by Barbara Ebel
“Absolutely.”
“Besides the dogs, my ranger partner has been close to mice and their nesting areas lately. It makes me wonder …”
“Sure thing. The rodents may be carrying the responsible bacteria. Your partner and Twist could have been infected from the mice, especially from mice urine, which goes unnoticed wherever they are scurrying about. Or the dog became infected by the mice and your partner infected by the dog.”
Patty slowly nodded. “I’m glad we spoke. I will share this information with the doctors taking care of Jae.”
The vet opened the door. “Sometimes communication between different health care staff solves or averts a lot of problems.”
“Thank you. You did more than treat one of my best pals.”
-----
“I visited Bob yesterday,” Annabel said to Dr. Schott as she stored her backpack in the office. “Chances are, he’ll be calling you any minute to say he’s not coming in.”
Donn leaned against the desk and rubbed his chin. His newspaper was nowhere in sight.
“We’re approaching the tail end of the whole rotation. He’s risking a ‘not complete’ for the course.”
“He doesn’t have a choice. It’s like there is nothing wrong with him, but there is.”
“That doesn’t make any sense.”
“I know.” She squared her shoulders. “I left a message at his doctor’s office, so he should get an appointment today.”
“A few more absent days and he may need to redo some, if not all, of the rotation.”
“That’s what he’s worried about.”
The rotation was already dismal without him. If he didn’t finish, it would probably disrupt them from being together on the next specialty. She swallowed hard. Since the third year of medical school had started, they had been inseparable and the situations they’d shared were unforgettable.
Donn soon waved the team into the hallway. His cell phone beeped with a text message and he looked over his shoulder at Annabel. “It’s Bob. Like you said, he’s not coming.”
-----
After rounds, Annabel stayed in the ICU. She wrote her notes on Jae Nixon and waited. The infectious disease consultant had not been by on Sunday. She was due any minute.
The coffee she sipped on was fresh; she had made it herself. She popped a chocolate espresso bean into her mouth, let it melt with the hot brew, and thought of Bob.
What’s going on with a doctor’s appointment? she typed on her iPhone to him.
They are booked today, but they stuck me on the schedule for tomorrow at 4 p.m.. I’ll see Dr. Raymond and he’s worth the wait.
Didn’t you tell them you were a medical student?
What difference does that make?
I don’t know. I’m just saying.
Are you worried about me?
As worried about you as you were about me when you drove me to TN because my dog died. You didn’t want me driving myself!
Oh.
She smiled at his minimal response. Can I bring you food tonight?
No. You need to study.
I can still do that. I’ll study out loud at your place.
Okay. A smile emoji popped up.
I’ll be over, she responded.
As Annabel slipped her phone away, she sensed a figure in front of her. A woman wearing a long, white physician’s coat beamed down at her with a warm yet authoritative expression. Her cheekbones sat high on her face and her skin wore age spots. Her peppered white and black hair was pulled taut into an old-fashioned bun.
“May I?” the woman said.
Annabel’s hands rested on Jae Nixon’s chart. She grasped both ends and handed it over without a word. The physician nodded with approval and opened the chart on the counter as Annabel observed her name tag – Shania Enno, M.D.
“Medical student Tilson,” the woman said with a smooth voice, as if she oozed yoga from her vocal cords.
Annabel held her gaze.
“Tell me everything you know about this bereft man on a ventilator. I am the infectious disease doctor, Dr. Enno.”
Annabel hesitated, wondering if the woman would continue to stand. She appeared to be in her early seventies and her bumpy-boned hand rested on a cane.
“Alejandro will take care of me,” Dr. Enno said.
“Alejandro?”
The woman raised her cane off the floor and waved the handle, which was patterned with natural dark and light wood. A turquoise stone or inlay was embedded in the end of the handle and the wood of the long shaft was striated like Mother Nature had painted her herself. Polyurethane coated the whole piece, no doubt smoothed and coated by a master craftsman.
