The Dr Annabel Tilson Novels Box Set

by Barbara Ebel

  “You too.”

  “Thanks,” Dustin said.

  Jerry went back to his bar stool and Annabel stuck her fork into the icing. It’s a small world, she thought. Too small. She watched Dustin. She needed to shake off the close encounter; one which Dustin wouldn’t appreciate knowing about and one which she had mixed reservations about. Her time with Jerry was enjoyable the night they met. They ended up sharing personal stories and physical intimacy.

  “Jerry lost his wife,” she said. “and I think he’s still getting over her. He told me when he gave me his business card that he named his boat after her … Hannah.”

  “That must be a special boat.”

  “I think so.” She savored another piece and she wondered why he was looking at her so intently. “You mentioned you wanted to ask me something important.”

  Dustin shook a packet of sugar in his coffee. “It was nothing that can’t wait or maybe my idea should be tabled indefinitely.”

  CHAPTER 31

  “Oliver,” Annabel said, “you are amazing. To think you spent the afternoon with a chatty bird in another new place and were good as gold. After all, you’re still a big puppy, and young dogs are known to be unpredictable at times.”

  Annabel sat on her desk chair after getting home from Dustin’s and looked Oliver square in the eyes. The dog stared back at her and then stretched out, ready to settle after the busy day. She went and poured a glass of water from the kitchen sink. Totally full from the wonderful meal, that was all she brought back to her desk.

  Dustin’s company and the early dinner had been stellar, but she could have done without bumping into Jerry, her previous date with his own boat. He was a fine man, but most women know it’s not wise to mix new boyfriends with old ones. Well, she thought, Jerry didn’t qualify as a previous boyfriend. He had been a one-night stand. However, he would certainly make a fine partner for someone after the grieving for his deceased wife was behind him.

  Thank goodness, she thought, that the short interlude with Jerry at their table had not delved into a more in-depth conversation. She liked Dustin very much and wanted in no way to jeopardize their relationship. After all, she wouldn’t be happy if she found out that he had a history of a flurry of one-night interludes in the not-too-distant past.

  She showered and put on pajamas and went back to her computer, all the while trying to wipe relationship thoughts out of her head. She opened the desktop; she needed to go through her lecture one more quick and final time.

  Satisfied that she knew the presentation as well as she could, she closed down, and bused her glass back to the sink. Now, as importantly, she needed to get a full and perfect night’s sleep. It was 9 p.m., so she was on track. She set her alarm for 5:30 a.m., allowing a half hour to walk and feed Oliver, and an hour to dress, drink coffee, and leave.

  Oliver followed her over and settled next to the bed. Before getting in, she kneeled down and ruffled his hair. “Good night, buddy.” She gave him a kiss and then scrambled under her covers. Within a half hour, she was fast asleep.

  -----

  Startled right out of her sleep, Annabel woke and tried to figure out what the hell was going on. Oliver walked on top of her, prancing on top of her abdomen from one side of the bed to the other. She extended her arms, barricading him from coming up any closer, and then sat up.

  “Oliver, bad dog! Get down.” She tried to push him off, but he insisted on staying put and carried on prancing all over her sheets, trying to sidle as close as possible to her. He panted like crazy.

  She glanced at the clock on the nightstand. It was only ten o’clock. She swung her legs off the side of the bed. Oliver jumped down. He lowered his head and squeezed past her rolling chair and into the space below the desk. He cowered against the wall but, not satisfied, he slinked back out. Pacing back and forth, he stopped momentarily and clung to her legs.

  “Oliver, what’s going on with you?”

  She turned on her room light, stepped into the bathroom, and sat on the toilet. Oliver tagged along. When she stood and washed her hands, the dog tried to jam himself behind the commode. Now she wondered if she had a mentally disturbed dog on her hands. She said, “What on earth is wrong?”

