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"Hi, Hailey," Rachel, one of her nursing colleagues, greeted her when she approached the desk. "You're working arena team two today."
"Sounds good." Hailey had started at Cedar Bluff hospital about two months previously, but she'd worked in the emergency trauma center at Trinity Medical Center in Milwaukee for several years, so she hadn't needed long to learn Cedar Bluff's way of doing things. Rachel had been her preceptor but they'd quickly grown to be friends.
"I'll be right next to you in team three," Rachel said cheerfully. "So if you need something, or have questions, just let me know."
"Thanks." Hailey appreciated Rachel's sincere offer. The other nurses were friendly too, but most of them were married with children so they weren't exactly anxious to stop for a bite to eat after work, or go to a movie. Rachel was single, and she and Hailey had bonded after a particularly stressful shift a few weeks back.
Moving to Cedar Bluff had been a good decision for her. She loved the homey atmosphere of the hospital and the town. Plus, her apartment was only a few miles from the hospital, making it easy to ride her bike to work every day.
Hailey glanced up at the assignment white-board and couldn't suppress a tingle of excitement when she noticed the physician leader assigned to her team was none other than Dr. Simon Carter. She knew who he was, of course. His chocolate-brown eyes, mink-colored hair and broad shoulders stood out dramatically, in her humble opinion, among the rest of the physicians. But in the two months since she'd started in the ED, they'd only worked together a few times and those had all been during her orientation, with her preceptor primarily interacting with him.
He seemed like a nice guy. And one of the few not married. Rachel had warned her that Dr. Carter didn't date any of the staff at Cedar Bluff, ever, but she couldn't seem to control her physical reaction to him. But it didn't matter because she wasn't in the market for a relationship either, so Hailey was more than happy to admire him from afar. She'd noticed all the staff called the doctors by their first names, but she couldn't bring herself to follow their example. Especially with Dr. Carter. Using his first name, Simon, seemed far too personal.
Heaven knew, it was bad enough that Dr. Carter's handsome face managed to invade her dreams.
Shaking off the inappropriate thoughts, Hailey quickly took report on the patients in her team from Alyssa, the day shift nurse in team two. With sixteen-month-old twin girls at home, Alyssa only worked one shift per week, and often that shift was a weekend.
"Hailey, do you have any questions?" Alyssa asked, when she'd finished her rundown. "Because if not, I need to go, I have to pick up the girls from their grandma. As much as my mother-in-law enjoys babysitting, I think it's getting to be a bit much for her now that the girls are walking."
"No questions," Hailey said reassuringly. "I can't imagine what it's like to take care of twins."
Alyssa laughed. "It wasn't too bad until Grace and Gretch learned to walk. They were preemies and a bit delayed in reaching their milestones, so they didn't figure it out until just a few days ago. Now it's like they're each on a different mission, heading off in opposite directions. Keeps us running."
"No doubt," Hailey agreed, ignoring a twinge of envy. Alyssa's husband, Jadon, was one of the ED doctors she enjoyed working with. They made a beautiful couple.
Once she'd envisioned a similar future for herself. Husband. Babies. Happily ever after. But not anymore.
Moments after Alyssa left, Leanne, the charge nurse, came over. "Hailey? I just put a new patient in room seven. Here's the paperwork." Leanne thrust a clipboard into her hand. Most of their nursing documentation was on computer, but the registration and consent for treatment forms were still on paper. "Fifty-five-year-old guy with abdominal pain."
"Thanks." Hailey took the clipboard and glanced up in time to catch Dr. Carter staring at her. The moment their gazes collided, he seemed to go still, and then tore his gaze away.
Had she imagined the flash of interest in his eyes?
Most likely. Rachel had confided that she'd tried to ask Dr. Carter out several times, but he'd always politely declined.
Not that Hailey was interested in dating him, the way Rachel had been. Still, it felt good to be noticed.
"Good afternoon, Mr. McLeod," Hailey said with a smile as she walked into her new patient's room. His wife was there too, standing next to his bed. Hailey quickly introduced herself. "Tell me what brought you to the hospital today."
The middle-aged gentleman grimaced. "We went out for lunch with my daughter, she's a sophomore at the university, and ever since we finished eating, my stomach has been hurting. The pain is cramping, and it seems to come and go. Do you think I have food poisoning?"
