The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  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 that 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.”

  He glanced toward Sam’s bassinette and said with emphasis, “It is our responsibility to not over-feed Samantha.”

  “I’ll be sure not to mention the diagnosis to the mother until you do. Would it be all right if I visit and pick up baby Barker?”

  “Be gentler than you would be with any other newborn,” he said and motioned her over. “And, if you are a remarkable student wanting to learn as much as you can, add OI to your list.”

  Annabel smiled. One more topic to read, she thought, or at least an abbreviated summary because her OB/GYN one and only exam needed her primary focus. However, she would get her hands on an abbreviated summary of OI.

  She leaned over the bassinette, took the swaddled neonate in her arms, and darted her eyes back to Dr. Thomas with alarm. Samantha had bluish gray sclerae.

  “Yes, the whites of her eyes have color. A feature of OI.”

  Annabel nodded.

  “Don’t fret too much,” Dr. Thomas said. “Out of a person’s differences come great successes and the birth of extra creativity. Look at me. Part of my face was unsightly when I was a child and I was bullied like hell and made fun of. Instead of rolling up in a ball and letting life pass me by, I became stronger and excelled. I became the first person in my family to go on and earn an advanced degree. I also chose pediatrics because I can empathize with the plight of children, especially those who are different than the norm.”

  Annabel held the baby ever so gently. “Thank you for sharing,” she said. She hoped she would see him again during her pediatrics rotation. She picked up more information from him that she could bank away and always remember, than from her present teammates.

  Dr. Thomas gave her a good-bye tap on the shoulder and went out the back door. She knew of no other way to hold a baby except gently, but with this one she followed his advice and cuddled with extra care. What if, because of her frailty, she suffered a shortage of hugs and physical closeness as a baby, as a child, or her whole life? Annabel held her closer and the baby opened her eyes. She slipped her index finger into Sam’s light grasp and their eyes locked.

  “Welcome to the world, Samantha. You’ll be fine, just fine.”

  -----

  Dr. Harvey and the residents were gathered in the lounge when Annabel returned. The attending doctor had stripped off his white jacket and was preparing yet another cup of coffee. She hoped it was decaf because he twitched and paced like he was waiting for the delivery of his own infant. They ignored her as she slinked to the couch and decided to heed her gut inclination not to interrupt the brooding group about baby Sam’s diagnosis.

  “Mike Chandler and his wife are still downstairs in the basement with their daughter,” Caleb said to Roosevelt. “Sorry if we called you too early.”

  “That’s okay. They’ll be more ballistic if they come up and wait on me. In the meantime, we still have no answers about the woman’s death.” He wrapped his fingers around the handle, and with his other hand, he tapped the mug with his fingers.

  “Since you all did H&Ps on her, was there any inkling that she could have had a diagnosis we didn’t know about? Say, for instance, a Wolfe-Parkinson-White syndrome heart condition? Or a weird subset of sleep-apnea? Or maybe there was a heart problem at birth that she never followed up on but was supposed to? Patients often don’t go back to their doctors. They start feeling better and believe that the diagnosis went away.”

  At this point, Caleb and Ling leaned against the counter. He was pouring her a coffee while the attending trailed off mumbling to himself. He finally snapped out of it. “Does anyone know if Mary Chandler was her parents’ only child?”

  Caleb poured creamer in Ling’s coffee. “I believe so,” he said. “At least Mary told me it was going to be the parents’ first grandkid.”

  The door to the lounge opened wider and Kristin Fleming poked her head in. “Emmett wheeled a patient up straight from admissions. She’s an induction on the OB schedule for today. She already told the nurses she’ll want an epidural so holler after someone’s seen her and gets her labor going.”

  “We’ll holler,” Ling said. “And Annabel, pick her up as a patient. Do your H&P soon with or without us, which will be more experience for you that you are lacking. You’ll have to think on your feet without copying our notes.”

