by Barbara Ebel
Table of Contents
DOWNRIGHT DEAD
Copyright © 2018 by Barbara Ebel, M.D.
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
CHAPTER 24
CHAPTER 25
CHAPTER 26
CHAPTER 27
CHAPTER 28
CHAPTER 29
CHAPTER 30
CHAPTER 31
CHAPTER 32
FROM THE AUTHOR
DOWNRIGHT DEAD
by Barbara Ebel, M.D.
Book Five of the Dr. Annabel Tilson Novels
Book One: Dead Still
Book Two: Deadly Delusions
Book Three: Desperate to Die
Book Four: Death Grip
Book Five: Downright Dead
Copyright © 2018 by Barbara Ebel, M.D.
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
eBook ISBN-13: 978-1-7324466-1-8
Paperback ISBN-13: 978-1-7324466-0-1
This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.
CHAPTER 1
“I don’t know nothin’ ‘bout birthin’ babies, Miss Scarlett!”
Sitting on her boyfriend’s couch, Annabel Tilson leaned forward and laughed. The popcorn she was eating practically hurled from her mouth as she hit the pause button of the TV remote. Gone with the Wind stopped.
“Can you believe it? she asked. “That’s exactly how I feel. Just like Scarlett O’Hara’s otherwise helpful maid, I don’t know squat about obstetrics and gynecology.”
“Tomorrow that will begin to change,” her boyfriend, Dustin, said. “In four weeks, you’ll be able to deliver a baby better than I can.” He inched closer and rubbed her shoulder.
She glanced abruptly at him. “I’m only a third-year medical student. The residents will be catching the babies. I’ll be observing, studying, and doing the scut work.”
“Being privy to some of your prior medical cases that ended up in the police department, you’ve been doing more than that.”
“Yeah, well, whatever.” She leaned back into the upholstery and gave him a hard stare. “Do you mean you’re one of those policemen who have escorted a pregnant woman in labor, ready to pop, in his patrol car?”
A sly smile crossed his lips, highlighting the dimple in his chin.
“Want to hear about it? I can give you the details back there.” He pointed to his bedroom and his grin grew wider.
“Dustin Lowe! Don’t tempt me. Can I take a rain check? I’d better head home and get ready for my first day on OB.”
He moved the bowl of popcorn between them to the cocktail table. “I understand. New subject matter to ingest in only four weeks and your normal composure is turning into the jitters. Anything I can do to help?”
“No. You’re empathetic about my studies already, which may stem from your own nerve-racking career. Actually, it was wonderful having these two days off after finishing my internal medicine rotation on Friday. Thanks for a nice day and a great wrap-up to the weekend.”
Their knees touched and Dustin put his hand on her leg. The other one went around her neck and they closed the gap for a tender kiss.
She rose and toyed with her silky long hair. “We’ll finish the movie next time. We have to. Atlanta is in flames and Scarlett’s friend is about to give birth.”
Dustin’s yellow-naped Amazon parrot, Solar, flicked his head from his perch. “About to give birth,” he quipped.
Annabel twisted her mouth at him. “Nobody asked for your two cents.”
“What’s your problem?” he countered.
She knew that was his favorite line, so Annabel threw up her arms. “Take care of Dustin and I’ll see you next time.”
She grabbed her purse and car keys while Dustin joined her at the door.
“Lucky you,” he said. “He didn’t give you any more back talk.” He perched his elbow on the door frame and brought his hand to her hair.
“Don’t look at me that way.”
“What way?”
“You know what way.” She gave him a quick kiss and tapped her finger in his dimple. “See you soon.”
“Likewise. Go crush your OB/GYN rotation.”
-----
Annabel thanked the Uber driver, walked in the hospital entrance, and eyed the coffee stand. She veered right; she had a few extra minutes and couldn’t resist.
“You’re back,” said one of the baristas.
Annabel chuckled. “Yes, back at the University Hospital. I’m starting OB/GYN and the VA Hospital doesn’t exactly specialize in that patient population.”
“I should say not. What can I make for you?”
She ordered and left with a mocha cappuccino. The team was supposed to meet and gather on the obstetric side of the fourth floor, so she punched the elevator button and rode up while sipping her hot beverage. The doors opened and the signs hanging in the peaceful lounge in front of her designated all of obstetrics to the right and gynecology to the left.
Annabel took a big sigh as she walked. After rotating in surgery, psychiatry, and internal medicine, she still did not know for sure what specialty she wanted to go into. She wondered if this rotation would pique her curiosity enough to treat more pregnant ladies and gynecology patients in the future.
Doors to the unoccupied labor and delivery rooms stood open. She poked her head in one of them. They looked more like hotel lodging than typical hospital rooms.
Annabel proceeded down the squeaky-clean hallway and a door flew open; a long-coated male doctor stuck his head out and looked toward the counter at the end where several people were milling about.
“I need help in here!” he shouted.
