Dr. Monica Quartermaine exhaled as she threaded the Swan-Ganz Catheter through the introducer sheath. "Balloon up," she commanded then she watched the waveform on the monitor as she floated the catheter through the Right Ventricle and into the Pulmonary Artery. The catheter wedged, she waited for end exhalation on the ventilator and then announced, "Wedge is 26, balloon down!"
"So do you think this is just Right Ventricular Failure?" Dr. Desai asked from the doorway.
"By definition it is Bi-ventricular failure. The TEE showed a Left Ventricular Systolic Function of 20% and she has so much Pulmonary HTN that perhaps that skews the Wedge Pressure and CVP, but it really looks more like RV Failure. If you are asking for recommendations, I would favor starting Milrinone and Epinephrine. Titrate the Epinephrine until you get your MAPs up enough to try to allow diuresis. I would also try to bleed Nitric Oxide into the ventilator circuit and see if that unloads the RV and PA enough that you actually can diurese. We can leave the Swan-Ganz Catheter in place if your want to use the parameters to better titrate your drips. See how she responds to this over 48 hours and then we can re-evaluate. She will need at least another echocardiogram and likely another right heart catheterization and depending on that we can consider what other options we have," Monica said.
"You mean like transplant?" Dr. Desai asked.
"If she doesn't recover some function that could definitely be a possibility. We need to send an expanded toxicology panel along with a viral panel. There is something about this whole picture that just doesn't fit," Monica said.
"Honestly nothing about this whole case fit. Thanks for coming in and doing the TEE and the right heart catheterization," Dr. Desai agreed.
"Of course, this is why there is always someone on call for Non-STEMI cardiology. We want to help," Monica said.
Dr. Desai raised an eyebrow at her response. "Let's just say not all of your colleagues are as motivated to be helpful and leave it at that," he said.
"Ok, I can respect that, but I would also encourage you to consider reporting any issues you have with physicians of any specialty not delivering the kind of care you would want for a family member when on call. Our Medical Executive Board can't fix the problem if we don't clearly understand there even is a problem," Monica said.
Dr. Desai just gave a shrug of his shoulders and Monica decided not to press further. At least not in the moment. "Coming back to this patient specifically, I'm on call until tomorrow morning so please don't hesitate to call."
"Is it alright if I just have the nurses call all the Swan numbers to you and let you adjust drips?" Dr. Desai asked.
"That's fine. We literally do not have CCU beds and I'm afraid this really isn't a purely cardiac issue, or at least it didn't start off that way so I really think you should still be primary team, but I understand that may change as we go," Monica offered.
Dr. Desai gave another shrug of his shoulders. "I guess that is all I can ask," he said.
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Keesha Ward surveyed the Quartermaine Ballroom. The decorations had really come together, and it was only quarter after two. There were still a few minutes before even the early arrivals should appear. "Thank you so much for your help," she told Simone.
Simone shrugged her shoulders. "It really wasn't a big deal; I just blew up a few balloons," she said.
"Well, I appreciate it," Keesha said.
"Yeah, thanks," Brenda said. "Umm I should probably go see how Emily is coming with supervising Serena and Katelyn's punch making process," she added and then made her way out of the room.
"So, Brenda is another of AJ's sisters?" Simone asked once the brunette had left the room.
Keesha laughed. "Umm, no. Last year at this time she and AJ were a couple. Of course, now, AJ swears he thinks of her like a sister. If she looks familiar, it's probably because you saw her in a magazine or maybe on a Billboard. She's a former Deception Cosmetics spokesmodel and now she is the face of Jacks Cosmetics," she said.
Simone realized that she actually had seen her likeness on a billboard on Fashion Avenue. She supposed she should be impressed but somehow, she wasn't. "Do you trust her?" she asked.
"Shouldn't it really be a question of whether I trust AJ? He's the one I'm dating. Brenda and I were friends before either of us were dating AJ and nothing has changed there. So, yes, I trust her. Anyway, she is dating venture capitalist, Jasper Jacks," Keesha explained.
Simone nodded. She decided it wasn't her best approach to point out that Keesha's long and diplomatic justification just made her more suspicious of the model.
