Dr. Monica Quartermaine was anything but thrilled to have Katherine Bell back on her CCU service she just couldn't say that aloud. So instead, she pasted a smile on her face and examined her patient with compassion. Then, she reviewed the STAT EKG, which was normal; labs, which showed azotemia and a creatinine of 14 but more relevantly included a negative troponin and a normal D-dimer; and the chest x-ray which showed moderate pulmonary vascular congestion not unexpected given the volume overload from her oliguric renal failure. Finally, she picked up the phone and called Dr. Tracey Adams.
"Dr. Adams, hello, this is Dr. Monica Quartermaine. As you know Katherine Bell syncopized in dialysis before they were able to start her treatment. Now she is here in CCU, and vitals are appropriate, EKG didn't show any evidence of ischemia or arrhythmia, labs are all normal except for the expected renal derangements, and I would even argue that her chest x-ray while not normal is perhaps better than expected given the rest of the clinical picture," Monica began.
"So, she basically just needs to start dialysis?" Dr. Adams asked.
"Essentially, yes. I presume though that now you would like to do at least the first treatment bedside in the CCU," Monica said.
"I think we have to," Dr. Adams said.
"I don't disagree," Monica conceded.
"I know ICU beds are tight so if we do this today and it goes fine then you can transfer back to cardiac stepdown this evening and we'll do her second treatment in the dialysis unit tomorrow morning," Dr. Adams offered.
"That's one of the best things I have heard so far today!"
Dr. Adams laughed. "So, it's been one of those kinds of days?"
"Basically, and it's only 9 o'clock and I have STEMI call tonight," Monica said.
Dr. Adams laughed again. "And here I thought my life was bad. Anyway, thanks for your help. I'll change the hemodialysis orders and let the nurses know to start dragging a machine in the direction of the CCU," she said.
"Thank you, hopefully both of our days will get better," Monica said.
"Sure, a girl can dream right?" Dr. Adams asked.
This time Monica chuckled as well. She had just hung up the phone when her intern arrived on the unit and wheeled over to join her.
"Good morning, Dr. Harmon, how was morning report?"
"Truly interesting! I still think I want to do surgery but there is something fascinating about Hematology," Dr. Harmon said.
"I would have to agree with you. I also considered the specialty when I was at your stage. On that note, I think I'm done here. Can we see if we can round on 6 North and that Stepdown unit somewhat expeditiously because apparently Mr. Cassadine called for an emergency meeting of the hospital board at ten o'clock," Monica said.
"Sure, I was actually supposed to try to meet with my attending mentor sometime this morning so maybe I can do that while you're at your meeting," Dr. Harmon suggested.
"Of course, or a different time if that works better," Monica said. She was almost certain that Dr. Harmon's attending mentor was her mother.
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As they sat in the Port Charles General Hospital Boardrooom, Amanda Barrington knew that Edward Quartermaine was being polite when he inquired how her granddaughter, Ashley, was. Although their grandchildren had briefly dated it was clear that Alan James Quartermaine Jr. had moved on. "Ashley is taking a year off from Fairleigh Dickinson to focus on this November's Debutante Ball and her first social season," she said. That was the truth, it just glossed over the fact that the year off had been strongly recommended and really her only option to avoid outright dismissal. Unfortunately, it seemed that Ashley had inherited her mother's intellect, or lack thereof, and her impaired moral compass. Both issues concerned her greatly.
"Lila has become quite conflicted about the whole Debutante Ball process. Have you also? Would you prefer that Ashley just focus on her studies and then her career?" Edward asked.
Amanda supposed she should have always been conflicted by Debutante Balls or maybe she was just as much of a hypocrite as her daughter in law Elizabeth accused her of being. She had lacked the family wealth or social standing to make her own Debut, but she had caught the attention of Markham Barrington anyway. In her heart she knew she had married him for his money but in time she had fallen in love with his gentle and generous soul. Because she herself had been a gold digger, she had quickly spotted those traits in her eldest son, Malcolm's wife, Elizabeth Winthrop; her second son, Derek's college girlfriend, Gina Carter; and Blair Daimler, a girl who had lusted after her youngest son, Aaron during his college years. Perhaps it had rankled more because it was familiar. It was who she had been so she was sure some would argue she should have understood.
Or maybe the problem was that she understood far too much.
XXXXXXXX
In the Port Charles General Hospital SICU, Ned Ashton gently kissed Carly's forehead and then took a step back. "Apparently I am needed at an emergency meeting of the hospital board. I'll be over in the boardroom in the administrative pavilion in case Carly needs anything and I'm not getting cellular service over there," he instructed the nurse.
"Of course, Mr. Ashton, that will give me a chance to get your wife cleaned up a little bit. I'm sure she will feel much better after a good bed bath," Leila Matthews RN said.
