by Barbara Ebel
“There are many national parks and monuments in the desert Southwest where rangers are stationed,” Patty said. “I’ll remember that.”
“At least out west, doctors occasionally come across the disease. But here, doctors will most likely never see a case of coccidioidomycosis in their entire career. So what’s out of sight is out of mind.”
Patty put her hands on her lap. “Do you think Jae is infected with some kind of rare tick disease?”
“I believe so. I heard he is a hunter. Any other recreational or job-related situations where he’s in contact with wildlife or other mammals?”
“Well …” Patty thought. “Are you aware that one of our dogs on the property almost died from Leptospirosis?”
Dr. Enno looked at Annabel.
“We happened to know about the dog,” Annabel said.
“And your dog could have gotten the responsible bacteria from a tick,” Shania said, “At least in Poland, they have found the bacteria in ticks. Or perhaps something else. Does the dog go on the hunting trips?”
“Never. There are two dogs on the property and neither of them go with Jae.”
“Any deer or other common critters living in the area right where you both reside?”
Patty blushed. “We both live in separate cabins next to each other.” She narrowed her eyes, put her hand back up, and tapped a finger on the table. “We rarely come across deer in the vicinity. The trails and woods don’t encompass that many acres and humans traverse them all the time.
“But the vet thought Twist could have gotten infected by mice and Jae could have gotten infected by Twist.”
“What mice?”
“White-footed mice. They are more and more prolific, breeding like prairie dogs. Jae goes out there and tries to cut back their population.” She grimaced at the unpleasant job.
“Mice!
“You ladies are unconscionable not telling me all this.
“Or I’m slipping on my questioning, like a private investigator who needs to be given a desk job after years of being out in the field. Maybe it’s time to retire.” Shania’s eyes glazed over. “But what would I do? Count the pills I take all day?”
“We’re sorry,” Annabel said. “We didn’t mean to make you upset. None of this may have a direct bearing on whether or not Mr. Nixon pulls out of this. I understand it’s scientific knowledge and intellectual curiosity, but don’t be so hard on yourself.”
Shania patted Annabel’s hand.
“The epidemiology side of me realizes that the white-footed mouse has much to do with the spread of tick-borne diseases. People think that because certain ticks are called ‘deer ticks,’ the ticks are exclusive to deer. Not so.”
Annabel glanced at her watch and frowned. “I must get up to the office and meet my team for rounds. Otherwise, Dr. Schott will cause me grief.”
“Yes, dear,” the older woman said sweetly. “I will sit another moment for a cup of coffee with Ms. Caye before she, too, runs off.”
Reluctantly, Annabel hustled to join her group in the office.
-----
That afternoon, Donn burst into the clinic door, dripping water off of his umbrella.
“We don’t have clinic next week,” he announced to the team, “so make the most of it today. You all have less than two weeks left on the rotation, so next week we’re mostly in the hospital and we’ll gather for some extra discussions. Think about any medical areas you’re weak in.”
“Dr. Enno is giving grand rounds too,” Annabel said. “If Bob is up to it, he may come.”
“How is he? Will he be able to sit for the final exam?”
“He’s still very tired, but he’s steadily improving. Dr. Raymond’s office called and his test results were positive for Ehrlichia.”
“I’m not surprised. I’m glad the diagnosis is proven, but I regret the loss of him from our team.”
Donn curled up his mouth, hesitant with what he had to say.
“Annabel and Dr. Burg, I received bad news. Our metastatic lung cancer patient, May Oliver, died at home.”
“That’ll be one less patient to see today,” Jordan mumbled.
“Dr. Maldonado, she wasn’t scheduled today anyway,” Donn said, “and keep your insensitive thoughts to yourself. Besides, no one in the health care profession should ever think that way.”
Annabel stared down at her shoes. May had been a patient, but she turned out to be more than that. She would stick out as a memory from her one and only rotation through medicine as a student.
Dr. Burg patted Annabel’s sleeve. “I always accept the death of older patients more readily than the younger ones. At least May died at home like she wanted.”
“So true,” Annabel said.
“Time to see patients,” Donn said, “although I think the rain is causing some cancellations. There are a lot of empty chairs in the waiting room.
“I also have another announcement. Instead of the final exam being given at the end of next week, it’s been moved up because of a scheduling conflict. The test is on Monday. At least it will be out of the way, but it doesn’t mean any of you can turn into slouchers for the remainder of the week. Also, we’ll wrap up with Dr. Enno’s infectious disease lecture early in the week as well.”
Jordan let out a gasp and Annabel curled her mouth. Stuart looked up momentarily.
“Be sure to tell Bob too.”
“I will,” Annabel said.
In a few minutes, all the students had a chart to look over before walking into a room. Annabel squeezed in on the counter between Jordan and Stuart. Jordan pulled a book out of his lab coat and looked something up in the index. When he laid it on the counter, Annabel noticed it was an extra small version of an internal medicine handbook, nifty and portable. Perhaps she should buy one of those, she thought, but didn’t see the point.
