The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  A stout young man from respiratory therapy sidled next to Dr. Fleming and hooked up a suction catheter. Kristin yanked on nylon gloves, opened Bonnie’s mouth, and in two moves with the blade and the tube, had Ms. Barker’s trachea intubated. The therapist hooked it up to an Ambu bag and squeezed oxygen into Bonnie while Kristin verified breath sounds.

  Dr. Fleming nodded. The tube was in the right place, not the esophagus, and both lungs rose with bilateral breath sounds. Another therapist wheeled in a ventilator and the team finalized everything they had done.

  “Her heart likes that much better,” Caleb commented. “But I’m not crazy about it. She’s slow … in the fifties. Now she needs to be in the unit.”

  “Yes, get her transferred to the ICU right away,” Kristin said. “What on earth happened?”

  “I intend to find out.”

  Annabel thought back through the afternoon’s events. “Bonnie Barker complained about pain when we rounded on her early today. I think Dr. Harvey and Dr. Watson came to a treatment decision and the nurse dispensed her medication this afternoon. The RN wondered what was written.”

  “That’s a start,” Caleb said as the therapists and Emmett unhooked connections and began wheeling Bonnie Barker to the ICU.

  Caleb ran to find her chart. He needed to document the occurrence as well as write orders for the transfer. He also needed to alert Ling, wherever the hell she was, and put in for a medical consult with internal medicine for management in the ICU. The electronic medical record was another thing, but he also needed to investigate what Annabel had spoken about.

  Annabel tailed after him. She could almost see the wheels in his brain churning. They both heard the running of shoes on the shiny corridor until Ling stopped short next to them. She tried to catch her breath. “Our patient passed me on her way to the ICU with a breathing tube jutting out of her mouth. What the hell?”

  Caleb and Annabel glanced at each other first.

  “Annabel showed up first.”

  “She was nonresponsive and barely breathing.”

  “And I have my hands full at the moment,” Caleb said. “We honestly don’t know what happened yet. Maybe you can follow Ms. Barker over to the unit, give them ventilator settings, and request help from internal medicine or a hospitalist.”

  Ling’s ponytail swayed as she turned on her heels and left.

  Annabel and Caleb looked at each other again.

  “That was a surprise,” Annabel blurted out.

  “Easier than I thought,” he said. “Perhaps she figures she’ll follow the path of least resistance.”

  Annabel nodded. “We better take a look at Bonnie Barker’s previous orders and then the medicine cart to check what was or was not given.”

  “I hope Emmett didn’t grab her chart when they went over.”

  “If he didn’t, they’ll be calling for it any minute.”

  They hustled to the stack of charts at the nurses’ station and Caleb found it under the lip of the counter.

  Dr. Gash flipped to the end of the “Orders” tab to look for recent activity. There were a set of orders from earlier in the day. They both angled so close to each other their sleeves touched. He pointed.

  “I’m having difficulty reading this order,” he said.

  “Dr. Watson’s handwriting is …” Annabel started.

  “Illegible. The 200 mgs looks fine. What’s in front of it, with normal scrutiny, looks like morphine because the “m” and the “o” are clear.” He averted his gaze to Annabel and his eyes popped wider.

  “Shit,” Annabel whispered. “Bonnie Barker received 200 mgs of morphine. Dr. Watson should’ve written the real pain medicine of Motrin really clear. The nurse, her last name is Fox, said something to me about it in the hallway and I sort of questioned her thought process.”

  “Let’s check the medicine cart.”

  They ripped across the aisle and into the supply room. Annabel opened the record lying on top. “Sure enough, it’s what we thought.”

  Their eyes met.

  “We should reverse the actions of the opioid,” Annabel said.

  At the same time, they both quipped, “Narcan.”

  “Come on.” Caleb waved past the doorway.

  Before they made it to the staircase to run up to the unit, Dr. Harvey stepped out of the family consultation room near the waiting room. They almost banged into him. He wore a forlorn expression. His toupee lacked buoyancy and sat atop his head like someone had sat on it.

