November 1, 1997
Thanks to the time change the earliest pink embers of daylight were breaking when Dr. Monica Quartermaine made her way across the parking lot outside the Port Charles Fitness Club. She paused momentarily as she opened her car door and took in the spreading pink glow. Despite the associated biblical warning of impending foul weather, it really was beautiful. Or perhaps the message was really intended to be the importance of persevering through the storm. That was something she was far too familiar with. With that thought she got into the car and made her way to the hospital.
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When he helped carry his "brother" Alexander Hoffman's latest victim out of the Kappa Alpha Delta Fraternity House, Port Charles University Junior Hank Bennett, knew he wasn't doing the right thing. He rarely had since he had pledged the fraternity two years earlier. Unfortunately, he was in far too deep for a crisis of conscience.
The blonde in their arms stiffened and moaned as they crossed the threshold and stepped out into the chilly November morning. It was approaching five thirty and dawn was breaking a lot more than was ideal for a dump and ditch. Hank met Alexander and Evan Tucker's eyes uneasily. They had to realize the same thing. Didn't they?
"How about we go local?" Evan asked.
Alexander shrugged his shoulders nonchalantly. "Works for me," he said.
Hank considered that. They usually went into Moriches to avoid any obvious connection to themselves, but it would be close to six before they could get over there. Perhaps it was for the best. "Ok, but we need to get at least fifty yards beyond the property line and up the road. Last year some pledge basically dumped a girl on our lawn," he said.
Alexander laughed. "Don't remind me! I'm the one who had to tap into my trust fund for the ten k which helped her remember she had actually been partying at TKE," he said.
Evan joined in heartily and Hank was once again reminded how in over his head he was. He didn't have a trust fund to tap into. His parents were both dead but even when they had been alive, they hardly had the financial resources or political capital to broker some kind of get out of jail card. Perhaps his oldest brother, Sam, should have that power. He was the Police Chief of a smaller city in Maine. Except, even if Sam had been able to help him, he clearly would have been far too sanctimonious about it all for Hank to have ever considered going there. After all, he had largely selected an out of state college to get away from Sam's scrutiny and reproach.
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As he worked his way through his rounds in the SICU, Dr. Alan Quartermaine paused a minute with trepidation before he crossed the threshold into the room occupied by his niece by marriage. Carly's situation was still extremely tenuous, but she had survived the night which could be considered an accomplishment. Her hemoglobin also appeared to have finally stabilized so there was hope that the bleeding had stopped as well.
There was also the possibility that they were just transfusing very effectively. Although usually, even with massive transfusion protocols, in the context of DIC unless things were improving it was hard to just not keep getting further behind. But her abdominal exam seemed to be improving and the surgical drains were no longer pouring out blood as they had been, so he dared to hope she was truly improving. "The fibrinogen was still under one hundred, so I ordered more cryoprecipitate, did that come from blood bank yet?" he finally asked.
Mitch Harris gave a quick roll of his eyes and then started to shuffle through a stack of blood slips. "It's ready but I can't exactly leave a patient on multiple drips, so I sent Beth down to blood bank to return the cooler collection and she is supposed to be picking up that cryoprecipate," he said.
"Great!" Alan said with forced enthusiasm.
"Not exactly Beth's sentiment. Apparently, she isn't a fan of night shift, or getting pulled to cover the SICU, but it could be worse, at least Beth can be trusted to go directly to and from blood bank without a detour through the ED to see if her boyfriend's ambulance crew just happens to be dropping off a patient, and he feels like getting a little something, something, while his partner cleans the rig," Mitch said.
Alan let that comment go. That was often the best strategy with Mitch, and he thought that Amy Vining and Gary Ross had broken up anyway. Then Dr. Meadows entered the room with several residents in tow, so he turned to focus on her.
"Thank you for all of your assistance yesterday evening. It appears that oversewing the uterus has stabilized things," Dr. Helene Meadows said.
"I hope so. I ordered another pack of cryoprecipitate, because the fibrinogen was still low," Alan said.
"I saw that. Dr. Collins is taking inhouse call today but I told her she could call me if there were problems. I'm going to be optimistic and go ahead and get an explorative washout on the schedule as a Sunday morning case. I would appreciate it if you could scrub that with me just in case. Are you going to be in house?"
"I'm actually taking second trauma call the rest of the weekend so I'm rounding and then I'll come back if we need a second trauma surgeon. If you schedule this for 7:30 as the first Sunday urgent case then I'll need to arrange for someone to pick up my kids from swim practice but if all goes well, I should be able to make it to church for the Communion of Saints," Alan said. Then he offered a silent prayer that their family would not have any additional members to celebrate on All Souls Day.
"I can do that," Dr. Meadows agreed.
"Thanks, and you can tell Vivian if she has any problems or feels she needs to go back to the OR this afternoon she can just call me directly. Technically Dr. Boardman has the first half of the inhouse trauma shift today but it's probably easier if she just calls me," Alan added.
"Thank you, Alan, I appreciate that," Dr. Meadows said.
