by Barbara Ebel
“That makes sense. The flu didn’t hit a staggering number of patients this winter, but the season was a bit more extended into this month. You caught the tail end of it.”
“Just my luck,” he said, shutting his eyelids. “In medical terms, they said they’re going to treat my symptoms here and I should be able to go home in a few hours. ‘Supportive care,’ they explained. The pain medicine they gave me for my headache should kick in soon as well.”
“I hope so, but now I feel responsible. Your car is in the parking lot of the submarine shop. What are you going to do?”
“I could call someone to give me a lift there, but there’s no need. I have my cell phone and plan on calling Uber when they let me go.”
Annabel nodded and glanced at the monitors - heart rate a little elevated, but not a big deal due to his slight fever - and his IV fluid bag was half-drained. He had also regained some color back to his face since she dropped him off.
“I better go,” she said. “Looks like you and the ER doctor have your situation under control.”
“Thank you again. I’m sorry I’m not more hospitable. Before I go, I’m going to doze some more.”
Annabel sighed. Even though Jae would not be one of their admissions, she was glad he was successfully being treated and would soon be sleeping in his own bed.
As she twirled the long waves in her medium-blonde hair, she realized she’d be lucky to even open the door of a call room later and glance at a bed … because outside Jae’s room … medical patients were stacking up.
CHAPTER 3
Annabel felt a tug at her sleeve when she left Jae Nixon’s room, which forced her to stop. Dr. Schott was beside her and yanked on her short white lab jacket again.
“You have a real admission,” Donn said, “not someone you drove in here for an ER visit.”
“Are you annoyed at me for bringing that man in?”
“On the contrary, but don’t worry. This patient is more interesting than one having the flu. Her suspected diagnosis is a stepping stone to studying normal and abnormal heart conditions.”
Dr. Schott pointed towards Chineka, who was writing at the desk. “You’re working with her on this one. She’s writing up the patient’s H&P.”
Annabel knew the familiar jargon – “H&P” stood for history and physical. She also liked both the team’s female residents, so it didn’t matter which one she worked with. Chineka Watt and Melody Burg were sound teachers to the students and vastly unalike in their backgrounds and personalities. Based on what Chineka had told her, her upbringing as an African-American had been probably more difficult than Melody’s. She also lacked Melody’s fashion flare, but she was more focused and attentive to her patients.
Donn’s hand brushed over his beard. “Your patient’s name is Meagan Helm. She’s complaining of heart palpitations and, like me, she’s in her forties. A tech is doing an EKG on her right now. Go ahead, skedaddle.”
Annabel gave him a questioning look.
“Scram. Get in there.”
She did an about-face and surveyed the board again, this time for Meagan Helm. She didn’t want to disturb Chineka by taking the chart away from her so, in essence, she felt like an airhead marching into Room 8 unprepared.
Mrs. Helm’s door was wide open, so she went straight in and found a group of people swarmed around her. The EKG technician, finished using her machine, was coiling up the wires which had extended to the electrodes on Meagan’s chest.
“Now who might you be?” Meagan Helm asked and then took in a deep breath.
“Dr. Tilson, a medical student. I work with Dr. Watt and Dr. Schott. May I ask you some questions?”
“Like all my kids here, you’re probably learning your future career, so I don’t mind.”
Annabel nodded at the man and two young women.
“That’s Walter,” Mrs. Helm said. “And the twins are Sally and Susan.”
The three of them, close in age to her, nodded hello.
“You have more family around you than I normally see from patients in here,” Annabel said.
“I’m a lucky lady. They all live in the general Cincinnati area.” As if Meagan was having trouble with her heart, she patted her chest.
“I have a close family too, but no one lives nearby.”
Sally sat on the stretcher, smiled at Annabel, and then went back to watching her mother.
“This will be on the chart,” the technician said, waving the EKG as she approached the door.
“Aren’t you going to look at that?” Mrs. Helm asked Annabel.
“I am only in my first year of clinical rotations, which is my third year of medical school. I must confess - I am not yet a wizard at reading them. I’ll scrutinize it with my upper level residents giving me guidance.”
“I understand, and feel free to ask me questions with my children here.”
Walter hovered on the other side of the stretcher with his sisters; their devotion to Meagan apparent. His deep set eyes stayed focused between the door and his mother.
“What made you come to the ER tonight?”
“Ah-ha, in other words, what’s my chief complaint?”
Annabel raised her eyes with surprise.
“I work part-time in a doctor’s office, on the business end of things. Although I don’t know enough about medical illnesses, I do hear the buzz words.”
“It’s always helpful when patients understand the lingo. In my limited experience, they tend to answer questions more succinctly.”
“So true. Patients can diverge into long-winded stories instead of getting to the point of the health-care worker’s questions. I hear that complaint all the time.” She took a quick breath and patted her chest.
Annabel nodded and waited.
Sally spoke up. “My mom’s heart is beating funny. It’s been speeding up today.”
Meagan’s hand slid up and glided along her long brown braid sitting on the front of her print blouse; she gulped for another mouthful of air. “I didn’t work today,” she said. “Otherwise, I would have said something in the office. I’ve been short of breath, my heart’s palpitating, and I hear a ‘ba-boom’ echoing in my ears.”
