by Barbara Ebel
Table of Contents
DESPERATE TO DIE
Copyright © 2017 by Barbara Ebel, M.D.
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
CHAPTER 24
CHAPTER 25
CHAPTER 26
CHAPTER 27
CHAPTER 28
CHAPTER 29
CHAPTER 30
CHAPTER 31
FROM THE AUTHOR
DESPERATE TO DIE
by Barbara Ebel, M.D.
Book Three of the Dr. Annabel Tilson Novels
Book One: Dead Still
Book Two: Deadly Delusions
Book Three: Desperate to Die
Book Four: Death Grip
Book Five: Downright Dead
Book Six: Dangerous Doctor
Copyright © 2017 by Barbara Ebel, M.D.
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
Paperback ISBN-13: 978-0-9977225-5-0
eBook ISBN-13: 978-0-9977225-6-7
This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.
CHAPTER 1
Annabel Tilson read “coughing up blood” on her first patient’s ER admission form. She yanked open the drapes to the cubicle with anticipation and formulated the most pertinent questions she could think of. However, how much could she possibly know about the subject? After all, she was only a third year medical student on the first day of her internal medicine rotation.
Her patient, May Oliver, sat slouched over the side of the stretcher with a blue pan in her lap. She gripped the plastic ends up higher as she coughed three times and spit.
“Mrs. Oliver,” Annabel said as May used a crumpled tissue to wipe her mouth, “I’m Dr. Tilson. I will be the medical student taking care of you along with the rest of the team.”
Simultaneously, they looked into the bucket at the bubbly, rust-colored mucus with streaks of blood. May peeled her gaze away and, with wide eyes, gave Annabel a pleading stare. Her hands trembled and the pan jolted from her lap, but Annabel quickly grabbed it before it slid to the floor.
May sighed. “Thanks. That means I’m going to function as your guinea pig.”
“The situation isn’t that stark,” Annabel said softly. “Actually, every one of us on your team, no matter what our rank, is learning something new from our patients every day. I have less clinical experience than they do, but my path has begun and I treat it with awe, curiosity, and respect.”
Annabel let May absorb what she said while she observed her patient carefully. She had learned from previous rotations the essentials of doing a good history and physical and ‘general appearance’ always came first. The thirty-two-year-old woman would be attractive, she thought, if not for her general physical wasting and apparent malnutrition. Her auburn hair was pulled back with a French clip and she had high cheekbones as well as lackluster eyes. She wore a turtleneck sweater tucked into black cotton pants and a warm jacket and wooly hat were thrown on the nearby chair.
Annabel reached over for another Kleenex and handed it to May. Even though she had scanned the ER notes, her job was to start questioning Mrs. Oliver from the beginning.
“What brought you to the ER this evening?” she asked.
“I finally admitted to myself that something’s not right. I’ve been upchucking blood from my lungs or my throat and today I had a real spell of it … red, nasty, and more voluminous than ever before.”
“How long has this been going on?”
“Seems like a couple of months.”
Annabel grimaced. “What’s a ‘couple of months’?”
“Three or four,” May said sheepishly.
“Any weight loss during this time?”
May froze, knowing the answer; it was stuck in her throat as she nodded affirmatively and gritted her teeth.
“How much weight loss?” Annabel asked.
“I scaled in here at ninety-five pounds. A half-year ago, I was a hundred and twenty-five.”
Annabel tried not to register alarm on her face. “And to be clear, you did not see a doctor before this, so there is no prior work-up record?” It was a must-ask question for her now since she had been burned on rounds once before when a prior illuminating record was available which she didn’t know about.
“That’s correct. I’m guilty as charged; dedicated enough to have served in Afghanistan but stupid enough not to seek medical care.”
“Don’t feel bad, Mrs. Oliver. Taking care of yourself last is a common affliction of hard-working and caring people.”
Annabel took May’s hand and settled her fingers on her wrist. She proceeded to take her pulse and other vital signs so as to not rely on the ones already recorded. Along the way, she asked her patient about other medical problems and surgical procedures. She asked about her family history and medication use and then addressed her social history.
Knowing May’s reason for being in the ER, Annabel suspected that her tobacco use would be the most significant piece of the puzzle. The woman probably smoked her way through the armed forces and already did irritating damage to her large and small lung passages. Her patient was younger than the folks who abuse their respiratory tract over decades, but she could still qualify if she was a big chain smoker or used the heavy-duty tobacco brands.
Annabel took her stethoscope off her neck. “Do you smoke?”
May shook her head.
“No?” Annabel asked, doubtful and surprised.
“No. Really. I tried it when I was seventeen. Not only did it leave me in a smoke cloud, but it left an aftertaste and made my breath smell bad.”
Annabel grinned; her thoughts exactly. “So what do you do now after serving in the armed forces?”
