The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  “Your white jacket is different from those other two,” Mary said to Annabel.

  “I’m sorry. I thought I blended into the background. I’m a medical student; the rotation just began for me, so I am naive yet useful. I learn fast, and believe it or not, many, many patients become imprinted into my memory bank. Almost every patient can demonstrate a lot to someone in training.”

  “I’m a guinea pig, aren’t I?”

  “More like a celebrity. For the rest of my career, I’ll remember you as much or more than a favorite actor in a good movie scene.”

  “Wow. Then I came to the right place.”

  “Did they give you the antihypertensive medication yet through your IV?”

  “Yes, and Dr. Watson and Dr. Gash said they were … ‘cautiously optimistic’ that they wouldn’t have to get my baby out soon.”

  Annabel checked the pulse oximeter reading again and then glanced at the continuous electronic fetal heart monitoring. Mary did the same. The ultrasound transducer placed on her abdomen conducted the sounds of her fetus’s heart; the rate and pattern of the fetal heartbeat were displayed on a computer screen and printed onto a special graph paper.

  “It looks like Greek to me,” Mary said.

  Annabel leaned closer to the bed. “Don’t tell anybody, but right now, it looks that way to me too.”

  Mary’s tense shoulders relaxed. “You ever get pregnant and give birth?”

  “No. Not yet. I would be anxious just like you. Try to keep calm and brave for your unborn child.”

  “I’ll try. I’ll feel better when my mom gets here tomorrow. My parents were furious with me when I got pregnant, but they’ve accepted it. My mother more than my father. My mother finally told me … everyone makes mistakes and they must learn to live with whatever it is. Mine was bigger than most and it will leave a footprint on the rest of my life, but I must make it a huge growing experience. I will be thrust into the immediate demands of taking care of another human being and adult priorities will take root.”

  “Sounds to me like you’re maturing already.”

  Mary smiled and patted her belly like her unborn fetus had taken his or her first step.

  Caleb Gash poked his head in the door while calling Annabel by name. “Better hunt down Ms. Chandler’s chest X-ray and bring it up here … the one they did before she left the ER. There’s a lot riding on that.”

  “I’m on my way.” She passed Caleb while realizing she still needed to write up her H&P on Mary. It would have to wait.

  In the radiology department, Annabel did what she often did. Many students would just pick up the films from the slot box and leave, but radiologists, she found, always seemed willing to teach a medical student. Their days did not bristle with human interaction like the teams on the floor, so she figured they enjoyed it when she asked them questions. Plus, she should learn everything she could and not discount the field as a future specialty.

  The door was open to the doctor’s dimly lit reading room. “Can you give me any pointers about our obstetric patient’s chest film?” she asked the man.

  He squinted his eyes. “Sure, come on in.”

  Annabel handed him the envelope and, after reading the note from the referring doctors, he slipped it in the viewing box. “Aha. Says here the presumptive diagnosis is preeclampsia. So the status of her lungs is very important. Did you do a physical on her?”

  “Yes, sir. Her lungs sounded clear to me.”

  “Isn’t today the change-over for medical school rotations on your service?”

  Annabel nodded. “I’m as green as a frog.”

  The doctor laughed. “Have a seat, young lady.” He read the name tag on her jacket. “Dr. Tilson, that is.”

  The man took off his glasses and rolled his chair back a few inches. “Do you know the three features that make a case of preeclampsia ‘severe?’”

  “For sure, a high blood pressure. Over 160/110 mm Hg fits the category.”

  “A patient can have chronic hypertension with a superimposed high blood pressure from preeclampsia. Does she have a preexisting chronic condition?”

  No one had mentioned that possibility, but then she remembered reading the pressures from the clinic notes. “No, her early visits in the prenatal clinic gave no history of chronic hypertension and her vital signs were all registered as normal except for the last pressure, which crept up.”

  “Excellent.”

  “There are many other abnormalities for severe preeclampsia, but I’m not sure exactly which ones qualify as the worst.”

