Obstetrics and Gynecology had been the rotation that Dr. Evelyn Lambert had been dreading. She had tried to arrange to work directly Dr. David Adams who was a Gynecologic Oncologist. He took Gyn Call but did not do any Obstetrics which had suited Eve just fine. Unfortunately, apparently the whole point of doing a transitional year was to have the breadth of training in all specialties, including Obstetrics, so her great plan had been quashed by Dr. Burgess. That left her taking every fourth night Obstetrical Call in a rotation with the other residents.
Essentially that meant she was stuck sitting on L&D listening to the nurses' gossip while she waited to do yet another H&P for an admission for labor. Eve suspected she would have found the process tedious and limited in learning opportunities regardless; but given her history, it was also a bit triggering and traumatic. Of course, she wasn't about to admit that aloud.
"Dr. Meadows is admitting a patient from her office she wants them to go into a private room, I guess it's some VIP's wife," Judy Clampett announced once she hung up the phone.
"Is she admitting for an induction?" Carla Greco asked.
"No, I think the princess is only around twenty-nine or thirty weeks but apparently she isn't feeling well so Dr. Meadows wants her admitted for monitoring," Judy Clampett said.
Eve noted the way the gray-haired nurse who had to be pushing seventy rolled her eyes. She had already made it quite clear that in her time women pushed their babies out without luxuries like epidurals and doctors could function without central monitoring. It was clear that in her opinion the "Princess" needed to buck up, go home, clean her house, fix dinner, and accept that pregnancy could be uncomfortable.
"Ok, then she can go into 2510. There isn't a labor bed in there but hopefully we won't be delivering. I can go ahead and take that patient since I will be here until midnight," Carla offered.
Carla was apparently the charge nurse for the day, but Eve could read between the lines. At best Judy would likely tick off the VIP's wife and at worst she would completely miss subtle ominous sign because she was too busy mocking her inability to buck up and deal. Neither was ideal.
Judy rolled her eyes again and shrugged her shoulders. "Suit yourself," she said moments before Dr. Meadows herself appeared on the L&D unit along with one of the orderlies pushing a bed.
Carla quickly stepped forward and led them into the correct room.
"Dr. Lambert, are you on call tonight?" Dr. Meadows asked as she approached the desk.
"Yes, I guess you brought us our next patient," Eve said.
"Yes, I am admitting Carly Ashton. She is a G1PO at 30 weeks. She had a near syncopal event during a growth ultrasound. She was profoundly hypotensive, but blood pressure improved to about 80/40 once we laid her down flat on her left side. I ordered a cardiac panel, CBC, CMP, urinalysis, and an echocardiogram. We gave 1L of IV fluids in my office and her blood pressure improved to 90/60 so I think she is hypovolemic and should improve with some additional fluids. I want at least 24 hours of continuous external fetal monitoring and if that is ok and the workup doesn't reveal anything ominous, we will discharge her tomorrow evening or Saturday morning to follow up with me for a Non-Stress Test on Monday."
"Has she been vomiting?" Eve asked. She supposed it could just be dehydration but personally she wouldn't fault anyone for not feeling great with a blood pressure in the 70s.
"She actually hasn't. She says she really hasn't even really had any nausea with the pregnancy. The only thing she has really noticed is fatigue, but she attributed that to the pregnancy."
"Does she have any other medical problems?" Eve asked.
"Not really. She was profoundly anemic on her initial prenatal labs but other than that, no."
"Was the ultrasound ok?"
"I would have liked to have seen better interval growth, but some babies are just small and if she hadn't had the near syncope, I probably would have been ok with it," Dr. Meadows admitted.
"Ok, I'll take care of the H&P and orders. Dr. Anderson is on inhouse call tonight. Do you want me to staff this with him also or should I just call you?" Eve asked.
"I already gave John a call to let him know about the patient and I dictated an attending note, but you can certainly call me with anything. Try to keep her in the left lateral recumbent position. We considered putting her into a wheelchair for the trip over from the outpatient pavilion, but it was obvious that wasn't a good idea before she even got all the way up," Dr. Meadows said.
