The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  Emmett reached up in front of the suspended shelving and stacked clear plastic bags with bedpans on an upper shelf. He then pushed the empty box to the corner and ripped open a large cardboard box with liter IV bags of Lactated Ringer’s solution. There were four such containers, so he readjusted other LR solutions on a middle shelf to make room for his load.

  One of his favorite nurses, Sherry, strolled in. The upper middle-aged, practical woman always wore tight, matronly-looking blouses that were tight across her chest, and he sometimes wondered if he’d be around when one of the buttons would finally pop. She also always wore the same clip in her hair every day with glassy beads. He came to understand her reason why when she told him that her only granddaughter had given it to her. … on a Mother’s Day, no less.

  Sherry planted her thick, rubber-soled shoes in a dead stop and shook her head.

  “Emmett, at least you didn’t leave a stretcher at the door like in Mary Chandler’s room where I could have landed on it.” She gave him a serious scowl and then broke into a smile.

  The big man chuckled. “The new medical student made an innuendo about that too.”

  “Dr. Tilson better keep her thoughts to herself. Dr. Watson is not all that nice, but she’s worse when it comes to other females, especially if they appear to jeopardize her sovereignty.”

  “Women are other women’s most successful enemies.”

  She leaned against the shelves and considered his statement. “Spoken like a master. I’d go a step further. I never want to witness a woman president in my lifetime because I wouldn’t trust one with the nuclear button on her desk.”

  Emmett leaned down into the box, grabbed a few more bags, and stuffed them in above. “You’re a traitor to your own kind.”

  “It’s true and you know it.”

  He glanced outside where Annabel was nodding good-night over at them. “At least they let her leave on time,” he commented and waved.

  Sherry also acknowledged Annabel’s departure with a slight flick of her hand. “Now give me two of those bags you’re unpacking. This is the last doctor’s order I’m following and then my old lady shoes will be close behind the homeward-bound path of that young, dynamic student.”

  Emmett handed her two bags. She ripped open the outer, tougher packaging bag of both, put the two LRs on the waist-high shelf next to her, and dropped the trash in the garbage. In the corner, she opened a medicine cart and pulled out a bottle of magnesium sulfate and a needle and a syringe. She aspirated 40 grams and then injected it into the medication port of the nearest bag.

  Emmett stacked the next empty cardboard box into the last one and stood straight. “I’m out of here too. I’ll take this stuff to dispose of on my way. Any more garbage from you?”

  “No,” she said, shaking her head and dumping the used needle in the sharps container on the wall. She stood in the corner as Emmett carried his bulky load out the door.

  “See you tomorrow,” he said, “when I’ll be pulling another twelve hours.”

  Sherry plucked the bags off the shelf and placed them on the medicine cart. “Have a good one,” she said. She dug into her pocket for the already-made-up admixture label regarding the magnesium sulfate and slapped it on the bag nearest the door.

  Even though her shift was almost finished, Sherry’s stamina was devoid of significant adrenaline, so she took her time. She took the Lactated Ringer bags and necessary tubing packets and arrived at Mary Chandler’s room. They chitchatted while Sherry set up the infusion pumps. One was for delivering the patient’s maintenance fluid and the other for the infusion of magnesium sulfate. She started a 6-gram bolus dose of the mag sulfate and, after that, started its infusion at 3 grams per hour.

  Mary groggily watched as her nurse hooked things all together like voodoo and taped tubing, which now attached into her IV, down to her skin. She uncrossed her legs and asked, “What did those doctors say about my last blood pressure?”

  “It dropped a few points in the right direction, so I think everyone is hopeful that your baby will not have to come early. Also, this medicine I’m giving you will help prevent you from having seizures, which can happen with preeclampsia.”

  Mary bit her lip. “Then I hope it gets in fast.”

  “In due time.” She spiked the other bag with tubing and set it to run at 300 mL/hour. “This is just maintenance fluids,” Sherry commented. Her patient’s brown eyes were alert with alarm, so she continued. “It’s called Lactated Ringer’s solution. Consider it like the glass of water or cola that you would be drinking this evening if they would allow it. In case they have to deliver the baby quickly, they don’t want you eating or drinking, especially because of the need for possible anesthesia. The IV fluids will keep you hydrated and they are running at a hefty rate.”

  “And my baby’s heart rate is okay?”

  “Nothing to be alarmed about, so try and steal some sleep. I’ll be back tomorrow. Now comes shift change.”

  CHAPTER 7

  Annabel lived southeast of the Cincinnati medical campus and University Hospital in a third-story apartment of a rental house where young working and academic types lived in the area. She felt at home as possible with her living situation, even though she missed her family and home in Nashville.

  Since finding parking spaces on the narrow streets where she lived was near impossible after her long clinical days, she had taken up grabbing taxi services to go back and forth, and used her car less than before.

  A dark SUV pulled up at the hospital entrance. “Annabel?” asked a woman wearing a stylish cap.

  Annabel signaled a thumbs-up and scooted in. “You’re the first woman Uber driver to give me a lift; not that it makes any difference.”