  “And that’s a hell of a blood pressure for a pregnant lady who is usually acceptable and low. At 160/110 … can you imagine? A woman could suffer a stroke!”

  A no-brainer, she thought, but he was enthusiastic about teaching and so willing to talk to her.

  “The second most important severe feature,” he said, “is pulmonary edema. So your patient’s chest X-ray is clear.”

  The certainty of no fluid in Mary Chandler’s lungs made Annabel feel more comfortable. “Makes her situation a bit safer.”

  “Regular preeclampsia is still an alarming case. The third severe feature is elevated liver function tests.”

  “I believe those results are still pending.”

  He scooted his chair back in. “Of course, your residents must be focusing on stabilizing the mother’s status over and above the fetal status. Seizures are a complication.”

  Annabel now remembered that; she was glad he reinforced that bit of knowledge.

  He scooted back up to his table and scrutinized her. “Have your residents started her on seizure prophylaxis yet?”

  “I don’t know. I am behind with her case; haven’t written up her H&P yet or reread the residents’ notes since the patient arrived in her room. What is the drug of choice?”

  “Magnesium. Magnesium sulfate. A blessing for seizure prophylaxis and delivery.” He flipped the film down and handed it to her.

  “Thank you so much for the discussion.” She rose and slipped the result in the envelope.

  “Any time.”

  In the main doctor’s lounge on the first floor, Annabel slid up to a computer and plugged in her patient’s name. She added the newer lab results to her index card; there were now a host of laboratory values: CBC with a platelet count, renal function tests, and the liver function tests or LFTs. Sure enough, the LFTs were higher than normal values. That now categorized Mary Chandler with one of the three severe criteria of preeclampsia. Although … she was close enough to having all three. Annabel glanced at the wall clock. The day was zooming by and her appetite to learn more about obstetrics was ramping up.

  -----

  Gone astray or hidden from action, Annabel didn’t see the residents when she made it back to the nurses’ station, so she stole Mary Chandler’s chart from the rack and settled into the lounge to write her H&P. With all the lab results and the senior doctors’ notes already written, her chore would be a lot easier, so she began:

  Mary Chandler is an 18-year-old G1P0 woman at 29 weeks’ gestation who presented to the ER because of a several hour history of dyspnea. She denied any previous medical problems and also stated her prenatal course has been unremarkable. Prenatal blood pressures in the clinic were normal except for a slight increase last week of 130/88.

  Her presenting blood pressure was, however, 154/106, and respiratory rate was 30 breaths per minute. Oxygen saturation was 96%. Fetal heart tones stayed in the normal range of 110 to 160 bpm.

  Annabel continued on, finishing with the “Diagnosis” and “Plan.” Pleased with herself, she looked up to find Emmett over at the nearby table reading a newspaper headline.

  “You sure are quiet,” Annabel remarked. “That newspaper in here reminds me of a chief resident I had on internal medicine. He read us interesting tidbits from the paper every day.”

  He glanced over at the door. “Doubt if you’ll experience that on this rotation.”

  “I suppose not. I’ll go back to
being clueless about what’s going on in the world besides my rotation.” She closed the chart while he put down the paper. “I bet you moved the stretcher out of Mary Chandler’s room pretty darn quick after what happened.”

  “For sure … after I moved her belongings.”

  “Hmm. Stretchers are substantial pieces of medical equipment to miss seeing. At least that’s what I’ve always thought.”

  “Really? Like you’ve thought about that?” His thick eyebrows raised. A smile crossed his lips.

  “Yeah. Just this morning, I woke up and figured there was no way I was going to stumble over a large object left a few minutes near a patient’s doorway. And even if I did, it would be my own stupid damn fault.”

  “You thought all that, huh?”

  Annabel shrugged. Emmett winked.

  “Dr. Tilson, I’m so glad you’re on board for the next two weeks.”