“Plus,” Sally said, “she told me on the phone she was feeling dizzy.”
“Ever experience this before?” Annabel asked.
“I don’t remember too much about it, but a long time ago when I was pregnant with the girls, my heart rate went crazy. My mother told me I had rheumatic fever when I was a kid and that could possibly cause problems later on.”
Rheumatic fever, Annabel thought, puts a spin on the problem. More assured that she had a clear understanding of her patient’s chief complaint, she asked Meagan more questions. Mrs. Helm denied taking medications, using tobacco, alcohol, or illicit drugs. Her other past medical and surgical history was insignificant.
Annabel slid her dangling stethoscope off her neck and placed it on Meagan’s chest to listen to her lungs and heart. Listening to her heart sounds, she thought she heard a murmur like a diastolic rumble, which would signify turbulent blood flow across one of the heart valves.
“I’m finished,” Annabel said and smiled at the twins. “It looks like that pregnancy a long time ago turned out really well.”
Meagan agreed with a nod of her head. “Both pregnancies and all three kids.”
-----
Meagan Helm’s H&P should be easy enough, Annabel thought as she walked over to Dr. Watt. Except, of course, for the last part of it - the “diagnosis” and “plan.” That was where the students had to rely on their two residents and chief resident for their expert clinical judgment. One more person was involved in the equation as well - their attending doctor, Dr. Sebastian Mejia, a sixty-year-old cardiologist who Dr. Schott reported to and who occasionally showed up for rounds.
“What do you think about Mrs. Helm?” Chineka asked, glancing up.
“I’m out of my league; like a plumber trying to do electrical work.”
�
�We’re soon going to fix your deficit because the heart’s electrical activity is exactly what you’re going to learn.”
Annabel swung around the corner of the desk, eager to examine the EKG with her.
Dr. Watt held the electrocardiogram in front of them. “You have heard some of this already, so in addition to new information, you’re going to hear a recap of what you think you know. There are four chambers to the heart – two upper atria and two lower ventricles – as any fifth grader knows.”
Chineka began pointing to the spikes and dips, or waves, in the line tracings. “The P wave is a record of the heart’s electrical activity through the atria and the QRS complex signifies the electrical impulses moving through the ventricles. What you heard with your stethoscope and what we see here is an abnormal heart rhythm with chaotic generation of electrical signals in the atria. Or …?”
“Atrial fibrillation,” Annabel guessed.
“Spot on. I bet you wish you were earning a cardiologist’s salary.”
“I’d even settle for the electrician’s.”
“When you listened to her lungs, did they sound clear?”
“I believe so.”
Chineka motioned Annabel into the side room, holding a long brown envelope, and took out Mrs. Helm’s chest x-ray. She slid it up on the viewing box. “Yes, her pulmonary status seems fine … right now. However, when atrial fibrillation develops with the erratic firing of the atria, the ventricle responds rapidly and causes shortened diastolic filling. The result is usually pulmonary congestion.”
“So why hasn’t she developed that?”
“She made it to the ER quick enough. A big consideration is what caused her atrial fibrillation.”
“Her heart rhythm was not only irregular, but there was a murmur and I learned she has a history of rheumatic fever.”
“And a late sequela of rheumatic fever is rheumatic heart disease with the mitral valve between the left atria and left ventricle most frequently involved.” Chineka pulled down the X-ray and sat back at the desk. “See how far we’ve come? The cause of her atrial fibrillation is most likely mitral stenosis. However, I had the benefit of Dr. Schott’s input.”
“So what do we do for Mrs. Helm?” Annabel asked with a worried tone.
“There is an urgent treatment plan if a patient is hemodynamically unstable, they’re having angina, or they’re experiencing pulmonary edema. In which case, she would need a direct current electrical shock to her heart … to convert her to a normal sinus rhythm. However, we recognize that she’s pretty stable and lacking lung congestion. What we’re going to do is control her ventricular rate - her fast irregular heart beat - with intravenous drugs to slow the conduction through the atrioventricular, or AV, node. Beta-blockers, calcium channel blockers, or digoxin are the drugs of choice.”
“Lucky for her no one is going to loom above her with electrical paddles. That would be a frightening scenario for any patient.”
“If that were the case, we’d ask an anesthesiologist for assistance to make her comfortable.”
Annabel nodded. “They sure come in handy.”
“You better start writing your H&P. I’m going to show Dr. Schott the EKG, find out which drug we should order, and use it on her as soon as possible.”
-----
Annabel found a cubicle off to the side to write Meagan Helm’s H&P. The main desk didn’t need to be cluttered up by a medical student where ER physicians and other doctors and nurses had more important work to do there than she did. She first read every morsel of information written by everyone else who had written a note and then penned her own. When she finished, she regarded the board again. Jae Nixon’s name was still up there.
Annabel slipped Mrs. Helm’s chart in a slot and noticed the nurse next to her was the one taking care of Mr. Nixon.