  “Yeah. Doesn’t matter which gender has their hand on the wheel.” She pulled away from the curb as her GPS app highlighted directions.

  Annabel buckled up. “Ever feel unsafe, however, with who you’ve got in your car?”

  “Not really. I don’t take any bookings to remote locations. I transport only in the city area.” She made a turn, and after they made an entrance onto I-75, Annabel pulled out her iPhone, ready to give Dustin an update of her day.

  The police officer was someone she had known for a while, but he was new as her boyfriend. Being the cop that he was, he appreciated knowing a bit about her whereabouts, especially when she hopped rides in strange cars. She didn’t mind. He didn’t meddle with her activities; they had distinct separate lives in separate fields. However, the similarity was that they both helped people for a living. The characteristics of wanting to serve others, to see to the public’s safety or health, made them similar humanitarians.

  Holding her iPhone tight, she scrolled across the keypad:

  “First day is behind me and I’m headed home. My reading is already stacked up!”

  She waited for a response as the young woman cracked a wad of gum.

  “It’ll always be piled high. You will never get out from under. BTW…did you deliver any babies?

  “No, not as the low man on the totem pole.”

  “You figured that. I enjoyed last night. Can’t see you tonight, can I?”

  She smiled. “I wish, but no way. My unpleasant chief resident has given me an assignment.”

  Coasting along, the SUV stayed in the middle lane as she waited for Dustin’s response.

  “Okay. Pencil me into your calendar when you can.”

  “Will do. Give Solar a treat for me.”

  “For sure. Good night.”

  “You too,” she replied.

  The SUV took the exit ramp and headed into her neighborhood. She stopped thinking about the present and jumped ahead a year … and to what that would mean. A year from now would be the end of April, the latter part of her fourth year, a milestone in her training. Applications for residency spots would have been previously sent out and evaluated. Medical students would officially be paired with programs they wished for … or not.

  What did she want
to go into? The question in the back of her mind nagged at her. Whatever she chose would affect her the rest of her life. It was imperative that she considered all the options and make the very best decision for her talents and desires. During her surgery rotation, she had been interested in anesthesia, but now she just wasn’t sure.

  The driver slowed, stopped, and gazed back at her. “My roommate and I just split up. You’re welcome to come over to my place.”

  Annabel grabbed her backpack. “No thanks.” She scooted out, walked between the parked cars, and headed to the side entrance of her place where a young man was sitting on a step.

  “Bob Palmer! What are you doing here?”

  Bob was a close medical school friend. They had journeyed together so far on every third-year rotation – surgery, psychiatry, and internal medicine – until today. He was recuperating one more week from an illness he had picked up at the end of the medicine rotation and was now out of synch with her schedule. Even though he had passed the medicine final exam beforehand, next week he had one more clinical week to make up.

  With his normal cheery expression, he looked hard at her. “I came to find out what OB/GYN is like.”

  “Today was only my first day!”

  “You grasp everything in one day. Admit it. Besides, we must discuss our commitment to get a dog together.”

  She glanced down at his blonde hair and stylish haircut. “I haven’t forgotten, but I have to tackle a ton of reading.”

  Bob frowned and hung his head. “Actually, sooner or later, I need to follow what you’re studying anyway. Can we pore over the material together?”

  “Bob, you should be resting.”

  “I rested and napped most of the day and was to the point that I yearned for fresh air. I’m only good for an hour or two anyway, and then I’ll go home to bed.”

  “Which will be the most for me as well.”

  “So there you have it.”

  She squinted her eyes at him. “All right, then. What an unpredictable day.” She turned to check if the SUV had left. “I think the female driver just made a pass at me.”

  “Why not? You’re a hot chick.”

  She tapped her fingers on his head. “A chick without anything in her pantry. Why don’t we go up to the intersection? My OB books are with me; we can grab a bite as we study.”

  -----

  The bell above the door tinkled when Annabel and Bob walked into Pete’s Café up the block. Annabel settled her things at a table against the wood-accented wall and they went to the counter.

  “Hey, Pete,” she said.

  The owner had a slight build and a warm smile. “Welcome back. You two students look like you could use some brain food. My special is a classic Colby Jack grilled cheese sandwich with a salad.”

  Annabel nodded. “If we can study over there for an hour.”

  “No problem. I love when you clutter up my place.”

  “You can skip the sandwich for me,” Bob added. “I’ll take your beer cheese soup instead.”

  “Coming right up.”

  “Throw in some water too,” Annabel said.

  At the table, they sat side-by-side on the bench. She opened a book and went to the index. “I’ve been given an assignment by the chief resident of what to read tonight. Like I can’t pick out what I should be reading myself. For instance, the pharmacology of the certain drugs that kept coming up today, or postpartum hemorrhage, or preeclampsia …”

  “Ouch. So what’s the assignment?”

  “The physiologic changes of a baby’s first breath.”

  “We covered that a little bit last year in class.”

  “A tad, but that information is dusty, and look at this.” She grabbed at least one hundred pages between her thumb and index finger, looked at him, and rolled her eyes. “This barely covers the topic.”