  CHAPTER 6

  The vertical blinds were closed, blocking any remaining sunshine of the day from entering Bonnie Barker’s room. A plush recliner was by the side of her bed. Tony sat there, the end of his sneakers bobbing forward and backward on the extended footrest. Annabel glanced at the clipboard hanging at the bottom of the bed. Her patient’s vital signs were fine after her huge obstetric fiasco. “She’s doing quite well,” she whispered to Tony, “after all she’s been through.”

  “They let the baby visit us before. I held her and Bonnie breast fed her. Or at least tried.”

  “I’m glad to hear it; no wonder she’s so tired.”

  “Bonnie asked me if I was okay with the name she has picked out.” He shrugged his shoulders. “At least she asked me.”

  “That’s a start.”

  “Her name is Samantha, but she wants to call her by her nickname of Sam.”

  “Either name will fit her like a glove, I’m sure.”

  “I guess newborn babies are fragile, but the nurse told us to be really careful with her. She said the doctors seemed concerned and they’d know more later.”

  Annabel wondered, especially because of the previous mention of genetic testing. “I haven’t done my medical school rotation of pediatrics yet, but I also think babies are delicate. My aunt and uncle had twins and they were so little, it made me nervous to hold them.”

  “Like trying to hold a butterfly and accidentally damaging its delicate wings.”

  “That may be more in line with holding a premature infant, one that barely weighs a few pounds.”

  “No thank you. No way.”

  Bonnie opened her eyes, and in another second, they fluttered shut again. “Another medical student will be here for the night,” Annabel said to Tony, “and I’m leaving soon. Make sure Dad sleeps tonight too.”

  Tony stopped wiggling in his shoes. “I’ll go take a dinner break, but I plan on spending at least tonight with Bonnie and Samantha … and sleep in this chair.”

  Annabel quietly padded out and went straight to the lounge, where Dr. Watson was reading a chart. Dr. Gash stood next to her. For a moment, she thought Caleb’s hand was rubbing Ling’s left shoulder, but it was by his side when she walked over.

  “Annabel,” Dr. Watson said, “you can go whenever you’re ready. We’re not having distinct rounds this late because Dr. Gash and I still have resident’s work to do before giving a report to the night docs. However, try and give the medical student who’s coming on soon a few pointers on your way out.”

  “That will be Stuart Schneider. He was with me on internal medicine.”

  Ling looked up with an empty expression.

  “He’s really smart,” Annabel said. “In the top of our class.”

  “Test-taking scores the first two years don’t necessarily correlate with hands-on, clinical skills or smarts from there on in.”

  Annabel wanted to say that Stuart retained his rank during their third-year rotations, but she thought better of it.

  “Anything you need to tell me about our patients that I may not know?”

  “I don’t think so. I do have a question, if you don’t mind. The radiologist who pointed out Mary Chandler’s clear chest X-ray mentioned magnesium sulfate in the treatment of severe preeclampsia. Since our patient almost qualifies as severe, are you going to use it as a treatment?”

  “Absolutely.”

  “We must prepare for a worsening situation,” Caleb added. “Because of the preterm gestation, we’re also promoting antenatal lung maturity with corticosteroids just in case we have to deliver Mary Chandler’s baby. What goes on with her condition overnight will tell us a lot as to how we’ll proceed tomorrow.”

  “That’s where the head honcho comes in,” Ling said. “His name is Dr. Roosevelt Harvey, our attending. Most of the time, he’s in clinic.”

  “She talks to him on the phone,” Caleb said. He snapped a pen off his top pocket and handed it to Ling. She rolled away the one she’d been using, empty of ink.

  Annabel went to the couch and opened up her OB book. Dr. Watson stood, took off her lab jacket, and started to leave with Caleb. “By the way,” she said, “your H&P on Ms. Chandler was fine. We’ll see you in the morning. Don’t forget … your reading tonight is the physiologic changes of a baby’s first breath.”

