by Barbara Ebel
CHAPTER 6
The vertical blinds were closed, blocking any remaining sunshine of the day from entering Bonnie Barker’s room. A plush recliner was by the side of her bed. Tony sat there, the end of his sneakers bobbing forward and backward on the extended footrest. Annabel glanced at the clipboard hanging at the bottom of the bed. Her patient’s vital signs were fine after her huge obstetric fiasco. “She’s doing quite well,” she whispered to Tony, “after all she’s been through.”
“They let the baby visit us before. I held her and Bonnie breast fed her. Or at least tried.”
“I’m glad to hear it; no wonder she’s so tired.”
“Bonnie asked me if I was okay with the name she has picked out.” He shrugged his shoulders. “At least she asked me.”
“That’s a start.”
“Her name is Samantha, but she wants to call her by her nickname of Sam.”
“Either name will fit her like a glove, I’m sure.”
“I guess newborn babies are fragile, but the nurse told us to be really careful with her. She said the doctors seemed concerned and they’d know more later.”
Annabel wondered, especially because of the previous mention of genetic testing. “I haven’t done my medical school rotation of pediatrics yet, but I also think babies are delicate. My aunt and uncle had twins and they were so little, it made me nervous to hold them.”
“Like trying to hold a butterfly and accidentally damaging its delicate wings.”
“That may be more in line with holding a premature infant, one that barely weighs a few pounds.”
“No thank you. No way.”
Bonnie opened her eyes, and in another second, they fluttered shut again. “Another medical student will be here for the night,” Annabel said to Tony, “and I’m leaving soon. Make sure Dad sleeps tonight too.”
Tony stopped wiggling in his shoes. “I’ll go take a dinner break, but I plan on spending at least tonight with Bonnie and Samantha … and sleep in this chair.”
Annabel quietly padded out and went straight to the lounge, where Dr. Watson was reading a chart. Dr. Gash stood next to her. For a moment, she thought Caleb’s hand was rubbing Ling’s left shoulder, but it was by his side when she walked over.
“Annabel,” Dr. Watson said, “you can go whenever you’re ready. We’re not having distinct rounds this late because Dr. Gash and I still have resident’s work to do before giving a report to the night docs. However, try and give the medical student who’s coming on soon a few pointers on your way out.”
“That will be Stuart Schneider. He was with me on internal medicine.”
Ling looked up with an empty expression.
“He’s really smart,” Annabel said. “In the top of our class.”
“Test-taking scores the first two years don’t necessarily correlate with hands-on, clinical skills or smarts from there on in.”
Annabel wanted to say that Stuart retained his rank during their third-year rotations, but she thought better of it.
“Anything you need to tell me about our patients that I may not know?”
“I don’t think so. I do have a question, if you don’t mind. The radiologist who pointed out Mary Chandler’s clear chest X-ray mentioned magnesium sulfate in the treatment of severe preeclampsia. Since our patient almost qualifies as severe, are you going to use it as a treatment?”
“Absolutely.”
“We must prepare for a worsening situation,” Caleb added. “Because of the preterm gestation, we’re also promoting antenatal lung maturity with corticosteroids just in case we have to deliver Mary Chandler’s baby. What goes on with her condition overnight will tell us a lot as to how we’ll proceed tomorrow.”
“That’s where the head honcho comes in,” Ling said. “His name is Dr. Roosevelt Harvey, our attending. Most of the time, he’s in clinic.”
“She talks to him on the phone,” Caleb said. He snapped a pen off his top pocket and handed it to Ling. She rolled away the one she’d been using, empty of ink.
Annabel went to the couch and opened up her OB book. Dr. Watson stood, took off her lab jacket, and started to leave with Caleb. “By the way,” she said, “your H&P on Ms. Chandler was fine. We’ll see you in the morning. Don’t forget … your reading tonight is the physiologic changes of a baby’s first breath.”
