October 11, 1997
It was still dark when Dr. Monica Quartermaine exited the Port Charles Fitness Club after dropping Allison and Kirk at swim practice and swimming a few miles worth of her own laps. As she got into her car to head to Port Charles General Hospital, she reflected on the busy Saturday that lay ahead. She had to make ICU and CCU rounds and then meet Karen to round on the rest of her Cardiology inpatient and consult service. Ideally Alan would be done with his rounds in time to pick up Allison and Kirk from practice by seven-thirty. Katelyn had junior swim team practice at ten; Kirk and her nephew Dylan's soccer team had a ten-thirty game at Community Commons; the Lilac Park Elementary Fall Carnival started at one; Katelyn's soccer team had a one-thirty game; and apparently her father in law had invited the entire Longsworth Family for dinner. To top it all off she was taking STEMI call so there was a distinct possibility that she would miss some, or all of the events to spend quality time in the catheterization lab.
When she pulled into the physician parking garage and parked, Monica was a little surprised to see Stefan Cassadine was also getting out of his vehicle. While some of her colleagues would argue that the real question was why an administrator was parking in the physician parking garage, Monica was a bit more curious about why the hospital CEO was arriving to the hospital a few minutes after five AM on a Saturday morning. "Good morning, Stefan," she called as she hit the button on her key fob to lock her Mercedes.
Stefan grunted and then tried, unsuccessfully, to hide a sneer. "Good morning Dr. Quartermaine, I see that you are getting an early start to the day."
"Not particularly, actually, two of my children have swim team practice at four AM so I drop them, swim some laps, and then head to the hospital. I rarely arrive after quarter past five," Monica said.
Stefan seemed to consider that but didn't speak as they waited for the elevator which would bring them to the atrium connector to the hospital.
"Do you usually arrive this early?" Monica asked as they stepped into the elevator. She was quite certain that he did not. After all her father in law was still complaining about his tardiness for the last hospital board meeting which had started at eight AM.
"I am departing for a conference in London this morning and need to retrieve a file from my office first," Stefan said.
Monica supposed that was possible. Stefan spent a lot of time traveling to conferences in foreign countries. "Well, have a good trip," she said as they both reached the hospital and turned in separate directions.
Stefan merely grunted.
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Dr. Chris Ramsey forced a smile when Dr. Monica Quartermaine entered the CCU. "Good morning!" he said with forced cheeriness.
Dr. Quartermaine smiled back at him. "I hope your night wasn't too bad," she said.
"Let's just say I've had better nights which cost me a lot less," Chris said.
Dr. Quartermaine laughed discreetly. She had a nice laugh, almost melodic. "Aah the joys of internship. Now, since you're sitting in the CCU, should I presume it was one of my patients who gave you problems?" she asked.
"Actually, it was one of Dr. Devlin's patients. Although I think my resident is trying to convince him to transfer to your service so he can get better care," Chris said.
Monica raised an eyebrow. "While I completely believe in the second opinion process and think we all benefit from collaboration at times there is a way to handle that professionally. It is never appropriate for physicians to undermine other physicians, it would serve you well to remember that, Dr. Ramsey," she said.
Ooops! Chris thought. He realized that his efforts to undermine his resident needed to be a bit more subtle or he would be the one considered in the wrong. "Perhaps, I took Dr. Belden a bit too literally. He feels that the patient needs a pacemaker placed and feels that Dr. Devlin is not being suitably proactive. I'm sure he is explaining everything very diplomatically to Mr. Moran and his niece. He is really just being a patient advocate," he said.
Dr. Quartermaine looked like she wasn't quite sure she really believed that but then Dr. Belden came out of Mr. Moran's room and she went off to help him.
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Melissa McKee-Murdoch turned the Dopamine infusion up to 10 micrograms without much hope. She would hardly deny that Beth Maynard was a drama queen and she would adamantly agree that she didn't know as much as she thought she did or likely even half as much as the interns and residents she criticized on the regular but she had a point when she insisted that Mr. Moran needed a pacemaker at while giving report close to twelve hours ago. For some reason Dr. Devlin didn't really seem to care.
"Melissa, go ahead and push Atropine 0.5mg IV now and then let's get pacer pads on the patient," Dr. Monica Quartermaine said as she burst into the room with Dr. Belden trailing in her wake.
"I'm Dr. Quartermaine and I'm going to help Dr. Belden out since I am in house now. When your uncle is more stable then I will reach out to Dr. Devlin and bring him up to speed," Dr. Quartermaine said to Mr. Moran's niece.
"Actually, we want him moved to your service. You took care of my father in law when he had a heart attack a few years ago. My husband said I was crazy if I didn't demand the best for Uncle Angel," Hillary Weeks said.
