by Barbara Ebel
“Hey, you.” A woman’s voice they recognized approached from behind. “Doctor?”
Annabel and Caleb whirled around. It was Kathleen Chandler and the man from the elevator behind her.
“You two were in the room,” Kathleen said. “This is my husband, Mike Chandler. Mary’s father.”
“You were afforded a lunch hour?” he said sarcastically with a British accent. “My wife and I surely won’t be eating anytime soon. Our daughter passed away,” he continued. “We aren’t doctors, and my wife isn’t a midwife, so we don’t even know what questions to ask. But if there is no absolute understandable reason why Mary died, a lawyer is going to be asking our questions for us.”
Annabel gulped for air and her heart pounded while they all suffered an uncomfortable silence.
“I’m Annabel Tilson, a medical student. Our attending doctor can help you. We can call him.”
“And where is our daughter?” Mark barked.
Annabel glanced at Caleb, who peeked down at his shoes. Surely Dr. Harvey and Dr. Watson had told her that a legal autopsy would be performed.
“You can inquire downstairs in the basement where they’ve taken her.” Hopefully, Annabel thought, no one had started the autopsy yet and Mike Chandler would still be able to see his daughter.
“We’ll be back,” he said.
Annabel and Caleb made sure they were out of range. “I’m sorry,” he said. “I have more to lose than you if they end up being pissed off at me. I’m in an OB residency and you’re not.”
“Thanks a lot, Caleb.”
“You handled them perfectly.” He rubbed his fingers in his beard and then used his iPhone to alert Dr. Harvey that the Chandlers wanted to talk to him.
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Caleb pulled ahead as Annabel walked past each labor room. A few of the doors were closed and she wondered if any new patients had been admitted. Then she realized she hadn’t given Bob and their potentially nonsensical plan a thought all day. She pulled her iPhone from her pocket and found no email or text messages from him. Maybe he aborted their dog plan but she doubted it.
Bob could be at a Petco or PetSmart right now shopping for a sturdy dog collar and a nylon leash. Or he was in the process of making other decisions: what type of food would he start their puppy or dog on and which bowl should he buy? Those were fun items to shop for and they might belong to the dog and the two of them for the entire life of their pet. Yet, although she was missing the shopping trip with him, it was handy that he was available to do it. More important was their decision of which dog to adopt. She was part of that no matter what and, now that the time drew near, she couldn’t wait. Maybe tomorrow at this time, she’d be a dog mom.
One of the day shift RNs rolled the red medicine cart ahead of her. The woman pulled the twelve-hour shift on the days when Sherry had off. She stopped, parked herself outside Bonnie Barker’s room, and stared down at an open chart.
“Dr. Tilson,” she said as Annabel began passing. She gestured at an order page, her bracelets clanking together at the bottom of her lanky arm. “This looks like chicken scratch. What did Dr. Watson write? It’s for Bonnie Barker.”
Annabel stopped. The nurse’s name tag said “Melba Fox, RN.” She peered down. “Looks like morphine 200 mgs, but that can’t be right because that’s too high.”
“Not necessarily. Ms. Barker is already on a nonsteroidal, which isn’t holding her pain in check, so she needs something in addition to that. And you’re a medical student. You haven’t been around long enough to understand that some of these patients are previous or presently drug addicts. That means that they have an accumulated tolerance to opioids and need and take far more than anyone else. I see it all the time.” She flicked her hand in the air. “After all, look at her. Eighteen years old with a baby already. And a newborn with some kind of a problem, which is what I heard. In all fairness, she’s a druggie and her baby is suffering the consequences.”
Annabel narrowed her eyes and studied the woman with thick-penciled eyebrows.
“Really,” Melba said. “I don’t mean to sound cynical like your chief resident. I’m not that bad. I am just reporting what I see around here.”
“I hope the opioid addiction problem isn’t that bad.” Talking about Bonnie Barker’s baby made Annabel turn around and walk over to the nursery. Maybe baby Samantha could use a visitor.
