Showdown

Part 10

Barely with the words out of Randi's mouth, Jing-Mei was headed towards the elevator, frantic. It seemed like forever before the doors opened. Finally, she stepped on and pushed the button for the cardiac floor. She arrived within minutes after the call down to the ER. She ran into Dave's room to see the nurses writing down his stats and Dr. Casin on the phone with the cath lab. She eyed Dave's heart monitor and it showed sinus rhythm with an obvious murmur. Dr. Casin hung up the phone and approached Jing-Mei.

Jing-Mei(hysterical): What happened, Dr. Casin?

Dr. Casin: He started throwing PVC'S and before we knew it he was in V-Fib. He's had a mild MI.

Jing-Mei: God! How long was he down?

Dr. Casin: About three minutes. We're taking him down to the cath lab now.

Jing-Mei: What do you think caused this?

Dr. Casin: I won't have all the answers until after the lab results. It could take a couple of hours.

Jing-Mei: Your best guess?

Dr. Casin: A blockage in an artery, maybe. I really don't know. Now, if you will excuse us.

Jing-Mei: Page me as soon as you have the results. I'll be back down in the ER.

Jing-Mei stood on the side as the orderlies wheeled an unconscious Dave by her. She saw that his face was still soaked, perhaps from the tears he shed earlier when she left him.

Back down in the ER, the others gathered around Jing-Mei when they saw her get off the elevator.

Luka: How's Malucci?

Jing-Mei: Alive. He's had a small heart attack. Dr. Casin just took him down to the cath lab, so I won't know how serious it is for awhile.

Kerry: He's not doing so well, is he?

Jing-Mei: He was until...(pause) this is all my fault.

Mark: What? How do you figure that?

Jing-Mei: He had a pretty intense session with Dr. Legaspi earlier and then when Dr. Casin said he was keeping him for observation, Dave, he did not want to stay here. In fact, he was insistent that I take him back home, but I knew that Dr. Casin wouldn't have said he wanted to admit him unless it was serious. I tried to explain it to Dave but he wouldn't listen. So, against my better judgment and with Dr. Casin's persistence I left him there in his cardiologist's care. God, Dave was so upset when I left him earlier. That coupled with the session with Dr. Legaspi, I know I shouldn't have just walked away from him.

Carter: Then why did you?

Jing-Mei: Dr. Casin said the best thing I could do was to go. It would only be harder on him if I stayed longer. Now, he's so sick and I feel totally responsible.

Kerry: Don't. If Dr. Casin wanted him to stay, he must have seen something wrong with him.

Jing-Mei: Yeah, he said that Dave was probably having problems for awhile. (takes a deep breath and exhales) I should have known something like this was going to happen. I was too happy with our upcoming wedding that something bad was bound to happen.

Kerry: That's superstitious nonsense. Now, go home and get some rest.

Jing-Mei: I want to since I have to come back in a few hours for my shift but I don't want to leave Dave now.

Mark: I'll find an empty room for you to lay down in.

Jing-Mei: Thanks Dr. Green.

Two hours pass, when Jing-Mei is awaken by her beeper. She wipes the sleep from her eyes and stares at the pager. It's Dr. Casin. She gets off the bed, stretches and heads up to the cardiac floor.

At the admit desk, Dr. Casin is going through Dave's chart when he sees Jing-Mei.

Jing-Mei: How's Dave?

Dr. Casin takes Jing-Mei's arm and leads her to a private area in the waiting room. Both sit while Dr. Casin explains the test results.

Jing-Mei: Looks serious.

Dr. Casin: I'm afraid it is. My diagnosis of a blocked artery was correct. I want to do angioplasty on Dave. I need to get in there and open the blocked artery with a balloon and apply a stent to keep it open, but also the valve that was replaced when Dave first came back to the hospital after the rehab center it's weakened again, so I need to replace it and put in another stent to take the pressure off the heart abnormality and lessen the chance of it collapsing again. There is one other thing. I'm a little bothered by the fact that Dave's pacemaker didn't respond to the arrhythmias he was having, so I'd like to scan that as well.

Jing-Mei: More heart surgery, Dave's not going to like that.

Dr. Casin: I know but you also know that I wouldn't do it unless absolutely necessary.

Jing-Mei: I do and I know he needs the surgery, it's just...his orthopedist said that he wanted to have Dave back in for more surgery on his legs soon and that was going to slow down Dave's physical therapy and now with heart surgery that's going to put him back even further.

Dr. Casin: This can not be avoided. It needs to be done ASAP.

Jing-Mei: When do you want to do it?