  Back in her big room with Oliver at her heels, she went to the front window and peeked out. Through the heavy clouds, which had built up during the evening, she detected a flash of light … lightning somewhere off in the distance. By the time she tried to settle back in bed, she heard a low rumble of thunder.

  “Oh no,” she said aloud as Oliver pawed at her closet door. She padded over and opened the accordion door. He hurried in, wanting to bury himself in the back confines of the space behind a pile of shoe boxes. Which lasted a half minute. He weaved himself back out and circled her.

  She would have never counted on this in a hundred years. It appeared that she and Bob had a dog who was deathly afraid of thunderstorms; their otherwise well-behaved Oliver was revealing his phobia to her. She’d known about such dogs, but her family never owned one with this problem. If the storm continued, she thought, his behavior would escalate. The thunder and lightning was headed in their direction.

  Annabel slumped on the floor, her back to her bed, and coaxed Oliver over. Wrapping her arms around him, she whispered in his ear, “It’s okay, boy. The storm won’t hurt you.”

  A significant thunderclap sounded and Oliver broke from her grasp. He panted all the while, his tongue hanging and his chest cycling faster than an athlete’s respiratory rate after a hard run. Annabel shook her head. After eleven o’clock, she slid under her covers again, but Oliver jumped up and wasn’t satisfied unless he was walking over her chest and up to her face.

  She pushed him gently but firmly. Midnight was approaching and she was losing valuable sleep. This was an untimely situation, she thought. The presenter of any fine medical lecture needs to be rested and coherent from a long and halfway decent night’s sleep.

  The thunderstorm grew more significant, and by 1 a.m., the rain pounded forcefully on the roof above her. Being on the top floor of the house, her place bore the brunt of it. The lightning continued with a light show and the thunder roared with impetuous claps that dwarfed their senses. Her heart wrenched in her chest as she watched her previously calm companion strive to escape and take shelter from the ungodly weather. But there was no escape from Mother Nature and there was no sleep for Annabel.

  The hours ticked by and, as the rain tapered off to a trickle and the thunder and lightning ceased, she threw some clothes on and walked Oliver at 5 a.m. When she came back in, she dried his paws and put on a French vanilla Keurig coffee cup. Her bed in the other room was like a magnet trying to snap her over. She placed her elbows on the kitchen counter and dropped her head into her hands.

  “What lousy timing,” she mumbled and lowered her hands. Oliver, now subdued, cocked his head at her. He no longer panted or paced. “What? You want to eat and, while I’m gone, you’re going to catch up on your lost sleep?”

  She dressed in tan trousers and a plaid blue blouse and tried to camouflage the circles under her eyes with makeup. When she left the apartment, her thinking was so fuzzy, she almost forgot the flash drive on the kitchen counter.

  CHAPTER 32

  On Monday morning, a few early medical students dotted the OB/GYN department’s auditorium as Annabel made her way down the aisle to the stage. A technical assistant at the podium fiddled with wires from the laptop stationed there and, as she stepped up the stairs, she heard Bob call her name. He approached her from a chair in the front row.

  “You made it,” she said. “Did your internal medicine chief resident give you a hard time about peeling away from the ward?”

  “I really lucked out. My chief resident for this make-up last week is our old chief, Donn Schott. He said your lecture subject matter is extremely important. He even sent another one of the students on the rotation with me.” He pointed to a student behind him.

  She nodded and followed up with
a grimace. “This is going to be awful. My head isn’t screwed on this morning to present a lecture. I went to sleep for one hour last night and then that storm blew in. So guess what?”

  Bob shook his head.

  “Oliver is deathly afraid of thunderstorms. He acted like a cornered jungle cat and didn’t know what to do with himself. No matter what I did, I couldn’t appease him. The poor boy. However, whenever I tried to go back to bed, he was up and down and all over me. And his panting and trying to get away from the weather was crazy. Ha! Now he can de-stress and sleep and I have to give this lecture.”

  Her eyes narrowed and her lips trembled. As she stared at the floor, she shook her head. “There’s not enough coffee in the world right now to help me sharpen my brain cells.”

