by Barbara Ebel
“I could use a bite,” Nell said, narrowing the space between her and Bob.
Annabel paused and turned to Dustin. His hair was not as curly as usual and the dimple in his chin was not highlighted above with his usual warm smile.
“What do you think?” Annabel asked.
Dustin turned sideways to talk to her. “Like you were last night, I’m overdue, overtired, and stressed from several days of working a late shift and not making up enough sleep during the day. Being out and about any more today is not a good idea for me. Sorry to say, but I’m backing out of any more adventure. I’m glad the three of you won. I’m sure Bob can take you home in his car.”
Annabel stood motionless, stunned by his words. What he just said didn’t fit the occasion. His words were like clouds raining over a child’s birthday party. Her birthday party.
Dustin placed his hand on her arm for a moment, like reassuring her that she would be fine. Even if she knew what to say to him, she didn’t have the opportunity. He stepped away, headed towards the entrance they came in before, and was gone.
-----
“Should I order one that we can all share?” Bob’s eyes studied a funnel cake stand and Nell answered.
“We can split one ourselves. Maybe Annabel and Dustin want something else.”
Bob turned to Annabel for her response. Her eyebrows were furrowed, and a concerned expression had replaced her happiness. “Hey, our Oliver just won the top dog prize.” He peeked behind and to both sides of her. “Where’s Dustin?”
“He took off. He’s been working too hard. Can you drop me off at my place on your way home?”
“Not a problem. Is everything okay?”
She hesitated. “As far as I know.”
“Can I buy you a funnel cake?”
“I’ll skip and eat a chicken kabob instead.”
“I hope you give Oliver a morsel. He would love that.”
She petted Oliver’s forehead and his tail spun around in a circle. Not resisting his happy face, she crouched down and gave him a hug. After downing a few fast food items and checking out two exhibits, they made their way to Bob’s car.
During the drive, Nell chatted away, but Bob glanced in the rearview mirror as much as he could. Annabel was not chipper like before the dog show, nor was she still excited about their win. He stopped the car next to her apartment and turned around. “If it’s not a problem, I could leave Oliver with you today. After all, you and he had a special day.”
“A deal is a deal. He stays with you today.”
“Then for sure, take his trophy, his ribbon, and his five-dollar bill to display in your apartment.”
“I can do that.” She slid the items into her canvas bag and exited the car.
-----
Annabel hung Oliver’s blue ribbon on his trophy and placed them on the windowsill behind her desk. She stuffed his five dollars into an empty cookie jar. She had the rest of the day to contend with, with plenty of time to study. Even better, she was well rested and ready to absorb pediatric subjects she had not yet studied.
After kicking off her shoes and getting an iced tea, Annabel folded a leg under her and got comfortable on her desk chair. She first tackled salmonella food poisoning, for which the literature fiercely recommended frequent hand-washing practices for children, particularly at group functions and public places. Then she turned to head trauma, an awful subject to think about in the pediatric population. At least she had a fine grasp of that area, such as subdural hematomas, because of her neurosurgeon father who, over the years, told the family a thing or two about head injuries and intracranial pressure.
Several hours ticked by. Her glass was empty and she stretched her legs. That was solid studying this afternoon, she thought, and she pulled it off not by happenstance. She had deliberately pushed Dustin to the back of her mind because something was just not right with him. Winning the mixed breed event with Oliver and Bob was special to her, but Dustin seemed to be an uninvolved spectator and barely acted like they were boyfriend and girlfriend.
And he left in a strange way.
Annabel rose and padded to the kitchen. She glanced at her iPhone to find no messages. She perched herself on a stool and peeled a banana. What was she thinking? If she were in his shoes, she’d be annoyed at her too. She didn’t mean to fall asleep early last night, but the way it all evolved was not right. She did care about him and needed to take credit for being inconsiderate, maybe even flippant, about acknowledging his side of the issue. He was a good man; underneath it all, she had a deep sense, an enlightenment, that she’d done him wrong by not contacting him back. In her defense, however, she felt he was taking her bad social behavior much more critically than what it deserved. Over the course of the next few days, she figured she would know by his actions, or lack of actions, one way or another.
-----
Although Linnell made innuendos to Bob that they spend more time together the rest of the day, Bob dropped her off at her place. He wanted time to study and wanted to appreciate a few dog walks and bonding with Oliver.
After he pulled into his apartment complex, he half trotted on a walk with Oliver. The last twenty-four hours were so eventful, his blood acted like it had been spit through a purifier and sent happy hormones to his brain. When they burst into his apartment, he gave Oliver a new rawhide bone for his win and then studied for a few hours. As he grew tired early after having no nap, he nonetheless began a preliminary search for orthopedic residencies.
Then it dawned on him. He and Annabel might sustain a long-term friendship, but with different residency programs in different cities or entire opposite ends of the country, that would more than likely terminate his hope to get together with her. He might always love her, but any chance of them getting hitched as boyfriend and girlfriend in the near future would die and be buried.
He realized starting a residency somewhere would mean the end of seeing her on a regular basis. He admonished himself for the next selfish thought. When she left for a residency program, that would more than likely end her present relationship with Dustin Lowe. He was sure that would not be to her and the policeman’s liking.