  “Are you two going to a fire?” he asked. His attention focused on Annabel; sometimes students divulged more than their higher-ups.

  Annabel held her tongue for an extra moment, hating to saddle her attending with another team medical emergency. “Ms. Barker is in the ICU on a ventilator. She mistakenly received morphine instead of Motrin.”

  Roosevelt Harvey gasped while Annabel peered into the room he had exited from. The Chandlers had fortunately not been close enough to hear their conversation about another patient. Mike tried to control his sobbing wife while he wiped tears away from his own eyes.

  -----

  Dr. Harvey, Caleb, and Annabel swiftly left the corridor and caught the attention of visitors in the waiting room as they walked shoulder-to-shoulder with their heads down.

  “Are you sure about this?” Roosevelt asked.

  “The entry is in the record,” Caleb said, shaking his head. “I can understand why the mistake was made.”

  Roosevelt stopped short. “There is no excuse for errors!”

  Caleb and Annabel flinched.

  “What? Tell me your interpretation of the mistake.”

  “The nurse may have misinterpreted Dr. Watson’s handwriting,” Caleb said.

  Dr. Harvey sagged his shoulders more than usual. “God forbid,” he mumbled as he opened the door to take the stairs instead of the elevator. He took one step at a time like it was a chore and he was out of steam. “We all have patients to take care of, there are women in labor, and I’m due back over in my office. You all are making a mess and all I’m doing is putting out fires!”

  Caleb reached for the doorknob and they exited next to the ICU. The automatic doors opened and the first person they saw was Ling.

  “Dr. Watson … Dr. Gash and Dr. Tilson just informed me that Ms. Barker received high-dose morphine.”

  “Based on her pinpoint pupils, I guessed that. What stupid idiot did that?”

  “Your handwriting may have been misconstrued based on what your teammates are telling me.”

  Ling took a second to process that and then gave Caleb a heavy glare. “What you are implying is preposterous. There must be more to it than that.”

  “Let’s put this to rest right now and check with the RN.” He tilted his head towards Annabel.

  “Melba Fox,” she said.

  “We’ll talk to her,” Ling said, “but we need to give Bonnie Barker an opioid antagonist.”

  The group went into her ICU room and Dr. Harvey examined her. Bonnie was covered with a sheet to her shoulders and the tubing to her endotracheal tube pulsed with the respirations from the machine.

  “Here’s what you’re going to do, Dr. Gash. While Dr. Watson and I go talk to the nurse, you’re going to methodically treat her overdose. You can start off by titrating slowly and staying right here for a few doses. Since she is on the ventilator, we don’t have to worry about her oxygenation. Start with an initial dose of 0.4 mg of naloxone IV and you can use repeated doses if necessary.

  “Dr. Tilson, you will stay with Dr. Gash to learn an important point. Even though you both may think she begins to come around and breathe adequately, the duration of action of the morphine will probably exceed that of the Narcan, so she needs to be kept under continued surveillance. No extubating her prematurely. No taking her off the ventilator just because she may open her eyes.

  “Meanwhile, Dr. Watson and I will go talk to the RN who was responsible.”

  -----

  “This will be a slow
, easy process,” Caleb said after he gave Bonnie her second dose of naloxone. “As a matter of fact, it’s best if we reverse at least half of the overdose and let her rest tonight on the ventilator.”

  “That makes sense.”

  “I’ll give her a third dose in a little while. In the meantime, grab a chair.”

  Annabel perched herself at the end of the nurses’ station and took out her cell phone. The volume was turned down all day, so she checked immediately if Bob had contacted her, hoping that today was yet another improvement in his energy level. Especially since he was the appointed task master for setting up for their pet. The dog might end up memorable in more ways than one and more pleasant than the events that took place on the ward.

  Her index finger plugged in her opening password and she went to text messages where his message popped up. Even if he had not made progress with their agenda, she was glad to see it.

  “Hey, workaholic medical student. Don’t deliver too many babies today. Save some for your residents!”

  What a doofus, she thought with a smile.