  “I suppose we must start at the beginning. Like with what is the most essential adaptation in preparation for birth.”

  “The adequate development of the fetal lung to support gas exchange.”

  “Exactly. I’m impressed with your chief resident’s homework assignment. The transition from a fetus to a newborn has to be the most complex adaptation of a human being’s experience. She must be a sharp cookie and a fine teacher to spring you with this.”

  Annabel wondered. Bob had a point. “To tell you the truth, she’s starting out rough, but now that you mention it, I’ll give her the benefit of the doubt.”

  She scrolled her finger down to the beginning paragraph. “At least there are charts that break up the physiology into parts.”

  Bob honed in closer and scanned the first box, an overview of the neonate’s transition:

  “Clearance of fetal lung fluid

  Surfactant secretion, and breathing

  Transition of fetal to neonatal circulation

  Decrease in pulmonary vascular resistance and increased pulmonary blood flow

  Endocrine support of the transition”

  “Before I went to medical school,” Annabel said, “I assumed the growing fetus’ lungs were filled with amniotic fluid. Fetal lung fluid is different. It is secreted by the airway epithelium; production and maintenance is essential for normal lung growth. And in the last, third trimester of gestation, the lung tissue separates into septa … about four million distal saccules.”

  “And if the baby grows up and decides to, he or she starts smoking and destroys some or much of the hard work that Mother Nature did to build the respiratory system for breathing.”

  “So true.” Annabel raised her head while Pete balanced both their salads in his hands. The waitress placed down the remaining items.

  Bob pushed the textbook further away. “Thanks.”

  “You two reading how to use a stethoscope to listen to someone’s lungs?” Pete asked.

  “We’re ingesting material a lot more complicated than that,” Annabel said.

  “You two can handle it, I’m sure. Need anything else?”

  “We’re fine,” Annabel replied, not needing to tell him that they were now separated from their rotation. The Café thinned out as she started with her sandwich. Between bites, she read:

  “The cardiovascular response requires striking changes in blood flow, pressures, and pulmonary vasodilation with the removal of the low-pressure placenta. The newborn must also quickly control its energy metabolism and thermoregulation. The primary mediators that prepare the fetus for birth and also support the multi-organ transition are cortisol and catecholamine.”

  “Modern medical deliveries have this down to a science,” Bob said. “Helping the neonate transition by suctioning out its mouth, maintaining the temperature of the delivery room, and putting it in a warmer. Of course, all the rest of it, too, like cutting the cord …”

  “Where’d you learn all this? I’m the one taking OB, not you.”

  “You forget what I tell you. My mother is a nurse. Also, while I was resting today, I watched one of those clips on our list of useful video content.”

  “I remember your mom’s career. You just don’t talk about your parents that much. However, it sounds like you learned more than me today.”

  “Maybe today, but over the coming days, you’ll learn more from real patients that you’ll never forget.”

  “So true. That’s a given. So speaking of real patients, don’t forget that we’re naming the dog we’re getting after one of my prior patients, May Oliver. May if it’s a girl and Oliver if it’s a boy. She was a unique lady and I admired her. I wish she had not battled with and died from lung cancer.” Annabel pictured her sweet expression and close-cropped haircut and thought about their conversations.

  “I liked her too. We all did our best to stop her illness. She would have been tickled to know that you are going to use her name for our dog … a pet who will end up being a part of our lives and, I hope, a piece of our hearts.”

  “You are making me hungry for one already.”

  “How should we do it? Pick a dog
out from a breeder’s litter or go to the animal shelter and adopt? What’s your favorite breed and when should we do it?”

  She finished chewing a bite while Bob spooned more soup into his mouth. She shook her head.

  “We’re in this fifty-fifty. What are your thoughts?”

  “I asked you first.”

  “You are cognizant that I have a love affair with Chesapeake Bay Retrievers and that my family lost Dakota. Finding a breeder in the region for them may not be easy and then it may take months before puppies are available. Also, our landlords may not appreciate that large of a breed.”

  “So let’s consider the diversity available at the animal shelter. They must house a smorgasbord of breeds and mixes, sizes, personalities, and both genders. And more importantly, we would be saving a dog’s life if we adopted from there.”

  Annabel picked at her salad. “What if … “

  Bob put down his spoon and tilted his head.

  “If you are feeling up to it, this week may be our best opportunity to pick up a dog. You could be at home with it and I’m also not on night call. Next week, you go back for only one week of internal medicine; maybe pull one night call, and I’ll be on night call only. Like we thought before, between the two of us, one of us would be available to be with May or Oliver quite often.”

  A sly smile creeped over Bob’s face. “And we’ll split costs?”

  “You’re more strapped financially than me,” she said fiddling with her shoulder-length hair. “But yes, we’ll split the dog’s bills or work something out.”

  “How about tomorrow?”

  Annabel’s eyes grew big. “Really?”

  “Why not? If they close early before you’re off, I’ll ask them to stay open a little later. I’ll pick up the essentials tomorrow. Don’t worry, I’ll make it a short run to the pet store.”