In essence, both men would most likely lose her for good.
CHAPTER 16
Sunday morning, Bob got up extra early, put on a pair of trousers and a shirt, and enthusiastically gave Oliver a walk. He only needed to go into the hospital for morning rounds because the on-call team for the day would cover all pediatric patients for the rest of the day after each team made their own rounds.
The apartment complex was quiet with only one other dog walker, and Oliver made his mark on shrubs and trees before Bob went back inside and fed him.
“You mind the apartment, Oliver. I’ll see you later.”
He made his exit and individually saw each of his patients on the pediatric ward, leaving his consult for last. He liked to leave extra time for Toby; he hated for the youth to be strapped with his flu-like symptoms while he was nursing a leg fracture and a cast. Any eleven-year-old kid concerned about not starting back to school on time had his attention and respect. Bob thought back to that age, at which time he was in no way conscientious. In fact, he remembered, once in a while, he faked symptoms to his mother to avoid going to school.
Bob stopped first at the nurses’ station and read all the orthopedic and nurses’ notes on Toby’s chart since yesterday morning when he left post-call. The ortho team mainly reported on their patient’s orthopedic progress and slow going with physical therapy. The nurses’ notes were dotted with additions of “still complaining of a headache and Tylenol given,” and “Phenergan was ordered for nausea and vomiting.”
A nurse passed him and noticed him with Toby’s chart. “You pediatricians need to do something about him.”
Bob frowned and nodded. “You know how medical care slows down on the weekend, but I’ll see to it.”
She smiled and added a big “thank you.”
Bob entered Toby’s room and o
pened the blinds to halfway. The morning light aimed at the floor and made the room less dreary.
Toby’s arm moved to the edge of the bed and he groaned. “Don’t open them any more. The light is bothering my eyes.”
“Good morning, young man.” Bob tweaked the blinds a little less open.
“Dr. Palmer, I’m glad someone came to visit me.”
“Nurses were in during the night, Toby.”
“That doesn’t count. I was asleep. Now it really matters because my neck aches.”
Bob glanced at the new set of vital signs on the bedside chart and, although Toby still had a low-grade fever, he figured it was dampened by the Tylenol he was getting for his aches and pains.
“What do you mean, you have a neck ache?”
Toby used his hands to scoot up, trailing his casted leg with him. He turned his head from side to side. “My neck is stiff as a board. Aren’t old people the only ones who get stiff necks from sleeping funny?”
Bob stepped over. “I wish there was some truth to that, Toby. How about a headache? Is it still there?”
“Yeah, but they keep giving me pain and headache medicine. My muscles ache too.”
“Did you eat anything last night?”
Toby started to shake his head but grimaced. “No. The nurse told me at least I was getting something to drink in my IV.”
After examining him, he assured Toby the team would stop by, and scurried to the office, where his teammates had assembled.
“I just told everyone your dog won yesterday,” Nell said.
“Great job,” Dr. Mares said. “I’m proud of the way you two spent some time out of the hospital. Of course, give your dog an extra biscuit for his accomplishment.”
“I certainly will.”
“Let’s huddle around the table and run through our patients’ lists and then do quick bedside visits. Afterwards, students are ordered to go home and study.” Rick cracked a smile.
The chief resident listened to each student report on their patients as they drained a pot of coffee. As the last order of business, Rick asked, “What about our consult, Bob?”
“Toby Owens’ vital signs have statistically not changed. Since yesterday, he continues to have nausea, little vomiting, muscle aches, a headache, and now a stiff neck.”
“A stiff neck?” Bob had Rick’s undivided attention.
“Yes. I may be a medical student with a lot to learn, Dr. Mares, but these symptoms are screaming out to me that Toby may have meningitis.”
“A smart presumptive diagnosis, Dr. Palmer. What would be the next step?”
“A lumbar puncture.”
“You need to finish your train of thought. Why?”
“To take a sample of the fluid that surrounds the brain and analyze it to confirm our suspicions.”
“The fluid may or may not be diagnostic of the type of meningitis, if he does indeed have it, but it is absolutely needed for diagnosis. Also, his other lab work has proved not to be enlightening.
“All right, then. Are you all tanked up with enough coffee?”
All four students rose and nodded. They would skip more coffee if it meant rounding and going home sooner.
At the nurses’ station, the students rounded up their patients’ charts. Bob finished quickly and decided to text Annabel. Even if she wasn’t up yet, she’d get his text later in the morning.
“Good morning, dog winner. Guess what? Toby Owens may have meningitis. We may do a lumbar puncture on him.”
As they walked to the far end of the hallway, his phone flashed a return message. “Darn. Poor kid. Would your chief resident mind if I was there too?”
“Are you crazy? On a day off?”
“Not crazy. I’ve been following him from the beginning. It makes sense and I’m interested.”
“Anybody ever tell you how dedicated you are?”
“You just did.”
Bob texted an emoji smile. “If we’re going to do the spinal tap, I’ll ask Rick.”
Annabel countered with a happy emoji as well and waited. She was up and going through her second cup of hazelnut coffee. Bob’s Keurig machine present to her continued to be used daily.
