Richard Mabry - Lethal Remedy

"Would it be okay if I wander over to the General Internal Medicine clinic and get the lay of the land?" "Sure. I'll take you over to GIM and introduce you. Just remember that you can't participate in patient care until we get the last of your paperwork approved." In the clinic, Kim sought out a middle-aged blonde in nurse's scrubs. "Gloria, this is Dr. John Ramsey. Dr. Ramsey, this is Gloria, our head nurse." And with that, she hurried off. Gloria's smile lit up the hallway. "We're looking forward to having you with us, Dr. Ramsey. I don't know who'll be assigned as your nurse, but for now, if you need anything, just ask me." "Thanks. Today I'd just like to see how the clinic is laid out, so I don't get lost when I come back." "No problem." The pager on her belt let out a muted buzz. "I've got to answer this, but I'll be around if you need me." John peered through the open door of an exam room. It was clean, compact, and pretty much like one in his private office- when he had a private office. Of course, in that setting, when he encountered an especially perplexing problem he'd often told the patient, "I need to send you to a specialist at the medical school."

Now he was that specialist, or at least one of them. "May I help you?"

The woman in the doorway was about John's age. She wore a clean white coat over a simple blue dress. Low-heeled shoes put her eyes at the level of John's chin. Those eyes, behind rimless glasses, were pale blue, the same color as Beth's. He felt tears coming, and fought them back. "Thanks, but I'm just looking around." He extended his hand.

"I'm Dr. John Ramsey." She tucked a stray lock of salt-and-pepper hair behind her ear. "I'm Lillian Goodman, one of the GIM clinic doctors. I understand you'll be joining us here soon." "As soon as the paperwork is finished." He made a sweeping gesture. "Apparently news travels fast around here." "You'd be surprised at how efficient the grapevine is." Her expression softened a bit. "And on a personal note, I was sorry to hear about your loss. My husband died almost ten years ago, so I really do know what you're going through." John was trying to frame an appropriate response when he heard footsteps in the hall-not running, but definitely moving at a fast clip. Gloria appeared in the doorway and said in a low, urgent voice, "Dr. Goodman, a woman just collapsed in the hall near the elevators." Lillian was already in motion, and John fell in behind her, not exactly sure what his role should be but anxious to help. People milled around in the elevator foyer. John pushed through and saw an elderly woman crumpled on the floor like a marionette dropped by a careless puppeteer. John knelt at the side of the unconscious woman. Lillian assumed the same position opposite him. "Carotid pulse is weak and irregular," he said. "She's breathing spontaneously, but sort of shallow," Lillian replied. She looked up. "Did anyone see what happened?" There was a general murmur in the group, a mass shaking of heads. A rumble of wheels and rattle of equipment announced Gloria's arrival. "Here's the crash cart. What can I do?" "Give me a second," Lillian said. "Right now she's breathing on her own. John, check her blood pressure. I'm going to do a quick neuro exam." In a moment, John straightened. "Mildly hypertensive. Heart rate about seventy but the rhythm is grossly irregular. Probably atrial fibrillation." Lillian didn't look up.

"Atrial fib fits. She's probably had an embolic stroke." John had already reached the same conclusion. A small clot forming on the heart wall had broken loose and made its way to the brain. "We need to get her out of here so we can start treatment," Lillian said. "How-?"

Lillian stood and swept her gaze over the small crowd that had gathered. "We've got a medical emergency here, folks. I'm going to ask all you visitors to clear the area. If there are physicians or nurses here, please stand by. All other medical center employees please go back to your positions." "Do we transport her into the clinic?" John asked. "It's a nightmare getting through all the hallways between here and Parkland. It works better if we get EMT's up here, take her down in this elevator and around to the Parkland Emergency area by ambulance." "I'm on it," Gloria said. "I've already called 911. EMT's should be here any minute." "Her breathing's slowed down considerably," John said. "Want me to intubate her?" Lillian looked him in the eye. "How are you at inserting an endotracheal tube?"

"Probably a little rusty. I'm due for recertification in advanced cardiac life support." "I had my ACLS refresher last week. I'll tube her. You start an IV." John was adjusting the flow of IV fluid while Lillian pumped an Ambu bag to inflate the woman's lungs when the elevator door slid open and two emergency medical technicians wheeled offa gurney. His heart was still racing when Lillian left to accompany the stretcher back onto the elevator and down to the waiting ambulance. He'd hoped joining the medical center faculty would energize him, give him a reason to get out of bed in the morning, but he certainly hadn't bargained for this much excitement on his first day on the job.

Rip felt the buzz of his cell phone against his hip. He saw the number on the caller ID display and thought, "Oh, boy. Here it comes."

He punched the button and said, "Dr. Ingersoll, I'm in a patient room.

Hold one second until I can step outside." He excused himself and made for a quiet corner of the nurses' station. "Okay, now I can talk.

Where are you?" "I'm sitting in McCarran Airport, listening to the racket from about a million slot machines and waiting for my flight to take off. We were diverted here for a medical emergency, and then they found some sort of mechanical problem with the aircraft that kept us here overnight." "What kind of medical emergency?" "A passenger-Never mind. It doesn't concern either of us. I'm calling to see how that girl we enrolled in the study is responding to the medication." Rip interpreted Ingersoll's statement about the medical emergency not concerning him as meaning he'd sat on his hands and let someone else handle it. He'd bet he was right. And he hadn't bothered to learn his patient's name. Just "that girl." Typical. "Chelsea's doing better.

She's responding well to the antibiotic." He took a deep breath. "But there's a problem that may impact her eligibility for the study." He waited for the firestorm he was sure would ensue, but instead there was only silence. "Dr. Ingersoll? Dr. Ingersoll?" Nothing. Rip wondered at what point Ingersoll's phone had dropped the cell. In an ideal world, it would have been right after, "responding well to the antibiotic." He waited for Ingersoll to call back, but his phone remained silent. Finally, Rip decided that his time of reckoning had been postponed for a bit. He didn't know how long-minutes or hours-but he was sure of one thing. It would definitely come.

Sara pushed away the remains of her dinner. It didn't matter that she often couldn't recall what she'd eaten or what program she'd watched. The ritual-and that was what it had become- was designed to get her through one more evening. Frozen meals from the microwave, the TV for company, falling into bed, frequently awakening at four o'clock in the morning to the cries of an infant who wasn't there. Most of the time Sara was halfway out of bed when she realized there was no baby in the house, no source of crying. That had ended almost two years ago when she found her infant son lying cold and lifeless in his crib. She knew about SIDS, of course. Sudden infant death syndrome was the fear of every reasonably intelligent mother, and as a physician she'd made sure she did all the right things. No exposure to smoke. Put the baby to bed on his back, always with a pacifier. But still, it had happened. She'd tried to lean on Jack for comfort in the days that followed the baby's death, but he withdrew, acting as though Sara was somehow to blame in the matter. It must have been her fault. She'd given him a son who was flawed, unable to survive. Jack came home later and later, usually slipping into bed after she'd cried herself to sleep. Sometimes he didn't come home at all, offering a flimsy excuse or none at all. Sara begged Jack to come with her for counseling. He refused, and eventually she stopped asking. She wasn't surprised when the divorce papers arrived, citing "incompatibility."