ok, it's been a while since I wrote any fics with any patients in them. yeah whoops, I've made my fics as character-development related as ER became!(sorry, I still love it, but have you noticed how much it changed? I miss "the golden days of ER"-seasons 1+2)!~~Thena
"Abby, can you get James here into a room and start a chart? I'll get a doc in as soon as I can, but I've got too much paperwork to do to see patients." Kerry was being abnormally nice, but Abby was too tired to notice. She took the young boy into exam 4, instructing him to change into a gown while she pulled the curtain around his bed.
"Mrs. Williams, hi, I'm Abby. Can you tell me what the problem is?"
"James, he hasn't been feeling well, he's tired and he had a stomach virus or something, he was throwing up. He even stayed home from school. He hates to stay home, but he didn't seem to want to go this week. Didn't even fight me."
"OK, anything else?"
"I don't think so, but I could barely get him up this morning he was so tired, and he stopped throwing up almost two days ago. He started eating again yesterday."
"And what did he eat?" Abby knew the doctor would ask the same questions later, but she thought she might be able to save whoever it was some work, and besides, she needed to start the chart. She had to admit, she was still a bit interested in being a doctor, and most likely would have mailed in her application had Luka not done it on his own. Now that she'd yelled at him, she couldn't change her mind.
"He wasn't very hungry, we let him have some ice cream and we had hamburgers for dinner, some grilled vegetables. He didn't eat much of that though, just some ice cream...and some cherries. He had an apple today, and he's been drinking a lot of juice. His pediatrician said he needed fluids."
"What do you mean by 'a lot'?"
"Just a few glasses yesterday and two today. He threw up after that, so I didn't give him any more, and I brought him in." Mrs. Williams didn't seem to remember how much he had drank, but Abby didn't push it.
"OK, well, a doctor will be in to examine James soon. There are a few parts of the forms you still need to fill out, I know we called you in before you finished, but it's not a very busy day and we had the room. Better to get a room early around here before we get filled up." Abby smiled, and turned to the curtain. "James, are you ready in there?" He responded by opening the curtain and smiling.
"Mommy, I'm thirsty, can you get me a drink?"
"Of course James, I'll be right back. Abby, will he be alone if I leave him here? I don't want him to be all alone."
"No Mrs. Williams, I can stay with him while you get him a drink, and the doctor will be here soon. But the doctor will want to speak to you when he gets here, his name is Dr. Carter." Abby knew they'd send Carter, because Cleo was off and he was the best with kids.
"Oh, I'll hurry back. Thank you, Abby."
"No problem, Mrs. Williams." The boy's mother hurried off and Abby turned to James. "Hi James, can you lie down on the bed here please?"
"OK. My friends call me Jamie." He seemed tired, and did as he was told without complaints. Not often did a young child cooperate so much. They both turned around, startled by the sound of Dr. Carter coming through the exam room door.
~*~
"Abby, get a CBC, Chem 7, Lytes, blood glucose and U/A, start a line and rehydrate him. Did the mother sign the consent?"
"Yeah, she signed it."
"Great. She's been getting a drink for an awfully long time." As John said this, the door opened and in walked Marie Williams, holding a can of Coke.
"I'm so sorry, the soda machine here was broken, and I had to go get it from another floor, and I got lost on the way back."
"Mrs. Williams, I'm Dr. Carter, I think maybe we should hold off on the soda until we get the test results back. Can I speak to you about James outside please?"
"Of course, Dr. Carter. I'll be right back sweetie, let Abby take care of you."
"OK Mommy." John and Marie left the room, and Abby placed the soda on a tray, moving it away from James. "Abby, can't I have my soda?"
"How about a nice glass of water?"
"But I want my soda!" He insisted, pouting and crossing his little arms over his chest.
"Come on James, the water will make you feel better. We don't want to give you soda until we know what's wrong with you." The truth was, both Carter and Abby were almost sure it was diabetes, and they didn't want him having any sugar until the labs came back.
"Oh....OK, fine."
"But, before I give you the water, I have to take some of your blood for tests so we can see what's making you sick."
"Will you have to use a needle?"
"Yes, but it won't hurt, I promise. And I also need to put this in." She held up a foley. "It might feel a little uncomfortable, but it's just for a little while, OK?"
"If you promise you won't hurt me with the needle. I hate needles."
"You know what? Even I hate needles."
"Really?"
"Really. See, told you it wouldn't hurt." Abby pointed to the syringe full of blood she was holding. "You didn't even know I did it. OK, one more needle. You can look away if you want to." He did, and she started the IV, letting the saline run into his bloodstream. "There we go. Now you have to lie down really still while I put this in." She inserted the foley, got the urine sample, then called into the hall for another nurse. "Chuni, can you run these to the lab, here's the order...put a rush on it. I don't want to leave the kid, and Carter's talking to his mother."
"Sure. You really need a rush? We're filling up again."
"Yeah, definitely put a rush on it. Make sure they do it quickly. Thanks Chuni."
"No problem Abby." Chuni took the samples and walked off to the lab, adding it to the tray she was already carrying from her patients. Abby stepped back inside the room.
Abby took a pitcher of water and poured him a cup. He took only a few sips and then handed it back to her. "Abby, this water is yucky."
"Well, it's good for you. Now drink up, buddy."
He took another few sips, draining the small cup. " Now can I drink my soda?"
"Think you'd better stick with water, Jamie."
"Abby!" He groaned, but he didn't mind very much.
"Jamie!" She whined back, laughing. "Here's your water." She handed him the refilled glass.
"Fine." He wrinkled his nose, but drank the water. Abby laughed and took back the cup, placing it the tray with his soda and the pitcher.
