The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  “No,” she said. “I’m too attached to that place. I have a quiet neighbor downstairs and I wouldn’t trade that in for the world.”

  “Flattery will get you everywhere.”

  “Actually, I’m going to stay at my friend’s place for a few days. He’s sick, so I’m going to watch over him as well as help him study.”

  “Sounds platonic, but that’s none of my business.”

  “He’s my best friend.”

  “You need some help?”

  “Would you? I’m struggling with no sleep. You’d be a lifesaver.”

  “It’s not every day I rescue a doctor-to-be.”

  Annabel transferred an armload to him and they walked to her car.

  “I’ll keep an eye on your place,” Travis said after he placed two duffel bags in her trunk.

  “Thanks so much.” She opened the Nissan’s front door and hesitated. “Would you mind? Perhaps we should have each other’s number.”

  “Good idea.”

  They exchanged numbers and Annabel took off. Since the morning, the gray day had turned cloudless and she soaked in the sun’s rays through the windshield as she drove.

  -----

  After parking, Annabel walked a short distance to Bob’s apartment and appreciated that he lived on the ground floor. She rang the bell twice and he opened the door after a delay. His usual stylish haircut looked less perfect and a puffiness had grown under his eyes.

  “You look like something a cat dragged over,” he said.

  “I was going to say the same thing about you.”

  “Then we’re even.” He extended his hand and took a duffel bag. “Now I feel bad you came.”

  “Our night on call stayed crazy with admissions, but don’t worry about it. We’ll work together on study material and independently catch up on needed sleep. And look … I brought us leftovers.”

  Annabel opened the shopping bag on his counter, popped a container in the microwave, and then split up the jambalaya on two plates.

  “How are you feeling?” she asked. “Do you think you can eat some Cajun food?”

  “I’m not any worse. I might eat Creole.” He smiled and handed her utensils.

  “There’s a difference, you know, between Cajun and Creole.”

  “Will our internal medicine final exam test us on food?”

  “Dr. Raymond’s doxycycline prescription must be making you feel better. You’re joking.”

  “I hope so.”

  “No kidding. This rice dish is technically Cajun, so it’s a bit more spicey than it’s Creole counterpart, which is milder and sweeter.”

  “Sometimes I forget you’re more southern than I am.”

  “Do you hold that against me?”

  “Never. Where’d you get this anyway?”

  “I may have mentioned I went on a date with the police officer. Dustin took me to this Cajun restaurant and, well, we didn’t finish our food. In essence, we were sidetracked by a woman needing the Heimlich maneuver.”

  Bob’s expression dimmed. “He took you to a place where the dinners were that bad?”

  She swatted his upper arm. “Very funny. We better not dillydally because I’m running on caffeine.” On purpose, she didn’t mention Dustin stopping the robbery at the cash register.

  Bob nodded and ate half of what Annabel served him. They went over to the couch and Annabel laid out notes from the last grand rounds and opened her internal medicine textbook.

  “Why don’t we approach a case history,” she said, “like we did in our first and second year in the unit labs. A team-based approach … and work through a patient with a chronic cough.”

  “Sounds perfect.”

  Annabel buckled her legs under her. They scooted the coffee table closer and used it to spread a chart and books. They worked through an entire algorithm for the diagnosis and treatment of a chronic cough and ended up studying all methods of testing, disease entities, and treatments. They even ended up at a dead end workup with a patient who had a psychogenic cough.

  They took a break; it was getting late and both of them poured a half glass of wine. Annabel slumped further into the couch. She could not keep her eyes open any longer and fell asleep, but Bob didn’t want to disturb her. He was half dozing himself. With an easy pull, he lowered her to a pillow near the armrest and draped an afghan over her.

  Bob started for the bedroom, knowing he needed to set an alarm for her for the morning. On the kitchen counter, he heard her phone beep with an incoming text and decided to lower the volume so she wouldn’t be disturbed. His finger hit the screen and the text message popped up.

  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 mach
ine 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 blurted 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 do
es 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.