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Bob Palmer’s common occurrence these days was to sleep late for two reasons. Ehrlichiosis was the medical reason; besides other significant signs and symptoms, the tick-borne disease made him especially tired. His energy level returned only somewhat faster than a snail slinking across the street and he hoped that by next Monday, his return to the last week of internal medicine would be almost normal.
The second reason for sleeping in late was simply because he could. Since starting medical school, he couldn’t remember a few days in a row like this when he woke with the sunrise peeking through his window treatments and then he would fall back asleep several times until it was midmorning. It was glorious. However, deep down he knew it only qualified as a treat, like a present that would befall a kid on a major holiday, so he better not get used to it.
Today, however, he not only didn’t sleep in, he was more vibrant and snappy. The thought of finally getting a dog with Annabel made him spunkier, both because of a new pet, but also because he’d be working with her in a separate collaborative manner. Different from the way they had been working together on medical rotations. Now they would have an outside interest all to themselves, a healthy way to step aside from the wards, sickness, and studying, as well as to take a break from following orders and the attentiveness and empathy they needed when dealing with patients.
Annabel Tilson had caught his attention the first two years of medical school when everyone was getting their feet wet and becoming accustomed to the crazy education and training they had signed up for. But he never had the opportunity to get to know her better. That changed when he landed on the same rotation as her in surgery. However, a friendship grew rather than a love interest because Annabel became enamored at that time with their chief resident.
Because they intensified their friendship, that hurt him rather than helped him. She went on to meet and later date the policeman, Dustin Lowe. Putting the situation into perspective, he realized that the only way she “saw” him was as a true friend, even when he had accompanied her to Nashville when her family dog died. Meeting her family in Tennessee also brought him closer to her and he enjoyed the whole household, but it made him more certain. Romantic notions about him did not fill her head like the way he thought of her.
Bob weighed his options quite often and always came up with the same result. If he stated his feelings to her or if he made a romantic gesture, he stood the chance that would make her uncomfortable; he could even lose her as his very best friend. He innately sensed this and his feelings usually didn’t lie.
It had been a tough situation to deal with on a regular basis on their shared rotations. But now their schedules were unhitched … which was why he had to drum up a more permanent method of seeing her. Dustin Lowe might be sharing his bed with her, but Bob could share a dog with her and continue their strong-bonded friendship.
For now, it was the best plan he could come up with and it better work. He not only loved her, he practically adored her. She was a knockout, but she was so much more than that; personable, agreeable, and thoughtful to just about everyone. And she always dove to the bottom of a situation with more streetwise smarts than he ever possessed, which always struck him as ironic since she came from a more well-to-do family than he did.
So, he thought, as they were about to embark on a new journey together, he’d be sure to keep a tight rein on his emotions and not display his feelings and jeopardize what they had.
Bob dragged himself out of bed, showered, and dressed in cotton sweatpants and a t-shirt. He savored a flavored coffee at a coffee shop and then drove to the back of
the shopping strip to the pet store. He realized most customers probably shopped online because there were only a handful of customers in the spacious store. This was a new experience for him, however, and he preferred picking out the items in person.
One whole side of an aisle displayed leashes and collars for dogs of every size, which posed to be a problem. How could he buy anything if he didn’t know how big the dog would be? Yet how would they bring home a dog if they didn’t have the proper gear?
He spotted one collar of its kind … a red collar with five solid bells attached. Labelled for a “large” dog, he figured he could tighten it for a medium dog as well because of so many punched holes. Not only Christmassy, but it was also unique, fun, and frivolous. Their dog would clatter with tinkling bells every time he or she would make a move or run. He clutched it in his hand and then moved on to leashes, where he found a perfect matching off-white nylon leash with two red stripes.