Dr. Casin: I was getting ready to look over my surgery schedule when you arrived.

Jing-Mei and Dr. Casin walked over to the front desk and Dr. Casin glanced at his schedule.

Dr. Casin: I can fit him in tomorrow morning.

Jing-Mei: So soon. I guess the quicker the better and get it over with. Besides, if he has the surgery now, he should be home in time for Thanksgiving, right.

Dr. Casin: Barring any complications, yes, I think we can get him home by then.

Jing-Mei: Good, it'll be our first as a family and it's kinda important to all of us. We were all looking forward to it. (pause) Does Dave know about the surgery, yet?

Dr. Casin: Not yet. I wanted to wait until he was more alert before I told him.

Jing-Mei: If you don't mind, I'd like to tell him.

Dr. Casin: Sure, but if he's going to take the news bad, are you sure you want to be the bad guy---uh, girl and give it to him.

Jing-Mei: I think he'll put up less of a fight with me then with you. No offense. Can I see him now?

Dr. Casin: If you are sure you want to do this. Yes, you can go in but I don't know how far you are going to get with him. He was sedated for the tests and to ease his pain so he's barely conscious.

Jing-Mei: I'll manage.

Dr. Casin walks Jing-Mei into Dave's room. Dave is sleeping deeply, attached to a heart monitor, pulse ox and a vent.

Jing-Mei: You didn't say he was on a ventilator. Is he having trouble breathing?

Dr. Casin: No, but this it just to help him with his breathing so his lungs won't have to work as hard taking some of the pressure off his heart.

A nurse walks up to Dr. Casin and hands him a chart.

Dr. Casin: I have to attend to another patient, Jing-Mei. I'll speak with you later.

Jing-Mei heads over to Dave's bedside. She sits down, holds his hand and starts stroking his head with her other hand.

Jing-Mei: Hey, handsome. Time to wake up.

Dave remains unresponsive.

Jing-Mei: Just for a few minutes and then you can go back to sleep.

Dave's eyes flutter open. He squints at his wife unable to focus his eyes yet.

Jing-Mei: Hi there, brown eyes. You're tired, aren't you? Well, I won't keep you awake for long. We have to talk. (pause) You probably aren't going to like what I have to say but you must remain calm or it will make the situation worse.

Dave blinked his eyes at Jing-Mei, trying desperately to focus them and fight off the urge to go back to sleep. As hard as he tried, all he could see was a blur, that he figured was his wife. Jing-Mei continued to stroke Dave's head trying to figure the best way to tell him while he was still awake.

Dave(mumbling): Ccchrin....

Jing-Mei: Shhh! You can't talk with the tube down your trachea, so don't try. Just listen. Dr. Casin says that you're very sick and you need more surgery. They have to cut into your heart...

Dave starts to panic.

Dave(shaking his head vigorous): Mmnoo.....

Jing-Mei: Yes, Dave, I'm afraid so. Now, we talked about this before and I explained to you that you would probably need surgery again. This is important and it has to be done. So, no arguments---okay. Do you think I would let anyone ever hurt you again?

Dave shakes his head.

Jing-Mei: Dr. Casin said that if he does the surgery tomorrow, then you should be home in time for our first Thanksgiving. Won't that be great? You'll be able to have turkey with all the trimmings and watch the football games and the parade...and play with your sons.

Dave(mumbling): Iiii haf dddrumstk.

Jing-Mei: Sure, you can have the drumstick, but only if you let Dr. Casin do what he has to and not put up a fight.

Too tired to argue anymore, Dave allows the sleep that has been defiantly trying to take him over, come and he shuts his eyes and rests. Jing-Mei gives him a final kiss on the head.

Jing-Mei(whispering): Goodnight, my love and I promise you that soon all this surgery will be just a memory and that you'll be healthy and strong again. I love you.

Jing-Mei heads out of the room when she runs into Dr. Casin.

Dr. Casin: How did he take the news?

Jing-Mei: Just as I thought, he wasn't thrilled so I had to bribe him with Thanksgiving dinner to get him to agree. He's sleeping now.

Dr. Casin: Good, the more rest he gets the better things will go tomorrow.

Jing-Mei: Dr. Casin, do you have a moment? Something has been bothering me and I need to ask you...

Dr. Casin: What's on your mind?

Jing-Mei: You said that Dave has been taking his nitro pills more often then he should, right.

Dr. Casin: That's right.

Jing-Mei: When I brought Dave in here last week with a leg injury, one of the nurses was carrying a cup of water out of his room when I went in. Lydia, the nurse, said Dave needed to take a pill. Now, I thought that was strange because Dave wasn't scheduled to take any medication at that time...

