by Barbara Ebel
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Since Jae intermittently napped in his ER room, he wished someone would snuff out the brightness of the overhead flourescent light. It bothered his headache as well as his sleep. But, he thought, ERs weren’t for a patient’s comfort. His visit to the hospital was meant to get him back on his feet and normal again. He had no plans to miss work the next day. There was enough to do every day for him and the other ranger, Patty Caye.
Jae and Patty each lived in separate small wooden one-story houses on the park premises. Rangers lived at their work site but, of course, being one mile north of Cincinnati wasn’t exactly living in one of the mountainous park spots. There was, however, a feeling around their cabins like being out in the country and enough greenery and woods to make him happy.
Too busy lately with school field trips to the visitors’ center and hikes for the kids on the adjoining trails, he was overdue to take care of a chore at work.
Tomorrow, he wanted to address the upsurge in the mouse population on the property.
Even though the mice were sneaky about not being seen, they were running around between their cabins, in the storage shacks, and in the vicinity in and around the woods. His own cabin showed signs of increased mouse droppings as well.
Because of the mild and shorter winter, the damn white-footed mice were rampant and proliferating like stray dogs in heat. The successful rodent, native to Eastern North America, was expanding northward and responding to climate warming by pushing its tolerance and adaptability to its limits. It was a fact that its population and expanse was increasing as far as southern Quebec at an unparalleled rate.
Even though mice also have an important part in nature’s ecosystem, such as to provide food for “good” black snakes, he knew their numbers needed to be culled. He must go outside earlier than usual, he thought, and selectively put down poisonous bait feeders to kill them and also traps to catch them. He should have done it a month ago.
He opened his eyes for a moment and checked the status of the fluid bag hanging from the pole. There didn’t seem to be a drop left to drip into him and he did feel more revived. Knowing that the ER was in the middle of a shift change, now he waited impatiently for his discharge.
Finally, an RN showed up, introduced himself, and explained the paperwork and medical instructions.
“You’re good to go,” he said, taking out his IV. “See your primary care doctor if you deteriorate after tonight and obviously come back to the ER if you need emergent care.”
“Thanks. I plan on staying away.”
Jae tapped his phone app for Uber transportation outside the hospital and, in a short while, after his ride appeared and drove him to the fast-food sandwich place, he drove his own pickup truck and pulled up to his home at the park.
Although he never ate dinner, he had no desire to eat and was soon out cold in a deep sleep.
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At six o’clock the next morning, Jae stepped outside on the squeaky boards of his porch with a cup of coffee in his hands. The cool, crisp air was not cold enough for him to don a jacket. The quietness broke when Curley and Twist came bounding toward him and shook their torsos. He had selected the names for the two dogs based on their furry coats. They were not exactly strays any more since he and Patty put food out for them, let them in and out of their cabins whenever they needed shelter, or when the two dogs gave them a pitiful look like they wanted human companionship.
Jae patted Curley’s back as the mutt pushed against his leg. He tried to be cognizant of both the dogs’ health needs and caved in to take them to the vet six months ago for annual vaccines. But then again, between the two rangers, they were not that careful about keeping up-to-date with their monthly parasite prevention medications.
“Good morning,” Patty said loudly as she pranced across the grass between their cabins. “I was concerned about you last night because your place stayed dark up until I went to sleep. I’m not spying on you; it just crossed my mind that you never mentioned any plans for being out late. I never saw the truck lights come in or any lights go on over here.”
Jae smiled at the five-foot, three-inch ranger. She was not as old as him, looked younger than her age, and could be mistaken for a boy when she wore her ranger’s hat. Although she was little, she was tougher than she appeared – mentally and physically. Alongside him, she had helped rescue stranded and sick visitors, and always pulled her weight when it came to clearing tree limbs and brush from the trails after storms.
“Thanks for your concern,” he said. “I left in the evening to pick up a sandwich and, instead, ended up in the ER because I felt lousy. Turns out I’m walking around with the flu.”
