Author's notes, on updating: I'm very, very glad people read my stories, I'm especially happy for reviews and PM's. But I write not only when I can but also only when the spirit moves, and that is something that comes and goes. I can't force it. This isn't medical, legal or academic writing – that I could sit down at my desk and write almost any time of any given day and I did well.
This – fiction writing that is – is hard for me, especially to do at all well. I do it for self improvement as well as enjoyment.
As far as concentrating on only one story, I've thought about it. I won't necessarily write or post more, in fact, I think I write and post less. Trying to channel writing energy into the wrong story or away from a one-shot or new story doesn't help; in fact, I end up writing nothing and just wasting that time.
And life gets in the way, a lot. Adult and parental obligations are different and tend to bleed over into every moment of the day.
I don't mean to vent, but I want people to know that I am so glad people are enjoying and following my stories. I will post when I can, quality over quantity and speed I hope, but things will get in the way of writing at times.
But don't worry: I love this story, and I will finish it; in fact a lot of the rest of the story is written.
Disclaimer, reiterated: I do not own DC Comics nor Warner Brothers, the Teen Titans, or the characters this AU (alternate universe) fic is based on. I do, however, own the plot. I do own a copy of Red Hood and the Outlaws #1, and I'm not happy with DC at all.
New Character:
Jesse Chambers, RN (Jesse Quick, Liberty Belle, The Flash); married to Richard Tyler (Hourman)
Medical Definitions:
hCG: human chorionic gonadoptropin: pituitary hormone measured as a qualitative level of pregnancy; not only will it indicate that a woman is pregnant, it can estimate how many weeks.
Hypovolemia: a decrease in the amount of circulating blood plasma by volume, somewhat synonymous with decrease in the amount of circulating blood.
Peripheral Line: Intravenous IV line in the arms, legs, hands, feet or scalp.
Central Line: IV line in the neck, chest, torso or groin.
Cut Down: Surgical incision usually of the neck or groin to allow visualization of the large veins or arteries for placement of a central line. Used for a severely hypovolemic person when other means of IV access have failed. (It's no fun.)
Non-rebreather mask (NRB): a mask that covers the nose and mouth with an attached bag that inflates; used mostly in emergency situations because it can give a patient oxygen in very high concentration, up to 100%. It is a mask used when a patient is still breathing on their own.
.
So let's see what's wrong with poor Kori...
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Double Take
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Chapter 77
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Kori had been just waking up a bit, presumably feeling better with the additional intravenous fluids. Rachael had left the trauma bay, leaving Dick briefly alone with Kori, so she could see what was going on; Rachael wanted to make sure that all the possible tests were being run on the blood already drawn, so a diagnoses and a treatment plan for Kori could be expedited.
Things were moving far too slowly.
There was a single knock and the door simultaneously opened and a slim blonde woman walked into the room. "Hello, I'm Jesse Chambers, I'm coming on with the three o'clock shift, and I'll be the nurses working with Ms. Anders. I'm here to check her vital signs."
Dick stood up and turned around to face the nurse in her mid-thirties. "Hello, Mrs. Tyler. I'm glad Kori will be in good hands."
"Oh, uh, Dick, hi." Jesse had pursued Dick while already involved with her now-husband, Rick Tyler, something Dick was not particularly appreciative of, especially because he liked her quite a bit. Dick never meant to get in the middle of another couple and it wasn't like he didn't have plenty of other women to choose from.
"How is she doing, Dick?"
"Kori was just beginning to stir a bit. She may be a little more comfortable, she seems more relaxed. I was going to let her rest until she needed to be awakened."
"Okay, I'll be quick, I'll just take her signs and then give her a Tylenol suppository. There was just a new order for one."
"I'm glad she's finally getting something for her fever. It seemed to come on suddenly late this morning right before we come in here."
Richard would have preferred she get Tylenol pills, but if she was vomiting and at best barely awake, it wasn't the best idea either. He moved to the left side of the bed, knowing that Kori would be rolled onto her left side to be given a suppository, and pulled a chair around to that side of the Stryker trauma stretcher.
Jesse first checked the flow chart, which summarized Kori's vital signs. They'd been taken every fifteen minutes since her arrival in the ER, and she remained on a heart monitor which kept a continuous recording of her heart rate, respiration rate and the oxygen level in her blood. It also took her blood pressure every eight minutes. With those readings, Jesse only had to manually take Kori's temperature.
Jesse took glances at Dick a couple of times as she moved about the room. It wasn't that Jesse wasn't focused on her job, it was just that it was an awkward situation. When she picked up Kori as a patient at the change of shift, she was asked to because she didn't know Kori as Jesse had just taken the job in the ER full-time. Rumor had it that with Dick's hand injury, he might never come back. Not that she thought it would be that awkward working with Dick; they were both professionals.