At last the team stood in Bob’s patient’s room and, after evaluating him, Rick said, “I’m giving your mom and dad a call, Toby. We would like to do a procedure, one which may give us important information and be diagnostic.”
“What procedure?” Toby asked. He had a bad feeling about this.
Through experience, if Rick could help it, he had learned not to tell all patients the names of procedures. The technical terms only served to scare younger ones more than needed. He, however, did tell parents the name, description, risks, and other information of any procedure he performed on their child.
“We want to insert a needle between the bones in your spine and take out a small amount of fluid for analysis. I’ll go talk to your parents about it and be back.”
Rick turned to Bob. “You can stay with Toby for a few minutes. The rest of the team, go write your progress notes and be back bright and early tomorrow.”
“Dr. Mares,” Bob added tentatively, “Annabel Tilson would like to be here. Is that okay with you and Toby?”
Rick’s eyebrows rose. “Fine with me.” Toby nodded an okay.
Bob sat next to Toby’s bed and texted Annabel. “You’re welcome to come. Dr. Mares is getting parental permission, which shouldn’t be a problem.”
“I’m on my way.”
-----
Toby’s forearm trembled. For the last few days, he had done everything possible to tolerate his situation, not complain, and act like a grown-up person. Which he wasn’t. Missing the familiarity of his own bed and room, he was reduced to sleeping in a hospital. Nights were scary and uncomfortable and laden with strange sounds and strange people in the hallways. Most were hospital employees, but they came and went like he was some object of their eight-hour shift.
Besides the bulky cast on his leg and the futile attempts at physical therapy, he felt like crap and it was only getting worse. And within the last few minutes, he was stupefied about what Dr. Mares had said, but now, as he began processing it, he started to freak out. It was bad enough when the technicians were drawing blood from him and when the nurse had slipped in an IV, but the fear of having a needle stuck into his back was terrifying.
Bob remained silent. At least someone was with him, Toby thought, but the youth could no longer contain his worry over what would happen to him. His head and neck hurt and he wished he were home and buying school supplies like everyone else his age. No longer able to hold back his emotion, he started to cry.
Bob leaned in, propping his elbows on the bed. He patted the boy’s forearm. “Toby, what? What is it?”
“I’m scared. I want to go home.”
“I promise, we’ll take extra special care of you. First, we must find out what’s wrong, fix it, and then send you home. We must.”
“I don’t like needles.”
“I hear you. But this may be easier than you think. As opposed to the other needles you’ve had so far, Dr. Mares can use a baby needle to put some numbing medicine under your skin before he puts in the next needle to draw the fluid he needs. It’ll be a snap and Annabel and I will be with you the whole time.”
Toby grabbed a handful of his bed sheet and wiped his eyes. “Here,” Bob said, and handed him a tissue from the nightstand. The youth took a deep breath and his sobbing lessened. The more they waited for Rick and Annabel to appear, the more Toby calmed down.
-----
Annabel slipped in the door with the spinal tap tray and other medical necessities for Toby’s procedure
“Hi, you two,” she said. “Dr. Mares is waiting for your parents to arrive, Toby. They want to wait in the lounge while you have your procedure. And Dr. Mares asked me, since I was headed this way, to tell you something.” She looked at Bob, who nodded and placed the kit on the tray table.
“Do you mind if I tell him,
Bob?”
“Absolutely not.”
“Dr. Mares and Dr. Palmer believe you have meningitis.” She paused to let the word sink in. Maybe or maybe not, Toby had heard the word before.
“That sounds bad. What does that mean?”
“Meningitis is an inflammation of the membranes that enclose your brain and spinal cord, inside your skull and the bony canal in your back.”
“Which is caused by an infection, Toby,” Bob added.
“Oh. So some germ is multiplying inside my head? That’s dangerous, isn’t it?”
“We’re right here with you,” Bob said, “and we’ll get to the bottom of what is causing it and what we can do about it. We want to nip it in the bud. How does that sound?”
“You better.” Toby kept from crying. He liked the fact that both medical students he liked and trusted were explaining it to him so that he could understand.
“One more thing,” Annabel added, “because the team thinks meningitis is the problem, but they don’t know what kind, they are going to restrict the number of visitors and you’ll be quarantined.”
“What do you mean?”
“You will be isolated from other patients or many visitors,” Annabel said.
“So that other people don’t accidentally catch what you may have,” Bob said.
When Dr. Mares came in, he began to set up for the procedure. Toby’s leg in a cast didn’t help matters, but with Annabel and Bob helping out, he managed to drain Toby’s cerebrospinal fluid into the necessary vials and hastened it off to the laboratory himself, ordering Bob and Annabel to leave and possibly go study.
-----
“You must be thinking what I’m thinking,” Bob said after both students stepped out from the hospital’s revolving doors to the sidewalk.
She glanced over. “I’m wondering if he has a bacterial meningitis, in which case Toby Owens could possibly die.”
“Haven’t we learned that with a bacterial meningitis, it’s onset would be quicker? In other words, he had symptoms a few days. If it were bacterial, he’d be much sicker already.”