October 30, 1997
When Dr. Monica Quartermaine stepped into Carly's room on the High-Risk Obstetrical Unit of Port Charles General Hospital it was instinctive and almost innate that her eyes were drawn towards the infusion pumps. She noted the Protonix Drip, the Magnesium Sulfate, and the Phenylephrine Drip infusing through a left subclavian central line at 350mcg/min, quite a significant rate. Instinctively that brought her eyes to the monitors where the heart rate registered around one hundred forty beats per minute and the arterial line transducer showed a good waveform and a barely acceptable mean arterial pressure of sixty-six. None of that was really reassuring.
Underneath all of that, Carly lay jaundiced but flushed, diaphoretic, and panting with labored ragged breaths. Her gravid but also very swollen and ascitic abdomen splayed out in front her. Beside her, Ned looked exhausted and helpless as he alternated between rubbing her back and readjusting the cool compress that laid on her forehead. Monica feared they had both been up all night as it was clear that poor Carly was too uncomfortable and ill to rest.
Despite all that she had taken in, Monica laid a hand on Ned's shoulder, leaned down, and asked, "How is she doing?"
"Not well and I'm afraid she is getting worse. The fever got up over 104 but they're afraid to give her anything because of her liver. She was so restless and uncomfortable earlier but now I think she is only so still because she is too weak to move. Dr. Meadows said that she was going to call you to repeat the echo and then maybe move her to the ICU," Ned said.
"I agree she needs to be in the ICU now. I think we should also intubate so her airway is protected, and we can support her respirations better in transport. I'm going to take care of that and then we'll find an ICU bed somewhere," Monica said. Her own words surprised her a bit but in just the few minutes that she had stood in the room she could see the situation deteriorating.
Monica turned to the nurse. "Sandra, can you grab the code cart and page RT. We're going to need to intubate her before we transfer to ICU. I'm going to switch this mask over to a 100% non-rebreather while we are waiting," Monica said as she started to do just that.
Carly opened her eyes as she laid the new mask down and adjusted the straps. Monica saw the terror, so she patted Carly's shoulder. "I know you're scared but we're going to do everything we can for you and your baby. I know how hard you've worked to carry this pregnancy and now you can just rest and let us carry you. I'm going to put a tube in so we can help you breathe, and you can just rest, ok?" she asked gently.
Carly nodded slightly but unfortunately Monica doubted she had the strength to do anything more than that. She gave her shoulder another pat. "I'm going to try to use Propofol and Succinylcholine for my intubation it's better for the baby because neither cross the placenta," she told Sandra.
XXXXXXXX
Celia Quartermaine waved to the security guard after she swiped her badge to enter the ELQ Enterprises Office Building that was the centerpiece of the ELQ owned Executive Park Office Complex. She was often in the office by six AM in Utah, so she had decided to continue the practice during her stay in Port Charles. It just made sense; she loved the silent stillness of daybreak. It truly inspired productivity. Additionally, it essentially guaranteed she couldn't be stuck having breakfast with her father.
XXXXXXXX
Dr. Monica Quartermaine slid the endotracheal tube throught Carly's cords, and then swiftly pulled the stylet out. She leaned back slightly but held the tube securely as one RT attached the bag and started to ventilate while his colleague started to secure the tube. "Did the Nursing Supervisor ever call back with an ICU bed?" she asked.
"As far as I know, unfortunately, no," Hank Frazer said as he locked the tube securing device.
"Ok, in that case why don't you put her on the ventilator AC 18 450 100% +10 PEEP should work. The nurses are going to want her back on her left side so can you help them with that and make sure the tube is protected?" Monica asked.
"Of course, Dr. Quartermaine," Hank said.
Monica noted that he sounded less than thrilled. She understood that intubating on 3 East was generally avoided but sometimes it just couldn't be helped. Even with 100% oxygen Carly's saturations were only 94-95%. "Also, for transport you will probably need a PEEP valve in line with the Ambu Bag so can we arrange for that?" she asked.
"Sure," Hank said.
Hank looked even less thrilled than before, but he would do his job and Monica could respect that. "I'm going to go update her husband," she said.
Carly's husband, who also happened to be her nephew, was leaning against the wall when she stepped out into the hallway. He looked up when she approached. "Is everything ok?" he asked.
"The intubation went well. She is on the ventilator now but we're still waiting for an ICU bed, so she is going to need to stay on this unit a little longer. I need to go change a central line in CCU and see if I can wean a balloon pump on another patient there, but I'll have the nurses let me know once Carly has moved to the ICU and I'll do the Echo then," Monica explained.
"Thank you, for everything," Ned said.
"Of course, Ned, I hope Carly can at least rest now and regain some strength," Monica said.
XXXXXXXX
At Port Charles General Hospital, Theresa Falconeri guided her sister-in-law Angela Falconeri Mazza into the West Elevator and pushed the button for the 4th Floor. She vowed that she would extend much more compassion to Angela than she had seen fit to extend her first when her Connie had basically literally disappeared fourteen years earlier, and even later when her son Carlos, died after colliding with a wrong way driver in the Brooklyn Battery Tunnel. The irony was that it was likely that Angela's son was going to be fine, because, somehow, Angela's problems were always solveable.