“Jae! Why didn’t you call me?”
“Why? They put me back on my feet, as you can see.”
“Still … I don’t know about you. We should ask each other for help when we need it.” She shook her head as Twist jumped off Jae’s porch and sat next to her.
“I don’t disagree. Had they kept me overnight, I surely would have called you.”
“Under that circumstance, you would have been forced to. Are you okay to work this morning, or can I help you out with some of your duties?”
“I’ll be fine. I’m going to go to war after the damn mouse population around here before I open up the visitors’ center.”
“I’ll leave my cabin door unlocked so you can get in over there too. I’ll open up the visitors’ center, so don’t worry about hurrying over there.” She clicked her tongue a few times at the dogs. “Come on, you filthy beasts. Leave Jae alone. I’ll grab you some food. You both could use baths, too, but it’ll be hell or high water before I do that.”
Jae took another sip of coffee as he watched them leave. Inside his cabin, he put down his mug. He hated to admit it to himself, but the coffee tasted lousy, his GI tract felt like it was stuffed with saturated sponges, and his headache was ramping back up to a dull roar.
He gathered more mental optimism about the rest of the day. It was probably crappy coffee that started him off on the wrong foot. He stepped in the laundry room at the back of the house where he owned a freezer chest and opened the lid. He grinned at the bags of venison, took one out, and couldn’t wait to savor the rich, gamey taste, which reminded him of the diet the deer ate during it’s own life: acorns, herbs, and sage.
Maybe he was run down to have caught the flu, so there was no better “meat” for him to eat than venison - abundant with vitamins and minerals and low in fat content.
For now, Jae put the bag in the kitchen refrigerator, gulped down a sample of orange juice, and reeled back with surprise due to its sweetness. It tasted terrible, so he dumped the rest down the sink. He reverted to getting out an ibuprofen for his growing headache and swallowed it with water.
Jae then gathered the supplies needed for his mouse-trapping chore. He realized something which had not occurred to him before. What stupidity. He and Patty should take in a cat or two; let them go in and out between the cabins and the woods like Curley and Twist. What better way to curtail the mouse population than with natural predators?
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A big yellow school bus was parked in the lot of the visitors’ center when Jae ambled over and entered the front door. The gift shop to the right, staffed with an elderly volunteer at the cash register, was cluttered with school kids.
“Did you accomplish your mission?” Patty asked as she approached him.
He nodded and brushed his hand along the crease of his forest green uniform trousers after all the crouching down he’d done. “I’m finished for the time being and came to relieve you. I can do half the paperwork in my cabin later.”
“Appreciate it. I just gave these kids a tour of Taft’s restored Victorian house. There’s a volunteer over there starting another tour. I’ll swing by later.”
Jae opened the door for her since he stood closest to it. After Patty left, a woman leaning against the exit area of the shop pushed away from the wall and walked over. She w
ore a furry pink cap and stared at him with large brown eyes.
“Hi,” she said. “My students are buying out the gift shop.”
“We don’t mind that,” he said. “As long as their parents gave them a limited amount of money so they don’t go home in trouble for spending too much. What grade are they in?”
“We’re fifth grade. I’ve been teaching that grade for years, but to tell you the truth, I really envy your job. I would have loved to be a park ranger. It would be like being on vacation every day without a care in the world except for wondering what kind of wildlife you would see on a particular day.”
Jae’s energy was draining, even for a conversation, but he never gave up an opportunity to highlight the unseen and unknown perils of being a park ranger. Yes, it was glamourous. Dangerous too.
“It can be more involved than that,” he said. “Who do you think has the greatest likelihood of being assaulted on the job: someone in the Secret Service; the Bueau of Alcohol, Tobacco, Firearms and Explosives; the DEA, FBI, or any other federal office?”
She scrunched up her eyes. “I would say the officers working with intoxicated people and those with weapons. So, the Bureau of Alcohol, Tobacco, Firearms and Explosives.”