"Ok, we're going to have you step into the waiting room so we can take care of him. I promise I will come talk to as soon as I can," Dr. Quartermaine said.
Hillary took another look at her uncle and then said, "Uncle Angel has always been there for me, always, so please, please, take care of him." Then she almost ran from the room.
Dr. Quartermaine crossed over to the bedside and removed her stethoscope from the pocket of her white coat and started to auscultate. She removed the stethoscope, glanced over at the monitors and frowned. "So, he really didn't respond much to the Atropine," she said.
"Well, the heart rate was over thirty briefly, so that is something, I guess," Melissa said as she opened a set of pacer pads.
"Let's go ahead and try transcutaneous pacing then. Please turn the Dopamine infusion up to 15mcg then give him one milligram of Versed IV once you have the pads on and let me know when you have done that," Dr. Quartermaine said.
Melissa finished placing the pads and hit the appropriate buttons on the IV pump. She reached into the bottom drawer of the embedded code cart to pull out Versed and drew that up. Dr. Quartermaine might be a bit direct and terse but she never yelled or belittled people which was far preferable to some of her colleagues, like Dr. Devlin or Dr. Dorman. "Ok, the Versed is in," Melissa said.
"Thanks, so turn the pacemaker on and switch into demand mode. Set the demand rate at 60 and we'll see if we can capture. Dr. Belden why don't you let the catheterization lab know that we're going to need to put a pacemaker in. If we can't get capture then we're going down with the emergency team now for a transvenous."
Dr. Quartermaine watched the screen intently. She smiled when she saw pacer spikes. "Great, we have capture, ok so turn the Dopamine up to twenty micrograms and I'll let the catheterization lab know that we're going to put in a pacemaker. As long as he's stable I can wait for the second team so I'm not tying up the emergency team unless we have a six AM STEMI but I would like to get this done before eight when I have STEMI call so I'm not trying to deal with two patients at once."
Melissa nodded. She could understand that, especially since she was pretty sure Dr. Devlin had second STEMI call and would be way less than willing to actually come in and try to save myocardium. Some people just shouldn't be physicians, or nurses!
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Brenda Barrett glanced over at the clock as she tried to let go of the images of her nightmares. It wasn't even six AM! Of course, it was apparently almost eight in Fernando de Noronha, Brazil the latest stop on Miguel's South American tour. With that thought she reached for her cell phone.
"Hola, Buenos Dias," Miguel answered on the second ring but his voice sounded funny as if she was waking him up.
"Miguel, hey," Brenda said.
"Brenda! So, you're in luck, because if I fly directly back to NY after my final concert Monday night then I should get into JFK on Wednesday morning and I could come up Thursday to go to the gala with you on Friday night."
"You would do that?" Brenda asked. She hadn't been expecting that and had been working on how she convinced Jax to go with her and not be a completely insensitive jerk.
"For you? Of course!"
"You're the best, really."
"Isn't it still really early in Port Charles?" Miguel asked.
"Yeah, I'm sorry, did I wake you?"
"No, not at all, I was actually about to go get some breakfast. But you're usually not up voluntarily before eight and definitely not before six. Is everything ok?" Miguel asked.
Brenda hesitated. A part of her wanted to tell him the truth that everything couldn't be further from ok but she had already dumped so much on him over the years. Plus, if he probed more deeply, she wasn't about to admit that the nightmare which woke her up before six AM had been a traumatic recreation of the night that his former fiancé Lily Rivera Corinthos had died in a car bombing. So perhaps a true statement which was pretty far from the whole truth was the way to go. After a deep sigh she said,"Everything is fine. I guess Robin is unexpectedly back in town and she wanted to get breakfast at Kelly's this morning. You know it takes me awhile to get ready."
"Tell Robin, I say hello. She must be so busy with medical school," Miguel said.
"I guess. I actually didn't get a chance to talk to her yesterday. She left a message with Lila while I was out picking up everyone from school. I left a message on Mac's machine that I could make it and would meet her. On that note, I guess I should go get ready so I can do that," Brenda said. She was actually meeting Robin at ten but she had reached a point where she could face a new day.
"Ok, have fun with Robin and I guess I'll see you on Thursday. I think I'm going to see if Ruby has any rooms because Ned offered but it seems unfair for me to accept since he and Carly are newlyweds."
"She probably does. After you moved out last spring and Carly moved out this spring, I don't think she has any long-term tenants so she is probably doing a lot of weekly rentals. If you want, I can check on that for you," Brenda offered.
"That would be great, Bren, thanks!"
"No problem, ok now go eat breakfast."
"You too!" Miguel admonished.
"Bye," Brenda said. However, as she closed her cell phone she wondered if his comment was as lighthearted as she wanted to believe.
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Dr. Alan Quartermaine checked patients off on his list as he rounded. Some of his colleagues crossed patient names off their list as they went but that had always held a bit of an ominous vibe for him. Hence the check off system.