  Bob’s expression changed to concern as he reached forward and touched her forearm. “Annabel, I’m so sorry. I had no idea. There were no storms when Oliver was at my place. Had I known, I would have never brought him over to you.”

  “What happened is not your fault. Besides, you needed to sleep as well before starting back today.”

  “However, giving your first big lecture to the whole department and then having to be on OB/GYN call tonight is a different ball game.”

  The technician plugged in a cord on the wall socket and pointed to Annabel. “If you’re the one giving this lecture, we better get ready.”

  “Yes, I’m coming.” She looked at Bob and their eyes held.

  “Good luck,” he said. “Only focus on the lecture material. You can do this.”

  She grimaced and, on the top step, she glanced back at him and gave him a faint nod.

  Bob took a seat next to his student colleague in the front row and Annabel pulled out the flash drive from her white jacket. The technician plugged it in as Dr. Harvey came strutting down the aisle and joined her on the stage.

  “Good morning, Annabel,” he said.

  “Dr. Harvey, an unfortunate event occurred at my apartment last night during the storm. So not only am I scared to be up here and talk, but I basically didn’t sleep all night. I apologize beforehand because, in all honesty, I’m going to blow this talk.”

  She watched his hands and expected Roosevelt to tuck in his shirt, but he didn’t. He sighed and scratched his neck.

  “I wish I could recite some significant quote to help you get over your sleepiness, but you have an inner strength that you can pull from, despite your tiredness, and your fear, and your nervousness to present this talk. As a matter of fact, for the next hour, your fight and flight hormones will kick in, and if you know your subject matter, which I know you do, they will pump you with enthusiasm and wakefulness and you will do better than you think.

  “Another thing … a lecture is not about the lecturer, it’s about the content. Take yourself out of the picture. It’s not about you. Deliver the important subject matter so that each individual sitting here goes away with something they learned. They don’t care if you mess up a little bit; they want to know the bulk of what you’re enlightening them with.”

  Although Annabel’s heart rate had inched up, her attending’s words were like manna from heaven. She gave Bob a second glance.

  “I’ve pulled up your lecture,” the technician said and showed her how to use the laser pointer. He pointed out the forward and back buttons for her slides and clipped the wire for the microphone on her lapel. “You’re ready to go.”

  The auditorium had filled up with long-coated attending doctors and residents, short-coated medical students, and some folks without white jackets at all. Situating themselves on the end of an aisle, Kristin Fleming and Caleb took a seat. Annabel glanced up at the three screens … one behind her and two to the side … confirming the title slide to her lecture:

  “Medical Errors, Physician Burnout, and Drug Shortages.”

  -----

  Her heart raced like a runaway thoroughbred as she cleared her throat. To stand behind the podium felt too formal, so she stepped to the side, looked at her audience, and then the center screen.

  “Most of you know me. I’m Annabel Tilson, an almost-fourth-year-medical student, and I’m about to cover three subjects of importance to physicians in any field of medicine and students on all rotations. Although each subject is important, I’m starting backwards, first with drug shortages. I’ll end with medical errors.”

  With each sentence, Annabel’s pulse slowed down and a bit more composure took root. She went to the first slide.

  “The FDA, or the Food and Drug Administration, has a strict definition for drug shortages,” she said, pointing the laser at the slide. “A period of time when the demand or projected demand for a medically necessary drug in the U.S. exceeds its supply.

  “What this means to us is that doctors cannot give the right drugs to patients when needed. I had a first-hand glimpse of this recently when one of our obstetric patients was not able to receive the epidural drug that our astute anesthesiologist wanted to inject.

  “This is a problem some of us in training are not aware of, but need to be by the time we’re loaded up with more responsibility. At present, our country is short on 182 drugs and medical supplies and the list is insane.”

  Her arrow scrolled down the list on the slide and she read some of them aloud: “IV bags, injectable morphine, other painkillers, anesthetics, antibiotics, electrolytes, cancer drugs, and much more.”

