The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  “As we know, we found out she had mitral stenosis secondary to rheumatic heart disease. We believe she developed acute pulmonary congestion. Her son found her and called EMS too late. She could have also had a major stroke.”

  He let the group think about that.

  “Is there a question about the care she received?” Jordan asked.

  “That’s part of it. We had discussed at length our decision for her discharge. Chronic atrial fibrillation warrants anticoagulation since it minimizes the risk of embolization and stroke. She wasn’t your patient, Dr. Maldonado, but you should know the risk-assessment tools we used for our decision.”

  “Yes,” Jordan beamed. “Multiple factors made her a less likely candidate for oral anticoagulation: her younger age, her lack of hypertension, diabetes, and history of stroke. She also didn’t have a history of atrial fib which categorized her as ‘chronic.’”

  “Well done. You are paying strict attention to your area of interest. Anyway, the family is boiling mad. They probably went to the internet, read a little bit on the subject matter, which makes them experts, and are hiring an attorney to sue Dr. Schott, me, and the hospital for negligence.”

  Chineka Watt winced. She could be involved as well.

  “Maybe the family will reconsider,” Annabel said, “once the reality of the situation sinks in. Perhaps with the shock of their mother dying, the grown kids are displacing their emotions on the care she received rather than their loss.”

  Dr. Schott sighed and rubbed his beard, but he continued to stand inches back out of their circle.

  “And you could make a good psychiatrist,” Dr. Mejia said, glancing at Annabel.

  “In any case, besides following the standard of care, always do what your clinical experience and hearts tell you to do for the benefit of your patient. The chances of a bad outcome when you do all those are small. What happened with Mrs. Helm is a one in a thousand probability.

  “We must keep our wits, not change our perspective, on how we treat our patients, and handle legal battles with courage and truthfulness.”

  CHAPTER 14

  Dr. Mejia glanced into the window of Jae Nixon’s ICU room as the team continued on Sunday morning post-call rounds.

  “I heard,” he said, “we admitted a national park ranger in a coma.”

  Jordan Maldonado’s ears perked up. Often, rounds were the first time he would hear about the other students’ patients. He thought back to yesterday when a female ranger in the cafeteria talked on the phone about her partner being in the hospital. Chances are, he thought, this patient must be her partner. The woman’s discussion had also covered someone else in her life who was ill and had been diagnosed with the unusual disease he had indexed and read about.

  “Dr. Burg and Dr. Tilson are on his case,” Donn said. When he added no more information, Dr. Mejia looked at Annabel.

  “Dr. Tilson, go ahead.”

  Annabel swallowed her nervousness and began her presentation of the patient.

  “Jae Nixon is a thirty-five-year-old white male who came into the ER about a week ago and was diagnosed with the flu. He returned yesterday, brought in by his partner, complaining that he was not getting better. His partner also shed light on his history. Mr. Nixon’s malaise and overall flu-like symptoms were worse. His headache was still there, he had a low grade fever, nausea, vomiting, sensitivity to light, and he had developed confusion and some stiffness in his neck.

  “Mr. Nixon has no allergies, doesn’t smoke, drinks occasionally, and works as a national park ranger here in Cincinnati.”

  She shifted her weight to the other foot. “His past medical and surgical history are both negative. Not even a strep throat or a tonsillectomy.

  “On physical exam, he presented with a low-grade fever and a mildly elevated heart rate in the eighties. He was hunched behind a towel to shield his eyes from the overhead light. His lungs were clear and his heart had a regular rhythm. The mini-neuro exam showed no facial droop or fundoscopic abnormalities, but he did talk intermittently with mental uncertainty.

  “I have some testing results on Mr. Nixon, but I need to update what happened by the time he transferred to the floor yesterday.

  “His mental sluggishness and sickness grew worse.

  “He lapsed into a profound lethargy and coma.

  “And since his respiratory rate declined and his ABGs and oxygen level were diminishing, anesthesia came by and intubated him. Now here he is in the ICU.”