That and a dozen other topics neither of you talked about today, Annabel thought. She could open a book while waiting for Stuart, but her stomach growled and she went out to the nurses’ station to scrounge around for food. Not a shred was to be had in the lounge. Outside, a bowl of miniature candy bars was sitting below the counter, nestled in the corner. She picked up a chocolate-coated mint patty. The supply room was directly across the way. The RN in Mary Chandler’s room before was inside, and Emmett stood nearby. He smiled over when he saw her. Annabel gave him a little wave, put the mint in her mouth, and was relieved to spot a man walking down the hallway in a medical student’s jacket.
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Although Stuart and Annabel were not tight friends, they were compatible on the same team, always helpful towards each other, and non-competitive. In a way, he inspired her. She did well, both academically and clinically, but Stuart usually topped off higher in the nineties on exams. She outsmarted him, however, with what could be considered more “street” smarts when it came to their team dynamics and patients.
Stuart was thin as a dime and he could care less about the stashes of donuts medical students would discover behind nurses’ stations or in doctors’ lounges. He was quiet and generally added his two cents worth only when called on. Most of the time, his head hung low, and he spared most people direct eye contact. He approached Annabel and gave her a quick smile as they turned into the lounge.
Annabel took a big sigh. “I hope you’re ready for OB/GYN because I found out today that I wasn’t.” She pointed to the couch. “You can throw your stuff in here until you find the call rooms.”
Stuart put a backpack down and pulled out a chair. He noticed the board on the wall and Annabel followed his gaze. “I’ll tell you what I know about those patients, but I can’t tell you what residents will be on tonight. I think Dr. Watson and Dr. Gash will be leaving soon.” She shook her head. “Like me, I don’t think you’ll be comfortable with the way this rotation is structured.”
“Did you do any pelvic exams or see any babies being born?”
“Ha! I saw enough to personally put off having a baby as long as I can and we’ll probably only get to do a pelvic exam on the GYN service after OB.”
A small muscle on his face twitched. “That’s fine by me. I’m narrowing down what I’m interested in for residency and this won’t be one of them.”
“You made up your mind before starting?”
“Absolutely. Same thing with urology. There are pleasanter places on a human being to work with than inserting scopes into men’s penises or doing manual exams on women’s vaginas.”
“I’m still open minded.”
“I’m banking on subjects like psychiatry or neurology.”
“I can picture you setting your sights on one of those. In the meantime, let me tell you about Bonnie Barker, who almost exsanguinated from her delivery. When you go into her room, her boyfriend is sleeping next to her in a chair. And I’ll fill you in on Mary Chandler, an eighteen-year old with preeclampsia.”
After ten minutes, Annabel called Uber for a ride home, gathered her things, and nodded good-night to Emmett and the RN who was in her patient’s room before when her chief resident had blown a fuse. They still chattered across the hallway in the supply room as she left with a tempo to her step.
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At 5 p.m., Emmett started off in the supply room all by himself. He was pulling a twelve-hour day, which he didn’t mind in the least. His whole life, he had been a hard worker and could count on one hand how many times he had taken a day off from his present job, and those rare times he had been sick enough to qualify as a patient in the hospit
al where he worked.
With his orderly job, he had enough human interaction during the day that he felt no need for additional social interaction. His life was simple: a small house with a patch of land he tended to himself, a small chunk of time in the gym, and a bit of binge-watching when it came to streaming movies or series content on his tablet. Part of his simplicity and care-free lifestyle also came from the fact that he had never burdened himself with a wife and kids. He helped out the hospital obstetric patients and families, but the beauty of that rested with the fact that he could walk away from them at the end of the day.
There was simply enough joy, he believed, in watching other couples have kids. Like a grandparent, he could admire and get a kick out of babies, but he carried no direct responsibility for them. This was even more important when he witnessed the miniature premature infants coming out of the labor rooms, or the ones that came out with genetic malformations or maladies, or the ones that started out with a tumultuous, life-threatening birth. There was no way he would take on the remote possibility of being a father involved in any one of those scenarios.
