On the Quartermaine Jet, Celia Anne Quartermaine could feel her father's eyes and his concern. So, she took a deep breath, closed the prospectus on her lap, and then looked up and met his eyes. "For the record, I was planning on bringing Brian with me tomorrow to meet with Ross Chandler. I am well aware that he is a convicted rapist, and if I wasn't Edward had Ned remind me of that and then called himself just to make sure Ned wasn't too distracted and forgot to mention it," she said.
Quentin Quartermaine blanched. Celia could only presume that he had actually been worried about the other elephant in the room; her frequent visits to her mother who was a long-term resident at Rose Lawn Psychiatric Hospital in Shepperd, NY.
"If you're more stressed about my visit to see mom, you don't need to be. I have already made plans to meet with Tracy for lunch on Saturday after I visit. She always helps me put everything in perspective. Perhaps you should return the favor to Ned," Celia said.
"I am not really sure what you want from me, honey," her father said.
"Right now, just trust me, I'm fine," Celia said with a quick smile. Then she smiled more deeply as she reflected on Julia Barrett's perspective on that word. From Julia's perspective, fine could also be an acronym for Frustrated; Insecure; Needy; and Emotionally Unstable. Of course, Celia supposed she had, certainly had a few of those moments as well.
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Dr. Monica Quartermaine offered a moment of silent prayer as she hung up the phone. Alan would not be making it home for dinner because he was going to the OR to do an emergent endoscopy for a patient massive GI Bleed. Unfortunately, the Gastroenterologist on Call, Dr. Walt Thurston was already performing esophageal banding on different patient, so the procedure fell to Alan. More unfortunately, the patient in question happened to Alan's niece by marriage who just happened to be pregnant with his nephew's unborn child. This was one of the hazards of being a surgeon on call in a small city.
Alan had faced the same situation before, ironically with the same nephew. Then Monica hadn't realized anything until after the fact. Patient privacy and confidentiality standards held even in dual physician families. Protected health information could only be shared on a need-to-know basis. Unfortunately, because Alan and the anesthesiologist both feared that Carly was in danger of going into Cardiogenic Shock, she had a need to know, and a much greater need to pray. If the worst happened, how would Ned survive the loss of another child? How would Ned survive losing another wife?
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Dr. Eve Lambert flipped her grilled cheese sandwich with a smile. She always enjoyed the nights when she had the Scanlon home to herself. The basement apartment she was sharing with her fellow intern, Dr. Julianne Devlin did have a small kitchenette, but it wasn't really appropriate for actual cooking. Technically, their lease entitled them to full use of the full kitchen on the main floor, but Eve always felt a bit like an intruder, unless she was home alone. That happened rarely but tonight Joe was on call for Internal Medicine and apparently Julie and Frank must have gone out. That had been a bit of an unexpected blessing, when she had arrived home and seen that Julie wasn't home. She hadn't been expecting that, since she knew Julie was post call and Julie and Frank had never seemed to be the go out during the work week type, but who was she to question?
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Melissa McKee Murdoch smiled when she stepped into the West elevator and pushed the button for four. She was in such a good mood that even being pulled to SICU couldn't crush that. Chase had finished presenting his case in the Dr. Pierce Dorman murder trial, so they had been able to spend Judge Lombardi's court dark day together. In the morning Chase would be back on task poking holes in Justus Ward's theory of defense and she would be catching up on sleep since her efforts at a pre overnight shift nap had been a bit thwarted once she lay down beside her husband.
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Dr. Alan Quartermaine squirted some irrigation over his cautery site and surveyed his work. Hemostasis appeared to be achieved. Normally he could be a little more optimistic about that than he felt in the moment. Perhaps it was that he had two patients or perhaps it was that the whole situation seemed both far too familiar and far too surreal at the same time. He advanced the endoscope a little further and moved out of the stomach into the duodenum which looked fine. "How is the baby doing?" he asked with trepidation.
