by Barbara Ebel
Our night together was awesome. I hope you weren’t dead tired being on your call.
I do plan on making us the dinner I promised. This weekend?
Bob’s heart skipped a beat and then it palpitated like it was hit with a club. He wished it weren’t so, but the text from Dustin was blatant.
Not only did it appear like Annabel and the cop had gotten hot and sweaty together, but she might have lost sleep doing it. And by the sound of it, they made more plans to be together in the near future.
His lethargy from Ehrlichiosis grew worse and he craved sleep that much more.
CHAPTER 24
Patty Caye found out the hard way how much she and Jae kept the William Taft National Historic Site operating efficiently.
Since her colleague’s hospitalization, her work had more than doubled. She finally asked the national park system to officially lend her the part-time ranger who was filling in for Jae. They agreed to commit him for the next month. At least now, she thought, she didn’t need to scramble every few days to write up the paperwork necessary to request extra help.
She ladled the sautéed venison which she’d just prepared on the stove to a dinner plate. Jae had given her a few single-serving freezer bags of his last processed deer meat. Since presently he was living his life in an ICU, she was glad he had given her some before, but eating venison made her remember him and miss him that much more.
She looked down at the dogs.
“There’s not enough to go around. Besides, this is my dinner.”
She frowned at Twist. “Plus, you’re getting better after your bout with that Leptospirosis disease. There’s no way I am going to feed you something exotic.”
The dogs understood the gist of her words and stretched lazily on the throw rug. She cut the slices she had prepared into smaller pieces and ate a sample. Pleased with her preparation, she spooned over the accompanying vegetables.
Sometimes Jae worked way too hard, she thought. The last day he hunted, processed, and hung the buck was crazy. And then his big payback from nature was to shower and find ticks. He had told her on more than one occasion how much he loathed them.
She guessed a tick bite might not be important in Jae’s medical history, but she wondered.
Had he told the medical team upon his admission that he had recently hunted and was exposed to, and bitten by, one or more ticks? Like the dogs, she and Jae were exposed to the positive and negative secondary gains of the great outdoors, but with Jae, it was much more. His deep woods adventures were as redneck as they came.
Patty was overdue to pay Jae a visit in the ICU, so she decided that tomorrow she would weed out the time needed to see him. She wanted an update on his condition, but it wouldn’t hurt to check if the team knew about his endeavors in the woods and his recent intimacy with a tick.
-----
Annabel woke with a start upon hearing an alarm clock. Disoriented, she kicked off the afghan draped on her legs and then realized she was on a couch. Bob’s couch.
Bob stumbled out from his bedroom with the portable clock in his hands and clicked off the noise.
Annabel rubbed her eyes. “Thanks for setting the alarm. Now please go back to bed. I’ll be fine.”
“You were a super teacher last night and we covered a lot. I’m the one who should be thanking you. Feel free to make a single-cup coffee with my machine in the kitchen. I’m taking your advice and going back to bed, especially if you’re going to repeat another session tonight like last night’s.”
“I will dream up a different topic for us and you’re welcome.”
Annabel scrambled, left shortly, and went to her own car. It was weird waking up in Bob’s apartment, but she was glad she did it. They were so “at home” with each other, they were almost like siblings. Or better, she thought, because she wasn’t even on speaking terms with her own sister.
She punched in her iPhone password to unlock it and quickly checked for any important overnight messages. When she saw Dustin’s message about their date, and that he wanted to keep his cooking promise, she broke out in a smile. She scrolled him back a response.
You’ll have stiff competition outdoing our Cajun dinner, but I’ll take the chance.
She signed off with an emoji smile and started the car.
At the hospital, Annabel went to the ICU first before seeing any patients on the regular floor. When she passed through the automatic doors, an RN signaled to her from the desk.
“Dr. Tilson,” she said, “the park ranger friend of Mr. Nixon is here to talk to anyone from the medical team.”