“Oh,” Annabel said, realizing the woman had named her walking aid. Her mind was now clear of her patient and solidified on the infectious disease specialist before her.
The woman planted the cane back down and practically read Annabel’s mind. “I can do without sitting right now. I make sure I stay on my feet for a portion of the day. The veins in my legs must work harder and stay in better shape pumping that blood clear back to my heart.
“Tell me about your patient.”
Annabel presented Jae Nixon’s entire case to the elderly physician. In the end, she paused and then said, “However, after all the uncertainty of Mr. Nixon’s illness, one of the other medical students came up with Leptospirosis as the working diagnosis.”
Dr. Enno’s expression stayed the same; she registered no wonderment at the mention of the disease. Meanwhile, the ICU doors slid open and a woman wearing a park ranger’s uniform went straight to Jae Nixon’s room.
“One of Mr. Nixon’s visitors,” Annabel said, pointing past Dr. Enno. “I should go talk to her.”
“Let’s both go.”
Annabel walked at Dr. Enno’s speed into the stark room. Patty Caye turned with frightened eyes at both of them.
“I’m Dr. Enno,” the physician said, “and perhaps you’ve met Annabel, Mr. Nixon’s medical student on his case. I was called in for my expertise in infectious diseases.”
“And I’m Patty Caye. I work with Jae. I just came back from picking up one of the dogs that Jae and I take care of, and I have very important news which may help. Our dog was diagnosed with Leptospirosis and is making a fine recovery, but I learned that people can get it too. It’s possible Jae picked up the same thing as the dog. Both of them may have acquired it from the mouse population we’re plagued with or Jae got it from the dog who still picked it up from the mice.”
“Thank you so much,” Dr. Enno said. “It is a working diagnosis on the table for the time being. But tell me more about the area you work in, what you do, and this mouse population. Infectious diseases are notorious for specificity; their geographic distribution, their hosts, the time of year, and the life cycle of the infectious agent.”
Patty gave Dr. Enno a vivid description of life at the park and Jae’s tasks with the trails, the wildlife, and exterminator duties with rodents.
“Since our dog is better,” Patty said in the end, “I’m assuming Jae is also going to pull out of this.” She put her hand to her mouth, hoping for a positive response.
“We can never predict what comes tomorrow,” Dr. Enno said. “Right now, I need to examine my new patient and check his chart and test results. After I do my consult, I am sure that Dr. Schott will contact you.”
Patty’s eyes were fixed on the woman as she patted Jae’s arm. “I’ll go grab breakfast and go back to work. I needed to come in and see him today for myself. I hope I helped.”
“Yes, dear, thank you.”
Patty left and Dr. Enno walked to the top of the bed. She stared at Jae’s tattoo.
“That is magnificent body artwork,” Annabel said, taking a chance that Dr. Enno also appreciated it.
“I agree. I am half American Indian, so I admire the subject matter as well as the colors.” She proceeded to pull medical gadgets out of her pockets and examine Jae. Annabel watched the woman’s methodical
physical exam and then walked back to the desk with her.
“Alejandro, your cane,” Annabel said. “What does that mean?”
“’Defender’ or the ‘protector of mankind.’” The lines around her eyes crinkled. “Obviously, my cane is most useful to me rather than the entire human race.”
-----
It was early afternoon, often when Annabel would find Donn in the office eating his pb&j sandwich, especially if he hadn’t gone to the cafeteria. She poked her head in, only to receive a haughty stare from Jordan. After crossing the pedway to the call room area where Donn had his own private office, she rapped on his door.
“Come in,” she heard. The shelves were stuffed with textbooks and paperbacks. An unopened cellophane-wrapped sandwich sat on the end of his cluttered desk.
Donn stifled a sigh. “What brings you over?”
“Sorry to disturb you. I have a request … if I can leave tomorrow by three o’clock so I can drive Bob to the doctor’s appointment he has at four o’clock.”