  Annabel sucked in a deep breath. She felt too much pressure, especially since Dr. Schott was keeping quiet.

  “Keep going,” Dr. Mejia said. “Test results should be revealing.”

  “Mr. Nixon’s CT scan was negative.”

  “We’ll jump ahead, then,” Dr. Mejia said with a serious tone, “to the assessment that was made. Why did you all order a CT of his head?”

  “Due to an ongoing, worsening headache, light sensitivity, and a fever,” Annabel said but knew there was more she needed to divulge.

  “That could be from a migraine headache. We don’t usually do a CT scan on someone with a suspected migraine. Do we?”

  “Perhaps.”

  “In this case, the entire clinical picture was quite detailed, making your chief resident’s decision warranted. What was it he was concerned about?”

  “A central origin for his sickness, such as meningitis or enchephalitis, or maybe a space-occupying lesion.”

  “And the CT turned up nothing. What came next?”

  “A spinal tap. The results aren’t in yet.”

  “And other labs?”

  “His CBC, Chem 7, LFTs, U/A are mostly within normal limits.”

  “We are up a creek, then.” Dr. Mejia’s hand brushed his sport’s jacket collar and he considered. “However, what is your assessment? Working diagnosis?”

  “Enchephalitis or meningitis, sir.”

  He nodded. “We think our high tech CT machine can tell us everything, but here’s the truth. He can have one of those despite a negative scan.”

  Annabel nodded. “He is receiving antibiotics.”

  Dr. Mejia stole a glance at Donn, who nodded his head. Annabel hoped she was off the hook.

  “The antibiotics are empirical,” Donn said, “so there is the possibility that this young man continues to deteriorate if we don’t find out what we’re dealing with.”

  Jordan took one step forward, ready to divulge a storehouse full of information. He had nothing to lose. He was dead certain about the situation because of what he’d heard yesterday from the female ranger.

  He puffed up his chest, ready to regurgitate exactly what he read yesterday.

  “The history of this patient that Ms. Tilson just told us about,” Jordan said, sounding like the attending, “sounds like a textbook case to me.”

  “Pray tell,” Dr. Mejia said, furrowing an eyebrow. Annabel shifted position. Jordan called her “Ms.”

  “First, the patient presented with classic symptoms of many diseases, but in his case, there are two distinct phases. The first, in which he had the common symptoms of headache, fever, and nausea and vomiting. And then a week later, a second, severe phase with apparent meningitis.

  “Jae Nixon most certainly has Leptospirosis.”

  Silence ensued. Either Jordan Maldonado was the smartest med student ever to figure out a rare diagnosis or he was a crackpot to bring it up.

  “Leptospirosis?” Dr. Mejia asked. In the past, he had heard the name of the disease but knew nothing more.

  “Yes, sir. It makes sense. Even because of his job. It is caused by a bacterium carried by rats and mice, dogs, and wild animals and it takes contact from water, soil, or body fluids into the skin to acquire it. Annabel’s patient is probably outside a lot working, or involved with outdoor activities being a ranger so, again, it makes sense.”

  Jordan looked at Annabel, his smugness penetrating her.

  “Your studying is going forward well beyond your interest in cardiology,”
Dr. Mejia said crisply. “What else can you tell us? What about diagnosis or treatment?”

  “The disease is caused by a Gram-negative bacterium. Since he’s on antibiotics, he’s probably going to get better. The illness can last from a few days to three weeks or longer, but there is better success the earlier the treatment is started. But without antibiotics? Recovery may take several months.”

  “Okay, Dr. Maldonado,” the attending said, their roles clearly reversed, “can we make sure about the diagnosis?”

  Jordan nodded emphatically. Annabel thought his head was going to fly off.

  “There are screening tests and specialized labs can do the serology.”

  Dr. Mejia turned to Melody. “Dr. Burg, you are the resident taking care of Mr. Nixon?”

  “Yes.”

  “Be sure and talk with Dr. Maldonado after rounds for any more information.”