Ned was much less sure about that, but he just nodded and then turned and left the room. He left the SICU and made his way to the West Elevators where he was only mildly surprised to see his Uncle Alan standing with one of his residents.
The elevator arrived and they all stepped inside. Alan quickly depressed the buttons for the first and second floor and then turned to his resident. "I need to go to this board meeting, so why don't you go over to the Main OR and catch up on your dictations? I'll meet you in the Doctor's OR lounge for that port placement," he suggested.
Alan's resident seemed less than thrilled with the suggestion. "What if I just go grab some lunch?" he asked.
"I never want to be known as the attending who withheld nutrition and sustenance, Dr. Cerami, so, if you're hungry then by all means address that but please also make sure that you are also addressing your discharge summaries. I understand that there is a lot going on and often it is just easiest for me to dictate them right before patient leaves, but Dr. Boardman doesn't share that sentiment and administration has informed me that you have several outstanding ones on his patients from August, please start with them once you've finished your meal," Alan said.
Dr. Cerami shrugged his shoulders and then scowled again as the elevator stopped on the second floor then resumed its trajectory down to the first floor. There he stepped out quickly and headed in the direction of the main hospital cafeteria.
"Isn't it a little early for lunch? It isn't even ten o'clock," Ned said as he and Alan walked.
"I suppose it's afternoon somewhere," Alan said.
Ned chuckled. "Fair enough. Any idea what this emergency meeting is about?"
"Technically, no. But if I had to guess I would presume that Stefan didn't appreciate that neither Monica nor I are favorably impressed with the new cardiologist he wants to hire," Alan said.
"Hmm," Ned said. "Do we need another Cardiologist?"
"We do, but we really need another interventional cardiologist," Alan said.
"And this person Stefan wants to hire isn't an interventional cardiologist?" Ned asked.
"Technically he completed an Interventional Fellowship but would likely not qualify for privileges in Interventional Cardiology at PCGH without significant proctoring so that would likely increase the burden on our current interventional cardiologists and not reduce their STEMI call."
"So that is why Monica isn't so thrilled about hiring him?"
"Monica also has a former fellowship colleague who has worked with him in the past and had some clinical concerns which is even more of an issue for her. She is always so determined to give fellow physicians all possible chances so she would probably make the proctoring work out somehow if it was someone, she could believe in. But her former colleague's inability to recommend him, and the reality that he hasn't passed his general cardiology boards make it a hard sell."
"That is more than understandable. So why is Stefan so determined to hire him?" Ned asked.
"That is the question I've been asking myself," Alan said as they started down the connector to the Administrative Pavilion from the North Wing.
XXXXXXXX
Leila Matthews laid a fresh gown over her patient and gently closed the snaps around her arms. Even on the ventilator the poor woman still looked so uncomfortable. Dr. Monica Quartermaine had done a TEE and said that her heart itself looked good. Then, she had placed an arterial line, ordered a second vasopressor drip, and said as long as Dr. Meadows wasn't opposed, she could titrate that up which should allow her to increase the Propofol Drip. Leila had tried that, but her patient was still restless and distressed.
"Whoa! I guess that is like the definition of knocked up!" Amy Vining said as she came into the room.
Leila quickly pulled the gown down over Carly Ashton's swollen abdomen and shook her head. Apparently, Ms. Vining's remedial course on professionalism and ethics hadn't impacted her behavior at all.
"Don't look at me like that! I mean seriously we've had bariatric patients with smaller bellies!" Amy said.
"You can't come in here and make depreciating comments about a critically ill patient who is quite literally fighting for her life and that of her child," Leila said.
Amy rolled her eyes. "Oh please, this is Carly we're talking about. Perhaps she will consider that pregnancy comes with weight gain before she goes back to her homewrecking ways! Anyway, I'm going on break, so you need to listen for my patient's drips," she said before she turned on her heel and stalked out of the room.
Leila readjusted the gown and then pulled a clean sheet over her patient. "Hang in there, honey, Dr. Meadows, and Dr. Quartermaine are really trying to help you and your baby," she said.
XXXXXXXX
Tears stung Carly Ashton's eyes. She supposed Amy hadn't said anything that she bet all the other nurses hadn't thought. It still hurt though. Everything hurt!
XXXXXXXX
As she sat in the Board Room listening to Stefan Cassadine extol Dr. David Hayward's talents, Dr. Monica Quartermaine decided if she didn't know better, she might feel that he could actually be an asset to PCGH. Except she did know better!
"So, at this point, I would like to recommend that we vote by affirmation to hire Dr. David Hayward as a new Interventional Cardiologist," Stefan Cassadine said.
"Technically, before you can do that, we need a motion to close the discussion on the matter," Ned Ashton said.
"Which would be a bit premature since you're the only person we've heard from," Edward Quartermaine said.
"I think we should at least hear from Dr. Monica Quartermaine since essentially her department would be hiring Dr. Hayward, right?" Edward asked.
