Dr. Monica Quartermaine completed the echocardiogram and retracted the transducer probe, finally removing it from her husband's cousin's wife's mouth. "Her heart function itself really does look normal. I wanted to check again since she has become so edematous but with a normal echocardiogram, I can only conclude that is due to her underlying malnutrition and the significant fluid shifts from that," she said as she readjusted the device securing Marla's endotracheal tube.
Hugh Lars Quartermaine paused in his pacing at the foot of his wife's bed. "So does that mean that she won't need the permanent pacemaker after all?" he asked.
"Unfortunately, she will need the pacemaker because her heart rhythm hasn't stabilized as I had hoped it might. I know that you said Marla wasn't taking any prescribed medications but was she taking supplements? Unfortunately, those are not regulated by the FDA and sometimes can contain harmful ingredients," Monica said.
Hugh Lars shrugged his shoulders. "I truly have no idea! The only thing I am sure of right now is that I really knew very little about what Marla was going through. We kind of got into this rut. I worked at ELQ, and Marla took care of the home and our kids. At first, I thought it was just how the world worked, my mother stayed home with us, dad practiced law around his legislative activities," he said. His voice trailed off and his cheeks grew crimson.
Monica smiled. "There isn't necessarily anything wrong with that approach. It seems to work for Edward and Lila," she said.
Hugh Lars shook his head. "But it wouldn't work for you and Alan?" he asked.
"I was a fourth-year medical student when I married Alan. He knew I was planning on practicing medicine. He supported my goals because he loved me. We both wanted children though and we figured out how we made that work for our family. We're an N=1 and what we have done might not be right for anyone else," Monica said.
"I love Marla, I guess I just find it so hard to support her goals when she refuses to share anything with me. I've known something was wrong for a while. I have tried to get her to open up. I even offered to go to marriage counseling," Hugh Lars said.
Monica saw the desperation in her cousin by marriage's face. It was clear that he loved his wife. Although there had certainly been times in her own marriage when she had questioned if love was truly enough, she wanted to believe it could be for Hugh Lars and Marla. "So, I will put in a permanent pacemaker defibrillator in the morning, and I hope that then it will be easier to get her off the ventilator," she said.
Hugh Lars sighed. "Thank you, seriously, thank you for everything," he said.
"Of course, it is what we do and while I want the best for all of my patients I am definitely praying for Marla, and for you, Craig, and Brynn. I think that Alan was going to mention this but if your parents were going to come and bring the children, we do have an unoccupied guest house which could afford more privacy than an executive suite at the Port Charles Hotel," Monica said.
"I appreciate that. Currently, dad is trying to get a budget passed and avoid a government shutdown and the kids haven't destroyed Missy's house yet, so I think maybe they are better off staying put. Or maybe I just have no idea how to explain any of this to them. Probably that," Hugh Lars said.
"Just remember the offer stands. On that note, if you don't have any more questions, I am due in the cardiac catheterization lab soon," Monica said.
Hugh Lars just shook his head which made Monica suspect that he did truly have more questions just ones he wasn't quite ready to ask. She didn't envy that.
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Dr. Alan Quartermaine cautiously retracted the endoscope taking another look at Carly's gastro-esophageal junction as he withdrew. "I don't see any active bleeding and the ulcer base looks clean. There is a lot of background gastritis so I would continue the Protonix Drip, but I don't think that explains the hemoglobin drop. Has the blood pressure come up much with the transfusion?" he asked Dr. Stuart Duncan, the anesthesiologist.
"I guess it came out of the seventies, but it was still low. I started Phenylephrine peripherally unless you want something else. Is there any possibility that you could put a central line in, in PACU? This case bumped Dr. Stratton's total hip and I'm sure he is chomping at the bit to get going," Dr. Duncan said.
"If the fetal tracing looks good on Phenylephrine, I'm ok with that. I know it is what my wife likes for her cardiomyopathy patients in labor. What if I throw in a quick Subclavian Central Line now while you're calling out to PACU? You want to extubate in PACU right, Helene?" Alan asked. He turned to the circulating nurse. "Janie, can I get a Central Line Kit and another pair of size 8 gloves?" he asked.
Dr. Helene Meadows took another look at the fetal strip and then looked up at Alan. "The fetal heart rate has good variability so I'm not planning on an emergent cesarean now so, yes, let's try to extubate. Ideally here before we move to PACU. Maybe just let Alan get his line in first," she said.
Dr. Duncan just sighed again as Alan reached for the central line kit from the nurse and started setting up his table.
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Celia Quartermaine stepped off the West Elevator on the second floor with some trepidation. She had bumped into Monica when she had been bringing Hugh Lars lunch and she had mentioned that Ned was likely in the waiting area outside the Main OR because Carly was having another emergent endoscopy. She had no idea what to say to Ned, but she suspected it was worse to say nothing, so she had stopped on the second floor on her way out.
Celia quickly spotted Ned against the far wall, seated with his head dropped into both of his outstretched hands. He looked so broken. She took a deep breath, crossed the room, and sat down beside him. "Ned, I'm sorry," she began.
Ned raised his head and offered her a wan smile. "Yeah, me too. I guess it's in Alan's hands now, or maybe God's," he said.
"Is there anything I can do?" Celia asked.
"Pray. Dr. Meadows was afraid that the baby might not tolerate another endoscopy, so she went down to the OR with them in case she needed to do an emergent cesarean section," Ned said.
"Carly is roughly thirty weeks?" Celia asked.
"She was thirty-one weeks on Monday. I know it is too early but these past two weeks have been so hard for Carly so I'm starting to wonder if it might just be for the best," Ned admitted.
Before Celia had figured out a response, she realized that Alan was walking towards them. She really hoped he had good news.
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Dr. Alan Quartermaine took a deep breath and then released it as he approached his nephew. As grim as Carly's situation might appear, it actually could be worse. Of course, that also suggested that it could get worse.
"Alan?" Ned asked with hesitation, as if he wasn't sure he was quite ready to hear what had happened.
"Why don't we start with the positive? The endoscopy didn't show any active bleeding and the base of that ulcer that bled before looks clean," Alan said.
"Ok, but then why isn't she getting better? She nearly passed out in the shower this morning," Ned said.
"I suspect that was because her blood pressure was so low. The anesthesiologist had to start medicine to better support it in the OR and it looked like that was going to need to continue so I placed a new central line for Dr. Meadows. They're trying to extubate now and then if everything goes well, she will get admitted to our high-risk obstetrical unit on 3 East," Alan said. He waited for Ned to ask what would happen if things did go well, but he didn't. Alan was almost positive that was because Ned was well aware that was a distinct possibility.
Well aware of the less than comforting reality his nephew was living in, Alan gave his shoulder a squeeze. "I'm not going to suggest that you should call your mother, as much as I know she would want to support you, Carly, and your son, I understand that you may be far too overwhelmed to even go there. So, I guess I should just tell you I'll be around for a while if you need anything and you know how to get a hold of me," he said.
"Thank you, "Ned said weakly.
Alan gave his nephews shoulder one more squeeze. "Of course, I know this has been hard and I suspect it will get harder before things are ok, but this whole family wants to be there for you, Carly, and the baby. I have to scrub on another case soon, but I just wanted to let you know where things were. Dr. Meadows was also going to come out and talk to you once she knew for sure which unit Carly was going to after PACU.
Ned nodded but didn't speak, and with that Alan turned to head back into the OR.