Emmett reached up in front of the suspended shelving and stacked clear plastic bags with bedpans on an upper shelf. He then pushed the empty box to the corner and ripped open a large cardboard box with liter IV bags of Lactated Ringer’s solution. There were four such containers, so he readjusted other LR solutions on a middle shelf to make room for his load.
One of his favorite nurses, Sherry, strolled in. The upper middle-aged, practical woman always wore tight, matronly-looking blouses that were tight across her chest, and he sometimes wondered if he’d be around when one of the buttons would finally pop. She also always wore the same clip in her hair every day with glassy beads. He came to understand her reason why when she told him that her only granddaughter had given it to her. … on a Mother’s Day, no less.
Sherry planted her thick, rubber-soled shoes in a dead stop and shook her head.
“Emmett, at least you didn’t leave a stretcher at the door like in Mary Chandler’s room where I could have landed on it.” She gave him a serious scowl and then broke into a smile.
The big man chuckled. “The new medical student made an innuendo about that too.”
“Dr. Tilson better keep her thoughts to herself. Dr. Watson is not all that nice, but she’s worse when it comes to other females, especially if they appear to jeopardize her sovereignty.”
“Women are other women’s most successful enemies.”
She leaned against the shelves and considered his statement. “Spoken like a master. I’d go a step further. I never want to witness a woman president in my lifetime because I wouldn’t trust one with the nuclear button on her desk.”
Emmett leaned down into the box, grabbed a few more bags, and stuffed them in above. “You’re a traitor to your own kind.”
“It’s true and you know it.”
He glanced outside where Annabel was nodding good-night over at them. “At least they let her leave on time,” he commented and waved.
Sherry also acknowledged Annabel’s departure with a slight flick of her hand. “Now give me two of those bags you’re unpacking. This is the last doctor’s order I’m following and then my old lady shoes will be close behind the homeward-bound path of that young, dynamic student.”
Emmett handed her two bags. She ripped open the outer, tougher packaging bag of both, put the two LRs on the waist-high shelf next to her, and dropped the trash in the garbage. In the corner, she opened a medicine cart and pulled out a bottle of magnesium sulfate and a needle and a syringe. She aspirated 40 grams and then injected it into the medication port of the nearest bag.
Emmett stacked the next empty cardboard box into the last one and stood straight. “I’m out of here too. I’ll take this stuff to dispose of on my way. Any more garbage from you?”
“No,” she said, shaking her head and dumping the used needle in the sharps container on the wall. She stood in the corner as Emmett carried his bulky load out the door.
“See you tomorrow,” he said, “when I’ll be pulling another twelve hours.”
Sherry plucked the bags off the shelf and placed them on the medicine cart. “Have a good one,” she said. She dug into her pocket for the already-made-up admixture label regarding the magnesium sulfate and slapped it on the bag nearest the door.
Even though her shift was almost finished, Sherry’s stamina was devoid of significant adrenaline, so she took her time. She took the Lactated Ringer bags and necessary tubing packets and arrived at Mary Chandler’s room. They chitchatted while Sherry set up the infusion pumps. One was for delivering the patient’s maintenance fluid and the other for the infusion of magnesium sulfate. She started a 6-gram bolus dose of the mag sulfate and, after that, started its infusion at 3 grams per hour.
Mary groggily watched as her nurse hooked things all together like voodoo and taped tubing, which now attached into her IV, down to her skin. She uncrossed her legs and asked, “What did those doctors say about my last blood pressure?”
“It dropped a few points in the right direction, so I think everyone is hopeful that your baby will not have to come early. Also, this medicine I’m giving you will help prevent you from having seizures, which can happen with preeclampsia.”
Mary bit her lip. “Then I hope it gets in fast.”