XXXXXXXX
"I thought Sarah was supposed to have a private room," Audrey Hardy said when the transport tech pushed her granddaughter's gurney through the door.
The tech just shrugged his shoulders.
"Hold on a minute I'm going to go find Grace," Audrey said.
Grace Benton, Pediatrics Nurse Manager heard Audrey Hardy's shrill voice all the way down the hall to her Office. One would think that, as Director of Nursing, Audrey would be aware that the Pediatrics Census was at an all-time high and they were just unable to accommodate private rooms for any patient that was not in isolation. Of course, despite that, Audrey seemed to feel that somehow an exception should still be made for her granddaughter. Grace shook her head and then exited her office to face her superior's wrath.
"Oh, there you are, Grace! There seems to be some mistake because Sarah was placed in a room with another patient," Audrey said. She wagged her index finger for good measure.
"Audrey, I am sorry, but we seriously do not have any open rooms other than the room I placed Sarah in. If she will be here after tomorrow and we have any discharges I can certainly try to move her to a private room but right now our census is very tight. If she really must have a private room the only other option would be to see if she could be admitted to one of the North Wing Medical Units but Dr. Stryker does not have privileges over there so that would be a problem," Grace said.
"Do you have any overflow patients that could be moved over there and then Sarah could have their room?" Audrey asked.
"We do not have any overflow patients, so, unfortunately, that will not be an option," Grace said firmly.
XXXXXXXX
Miguel Morez closed his cell phone and laid it back on the table. "How far along did you say Carly was?" he asked.
Brenda shrugged her shoulders. "I think she is supposed to be due at the end of December, why?" she asked.
"That was Ned. We were going to get together tonight but I guess Carly is being admitted. It seemed way too early for her to be having the baby, but I didn't really want to make a big deal of that and stress him out even more," he said.
"Did he actually say she was in labor? She could be admitted for a ton of other reasons besides being in labor. Or, even if she is in labor, they can do things to stop it. They did when Lois was pregnant with Brooke," Brenda said.
"True," Miguel said yet he seemed unsettled.
Brenda reached out and laid a hand over Miguel's. "Are you thinking about Lily?" she asked.
Miguel didn't answer her at first which pretty much gave her, her answer.
"I'm sorry. I won't say I understand, because I don't. But I do care, and I am sorry," Brenda said.
"It's alright. I am happy for Ned and Carly. I am very happy that they are going to bring their baby into the world in a very different situation than Lily and I did. So, since AJ is picking up Dylan and Kirk from school and taking them to soccer practice in exchange for Tracy taking both Serena and Shannon to ballet do you think maybe you could come with me to see Ned and Carly?" Miguel asked.
"I'm not sure that Carly would even want me to visit," Brenda said.
"I thought you were planning her baby shower?" Miguel asked.
"I am helping Keesha plan her baby shower. Apparently since Keesha is dating AJ and AJ was Ned's best man at their pseudo shotgun wedding she feels it is her duty. Keesha is seriously going to be such a great Quartermaine wife," Brenda said.
"I think Keesha has far too much spunk to be a good Quartermaine Wife," Miguel said.
"Who says a good Quartermaine Wife can't have spunk? Seriously, you've met Tracy, you've met Monica. Do you really think either of them are particularly deficient in spunk? I mean,Tracy scares me!"
Miguel laughed. "Ok, fair point. I think part of my bias is that I had heard all of Lois's tales of woe before I ever had much interaction with the Quartermaines. Even with that I still eventually came to believe that the entire Quartermaine contingent really adored Lois much more than she will probably ever trust. I can accept that it is too late for Ned and Lois, at least as a couple, but I guess I just pray that in time she will find a way to coparent with Ned and help Brooke have a relationship with her extended Quartermaine Family."
"Yeah, that would be nice," Brenda said. She didn't really have a lot of hope it would ever happen. Perhaps it was ironic that she was discussing Ned and Lois and their inability to grieve together for a child they had both loved when Miguel had been the one who had originally introduced her to the concept when he explained why, despite loving her immensely, he had to let Lily go.
