by Barbara Ebel
May managed the first step with decreased muscle tone, but the second step completed the new turn of events. Confused, with her vision turning blurry, she fell back against the mattress and onto the floor. Her body became tense, and fast jerking movements took over her arms and legs. Her tremors lasted briefly, but she lay clumped up on the floor with a memory lapse of the fine details of what happened.
The next thing May knew, her young medical student was above her, talking to her. But what was she doing on the floor?
-----
Annabel had a restful post-call day and she studied two whole internal medicine chapters. She was glad, however, that it was Friday and she was scheduled back in the hospital. Her sister would be in for the weekend late in the day and then she looked forward to Saturday night. Besides going out with her colleagues and Nancy, she had the date or tryst set up with Ben Rogers, the Secret Service Agent. It was a toss-up which part of the evening would be more fun.
Dr. Schott was not yet in the office with the newspaper clouding his face, nor were any other students. Their jackets were all hanging on hooks. She went to the nurses’ station and read all the new posts and lab work in May Oliver’s chart, and then knocked on her door. She waited a few moments, wondering if Louise Oliver slept inside on a cot from the night before. The only sounds she heard were the occasional paging to physicians or staff members over the hospital PA system and not a peep came from inside May’s room.
Annabel eased the door open and quietly stepped in. May must be out strolling a hallway, she thought … a good sign. The bathroom was empty, the door open, and May was not in bed. She stepped in further to check if the cot was occupied against the window. It was empty but, beside the bed, May was sprawled on the floor and stirring like she had slept.
Annabel crouched down beside her. “May, what are you doing on the floor?”
May’s right arm appeared bruised and she was not able to respond right away; she seemed confused and weak.
“Did you fall?” Annabel asked.
May stared back at Annabel with sleepiness and memory loss over what had happened. After attempting to support herself, she took Annabel’s arm and leaned into her.
Annabel helped May get up; her patient had some weakness, at least in her left leg. She shifted her straight into the chair, called the desk, and asked someone to call in Dr. Burg or Dr. Schott. At least one of them should be in the hospital by now, she thought.
Annabel focused back on May. “I’m the medical student. Do you remember me and what happened? Are you having any chest pain?” Annabel took her vital signs and listened to her chest as May thought about her questions. She evaluated her pupils and did a short neurological assessment.
Dr. Schott hotfooted into the room and narrowed his eyes, standing beside her.
“I wonder if she had some kind of stroke,” Annabel said. “I found her sprawled on the floor.”
Donn physically assessed May in a few short minutes. “Do you know where you are?” he asked.
May blinked multiple times like she was uncluttering her brain of unneeded information and then her vision fell on Annabel. “I remember you now. The medical student.”
She looked at her chief resident. “I think I’m in the hospital.”
“You fell,” he said. “There is a bruise on your arm, but otherwise, I don’t see any other injuries. Is anything hurting you?”
“Not so much. My thoughts are fuzzy and my leg is weak.”
Donn stood straight. “We’re sending someone in with you while I order some tests. Have you ever had a seizure before?”
The question caused a look of fear on May’s face. “No. Not ever.”
“I suspect that’s what happened, but we’ll figure it out.”
“Why?” she mumbled but lost her train of thought.
Donn decided not to explain things to her that she might forget. He ordered a stat EEG and a neurology consult.
After they made sure she had extra supervision, Donn and Annabel headed to the office.
“A seizure was on my differential after I found her,” Annabel said.
“Good thinking,” Dr. Schott said.
“If it was a seizure, it was caused by her brain tumor, wasn’t it?”
Donn frowned. “A sure bet. From her metastatic lung cancer.”
CHAPTER 26
Annabel and Bob stood in the back of the group as Stuart gave a flawless update of one of his patients with unmanageable diabetes. After he rattled off the plan for the man’s dietary and lifestyle modifications and change in medical therapy, they cluttered the hallway to go see the next patient.
Bob and Annabel faced each other as they weeded out espresso chocolates from the palm of her hand. Donn watched and cleared his throat.
She read the room number by the side of the door and realized where they were. Her overdose patient from the ICU had been transferred. “Sorry,” she said. “Mick Rhoden is status-post day two after a tricyclic antidepressant overdose. Yesterday, he was successfully extubated and sent to the floor. He complains of a sore throat this morning which he says is due to ‘the stupid breathing tube.’ He also mentioned there will be no more anti-depressant overdoses in his future because he never wants to go through that again.
“His vital signs are stable and all his lab work this morning is normal. Psychiatry will be by this morning to do a consult on him. Although his affect is dull, he actually smiled this morning while we talked.”
“You students and residents,” Donn said, “are performing miracles with your patients and your presentations.”
“We can’t take credit,” Melody said. “The on-call team yesterday supervised Mr. Rhoden’s extubation after we left.”
“But the patient smiled at Annabel,” Bob said. “Her presence with a patient counts for lifting their spirits.”
Annabel rolled her eyes, but then she decided to go along with the compliment and bowed her head.
“There’s some truth to that,” their chief said. “Now let’s go in.”
Mick Rhoden’s eyes widened when he counted all seven of them parade into his room. “This is more attention than I deserve.”