With help from a young woman with a bouncing ponytail, Bob decided on dog food and a bowl for water and food. He paid and left and found himself debating over his next move while sitting in the driver’s seat of his Honda Fit. He was doing fine as far as his energy level, so why not poke into the animal shelter instead of calling them? At least get a head start before Annabel was sprung from the hospital.
He drove a few miles north and down a less-travelled road to a cul-de-sac, where he heard the cacophony of dogs barking. The county had built a new shelter with outside dog runs with funds acquired over several years from a fundraising organization. He went inside where a woman stood at a long desk and a couple peered into the cat window of a spacious room. Another woman mopped the floor to the side.
“Do you have dogs to adopt?” Bob asked at the desk.
“Always,” the woman said. “Behind that door.” She finished tying a scarf around her forehead and pointed.
Bob nodded and went inside. On both sides of the aisles, there were concrete kennels with in-and-out wall openings leading to dog runs. Every stall seemed to house one dog or more. Although some of the dogs seemed not to care that he was there, the barking picked up from the ones who showed interest as he walked along. The ones that glued their eyes on him all said the same thing. He interpreted each one of them: “Take me home with you. I’m a good dog and I’ll love you forever. None of us should live like this.”
Bob’s heart broke. There were too many of them: a coonhound with a shiny coat, a poodle mix with dirty curls, a Labrador retriever mix panting like she was ready to play ball. He slowed his pace and sauntered up the other side of the middle counter. After passing two short pit bulls, he came to the happiest face of all. The dog in front of him wore a smile despite the four walls surrounding him.
Bob bent his knees and lowered himself while the dog’s tail swooshed back and forth like a motorized feather duster. “Holy cow,” he said, “you are the handsomest dog I’ve ever laid eyes on. Happy too.”
The dog was a mixture of white and tans and light reds all streaked along his long hair like an artist had whipped up paint and streaked it on a canvas. He stepped closer to the bars of the door and sniffed Bob’s hand.
Bob read the index card posted on the door.
“Retriever mix? Approximately nine month old male. Neutered.”
Bob put his hand in to pat the dog’s head. “I think Annabel needs to meet you. I hope she falls for you like I am.”
Back outside, the couple looking at cats had a cardboard box with a handle. “Our daughter is going to love her,” the woman said as they opened the door to leave, their new cat scratching the box from inside.
Bob smiled at the woman at the desk wearing the attractive scarf. “That nine-month-old on the left with the unusual coloring … what can you tell me about him?”
“The lanky Retriever mix?”
“That one.”
“We think that’s what he is, but we can’t be sure. We’ve only had him going on three days. If you want him, I suggest you grab him. As handsome as he is, he’s not going to last. Plus, we think he’s housebroken and friendly and he’s not an annoying barker like some of them.
“And as you know, we do euthanize here, so if he doesn’t go, he’s destined for ashes.” She frowned with displeasure. “I’m citing the eventual sad reality of many stray dogs and cats running wild that breed like rabbits because they aren’t fixed and don’t have homes.”
Bob sighed and propped his elbow on the desk. “How did he end up here? Do you have any history at all?”
“A man brought him in. Said he can’t keep a dog because he’s hardly ever home. He thought someone dropped him off either at his house or close to it. It was like the dog knew he got dumped off and needed safety, so he hung out in the man’s garage after the man left the door open. Like I said, I bet he’s a good dog.”
Bob’s eyes narrowed. The seconds ticked away. He could barely stand leaving the dog at the shelter. But Annabel was in this thing too.
“What time do you close?” he asked.
“Five o’clock.”
“Would it be possible for you or someone to hang around later? Otherwise, my friend and I may never make it in here together and we most certainly are going to adopt.”
The woman bit her lip. “I suppose I can stay over and get some extra work done.”
Bob didn’t want her to change her mind.
“See you around six, then.”
CHAPTER 12
Annabel tapped on the window of the newborn nursery where baby Samantha Barker slept in a clear plastic bassinet. At least the infant had been transferred and upgraded from the neonatal intensive care unit. She must be making progress from whatever ailed her on delivery, she thought, and more importantly, baby Sam may not be an infant born to a narcotic-addicted mother like Melba Fox, RN had told her.