XXXXXXXX
Dr. Alan Quartermaine decided there should be a rule against having two patients with intense parents or guardians in the same room. Unfortunately, the hospital was very full, so pairing Sarah Webber and Rachel Berlin on 5 East had been the only option Pediatrics Nurse Manager, Grace Benton, had been able to find. With that knowledge, Alan took a deep breath and entered the room with his resident in tow.
The first thing Alan noticed was that Raymond Berlin had taken at least a brief respite from the bedside vigil he had been keeping since Rachel had been transferred from a small community hospital in Greene County two days earlier. He extended his hand to the brunette sitting bedside. "I'm Dr. Alan Quartermaine one of the pediatric surgeons. This is our surgery Chief Resident, Dr. Connie Pogue, are you Rachel's mother?" he asked.
"Please call me Naomi," the woman gushed, and she took his hand.
Alan noted how Rachel, rolled her eyes and scowled before returning to her magazine. "It is nice to meet you. I spoke with your husband right after Rachel's endoscopy. Everything looked good, I did send biopsies just to be certain and I placed a Gastrojejunal tube without difficulty. We will continue the TPN tonight and then tomorrow we will attempt to start feeding through the GJ tube and wean the TPN off," he said.
"How long will that take? Raymond had to get back to the city. The stock market doesn't exactly take holidays and I am supposed to be leaving on a cruise tomorrow morning," Naomi said.
"It is hard to determine before we start enteral feeds. As I explained to Rachel and your husband yesterday, I think that a lot of the gastroparesis is due to the malnutrition. So, I am cautiously optimistic that as we start to feed it will get easier. By a rough estimate, it might take us a week to get to full enteral feeds through the J port and off the TPN," Alan said.
"I see, unfortunately, it is far too late for me to cancel my trip."
Rachel crossed stick like arms across her chest, rolled her eyes again, and then glared at her mother. "Yes, of course it is, mother," she said.
When he stepped over to the sink to wash his hands and don a pair of gloves, Alan figured he was probably biased because he didn't foresee himself ever having time to go on a cruise but he disagreed that it was too late to cancel. He highly doubted anyone was going to force Mrs. Berlin to board the cruise ship. They might refuse to refund her ticket. In fact, they probably would, but he highly doubted that anyone would track her down and compel her to board. "I hope you get everything resolved. Rachel, I just want to take a quick look at the G-J site. Are you having much discomfort?" he asked as he returned to the bedside.
Rachel Berlin made a production of closing her copy of Vogue, then she pulled the blankets back. "It doesn't hurt but, like I told that annoying nurse, I am extremely nauseous!" she said.
Alan carefully lifted her hospital gown just enough to expose the GJ tube and then palpated a little around the site. Everything seemed fine. "I will check with Betsy and see when the next dose of Zofran is due," he offered.
"Thank you, Doctor, or can I call you Alan?" Naomi Berlin asked as he stepped away from the bedside.
Although his back was to Rachel at the sink Alan was quite sure that her eyes were rolling. He couldn't really blame her. He turned around while drying his hands. "I think Dr. Quartermaine would be most appropriate," he suggested. He realized after the words were out that it was unlikely Naomi Berlin cared much about appropriateness.
After another cleansing deep breath, Alan made his way to the other side of the room where Audrey Hardy had just finished applying a cold compress to Sarah's forehead. "There is definitely something very wrong, Alan. Sarah is stoic like her father so if she is saying there is something wrong then it needs to be taken seriously," she said.
Alan wasn't sure exactly how Audrey felt no one was taking Sarah's somewhat dramatic complaints seriously. Sure, he suspected that Dr. Larmon had taken his usual order CT Scan first and try to avoid examining the patient later approach to abdominal pain, but the CT scan had been completely normal. Then multiple other very competent and extremely thorough physicians had examined Sarah, ordered, or even personally performed several other tests which were all also absolutely normal and in spite of all of that Dr. Stryker had still opted to admit Sarah for overnight observation. "That is exactly why I'm back to do another exam. Now just allow Dr. Pogue and I to wash our hands first," he said.
When he returned washed and gloved to the bedside, he noticed that Sarah had deigned to open her eyes. "Are you feeling any better, Sarah?" he asked.
"I actually think I feel worse. I just feel so weak, I had to call Gram to help me back from the bathroom," Sarah said.