“No,” he said. “It’s a national park ranger.”
“I’ll be,” she stuttered. “Why’s that?”
“We rescue people out of dangerous situations but face the same perils ourselves; we fight wildfires; come face-to-face with wild animals, and deal with unhappy visitors with short tempers, to name a few.”
“Hmm. I never thought about that.” As if she lost her enchantment with park rangers, she went back to waiting for the students at the exit of the gift shop.
Jae left the lobby, went down the next hallway, and into a small office. The visitors’ center had it’s own stash of clerical work, which needed the ranger’s daily attention. He sat and leaned over into his hands. It was lunch time, but he didn’t feel like eating a thing. Hopefully, his venison would appeal to him that evening.
CHAPTER 5
After walking away from the call rooms, Annabel dropped her overnight bag in the corner of the office while Bob followed behind her.
“Did you get any sleep?” he asked.
“Enough,” she replied. “How about you?”
“More than you. I stirred when I heard you come in next door.”
“Sorry. I probably made more noise than I should have. I stayed up and monitored Mrs. Helm’s atrial fibrillation treatment. That was pretty cool watching her heart’s chaotic electrical impulses convert to a normal sinus rhythm.” She sorted the index cards in her hands, each one representing a different patient. “We better go see our patients before official rounds, and before Dr. Schott shows up and starts reading his USA Today to us.”
“Since we’re post-call, he probably won’t do that. He’ll have yesterday’s paper and he already read those highlights to us.”
“You have him figured out.”
“What’s not to figure? He’s super nice to us, a good teacher, likes his food, and, besides medicine, he keeps his finger on the pulse.”
Annabel slid the white cards back in her lab jacket and smiled. “We should do something for him.”
“Let’s think about that. In the meantime, let’s find coffee to gulp down and then see our patients.”
“A lot of coffee. Dr.Mejia is joining us for rounds this morning, so we better be on our toes.”
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Annabel’s current favorite patient was May Oliver, a thirty-two-year old-woman who came in with coughing up blood, or hemoptysis, as the medical team called it. She was diagnosed with lung cancer; the adenocarcinoma had already sneakily metastasized to her bones and brain. It was bad enough the young woman suffered respiratory symptoms, but having a cluster of the cancer in her brain had caused seizures, and the foci in her tibia, or shinbone, had made her more and more unsteady on her feet.
Annabel tightened the strings on her scrub pants as the entire team stopped in the hallway outside May’s room. The students and residents needed to highlight the recent activities of their patients and thoroughly “present” any new patients that had come in during their call.
Their attending put his hand up to his hair as if checking the placement of his neatly organized comb over and then looked straight at Annabel.
“Mrs. Oliver had another radiation treatment yesterday,” she said. “She kept down hot cereal this morning, her vital signs are stable, and the oncologist plans no more treatments for the time being.”
“He wants to see her in a month,” the resident on the case, Dr. Burg, added.
Dr. Mejia nodded his approval. “Sounds like she tolerated the third treatment the best.”
“Third time’s a charm,” Dr. Schott said. “Whenever that happens with a patient getting chemo or radiation, I think of it like tolerance to a narcotic. The effect becomes less, but in this case, the nasty side-effects.”
“For our patients’ sakes, I wish that was a universal occurrence.”
Dr. Mejia straightened his tie; the only team member wearing street clothes. He always dressed refined and wore what society expected of a distinguished cardiologist. “I suppose it’s time, then. To send Mrs. Oliver home.”
He frowned, making Annabel worry about May’s fate. Her patient was too young for the cards she had been dealt and the two of them had bonded because of similarities in their lives.
Dr. Schott gestured and the group clamored into May’s room.The woman slurped through a straw while holding a liquid nutrition drink. Only a stubble of hair clung to her scalp and she wore a green sweater, too loose for her slight frame.