Angela sniffled and dabbed at her red rimmed eyes with a tissue. "I never should have let Pauly banish him up here to the tundra!"
Theresa decided there wasn't really a response she could give to that. Or at least not one that Angela would appreciate. Her younger nephew Sal had always been a Mama's boy even after he grew into a ladies' man. Her older nephew Vinny had definite anger management issues that had never been addressed so options had been limited when Vinny learned that his wife was cheating on him, with his brother. While she liked to think that if they were hers, she would have addressed Vinny's volatile temper and Sal's inability to understand the value of family or the reality of consequences several decades ago she supposed it was most supportive to believe that Paul and Angela had done the best they could with their boys. Just like she and Leonardo had tried their best with Connie and Carlos. So, she just patted Angela's shoulder silently.
The elevator stopped on the fourth floor, so Theresa stepped out and then followed the signs that led to the Surgical Intensive Care Unit.
XXXXXXXX
In the Port Charles General Hospital Cardiac Critical Care Unit, Dr. Monica Quartermaine tied the final knot on the central line she had just placed. She reached for the scalpel to cut the suture and sighed. A quick glance at the clock told her it was only a little after eight o'clock, but it seemed like it had already been such a long day. The irony was that she thought the feeling had very little to do with the fact that she had gotten up at quarter after three so she could take Allison and Kirk to swim practice and swim several miles herself. More unfortunately, she didn't foresee her day ending anytime soon or even getting less stressful in general.
With that thought, she released another sigh as she applied the dressing over the central line insertion site. "I'm all done! I'll clean up the field if you can call for an x-ray to confirm line placement," she said.
"Umm, sure," Madeline Mathers RN said quickly even if she appeared a bit flustered. She quickly stepped out of the room presumably to call radiology for the chest x-ray.
As Monica removed the sharps from the field and deposited them in their designated hard plastic container, she released another sigh and tried to psych herself up for her next and final CCU patient, Lucy Coe Stanton.
XXXXXXXX
Alexis Davis hated mornings. She really hated mornings which started before nine. So, when she found both her cousin Stefan and Dr. Tony Jones waiting outside her closed office door at 8:30 she thought it showed amazing professionalism that she resisted the temptation to run screaming in the opposite direction. "Good morning," she said weakly instead.
Stefan raised both eyebrows with displeasure. "It is almost nine o'clock," he said.
"The emergency board meeting is not until ten o'clock," Alexis said flatly as she stepped around both men and opened the door to her office
Stefan raised his eyebrows again and then knit them together. "I will be in my office when you are done dealing with Dr. Jones's crisis," he said then he turned and left.
Alexis shook her head and deposited her briefcase on one of her office chairs. "Although I'm sure I will regret this later, what can I help you with, Dr. Jones?" she asked.
Dr. Jones grunted as he came into her office. "Carly got moved to the SICU. I need you to find out if that means she had the baby and then file for me to get sole custody if she did," he said.
"Didn't you say she wasn't due until the end of December? I'm not a physician but if the baby is 2 months early won't they end up in the NICU or something?" Alexis asked.
Dr. Jones just glared at her. "I would think that would only support my case. Carly is Physical Therapy Assistant who failed out of nursing school. I'm a neurosurgeon. I do brain surgery!" he said.
Alexis's eyes rolled almost spontaneously. "But at the moment, you aren't even considered the father of any child Mrs. Ashton may or may not have delivered. The first step would be to file an order of filiation, but that can't be done until the baby has been born," she said.
"I am surrounded by incompetence!" Dr. Jones screamed before he stomped out of her office.
Alexis just sighed.
XXXXXXXX
Katherine Bell felt clammy, so nauseated, and just generally unwell as the nurse started to connect the line Dr. Quartermaine had put in the day before to a large machine. "I still don't understand why, this is necessary," she whined.
Katherine caught the way the nurse's eye's rolled eyes before she pretended to be focusing intently on connecting the line. "Didn't Dr. Adams explain this to you?" she asked.
"Hardly! I think she was too busy accusing me," Katherine started but then she realized she didn't really want to explain what Dr. Adams had accused her of. She could only imagine the rumors that would inspire. Then she started to wonder what rumors were already out there. It had been at least a week, no more like two weeks or maybe even longer than that since she had been to work. What exactly were people saying. Was she already the laughingstock of Deception Cosmetics if not Port Charles at large?
Suddenly it felt as if an entire brick wall had collapsed onto her chest and the was hardly enough air. She gasped and panted and spluttered until everything turned black.
XXXXXXXX
In the Port Charles General Hospital Cardiac Critical Care Unit, Lucy Coe Stanton lay helplessly on the ventilator, tethered by various monitor cables, infusion lines, and an intra-aortic balloon pump but seething with anger. How dare her husband proclaim that Dr. Monica Quartermaine was some kind of hero just because the woman had manged to reduce some setting on her cardiac support? Wasn't that her job? In fact, wasn't her job to heal her and get her off the damn thing?