Audrey Hardy reached down and patted Sarah's shoulder. "It's ok, honey, I don't mind," she said.
Alan focused on his abdominal exam first auscultating very normal bowel sounds and then initially gently and then firmly depressing his stethoscope into Sarah's abdomen all over. There was no evidence of discomfort. He removed his stethoscope and at the first contact of his hand with Sarah's abdomen he felt her yelp. Yep, that is malingering!
"See, how tender she is!" Audrey admonished.
Alan figured he wasn't going to diplomatically explain that his exam actually showed the contrary. "It is reassuring to me that your abdomen is completely soft, and there aren't any peritoneal signs. Dr. Pogue is going to do her own exam since she is on call tonight and she will be the one doing serial exams," he explained.
As he stepped away from the bedside, he realized that perhaps Audrey was right Sarah was a lot like her father. In his professional opinion, Dr. Jeff Webber was a melodramatic malingerer as well. Of course, that hadn't exactly been the kind of thing a PGY5 surgery resident could write in a chart when the patient was the Chief of Staff's son.
December 3, 1979
On 4 North, Dr. Alan Quartermaine closed the chart of his colleague, Dr. Jeff Webber, and started towards the room when he saw his wife approaching. "Good morning! How was your call?"
"I almost literally spent the entire call in one of the ICUs. I personally did six intubations this is definitely going to be a bad Influenza season," she said.
Perhaps Monica caught the concern in his eyes because she quickly added, "Don't worry I was completely masked and gowned for all procedures!"
"You know I just worry about you."
"I know and I love you for it. Are you here to see Jeff?" Monica asked.
"Yes, apparently decided he was most comfortable with a surgery consult. Between you and me, I'm not quite sure why," Alan said.
"Oh, I don't know, maybe he was afraid of the Chief of Staff's son dying from a ruptured appendix on his watch," Monica said.
"Fair enough, although it doesn't appear that Dr. Thurston shared those concerns when he did the H&P."
"Walt is only an intern, or maybe he is being overly cautious. I can't really comment because I didn't examine the patient," Monica said.
His wife's diplomacy was not lost on Alan and he was perfectly happy if she kept her distance from her errant colleague who also happened to be her former boyfriend. The latter fact was not one Jeff seemed inclined to allow Monica to forget anytime soon. "Ok, well wish me luck," Alan said.
Yet, as he took the final strides to Dr. Jeff Webber's hospital room and donned his own isolation gown and mask, he realized it wasn't luck as much as patience that he needed. He was sure that Jeff saw him as a jealous spouse. On the contrary, he trusted that Jeff and Monica's relationship had been long since over and done with before theirs had begun. Monica was his wife and he trusted her explicitly and implicitly. His fears related to Jeff's attempts to pull her back into a relationship stemmed not from concern about infidelity, but rather from the toll It was all taking on Monica herself.
When Jeff and Monica had both been interns in October 1976 Jeff had shot himself after a night of partying at Barney's, a downtown bar. Afterward he had professed despondency and Monica had of course felt badly. At first, Alan himself had even felt badly. But after months of watching the man play on the sympathy of a woman who was working extra hours, at least partly due to his medical leave, and struggling with pregnancy, Alan had become a bit miffed on his wife's behalf.
Even after Jeff was cleared to return to residency at the end of the following February and Monica delivered their child, Alan James Quartermaine Jr., in May; Jeff persisted in his pursuit. In Alan's opinion his melodramatic proposal to Heather Grant at the Housestaff Halloween Party roughly a year after his suicide attempt was nothing more than a futile attempt to make Monica jealous. Except Monica hadn't been jealous she had happily told Jeff she truly hoped he and Heather would be as happy as she and her husband were.
Jeff married in a joint ceremony with his older brother Dr. Rick Webber, a local internist roughly three weeks after his Halloween Party Proposal. Unfortunately, neither of the Webber marriages were particularly happy. Both brothers seemed to feel the need to air their marital problems at the hospital to anyone who would listen so Alan knew far more than he ever should have. More unfortunately, Heather Grant Webber had been hospitalized after a psychotic break in August 1979 and Jeff had purportedly been too stressed to function.