-----
At the end of late-day rounds, the rhythm of Jae Nixon’s monitors was steadier than the rain bouncing off the window outside his ICU room. Annabel sat in a chair in his room and carefully went through all of Shania Enno’s notes and orders for the last two days. Only because of the infectious disease specialist on his case, a newfound optimism for her patient ran through her thoughts.
Annabel pondered one of Shania’s notes:
An IgM viral test I would like to run is not commercially available. I have requested and sent one of Mr. Nixon’s samples to the state health department laboratory as well as the CDC.
The secretary from the desk stepped in and handed her a paper. “Hot off the press. For the chart.”
“Thanks,” Annabel replied. Shania had ordered another EEG and an MRI while they were in clinic. Annabel smiled. It seemed like test results came back a hell of a lot sooner when she was the ordering physician rather than a resident or a cosigned medical student.
She read the first report:
Jae Nixon’s electroencephalography shows generalized slow wave activity but, of note, there is a marked improvement since his last EEG.
Annabel glanced at the ranger, his body more angular than when he arrived. Maybe he did hear her when she talked to him. “Time to wake up,” she whispered.
She went back to the second report:
The mild ischemic changes seen on the last MRI of Jae Nixon’s parietal lobes appear to be fainter.
Holy smoke, she thought. She couldn’t wait to tell Bob that Jae Nixon had not only stabilized but, neurologically, seemed to be getting better. She clutched the chart, walked over, and patted Jae on his tattoo. “They are waiting for your return at the National Historic Site.”
Jae’s RN walked in. “You talking to him?”
“I’m embarrassed to say that you caught me.”
“Don’t be embarrassed. I do it quite often. Talk to my patients … whether they’re awake or not.”
“Do you think it helps?”
“I know it does.”
Annabel nodded. “I’ll lay his chart on the counter. And good night, Mr. Ranger.”
-----
Before she started her car, Annabel sat while the wipers washed her windshield with the rain. She opened up her iPhone to messages and still found no response from her sister. That was that, then. Her sister had nothing to say to her and chose to ignore Bob as well.
Unlike Jordan, she had kept off her phone all afternoon. Dustin had texted:
How about I cook for you tonight or tomorrow?
Too bad she had missed it, she thought, and wrote:
I’m just leaving the hospital. Can’t come over now. A friend is expecting me over. Tomorrow would be fine!
Tomorrow it is. Dinner at my place around 6 or 7. Text me. Enjoy time with your friend. I suspect you’ll be studying with her?!
Annabel grimaced. His assumption that she was going to study with a female made sense, but that was not the way it worked anymore for students. Gender didn’t matter and, besides, Bob was a close friend. She bit her lip and contemplated.
Dustin knew a little about her past dating methods and seemed to be overlooking that history. She wasn’t sure how he would react, however, if she told him that she was studying with Bob and sleeping at his place the last few nights.
She contemplated. Trust was a big part of a relationship and she and Dustin had not been dating again that long. This information might give him cold feet, even if she told him that her friend was sick and she was helping take care of him.
With her past history, could Dustin really trust her? How would she feel if she had a new boyfriend who was sleeping at another woman’s apartment? She frowned. Would she cut off the relationship because it could signal a sign of things to come?
Her fingers lingered. Finally, she avoided his reference to gender.
Studying for sure. Our final exam is nearing. Looking forward …
-----
Bob wore a sheepish grin as he opened the door. He wore sweat pants, a Caribbean T-shirt, and no shoes.
Annabel walked in and plopped down her bag. “You doing any better?”
“Hanging on.”
“I swear, you’ve lost a few pounds. Despite my feeding you.”
He pranced across the cold hard floor and widened his smile. “I had a fabulous idea a few minutes ago.”
“Forget it. You’ll get caught. Murdering Jordan isn’t worth getting a life sentence for yourself.”
He widened his eyes. “Ha … very funny. No, now that you and I are messed up, out of sync with rotations, maybe we could share a dog together. You lost Dakota and always want a dog and yet you can’t do it because you’re gone from your apartment too much and on call sometimes. Out timings will be different, at least in the immediate future, so we could flip-flop a dog back and forth.”
He locked his hands together. “It’s a win-win situation. He or she would live in two homes and we’d benefit with a furry companion and all the joy the dog would bring to our lives.” Not to mention, he thought, it would assure him of still seeing Annabel on a regular basis.
Annabel lowered herself onto the coffee table and crossed her legs. “Interesting idea. There are pluses and minuses. Are dogs allowed here?”
Bob nodded.
“I can have pets where I live, but I don’t know. It wouldn’t be as easy as you think. The dog would still be alone a lot.”
“Look at it this way. Later in life, you may want another purebred like your family had. However, we can go to the shelter and rescue a poor dog who may end up euthanized. Wouldn’t he or she be better off alive sharing two homes with two ridiculous type-A medical students instead of turning into dust?”
Annabel tapped her foot. “If you were taking an oral exam right now, you’d be passing with whatever health care argument you were presenting.”
“Good. I need the practice.”
“By the way, our test has been moved up to Monday.”
Bob stole a glance at the textbook on the table. “That’s cutting it close. But what do you think about my idea?”
