know that better than anyone."
He certainly did.
Bruce gently knocked on the glass door as he slid it open. When he pulled the privacy curtain open, he saw Lois sitting beside Duke's stretcher. The boy certainly looked more comfortable than he had before, though there was a new heaviness weighing him down.
"Hi, it's me again. I wanted to check on you one more time before you go upstairs. How are you feeling?"
"I'm fine," the boy replied weakly.
Bruce sighed. "Listen, Duke, I heard about your foster parents. I'm very sorry that happened."
Duke shrugged, looking defeated. "It is what it is."
Lois reached over and out a hand on the boy's arm. "I've already reached out to a few potential families. Hopefully, the next one's a better fit."
"Doesn't matter," the boy shook his head. "My mom's gonna get better soon, and then I'll go back to living with her."
"Duke, we've talked about this," the caseworker sighed. "Your mother loves you, but she's very sick."
"The doctors just haven't found the right meds yet. They will."
Lois shared a look with Bruce. "I hope so—really, I do. But until then, you deserve a stable home where you'll be safe and cared for."
"Yeah, until they decide I'm too much work like the Quentins did. Like everyone always does."
Bruce felt an all-too-familiar tug on his heart. He'd seen plenty of cases like Duke's in his many years working in the ER, but for some reason, this one just seemed to hit harder.
"Don't do it," he internally chastised himself. "You already have five children. You'd never hear the end of it. Imagine what everyone else would think."
But resistance was futile. He couldn't stop the words from flooding out of his mouth:
"Lois, may I speak with you out in the hallway?"
Yep. Alfred was definitely going to kill him.