The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  “I think you’re right, Emmett. Ever think about changing anything now?”

  “Nah. I’m better than okay with my simple life and what I got. I love my routine and making changes makes me uneasy like a bear watching a bulldozer knock down his forest. Hands-on medicine is for other folks. You know, everyone has a place in this world. I’m lucky I found mine.”

  “I’m glad you’re content. Living with less stress is good for your health.” The coffee stopped dripping. She poured him a cup first and then herself. He handed her a flavored creamer, guessing she wanted one. She dumped it in and tossed the container in the trash.

  “I’d better chug this down fast,” he said. “Rarely do I drink coffee in here.”

  “I’ll stand right here with you. We’ll enjoy it together until the other two docs arrive and then I’ll be summoning up my nerve to ask my naïve questions.”

  CHAPTER 25

  Emmett passed Dr. Harvey and Dr. Gash in the doorway as he left to finish his shift. Roosevelt patted the resident on the shoulder as they came in.

  “Dr. Annabel,” Roosevelt said, “you witnessed a perfect outcome for a shoulder dystocia delivery.” He jockeyed his shirt into his pants with a shove and beamed his love for obstetrics all over his face.

  “I don’t understand why you didn’t apply fundal pressure like I’ve seen in other deliveries. Wasn’t that the problem … getting the baby out?”

  “You noticed the difference. We absolutely avoided that maneuver in this situation since it’s associated with an increased incidence of neonatal injury. We performed, and you witnessed, the first-line treatment … which is the McRoberts maneuver. Most cases of shoulder dystocia are relieved by doing it but, if not, there are a host of other named actions which can be used. You should look them up: the Zavanelli maneuver and the Wood’s corkscrew.

  “The delivery can be fraught with trouble,” Roosevelt added, shaking his head. “The longer the delay from the delivery of the head to the body, the greater the risk for significant fetal hypoxia. Other complications for the fetus are things like brachial plexus injuries, clavicle fractures, or even death.”

  “And the mother,” Caleb said, “can suffer consequences too. Like lacerations to her vagina or perineum, or a postpartum hemorrhage similar to the one you witnessed the other day.”

  “Studying this subject will now be so much easier,” Annabel said. “Thanks so much.” She turned to the counter and pointed. “I made fresh coffee.”

  “We’ll help ourselves,” Roosevelt said. “We’ll round on patients, update the board, and then you’re out of here. And, Caleb, you give report to the night team.”

  -----

  Annabel decided to go home wearing the hospital scrubs she had on, so she folded the nice clothes she wore for the funeral service that morning into her bag. She booked her ride home using her iPhone app, waited in the lobby, and was soon in the back seat of a minivan.

  The driver, clean shaven and crisply dressed, fiddled with his GPS app and then pulled forward. A small picture of him and a woman was stuck on his vent and a shark’s tooth dangled from the mirror.

  He turned his head. “How are you doing today?”

  “Not bad for a long day. How’s the rush hour traffic on the interstate?”

  “Moving like a stream down a mountain.” He glanced into the rearview mirror. “Hospitals must be interesting places to work. Are you an X-ray technician or a nurse?”

  Strike one, she thought.

  “What if I told you that female medical students now outnumber male medical students?”

  “That would be crazy. Then sooner or later, there will be a glut of family practitioners.”

  Strike two, she thought.

  “Why do you think that?”

  “Because females don’t possess the physical strength of a man. For instance, to do orthopedics. Those surgeons ream rods into bones, like hips, or reset fractures. Stuff like that.”

  Strike three, she thought.

  “Even if that were true, there are many other specialties.”

  “Yeah. Like heart surgeons. My uncle had open heart surgery and the male surgeon used a saw to cut through his sternum. You know … the breastbone. A woman can’t do that.” He laughed. “At least I wouldn’t want to be the patient under a woman coming at me with a power tool. She’ll miss and split open my heart.”