“Is Jae Nixon still going to be discharged from the ER?” Annabel asked.
“Sure is. He won’t be needing your team. The secretary is getting his paperwork together. Besides the needed medical care, he seems to like the rest. Keeps closing his eyes and nodding off like he’s catching up with his dreaming.”
Annabel smiled. “Maybe you made him feel comfortable.”
“I wish most guys who show up in here were as polite and down-to-earth as him,” she said, unwrapping a stick of gum.
-----
The night wore on and Annabel realized the students had scattered, so she headed upstairs to the office. However, once Mrs. Helm was transferred to a room, she would check in on her and also gather any pending lab work. One thing making her case easier was the absence of a pile of old charts from previous admissions and medical problems. Some of the vets had stacks of them from chronic admissions for their heart and lungs.
“There you are,” Annabel said when she found Bob on the couch. “What was your admission?”
“An elderly man with COPD having an acute exacerbation. I still need to take a quick survey of his records and figure out what usually works best for him.”
“You’re not going to practice cookie-cutter, one-size-fits-all medicine, are you?”
Bob chuckled. “Hey, admit it. There’s some truth to that.”
“Although my dad always tells me: just when you think you’ve seen it all, something new pops up.”
Annabel’s father was a famous Nashville neurosurgeon whom Bob had met. “How is your dad, anyway, and the rest of the family?”
“He’s still mourning the loss of our family dog, but other than that, they are all good. And get this … my sister, Nancy, who came up from Nashville and went out with us all recently, has taken up texting with Jordan.”
“I was wondering about them. They seemed a bit chummy that night. Jordan is not the most stellar medical student for her to become involved with.” He frowned, but Annabel laughed.
“He thinks he is. I suppose that to many people our age, dating a medical student may be a great catch. At the end of their training, their pockets may plunge deeper.”
Annabel wondered if she should mention to Bob that she saw Jordan cheating that morning while taking his midterm test. It had surprised her and sickened her that one of them would do such a thing. At least for now, she decided to keep the information to herself.
“Distance is a problem if your sister and Jordan are going to date,” Bob said. “Nashville is not exactly down the road from Cincinnati.”
“She says she’s going to drive up again when she can. Like my apartment is her apartment, or something like that.”
Bob rolled his eyes. “An intermittent roommate? Have fun trying to study.”
“Right. Tomorrow after call, how about we check our grades from our test today?”
“It’s a deal, but our results may either spoil the rest of our day or give us cause to celebrate.”
“My celebration, if I am rested enough, will be to run down the steps in the neighborhood and then along the Ohio, or maybe go jogging at Eden Park.”
“Can I join you?”
“Sure. I never knew you enjoyed running as a sport.”
“There’s a lot you don’t know about me. I rarely do, but a trip to the park for a run with you sounds like the perfect excursion away from the wards and books.”
CHAPTER 4
Jae Nixon was as patriotic as they came for his age. He had served his country for a short time when many his age never contemplated doing such a thing. He figured a guardian angel protected him after that because he succeeded in paving his destiny to work in his dream job.
During high school and college, Jae burned through biology books like a chain smoker. He absorbed the biological classification of living things - from families to genera to species - like a sponge.
Taxonomy was only one aspect of what he loved about the field. In those days, he suspected that learning biology would give him the background necessary and foster the ability to later work in the great outdoors. He was born to comingle with nature and vowed to stay away from a desk job, or in an inside,
full-time biology job confined to the four walls of a scientific lab.
He knew exactly what he wanted to do after procuring his bachelor’s degree in the natural sciences - become a U.S. park ranger.
Jae prepared a smooth, easy way to attain his goal by gaining experience in seasonal park ranger jobs and doing volunteer work. By doing that, he also fully realized the scope of going into that career. The men and women wearing ranger uniforms and telling tourists about the sites they were visiting were not just “park rangers.”
They were, in essence, police officers - police officers of state parks or “law enforcement park rangers.” Jae was proud to have completed special law enforcement training to do his job.
There were no regrets. He had found his own heaven with his guardian angel in tow. He enjoyed being outside, he helped protect the animals and plants in the parks, and he passed on his enthusiasm to visitors from around the world.
Jae also liked one of the aspects of the job that some rangers despised. They did not stay posted to one park; they were subject to transfers. Although they needed to “get up and move,” they broadened their experience and horizons by being stationed at a variety of national parks. It could be an American president’s historic site such as the Hermitage in Tennessee, Acadia National Park in Maine, or the vast Yosemite National Park out west.
A ranger could even be assigned to the National Parks Service in Washington, D.C., the service in charge of the capital’s major monuments. He enjoyed and welcomed each new assignment.
Jae was now in his second year of working at the William Howard Taft National Historic Site in Cincinnati. It didn’t have the grandeur of the Great Smoky Mountains National Park or the Grand Canyon, but it embraced the history of the 27th president of the United States. Since he had a strong patriotic side to him, he enjoyed the spot as much as the other two places he’d worked.
Plus, he beamed when he told clueless vistors the history of William Taft – the only American president to have served as both president and as the chief justice of the Supreme Court.