Donn crossed his legs. “Tomorrow there is no clinic or call. Consider it done. Who is he going to see?”
“A family practice doc named Dr. Raymond.”
Donn raised his eyebrows. “I know family practice and internal medicine doctors who are stumped with unusual illnesses and their patients are sent off to big name institutions. But Dr. Raymond? He’s diagnosed conditions that even the Mayo Clinic couldn’t figure out.”
“Really? Bob said he was worth the wait to see him.”
“I have bad news, however. The department said if he doesn’t come back by the end of the week, he’ll need to make up the time.”
“Can he take the final exam?”
“That may be up to him, but he stands the risk of failing.”
Annabel fixed her eyes on his desk. Not if she could help it, she thought.
“Can I tell him what you said?”
“Yes, it would be best if you do.”
Annabel ran her hand through her hair; the waves settled on the front of her jacket. “One more thing. The infectious disease doctor just saw Jae Nixon. A Dr. Enno.”
Donn’s eyes widened. “We’re striking home runs. They don’t get any better than her.”
“I wondered about that. She certainly is different.”
“She has years of experience and, despite her age, knows of every new potentially dangerous organism that breathes, crawls, swims, or has anything to do with humans. She’s like a one-man CDC. She can be unnerving with all that knowledge except for the fact that she emanates calmness like a spiritual goddess.”
Donn extended his arm and grabbed a nearby soft drink. His pensive expression returned.
“Dr. Schott, I’m really sorry you’re dealing with the threat of a lawsuit.” She turned to leave. “And thanks for letting me leave on time tomorrow.”
CHAPTER 16
“Did you manage to sleep at all today?” Annabel asked when she went to Bob’s that evening.
“I rested on and off. At least I’m in a chair for your visit and not on the couch.” His legs were straight out on the recliner and covered with an afghan.
“I brought you something tasty, light, and bland - stone cut oatmeal - and I had Pete drizzle honey on it. The contents are still warm.” She dug in the bag she brought and handed him a Styrofoam container and a spoon.
“What would I do without you?”
“You’d manage. I bring good news too. Dr. Schott is making sure I’m out on time tomorrow to bring you to the doctor’s. I won’t be calling you an Uber driver.”
Bob slid down oatmeal and shook his head. “You don’t need to do that.”
“But I will.”
Annabel pulled out a sandwich from her own take-out order. “I’m going to read to you again after I eat.”
They ate in silence and she glanced at her phone. She was overdue to text Dustin back from earlier in the day, so she went ahead and typed.
I’m looking forward to tomorrow night as well. How did the domestic abuse case work out?
I hate them! he responded. Most of the time, whatever the situation is, it grows worse over time.
Not good.
“Are you texting Nancy?” Bob asked. “Are you back on speaking terms? You can’t let some idiot like Jordan influence the both of you.”
“No. She’s ignoring me. This is from Dustin Lowe. We’re going out tomorrow night.”
Bob attempted a half-hearted smile. “Your schedule tomorrow is packed with men. One enjoyable and one nothing but a burden.”
“You’re not a problem. Plus, you don’t know and I’m not telling you - my life regarding men right now is totally toned down. Compared to normal.”
Bob tilted his head. She wasn’t going to divulge any more, so he continued eating.
Another message popped up on Annabel’s phone. Text you late tomorrow for a definitive time.
I have a little chore to do which may or may not delay me, but we’re on no matter what!
Bob crossed his ankles as Annabel put down her phone. “Did Dr. Schott say anything more about my finishing the rotation?”
“Yes. If you’re not back by the end of the week, you’ll have to make up any lost time on another internal medicine rotation. However, you can take the final exam if you want. If you pass, it’ll count. If you fail, you must repeat the entire length and testing of the rotation.”
Bob squinted his eyes. Getting through the rotation was one thing, but he realized that if he didn’t get back on the wards soon, he would be out-of-synch with Annabel. The possibility of rotating next with her on ob/gyn or pediatrics would be lost.