A male nurse peered through the glass at the onlookers with wide grins. It was amazing the faces people made at the infants who had no concept yet of who, what, and where they were. Visitors waved, bobbed their heads, or stood transfixed like the little beings were all flown in on wings and dropped into the bassinets by angels. Siblings wiggled their fingers from their ears with their tongues out. Childless women tended to watch the infants with relief about their own status or with longing to have their own in the near future.
The RN pointed at Annabel, and although no visitors were allowed for another hour, he waved her to the door.
“Can I visit baby Barker?” she asked softly.
“Since you’re a student, I’ll give you slack. If you want to give her a little comfort and pick her up, however, check with Dr. Thomas in the back. He just received the baby’s genetic test results.”
Annabel strode over where the middle-aged man stood hunched over a chart. When he glanced up, the poor outcome of his surgical cleft lip and palate repair, from the days when that surgery as well as other plastic surgery had not been perfected, became obvious.
Annabel introduced herself. “Mrs. Barker is one of my patients,” she said. “I came to check on her baby.”
“Did you rotate on pediatrics yet?” He set down the chart and crossed his arms.
“Not yet.”
“It doesn’t always work out that way … for students to take OB/GYN first followed later by pediatrics. You’re lucky because that is the natural order of the two specialties.”
“I see your point. I never thought about it that way.”
“Since that is the case, you will almost certainly not have heard of the problem that Samantha Barker was born with. And even when you take pediatrics, chances are you won’t see a patient with it. The incidence is only one in ten thousand.”
Annabel’s chest tightened for a moment. Infants are so fragile and innocent; they do not deserve for anything to be wrong.
“The first obvious symptoms made us suspicious. The babygrams or skeletal survey showed up as being osteopenic or osteoporotic, so we sent samples off for specialized genetic testing. Unfortunately, the results confirmed t
hat there is an issue. Samantha has brittle bones.”
Without blinking, Annabel waited for more. Was “brittle bones” a loose term for a real medical problem?
Sensing her naivety, he said, “Osteogenesis imperfecta or OI. Poor baby Sam has, and will, continue to suffer imperfect bone formation. It is a disorder that goes way back to ancient times. She didn’t sign up for the unlucky cards she was dealt, but was dealt a problem because of genetics. If you did well with your genetic courses, she inherited OI in an autosomal dominant manner.”
Annabel clasped her hands and rubbed her fingers back and forth. “Although I don’t understand yet what that entails, this is very sad news to break to a young single mother who experienced a postpartum hemorrhage.” She glanced over at the baby and frowned. “Let alone this newborn who had no say in the matter.”
“I agree. I know about being born with something wrong right off the bat.” He paused and tapped above his upper lip.
“In my specialty, I see it too often for my liking … inherited diseases from little differences in the DNA of a chromosome. A transposed or messed up A, T, C, or G from what’s normal in the nucleotide pairing of a human being.”
Annabel envisioned the DNA base pairs of A and T, and C and G - which stood for adenine and thymine, and cytosine and guanine - and their helical structure when all linked together. Mother Nature was cruel when she mutated them negatively, and yet on the opposite side of the spectrum, mutations along the course of human history accomplished remarkable things as well … like bigger brains and opposable thumbs.
“Will you be telling Bonnie Barker today? The OB team plans on discharging her tomorrow.”
“Then she’ll be going home without her baby because we must keep an eye on Samantha for a longer period of time. So far, it is remarkable that we transferred her out of the neonatal intensive care unit. These newborns are at higher risk for pulmonary infections and, with their smaller stomachs, they are more susceptible for GERD. You know, gastroesophageal reflux disease. Plus, she will not have feeding requirements like other newborns or children because they often end up at the very bottom percentile of the Growth Curve. Not because of failure to thrive, but sometimes due to dwarfism.”