"Now I'll be right back, I'm going to see another patient. I'll come back soon, ok?"
"Do I have to stay alone?"
"Do you want me to find your mom?"
"No, it's OK. I'll be fine." He said bravely.
"I can stay, if you want."
"No, just come back soon."
"OK Jamie, if you say so. Try to get some rest, OK?"
"OK Abby."
~*~
"Hi Abby, how was your day?"
"OK Luka, but I have to call the lab. Hang on a second."
She dialed and waited while someone picked up. "Hi, yeah, Abby Lockhart in the ER, I need the labs on James Williams, we've been waiting forever down here. I know you're busy, but we need them now, we've been waiting for almost two hours!"
"Abby, maybe I should talk to you later..."
"ABBY! Your kid's crashing!"
"Get those damn labs!" She ran away without hanging up, leaving Luka standing at Admit. He stood speechless for a moment, then picked up the phone.
"I suggest you get those labs down here." He said, still bewildered by Abby's behavior towards him. He hung up the phone and made his way to exam 4.
"Get Carter down here NOW! Where are those damn labs!"
"They're backed up." Chuni replied. "We really got slammed this afternoon."
"Dammit! BP's 80/65, pulse is racing. What the hell happened, he was fine!"
"Get him on a monitor, get those labs!" Luka raced into the room, knowing they would need a doctor. "Where the hell is Carter!"
"Start an insulin drip. Luka, how much can we give him? I don't know how high his blood sugar is!"
"Get the drip going, I'll set it. Not too fast, don't start it wide open, she's right. Come on, let's go everyone, Lydia, get Carter now!" She ran out of the room, and Abby looked at Luka over the small boy's body. Without the labs, they had no idea how bad it really was.
"V Tach, get the paddles! Charge to 100! CLEAR!" Luka yelled, pressing the paddles to his small chest.
"What the hell is going on, BP's falling, 70/30!"
"Abby, does he have diabetes?"
"I don't know, that's what the labs were for! He probably does, we were almost sure. Dammit, the insulin isn't helping!"
"Charge again. 200." Even as Luka, Abby, and Chuni worked, they knew it didn't look good.
"Asystole."
"High dose epi and atropine, come on, let's get his heart started! Come on Jamie, come on!"
"How long has he been down?" Carter raced into the room.
"10 minutes, it's looking bad, where the HELL were you!"
"Talking to the mother, give me the bullet."
"Pulse racing, he's taching, we're thinking DKA, started an insulin drip, can't get the lab results yet. We have no idea how high his blood glucose is, or his potassium. BP's almost nonexistant. Started a line of saline, 2nd liter going in now. We..." Abby's voice broke off as she stared at the little boy and the nurse and doctor working on him. "We...oh god..."
"Gave a high dose epi and atropine, still asystole." Luka finished for her, his voice strong and clear. Luka and Chuni continued to work as Carter spoke to Abby, trying to decide what to do next.
He looked to Lydia, who had followed him in. "Call the lab. Tell them we need those test results. Make sure they know it's a matter of life or death."
Lydia grabbed the phone in the hallway and dialed the extension for the lab.
"How long since the last epi?"
"2 minutes." Luka repled without looking up.
"Give another amp, and another round of atropine. We're gonna have to crack him. Get a rib spreader in here NOW!" Chuni ran off to get it, returning with both the tool and Kerry Weaver, demanding to know why the boy wasn't in a trauma room. "Because if we move him, he will die." Carter explained simply, calling for a scalpel and making an incision in the boy's chest. "Give me that rib spreader! Come on, NOW!"
~*~
Abby sat by James' bed, muttering something. His mother had gone to call her husband, get him down to County. Carter silently entered the room and stood behind her, listening to her.
"Yitkadal vyitkadash shime raba, valma deevrach..." She paused, unsure of the rest of it.
"Is that the Kadish?" Carter asked, recognizing the Hebrew from a few patients' families' reactions to their relatives' deaths.
"I can't remember the rest of it." She said helplessly, looking up at him.
"Are you Jewish, Abby?"
She shook her head. "My dad was. When I was five, my pet rabbit died, and we had a little funeral. He taught me and Eric...but that's all I remember. Dad took us to his temple once, when Mom was in the hospital. And..." But she didn't continue.
"The labs came back."
"It's a little late for that."
"I know. His blood glucose was barely enough to cause DKA. Certainly not that soon."
"Carter, the labs don't matter." She pointed to the rolling tray, where the can of coke sat opened. He picked it up and found it was almost empty.
"He drank it?"
"No Carter, he hooked it up to his IV." Abby's voice was dripping with sarcasm, but she sighed and added, "Yeah, he drank it." John placed the can back onto the tray and stood near Abby, looking at her. She sat motionless, staring at James. "Damn Jamie, why'd you have to drink that?" Her voice was far away and calm, but she was fighting back tears. He put his hand on her back and stood with her, but she didn't look at him or respond.
"Abby, are you OK?"
"Jamie was Jewish." She said quietly. John wondered if she'd even heard him. "I'm OK."
"You sure?"
"I said I'm fine, Carter!" Abby turned and looked at him. "Can you...I need to be alone, Carter."
"Sure Abby. I'll see you later."
"Bye Carter." She turned back to her patient, the boy she had joked with, laughed with. It all seemed so surreal. "You were supposed to stick to the water, buddy." She said quietly, tucking some hair behind his ears. She took his hand carefully in hers, marvelling at how small his was in comparison. He was only six years old. Barely had a chance to live.
"Well Jamie..." She tried to think of something to say to the little boy. Finding nothing, she began to slowly chant, her memory returning, "Yitkadal vyitkadash shime raba, valma deevrach kroote, vyamlich malchoote..."