Alan completely understood that it must have been heartbreaking for Jeff to see his wife in a delusional state. He didn't even disagree that some time off to make arrangements for his wife's care would be reasonable but that wasn't exactly what Jeff had done. No Jeff had boarded a plane to the Caribbean and left all of the other housestaff scrambling to fill in for him. Conveniently, at least for Jeff, by that time it had been discovered that Jeff wasn't just the son of the Chief of Staff's best friend, but that Jeff was actually the son of the Chief of Staff. Apparently, Dr. Lars Webber had been shipped off to war and his best friend had kept his wife company.
So instead of being reported to the medical board for patient abandonment, Dr. Jeff Webber had just been granted another four months of "medical leave" which Alan believed should have ended the day before when instead of reporting for work he had called an ambulance for transport to the ED with fever, malaise, abdominal pain, vomiting and diarrhea. In spite of his stated complaints all of his vitals had been normal, and the nursing staff had not witnessed any vomiting or diarrhea.
"Alan, thank you for coming," Jeff began warmly.
"It is no problem; I am just doing my job. So, I understand you have been having some abdominal pain."
"Yes, I was supposed to work a night shift and I laid down to take a nap when it woke me from sleep. I have an incredible pain tolerance so if this is getting me down it has to be something serious," Jeff said.
Alan nodded although he didn't really believe that. "Any vomiting or diarrhea?" he asked.
"Seriously, I've got it coming out both ends. I realized I needed some fluids but didn't think it was safe for me to drive so I called the ambulance."
"I see, and they gave you some fluids and antiemetics in the ED have they helped?"
"Unfortunately, not, and, man, as embarrassing as it is, I had to call the nurse to help me back to bed after the last time. I'm just so weak and the cramps are unreal."
Alan made eye contact with Jessie Brewer RN who was pushing buttons on the IV pump. "So, were we finally able to send the stool studies and cultures the ED ordered then?" he asked.
Jessie shrugged her shoulders. "He had flushed before he called for help," she said.
"Ok, well let me examine you," Alan said.
If one discounted the histrionics, Alan felt Jeff's abdominal exam was completely benign. That had also been the view of Dr. Miller who had seen him in the ED, Dr. Thurston the admitting intern, and he suspected even Dr. Hollings the ward attending. Despite this, Dr. Pollard the surgical attending for the day had suggested that since the patient was a physician and the son of the Chief of Staff, they should likely follow up with a CT scan just in case. "Your exam really isn't concerning. I am going to order a CT Scan of your abdomen and pelvis just to make sure we aren't missing anything. Also let's try to get those stool cultures and studies because they might actually be the key to the diagnosis," he said.
As expected, the CT Scan had been completely normal. Jeff's symptoms had persisted for another week while he flirted with the nurses in between reported but always unwitnessed vomiting. Eventually he either had gotten better, or got sick of the attention, and had gone home. His residency restart date and then been conveniently pushed back to after the Christmas Holidays and poor Monica had been forced to add an extra ICU call on Christmas Eve.
Alan caught the look his Chief Resident was passing him and realized it would likely be best if they discussed her exam finding out of earshot of their Director of Nursing. "So, Dr. Pogue will be back to check on you a few times through the night. If anything changes in your exam, then she will let me know and I can come back in. Now why don't we let you get some rest?" Alan said. Then he took some quick and long strides back to the door and back out to the safety of the hall.
"She really isn't tender at all," Dr. Pogue said once they were alone.
"No, she isn't. I hesitate to accuse patients of lying and perhaps this is a bit of a somatization syndrome although usually those patients are unconcerned about their symptoms so I'm not sure. I'm also smart enough to know that any suggestion of a Psychiatry Consultation will not be well received," Alan agreed.
"I know you ordered a pelvic ultrasound and that was also normal, but could this be an atypical presentation of Gonorrhea or something? Somehow, I doubt that would be any better received than the Psychiatry suggestion though," Dr. Pogue suggested.
Alan chuckled. "No, I don't think it would and I think with a normal pelvic ultrasound it is unlikely, but I might be able to spin a Gynecology consult in the morning. That will cause Audrey to become embarrassed but probably not mortified and irate. That is definitely the better option," he said.