  “‘Shopping’ for dog ‘basics’ is done. And you won’t believe it. I scouted out dogs at the kennel … where some dog, I think, stole my heart. I’ll be curious to see what you think about the furry beast.”

  Annabel stroked her hair and hunched over the phone. A pathological euphoria swept over her and she contained a giggle. He might not be available to text back right away, but she responded.

  “You did take a picture, didn’t you?”

  “Nope. Sorry about that.”

  Caleb put two Styrofoam cups down with steaming black coffee and rolled out a chair. “It’s late in the afternoon for this, but I’m offering some to you in case you want to ruin your sleep tonight and study like me.”

  “Is that your agenda?”

  He frowned. “I may use the coffee to keep alert for a movie instead. God knows, after today, I deserve it.” He nodded his head toward her phone. “You seem chipper.”

  “Another student and I may be getting a dog.”

  “One of those four-legged things that need to be walked, and fed, and brushed, and taken to the vet? And jump all over you with muddy paws, and jump into your bed at night just when you’ve gotten to sleep, and bring in ticks and fleas? Besides the fact that they go through worse terrible twos than a little human being because they pull stuffing out of pillows, yank toilet paper out of the dispenser, and eat your sump pump?”

  He leaned back with assurance. “And unless you get yourself a trained security dog, he or she will lick the very palm of an intruder breaking into your apartment or house. He’ll soil your car with dog hair that will become a permanent fixture to the upholstery and it’ll bark like a spoiled child when you pull through a drive-through bank window because it somehow knows they keep biscuits behind the counter.”

  Annabel’s eyes grew with disbelief. “It can be that bad? Is there anything else you want to add to that?”

  “It’s worse than that,” he said forcing a scowl that he didn’t mean.

  “Hmm. Maybe my whole idea is a bit premature.”

  “Are you kidding? Don’t deprive yourself. There’s nothing like a dog.”

  CHAPTER 15

  Dr. Harvey stopped in the obstetric hallway and tapped Emmett on the shoulder. “Have you seen Melba Fox?”

  “Right in there. Since Bonnie Barker was temporarily transferred, she’s putting a few of her things out of sight. The patient’s boyfriend was just here too, and he frantically left for the ICU.”

  “I suppose he’s another unhappy camper,” Ling said.

  “He should be.” The attending poked his head in the door. “Ms. Fox, may I talk to you?”

  Melba strolled over. She nervously rotated her bracelets on her wrist. “I hope Bonnie Barker returns to her same room.”

  “We do too. Obviously, discharging her tomorrow is out of the question. I understand you may have given her an overdose of narcotics this afternoon.”

  Melba guessed she would be facing this type of confrontation. Since she learned of Bonnie’s respiratory depression, emergent treatment, and transfer, she’d been shaking in her shoes.

  “I followed orders, Dr. Harvey. Reading certain doctors or resident’s handwriting can be a big problem for nurses.”

  Ling put her hand on her hip and seethed.

  “However,” Melba continued, “I read Dr. Watson’s order as most likely being Motrin. In retrospect, it was damn cryptic to make out. Fortunate for me at the time, Dr. Tilson was nearby and I asked her what it said. She said, ‘Morphine 200 mgs.’ Which is what I gave. I feel so terrible about this, I’m almost in tears. I should know better than to trust the input of a medical student.”

  Ling slid her hand off her hip and relaxed just a bit. At least the accusation against her had taken a little turn. Most of the heat for the situation had been turned to Annabel.

  Roosevelt worked at tucking the bottom of his shirt into his trousers for the umpteenth time that day. He narrowed his eyes.

  Emmett listened intently, fiddling with the supply boxes on purpose. In his opinion, Annabel Tilson came to Bonnie Barker’s aid immediately when he reached out and grabbed her. She rendered aid efficiently at the time and he believed she was more professional in two days than what he saw of Ling Watson all the weeks and months she came and went from obstetrics at the University Hospital.

  “I don’t mean to interrupt,” Emmet said, “but the medication log book is right here on the cart.”