"Possibly," Hailey said, as she set the forms down and reached for a stethoscope. "But generally food poisoning sets in at least four hours after the meal. What did you have for lunch?"
"A steak sandwich and French fries," he admitted. His wife glowered at him and she suspected his wife had wanted her husband to pick a healthier choice.
"Hmm." She took his blood pressure, which was a bit elevated, either from the pain or because he had high blood pressure already. His pulse was tachycardic at 104 but his respirations seemed normal. "Put this under your tongue," she directed, holding out a probe for an electronic thermometer. After a minute, the device beeped. "Your temperature is normal, ninety-nine."
"Maybe it's just flu?" he said helpfully.
"Do you feel like you're going to throw up?" He shook his head no. "Have you been told you have high blood pressure?" she asked, logging on to the computer to review his medication history. "Are you taking blood-pressure medicine?"
"No." He grimaced again, and she glanced back at him in concern. Whatever was going on with him, she doubted it was food poisoning. His medical history wasn't too significant for anything other than heart disease.
"Okay, Mr. McLeod, I'm going to talk to the doctor about your case. I think we may need to do some blood work, just to make sure there's nothing going on with your heart. And then you might also need some X-rays or CT scans to see what's going on in your belly. I'll be back in a few minutes, okay?"
"Can't he have something for pain?" Mrs. McLeod asked, a worried frown in her brow.
"I'll check with the doctor. I don't know if he's going to want to wait until we know what's going on with your husband first." She pulled up a chair for the woman. "Please sit down so you're comfortable while you're waiting."
Hailey made a few notes on the computer and then left the room to find Dr. Carter. Mr. McLeod didn't appear too sick, but her intuition was screaming at her that something more serious was going on with his abdominal pain.
The sooner they could get tests ordered, the better she'd feel.
Simon glanced up to find Hailey striding purposefully toward him. Keeping his expression friendly but distant took more of an effort than it should have. "Dr. Carter? I need you to take a look at Mr. McLeod in room two. I'm concerned about his abdominal pain."
He frowned. "Appendicitis?"
"Maybe, but he said he doesn't feel sick to his stomach and he's not running a fever. He does have a cardiac history, and ate a steak sandwich and fries for lunch." Hailey's expression was troubled. "His blood pressure is up a bit. One-seventy over ninety-two."
"So we'll do a full work-up, then," Simon decided. "Draw a cardiac panel, basic chemistry panel and blood count. If he has an infection, his white blood cell count will be elevated." He could feel Hailey's piercing blue eyes on his back as he headed for their patient's room.
He introduced himself to the couple. "We're going to do several types of blood test, to see if we can narrow down what's going on with your abdomen. Once Hailey gets your blood sent to the lab, I'm going to order a CT scan."
Hailey came into the room holding a fistful of empty blood tubes. "Should I put him on the cardiac monitor too?" she asked.
"Cardiac monitor? It's his stomach that hurts, not his chest," Mrs. McLeod protested.
"Yes, put him on the cardiac monitor," Simon agreed. He turned toward the patient's wife. "Sometimes chest pain can radiate to other parts of the body. We don't want to miss anything, so we're going to do a full work-up."
"All right," the wife agreed.
"I'll be fine, Myra," Mr. McLeod said, patting his wife's hand. "I'll be out of here in a jiffy. I'm sure this is nothing more than food poisoning."
Simon suspected the gentleman was downplaying his symptoms for his wife's sake. He took out his stethoscope to listen to his patient's heart and lungs. Hailey came in close beside him, reaching around him in order to put the electrodes on Mr. McLeod's chest and then reaching up to turn on the monitor. He'd picked the wrong side of the bed, since the monitor cables were on the same side he was standing. Hailey's scent, something fresh, like the scent of the ocean, teased his senses. He eased away, as far as his stethoscope would allow.
When Hailey finished getting Mr. McLeod connected to the monitor, she went around to the other side of the bed, where the supply cart was located. Simon relaxed and finished his exam, verifying normal heart and lung sounds.
He moved his stethoscope to his patient's abdomen, expecting hyperactive bowel sounds. Instead, the normal gurgling sounds were diminished.
"Tiny poke here," Hailey warned. She deftly slid a needle into his vein, filling up her numerous blood tubes.