"Kori, my name is Jesse," the nurse said as she neared the head of the bed. Kori swallowed and nodded but did not open her eyes. "I'm going to put a thermometer in your ear for a temperature, okay? It might be a bit cold and I'll pull on your ear, but you know that, right Kori?" Jesse took Kori's temperature and it was 102.3 degrees Fahrenheit, a full degree warmer than it had been on arrival in the ER and given that a tympanic temperature (one taken in the ear) can translate a full degree different from the patient's body temperature, this was a concern in an adult.
"Dick, do you want to step out while I give her a suppository?"
In spite of the injury to his hand, he was there, he wasn't about to leave if he could help it and was going to assist with Kori's care as much as possible, especially in her compromised state. "I think I'll stay with Kori and give you hand, thanks." Dick replied. "Kori, we are going to roll you toward me to give you a suppository-"
There was another knock and Dr. Kovar ducked into the room. "Dr. Grayson, we double checked the pregnancy test to be sure and you were correct, Dr. Anders' hCG was negative."
Dick gave him a glare. Why bother doing a dummy chart if he was going to announce the results to the world? He'd bring it up another time, yes he would.
Jesse spoke up. "Leonid, Ms. Anders' tympanic temp is up to 102.3. I'm about to give her the Tylenol suppository you ordered. Anything else we need to do?"
"No, Jesse, just go ahead with that. I'll be back in a moment." Dr. Kovar nodded at Dick and left.
"Here we go Sweetheart," Dick said as he rolled Kori toward him, using his good left hand and his right elbow.
Kori struggled when Jesse had inserted the lozenge. She didn't open her eyes as she mumbled some words in Tamaranian that she felt very ill, was going to vomit and that her belly hurt.
"Kori, I'm here. I'll make sure we get you something for nausea, hold on a sec. Anything else wrong?"
"Meag grak iglslag'gster... vsl'ag..."
"Jesse, I'll need an emesis basin." Jesse handed Dick a kidney bowl just in time. "It's okay Kori... I'm here," Dick said soothingly.
Kori started to vomit up some tinges of blood with the bile.
"I'll get Kovar," Jesse said and left the room.
TtTtTtTtTt
Rachael entered the room with Dr. Kovar. "Fluid resuscitation is the cornerstone of care..." Kovar argued with Rachael as they walked into the room. She now had on her lab coat. "We need to examine Kori."
Years of working together, and with Rachael as his senior, Rachael had a way of telling Dick what to do. "I need to call Ambassador Galfore to tell him what is going on."
"She'll be fine Dick," Rachael said, squeezing his shoulder.
Dick was fighting tears when he left. He had a bad feeling about things.
TtTtTtTtTt
"As I was saying, fluid resuscitation-"
"I am well aware of that, but she is really very sick, Leonid."
"She looks better now, we have sent off lab work. We continue fluids, we await results they not much longer now."
Rachael grabbed the flow chart clip board at the end of the bed, "Temperature is up, BP is down on the systolic about 10 since she's been here, even with the fluids she's tach'ing at 120's... how about a C&S?"
"We will draw cultures and sensitivities-"
"Times two-"
"Yes, from two locations shortly."
"Stool cultures, ova, parasites, she was traveling overseas-"
"In Europe, hardly known for Traveler's Diarrhea- okay, yes. Plus, she has had weight loss since before she traveled per the history you gave. This may not be a completely emergent medical condition. I believe she needs admission, but I will not jump through hoops and get her fast tracked into aggressive treatment when she has had medical issues for two months just because..."
Rachael's eyes narrowed.
"Because she is Dick Grayson's girlfriend."
"Dr. Kovar, I question your lack of objectivity, let alone your reason for it. I will pull rank. Remember, I was here with her yesterday and she wasn't conscious when she came in today-"
"That is why we drew drug and tox screens."
TtTtTtTtTt
Dick returned to the room and went right over to Kori's bedside. "She seems less awake."
"She does yes, a bit less awake," Jesse agreed. "She spoke a bit, I'm not getting what she's saying, but she's asking for you."
Dick smiled sadly. "I thought the Tylenol would help."
"Give it time, Grayson. She do fine. As I say, Tamaranians are resilient people." Kovar exited the room with Rachael on his heels.
"You shouldn't provoke him."
"Because he's Bruce Wayne's son?"
"No, because he's a colleague and a very good doctor and because you are not doing a very good job taking care of his girlfriend."
Kovar rolled his eyes at Rachael and she ducked back into the room, letting the novice attending ER doc go for the time being. "She's not coming around again." Dick told Rachael. "Kori?" There was no response.
