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Dr. Monica Quartermaine watched the monitor as she deployed the stent into the Left Anterior Descending Coronary Artery. When it was secure, she paused then injected and watched the dye course through. Satisfied with the flow she started to remove her instruments from the sheath.
"So, apparently we don't have any cardiac stepdown beds so if you want to continue the Eptifibatide Drip then they will have to go to ICU," Anne Mathers said.
Monica released a sigh. She was so sorry that the hospital was very full, but she wasn't going to deviate from accepted standard of care just because of that. "We're always going to need a IIb3a inhibitor of some kind after PCI with stent so, I guess they're going to need to go to ICU. I'm guessing we also have no CCU beds,"
Monica said.
"We do not, unless Dr. Devlin decides to just discharge the patient that he was trying to transfer to cardiac stepdown two days ago," Anne said.
"Of course, he never rounds before nine and often not before ten so it isn't like we will know if there is a bed available. We might as well just find a MICU bed somewhere," Cassidy Reynolds said.
"That is fine, but if you're transferring to MICU either make sure that one of their nurses is sheath trained or the patient will need to go to post cardiac recovery and stay there until after the sheath is pulled," Monica said. That should be common sense but apparently it wasn't as evidenced by the call she got two weeks ago from one of the MICU units about a patient with a femoral sheath they weren't trained to pull.
Cassidy rolled her eyes which Monica decided could either mean she was insulted that anyone would presume she would do that or frustrated that she had been explicitly told not to do that so she couldn't just do it. If was probably best if she didn't try to decide which.
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Carly Ashton forced her eyes open when she heard Dr. Meadows's voice. She had promised they would discuss options in the morning. She struggled to sit up a little but realized that made her feel a lot worse and reluctantly laid her head back down. Perhaps Ned sensed why she had done that because he got up and joined her on the bed and started rubbing her back again.
"How are you feeling, Carly?" Dr. Helene Meadows asked.
"Better if I just lie still," Carly said. Technically that was true.
"The fetal tracing looks good. So, I think many perinatologists would attempt to manage this medically especially given the gestational age. My concern with that is that you're requiring escalating support," Dr. Helene Meadows said.
Ned gave her shoulder another squeeze. "I agree," he said.
"No! It is way too early for this baby to be born," Carly protested. It was! She might have failed out of nursing school, but she knew that thirty-one weeks was way too early.
"Honey, I know you're worried about Michael, and I am too but I'm also very worried about you. You are not doing well, and I do not see any way for you to survive another nine weeks of pregnancy," Ned said.
"I agree," Dr. Meadows said.
"Yesterday you said that you thought this was isolated HELLP. Do you still think that is the right diagnosis?" Ned asked.
"I do, more commonly we see HELLP Syndrome in the context of pre-eclampsia or eclampsia, but it is possible to occur outside of that. I did consult Dr. Kent, our hepatologist just to make sure he doesn't think this is an autoimmune hepatitis, but the clinical picture is less consistent with that," Dr. Meadows said.
"So, if it is HELLP and you manage it medically what exactly would that mean?" Ned asked.
"Once Dr. Quartermaine assured me that there wasn't any active bleeding I started steroids which seem to be helpful in addressing the hemolysis and should also hasten the baby's lung maturity. We also use Magnesium Sulfate and some more supportive treatments like medicines to support the blood pressure and oxygen," Dr. Meadows said.
Carly's head swum. It was so hard to follow the conversation Ned and Dr. Meadows were having. It was so hard to even keep her eyes open and as much as she didn't want to admit it, she was afraid she was dying. But maybe that was what was meant to happen and maybe that would give Michael the best chance at life. Despite her mother's contentions, and Tony's taunts, she wasn't always the most selfish person on the planet.
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"I'll take 3-0 Prolene on a straight needle for my skin closure," Dr. Monica Quartermaine said after taking one final look at the pocket fascia around Marla's new pacemaker-defibrillator combination. The tissue plane integrity was restored, and it was time to close skin.
"Can you use a curved needle?" Cassidy asked.
"I can, still with 3-0 Prolene, please," Monica said. She could use a curved needle it was just a little easier and faster to do a subcuticular closure with a straight needle. Apparently curved needles were a lot cheaper and there were other far more patient critical issues she was going to need to battle the current CFO, Dan Rooney on so she decided to let it go. She released a sigh, accepted the loaded needle from Cassidy and started a running subcuticular closure.
"Can this patient just go directly back to CCU to recover?" Anne asked.
"That's fine, I'll go across with you and make sure everything is settled and speak with her husband," Monica said as she sutured. She personally preferred that patients on mechanical ventilation didn't go to Cardiac Recovery and went directly back to their ICU.
"Oh, and CCU found a bed for your cath patient, so they went there," Anne said.