“I would love to have a dog. I feel like my life is so confined due to medical school and that most forms of enjoyment are being put off for the future. Which is stupid, because residency is only going to be more restrictive. How about we both think about it?”
“Meanwhile, I’ll start thinking about names.”
“What if the dog already has a name?”
“If it suits him, then he can keep it.”
“Who says it’ll be a he?”
CHAPTER 27
After the first beep, Annabel turned off the alarm clock. Bob barely shifted in his bed. She was pleased he didn’t awaken. They had studied late the night before and, for the first time, she believed both of them were ready to conquer their final exam on Monday.
She realized one thing after she dressed and made one cup of Bob’s single serving brew. Tonight she had a date with Dustin, so she left Bob a note letting him know she wasn’t coming over later. She also snickered as she wrote him instructions for the day: Rest, study, repeat. Rest, study, repeat!
That should bring a smile to his face, she thought as she closed his door behind her. As she drove to the hospital, she pondered his suggestion about the two of them getting a dog. Thinking over the responsibility that a dog would bring to her life was much better than making an impulsive decision. Yet, by the time she walked into the front entrance of the V.A., she realized that just thinking about a dog … a wagging tail and wet kisses on her hand … had stuck a silly grin on her face.
Annabel stopped in the office, dropped her things, and slid on her white coat. Stuart sat on the couch, head bent over a textbook.
“Have you seen your patients yet?” Annabel asked.
“Yup.”
“You’re super early.”
“The heat is on. I’m cramming and strengthening what I already know for our test. But you’re pretty early too.” He gave her a once over. “Your gypsy life style is showing on your lab jacket.”
Annabel brushed over her crinkled collar and pockets. “You’re correct about that.”
“I’m sure Bob will let you use his washing machine and iron.”
“I doubt if he owns an iron.” She turned to the door. “By the way, thanks for not making wise cracks about me staying at Bob’s. We’re strictly friends. You know … platonic.”
“No need to tell me. Individually, it’s clear where each of you stand.”
“Thanks.”
His head bent down again. Annabel gave him a second glance and stepped away. Now she felt self-conscious about her jacket and what did he mean by “it’s clear where each of you stand”?
She went to the ICU first, made the bend into Jae Nixon’s room, and almost bumped into Alejandro leaning against the counter. Today she must be the slacker, she thought, because both Stuart and Shania Enno were earlier than she was.
The cold, impersonal, beeping room was different as well. Although it played softly, music filtered out from a square black radio sitting by the sink. Dr. Enno stood at the foot of Jae’s bed.
“Good morning,” Annabel said.
The bottom of Jae’s sheet was ruffled up by his mid-calf and Shania focused in front of her. Annabel needed to look twice to discover the movement of Jae’s right toes.
“Wow!” Annabel exclaimed. “Is he waking up?”
“This is a start.”
Annabel put her hand on his ankle and squeezed. “I wonder what music he prefers?”
“It may be the only time in your career that music accompanies your patient’s arousal from a coma. Change the channel if you’d like.”
“Country.” Annabel switched channels and walked back, this time checking Jae’s vital signs on the monitors.
Shania straightened her posture. “Let’s step out. I was told our young ranger’s diagnosis.”
They left the music and the electronic beeps. Annabel could hardly contain her curiosity. After a few rapid breaths, she started fidgeting with her hands. Like the dog whisperer, had Shania really discovered Jae’s problem and th
e correct way to treat it? Could she order him the right drug to purge him of his infectious disease and let him do more than wiggle his toes?
Outside the door, Dr. Enno put her back to Jae’s window and tapped Alejandro. With bated breath, Annabel waited.
Twice, Shania shook her head slowly and finally spoke as Annabel swallowed hard.
“Mr. Nixon has Powassan virus.”
“Powassan?”
“An RNA virus of the genus Flavivirus. Injected into him from the bite of an infected tick.”
Annabel gasped. She glanced into Jae’s room.
“Of course, you haven’t heard of it. The general public, almost everyone, is clueless. Except for the CDC. And the unfortunate few people who have acquired it? Most don’t live to tell their tale.”
Past the window, Jae’s chest cycled up and down from the ventilator. “How horrid. We can rid him of this virus. Right?”
“There is no medicine. There is no cure. There is no treatment for Powassan disease.”
Annabel shuddered. “He moved his toes. Isn’t that a good sign?”
“Yes. The mannitol to decrease his brain swelling, the respiratory support, the intravenous fluids … the present care your team is providing is all that can be done.” Her mouth relaxed into a half-smile. “I am encouraged by what we are seeing this morning.”
Shania also glanced through the window, told Annabel much more than she could process, and then ended with a final comment.
“All I can say now is that he is lucky to be alive.”
-----
Back and forth, and in and out, Jae Nixon’s consciousness drifted as he resided in the confines of the ICU where his life was as artificial as junk jewelry. But sometimes when he was imbedded in deep sleep/unconsciousness, the time spent couldn’t be more real.
The nighttime hours were fading away and early morning was approaching as Jae was immersed in a dream. His boots snapped branches out back from his cabin as he foraged the neck of the woods for the damn mice living so close. Twist wagged his tail and his tongue dangled from the side of his mouth.