  Annabel rolled her eyes. At least the updated rider service gave the customer a chance to leave a tip. She would have the last laugh then. She didn’t equate his ignorance with his occupation, however, because his views probably represented a minority of men in any field outside of medicine. She took a deep sigh.

  After a spell of silence, he turned on Annabel’s street.

  “So what nursing unit do you work on back at the hospital?” he asked. “You may take care of me someday.”

  “I hope so. I’m a medical student, so someday I’ll be your cardiothoracic surgeon. You’ll be asleep with anesthesia and I’ll be above you wielding my power tool.”

  He jerked his head around to look at her. After creeping along to her address, he stopped and she jumped out with her bag.

  “Thanks,” she said, closing the door. He totally lost his tongue as she stepped on the curb. In the staircase, she took two steps at a time to her apartment. She felt bad after saying those things to the driver, but apparently, she couldn’t help it.

  -----

  Annabel hung up her dress clothes and stood at her window. Over the last week, the usual squirrel had reinforced his nest in the front tree and it busily nibbled away at an acorn it held in its paws. She needed to buckle down for the night; the pressure to study and work on her Power Point presentation weighed down on her shoulders. Yet she was overdue for some exercise.

  She donned running clothes and lightweight sneakers and hit the sidewalk. After passing the garden around the corner, she zipped down half the staircase, over the major road off the interstate, and to the path by the Ohio. She picked up speed but didn’t fail to notice the spot where Bob had sat down while running with her and had picked up the tick which had made him ill. Next time she ran or walked the path, she thought, Oliver would be with her. Just thinking of the dog trotting at her side put a smile on her face.

  The moon reared its majestic white ball in the sky rising up over the bridge from the Ohio to the Kentucky side. It looked like it was going to be full. Maybe Emmett was correct about the effect on pregnant women and the ward would be jumping overnight.

  When she slowed her pace in front of her apartment house, she kept going up the block. Needing to eat something, she rationalized a trip to Pete’s Café. She swore to herself that she’d work the rest of the night like a fiend.

  She stood in front of the coffee shop counter and Pete turned around.

  “Annabel, nice to see you. Which of your male friends will be joining you tonight?”

  “I’m solo, Pete. Heck, you’re making me wonder why I don’t have any female friends.”

  “I’ll ask the question, then. Why not?”

  “Except for sleeping, ninety percent of the time I have is for medical school and whatever rotation I’m on. The people I hang with come from whoever’s with me on the wards. Of which, there was one female who is gone now, but she couldn’t befriend a woman if she tried. My most precious time is spent with either a boyfriend or a best friend.” She eyed the menu on the blackboard. “Of course, you’ve met both of them.”

  “Sometimes I’m not clear which one is which, however.”

  She narrowed her eyes and twiddled with her hair. “Dustin’s the cop. He’s the boyfriend.”

  “Oh. Okay. I’ll try to remember that. Ah-ha, he’s the one who picks up the bill more often.”

  “That’s him.”

  “So what can I get you?”

  “A fried green tomato BLT and cole slaw and an iced tea with caffeine, which will give me zip for the work I’ll be doing tonight.”

  “Coming right up darlin’.”r />
  “And Pete, may I borrow a pen and paper? I can scribble notes while I wait.”

  He reached under the counter. “Here, keep them instead of borrowing them.”

  Annabel selected a booth against the wood-paneled wall. She jotted the major topics of her grand rounds lecture and began scribbling in highlights of her topics that she already knew. As the waitress bused over her drink and food, she came up with more and more points and made notes of what she still needed to research. Finally, she bit into her sandwich.

  “Annabel,” Pete said. She glanced over while noticing she was the last person in his café. “We’re closing in five minutes. I’d give you more time, but this place opens at 7 a.m., so I have a quick turnaround.”

  She looked at her iPhone. It was eight o’clock. “Sorry, Pete. Nothing like being absorbed with what I’m doing. The time also passed quickly because of your tasty sandwich. “Thanks a lot,” she said after paying her bill and folding her notes.