"I'll get Kovar." Dick gave her a look. "He's still her doctor."
Kovar bound in and looked at Kori. Dick looked lost, "Kori, Star?" He squeezed her hand.
Kovar reached in and gave a sternal rub and elicited a grimace from Kori, Rachael put her hand on Dick's shoulders to stop him from saying something before she did, "Kovar, we are not worried about a coma at this point, no reason to look for a pain response," Rachael said patiently. The sternal rub, rubbing the knuckles with pressure over a patient's ribcage at the breast bone is quite painful and saved as a way to measure whether or not a patient is in a coma.
"What antibiotics are we going with?" Dick said pointedly.
Kovar looked over, feeling challenged. "None before we call in medicine consult."
"She was out of the country, let's go with infectious disease." Rachael said.
"Is Sunday, no one available."
"Well, let's at least get her admitted." Rachel and Kovar stepped out to make the calls.
TtTtTtTtTt
"Her pressure is dropping, have you noticed that Jesse?"
"Hmm, some."
Dick squeezed the bridge of his nose. "And what's the only non-medicinal treatment for hypotension?"
"Umm-" Jesse scowled at him, "are you pimping me?"
He ignored her. "Same as we'd do for increased intracranial pressure."
"Raise head of bed?"
"Thirty degrees." Dick smirked, "learn something new everyday. Now, if she's hypovolemic, we'd do the opposite... but..." he faltered. God, what was happening, fluids in, she should be getting better...
"She'll be okay Dick, really. We'll figure it out."
"Not with Kovar faffing around."
"Rachael isn't going to let him screw this up."
"She's giving him too much free rein. I just got Kori back in my life, we haven't even worked through the details yet, and she looks so bad." Tears pricked his eyes and Jesse put a hand on his shoulder.
"We'll leave her head a bit elevated, and she's rolled up on her left side so she's facing you. Blood test'll be back soon, I'm sure they'll start some antibiotics soon or something-"
"Thanks, Jesse."
TtTtTtTtTt
Rachael waited back in Kori's room with Dick. The white blood cell count was, not surprisingly, very high, so there must be an infection. Antibiotics couldn't be started until the cultures were drawn. Jess was there as well, having been pulled off her other two ER patients to do one-on-one care with Kori at Rachael insistence.
Not that Dr. Roth would tell Dick directly, but Rachael really had a bad feeling about things. Her theory was that the previous weight loss had nothing to do with whatever was happening and whatever she did have was no simple thing like a bad infection of salmonella or one of the other common food borne illnesses. Her fear was that it was a biphasic disease, that is, one with two stages, and that the vomiting was the first stage and this was the start of the second phase and that things could get bad quickly.
TtTtTtTtTt
Dick left to meet Galfore and Bruce after a moment with Kori where he poured his heart out to her in Tamaranian, begging her forgiveness, telling her how much her loved her, hoping that they would have the future they planned. Why he didn't propose, well, he'd tell himself she wasn't in a position to respond.
Jesse prepped the inside of Kori's elbow, the antecubital space, for a blood culture. "I double checked with the lab Rachael and there was enough blood drawn in a plain tube to do one set of blood cultures, so we'll only need to do one, unless you think I should do two."
"Kovar's still the doc on the case."
"That's why I'm checking with you," Jesse replied.
"Jesse, this situation here today is unusual. We shouldn't let it cloud our judgment of each other's professional skills."
"All right, I'll try."
Jesse returned her attention to the concentric circles of Betadyne on Kori's skin and then allowed the skin to dry. Years of experience made all the actions automatic: laying out and accounting for all the necessary equipment ahead of time, maintaining the sterile field once the skin was prepped. Used to doing the procedure alone, she was more than happy for a hand; it made maintaining the sterile field much easier and she was concerned that Kori might react to the size of the needle – blood cultures require a decent amount of blood.
"Kori, tourniquet on your arm and here's a pinch-" Jesse said.
Kori didn't react at all and Jesse and Rachael shared a concerned look.
"Shit! Vein collapsed."
"Try a butterfly distally." Rachael cracked open a small bore needle with 'wings' and dropped it onto the sterile tray. Jesse tried it right down from the first site, but the vein didn't hold up.
"Nope."
"Crap."
"She's losing fluid, lets take a look at her."
Jesse broke down her IV tray and when she joined helped pull Kori's gown off, they were in for a shock...
TtTtTtTtTt
Within the half hour, Galfore arrived with Bruce. Dick had already been waiting for them, unaware of what was going on with Kori in the trauma bay. The two men looked concerned and were ushered into a nearby family room.
Dick was about to get into a major altercation with Galfore and he wasn't sure if his father was going to back him up or not.