"Of course! On that note I need to get over to 4 North and meet up with my residents so we can round on non-ICU patients, and I can go pick up my kids from swim practice this morning," Alan said.
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Dr. Evelyn Lambert reflected on Dr. Quartermaine's diplomacy as he strode away toward the back stairs. She supposed that was probably why he had been selected as Chief of Staff more than his surgical prowess. That probably didn't hurt though she supposed.
"So can you follow up on the repeat coags and CBC, Dr. Lambert?" Dr. Meadows's voice pulled Eve from her thoughts.
"Umm sure," Eve said awkwardly.
"You can always call Stuart if you have questions," Dr. Roman Gold said. He was a PGY4 who had a bit of a reputation for being annoyed by what he viewed as intern ineptitude on the regular. Generally, Eve just tried to stay out of his way.
"You can always call me, but just so we're all on the same page is our feeling that if the Hemoglobin is above eight, the platelets are above one hundred thousand, and the fibrinogen is above one hundred forty then as long as the coags are within one and half times normal then we're ok? That is what Dr. Quartermaine wrote in his note and it seems like usually when we comanage with surgery and the patient is in SICU then often Surgery gets called with these things even if we're technically the primary team," Dr. Stuart Cahill said.
Dr. Gold rolled his eyes. "You're complaining about not getting paged?" he asked his junior colleague.
"Dr. Cahill raises a good point. Part of residency should be learning how to work collaboratively with other services. I would like to think that our department is teaching this by example but in case any of you need other examples Dr. Alan Quartermaine, Dr. Monica Quartermaine, Dr. Gail Baldwin, Dr. Ryan Grabler, and Dr. Tracy Adams are colleagues outside of our field that I feel excel in their own specialties but also in communication and collaboration outside of their specialty. And, yes, Stuart, I agree with the parameters you outlined for this patient," Dr. Meadows said.
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In the PCGH Emergency Department, Dr. Richard Carmichael glanced from the EKG which showed atrial fibrillation with rapid ventricular response, to the disheveled party girl moaning and writhing on the gurney in front of him. EMS had brought her in almost twenty minutes earlier after she was found only partially dressed, about twenty yards up Windsor Road from the Kappa Alpha Delta Fraternity House, by some guy walking his dog. Although she was still registered as a Jane Doe, one of the nurses had pointed out that she was actually Tiffany Peterson, the granddaughter of Harvey Phillips London III. Perhaps paging whoever was on call for Pediatric Cardiology wasn't a bad idea after all.
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In the 4-West ICU, Dr. Monica Quartermaine watched the waveform on the monitor as she navigated the Swan-Ganz catheter into the Pulmonary Artery. "Balloon up," she commanded just as her colleague Dr. Kiran Desai entered the room.
Monica watched as the catheter wedged in the artery and noted the pressure. "Balloon down," she said.
Dr. Desai glanced at the monitors and nodded. "Thanks for doing this. I figured if Dr. Bensch was unable to get access overnight then it just made more sense for you to try," he said.
Monica secured the catheter within the introducer sheath before she spoke. "Of course, that isn't a problem. I was looking for you anyway, I managed to explant the balloon pump on our other mutual patient. I generally support sedation vacations and believe that they reduce ventilator days but ideally you would not hold or even wean the sedation for at least the next eight to twelve hours," she said. Typically, when she removed balloon pumps, she left patients completely flat for two hours and then did another six hours of calm bed rest. Of course, they were talking about Lucy Coe so calm was a challenge.
"Ah, yes, I understand. Were you planning on repeating the TEE before extubation?" Dr. Desai asked.
Monica considered that as she removed her gown and gloves. Lucy would definitely need a followup ultrasound and a TEE would be better and also easier to do safely while the airway was secured. "That sounds like a good idea. I was tentatively planning to repeat an Echocardiogram on Monday," she said.
"I don't see us extubating tomorrow so that sounds like a plan," Dr. Desai agreed as an ear-piercing sound interrupted both of their thoughts.
Monica deposited her gown and gloves into the biohazard trash and then reached to silence her pager with a single finger. She glanced over at Dr. Desai who was still frowning and fumbling around at his waist. "Sorry, that's me, if you're ok here now, I'm going to go see what the Emergency Department needs," she said.
"Yes, of course, thank you for your help," Dr. Desai said.
Yet, as she left the room, Monica wondered if her colleague looked a little more unsettled than usual.
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PCPD Officer Frankie Greco felt a bit lazy as he leaned back into one of the plastic chairs in the waiting area outside the Port Charles General Hospital Emergency Department. "Are you sure that Detective Capelli really wanted us to just wait here until we were able to take that Jane Doe's statement?" he asked.
"Capelli said not to bother him until we had some evidence that this was something more than some sorority girl who had a little too much to drink," Officer Donald Owens told his partner.
Frankie considered that. He agreed that it was likely the young woman they had found along the side of Windsor Road had been partying Friday night into Saturday morning. But she had been found with her skirt up enough that it was clear her underwear was missing which was certainly suspicious. "Do you think that is what happened?"
"I think that there is no way that my baby girl is going anywhere near PCU," Donald Owens said.