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When he sat in the waiting area outside the 4 West ICU, Rex Stanton almost felt remorse, but only almost. After all, it wasn't his fault Lucy had decided to get herself knocked up and then refused to terminate the pregnancy. She had left him no choice!
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Melissa McKee Murdoch lugged an oversized gift bag and across the inlaid stone path which led to the front door of the Quartermaine Mansion. Up ahead her mother-in-law, Eleanor Farnsworth Murdoch sauntered along effortlessly having already had her gift shipped directly. It wasn't so much the weight of the stuffed statues but just the feeling of once again not doing the correct thing. The fact that it was technically Chase who had done the wrong thing didn't really make her feel any better.
Eleanor paused when she reached the expansive front porch and turned back to face Melissa. "I'm sorry, I should have reminded Chase that Wyndham's has the best delivery service," she said.
Melissa decided that life was too long to not take her mother in law's words as genuine. "It's ok, I think he figured that out in retrospect," she said as she stepped up onto the porch just as Dr. Alan Quartermaine opened the front door.
"Eleanor, Melissa, I presume you are here for Carly's baby shower," Alan said as he stepped back from the open door to allow their entry.
"We are, perhaps we're a little bit early," Eleanor said.
"I will never fault punctuality. Unfortunately, Monica had to return to hospital after church and just returned home again, but I can show you into the Ballroom where everyone is assembling," Alan said.
Alan led them through the foyer and down a hallway that led past the formal parlor to the Ballroom. As she followed her mother-in-law inside and hoisted her gift onto a long table against the near wall, Melissa remembered the first time she had been in the Quartermaine Ballroom.
December 31, 1992
Melissa McKee was a bit awestruck when her date Chase Murdoch turned from Lilac Drive and made his way through massive wrought iron gates. The inlaid stone driveway was lined on both sides with luminaries which set the perfect tone for a festive evening. As a large brick colonial came into view Chase veered to the to a front drive where he shifted into park.
"Wow!" was all Melissa could say. She felt her cheeks grow warm as she stared but somehow, she couldn't look away. She had always presumed the Quartermaines were wealthy. They were both doctors and their nephew, Ned had certainly had material possessions most people didn't and likely would never have. But somehow their house, seemed to surpass wealth and move onto a whole level beyond wealth, if that was even possible.
Surprisingly Chase didn't laugh at her. "Are you ready to go inside?" he asked.
Melissa decided she was as ready as she would ever be. "Sure," she said.
Chase passed his keys to a waiting valet then he took Melissa's hand as they made their way along the inlaid stone path to the marble front porch adorned with poinsettias.
When they finally stepped into the front foyer, Melissa found herself face to face with Dr. Monica Quartermaine. Dressed in sparkly silver evening gown and a natural smile Monica appeared every bit the gracious host. "Chase, Melissa, it is so good to see both of you again. Good evening, and, welcome to our home," she said.
"Thank you, Dr. Quartermaine," Melissa said as she instinctively deflected her eyes downward.
"You really can call me Monica outside of the hospital," Monica said.
Melissa nodded and considered that. She had been told that before, especially after Bobbie had married Dr. Tony Jones but often people only said things like that to appear kind, they didn't really mean it. She was still considering that when AJ Quartermaine came into the foyer dressed much more casually in jeans and one of those long shirts that were supposedly the epitome of teen fashion. She had gotten her brother one for Christmas.
"Missy, hi!" AJ said.
Melissa smiled to avoid laughing. Apparently while she had been hopelessly lusting after Ned Ashton a few summers ago his twelve-year-old cousin, AJ, had thought she was all that and a bag of chips. "Hi, AJ," she said.
"I was actually just talking to Skeeter earlier. He is going to join us for the Habitat work project down on the docks on Saturday," AJ said.
"Oh, great," Melissa said. Skeeter was her fourteen-year-old brother. When their foster parents had divorced, Jake Meyers had arranged to adopt her brother unilaterally. Sometimes she understood that. Other times she just missed her brother, the only biological family she had left.
"Are you heading to Chip's party?" Dr. Monica Quartermaine asked her son.