"I'm going to call Radiology to schedule you for a CT scan," Simon told him. "You're heart looks okay so far, but I think you may have something going on with your abdomen. A CT scan is the best thing to show us what's going on."
"Do you really think that's necessary?" Mr. McLeod asked skeptically. "I'm sure I'll be fine in a while."
Simon frowned. "Yes, I do think this test is necessary," he said firmly. Hailey lifted a brow but didn't say anything as she slipped out of the room, no doubt to send their patient's blood to the lab. He sharpened his gaze on his patient. "You may have appendicitis or something worse, like a pocket of infection or an aortic aneurysm."
"Hank, please." Mrs. McLeod was practically wringing her hands at the list of potential problems. "Don't argue with the doctor. Have the CT scan, please."
"All right, I'll have the scan." A mutinous expression darkened the patient's eyes. "But I'm already feeling better. I'm sure there's nothing seriously wrong with me."
Simon wasn't so sure, but since Hank McLeod had agreed to have the scan, he wasn't going to waste any time in getting it ordered. "Someone will be in soon to take you to Radiology," he promised.
While he was on the phone with the radiologist, he realized Hailey was standing beside him, chewing her lower lip anxiously, obviously waiting for him to get off the phone. When he finished his call, he glanced at her. "What's wrong?"
She let out a sigh. "Do you think it's possible Mr. McLeod has an abdominal aortic aneurysm? Everything about his presentation reminds me of a patient I had about six months ago back in Milwaukee. Same type of abdominal pain, same relatively stable vital signs, except for the high blood pressure, and even the same stubborn denial that anything was wrong."
Simon was impressed by her gut instinct. "It's one of my differential diagnoses, yes. And if he does have one, we'll find it on the CT scan. They're finishing another patient now, but they'll be ready for him in about ten to fifteen minutes."
"Sounds good. I'm going to give Jimmy and his mom discharge instructions and then I'll be ready to go with Mr. McLeod. I just need you to write out his prescriptions."
"Jimmy?" Simon had to think for a minute to figure out who she was talking about, and then he nodded. "Oh, yeah, the kid with the dogbite." He logged on to the nearest computer and quickly pulled up the sixteen-year-old's record. He entered in the medications and then printed the prescriptions. "Make sure he understands he has to finish all the antibiotics."
She chuckled. "I will."
Simon handed Hailey the scripts and then turned his attention to the other patients in their team. There was a twenty-two-year-old female patient with a severe headache that he was still waiting for Neurology to clear before he could consider sending her home. He figured she was suffering from migraines, since everything else had come back negative, but wanted the specialist to see her just in case.
Twenty minutes later, he got a call from the lab on Mr. McLeod's blood count. The gentleman's hemoglobin and hematocrit were on the low side, reinforcing Hailey's suspicion that he might have a leaking abdominal aortic aneurysm.
As Simon was on the phone with the lab tech anyway, he took all the blood-work information, relieved that the cardiac injury panel was completely negative. The patient's white blood cell count was negative too, which made the drop in his hemoglobin and hematocrit even more suspicious.
The minute he hung up the phone, his pager went off. He read the text message. McLeod's BP is dropping, come to CT stat.
Simon didn't waste any time heading over to the scanner, thankfully located right around the corner in the emergency department. When he arrived, Hailey glanced up at him, her expression grim.
"I told them to keep the IV in place. Do you want me to start a vasopressor to bring his blood pressure back up?" she asked.
"Yes, let's start norepinephrine titrate to keep his blood pressure above 90 systolic." He reached for the phone to stat page Leila Torres, the on-call surgeon working today. He quickly punched in the number for the CT scan, followed by a 911 so she'd know to come straight over. "How much of the scan were you able to complete?" he asked as he hung up the phone.
"Maybe half?" Hailey said as she pulled the IV medication out of the crash cart and hung it on the pump.
He crossed over to the reading room to look at the images. They hadn't quite been able to get half the scan done, but he could still see there was the slightest hint of blood leaking near the guy's descending aorta.
"What's happening?" the patient asked Hailey. "Is the test over?"
"Your blood pressure dropped a little too low," she explained. "We're starting you on some medication to bring it back up."
He caught Hailey's hand. "Tell Myra I love her," he said.
Posted May 31, 2011
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