"Baby's heart rate is 140s with good variability. But the ventilator FiO2 is still at 100%," Dr. Raymond Lockhart one of the PGY2/CA1 Anesthesiology Residents said.
"That isn't surprising; I am almost certain she aspirated on L&D. I have no desire for you to even try to extubate in PACU. In fact, I would prefer that we go directly from the OR to SICU if they have a bed," Alan said.
"Dr. Rajeswami presumed you would say that. He asked if you want to do that if you would be willing to place a central line in the OR after your procedure before transfer to SICU because we were still running six rooms at six o'clock. He said you would understand that those nights rarely end well unless everyone works together," Dr. Lockhart added.
Alan heard the uncertainty in the younger physician's voice, yet despite the horrible situation, Raj's collective complaint and appeal for cooperation made him smile. That was also familiar. "That is fine. I'm just going to irrigate one more time to be sure I truly have adequate hemostasis and then I can place a line. Does that mean we have SICU beds?" he asked.
"Mary Briggs promised that they would find a bed somewhere if you put the central line in, in the OR," Janie Meyers, the circulating nurse, said.
"Well, if you put it that way. Seriously, I think this ulcer bed looks as good as possible, so if you have a central line kit and some size eight sterile gloves I can move on to the next task," Alan said. It all still sounded far too surreal.
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Dara Jensen pulled the door to Kelly's Diner open. Justus liked the place so if he picked, they ate there at least nine out of ten times. Dara felt that the cuisine left much to be desired and at seven thirty there were so many other, and far better options. But she had told Justus he could make reservations somewhere and he had chosen Kelly's Diner which eschewed reservations.
When she stepped inside, she saw that Justus was already seated with a cup of coffee in front of him and a legal pad to his right elbow. He glanced up briefly as Dara pulled out the chair opposite him. "I waited to order; I wasn't sure if you wanted the usual, or not," he said.
Dara cringed at the idea that someone might think she frequented Kelly's Diner enough to have a usual order. She went to Kelly's after eleven on weeknights when it was basically the only thing open anywhere near the courthouse and when Justus chose the restaurant. She didn't have a usual order!
"I'll probably regret asking this, but what would be the usual?" Dara asked as she sat down.
"A Club Sandwich," Justus said before he resumed scribbling on his legal pad.
Dara supposed that was one of the most edible options at Kelly's. It was also what Justus had ordered for her during that August 1995 night when she had been the midst of trying Laura Spencer for Damian Smith's murder and had been refused service by Laura's Aunt by marriage, Ruby Anderson. Justus had taken pity on her, sat down at her table, ordered a Club Sandwich with Fries and then slid the plate across the table. It had been the beginning of a professional friendship. Or maybe it had? She knew that Dr. Simone Hardy believed she had wanted Justus all along. Had she? Had he wanted her but just felt he had to give things with Simone a chance since she had divorced her husband, Dr. Tom Hardy, at least in part to be with Justus. It was really all too convoluted. "Ok, I guess that is fine," she said.
Justus laid down his pen and met her eyes. "If you're having a bad day and would rather go somewhere else, we can probably do that as well," he said.
As tempting as that was, inertia took over. "This is fine, really," Dara said.
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Hugh Lars Quartermaine watched the aerial skyline of Port Charles come into view. He found the smaller city charming and thriving. If he hadn't feared Marla might divorce him, he would have tried for the Main ELQ CFO position. But he did fear that! So, that left him as the ELQ West CFO for the foreseeable future. If Marla could just be happy, he could make that work. He really could, but his wife's genuine happiness seemed to be fading and fleeting.
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In the waiting area outside the SICU at Port Charles General Hospital, Ned Ashton dropped his head into his hands. When he had left for his conference call regarding the new Port Charles Hotel planned for the Napa Valley, he had felt uneasy. Even as he worked through permits and negotiated the construction contract his thoughts kept returning to Carly. His worst fears had been realized when he was in the executive parking garage underneath the main ELQ Offices. He had been two steps away from his car when his cell phone had rung, and his heart had sunk when he had heard Carla Grecco's voice on the other end. Now he was sitting waiting and praying that his Uncle Alan wasn't going to come out and tell him that his wife or baby was dead. Fifteen months earlier almost to the day he had sat in the same waiting area and prayed the same prayer.