  She glanced at her audience; almost all of them were paying strict attention.

  “So why is this so important?

  “Drug shortages have serious consequences. When a health care provider cannot administer needed drugs, then they are not providing the proper treatment. Shortages endanger patients’ lives.”

  Annabel went on to explain the reasons for shortages, much of what was explained to her by Dr. Fleming, and then discussed the effects the problem had on health care costs.

  “Drugs shortages also increase the country’s health care costs. Staff must take hours to manage the shortages by tracking inventory and figuring out alternative drugs. Decisions must be made about rationing the scarce resources that exist. And most despicable of all, certain drug vendors then price-gouge the drugs that are in short supply. All told, that alone costs the U.S. several hundred million dollars a year.

  “Dr. Kristin Fleming, one of the anesthesiologists, and I would like to mention one more thing. It is important to inform policymakers what is going on in the clinical setting. Without real-time stories of the drug shortages and how they affect our patients, they cannot set policies in place.”

  Annabel peered over at Dr. Harvey, who flashed her a smile and gave her a thumbs-up. Her composure ramped up. Perhaps her lack of sleep helped to settle her nerves, she thought.

  “Dr. Harvey and I will take questions in the end. I’ll go on to my second topic of ‘Physician Burnout.’” She scrolled to the next heading.

  “Presently, this is a huge topic for M.D.s,” she stressed. “My next three slides list the physical, emotional, and behavioral signs and symptoms of physician burnout. These are important because …” She focused on her audience and held her gaze. “We should learn to recognize these signs and symptoms in the doctors we’re working with and, hopefully, recognize them in ourselves.”

  The first slide she highlighted by talking about providers feeling tired and drained, having poor appetites or sleeping habits, and other physical signs and symptoms similar to depression.

  She thought about Ling Watson when she scrolled ahead. “Look for the emotional signs in your colleagues - things like no motivation, constantly being cynical, and voicing helplessness. Or what if they derive no more pleasure from activities that used to give them joy?”

  Annabel pointed to the third slide on the topic. “Here’s the third list, which I hate. Behavioral signs can include the physician turning to drugs or alcohol to cope, or snapping at their colleagues, or being nasty to their patients.” There were more signs and symptoms and she gave the residents, students, and staf
f a few moments to process them.

  “So, being in training or being an M.D. is stressful. Prevention is the first key to avoid burnout. If you haven’t learned tricks to lower your stress or create balance in your life, then it’s time to learn some. We need to stop being invincible and learn to admit that sometimes we’re just not tough enough to handle every responsibility dropped on our plates. We must learn to ask for help and to recommend help for other colleagues. This is where the Psychiatry department is skilled. They have a program for docs, which is stupendous, with different treatments, therapies, and discussion groups.

  “Don’t forget,” she said, “the symptoms we talked about can threaten your career as well as your marriage or relationships. Even your life.”

  Annabel took a deep breath and glanced down at Bob. He nodded his approval and she gave him a small smile.

  “Last but not least, here’s a problem that severely affects patients. The next department’s M&M meeting, or Morbidity and Mortality lecture, will cover an OB/GYN patient that we just lost because of a medical error.” Her face saddened, she scanned the faces in the room, and pressed the forward button on the remote. In bold letters, everyone read “MEDICAL ERRORS.”

  “Officially, what are the three top causes of death in the United States as reported by the CDC? Most of us know the answer to that and we see patients with these underlying issues daily in primary care, internal medicine, and the sub-specialties.” Her next slide listed:

  Number 1. Heart disease

  Number 2. Cancer

  Number 3. Chronic respiratory disease

  “But we have to wonder about this; perhaps this list will be amended. Over an eight-year period, researchers at Johns Hopkins calculated something else … that 250,000 deaths each year are due to medical errors. That would surpass the figure of 150,000 people who die each year from respiratory disease. In that case, medical errors would be the third leading cause of death in the United States!”