Annabel spotted Patty standing inside Jae’s room. She was hard to miss since she wore her uniform. “She sure is an early bird.”
“I’ll say.” The nurse raised her eyebrows. “I’ll pour you a cup of coffee since you often put a pot on for us.”
“Thanks.” Annabel poked her head into Jae’s room. “I hear you want to talk to one of us.”
Patty nodded and Annabel pointed past the door. They walked out and stood by the entrance.
“Has he made any progress?” Patty asked.
“Overall, he’s about the same. We’re managing a few more things, however, because his length of stay is getting longer.”
“The meningitis is still there affecting his brain?”
“Yes, I’m afraid so. Part of the critical care he’s receiving is medication to reduce the swelling in his brain.”
Patty gritted her teeth.
“You’re here extremely early. Can I get you a cup of coffee from the kitchenette?”
“No thank you. I must leave soon to drive back to work. I don’t know if Jae told this to any of you. It may or may not be important. I remembered it last night and, since you doctors are unsure why he’s sick, I couldn’t bear to not tell you right away.”
Anabel’s interest piqued, and she tilted her head. “A thorough history is the biggest chunk of the puzzle. What did you remember that may be helpful?”
“Jae uses a crossbow to hunt. Not that that’s important, but his hours in the woods and handling of deer is. Before he got sick, before he went to the hospital the first time and they told him he had the flu, he killed a buck. He brought it home, of course, but later he told me he’d been bitten by a tick.”
Annabel let out a gasp. Her thoughts raced straight to Bob and his Ehrlichiosis. One very bright family practitioner had hit immediately upon his correct diagnosis. Bob was sick enough, but if someone hadn’t figured out what he had, he could be in an ICU right now like Jae.
Maybe Jae had the same disease. Or, the possibility existed that it could be some other lecherous disease brought on by the same bloodsuckers. Maybe Lyme disease? She had a lot more studying or rereading to do about parasitic diseases.
Annabel needed to stop her racing thoughts and address Patty Caye standing in front of her. The poor woman’s hands were wrung into a knot.
“I took his history as did several other doctors. Nowhere did I read that in anyone’s notes. Mr. Nixon sure didn’t tell me and I never asked about bites or his extracurricular activities.
“I’ll be sure and tell the others. Especially Dr. Enno, the infectious disease doctor. This piece of information may be important.”
Patty gave a sigh of relief; her input was welcomed and appreciated.
“Thank you,” Annabel said, “for taking the time and effort to let us know.”
-----
Annabel rounded the corner into the office where she found the whole team quiet and distracted with their index cards or pocket manuals. Jordan’s head was lowered over a new iPhone. Donn leaned against the desk, his paper folded near the window.
“I have a news flash about Jae Nixon,” Annabel said.
“Instead of rounding at this moment,” Donn said, “why don’t you tell us? It’ll give me the opportunity to eat something. I’m starving.”
“Why are you starving?” Stuart asked.
“Peanut butter and jelly for breakfast?” Jordan b
lurted out after glancing up.
Donn pitched cellophane in the waste basket and grasped half of his sandwich. “It’s probably better than what you eat, since you can’t come up for air from another phone device.” He frowned, knowing he shouldn’t be talking to the students that way, even if he didn’t like one of them.
“Stuart, since your curious mind needs to know, I’m hungry because I didn’t eat a thing after leaving yesterday after call. I was back to the office for paperwork, over to the department for a meeting, and then a five o’clock appointment with my attorney about the Helm’s family lawsuit. Then I crashed at home because of getting no sleep on call.
“Does that cover it?”
“I’m sorry, Dr. Schott,” Stuart said.
“Yeah, well …” Donn looked at Annabel. “Go ahead and fill us in about Jae Nixon.”
Annabel gulped. She sure didn’t want to ruffle his feathers. “The other ranger, Patty Caye, was waiting earlier to talk to one of us. She wanted us to know that Jae was bitten by a tick before he got sick. He went hunting; it seemed like he caught it from the woods or the deer he caught.”