A female, also wearing a long white coat, dashed down the corridor and disappeared inside.
Annabel hesitated, wondering if she qualified as “help.” Probably not. Less than twelve hours ago, she had mimicked the words that she knew “nothin’ ‘bout birthin’ babies.” Besides, medical students were often in the way when a real crisis was taking place.
The male physician swung the door open again and shouted as a nurse came rushing his way.
“Call anesthesia.”
“He’s putting in an epidural right now.”
“Try and get another anesthesiologist from the main OR.”
“It may take a while, Dr. Gash.”
“Fetch another cart. I need more Pitocin and call the blood bank to send us two units of blood.”
She peeled away and his eyes fell on Annabel.
“You a new med student on the service?”
She nodded. “Annabel Tilson.”
He jerked his head in the direction of the room and she followed.
“Sir, you need to leave,” Dr. Gash said to a man inside. The man, who Annabel assumed to
be the patient’s partner, was near the door and she couldn’t see past him. When he turned, he appeared to be in his twenties and wore casual clothes and sneakers. His face was pasty white, his eyes bulged, and he stuttered something undecipherable. A nurse was behind him in a flash. She manually swept him away, escorting him out the door.
The sights and sounds in the room hit her like a harsh wake-up call from a dead sleep.
CHAPTER 2
A young woman about Annabel’s age was on a labor and delivery bed, which was broken down in the middle and functioned as her birthing bed; she still held on to the handles. Her legs were sprawled open in the lithotomy position, her feet in stirrups. The female doctor stood between them.
Blood cascaded from between the patient’s legs. A blue drape wasn’t holding the flow adequately and it began spilling on the wooden floor. A newborn was off to the side on a table with a nurse hovering above it as Dr. Gash evaluated its status and looked over at Annabel.
“Tell them to get a pediatrician for Ms. Barker’s baby,” he yelled. “Stat.”
The distressed patient on the delivery table grimaced and contorted her face, but with the clue that her baby was also in trouble, she let out a soulful cry.
Annabel darted two quick steps and hollered towards the nurses’ station. “They need a pediatrician.”
She breathed deeply and spun around to go back inside. She had completed her surgery rotation and had seen trauma cases, but this was the first time she’d seen that much blood pouring out of someone. From childbirth? This was insane.
Within seconds of her being gone, the group in the room came to another decision.
“We can’t contain this,” the female physician declared. “Bonnie Barker, you’re going to the OR.”
Annabel realized the physician must be Ling Watson, her new team’s chief resident. As she stepped back into the hallway, a strong-muscled orderly was backing an empty wheelchair out of a nearby room. “There’s an emergency in here,” she said. “Can you help them transport a patient to the OR?”
The man went inside, where Dr. Watson gritted her teeth and bimanually palpated the woman’s abdomen as well as inside her vagina. Confusion swept over Annabel. Was this some kind of CPR on the woman’s uterus after birth … something to help a bleeding situation like this one?
No further words were spoken as the bed flew down the corridor to swinging doors … straight into the obstetric floor’s own OR. Masks, bonnets, and shoe covers seemed to magically attach themselves to everyone going in. Annabel stopped short and busted into a women’s locker room and threw on scrubs. After getting properly attired, she rushed into the OR where Bonnie Barker’s life depended on the medical team.
-----
The patient’s vital signs were registered on the monitors and beeped from the head of the table, where the anesthesiologist had already arrived. He was stripping open an IV package and a tourniquet was wrapped on the patient’s left arm. When he whipped it out, he expertly slid the large-bore IV into a vein. Annabel realized the patient needed a larger IV than she already had. Fast replacement blood was needed to substitute for what she was losing.
The monitors painted a gruesome picture. Ms. Barker’s blood pressure sagged and her heart rate bounced higher and higher. Dr. Watson continued her bimanual compressions. The patient became more quiet.
Ling Watson’s eyes met the doctor at the head of the table. “Pitocin?”
“I just gave another ten units slowly,” he said.
As Annabel contemplated the drug, she remembered hearing that it was the same as oxytocin - a neurotransmitter in the brain. But why were they using it now? Meanwhile, someone thrust two units of blood through the door and wiggled them at her. She grabbed them and verbally cross-checked the bags with the blood bank slips with a nurse to make sure … correct patient and correct blood.
The anesthesiologist pulled the tab from one of the units and stuck the blood bag into an IV fluid setup and into a pressure bag. After pumping it up, blood began streaming into the woman’s vein.
“I’ll get blood for labs,” the anesthesiologist said.
“Yes, she could have a coagulopathy,” Dr. Watson said.
The anesthesiologist drew blood from the patient’s other arm. Soon an OR tech ran outside with the filled vials for the lab.
Dr. Watson slid her hand off of Bonnie Barker’s abdomen and nodded at Dr. Gash to help her out.
Caleb Gash stood on the other side of the table and began palpating. “What about a uterine laceration?”