  That and a dozen other topics neither of you talked about today, Annabel thought. She could open a book while waiting for Stuart, but her stomach growled and she went out to the nurses’ station to scrounge around for food. Not a shred was to be had in the lounge. Outside, a bowl of miniature candy bars was sitting below the counter, nestled in the corner. She picked up a chocolate-coated mint patty. The supply room was directly across the way. The RN in Mary Chandler’s room before was inside, and Emmett stood nearby. He smiled over when he saw her. Annabel gave him a little wave, put the mint in her mouth, and was relieved to spot a man walking down the hallway in a medical student’s jacket.

  -----

  Although Stuart and Annabel were not tight friends, they were compatible on the same team, always helpful towards each other, and non-competitive. In a way, he inspired her. She did well, both academically and clinically, but Stuart usually topped off higher in the nineties on exams. She outsmarted him, however, with what could be considered more “street” smarts when it came to their team dynamics and patients.

  Stuart was thin as a dime and he could care less about the stashes of donuts medical students would discover behind nurses’ stations or in doctors’ lounges. He was quiet and generally added his two cents worth only when called on. Most of the time, his head hung low, and he spared most people direct eye contact. He approached Annabel and gave her a quick smile as they turned into the lounge.

  Annabel took a big sigh. “I hope you’re ready for OB/GYN because I found out today that I wasn’t.” She pointed to the couch. “You can throw your stuff in here until you find the call rooms.”

  Stuart put a backpack down and pulled out a chair. He noticed the board on the wall and Annabel followed his gaze. “I’ll tell you what I know about those patients, but I can’t tell you what residents will be on tonight. I think Dr. Watson and Dr. Gash will be leaving soon.” She shook her head. “Like me, I don’t think you’ll be comfortable with the way this rotation is structured.”

  “Did you do any pelvic exams or see any babies being born?”

  “Ha! I saw enough to personally put off having a baby as long as I can and we’ll probably only get to do a pelvic exam on the GYN service after OB.”

  A small muscle on his face twitched. “That’s fine by me. I’m narrowing down what I’m interested in for residency and this won’t be one of them.”

  “You made up your mind before starting?”

  “Absolutely. Same thing with urology. There are pleasanter places on a human being to work with than inserting scopes into men’s penises or doing manual exams on women’s vaginas.”

  “I’m still open minded.”

  “I’m banking on subjects like psychiatry or neurology.”

  “I can picture you settin
g your sights on one of those. In the meantime, let me tell you about Bonnie Barker, who almost exsanguinated from her delivery. When you go into her room, her boyfriend is sleeping next to her in a chair. And I’ll fill you in on Mary Chandler, an eighteen-year old with preeclampsia.”

  After ten minutes, Annabel called Uber for a ride home, gathered her things, and nodded good-night to Emmett and the RN who was in her patient’s room before when her chief resident had blown a fuse. They still chattered across the hallway in the supply room as she left with a tempo to her step.

  -----

  At 5 p.m., Emmett started off in the supply room all by himself. He was pulling a twelve-hour day, which he didn’t mind in the least. His whole life, he had been a hard worker and could count on one hand how many times he had taken a day off from his present job, and those rare times he had been sick enough to qualify as a patient in the hospital where he worked.

  With his orderly job, he had enough human interaction during the day that he felt no need for additional social interaction. His life was simple: a small house with a patch of land he tended to himself, a small chunk of time in the gym, and a bit of binge-watching when it came to streaming movies or series content on his tablet. Part of his simplicity and care-free lifestyle also came from the fact that he had never burdened himself with a wife and kids. He helped out the hospital obstetric patients and families, but the beauty of that rested with the fact that he could walk away from them at the end of the day.

  There was simply enough joy, he believed, in watching other couples have kids. Like a grandparent, he could admire and get a kick out of babies, but he carried no direct responsibility for them. This was even more important when he witnessed the miniature premature infants coming out of the labor rooms, or the ones that came out with genetic malformations or maladies, or the ones that started out with a tumultuous, life-threatening birth. There was no way he would take on the remote possibility of being a father involved in any one of those scenarios.