Chapter 4
The light was muted in the ICU as Abby lifted her head from the pillow. She looked around, confused with the lack of light. She then realized she had slept all day, it was 9pm and the harsh overhead lights were turned off for the night.
She sat up shaking the cobwebs of slumber from her head. She looked over at Luka's unconscious form studying the monitors above his bed. His heart looked like it was beating strongly.
Suddenly a harsh beeping shattered the calm revere only moments earlier. Abby's eyes flew to the heart monitor and were shocked to see his heart beating at an alarming rate. Abby lunged to the call button and pushed it several times just as Luka's body went into a strong convulsion.
Deborah and another nurse along with Dr. Barrows, an attending, hurried into the room. They were alarmed to see Dr. Kovac taking a turn for the worst; he had been doing so much better.
Dr. Barrows quickly assessed the situation. "Draw up 5mg of diazepam as a bolus! Come on, hurry up!"
The nurses crowded around and Deborah quickly administered the anticonvulsant into Luka's IV.
Abby had recovered from her shock and tried to hold Luka's head steady as he thrashed around on the bed. Tears made their way down Abby's face as she heard the monitors beeping erratically in the background. Gradually he responded to the diazepam. His body stopped it's ferocious convulsing and he rested back on the bed.
Dr. Barrows quickly pushed Abby out of the way and took her spot at Luka's head. "He needs intubation, paralyse with sux." Dr. Barrows tipped Luka's head back and guided the endo-tracheal tube down into his trachea. "There, I'm in. Bag him."
"Deb, draw up some more blood and we need to repeat the cultures. Something has obviously changed since the last test. Keep him on the vent until he starts breathing better on his own. Call me with any change." Dr. Barrows looked sympathetically at Abby, "I'll be back when the tests are in. Do you need me to explain what just happened?"
Abby shook her head. She knew that Luka had just suffered a grand mal seizure, which they controlled with diazepam and intravenous fluids. He was on the vent because his breathing had deteriorated and they were running more tests to determine exactly what caused this neurological event.
Dr. Barrows placed a weathered hand on her shoulder. "I'll let you know what we find in the blood work. Hang in there."
Abby murmured a quiet thank you and sat down on the metal chair. She wiped Luka's sweaty brow with a soft white cloth and buried her head in her hands.
Deborah drew three vials of Luka's blood to be tested. "I'll put a rush on these labs, we should know the preliminary results in the next hour or so." She patted Luka's hand and rearranged the blanket, which had become disarrayed throughout the commotion.
"I'm off now so if you need anything, Jamie Scott is the R.N. on duty tonight."
"Thank you." Abby smiled warmly and watched the brunette nurse leave.
* * * * * * * * * * * *
An hour and a half later, Abby was shook awake by Dr. Barrows. She sat up, groggy from slumber. She looked over at Luka who hadn't moved since she fell asleep. Hell, he hadn't moved since they brought him into the ER nearly 24 hours earlier.
Abby studied the doctor's face intently. Her stomach sank when she saw worry lines creasing his forehead. "Miss Lockhart,"
Abby interrupted, "Please call me Abby."
"Sorry, Abby. As you know, we ran further tests on Dr. Kovac. One of these was a parasitic analysis. What turned up was disturbing. The parasitic load in his blood has doubled within the last twelve hours. We ran tests on these parasites by doing a comparison of species from a database provided by the Centre for Disease Control in Atlanta. Dr. Kovac is suffering from complicated malaria associated with the parasite form Plasmodium falciparum. This parasite brings about a complex form of malaria which can result in convulsions, renal failure, coma and even death."
Abby's breath caught as tears welled in her eyes for what she felt was the hundredth time that day. "What is his prognosis?"
Dr. Barrows looked unsure how to answer. "Well, this new discovery makes it very hard to treat, but we have to remember, Dr. Kovac is a young, previously healthy man who is in the right place right now. We need to use a more aggressive anti-parasitical called Quinidine Gluconate run in at 10mg/kilo for 2 hours. After the initial two hours, we will give him 0.02mg of Quinidine Gluconate per kilo per minute until these parasite levels drops and his vitals improve.
Meanwhile, we will treat any complications and watch him intently for signs of renal and respiratory failure. We have him on the vent now but we may be able to wean him off that after the initial treatment of Q.G. I'll get the nurse to start the drugs now and I'll keep checking in during the night. I'm going to stay until we see some improvement in Dr. Kovac's condition."
"Thank you doctor." Abby gripped Luka's hand and watched his face intently as if she could will his eyes open. He didn't stir. "Hang on Luka, we've got the right drugs now."
