Sorry, this is on the shorter side too. Very little dialog, a lot going on... more to come soon! I tried to not get overly detailed in either the clinical piece or diplomatic/international intelligence piece. I'm happy to explain the clinical end anytime... nurses are teachers.
There could be so, so much there, but it was getting too tangential, so I tried to focus on what is just affected Dick and Kori and their close friends. I'd like this fic to have under 100 chapters or so.
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Some Medical Definitions:
Paracentesis - the removal of ascites or peritoneal fluid, that is fluid collected in the abdominal cavity. The fluid is removed or 'tapped' by inserting a long, thin needle directly into the abdominal cavity and the fluid is collected into a vacuum tube. Varying amounts can be removed, as high as 4 liters at a time.
Critical Condition - Vital signs (heart rate, blood pressure, etc) unstable, not within normal limits, in need of critical care, indicators are unfavorable.
Grave Condition - also referred to as very critical condition, not always used, can mean death expected or imminent, indicators are for an unfavorable outcome.
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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.
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Double Take
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Chapter 79
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Dick shook off Galfore's words. He knew that there would be a confrontation between the two of them in the near future no matter what the outcome of Kori's illness was. Not something he looked forward to, but it was a small price to pay to be in Kori's life. A small but scary price.
Dick approached the trauma bays to the tell-tale bins of isolation gear. It was hardly a surprise. Piles of clean ones to put on, recepticals to dispose of the used ones. All the personnel and visitors going into that room, even for a moment would have to don special isolation gowns, masks and caps. Although anthrax is not communicable from an infected person to another person under normal circumstances, giving emergency room care is not normal circumstances; Universal Precautions are suggested but taking Special Precautions aren't unreasonable.
If anything, things were moving at a more frenetic pace with more people involved when Dick went back to Kori's trauma bay. Beyond the sea of yellow gowns and blue caps, Dick saw Kori, looking even smaller and sicker than when he left. He figured he'd be asked to leave soon, so he tried not to interfere, but he also wanted to be sure that everything was being done for her.
Kori had tubes everywhere. She remained on a ventilator so she had a breathing tube in her mouth, and had two intact central IV lines that Red had placed, one in the groin, the other in her neck. She had a foley cathetor draining a scant amount of urine into a bag.
Kori was being prepped for a paracentesis, Dick was relieved to note. Also referred to as a belly tap, it would remove some of the ascites fluid from her abdomen, relieving pressure from her organs and making her more comfortable in general.
Through her IV lines, Kori was receiving albumin, IV fluids, the broad-spectrum antibiotic Cipro and a low dose of Ativan for sedation so she would tolerate the ventilator. She remained on a cooling blanket for her high fever and would be receiving Tylenol via rectal suppository. If she showed any of the non-verbal pain cues, she would receive IV morphine.
Sympathetic glances were afforded Dick. Red approached him; not officially on the case, just pulled in to do the cut-downs for the central lines Kori had needed because she was so dehydrated her peripheral lines had failed, Red had stayed to lend a hand.
"The gram stain was positive. I've been on MedLine and I've pulled all the current treatment guidelines for GI anthrax," Red explained and then went on to all the particulars of the treatment regimen. "Any thoughts, Dick? You were the one that came up with the provisional diagnosis, anything we need to think about?"
Dick eyed Kovar suspiciously, and even though Rachael was there, he worried that taking too much ascities fluid off of Kori's belly would cause symptoms of a 'fluid shift', causing her body to try to compensate further, leading to more ascites fluid.
"We'll need to tap Kori's belly conservatively-"
Rachael glanced over, "Yeah, she's not going to tolerate too much at once." She turned her attention to the the novice ER doc. "Let's start off with 45 cc's."
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Within six hours from when the blood was sent, the first set of cultures grew out the preliminary finding of Bacillus anthracis, better known as anthrax, finally confirming Dick's diagnosis, not that it was in doubt at that point.
The treatment that Kori was receiving was combating the disease in so far as that the disease was not progressing as quickly, but she was slowly getting sicker. The physicians from the Centers of Disease Control, the CDC, were about to arrive from Atlanta to take over the case and had forwarded their latest treatment guidelines.
Galfore and Richard were each given some time with Kori, with Rachael and Roy very close at hand in case anything in her condition changed; a condition that Rachael was concerned would go from critical to grave if things got much worse.
Galfore entered the trauma bay and sat by Kori's head, trying not to let her hear his own shock and fear in his voice as he spoke to her in Tamaranian. "I have always expected great things from you my princess, and now is no exception. You are stronger than any illness. I know you can beat this. I wish to see you marry and have children of your own, my little bungorf, I wish to be their k'norfka as well. I love you, Koriand'r, be strong and fight."
Galfore stopped Richard at the doorway before Richard went in for his last visit for what was likely a number of hours. "I have been very disappointed with your treatment of Koriand'r of late, Richardgrayson, but if you truly love her, then I encourage you to tell her. Tamaranians give their hearts fully and I believe Kori has already given you hers. Knowing you love her will give her strength now, no matter how I feel about you or even how you've treated her."