  “Come back soon.”

  Back at her apartment, she lined her notes next to her computer, ready to be integrated into slides. Taking a break, she texted Bob.

  “How was your day with Oliver?”

  “He’s the reason I went out two more times after our walk in the park this morning. And he’s a hit around here. The schoolkids are going to be knocking at my door to give him biscuits!”

  “Awwww. Sweet.”

  “How were things on the ward?”

  “OB is so unpredictable! Saw a complicated delivery … obese patient with a ‘shoulder dystocia’ fetus. Good news is that the attending is teaching me like crazy.”

  “Sounds interesting. I’ll look that shoulder thing up.”

  “I’ll still see you on Sunday, right? We’ll swap Oliver?”

  “For sure. I’ll miss him.”

  “I’m ordering his DNA kit tonight.”

  “You’re busier than me. I’ll do it.”

  “Wow … thanks. I’ll reimburse you. Better go.”

  “Hope all’s well on OB tomorrow.”

  “I’ll keep you posted.”

  Annabel tossed her phone on the bed. She wondered how Dustin’s day went. Yesterday had been a scare. She needed to trust the fact that he was a skilled police officer and totally adept at taking care of himself. After tucking her legs cross-legged on her bed, she grabbed a textbook, ready to study OB for another hour or two. She could catch up with Dustin in another day or two.

  -----

  Exasperated, Dustin Lowe rubbed his hand along the side of his face and into the tight ringlets of hair from his ear to the top of his head. He stood on an exit ramp of the interstate way too long, taking a report and waiting for a wrecker to take away the two vehicles smashed up in an accident. Only one passenger had zoomed away in one of the two ambulances that had arrived and the other adults stood around giving their version of what happened. Probably a moot point, he figured, since the driver of the second car undoubtedly hit the vehicle in front of it. Most likely, in too much of a hurry to get off the interstate.

  Although he was working a late shift, he already craved some caffeine. This was his second vehicular accident in a few hours. He noted the rising full moon over the city, which was never a good sign. Based on his experience, with no data to back up his theory, people had some kind of circadian rhythm during a full moon. They stayed out more and were like non-thirsty vampires roaming the streets in cars and on foot. Getting hit by cars went for pedestrians as well. Which was why he made sure he stood well away from the occasional cars getting off of I-75, almost all with rolled down windows and drivers gawking at his accident scene.

  He was parked next to the two damaged cars with the stop sign in front of his patrol car. He held his clipboard and figured most of the immediate paperwork was done. Soon he’d be back at the station to tie up the loose ends, but maybe he could meet Sean somewhere for coffee and a dinner break. His colleague was still ribbing him about getting more serious with Annabel. Sean sensed he was successful in putting the bug in Dustin’s head and now used terms like “tying the knot.”

  “Exactly,” Dustin had replied. “Marriage is a knot. You’re laced up in a tight shoe and you can’t flip sandals on or off anymore and wiggle your toes in the sand.”

  But Dustin knew better. He was just trying to dampen Sean’s remarks. He was thinking about proposing to the medical student who’d gotten under his skin.

  Dustin went to his vehicle, slid into the driver’s seat, and placed his clipboard on the passenger seat. His police radio blurted out an incident in a shopping mall as he reached for his cell phone to call Sean. As he anticipated his buddy to answer on the third ring, a large thud sounded from the back as his vehicle jerked forward and slammed into the pole with the stop sign.

  Dustin pitched forward as well. His chest slammed into the steering wheel. His momentum, as well as the car, stopped. In a momentary daze, his shook his head. Son of a bitch, he thought. His chest felt like it was on fire and his heart palpated in a flurry.

  “Officer, are you all right?” A paramedic from the second ambulance yanked the cop car’s door further open. His female buddy was right beside him.