Then his wife had survived, but their baby, and marriage had not. It was more complicated than that. Most days he grasped that. Yet, as he sat helplessly, he could only focus on the reality that he couldn't pick out a tiny coffin again. That had been his best motivation for raising his cousin's child, to spare Carly and Jason that same fate. It was a bit ironic that he had buried a child because of the violence of Sonny and Jason's world, then Jason had acknowledged that risk and stepped back to save his child; but in the end Carly and the baby could bleed to death. It was even more ironic, or perhaps just more painful when Ned remembered some of his final conversations with Lois. He buried his head deeper in his hands as the tears started to flow.
When Ned regained a small amount of composure, or at least enough to lift his head, he saw his Uncle Alan appear in the doorway. Alan was still dressed in scrubs and looked exhausted, so it was hard to draw much confidence from his appearance. Ned took a deep beath, and then another but found that the words didn't come. He couldn't bring himself to ask the question that could change everything.
Perhaps Alan sensed that because he crossed the room, and then after giving his shoulder a compassionate squeeze, he sat down beside his nephew. "They are in the process of moving Carly to the Surgical ICU now. She and your son are both fighters and they're hanging in there. I managed to cauterize the base of the ulcer and get the bleeding controlled. They are going to give one more unit of blood in the ICU and then we will watch her hemoglobin closely. If the hemoglobin stays stable, then that supports my hope that we do have good hemostasis," Alan said.
"So, they will be ok?" Ned asked.
"I really hope so. I am also worried that she likely aspirated some of that blood and vomit into her lungs. She is running a fever, the chest x-ray shows infiltrates, and her oxygen requirements on the ventilator are still very high. I did a therapeutic bronchoscopy after the EGD to try to clean up some of that and so far, we've been able to support her through that though which is encouraging, and I am optimistic that she can, and will, recover. I think Dr. Collins wanted to repeat the ultrasound and take a better look at the placental blood flow once they were situated in the ICU," Alan said.
"Thank you, for everything you have done, Alan," Ned said.
"Of course, Ned, I know this is hard perhaps even more so because it is familiar. But there are some critical differences that I think should give you some hope. Your son is older gestationally than the daughter you and Lois lost, and although Carly's situation was very tenuous at first the blood loss was much more controlled and she was in a hospital and all of those things will give this baby a much better chance. I wish it could have been different for Carmina," Alan said. His voice trailed off as if he couldn't really find more words.
Ned could understand that. "I know you did everything you could for Lois and our baby. Brooklyn could be growing up without her Mama and it is because of you that she isn't. Perhaps I need to be thankful for that," he said. He did need to be thankful for that; Lois was a good mother, and Brooklyn needed her.
"You can be thankful for that and still mourn the baby you buried. Would it help if I called your mom?" Alan asked.
Ned shook his head quickly and then felt badly when he saw the change in his Uncle's eyes. Before Alan could explain that his mother would want to be there for him he said, "I will call her myself once I have gotten a chance to see Carly and we have a better idea of what we're really looking at.
Alan gave his shoulder another squeeze. "Ok, I'm going to go check on Carly in the ICU and make sure that Dr. Collins doesn't have any questions. I will do anything possible for Carly and the baby but that whatever happens this whole family will be there for you, Carly, and your son," he said as he stood up.
After his uncle left Ned just dropped his head back into his hands.
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After she finished priming the blood tubing and labeled the multiple drips, Melissa McKee Murdoch really regarded her new patient and took a deep breath. There were so many reasons to be uncomfortable both personally and professionally but when she saw Dr. Alan Quartermaine step into the room she decided to focus on the professional, like the fact that OB patients kind of freaked her out in general. "Hi Dr. Quartermaine, Dr. Rajeswami said to thank you for the central line."