“First, I finished college. There weren’t many jobs available when I graduated, so I started a job as a barista. As it turned out, I stayed there because I worked myself up to store manager. It’s a major coffee chain; we’re right off the freeway so the place is hopping all the time.” She cleared her throat and leaned back on the palm of her hand.
Annabel was glad her patient seemed a bit more comfortable. After completing her history and physical, she left the room thinking of the many possible diagnoses that coincide with a smoking history – if May had smoked. But now she was stumped. She would need the expert insight of her upper level residents or a block of time to search for May’s symptoms in the Principles of Internal Medicine.
_____
Compared to the University hospital where Annabel had rotated in surgery and psychiatry, the government hospital and ER was vastly different. One day at this hospital lent her to believe that the pace was slower and, in general, the patients older and with more chronic conditions. The ER department was busy enough this Monday night but quiet for its size; Annabel realized it was
because there were no noisy trauma cases like the bigger teaching facility where paramedics raced in with bloody stretchers, sometimes grappling with CPR and blaring monitors at the same time.
Nevertheless, a steady flow of adrenaline pumped Annabel up for the night, and there was no shortage of patients for her team on call. She positioned herself at a cubicle next to her medical school colleague and friend, Bob Palmer, and swiveled in the chair to face him.
“I still can’t believe what you pulled off,” she said. “It’s understandable we’re both now on the internal medicine service, but how you managed to position the two of us on the same team is beyond me.”
Bob stopped writing up his patient’s admission and turned his head. His tapered haircut was suitable and becoming on his round face and the glint in his eyes always portrayed his sense of humor. He had proven himself to be a dear friend and one she would never need to second guess in a pinch. He had also not held back in the past on respectfully expressing his fondness for her until he began dating an older medical school student during their psychiatry rotation. She wondered if his relationship with her was still intact.
“I went to the doc in charge of these things,” he said in a professorial manner. “He was lumping names together for the four teams of four students and he was making up the call schedule for our entire rotation. Everyone is aware of the horrific events that took place on our psychiatry rotation and I told him that you and I share a mutual bond, making it advantageous for us to work together again. We need to overcome the post-traumatic stress of our previous attending getting killed by a patient and there’s no better way than to talk about that if and when the need arises. Plus, we seem to have a better than symbiotic relationship as far as learning while on the same team.”
He dropped the serious expression, leaned back in the chair, and let a smile creep across his face. She realized the sincerity of his remarks and agreed with his reasoning.
“I can’t disagree with anything you’ve said, so thanks for taking the initiative and doing that. It will be nice to tackle the next few months together. Now hand me some of the extra paper in your stack. My patient’s history and physical needs writing up too.”
She crossed her trim long legs and yanked a pen from her pocket. They sat in their two cubicles and ignored the 7 p.m. ER shift change taking place behind them. In the next fifteen minutes, they both referred to condensed pocket handbooks as well as iPhone apps on internal medicine.
Annabel stretched and wrapped her hands together in front of her. “Who’s your first admission?” she asked.
“Seventy-year-old with a history of colon cancer who comes in with rectal bleeding.”
“Understandable history. Mine’s only thirty-two. She’s coughing up blood.”
“Better not say that on rounds.”
“Yikes. A week off between rotations and I’m already rusty. What I mean to say is that the patient’s chief complaint is ‘coughing up blood,’ but my term, or the correct medical terminology is ‘hemoptysis.’”
“Perfect. Knowing you, that’s the last slip up you’ll make for four months.”
“Bob, you can knock off putting me on a pedestal. You are also proving to be a bright student.”
“Yeah. We’re both making progress, aren’t we?”
“Probably more than we realize, but there are so many more years to train after med school that I often put that fact out of my mind. I think whoever made up the saying ‘one day at a time’ was a medical student.”
“Or in prison. But maybe those situations qualify as one and the same.”
“Hah! There is some truth to that. So did you do anything fun over our week off?”
“I took Karla to a concert last weekend and she sprung for a movie and dinner this Saturday. Other than that, I slept in every day like a slug in mud, took my sorry ass to the gym a few times and, I confess, read a little bit for this rotation.”
“I guess that answers my curiosity if you’re still going out with her. I was conscientious and forged ahead with reading as well.”
“What about you? Did you go home to Tennessee?”
“For a couple of days. Except for my sister, my family pampered me more than I deserve. I love going home, even seeing our dog, Dakota.”
“Your dad still working full time and running the practice?”
“He’s taking less call than his partners but, otherwise, he’s working as usual. If he’s not in the OR doing cases or in the office, he’s attending to something related to neurosurgery.”
“Any new thoughts about what you want to do? Like go into his field?”
Annabel furrowed her brow in contemplation. “I really don’t know. I still need to experience every specialty. Everything we take, I like, so there’s no shortage of ideas. I particularly liked watching the anesthesiologists while we were in the OR during surgery.”