"Richardgrayson, you have a great deal of explaining to do and the first thing I need to know is why Koriand'r is in the Emergency Room and I am called after she is already here. I am next of kin, not you! You made it clear that the relationship was not to be permanent!" Galfore's bombing voice was luckily well contained in the family room as he all but shouted at Dick.
"Ambassador, Koriand'r asked me to bring her here and I contacted you as soon as possible. As far as our relationship is concerned-"
"Stop right there! I no longer will allow such a relationship!"
"Ambassador Galfore, our concern today should only be for Koriand'r's health." Bruce interjected.
"Very well. For today. How is she?"
Dick was surprised how easily Galfore backed down and went on to get Bruce and the Ambassador caught up with what he knew about Kori's condition.
TtTtTtTtTt
All that fluid, so much of what they had been pumping into her was now going into her abdomen as ascites fluid. Why? And why so quickly?
All ascites is is an abnormal collection of fluid in the abdomen. The ER practitioner thinks trauma, or leakage from an organ such as from an appendicitis, or from an infection. A CAT scan could tell them a lot. That would be the next priority.
Kori was about to be seen by the chief medicine resident, already a tad overwhelmed by her patient assignment. She'd be way over his head. So would Kovar.
But Rachael wouldn't be in over her head, nor would Dick, not that a firm diagnosis would be in hand right away, but symptoms could be managed... well, hopefully, and Kori should be able to be kept alive while they got answers. The statistics were in their favor.
Time was not a luxury. Rachael cursed herself for giving Kovar any leniency. While he worried about Kori being pregnant, he should have continued working her up, not just assuming she was...
Kori's heart rate and temp were ratcheting up, they had her in a cooling blanket on her, still her temp was 104.1.
One IV failed.
A CAT scan would have to wait. Kori needed dependable IV access and she needed antibiotics.
Dick walked in, shell shocked from dealing with Galfore but wasn't prepared for the commotion and then, oh God, her condition. He'd seen the situation a thousand times, but the patient that everyone was working on hadn't been the woman he loved.
Jesse and Roy each tried to get peripheral IV access without success. A patient in this condition with one IV access is asking for trouble. Time for a central line.
"She's tough to get access on, she's third spacing with ascites fluid, so she's really hypovolemic. I'm sorry Dick, we can't start antibiotics until we get access and we can't get a CAT scan until we have patent access either."
"Hand me a central line kit, now," Rachael said, Roy tossing one from the supply cart to Jesse, who quickly set up the tray on the trolly. They were now opposite from before: Rachael was sterile and Jesse was assisting. Dick felt helpless as he watched Kori's upper chest being draped for the central line.
He briefly considered that Kori was naked under a single rumpled light blue bedsheet, her gown stripped away for access and continual assessment. He felt like such a lecherous creature: he'd never seen her naked before and here she was on a Stryker, almost crashing. But it was more than her being unclothed: maybe it was her protuberant belly; ironically with the ascites, now she looked pregnant.
Moments ticked away. The central line wouldn't work, both the subclavian and axillary veins on her right chest wall were prepped and both collapsed as Rachael did everything right, but Kori's body refused to allow the veins to be cannualized.
"Dammit, give me a cutdown tray." Rachael said, "Who's here who's really good?"
"Red-" Dick said tearing his eyes off Kori, having seen Xavier briefly as he walked from the family room through the ER to Kori's room.
Rachael looked at him sympathetically, "Can you grab him? We have our hands full. Thanks, Dick."
TtTtTtTtTt
Red burst into the room ahead of Dick, "Holy shit-"
"Red, can you do a cut down on the neck? Kori about to start to crash and I need a second line – I've just lost my last peripheral access and I'm doing a cutdown on the femoral and I-"
"Kori-?" Dick choked out, seeing her nearly white, now with an oxygen mask with non-rebreather on.
Warning bells started to go off on the monitors and the readings were flashing red...
"Dick, we need you to get out of here," Rachael said. "Call anesthesia, STAT!"
Roy had a free second, that was about it, "Come on Dick, let's step out, we'll get her stable, get access again, let us work our magic buddy, but we have to ask you to sit out tonight..."
TtTtTtTtTt
To be continued...
TtTtTtTtTt
Reviews always appreciated
So what is going on with Kori? (I'll tell you soon and it's a real disease); And will she be saved? (it would be an odd ending, but have you seen Deep Blue Sea? Nah, I wouldn't do that to you); And is this clinical situation plausible? (yes, experts were consulted... and all is being explained)
Also, raising the head of the bed is for chronic or long standing hypotension (low blood pressure). Dick's losing it. They'd want her flat or when she really crashes in Trendelenberg, her entire body tilted downward with the head at the lowest point.
I hope to update soon.