Donn’s eyes grew big. “What the hell?! Do we have a medical student and a patient incapacitated from a little bug?”
“That was my first reaction,” Annabel said.
Donn chewed on his sandwich and washed it down with a swig of cold coffee.
“How can people get bit now?” Stuart commented. “It’s winter.”
“You’re chatty today,” Donn said. “Did you sleep through the fact that they’re not forested down anymore throughout winter? Temperatures are warmer and their range has crept more to the north.”
“Dr. Schott,” Melody chimed in, “Dr. Enno needs to turn up so we can tell her right away. We’re not exactly experts in this area.”
“An unskilled family practitioner knew what Bob Palmer had,” Jordan said.
Donn scowled. “Unskilled? Don’t ridicule other doctors, particularly in that case. Behind my back, people may be ridiculing me right now because I’m being sued, but I practiced the standard of care for my patient.”
Annabel looked at the floor. Jordan was an idiot, but Donn was taking the lawsuit too seriously.
“Let’s get back to Jae Nixon,” Annabel said. “and I’ll hunt down Dr. Enno this morning. We’re not experts with tick-borne diseases, but everyone’s heard about Lyme disease. We should have a group discussion about it.”
“Transmission is misunderstood by most people,” Stuart said while everyone’s eyes locked onto him.
“How do you know?” Jordan asked.
“The topic of Lyme disease came up for me last summer. I must digress too, about how I spent that season of the year. After all, between the first and second year of medical school is the only summer that a future doctor will ever have off again. After that, our ‘childhoods’ are over forever.
“Anyway, I didn’t really take off. I shadowed a hospitalist at least twenty hours a week. He also wanted me to become familiar with writing medical papers. I co-authored a paper with him on Lyme disease.”
“Jeez,” Chineka said. “Was it published?”
Stuart nodded.
Donn shook his head. “The disease is an important topic and I can see to it that it shows up on a test.” He gave them a weak smile.
“Before we go any further, however, Jae Nixon does not have it. He was on antibiotics, which would have made him better. So, let me wrestle with the rest of my pb&j and, Stuart, you can teach these knuckleheads a thing or two about Lyme disease. Why is transmission misunderstood and what’s a major symptom that we don’t see with Jae Nixon?”
“Working on the subject,” Stuart said, “I came to understand that many laypeople believe it is the tick itself which is the direct cause of the disease. That is not true. It’s the tick’s saliva which is transmitting the infectious agent – a bacteria, a virus, or a parasite.
“With Lyme disease, it’s bacteria that’s the culprit. She’s called Borrelia burgdorferi. I’m sorry, ladies, I call it a ‘her’ because women are more harmful and entrapping than men.”
“How about that?” Donn asked flatly. “You have a personality capable of making a dangerous joke under that nerdy exterior.”
“Only when it comes to academics.”
“He just annihilated his female colleagues,” Jordan said.
“You took that spot a long time ago,” Melody countered.
Stuart shrugged his shoulders and continued. “I know what major symptom you are referring to, Dr. Schott. Besides symptoms such as a fever, muscle aches, a headache, or fatigue, the rash called erythema migrans is classic. Seventy-five percent of all patients with the disease show the rash within a few days or a month. Usually within the first week. It spreads from the site of the bite, but it really isn’t itchy or painful. The skin area looks like a target or a bull’s eye.”
Stuart looked back at the floor. “One of the reasons Lyme disease is so disruptive to people’s lives is that it can be a long-term, debilitating illness. It can cause severe joint pain and swelling. Imagine hiking to get exercise or to take a break from studying, and you get bitten by a tick and contract Lyme disease. You end up with severe arthritis when you’re only twenty years old because of your walk in the woods!”
“Bob was bitten by a tick,” Annabel said, “and we weren’t even in the woods.” She shuddered and Donn wiped his mouth, his sandwich finished.