“In due time.” She spiked the other bag with tubing and set it to run at 300 mL/hour. “This is just maintenance fluids,” Sherry commented. Her patient’s brown eyes were alert with alarm, so she continued. “It’s called Lactated Ringer’s solution. Consider it like the glass of water or cola that you would be drinking this evening if they would allow it. In case they have to deliver the baby quickly, they don’t want you eating or drinking, especially because of the need for possible anesthesia. The IV fluids will keep you hydrated and they are running at a hefty rate.”
“And my baby’s heart rate is okay?”
“Nothing to be alarmed about, so try and steal some sleep. I’ll be back tomorrow. Now comes shift change.”
CHAPTER 7
Annabel lived southeast of the Cincinnati medical campus and University Hospital in a third-story apartment of a rental house where young working and academic types lived in the area. She felt at home as possible with her living situation, even though she missed her family and home in Nashville.
Since finding parking spaces on the narrow streets where she lived was near impossible after her long clinical days, she had taken up grabbing taxi services to go back and forth, and used her car less than before.
A dark SUV pulled up at the hospital entrance. “Annabel?” asked a woman wearing a stylish cap.
Annabel signaled a thumbs-up and scooted in. “You’re the first woman Uber driver to give me a lift; not that it makes any difference.”
“Yeah. Doesn’t matter which gender has their hand on the wheel.” She pulled away from the curb as her GPS app highlighted directions.
Annabel buckled up. “Ever feel unsafe, however, with who you’ve got in your car?”
“Not really. I don’t take any bookings to remote locations. I transport only in the city area.” She made a turn, and after they made an entrance onto I-75, Annabel pulled out her iPhone, ready to give Dustin an update of her day.
The police officer was someone she had known for a while, but he was new as her boyfriend. Being the cop that he was, he appreciated knowing a bit about her whereabouts, especially when she hopped rides in strange cars. She didn’t mind. He didn’t meddle with her activities; they had distinct separate lives in separate fields. However, the similarity was that they both helped people for a living. The characteristics of wanting to serve others, to see to the public’s safety or health, made them similar humanitarians.
Holding her iPhone tight, she scrolled across the keypad:
“First day is behind me and I’m headed home. My reading is already stacked up!”
She waited for a response as the young woman cracked a wad
of gum.
It’ll always be piled high. You will never get out from under. BTW…did you deliver any babies?
“No, not as the low man on the totem pole.”
“You figured that. I enjoyed last night. Can’t see you tonight, can I?”
She smiled. “I wish, but no way. My unpleasant chief resident has given me an assignment.”
Coasting along, the SUV stayed in the middle lane as she waited for Dustin’s response.
“Okay. Pencil me into your calendar when you can.”
“Will do. Give Solar a treat for me.”
“For sure. Good night.”
“You too,” she replied.
The SUV took the exit ramp and headed into her neighborhood. She stopped thinking about the present and jumped ahead a year … and to what that would mean. A year from now would be the end of April, the latter part of her fourth year, a milestone in her training. Applications for residency spots would have been previously sent out and evaluated. Medical students would officially be paired with programs they wished for … or not.
What did she want to go into? The question in the back of her mind nagged at her. Whatever she chose would affect her the rest of her life. It was imperative that she considered all the options and make the very best decision for her talents and desires. During her surgery rotation, she had been interested in anesthesia, but now she just wasn’t sure.
The driver slowed, stopped, and gazed back at her. “My roommate and I just split up. You’re welcome to come over to my place.”
Annabel grabbed her backpack. “No thanks.” She scooted out, walked between the parked cars, and headed to the side entrance of her place where a young man was sitting on a step.
“Bob Palmer! What are you doing here?”
Bob was a close medical school friend. They had journeyed together so far on every third-year rotation – surgery, psychiatry, and internal medicine – until today. He was recuperating one more week from an illness he had picked up at the end of the medicine rotation and was now out of synch with her schedule. Even though he had passed the medicine final exam beforehand, next week he had one more clinical week to make up.