  The attending took a step back. “Also,” he said, “write an order for the infectious disease service to come by and do a consult on Jae Nixon. We’re most likely dealing with a rare disease, one that our own bright medical student has brought to our awareness.”

  -----

  In the front of the hospital, Annabel dropped her overnight bag and backpack with reading material on the sidewalk and called for a ride home. She never thought she would feel this, but she was super glad to break away from her team. Right now she had a stronger attachment to her patients than the doctors she’d been working with for the last several months.

  She correlated the information on her phone app with the Toyota slowing down in front of her. “Hi,” she said and scooted in the back seat when the driver stopped.

  The man in the car was barely tall enough to align with the head rest. “Today’s a beautiful day. You a nurse?”

  Annabel figured wearing scrubs and being female made her a nurse. She shook her head. “No, I’m taking the more sadistic approach and I’m training to become a doctor.”

  The drive home ensued in silence as she figured out her plan for the rest of the day. The driver was right. Lots of sunshine, so a run along the Ohio might brighten her disposition. And besides wanting to take Nancy out for brunch, she wanted to call and visit Bob.

  The driver stopped in front of her apartment and with a “thanks,” she scrambled out. She fumbled to find her apartment key. Noisy footsteps came down the staircase from above and then a young man with lanky limbs appeared on the last steps. His alert eyes settled on her.

  “I’m your neighbor on the second floor. I see you come and go. You a nurse?”

  “A medical student.”

  “Oh.”

  “Sorry about the noise the night before last.”

  “Yeah, well, it was the first time I had to bang on the ceiling to make you pipe down.”

  “It won’t happen again. It was a sibling squabble.”

  “I guess not. It looked like she cleared out this morning.”

  Annabel frowned. “I wasn’t expecting that. She was supposed to leave tomorrow.”

  He shrugged his shoulders. “I’ve seen you up at Pete’s.”

  “The Café is the only place close to eat which doesn’t require a ride in the car.”

  “I don’t cook much, if at all.”

  “You a student?”

  “Going to college. Got fed up with dorm life the first two years so my parents are footing this rent bill, which doesn’t hurt them in the least.”

  “You’re lucky. I better get going. Sorry again.”

  “No problem.”

  Annabel climbed the stairs and went inside to an empty apartment. Her sister had not even left her a note.

  -----

  Annabel ditched the scrubs and put on a Cincinnati Reds T-shirt and sweatpants. She sat, pulled on her sneakers, and smiled while thinking about her previous run with Bob and his lesson about lock laces. He must be feeling better after taking a whole day off, she guessed. Regardless, she wanted to help him out in any way she could. She popped his number up on her phone and called.

  After a few rings, Bob’s sluggish voice came on. “Hey. You home?”

  “Yes, off from call. You sound terrible.”

  “Thanks.”

  She shook her head. “Can I come over? Maybe bring you some food?”

  “I’m not hungry.”

  “But I think I better check on you.”

  “Hell. You’re a pain.”

  “I’m coming over.”

  “You don’t even know where I live.”

  “Which is quite appalling … after all this time we’ve known each other. However, I know the area where you live and I’ll GPS your exact address.”

  “I’m not up to entertaining you and, if you take your own car, heaven forbid, you’ll lose your parking space.”

  “To hell with the parking space and I’m not coming unless you roll out the red carpet and prepare me shrimp scampi. When was the last time you ate anything?”

  “Uh … yesterday morning.”

  Annabel clenched her mouth. She didn’t like the sound of his situation at all. “I’ll be there as soon as I can.”

  “The door will be unlocked.”

  -----

  Before getting into her car, Annabel walked to the neighborhood Café where she was happy to see Pete’s thriving Sunday after-church crowd. The food on the tables made her mouth water as she stepped to the counter.

  “What would you like, Annabel?” Pete asked.

  “A take-out. How about packing up two containers with scrambled eggs and toast? My friend is sick and that may be bland and light enough for him to eat.”

  “Is it your male med student friend?”

  “That’s him.”

  “I have fresh blueberry muffins right out of the oven. Why don’t I pack two of those instead of toast?”