“Stuart, thanks for the synopsis on symptoms,” Donn said. “Now let’s go round on our patients.”
He pulled ahead of all of them and spoke over his shoulder. “Annabel, hunt down Dr. Enno and tell her what you heard.”
CHAPTER 25
Annabel wrote updates in her patients’ charts after rounds and kept her eyes peeled for Dr. Enno. When she went back to the unit, she found a note from the infectious disease specialist on Jae’s chart. She had missed bumping into her, so the next likely places in the hospital were the doctor’s lounge or the cafeteria. More attendings and residents filtered in and out of the doctors’ lounge during the day than medical students.
Annabel never visited there very long, but she wished she could. Conversations often focused on the care of doctors’ current patients. Listening was an educational experience; she yearned to be in their shoes.
Even though Shania Enno sat facing the other way, Annabel knew it was her from the bun in her hair and Alejandro slanted alongside her chair.
“Dr. Enno, do you have a moment?”
“For a medical student? Always.”
“I noticed you went by to see Jae Nixon. I have information from his co-worker which, I believe, none of us knew.”
Shania’s slow hand picked up her cup, but her smile faded when she peeked in the bottom.
“Serve yourself from the counter over there and, if you don’t mind, fix me an herbal tea. Come back and we’ll discuss our patient.”
“Sure thing,” Annabel said warmly. The spread of bagels and fruit proved perfect since her stomach was running on empty except for coffee. She dropped a cinnamon spice tea bag and hot water into two different cups, made herself a small plate, and bused them over to Shania’s table.
“The young ranger’s brain swelling is under control,” Dr. Enno said, “and your crackerjack medical team is managing his respiratory support and IV fluids like a champ.”
“Dr. Enno, I worry every morning I step into the ICU that he’s taken a turn for the worse. I’ve heard of patients spending months on a ventilator in an ICU. How do medical care providers and families maintain their optimism under such conditions?”
“People in our modern society have lost the ability to be docile and tolerant of situations they cannot control. Under the scenario you speak of, they must unwillingly adapt and practice enormous patience.”
Annabel nodded as the older doctor steeped the tea bag and pulled a single packet of honey from her pocket.
“Now, what did you hear about your patient?”
Shania stirred the honey around in the cup while processing the missing part of Jae’s history. “In some cases, ticks are the size of a pinhead or a watermelon seed. It depends on whether it’s in the larva, nymph, or adult life cycle.
“Certainly, one of them could have injected Mr. Nixon with an infectious agent. This is an important piece of information.
“And most cases of meningitis are caused by viruses. Which is so critical, because meningitis accounts for one of the more important causes of hospital admissions.”
“My dad’s a neurosurgeon, so I’m always interested in the brain; from the neurology and medical aspect as well as the surgical standpoint.” Annabel opened a pat of butter and began spreading it on a bagel. “You went straight to talking about ticks transmitting viruses. Yet our absent medical student has Ehrlichiosis caused by a tick transmitting a bacteria, not a virus, and this morning, our medical team also talked about Lyme disease, a tick-transmitted bacterial disease.”
Shania gave her a half-smile. “Then your group is keeping up with the times. This gives me an idea. Are you aware of who the department asked to give grand rounds in the near future?”
Annabel paused, took a bite, and shook her head.
“I will be the speaker. Although I had a topic in mind, now it will be something entirely different.” She wrapped her hand around Alejandro and clicked it once on the floor. “I don’t know if ticks are our tiniest threat, but for the purposes of my discussion, they will be.”
Annabel raised her eyebrows. She wished she could sit with the woman the rest of the day.
“My talk will be called ‘Our Infinitesimal yet Colossal Danger.’”
“I won’t miss it, Dr. Enno.”
“So, back to Jae Nixon. Fortunately, the CDC does not put me on hold when I call, so I will talk to them soon, as well as our state health department.”