"Yeah, Bobby was on his way over five minutes ago, so I bet he is outside now," AJ said.
"You know he is welcome to come in," Dr. Monica Quartermaine said.
"I don't think he and the judge are on speaking terms at the moment, so he didn't want to do that," AJ said.
"Oh, well, that is unfortunate," Monica said.
"Yes, it really is. On that note, I shouldn't keep him waiting," AJ said as he opened one of the coat closets and removed a leather jacket. He shrugged the coat on and then took a step over and gave his mother a very quick kiss on the cheek. "I know, I can always call you or dad if something feels uncomfortable," he added then he made his way out the door.
Monica laughed and shook her head. "It's hard to imagine that a few years ago he was making the biggest ice cream sundae in our recreation room on New Year's Eve."
Melissa nodded. She was struck by the reality that she had probably been doing a lot worse things at fifteen than AJ ever would. Of course, that wasn't exactly something to bring up with one of the cardiology attendings at the hospital where she worked as an ICU nurse.
"Thank you for humoring me, please make yourself at home. I know Ned and Jenny are already in the Ballroom if you want to join them," Monica said.
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"Is Skeeter your brother?" Chase asked as they made their way down a long hallway past a formal parlor to a Ballroom.
Melissa took in the scene for a moment. Everything looked so glamorous. "Yes, he is a freshman at Port Charles High. He was adopted by Jake Meyers after our mother died."
"Oh," Chase said uncomfortably as if he wasn't sure what to say. He probably wasn't.
Melissa decided to let Chase off the hook. "Oh, look, Ned and Jenny are over there," she said and pointed towards the far corner where Ned was seated at the grand piano playing while his date Jenny Eckert leaned against the piano and looked on adoringly. It actually was kind of romantic, if you were into that kind of stuff.
At the time, Melissa had at least tried to convince herself she wasn't into that kind of stuff. She had also tried to convince herself she wasn't actually interested in Chase. In time, Chase saw past her defenses and even her defense mechanisms. They had come a long way. It had been almost five years since they had met, and they had celebrated their third wedding anniversary in June.
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Carly Ashton frowned at her reflection in the full-length framed mirror. She hadn't shown much even into the very beginning of the third trimester. Now suddenly, almost overnight she looked like she was pregnant with twins. Twin elephants at that! She sighed with difficulty and shook her head at the image in front of her.
Beth appeared at her side and wrapped an arm around her. "Do you want me to help you sit down?" she asked.
Carly heard the concern in Beth's voice as she let her lead her over to an overstuffed chair with an ottoman. She was embarrassed to admit she had been reflecting on how much she resembled a beached whale.
"I think everyone will understand if you just need to rest right now," Beth suggested.
Carly wasn't sure about that, but she just shifted her weight to her left some and took a very measured breath.
"So, I'm sure I don't really understand because I think I really had a pretty benign pregnancy experience, but I remember when Kensi must have shifted and or dropped or something and suddenly my abdomen was huge. It was bit uncomfortable those first few days I had no appetite and it seemed impossible to figure out how I was supposed to sit or sleep without feeling like I was being suffocated. I'm sure it's different because you aren't feeling well at all in general. However, if this is also the time when you hit that maximum uterine expansion phase I bet you're absolutely miserable and I'm really sorry. If it helps at all, after like three days my body kind of figured it out and it was ok so maybe that will be case for you too," Beth said.
Carly hadn't really considered that perhaps she was meant to suddenly look huge overnight. "Were you really nauseous?" she asked.
"Yeah, I actually spent an entire day lying on my side basically hugging an emesis basin. That worst part really only lasted a day. The next two days were a little better and then after that I mean I was like 31 weeks pregnant, but it was ok."
"I will be thirty-one weeks on Monday," Carly said.
"So just nine more weeks to go," Beth said.
"Yeah, nine more weeks," Carly repeated. There was no way she was going to survive nine more weeks!
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Jasper Jacks carefully debated his next move. Paul Williams had provided him with little more information than Alex Masters. He knew there was something more. There had to be. Desperate times called for desperate measures, so he pulled out his cell phone and connected with his brother, Jerry.