“We’re just thankful you’re still here to shower attention on,” Donn said. “Dr. Tilson briefed us on how well you’re doing.”
“Better than the last two days,” he said.
“Psychiatry is coming by today. Are you amenable to that? They can help treat your despair. We all like you, but we don’t want to ever see you admitted under the present circumstances again.”
“I don’t mind talking to them.”
“Any chance that you’re still contemplating hurting yourself?”
He shook his head. “No. And especially not after what I’ve been through.”
“What do you do? Are you employed?”
“I own a small computer store. I sell computers, but mostly I’m a tech geek and repair them.”
“Excellent,” Donn said. “That’s a modern career for a young person and you should be proud.”
“I suppose,” he said.
“Don’t suppose. It’s the truth. We’ll wait to see what psychiatry recommends. Most likely, we’ll transfer you to their service or we’ll be discharging you soon. In the meantime, would you like to share with us why you took the overdose, before talking to them?”
Mr. Roden fidgeted with his hands. “My girlfriend dumped me. Cold and hard. We were going out together for five years. Now I realize what I don’t have.”
“I’m not an expert in the relationship department, but maybe there’s a reason and there’s someone more special out there for you.”
The team left in the reverse order that they arrived and Donn announced, “There’s no man or woman worth killing yourself for. Let’s go see Bob’s patient, Manuel Hogan.”
Dr. Schott stood under an old photograph of the hospital hanging on the wall and asked for Bob’s update.
“Mr. Hogan was the last patient of mine that I saw right before w
e started rounds. He complained of his usual concerns: wanting a better heart, wanting the puffiness around his ankles to go away, and wanting to breathe better. Above all, he wants to go home.
“Interestingly enough, his beside vital signs were as good as after we did his paracentesis and drained off the fluid from his belly. His blood pressure was 150/86 and there is a documented one to two pound weight loss. I weighed him myself to make sure and found that to be accurate. On physical exam, his lungs sounded clearer than yesterday and his pedal edema was also better.”
Donn shot a look at Mr. Hogan’s resident, Dr. Watts.
“Mr. Hogan’s diuretics in the last two days caught up with him,” she said, “and there has been an improvement. He certainly can’t take a stroll around a block, but he is better than he was on admission.”
“How are his labs?”
“His BUN and creatinine are stable,” Bob said, “and his electrolytes are slightly improved. Of course, he doesn’t know any of this yet, and in his head, he believes that he’s going to die any day.”
“Can’t blame him,” Donn said, “because that has been the reality of his situation. However … I clasp on to some hope that this may be the window of opportunity we’ve been bargaining for.”
“You mean discharge him home before his next acute flare up of congestive heart failure?” Bob asked.
“What do you think?” Dr. Watts chimed in.
Donn stroked his mustache, continuing to give it meaningful thought. “Although Mr. Hogan has been desperate to die to escape his CHF, he’s more desperate to go home one more time before that happens. I say we discharge him home tomorrow morning if his condition stays stable where it is and we can schedule him back in clinic within a week.”
Everyone nodded in agreement.
“He’ll be so happy,” Bob said.
They neared the doorway and heard Mr. Hogan’s voice. “Don’t be talking about me out there. Let me hear what terrible things you’re planning for me today.”
Donn walked slowly as he wiped the thick lenses on his glasses. He sat on the end of the bed and smiled.
“If your CHF behaves in the next twenty-four hours, how would you like to go home?”
Manuel Hogan tilted his head and adjusted the nasal cannula oxygen in his nostrils. “I must be hearing things. Saints alive! You betcha. I’ll push my own wheelchair if I need to.” He lit up with a smile.
-----
Dr. Schott was about to read May Oliver’s chart for an update when his pager went off and he called the number from the nurses’ station. His tone became serious and he talked at length while the residents and students waited.
“It must be the neurologist,” Annabel said to Bob. “He’s talking about May Oliver. I didn’t get to tell you yet, but I walked in on her earlier and it looked like she had just had a seizure.”
Bob leaned his elbows on the counter. “What did you do?”
“She was safely over it. The boyfriend I had in Nashville while in college ended up having seizures after a sports-related head trauma, so I have a little bit of experience with the matter. No fun.”
“You’ve mentioned him. Do you two still talk?”
“Every once in a while,” she said turning around from Dr. Schott on the phone. “We’re good friends. Unfortunately, the whole experience railroaded his studies, but my dad invented a new device for certain seizure patients.”
“You’re so fortunate to have broadened your medical education because of your father.”
“But your mom was a nurse, wasn’t she?”
“Yeah, but she never felt confident enough to work in a hospital. She stayed in doctors’ offices her whole career. And Dad, he tinkered with wires since he was an electrician, but he was so good at it, he should have been a vascular surgeon working on people’s leg veins.”
Annabel laughed. “Or a neuroscientist working on synapses.”
Dr. Schott put down the phone and stopped leaning on the desk. “That was one heck of a fast consult,” he said. “The neurologist was in the vicinity, saw May right away, and hustled her off for an EEG. It showed abnormal brain electrical activity. She had slowing, or for you students, her brain waves were slower than we’d expect for her age. He said the problem electrical activity traces came from the region of her brain where her metastasis is.” He frowned. “We’re chasing something which is three steps ahead of us.”