Dr. Casin: Wait a minute, he takes about thirty pills a day. How did you know he wasn't due for any medicine?

Jing-Mei: I have been administering his meds now since his attack and I have him on a schedule. I know right when he should be taking each pill. After you've given him the meds every day for almost two years, you get to memorize things like that. Anyway, I asked Lydia earlier today if she knew what medicine he took. She said she didn't see the pill but he placed it under his tongue so she assumed it was a nitro pill.

Dr. Casin: So, I was right. And if you are correct about his medicinal schedule, then he was taking them more than he should.

Jing-Mei: Well, the nitro pill is the one medicine I have no control over. None of us have. Dave takes it if he needs it and only he knows when he needs it. That he took one, should have told me something was wrong, but really, that is not what is bothering me.

Dr. Casin: What then?

Jing-Mei: I didn't think much of it before, but now sitting here with Dave it's been eating at me. Lydia said Dave needed the cup of water to take the medicine---Dave doesn't take water with a nitro pill, he takes it sublingually and lets it dissolve under his tongue. Why did he need the water then? Come to think of it, he's been drinking alot of water lately.

Dr. Casin: Good question. I may have an idea but let me try running a test on him while I do his pre-op tests. Are you on tonight?

Jing-Mei: Yes I'm working graveyard until 5am. As a matter of fact, I'm late now. You will let me know what you find, right.

Dr. Casin: Yes, I will.

Jing-Mei and Dr. Casin part. He goes to care for his patient and she heads towards the ER to begin her seven hour shift.

At about 5:30 in the morning, Jing-Mei arrived home. Mrs. Peterson came out of the nursery with Antonio in her arms.

Mrs. Peterson: It's just you, Dr. Chen. You scared me.

Jing-Mei: Sorry, is everything alright with the baby? Where's Rusty?

Mrs. Peterson: He just needed to be changed. Rusty's still asleep.

Jing-Mei: After you put the baby down, I need to talk to you.

Jing-Mei headed into Rusty's room and sat on the end of his bed. Usually, she didn't believe in waking up a sleeping child, but in this case she made an exception. She started tugging at his foot and when that didn't arouse him, she put her hand on his back and gently shook the boy awake.

Jing-Mei: Rusty.

Rusty woke up, groggy and with his eyes still half-shut.

Rusty: Mama Jing?

Jing-Mei: Sorry to wake you, little guy, but I need to speak with you. Get up and come into the living room with me.

Jing-Mei walked out of Rusty's room and banged into Mrs. Peterson coming from the nursery. Both ladies sat on the couch and waited for Rusty to join them. He dragged his tired body in still wiping the sleep from his eyes and yawning.

Rusty: What going on?

Jing-Mei: Sit down, Rusty. I need to talk to the both of you.

Mrs. Peterson: Is this about Dr. Dave and why he's not with you?

Jing-Mei: As a matter a fact, it is.

Mrs. Peterson: Something's wrong. I knew it when he didn't come home with you?

Rusty: Papa okay?

Jing-Mei: Rusty, papa's very sick in the hospital. He needs to have another operation.

Mrs. Peterson: What's wrong with him?

Rusty: Papa have tonsils out, like me?

Jing-Mei: Not exactly. Your daddy's got something the matter with his heart and the doctor's have to fix it.

Rusty: Papa gonna be okay?

Jing-Mei: Well, his doctor said if everything goes smoothly that he should be back home in time for Thanksgiving.

Rusty: That good.

Jing-Mei: Very good. But I need a favor from you, too. Papa's going to be in the hospital for awhile and I need to spend time there with him so he won't be lonely or afraid so I need you to help Mrs. Peterson around the house.

Rusty: How?

Jing-Mei: By helping to care for Antonio and the dogs and keeping your toys picked up. I'm depending on you. And if you do a real good job, there will be a raise in your allowance.

Rusty(grinning from ear to ear): Thanks Mama Jing! But I hope papa gets better soon.

Jing-Mei: So do I. Now, why don't you go back in and get some more sleep and keep good thoughts for you daddy.

Rusty walks over to Jing-Mei and gives her a big hug and kiss.

Rusty: I'm man of the house 'gain. I won't let you and papa down. I promise and I love you.

Jing-Mei: I know you won't. Now scoot.

Rusty goes back into his room and Jing-Mei and Mrs. Peterson head into the kitchen.

Mrs. Peterson: Why don't you get some rest. You look exhausted.

Jing-Mei: No time. The doctors are running some pre-op tests on Dave and I want to be there when they get the results.

Mrs. Peterson: Then let me fix you something to eat.