  Dustin nodded. “I’ll be fine. Nothing like a punch to the chest. What the hell happened?” He swung his legs around and put them on the ground. The paramedics helped him out.

  He gazed at the rear end of his vehicle, where another third car had rammed into him. “What the …?”

  The paramedic team looked at each other. “Emily and I need to check you out. We think you should go to the hospital.”

  Dustin grinned. “What for?”

  “For the direct blow to your chest from the steering wheel which we bet on our next bacon and eggs that you suffered a blunt cardiac injury. You know, the force to your thoracic wall compressed your heart between your sternum and spine.”

  “I get it,” Dustin said. “You’re just doing your job.” He glanced back inside the vehicle and picked up his phone on the floor. He put it to his ear. “Sean?”

  “What the hell is going on there?”

  “You or some other officers need to come over to my accident scene because there’s been another one and they’re taking me to the hospital.”

  Dustin read the paramedic’s name tag. “Richard, which hospital?”

  “University,” he said while Emily went to get the stretcher.

  “Sean, they’re taking me to University. Don’t worry, I got rear ended and my chest slammed into the steering wheel. It’s not like I’m bleeding to death.”

  “Some of the worst things happen that are hidden,” Sean said, “so just do as you’re told.”

  “Who would have thought that you need to wear a seat belt when you’re stationary in your car and not driving?”

  The two paramedics placed the stretcher next to him.

  “I’d better go, Sean. I’ll update you from the hospital.”

  “I’m almost at your exit ramp. Don’t worry about a thing.”

  The driver from the vehicle behind Dustin’s stood watching the paramedics haul him off.

  “You’re sure you’re okay?” Emily asked the man.

  “Not a bone broken.” He stood against the stretcher nervously rubbing his hands in front of Dustin. “I’m sorry, man. I can’t believe I banged into a police car.”

  CHAPTER 26

  Dustin answered one question after another in the ER from a skinny, medium tall doctor with a facial tic. The man proceeded to give him a fast, yet thorough, physical exam. He proceeded in a business-like manner and was glad to be of service for a team player on the city’s “stellar police force.”

  Dustin rubbed his chin while a technician slapped EKG pads on his chest. The machine scratched out a squiggly tracing and the tech handed it to the doctor standing outside the drapes.

  Dustin assumed that his heart had settled down after the ambulance ride. It no longer made jump starts like he was running sprints. He felt sore and uncomfortable all over his bre
ast bone and on either side of it. Most people, he thought, are accustomed to bangs on their arms, legs, or other places on the bodies except for a direct hit to their chest. That area was like the door to someone’s heart and a steering wheel had just tried to open his.

  He observed the monitor to the side of the stretcher. The distinct wave form, which read ninety-nine percent, came from the clip probe on his finger. He had figured that out because when he took it off, the tracing disappeared. In any case, he realized that was an excellent score for something. He must be just fine.

  The next person who hastened into his room was a woman with a navy shirt and an white tag announcing her position as a laboratory technician. She took his arm, no longer clad in his uniform, only a sleeve of a cotton gown, and began siphoning out blood from a vein for a cluster of vials. He sighed when she left and sank his head back in the pillow.

  Now Annabel cluttered up his mind even more. He argued with himself whether he should call her and decided to not inform her of his circumstance. She would be home tonight after spending her whole day in an environment like this. Plus, she was none too happy when he told her about the diner shooting.

  Another person came to mind. No way would he tell his dear mother, who lived forty miles away. Knowing her, she would jump into her car and be next to him by midnight.

  The ER doctor came back in with another doctor. “This is Dr. Singh, a cardiologist,” he said. “He has all the information gathered so far.”

  Dustin tolerated another history and physical with a smile. The man grimaced, which emphasized his heavy black beard. “I recommend an overnight admission so we can keep our eyes on you. Cardiac contusion presents as a spectrum of severity and you did take a forceful shove.”

  “Where do you think I fall as far as the spectrum you mention?”