  Dr. Harvey liked the large man with the tattoos on his forearm. He nodded his approval for Emmett to grab it.

  Roosevelt’s gaze froze upon reading the order. “Dr. Watson, this is atrocious, and indecipherable. What did you think? By only writing an ‘m’ and an ‘o’ legibly, then someone reading it was given the liberty to fill in the rest themselves?”

  Ling bit her lip. She didn’t sweat when she worked out, but now beads of perspiration formed under her armpits.

  Dr. Harvey looked up. “And I suppose our medical student needs a scolding too.”

  Worried, Emmett backed up. Annabel didn’t deserve what was coming to her.

  -----

  Tony had left the hospital for a few hours to grab lunch and run errands. He’d taken another day off from his job as a coach, so he tried to fit in a few personal tasks while Bonnie began snoozing off to sleep. Otherwise, he stayed in her room like they were bounded by a history of forty years’ worth of wedding anniversaries … which wasn’t the case at all.

  When he came back, bad news hit him worse than a dismal season for the soccer team he coached. He wanted to kick himself for leaving.

  He stopped first at the newborn nursery. Dr. Thomas noticed him at the window swinging his head back and forth like he was humming a tune to baby Samantha. The pediatrician stepped outside and asked, “Are you Samantha’s father?”

  Tony nodded. “How can you tell?” He put on a wide smile and laughed.

  “She’s a doll baby like most infants. I planned on going over to see you and your wife soon because I must tell you some important news.”

  “We’re not married, but go ahead.

  Dr. Thomas rubbed above his lip and chose his words carefully. “We discovered a problem with your baby, which may end up causing lax joints, poor muscle tone, and poorer motor skills than other children her age. It affects bones; they may easily fracture.”

  Tony looked down at his sneakers while trying to grasp the pediatrician’s words. He knew a few things about kids who couldn’t compete in sports, even about a bone disease he once heard about.

  “It’s called osteogenesis imperfecta.”

  Tony gripped his hand as hard as he could. No, no, no, he thought. “How come? How did she get it?”

  “I’m sorry. It is a genetic disease.”

  “Does her mother know yet?”

  “No. Would you like to break it to her and I come by later or tomorrow and answer both your questions?”

&n
bsp; “That may be best. She suffered with a postpartum hemorrhage; I’d better dish out the news in drips and drabs the way I see fit, according to the way she responds and handles it.”

  “It sounds like you know best. Why don’t you call me when you’re both ready for the medical facts; when you’re ready to hear more?”

  “Thank you,” Tony said. Disheartened, he headed to Bonnie’s room, where he found it empty as a discarded soda can.

  -----

  At the nurses’ station, Tony learned of Bonnie’s transfer to the ICU. “Because she’s on a ventilator,” he was told. Upstairs, he was lucky with the visiting hours and went straight into the intensive care unit where he found Annabel and Caleb sat at the end of the desk.

  “Where is she? I came back to the hospital to find two catastrophic events with the two most important people in the world. Don’t you people believe in phone calls or text messages?”

  “Dr. Tilson and I are treating your girlfriend right now,” Caleb said, “which is our number one priority. Dr. Watson will be calling you any minute.”

  Annabel realized the young man said “two catastrophic events,” so she ventured saying, “Dr. Thomas must have told you about Samantha. He is an excellent pediatrician and she is in skilled hands. I went over and held her before. She’s the sweetest thing.”

  “I hope so. I mean, I think so,” Tony said, focusing on Annabel. He took a deep breath. “This is a lot to process.”

  “Both of them are going to be fine. Bonnie is in the room straight ahead. She was given too much pain medicine and Dr. Gash and I are slowly reversing those affects.”

  “Somebody made a mistake?”

  “Basically, that is what happened,” Annabel admitted.

  “I’d better go see her.” He slid away and, inside the room, pulled a chair as close to her as possible.

  “He was more tolerant than I would have been,” Caleb said when Tony stepped away.

  “He’s a dedicated father already,” Annabel said. “I sure wish the two of them would get their act together.”