“Anesthesia is like multiple specialties rolled into one.”
Annabel nodded and smiled. “Something else happened during the break.” She clasped her hands together, raised them to her chin, and straddled her index fingers across her lips like a child holding a secret.
Bob tilted his head. “I’m oblivious if you don’t tell me.”
“Actually, you’re not clueless. You told me a month ago on psychiatry that it was obvious I had a thing for our chief resident, Robby Burk, when we were doing surgery.”
“Who can forget him? Yes, I was a bit jealous of him for two reasons. First, someday I’d like to be as outstanding a physician as he is and, secondly, he held your undivided attention. I thought you were going to trip over your own feet a few times when he came into sight.”
“Bob!”
“Okay, you two,” came a voice from around the side of Bob’s cubicle. Their chief resident, Donn Schott, stopped directly in front of them. “Up and at ‘em. We have a break, so let’s go feed our bones and conduct updates on our admissions while we eat.” He stood close to Annabel’s swinging leg; he tended to clutter into people’s personal spaces. She couldn’t fault him; he wore thick glasses. Farsightedness was most likely an issue for him.
Donn turned and waved his hand from the side. Annabel and Bob both rose with their sheets and followed him.
“To be continued,” Bob said. “The med student’s crush on a chief resident.”
“Look who’s talking. Going out with an older PhD med student.”
“But you started the wandering eyes first.”
_____
In a private lunchroom off of the main cafeteria, Dr. Schott put down his dinner and then lined up two tables together. The clunk of trays going down on the tables sounded from the rest of the team – all four medical students and two residents.
“I intend to get informal rounds done over dinner, everyone,” Donn said, “but since you all scrambled around today picking up previous admitted patients from a prior team, we haven’t had a chance to effectively introduce ourselves. As you can tell from the premature gray hair on my head, beard, and mustache, I’m not your typical chief resident. I dabbled in selling real estate, acquired my late college degree over a long span of night classes, and finally buckled down when I figured out what I wanted to do with my life. So here I am. You’ll notice I’m kind of laid back so never worry about me riding your backs. And, as you can see, I like my food.”
All six pairs of eyes settled on his tray of pot roast and gravy lumped on top of mashed potatoes. He was busy buttering three pieces of Italian bread, so his chubbiness was now understandable. “I hand the spotlight over to you two,” he said.
“As you know, I’m Melody Burg. You’re already wondering about my accent. I’m from Louisiana, so that explains it. Unlike Dr. Schott, I won’t eat that drab stuff.” She wiggled the bottle of hot sauce she’d taken from the condiment section. “Anyway, feel free to ask me anything. I like to teach, which is why I love being a resident so much more than being a student.”
“I’m curious,” Annabel said. “You changed your
shoes into clogs this evening, but wasn’t it uncomfortable walking around all day with short heels on?”
Melody laughed while sprinkling the hot sauce on a piece of chicken. “Sorry, I hope I’m not making too much noise in the hallways.”
“No, it’s not that. I find heels so uncomfortable on the hard floors.”
Melody shrugged and smiled. “Until my feet tell me otherwise, I’m sticking with the feminine touch.”
“If heels were for men, they wouldn’t be wearing them,” the other resident, Chineka Watt, said. “I worked in Chicago and I even wore flats. Anyway, you students will find the subject matter in internal medicine so vast and overwhelming, you’ll wonder how to remember half of it. Be sure to soak up and get a working knowledge of caring for patients with the most common medical problems. I picked this specialty because I’ve watched my mom and dad both deal with hypertension, heart disease, and diabetes.”
“Did you grow up in Chicago?” Bob asked.
Chineka opened a salad dressing packet. Her eyes moistened. “I did. My brother died from a drive-by shooting when I was young and then my mom and dad focused on me. They saved every dime they could to send me to a decent college.”
“Sorry to hear about your brother,” Bob said, “but glad you made it to medical school.”
Donn cleared his throat. “Jordan Maldonado, why don’t you stop glancing down at your lap and put your iPhone away. I can’t stop any of you from the incessant social media but understand this: texting, phoning, Facebooking, tweeting, pinning, and all that mindless clicking is secondary after patient care. You’re up next.”
“Sorry, Dr. Schott,” Jordan said. “The students know me from school; I’m going to be a cardiothoracic surgeon.”
“That’s all?” Donn asked.
“I won’t be shy to consult the internal medicine service on my surgery patients after I attain my goal.”
“In the meantime, you must pass the course and pretend that you care,” Donn said, pausing his fork.
“I’m Stuart Schneider,” the other student said, not making eye contact. Annabel and Bob knew him to be a quiet colleague, thin as a dime, and in the top of their class as far as exams. “I’m a native of right here in Ohio,, so if you out-of-towners need local information, just holler.” He turned to Donn. “I want to do a residency in internal medicine.”