  “Perfect. Thanks.”

  Pete came back with the order and Annabel took off.

  Knowing that Bob lived northeast of her, Annabel avoided the interstate and drove the side streets. She pulled into the ample parking lot of his apartment complex; he didn’t have a parking problem like she did. She walked through the ground floor of the two story buildings looking for his apartment number and found it between the street and a covered pool.

  Clutching the bag of food, Annabel knocked and then poked her head in. “Bob?”

  “I’m in here.”

  She passed a simple walk-in kitchen space to the combined eating nook and living room area. Bob was on a thick burgundy couch against the wall and only swiveled his head to see her from his supine position. She sat on the cocktail table next to him.

  “When you call in sick, you’re not kidding, are you?”

  He managed to curl up one side of his lip.

  “What is going on anyway?” She placed the bag on the table for the time being.

  “I have no energy. It’s like there’s a pipeline inserted in my vein, draining me of adrenaline, testosterone, and thyroxine.”

  “What about other symptoms?”

  “Besides mild body aches, I don’t feel like eating, and I’m suffering from a growing energy deficit.” He took a deep sigh.

  “No GI symptoms, fever, or neuro symptoms?”

  “I don’t think so, Dr. Tilson.”

  Annabel rolled her eyes. “Maybe Dr. Maldonado should be here taking care of you. He’s become quite the clinician. I’ll have to fill you in on our team. But first, I brought you the perfect food.” She foraged in the bag, opened one container, and a utensil pack. “Come on, sit up.”

  Annabel crouched over, put her arm around him, and helped him to a sitting position. “This is fresh from Pete’s Cafe.”

  Bob stayed leaning over and, while Annabel made him some tea, he did his best to eat. She came back and placed the mug in front of him and began eating from her container while sitting cross-legged on the floor.

  “Thanks,” he said. “It is a good thing you brought me something.” He sank back into the couch. “Tell me about call.”
>
  “I’ll give you the highlights,” she said. “Our fearless leader, Dr. Schott, is not himself. His gumption to teach was sucked out of him by a patient’s family member who came in and hurled insults at him along with the threat of a lawsuit. The man’s mother died after we discharged her, my former atrial fibrillation patient.

  “Also, the man I drove into the hospital a week ago came back and is now my patient, but he fell into a coma and is in the ICU. Although we couldn’t figure out his diagnosis, know-it-all Jordan seems to have figured it out. I think Dr. Mejia is so star struck, he’s going to bequeath Jordan a trust fund.

  “And remember Nancy came up on Friday to go out with Jordan? Well, because of our fight about his cheating the other day, he stood her up. Now my sister isn’t talking to me because it was apparently my fault. She left today without a word.”

  “Is that all?” he mused.

  Annabel laughed, split off a piece of muffin, and put it in her mouth.

  “I have to lie back down,” he said.

  “Is your condition bad enough to bring you to the hospital?”

  “No way. That would be overkill.”

  Annabel fluffed up his pillow and he eased back down. She looked around as he closed his eyes.

  “Your furniture is sure nicer than mine. This place is pretty comfortable.”

  “I salvaged stuff off of Craig’s list.”

  “I’ll remember that for next time.”

  “Appreciate your coming over. You don’t have to stay any longer.”

  “How about I study for both of us? I’ll get your internal medicine book and read out loud?”

  “I’m worried I may not be able to keep up with the rotation.”

  “Please don’t say that. No way. I will read-study out loud. Just listen up.”

  She plucked his medical book off of the kitchen table. After thumbing through the index, she selected a chapter on “Adrenal Insufficiency” and began.

  “Primary adrenal insufficiency refers to adrenal failure or …”

  Annabel peeked at Bob every few minutes. In a half hour, he was fast asleep. She got up, stretched, and walked around. It was the framed photographs on the shelves that caught her attention the most. A wide-grinned, bright young Bob held a fishing pole near a shore line, and a college graduation picture with, more than likely, his parents. Their expressions registered sheer joy over their son’s accomplishment.