Ling took her hand out of the woman’s vagina. Blood clung to her glove and dripped down. She eyed the drapes, the floor, and back between Bonnie’s legs. “Thank God,” she mumbled.
“Slowing?” Caleb asked.
“Like someone has turned off the faucet.”
The three senior doctors in the room made eye contact with each other, acknowledging silently that the life-and-death situation was turning around. The patient’s uterus was clamping down; beginning to behave itself.
The anesthesiologist took down the empty unit of blood and hung the next one. Bonnie Barker’s blood pressure and heart rate began reversing their deleterious directions. Her oxygen saturation stayed acceptable with the oxygen the anesthesiologist had placed over her face with a mask.
“Let me take a good look,” Dr. Watson said. “Make sure I don’t have to ligate any blood vessels. Get me a Foley catheter as well,” she said to a nurse.
She leaned over Bonnie’s abdomen as much as she could. “Ms. Barker, we thought the anesthesiologist was going to have to put you to sleep and I would need to do a surgical repair to stop the bleeding. However, it is slowing down. We’re waiting on blood work, which will tell us more as well.”
Annabel had her hand close to the patient; Bonnie’s arm was stretched out on an arm board. The patient acknowledged Dr. Watson’s words by giving Annabel’s fingers a light squeeze.
The time remaining in the OR took longer than the emergent manner in which the doctors and nurses sped Ms. Barker from her room to the OR and palpated her uterine fundus and resuscitated her. When they finally steered her bed out of the OR, they brought her to the recovery room where they could watch her closely.
Dr. Watson and the anesthesiologist sidled next to each other.
“At least seven hundred cc’s blood loss in the delivery room,” she said.
“At least six hundred cc’s blood loss in the OR,” he said.
“A major postpartum hemorrhage is a hell of a way to start the day.”
Caleb Gash and Annabel stood nearby. He gave her a small nod. “Welcome to OB.”
CHAPTER 3
Annabel stood for the longest time while the senior physicians talked at Bonnie Barker’s bedside and then backed up to a corner, where they discussed the case in almost a whisper. She shifted her weight from one foot to the other, watching the post anesthesia care unit or PACU nurse tend to her patient. From the doorway, the patient’s partner stuck his head in and cleared his throat.
The PACU nurse waved at him. “Don’t be shy. You can visit for a few minutes. Bonnie will most likely be ready to nap soon after all she’s been through.”
He nodded and stepped in, but stood closer to Annabel than the bed. “How’s the baby?” he asked her.
“I don’t know. You can probably find out from the staff in the nursery or the pediatrician in charge. I take it you’re the dad?”
He looked at his sneakers and contemplated her question. “Yeah,” he said, nodding towards Bonnie. “But she quit me after she got pregnant.”
“Quit you?”
“She didn’t want to see me much after that. Like some big feminist idea to raise the kid with or without me. Turned down getting married. I mean, I offered after she didn’t want an abortion. I’m an accessory to her becoming a mother and this is only the beginning of this kid’s life.” He eyed Annabel. “What happened back in the room looked pretty scary. By the way, I’m Tony. How come there are so many
of you doctors taking care of her? She won’t be able to pay a humongous bill from each of you.”
“I’m a third-year medical school student, not a full-fledged doctor yet like them over there.” She pointed to the corner and finally sat on the edge of an empty stretcher. “In other words, I’m free of charge and I’m here to observe, learn, and gain experience.”
“Low man on the totem pole. Figures. You have a glazed-over expression like you’re clueless.”
“It shows that much?”
Without a parting comment, and with a soft stride, he was alongside Bonnie, who made a poor attempt to acknowledge him. Annabel wondered if it was only because of weakness from her harrowing experience, loss of blood, and resuscitation. She frowned and glanced at the doctors huddled together in the corner. At the moment, Tony wasn’t the only one being left out to dry.
-----
The orderly who helped out earlier passed by in the hallway and stopped when he saw Annabel. “Time you learn where to hang out when you’re not with a patient or doing scut work,” he said. “I’m Emmett.”
“I’m Annabel Tilson,” she said as they went down the hall and behind the main desk of the labor and delivery wing. “I bet you are aware of everything that goes on around here.”
His furry black eyebrows inched skyward and he laughed. “More than most.” He pointed towards the spacious room. Each of his forearms had a tattoo, but they were difficult to appreciate due to his dark olive skin tone.
“Pick a spot,” he said. “This is the lounge those docs back there use, but Dr. Fleming and Dr. Ridley, the anesthesia residents, are here more often. That’s cuz they’re posted here this month running ragged with what I call ‘mother’s pain.’ There’s no other pain like it in the whole world or the whole universe … I’m sure of it. If I’d been born the unfortunate sex of a woman, I wouldn’t be doing what other members of my sex do. No sir. No thank you. No spitting out babies for me. I’d make sure I stayed a childless woman, if you know what I mean.”