They stepped into May’s room, dreading to tell her the bad news. Her parents had arrived for their daily visit and Louise stood immediately.
“The neurologist confers that May had a seizure this morning,” Dr. Schott told them. “He is going to select the best anticonvulsant for her and her situation and hopefully we can prevent another one from ever occurring.”
“What’s next after that?” May asked. “A wheelchair because my leg bones become too breakable because of my bone cancer? Or as you doctors would call it, the metastatic lung cancer in my bones?”
-----
Gloria only had thirty minutes for lunch, so she wolfed down a sandwich in the cafeteria as fast as she could. She bused her tray to the stack of dishes, massaged in hand sanitizer, and hurriedly walked to the outpatient pharmacy off the front lobby of the hospital.
Attractive displays at the beginning of the aisles advertised happy people popping antacids for their indigestion and smiling couples satisfied with male erectile dysfunction drugs. Small bottles and flat and square miniature boxes lined the shelves in the three aisles. She considered carefully what she wanted to buy; over-the-counter drugs as neutral as possible. It would be best to also have pain relief pills because she would be substituting what she bought for real narcotics or strong sedatives in her drug cart. She wanted to make two purchases so she would have a variety.
In the section for aspirin and acetaminophen and nonsteroidal anti-inflammatories, she lingered while thinking about them. She picked out a generic bottle of an anti-inflammatory. Hopefully, the pills inside won’t have any markings on them, she thought, just in case a patient is wise to scrutinize every pill she dished out to them. She stepped over to the next aisle.
A middle-aged man in a security uniform left with his purchase and a gray-haired woman behind the counter focused on Gloria. “Can I help you find anything?” she asked.
“No, I’m fine,” Gloria said. In front of her were vitamins and minerals. Vitamins never killed anybody, she thought, and selected a bottle of fifty small pills. She didn’t want to use some chunky pill that someone would have difficulty swallowing. Next, she pranced up the end aisle looking for hand sanitizer to restock at the house. With her ethyl alcohol cleaner, vitamins, and nonsteroidal anti-inflammatories, she went to the register.
The woman at the counter rang up her items. “Taking care of your pain, your health, and the germs around here.” She grinned. “That’ll be $16.32.”
Gloria paid and hustled back to the medicine floor. In the locker room, she threw away the pharmacy bag and opened up each bottle, dispensing with the child-proof covers underneath the screw caps. She tapped the contents of the two bottles into the two front pockets of her work jacket and slipped the empty bottles and sanitizer into her purse. The pills from her pockets needed to be inconspicuously dispensed.
Gloria had a mid-day medication round to dispense right away. There were now less medications to hand out than in the morning or later in the day, but she could nevertheless begin implementing her plan. By the last round later in the day, before her shift ended, she figured her visit to Mr. Hogan would be the last time he would have to bother with swallowing a handful of drugs. She was such a guardian angel and thoughtful person - she had just spent most of the $16.32 because of him.
As she wheeled her red cart out, she noticed a note from Anna sitting on top:
Go by May Oliver’s room first. The docs want her to take her first dose of anti-seizure medication.
She parked herself outside May’s door with her back against the wall and faced her cart with only enou
gh room to open each drawer. The poor woman’s list of diagnoses was bad enough, but now they added seizures to the list. She shook her head, thanking the Lord that she was years older than May. The young woman would be struck dead well before reaching Gloria’s age. She was sure of it.
First, she needed to make sure May received her newly prescribed medication, so she went to the drawer with the appropriate first drug letters, took out one Phenytoin, and put it in the cup on top. Next, she scrutinized May’s other early afternoon meds and suppressed a smile. The narcotics to be dispensed from her cart were so easy, she thought, because the hospital doctors didn’t bother with trade names because of the increased cost of them to the hospital. They were all generic and May was taking hydrocodone with acetaminophen. She was disappointed over the acetaminophen part of it because she only wanted to steal the narcotic for Mr. Hogan. However, it didn’t really matter that he would later be getting extra acetaminophen or what she knew as Tylenol.
She took May’s dose of hydrocodone and acetaminophen and slipped it into the front pocket of her pants. Her hand then dug into her right jacket pocket and pulled out a vitamin, which she plopped into May’s cup as the substitute. She noted May’s prescriptions for late in the afternoon and sighed with relief that there was another narcotic dose and even a sedative/hypnotic for the evening, which she could also steal and give to Mr. Hogan instead.
“I hope you enjoyed lunch,” Gloria said to May as her patient sat near the window inside. “Although you didn’t eat much, did you?”
“What’s the point?” May almost cried.
“Think of it as comfort food. Especially that coffee that’s getting cold. I would be happy to ask them to warm it for you.”
“No, thank you.”
“Besides your regular meds, I have the new medicine for you that the neurologist and medical doctors prescribed.”
May held out her hand and popped one pill into her mouth. “I’ll chase these down with some water.” She grabbed the large plastic cup with a straw on her tray table and took a sip after each of the three pills Gloria handed her.