"Are we done?" Dr. Arthur Cerami, one of the PGY2 surgery residents, asked hopefully.
Surgery Chief Dr. Connie Pogue rolled her eyes but didn't speak.
"I still need to round on some pediatrics patients and check on that patient we did the femoral artery repair on one more time but perhaps you and Dr. Scanlon could start working on discharges while Dr. Pogue and I finish up."
"Start with the patients on 4 North," Dr. Pogue called as Dr. Cerami and Dr. Scanlon departed.
"Onward to the East Wing?" Dr. Quartermaine asked.
"Sure, and then we can head over to the Psychiatric ICU on 2 South. I guess you managed to get that worked out after I left. How did you get Dr. Davis to change his mind? Teach me your ways!" Dr. Pogue said as they entered the stairwell.
"Actually, Dr. Davis didn't take the patient; I guess he wasn't comfortable for some reason. I attempted to call him through the operator to speak directly after his resident, Dr. Kim, told me they couldn't take the patient but I think there was some problem with his cellular service and we were unable to connect. I was prepared to admit to SICU and have them assign it as a one to one with direct supervision around the clock but that was going to be a staffing nightmare so I wasn't feeling great about it and I'm sure that SICU Nurse Manager, Mary Briggs was hating me," Alan said.
"Ok, so how did the patient end up in the Psychiatric ICU?"
"Dr. Grabler did feel comfortable with admitting to his service so it worked out."
"So, there are advantages to practicing at a hospital inundated with your family. I guess I'll have to keep that in mind after fellowship. Unfortunately, the Pogues aren't as plentiful in medicine as the Quartermaines."
"We would love to have you return to PCGH after your pediatric surgery fellowship in Toronto. Who knows we might have even passed universal health care by the time you return," Alan said.
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Dr. Gail Baldwin pushed the door open to the Psychiatric ICU and stepped inside. She didn't usually start rounding at six-thirty AM but she wanted to finish in time to attend the Lilac Park Elementary Fall Carnival with Serena. If she had been able to adjust the call schedule on short notice she would have done so but she had felt badly about asking Ryan as he had young children in the same school; Dr. Davis had never agreed to a call switch that wasn't his idea in the more than fifteen years he had been part of the PCGH call group; and Dr. Locke would never agree to a weekend call; so she had been stuck.
"Good morning," Dr. Ryan Grabler said brightly when she stopped at the nurse's station of the unit.
"Good morning; I see you decided to round early as well," Gail said.
"Don't take this the wrong way but I have other places to be. Shannon has gymnastics pre-team tryouts at nine so I need to be available to console her if she doesn't make it or console my wife if she does. Then Dylan has a soccer game at 10:30."
"Is Shannon taking gymnastics at the old Webber Gym on the Waterfront?" Gail asked.
"Yes, Riverfront Gymnastics. Shannon considers it her personal gym because Edward came home and told her he bought it for her," Ryan said.
"And to keep Damian Smith from buying it and putting an incinerator there," Gail added.
Ryan laughed. "Well, that too, but when you're three years old, begging your mom to do gymnastics, and well aware that you have Grandpa wrapped around your little finger you only focus on that which is relevant to you personally," he said.
"Grandchildren really are the best! Serena definitely keeps Lee and I young. Karen too of course, we just don't see as much of her, you know the life of an intern."
"Don't remind me," Ryan said.
"Do you want to tell me about Lexi Starnes? I actually took care of her after her initial suicide attempt in January 1996. She was originally treated at Mercy Hospital but was then transferred here for admission to our Inpatient Psychiatric Unit. She was actively suicidal the whole time she was here and even with one:one nursing she had several aborted attempts. I didn't think I had a choice but to petition for long term commitment," Gail said.
"She was in Shady Brook for about twenty months. Dr. Reichman had just gotten her discharged into a Mental Health Group Home with twenty-four-hour attendants in Sutton. Apparently, she somehow got her hands on a knife and lacerated her femoral artery. She wouldn't or couldn't give me much history last night but my plan would be to reach out to Dr. Reichman on Tuesday and see if he will take her back whenever Alan is comfortable with releasing her."
"It is so sad. She is so young and from what I understand she was such a sweet girl before the rape."
"Yes, we discussed her case several times in Shady Brook's Complex Cases Conference. Dr. Reichman feels that the depression is reactive due to the trauma and PTSD from the rape. Initially he focused a lot on trying to treat the PTSD but after no success with that then he thought maybe that was because of the depression so he tried pretty much every medicine and medication combination but couldn't get the depression under control."
"It sounds like a vicious cycle," Gail said.