The light was muted in the ICU as Abby lifted her head from the pillow. She looked around, confused with the lack of light. She then realized she had slept all day, it was 9pm and the harsh overhead lights were turned off for the night.
She sat up shaking the cobwebs of slumber from her head. She looked over at Luka's unconscious form studying the monitors above his bed. His heart looked like it was beating strongly.
Suddenly a harsh beeping shattered the calm revere only moments earlier. Abby's eyes flew to the heart monitor and were shocked to see his heart beating at an alarming rate. Abby lunged to the call button and pushed it several times just as Luka's body went into a strong convulsion.
Deborah and another nurse along with Dr. Barrows, an attending, hurried into the room. They were alarmed to see Dr. Kovac taking a turn for the worst; he had been doing so much better.
Dr. Barrows quickly assessed the situation. "Draw up 5mg of diazepam as a bolus! Come on, hurry up!"
The nurses crowded around and Deborah quickly administered the anticonvulsant into Luka's IV.
Abby had recovered from her shock and tried to hold Luka's head steady as he thrashed around on the bed. Tears made their way down Abby's face as she heard the monitors beeping erratically in the background. Gradually he responded to the diazepam. His body stopped it's ferocious convulsing and he rested back on the bed.
Dr. Barrows quickly pushed Abby out of the way and took her spot at Luka's head. "He needs intubation, paralyse with sux." Dr. Barrows tipped Luka's head back and guided the endo-tracheal tube down into his trachea. "There, I'm in. Bag him."
"Deb, draw up some more blood and we need to repeat the cultures. Something has obviously changed since the last test. Keep him on the vent until he starts breathing better on his own. Call me with any change." Dr. Barrows looked sympathetically at Abby, "I'll be back when the tests are in. Do you need me to explain what just happened?"
Abby shook her head. She knew that Luka had just suffered a grand mal seizure, which they controlled with diazepam and intravenous fluids. He was on the vent because his breathing had deteriorated and they were running more tests to determine exactly what caused this neurological event.
Dr. Barrows placed a weathered hand on her shoulder. "I'll let you know what we find in the blood work. Hang in there."
Abby murmured a quiet thank you and sat down on the metal chair. She wiped Luka's sweaty brow with a soft white cloth and buried her head in her hands.
Deborah drew three vials of Luka's blood to be tested. "I'll put a rush on these labs, we should know the preliminary results in the next hour or so." She patted Luka's hand and rearranged the blanket, which had become disarrayed throughout the commotion.
"I'm off now so if you need anything, Jamie Scott is the R.N. on duty tonight."
"Thank you." Abby smiled warmly and watched the brunette nurse leave.
* * * * * * * * * * * *
An hour and a half later, Abby was shook awake by Dr. Barrows. She sat up, groggy from slumber. She looked over at Luka who hadn't moved since she fell asleep. Hell, he hadn't moved since they brought him into the ER nearly 24 hours earlier.
Abby studied the doctor's face intently. Her stomach sank when she saw worry lines creasing his forehead. "Miss Lockhart,"
Abby interrupted, "Please call me Abby."
"Sorry, Abby. As you know, we ran further tests on Dr. Kovac. One of these was a parasitic analysis. What turned up was disturbing. The parasitic load in his blood has doubled within the last twelve hours. We ran tests on these parasites by doing a comparison of species from a database provided by the Centre for Disease Control in Atlanta. Dr. Kovac is suffering from complicated malaria associated with the parasite form Plasmodium falciparum. This parasite brings about a complex form of malaria which can result in convulsions, renal failure, coma and even death."
Abby's breath caught as tears welled in her eyes for what she felt was the hundredth time that day. "What is his prognosis?"
Dr. Barrows looked unsure how to answer. "Well, this new discovery makes it very hard to treat, but we have to remember, Dr. Kovac is a young, previously healthy man who is in the right place right now. We need to use a more aggressive anti-parasitical called Quinidine Gluconate run in at 10mg/kilo for 2 hours. After the initial two hours, we will give him 0.02mg of Quinidine Gluconate per kilo per minute until these parasite levels drops and his vitals improve.
Meanwhile, we will treat any complications and watch him intently for signs of renal and respiratory failure. We have him on the vent now but we may be able to wean him off that after the initial treatment of Q.G. I'll get the nurse to start the drugs now and I'll keep checking in during the night. I'm going to stay until we see some improvement in Dr. Kovac's condition."
"Thank you doctor." Abby gripped Luka's hand and watched his face intently as if she could will his eyes open. He didn't stir. "Hang on Luka, we've got the right drugs now."