"Oh, good! I guess Dr. Devlin discharged his patient?" Monica asked. Although it also wasn't a battle she was picking at the moment, Dr. Devlin's general inability to arrive at the hospital before nine or ten most mornings was problematic. The fact that he had apparently seen at least one patient by eight AM seemed to be an improvement there.
"Actually, he did not, however, Dr. Atwood transferred two of his post-operative cardiac stepdown patients out to 6 North with telemetry, so Dr. Devlin's patient moved to Cardiac Stepdown. Hopefully he can print a patient census and find the patient rather than having a tantrum that his patient is missing but alas that will not be my problem. I'll consider sending Maddi a Consumable Cutie later. Between being married to my brother, raising his mini-he, and dealing with half of the Cardiology department at PCGH her life is not easy," Anne Mather said.
Monica decided it was better if she refrained from comment. She pulled the needle through and continued her closure.
"And that brings us to the awkward moment where Dr. Quartermaine is left to wonder if she is part of the difficult half of the Cardiology Department or not," Cassidy said.
Anne shook her head. "Obviously not!" she said then she turned and glared at Cassidy.
Cassidy glared right back.
Amidst the tension and drama, Monica pulled the sutures ends together and tied a knot. "Needle back. Can I get some steri-strips?" she asked.
Cassidy was still glaring when she accepted the needle driver. She handed over the steri-strips to Monica and said, "I seriously can't wait to get married and not have to deal with any of you anymore!"
Once again Monica decided it was better if she refrained from comment. She was mildly curious who Cassidy was engaged to. She was also mildly surprised that Amy hadn't already shared the salient details with anyone who would listen. Or perhaps she had, and Monica had just been focusing too hard on patient care to hear. Sometimes it was better that way.
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Cynthia Belden trudged back from the school bus stop alone. It had been all she could do to drag herself out of bed, make herself presentable, get Jordan ready for school and then onto the school bus, but she had done it and she wanted to believe that tomorrow would be easier. It couldn't be harder, could it?
As she came upon their house her heart sunk when she saw her mother in law's car in their driveway. Once she had released the thought, she immediately felt guilty because Carolyn had basically stepped in and taken care of her son for a week and even before that Carolyn had always been helpful and supportive. So many of her friends complained about their mother-in-law and before it had always made her appreciate how lucky she was. Only, after Marcus's death it was hard for her to feel lucky at all. But maybe she was still meant to appreciate Kurt's mom. So, she took a deep breath and steeled herself as she made her way up their driveway.
Carolyn got out of her car as soon as Cindy reached the top of the driveway. "I thought you must be dropping Jordan off at the bus stop. I was going to go to Carter's Orchard and get apples can I pick up any for your family? Or perhaps you would like to come with me and then we could go to lunch somewhere," she said.
Cindy considered that. She had signed up to make apple pies for the Harvest Dinner at Church, so she did need apples. It was probably far healthier to go with Carolyn than just wallow in her loss. That didn't exactly mean she wanted to do it though. "I would love to join you. I definitely need apples. I am making pies for the Harvest Dinner," she lied. As she climbed into Carolyn's Cadillac, she prayed she wouldn't regret that.
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Ned Ashton refreshed the cool compress on Carly's forehead. She stirred a little in her sleep but didn't open her eyes. He wasn't naïve enough to believe she was resting comfortably so he decided he would just pray that even uncomfortable rest might help her regain some strength. He was still considering that when the nurse came back in to hang more antibiotics and replace several of the drips.
"Ultrasound called and they should be up soon to repeat that Biophysical Profile Dr. Meadows wanted. Is there anything else that she needs?" Carrie Sanders Tyler asked.
"I don't know, she seems so uncomfortable. I know there are legitimate reasons that all the antipyretics are contraindicated. My aunt had suggested trying a cooling blanket, but Dr. Meadows felt that the cool compresses would be a better option," Ned said.
"She is very fortunate to have such a caring husband," Carrie said.
Ned looked down at the floor. "I really haven't done anything amazing here. Carly is the one who has dedicated the last few months of her life to carrying our son. She is the one with the heroic efforts," he said. In some ways it really was that simple. In other ways, he became more terrified by the day that his wife could die.
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Dr. Tracy Adams exhaled deeply after she left Katherine Bell's room. In a vacuum if a colleague told her they had a patient with rhabdomyolysis, a BUN of 126, and a creatinine of 14.2 who was complaining of nausea, myalgias, and malaise she would probably suggest that unless those numbers represented a downward trend, they should initiate dialysis. Katherine's numbers definitely didn't represent a downward trend, but she seemed to be a bit of an entitled, overly dramatic whiner even on her good days, so it was hard to tell if she was truly symptomatic or not. But the more she thought about it she realized that life was just too short, but really too long, for patients like Katherine. So, she stopped over thinking and put a consult in for Dr. Alan Quartermaine to place a tunneled dialysis catheter. It was time to initiate dialysis!