Jing-Mei: Coffee's fine.

Mrs. Peterson: What happened to him?

Jing-Mei: Everything seemed alright with him when we left here yesterday, but I found out differently when we got to his cardiology appointment. Well, first he had a difficult session with Dr. Legaspi and then we went for his orthopedic appointment where his doctor said that he may want to operate again on Dave's legs. He says that some of the plates and pins holding the bones together in his legs may be a little tight which would account for Dave having trouble moving and using them. It might have been the reason why he fell last week. He wants to make some adjustments to them.

Mrs. Peterson: What about his heart?

Jing-Mei: His cardiologist, Dr. Casin, said that Dave has probably been in pain for some time. He ran an EKG on Dave in the office and the results weren't positive. He said he needed to run more tests and to keep him overnight for observation.

Mrs. Peterson: Sounds reasonable.

Jing-Mei: Only problem was, Dave did not want to stay. He was hysterical when I left him. When I was down in the ER, I got a call that Dave was in trouble. He had a mild heart attack so now they need to open him up, replace a valve and insert a couple of stents.

Mrs. Peterson: Poor Dr. Dave. More open-heart surgery.

Jing-Mei: He's tough and I know he'll be alright, I just don't understand why he didn't say that he was sick earlier. Maybe then, we could have done something before it got this far. (pause, looking at her watch)Well, I have better get going. Dave goes into surgery in just over an hour. I'm off today but I think I'll be staying at the hospital for awhile. If you need me, call or page me.

Mrs. Peterson: I will but you go be with Dr. Dave and don't worry about us. We will be just fine.

Jing-Mei leaves for the hospital and arrives in just under thirty minutes. She heads straight for Dave's room. Dr. Casin is inside so she waits patiently outside for him.

She stands back as the orderlies move a sleepy Dave out of his room and towards the elevator.

Jing-Mei: Everything alright?

Dr. Casin: Yes, he's on his way to being prepped and if you can walk and talk with me, there is something we need to discuss.

Jing-Mei: Sure. What's wrong?

Dr. Casin: I've been thinking alot about what you said with Dave's excessive water drinking and I ran a test and it confirmed what I suspected. Dave is on his way to becoming severely dehydrated.

Jing-Mei: But how?

Dr. Casin: With his kidney failure, the dialysis and the water pills he takes for his heart when you think about it, it makes sense.

Jing-Mei: So, what happens now?

Dr. Casin: We can't cut back on his dialysis so I'm going to decrease his Lasix. Unfortunately, that may cause excess fluid to build around his heart but it's either that or I put him on a permanent saline drip IV. His veins are very fragile with all the IVS he's had over the years, that we may have to put the IV in his stomach or leg which will inconvenience him in his rehabilitation but so will fluid around his heart. So, it's a no win battle.

Jing-Mei: Do what you feel is best in Dave's interest. As long as he's kept alive, we will find a way to manage. We always do.

Dr. Casin: This is where I leave you. Try not to worry. Dave is in excellent hands. I'll take good care of him.

Jing-Mei: I know. How long do you think the surgery will take?

Dr. Casin: Barring any complications, I figured about 2-3 hours. You'll be around?

Jing-Mei: Down in the ER or lounge. Page me and good luck to both you and Dave.

Dr. Casin: Thanks and I'll tell him you said so.

Jing-Mei enters the lounge where she sees several co-workers on a small coffee break.

Mark: Jing-Mei, how's it going?

Jing-Mei: Dave just went into surgery and I don't want to leave until I know he's alright so I guess there's nothing to do but wait.

Kerry: We aren't busy right now, but we could use an extra hand if a trauma comes in. I know you're off today but if you want to keep busy while you wait...

Jing-Mei: Thanks Kerry. But I'm afraid my mind would be preoccupied on what is happening upstairs. I wouldn't be able to give my patient my full attention like they deserve.

Kerry: If you change your mind, let me know.

Luka: Have you eaten, yet?

Jing-Mei: Not really.

Luka: I'm off now. How about you let me treat you to some breakfast?

Jing-Mei: Thank you, Luka. I don't want to leave the hospital.

Carter: Dave just went into surgery, he'll probably be there for hours...

Luka: Right, and we'll only be across the street at Doc Magoos. They can page you there if there's a problem.

Jing-Mei: Alright, you've talked me into it.

Jing-Mei and Luka leave for Doc Magoos. Up in surgery, Dr. Casin cracks Dave's chest open once again, and takes a deep breath as he sees the condition of his patient.

Dr. Casin: Scalpel, please. He's in worse shape then I thought.

To be continued. Please read and review.