"You asked pediatrics to leave her NPO will you do an exploratory laparotomy in the morning if she is still complaining?" Dr. Pogue asked.
"Unless something truly changes clinically, no, because given the current picture I think the risks of that approach solidly outweigh the benefits."
"I agree, I just wanted to be clear because I have a feeling Mrs. Hardy will ask that question."
"Oh, yes, consistent messaging is especially important with potentially triangulating patients or their guardians. On that note, I think I am about to head out. If you need anything, I need to go pick up my daughter from cross country practice so try my cell phone and after six you can just try our main home number. If you don't get me then page of course," Alan said.
"Thanks, Dr. Q!"
As I write, I realize this story is growing more than a bit exponentially. I think all of my "Give Me Jarly or I will stop reading" folks have stopped reading but I actually really see how we get their couple only I think their path to happily ever after will be measured in years, not months.
So now I could really use some help:
1.) If Jason was going to be attacked by another mafia family in October 2001 who would be attacking him? [I'll work with canon if anyone knows what that was, I wasn't really watching then…]
2.) In a world where Carly is the Carly that has developed in this story, and never got involved with Sonny (so no hate sex) who might she get involved with in early 2002 and beyond if she and Ned had amicably parted and she believed Jason was dead. I would like this to be someone who is a decent guy and who it is conceivable she could love but also someone who she could leave for Jason (but only after being torn for awhile). Bonus points if you have an idea for who dumped decent guy could ultimately find a future with after the Jarly reunion.
People I would probably prefer not to use:
*Jasper Jacks [Will be in a relationship with Brenda Barrett in most of the year 2003. He and Carly will likely not be opening Club 101 together which happened during this period, although he may be doing that with a different female]
*Ned Ashton [This should be self-explanatory, but I am envisioning that he remarried Lois in November 2001. He and Carly are sharing custody of Michael Edward Ashton and Carly and Lois get along believe it or not.]
*Dr. Steven Webber [I believe that Carly did date him at some point in 2003 but from my chronology (and I think this is consistent with canon) Dr. Steven Webber arrives at PCGH to take an attending pathology position in August 2003. So he won't work because I need someone in PC in 2002 that Carly can go on a few dates in early 2002 when she is mourning Jason and then ultimately get more connected to and serious about over summer/fall 2002. For plot reasons it would be convenient if she got engaged to them in January 2003 right before Jason reappears in February or March 2003 but I'll write into their relationship as it works (and I'll write out of it as it works too so I guess I'm not promising Jarly even now at the very end, but I really think I am)]
*Sonny Corinthos [I have never thought that Carly and Sonny did each other any favors so I would prefer to not go there. Also, much of the time that Jason is presumed dead Sonny is also away from Port Charles living on the Island (with his BFF, Brenda)]
*Nikolas Cassadine [In this universe, Nikolas dated Emily Quartermaine from November 1999-March 2003 He started law school at PCU in Fall 2002. He did cheat on Emily with Gia Campbell (and I guess theoretically could cheat with Carly instead but I think the way Carly is still considering herself part of the Q family she wouldn't cheat with Emily's boyfriend for that reason, then there is the issue that Nikolas is probably also too young for her.]
*AJ Quartermaine [I think will be getting engaged to Keesha Ward early in 2003 so I think that rules him out. Also, I think in this Keesha and Carly are at least loosely friends (Keesha planned her baby shower when she was pregnant with Michael) so she just might not go there regardless]
**Are there other good guys left in PC?
3.) I asked about ideas for Carly's career before. I anticipate that she will start taking classes at PCU in September 2000 and I'm thinking that Ned helped her figure out how to CLEP and build on any of those nursing classes she somehow passed so she can graduate in May or August 2002. For plot reasons, it would help if she could work at ELQ in some capacity because that helps maintain her Q connection for her son's sake and then it could also have the Qs supporting her reunion with Jason because they hope that Jason will come back to them as well. Working at ELQ doesn't necessarily mean she has to do business (although she could) but ELQ has many subsidiaries so she could do something there or I suppose she could become their next CFO. Any other thoughts?