"It pretty much has been. There was some consideration of Electroconvulsive Therapy before but her brother was appointed her guardian and he opposed that. That probably needs to be reconsidered so I will see if Dr. Reichman feels it would be better for him to bring it up with the brother or if I should while she is on our service."
"Is Shady Brook doing ECT now?"
"No, Dr. Reichman would have transferred to our inpatient service for ECT if the brother had agreed. Although Rose Lawn is actually exploring starting an on-site ECT Program."
"Really?" Gail asked.
"Yes, it was discussed at our quarterly medical staff meeting last month. I mainly admit adolescents at Rose Lawn so I wasn't aware they were considering this and I think it will be almost impossible for them to implement it given the current Rose Lawn Campus. I suggested to Dr. Hannen that the other option would be for her to get Inpatient Psychiatry and ECT privileges at PCGH," Ryan said.
"Do you think she might consider that? We really need another attending especially with expanding the residency program. I fear that it is unrealistic to expect Kevin to be able to return to practice and neither Dr. Locke nor Dr. Davis enjoy working with the residents."
"She actually might. She says she misses teaching. She was assistant program director at Northwestern for about five years."
"That is encouraging. I think I will reach out to her next week," Gail said.
"Ah, it is two of my favorite psychiatrists. Good morning to you," Dr. Alan Quartermaine said as he joined them with one of his residents.
Gail smiled at her son in law. He was so diplomatic since their department currently consisted of four psychiatrists and he wasn't a fan of Dr. Davis and didn't really know Dr. Locke. "Good morning, Alan," she said.
Ryan nodded as a form of a greeting. "The nurses tell me that everything went alright overnight with our mutual patient," he said.
"Yes, although we may need to transfuse another unit of packed cells. We're going to start iron and repeat labs around noon," Alan said.
"You mentioned your concern for DIC last night. Do you think that is the issue?" Ryan asked.
"I think it is more likely that our initial blood loss was underestimated, but we will be checking coags and fibrinogen along with the CBC so we'll see. We definitely need another day in the ICU. We're going to go in and do an exam and I'll let you know if my thoughts change after that," Alan said.
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Dr. Monica Quartermaine exited the stairwell on 6 North and glanced at her watch. On the positive side, Angel Moran had a dual chambered pacemaker in place and was stable in the CCU. On the potentially problematic side it was already seven o'clock and although she had managed to round on all of the CCU and ICU patients while waiting for the back up team to arrive she still needed to round on a few cardiology floor patients and six stepdown patients. If Alan wasn't able to pick up their children from swim practice, she would have to figure out Plan C quickly.
As she was contemplating possible Plan Cs, she spotted Karen at one of the computers in the center work area and approached. "Good morning, Karen. Did Dr. Belden let you know that I was going to be held up for a bit putting in a pacemaker?"
"Yes, he did. It's fine, I've seen everyone and at least started all of the notes," Karen said.
"Great, could you grab the charts for this floor while I page Alan. If he isn't having a better morning than I am and able to pick up the kids from swim practice I will need to identify my Plan C quickly," Monica said as she called into the paging system and typed a call back number.
"Sure, no problem," Karen said.
Well that was fast, almost too fast, Monica thought as she reached for the phone. "Stepdown, this is Dr. Quartermaine," she said.
"Hello, Dr. Quartermaine, this is also Dr. Quartermaine," Alan said.
"Are you almost done rounding? I kind of walked into a patient of Dr. Devlin's who urgently needed a pacemaker placed so I just finished that but I still need to round on all non ICU or CCU patients with Karen and there is no way I am going to accomplish that in the next fifteen to twenty minutes so I can get Allison and Kirk from practice," Monica said.
"I just finished up with rounds and I am rerunning the list with Dr. Pogue. I should be able to leave here within ten minutes so I can get them. Do you have an idea of when you might be done?" Alan asked.
"I still have eight more patients to see so I probably need around two hours. Maybe I'll be home a little after nine, presuming no one has a STEMI of course."
"Right, I forgot you had STEMI call today," Alan said.
"Yeah, and I know the timing is not good with all of the various activities the kids have going on today plus your father apparently invited the entire Longworth Family for dinner."
"So, I guess today isn't the day that we have at least some say in who we entertain in our home," Alan said.
"Apparently not, don't get me wrong; I like the Longworths but I'm quite certain that by the time dinner rolls around I and the rest of our family will really need a quiet dinner at home without guests."
"Message received, unfortunately, it probably a bit late to uninvite them," Alan said.
"Alan, it is definitely too late to uninvite them. I should go, I don't want to keep Karen waiting any longer. Thank you for collecting the kids from swim team. Hopefully I will see you at home in a few hours," Monica said.
"Ok, I hope your morning gets better," Alan definitely.
"Thanks, the feeling is mutual," Monica said before she laid down the receiver and turned to face Karen. "Why don't we start with Ms. Hanson?" she asked.