Dr. Quartermaine laughed. "Did he now? I thought Raj was on team all for one for patient care. From my standpoint, I want to keep the Protonix and Octreotide drips running overnight and please call me if the post transfusion hemoglobin is below 9. Ideally, I would like it a little higher both because we have given four units and because I think my cardiologist wife would be more comfortable with that but there was that recent study that seemed to point to an increased risk of TRALI in pregnant patients and I think we would all like to avoid that. Also please call me with any hypotension because that may be the first clue that we don't really have hemostasis," he said.
"Ok, umm, was Dr. Collins going to come in? Dr. Rajeswami said something about her wanting a Biophysical Profile and I don't even know how to order that," Melissa said.
"Conveniently, I ordered the full Biophysical Profile for the morning. I'm just going to look at the doppler flow to the placenta now and then I will discuss with Dr. Collins," Dr. Stuart Cahill one of the OB residents said as he appeared in the doorway with an ultrasound machine. "Did you find the source of the bleeding?" he directed his question to Dr. Quartermaine.
"There was active bleeding from a gastric ulcer which I cauterized, and after post cautery irrigation the base looked good. I think we have good hemostasis, but we'll have to see what her hemoglobin and blood pressure do. I'm a little afraid that the lung issues will be more critical going forward. I did a therapeutic bronchoscopy in the OR after my EGD and I hope that will help," Dr. Quartermaine said.
"Dr. Collins was afraid of that as well. She spoke with Dr. Meadows who wants me to consult Dr. Martin and then give steroids if he doesn't think it will throw her into overwhelming sepsis because she is worried that we may need to take the baby early," Dr. Cahill said.
Melissa remembered Stuart from their high school days. He had been a decent guy, so she hadn't been interested in him during her hate the world rebellious period. He had still been incredibly kind to her in the aftermath of all of that, when many other students called much attention to her past. "Were you going to call Dr. Martin directly for that consult?" she asked.
"I can. Dr. Martin is usually ok with being called by the residents, so I'll call him after I check the doppler flow. I'm also going to send one of the L&D nurses down to set up continuous fetal monitoring. Dr. Collins and I will be inhouse all night so just call me if you have any concerns. I know it can be scary when you have two patients, but we really need the subspecialty help from our surgery and critical care colleagues right now so here we are," Dr. Cahill said.
"You can tell Dr. Martin that she received Piperacillin-Tazobactum before we started scoping and I wrote to continue it. If he wants to add anything else for the pneumonia, I am fine with that. Also, if you ever feel like any attending is not respecting you as a resident physician, I really do have an open-door policy. On that note, if neither of you need anything, I think I am heading out. Melissa, Dr. Breslin is in house for trauma but please call me with anything specific to this patient. Ned is in the waiting area and I think he would like to see her as soon as you're done with the ultrasound and have the fetal monitoring set up," Dr. Quartermaine said.
After Dr. Quartermaine had left Melissa watched the flashes of blue and red on the ultrasound screen not completely sure what she was looking at. "Is that what it is supposed to look like?", she asked apprehensively.
"For the most part. The flow is good, and the fetal heart rate is reassuring," Stuart said.
"So, does that mean you won't need to deliver?" Melissa asked.
"Not right now, which is good since she is only thirty-one weeks tomorrow. The problem is more if she doesn't come off the ventilator easily. The placenta pushes the diaphragm up and although it can be one of the unpleasant aspects of pregnancy most healthy women tolerate it, at least physiologically. Your patient isn't exactly healthy so there may reach a time when the continued pregnancy is actively thwarting her survival and to an extent anything that isn't good for the mom also really isn't good for the baby," Stuart said.
Melissa had a feeling, or perhaps more a fear, that his logical explanation wasn't going to play out so nicely in real life.