"I do love her Ambassador, and I plan to tell her that every chance I get."
Galfore gave Richard a quick nod and then left, allowing Richard to have his time with Kori. He too spoke to her in Tamaranian, sitting quietly at the head of the stretcher. "Hey, Kori m'love, I'm going to be not too far away if you need me, but some special docs from the CDC are going to be here with you to help you fight this anthrax for a bit and they won't let me do any backseat doctoring. You're doing a great job fighting, and just know I love you and when you're better, we'll work things out. Whatever you want. We can get married right away or wait, it's up to you. I am so sorry you're going through all of this. I wish I could take it all back, take the pain all away. Everything that happened, everything that came between us... it's been the biggest mistake of my life. You're everything to me, please baby. I love you so much, Koriand'r, and I'll be here when you wake up, okay."
Richard leaned in pressing his lips to Kori's temple, not liking the temperature of her skin at all.
"Hey, Rachael, she's hotter, I'm worried tha-"
Alerted by sudden movement, Dick turned back to see Kori having seizures.
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"Seizures. Crossed the blood/brain barrier, she has meningitis..." Dick said almost absently as he just stared at her.
Rachael grasped Dick by the shoulders, "Go out to the family room, I'm calling a code as a precaution only okay, but I've got to go my thing."
The alarm went off on the monitor, Kori pressure dropped to 68/40.
Roy activated the hospital's code system and then, for the second time, escorted Dick to the family room. He gave a nod to Red and a head motion to indicate to go back to the room before the automated voice came on over the hospital's PA system:
Code Blue ER Trauma Bay 1... Code Blue ER Trauma Bay 1... Code Blue ER Trauma Bay 1...
And with that, Kori's condition was officially downgraded to grave.
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Over the next few hours, the CDC was fully set up at the hospital to coordinate Kori's care, discover the exact strain of B. anthracis through analysing the genotype, containing any possible spread of the disease, educating hospital staff and offering public briefings.
Right on the CDC's heels were INTERPOL, the FBI and the CIA. Scotland Yard was sending investigators. Coordination was being set up with Greece's National Intelligence Service as reports had already come in that Kori was one of ten people made ill by confirmed or suspected anthrax, all who attended the G20 Summit, but reports were coming in. There had been two deaths, originally considered 'natural causes' that were also being investigated.
As the publicity of the case emerged, the press set up a tent and satellite dish city along the streets to the hospital. The local and national outlets along with the 24-hour news channels had arrived, and soon there was Sky News and CNN International, as this was truly an International Incident. Rumors were running rampent. Speculation of who the patient was had been short lived, and Kori Anders was identified and she was in the news again.
Because the anthrax was ingested, it could strike anywhere along the GI track, from essentially the mouth to the bowel. Some people that attended the G20 Summit were effected and some were not. It was obvious in some cases where people came from countries that innoculated the people and not the livestock against anthrax, there was an existing immunity. The industrialized countries were at a disadvantage.
Interviews were started to see what functions related to the Summit had been attended by the victims and then to look at the menus, assuming that the anthrax bacteria was food borne.
Even though there was a suspicion that it was the Citadel, they had been threatening for sometime and Kori had even been questioned by INTERPOL only days before, there was no proof that Kori was targeted by her sister; it may have been a happy coincidence by Komand'r, the terrorist that goes by the name Blackfire.
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Still in the ER, Kori responded to an increase in her Ativan for her seizures and a second antibiotic, a doxicycline-based one, was added to combat the infection. A lumbar puncture, or spinal tap, was done to confirm that Kori had meningitis.
Periodic paracenticis was continued to pull off some of her ascites fluid.
Within another three hours, Kori was showing improvement. Her fever dropped and she was making more urine. Her ascites was not getting worse again after getting her belly tapped. Her pressure was up to 85/60. She stopped having seizure activity. It was clear that her body was responding to treatment and fighting the disease.
Her condition was upgraded to critical.
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Dick was interviewed again by the authorities. Why he had to interviewed separately by the FBI, CIA and INTERPOL, he had no idea. Well, he did know, but it was frustrating. He was not a suspect, but he was being watched closely. If he'd try to go anywhere, he wondered if they'd try and do anything to stop him. But he wasn't going anywhere. He needed to be with Kori.
He had a break and Rachael and Gar brought him a sandwich. It was after Midnight. It was then when the true impact of the anthrax attacks on the Summit was coming to light and people were beginning to die.
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As much as Dick was relieved that Kori was upgraded, was this just a rally? He hadn't really considered they hadn't gotten the diagnosis in time, even after the meningitis... but if she could possibly have partial immunity from injections years ago that had just delayed her from getting the disease but did not prevent her from getting the full effect of the anthrax, well, that was unthinkable. After all that, could he still lose her?
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To be continued...
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Thank you for reading and please review.
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