"Dr. Hayward hasn't done a sufficient number of successful angioplasties to be privileged at PCGH so if the board opted to hire him then he would need to be hired as a general cardiologist and then go through proctoring. We do need another interventional cardiologist, but we really need to hire someone who can essentially take STEMI call from the beginning," Monica said. That was the most diplomatic version of the truth.
"I am sure an exception could be made. Dr. Hayward trained at Stanford," Stefan protested.
"Dr. Hayward hasn't yet passed his internal medicine boards and will not even be eligible to sit for his Cardiology boards until he does. Our by laws require that physicians achieve board certification within three years of completion of training. Dr. Hayward would be ineligible to be hired as an Internist. I really think we should just not proceed further with this candidate," Dr. Alan Quartermaine said.
"I agree," Stuart Longsworth Jr. said.
Stefan Cassadine looked furious. "You are being extremely short sighted. You realize that if we do not hire Dr. Hayward someone else will!" he ranted.
Monica wasn't sure about that. In the interest of expediency, she decided to just let that go.
"I'm going to defer to my sister as far evaluating Dr. Hayward's clinical suitability but aren't we missing the point that we can't hire him regardless since one of your current residents has a restraining order against him?" Scott asked.
"Technically, that is correct at least until that physician finishes their residency training which I believe will be in July of 1999," her father said. He would know since he was one of the hospital's professional counsels.
"Another physician has a restraining order against Dr. Hayward? That is enough for me to oppose hiring right there," Amanda Barrington said.
Ned released a tired sigh. "In the interest of expediency, I move that we close discussion on the candidate Dr. David Hayward," he said.
"I will second that," Monica said.
"I move that the board decline to offer a contract to Dr. David Hayward," Edward Quartermaine said.
"Second!" Scott Baldwin said.
"Call the question!" Ned said.
"Second," Alan said quickly.
"I demand a roll call vote," Stefan demanded.
Edward glared at Stefan. "If you insist—Edward Lawrence Ashton?"
"Yes."
"Dr. Alan Quartermaine?"
"Yes."
"Dr. Monica Quartermaine?"
"Yes," Monica said just as her pager began to vibrate. "Excuse me, I'm going to step out and return this page," she said as she quickly got up from the table and exited the room. That was twenty minutes of her life she was not going to get back. She forced a smile as she picked up a phone to return the page.
XXXXXXXX
Dr. Julie Devlin grabbed the ringing phone. "5 East, this is Dr. Devlin," she said.
"Hi Dr. Devlin, this is Dr. Quartermaine, someone paged me."
"Oh, yes, that was me. I have a twelve-year-old female, Lark Madison-5532- admitted for pelvic inflammatory disease who developed chest pain, so Dr. English wanted us to consult you."
Dr. Evan English was a Pediatric Rheumatologist. The pediatric subspecialty attendings were required to do at least one week of Pediatric Teaching Service each year to theoretically maintain touch with general pediatrics. Or at least that was the hope. "Ok, I'm happy to see the patient. Can you order an EKG and if you haven't done a recent chest x-ray that would also be reasonable.
"I can do that. Dr. English said to ask if you wanted to do a Rheumatic Fever workup? He also said something about everything looks like a nail, but I really didn't see any splinter hemorrhages," Dr. Devlin said.
Monica smiled. "I think perhaps he was suggesting that if you only have a hammer then everything looks like a nail which was his way of suggesting that since he is Rheumatology focused chest pain and fever might be Rheumatic Fever, or I guess endocarditis as you were thinking. If you haven't already, why don't you review the Jones major and minor criteria, and we can review them after I see the patient."
"Of course, thanks, I'll do that," Julie said. She hung up the phone and hoped Dr. Quartermaine didn't think she was an idiot just as Chris came around the corner.
"You look stressed, what's wrong?" Chris asked as he leaned on the counter in front of her.
Julie sighed. "Not really, on the positive side I now understand what Dr. English was alluding to on rounds, on the negative side Dr. Quartermaine may think I'm an idiot," she said.
"Which Dr. Quartermaine?" Chris asked.
"Monica, who is the one most likely to have any say in whether I get a Pediatrics spot next year," Julie said.
"I'm sure Dr. Quartermaine doesn't think you're an idiot. Anyway, they have at least one open spot for PGY2 next year and you're the only one who is doing all the pediatrics rotations," Chris said.
"Maybe," Julie said.
"No maybe, you can trust me on this, come on, I'll treat you to a muffin in the coffee shop," Chris said.
"Ok, and then you can help me review the Major and Minor Jones Criteria so I can redeem myself before Dr. Quartermaine comes up to do this consult," Julie said as she followed Chris to the elevator. Chris really could be sweet sometimes. Sometimes she wondered if her fellow interns misjudged him or if he truly treated her differently because he didn't see her as competition for his coveted surgery spot.