May took her lips off the straw. “I expected you all to come traipsing in here after Dr. Tilson visited me before. These are your ‘morning after’ call rounds with Dr. Mejia, who is fresh as a cucumber giving you all his words of wisdom about diseases and patient plans and outcomes, and the students are dragging and dreaming of going home. I’m a frequent flyer in here, so I know these things.” She said it in one long breath and again put her lips to the straw by her mouth.
Dr. Mejia laughed. “Dr. Tilson pegged you correctly ... you tolerated the last radiation treatment well. We will be sorry to see you go, but the excellent news is that Dr. Burg will be writing your discharge orders after rounds. Dr. Schott and this motley crew will expect you in clinic soon and you need to also be evaluated by the oncologist in a short time.”
May shifted position and stole a glance at Annabel. “I can’t thank you all enough. You broke bad news to me and then tried your best to cure me. Curing me was not meant to be; we have only stalled the inevitable. I’ll try my best, however, and practice Dr. Tilson’s advice to be optimistic.”
Annabel gulped. She felt so bad for May, but there was nothing more the team could do. In her limited clinical training, she had yet to witness a braver patient.
Dr. Schott peeled his eyes away from May. “Yes, carry optimism with you at all times. Enjoy the rest of that strawberry drink.”
The team cluttered back up the hallway and Bob patted Annabel’s shoulder. “You made her hospitalization more tolerable,” he said softly.
“Thanks. I’m going to do what my dad started doing a few years ago when he let religion back into his life. I’m going to say a prayer for her.”
As if he was privy to Annabel’s thoughts, Dr. Schott said, “Patients don’t always get better from our health care. Sometimes healing comes from spiritualism or an unknown force which infuses someone with the ability to overcome their own medical obstacle.”
“I tend to be more pragmatic,” Dr. Mejia said. “Maybe that’s why I went into cardiology and deal with the straightforward physical and electrical elements of the heart.”
“I’m going into cardiology too,” Jordan reminded him. “My thinking precisely.”
Annabel wanted to say, “No one asked you,” but she bit her tongue. She noticed Dr. Schott shake his head probably because Jordan
had overstepped his rank in front of the attending doctor.
“Religious discussion aside, who’s our next patient?” Dr. Mejia asked.
“We should do Mrs. Helm next,” Donn said. “She’s next door and is Annabel’s new patient from last night.”
All eyes focused on Annabel again as she slipped out her patient’s index card and checked the patient’s age.
“Meagan Helm is a forty-seven-year-old Caucasian mother of three who came in with an onset yesterday of rapid heart palpitations, shortness of breath, and dizziness. Her heart gave her similar problems when she was pregnant with twins and she has a history of rheumatic heart disease. Other than that, her past medical and surgical history is negative, and she never had a follow up for her heart.”
Annabel slipped the cards back in her pocket and continued. “On her admission physical exam, her heartbeat and pulse were fast and erratic and her EKG indicated atrial fibrillation.”
Jordan took a baby step forward, his enthusiasm for the heart condition as apparent as Dr. Mejia’s.
Annabel continued. “Her diagnosis is atrial fibrillation and the plan was to convert her pharmacologically and not by cardioversion. Dr. Watts ordered an IV calcium channel blocker and Mrs. Helm’s heart responded perfectly; her rhythm is now normal and regular.”
Dr. Mejia rubbed his hands back and forth. “Ahh. A clean, classic case. Dr. Schott must have told you atrial fib is the most common cardiac dysrhythmia and mostly occurs in the elderly. However, cases are increasing in younger people without structural heart disease.” He turned his attention to Jordan Maldonado. “They are a challenge and, by the time you are out of residency, you’ll be seeing more and more of them in the ER where the first diagnosis and treatment occur.
“Now I’ll ask the resident … Dr. Wattts, now that Mrs. Helm’s reason for admission is taken care of, are we sending her home?”
“We need to find out the cause of her atrial fib.”
“Correct.” Dr. Mejia turned to Jordan. “What causes a heart to be jumpy like that?”