“You’re not saying anything,” Annabel said.
“Actually, they are being fair with me.”
“I think so too. There is only so much you can do about getting yourself better in a hurry, but if that doesn’t happen, you can tackle the final exam if you think you stand a chance of passing. And, there won’t be that much time to make up on another rotation. One of the problems I see is that all your timings will be messed up.”
He wondered if she meant between the two of them. “Yes, that’s unfortunate. But, no matter what, despite being so tired, I must try and study like a madman.”
“You already are a madman, so you’re on your way to passing.”
Bob closed his eyes and shook his head with a grin. When he opened them, Annabel leaned over and took his empty container.
“If I have anything to do with it,” she said, “you are going to pass. We both are. Unless I’m on call, I’m going to help you out every night. And each day, I’ll tell you the clinical stories from the wards.”
She unwrapped her tucked-in legs. “Tonight, let’s take a crash course on hepatitis.”
-----
The next morning, Annabel sat behind a talkative driver on the way to the hospital. She wanted to tape his mouth shut. She had become such a regular customer of the transportation service that she could write out a preference list. The cars were never a problem because they were clean and the back seats roomy. Every driver streamed music; the genre was usually okay with her. She wasn’t picky, but the volume made all the difference in the world. Too loud made for a nerve-rattling drive, which she didn’t need at the crack of dawn.
In essence, the most important aspect came down to the driver. Once in a while, she’d hit the jackpot when a conversation began with an unusually interesting person and she’d hear interesting aspects of their life. At those times, she wished she could stay in the car and listen to more.
Overall, a respectable friendliness from the driver was the key, and a little light chit-chat was perfect. Too little or too much sapped her energy away from whatever it was she really wanted to think about.
And this morning, she thought about Bob and her date with Dustin that night. And as they pulled off the interstate, she wondered about Jae Nixon still in a coma and the woman who was holding all the cards for him to get better. If she ever considered infectious diseas
es as a specialty for herself, there would be no one better to shadow than Shania Enno. It was in her best interest to absorb as much as she could from the elderly woman.
She darted into the office, left her things, and headed to the ICU. In Jae’s room, she stumbled on the changing shift and heard the tail end of the night nurse’s report to the a.m. replacement. “I just changed out his Foley catheter and replaced a bag of IV fluids,” the husky nurse said. “This young man’s condition is depressing and I can’t wait to leave.”
Annabel nodded at them. She looked at the nurse’s clipboard at the bottom of the bed. Jae’s twenty-four-hour urine output was adequate. His vital signs were less robust than the day before, he still ran a fever, and she worried about his lungs. The longer he stayed on the ventilator, the greater chance that he’d end up with a respiratory infection. She knew … one thing could lead to another.
She finished a routine physical exam and spotted Dr. Enno at the main desk.
“Go grab your morning java,” the woman said, “and come back here and take a seat.”
Annabel filled a cup to the brim and came back. The woman rolled back the chair and crossed her ankles. Alejandro leaned against the counter between them.
“What is your personal thinking,” Dr. Enno wondered, “about the chosen antibiotic that Mr. Nixon is on … days ago and now?”
“It was done empirically, so it was justified,” Annabel responded truthfully, hoping the woman wasn’t annoyed at the team’s decision. “However, his condition has not changed, so it’s obviously not working.”
“Correct. In general, it takes at least three doses of an antibiotic to reach a steady therapeutic blood level, so if the correct agent is being used, a patient’s condition shouldn’t worsen after that but should begin to improve.”
Annabel pulled in closer and crossed her hands.
“He’s on an antibacterial and I don’t think Jae Nixon’s infection is coming from a bacterium.” She squinted her eyes at the open chart next to her. It was open to the lab work section.
“The rest of the LP results are back?” Annabel asked.
“Yes. The spinal tap shows a modest CSF pleocytosis count with predominant lymphocytes. This young man? It appears a virus is the catalyst for his profound illness. He most likely has viral meningitis.”