Richard Mabry - Code Blue

Cathy picked up her pen and signed the top check in the stack. She looked up when she heard the office door open."Jane, do we have someone else coming in this morning?"

"Not until after lunch. Let me check."

Cathy couldn't quite hear the mumbled conversation in the waiting room. In a couple of minutes, just as she signed the last check, she heard Jane's voice again.

"Come on in here and lie down. I'll get the doctor."

Cathy was out of her chair in time to meet Jane in the hall. "What's going on?"

"Mr. Phillips. Severe chest pain, difficulty breathing. Sweating and weak. Probably having that MI we predicted."

"Let's see."

Phillips lay on the examination table, his complexion as pale as the sheet beneath him. Large drops of sweat dotted his forehead. His coat lay rumpled on the floor. He'd loosened his tie and unbuttoned the top buttons of his shirt, but his chest heaved as he struggled for air.

Cathy rolled the portable oxygen tank out of the corner, turned the valve to start the flow, and cinched the plastic mask over Phillips's face. "Jane, give him an aspirin to chew and swallow. Then call 911. We need them here-fast. After that, call the hospital and alert them that we're coming in."

While Jane gave Phillips the aspirin, Cathy slipped a blood pressure cuffon his arm. His pressure was 116 over 70. Down from his previously high pressure, but not in shock- yet. Pulse 84 and a bit thready. Just what she'd expect with a myocardial infarction. She pulled the man's shirt open the rest of the way and applied her stethoscope to his bare chest. She frowned at what she heard: S3, a third heart sound. A classic sign of an early MI.

"Mr. Phillips, I think you're having a heart attack." She applied the leads for an EKG as she talked. "I'll check an electrocardiogram to see how severe it is. We'll transfer you to the hospital as soon as the paramedics get here. Are you with me?"

Phillips nodded weakly but did not speak. The muscles in his temple were knotted, and Cathy could hear his teeth grinding.

Jane bustled in. "EMTs are on their way."

"Give him a nitroglycerine to hold under his tongue."Cathy's eyes never left the EKG tracing. Rhythm stable. Slight ST segment elevation. A few isolated T waves flipped. Still early, probably no damage to the heart muscle yet-if she worked fast.

She hurried to get an IV going before his pressure dropped more and all his veins collapsed. When she had it running, she said, "Mr. Phillips, I'm putting some medicine into your IV."

"Whatever you say, Doc."

"Jane, add a vial of atenolol into a small IV bag, and I'll piggy-back it onto this one."

Phillips's color was better now. What else? Oxygen. Aspirin to slow down clot formation in his coronaries. Nitro for pain relief. Beta-blocker. The next step was an angiogram, but where was the ambulance?

She fixed her eyes on the EKG. No change. Good.

Sirens screamed in the parking lot, and in less than a minute, two paramedics wheeled a gurney into the treatment room. "What've we got, Doc?"

Cathy recognized the lead EMT as one of the team that responded after her accident. "Acute MI, Mark. Let's get him to the hospital right away. I'll ride with him."

Phillips plucked weakly at her sleeve. "Doc?" His voice was barely audible.

"I'm right here, Mr. Phillips. I'll ride to the hospital with you and turn you over to the specialists there."

"Whatever you say. But I want you around too." He swallowed hard. "And thanks."

Cathy stuffed her white coat into the laundry hamper."Jane, I'm gone. I'll have my cell phone on if I'm needed."

"How's Mr. Phillips?" Jane called from her desk.

"He's doing well. I saw him this morning on rounds."

Cathy reached into the workroom refrigerator and popped the top on a Diet Coke. After two deep swallows, she held it against her forehead and leaned against the wall.

Jane appeared in the doorway, took one look at her boss, and opened the cabinet above the sink. She pulled down a bottle and held it out to Cathy. "Would you like some Tylenol?"

Cathy shook her head. "Had some earlier. I'll be fine. Stop worrying about me."

"Someone has to. Now tell me about our star patient."

Cathy leaned back against the cabinet. "Dr. Rosenberg did a cardiac cath yesterday. Fifty percent blockage of the left anterior descending coronary artery. He did a balloon angioplasty and put in a stent. Phillips should go home soon."

"Who'll do the follow-up care?"

"Dr. Baker was the internist on call. He saw Mr. Phillips with me in the ER."

Jane snorted. "So he's stealing your patient. You know you're qualified to take care of post-MI patients."

Cathy shook her head. "It's been the practice here that myocardial infarctions are the province of the internists. Family practice docs diagnose them, give the patients acute care, and get them in the hands of the specialist. After Phillips is stable, Evan will send him back to me. Or not."She rolled her eyes. "Maybe I should settle for doing what all the other GPs before me have done." But she knew in her heart that she couldn't be satisfied with that. She'd worked too hard.

In the parking lot, she climbed into the little Chevy and buckled her seat belt. As she backed out of her reserved slot, Cathy pictured her Toyota resting with dozens of other junked cars, consigned to the scrap heap after serving her so faithfully. As she wheeled out onto the road, she looked carefully in all directions. No black SUV in sight.

Will was scheduled to come over tonight for another working dinner. Cathy smiled to herself as she remembered the sight of Will Kennedy, a bouquet in his hand, like a teenager calling on his first date. She might not have been prepared for him on that last visit, but this time she'd be ready. Cathy steered a course for the grocery store, her mind already turning over the choices of what she could prepare.

She was in the frozen food aisle when she saw a familiar face. Might as well try to make nice. "Sherri. Hi. How are you?"

Sherri Collins looked up from her shopping list. "Hello, Cathy. Or I guess I should say, Dr. Sewell."

"Cathy's fine. How are things?"

"Well-" The ring of her cell phone spared Sherri from what was obviously uncomfortable small talk. She gestured an apology to Cathy, answered the call, and moved away.

Cathy hurried through the rest of her shopping, loaded her groceries, and drove off, still wondering if she'd made the right decision in returning to her hometown. She'd thought it might be a safe haven, a welcoming place, after her world had crashed around her. But it appeared that small towns had long memories, including at least one that made Cathy unwelcome. She forced the problem from her mind and concentrated on her driving.

As she approached the next intersection, a black SUV shot out of a side street directly into her path. Cathy stood on the brake pedal. Her car immediately skidded to the right. A lesson from Driver's Ed flashed across her mind: steer into the skid. Still braking as hard as she could, she pulled the wheel to the right. She felt a massive bump and heard a loud bang. The car rocked once before coming to rest, the right front fender tilted like the bow of a sinking ship.

Cathy closed her eyes and rested her head on the steering wheel. She felt the cold sweat that adrenaline brings. Her heart raced a mile a minute. Deep breathing didn't seem to help. How much of this could she take?

When she heard an insistent tapping on her window, Cathy finally raised her head. A man stood outside her door, wearing a worried expression. She pressed the button to lower the driver's side window.

"Ma'am, are you all right?"

She made a tentative inventory of her body parts. Everything seemed to move. No blood anywhere. "I think so. Did you see what happened?"