  Annabel held her tongue. More and more, Ling was treating her like it was her first day of medical school.

  The phone mounted on the wall rang; Ling answered and raised her eyebrows at Roosevelt. “It’s the director of the lab downstairs,” she said and put the call on the speaker.

  “It’s Dr. Harvey,” Roosevelt said. “Is there anything you determined from the items we sent down from Mary Chandler’s room?”

  The man cleared his throat. “We finished analyzing the IV bag contents that were hanging on the infusion pumps upon your patient’s death. I bring bad news. Very bad news.”

  Roosevelt Harvey placed his coffee squarely on the table and stood tall. He signaled to Ling to close the door.

  “I’m listening,” Roosevelt said.

  “There were two one-liter Lactated Ringer’s bags, one of them drained more than the other. The one clearly labelled as ‘Magnesium Sulfate 40 mgs’ only contained Lactated Ringer’s solution with no Magnesium in it at all.

  “The other bag? Testing that bag which had no label, in other words, the straight Lactated Ringer’s solution, revealed that it contained 40 grams of magnesium sulfate. The infusion rate on the pump was at your probable rate of her maintenance fluids.”

  Roosevelt Harvey gasped and looked at Ling.

  “300 mL/hour,” she stuttered.

  “300 mL/hour is correct,” the director said. “I’m sorry to break this to you, but more sorry for the patient.”

  Roosevelt’s head nodded up and down and up and down like a marionette on a string. Refusing to let the information sink in as fact and not fiction, he stayed speechless for a few moments.

  “I’m not a praying man,” Dr. Harvey managed to say, “but I’m going to say all the Hail Marys that go on a rosary bead that you mixed up the bags yourself when they were deposited there.”

  “Doctor, I’m sorry. The bags, the labels, and the pump in front of me spoke for themselves.”

  Roosevelt dropped his head and closed his eyes. “Thank you. You are doing your job. I know what you’ll be doing next. Filling out all the incriminating paperwork.”

  “Every drop of it.”

  Dr. Harvey hung up. Ling sat at the table, knowing not to open the door again. She nervously patted her shoe on the floor. Caleb rubbed his bearded chin. The two of them searched each other’s eyes, wondering if either or both of them had anything to do with the mistake.<
br />
  Annabel tried to keep her pulse in check. The discovery was abominable and the fallout to her superiors might impact them the rest of their careers.

  “We have our cause of death,” Dr. Harvey said painfully. “Mary Chandler received a lethal fast dose of magnesium sulfate.”

  -----

  The group piled out of the lounge like it was on fire. Her team had other blazes to put out because of this news and were probably, in more ways than one, in deep trouble because of the medical error. At some point later, she needed to tell them about Samantha Barker’s diagnosis.

  While she thought about it, Annabel plopped herself straight into the end of the couch and went to a major pharmaceutical textbook to reference magnesium sulfate more thoroughly. It was a Godsend in obstetrics, but it was obviously lethal if overdosed or used in the wrong way. She scanned the primary description: … a small colorless crystal used as an anticonvulsant, a cathartic, and an electrolyte replenisher in the treatment of pre-eclampsia and eclampsia; it causes direct inhibition of action potentials in myometrial muscle cells. For its main mode of action, the summary stated … excitation and contraction are uncoupled, which decreases the frequency and force of contractions.

  Annabel squirmed before even coming to the overdosage part. The drug posed as an acute toxin by most routes: inhalational toxicity, skin or dermal toxicity, and toxic if swallowed. But an outright overdose brings bigger problems like a slowing heartbeat, severe confusion and muscle weakness, drowsiness and dizziness, all succumbing the patient to a loss of consciousness.

  She closed her eyes tight. Mary Chandler had ended up pregnant at a young age and there was no mention of the father of the baby. Apparently, he was out of the picture. She bet Mary would have thought twice about having a few minutes of sex with him if she had had a crystal ball to look into the future.