Emergency: Single Dad, Mother Needed

“Of course. You’ll need treatment, too.” She turned toward the isolation cart, opened a drawer and pulled out a face mask, gown and gloves. “Have you started him on antibiotics yet?”

“No. I thought I’d wait for your recommendation first. Especially as I don’t know the type of bacterial infection we’re fighting.”

“Start him on broad-spectrum antibiotics,” Holly advised, trying not to notice Gabe hadn’t changed much. Tall, with dark brown hair, bright blue eyes and broad shoulders, he had a rugged attractiveness that she’d always been drawn to. Maybe there were a few more wrinkles around his eyes, but otherwise he looked good. Too good. Distracted, she focused on the situation at hand. “Mark has already had symptoms for almost three days. I’m worried he’s going to take a turn for the worse if we don’t get a jump on this.”

Gabe nodded, agreeing with her recommendations. “I’ll get the antibiotics ordered right away.”

“Great.” Once all her protective gear was in place, Holly stepped into the patient’s room, leaving Gabe to enter the antibiotic order in the computer.

“Hi, Mark. Mrs. Kennedy.” She felt bad for the patient and his family, and could empathize with how it must feel to end up with an infectious disease. “My name is Dr. Holly Davidson. I’m the infectious disease specialist here.”

“Yes, Dr. Martin told me he was calling in a specialist.” Mark’s mom looked upset, her eyes red as if she’d been crying. “Is my son going to be all right?”

“I hope so. We’re going to start treating him immediately.” She approached the bed, shifting her attention to the patient. Gently, she placed a hand on his arm. “Mark? Can you hear me?”

The boy was very lethargic as he opened his eyes and slowly turned his head toward her. “Yeah,” he whispered.

Her stomach clenched. The poor boy was much worse than she’d originally thought. There was no indication in the record that he was this out of it, so maybe his neuro status had only just started to deteriorate. “Mark, we’re going to need to start an IV in your arm to give you antibiotics.” As she spoke, his eyes slid closed and he didn’t respond. She hid a flash of panic. “Mark? Are you all right?”

“Yeah.” He answered without opening his eyes.

She felt for his pulse, reassured herself that it was beating steadily beneath her fingers. She turned toward his mother. “Mrs. Kennedy, Mark seems to be getting worse. I’m worried the infection is affecting his brain.”

Mrs. Kennedy’s eyes widened in alarm. “What does that mean?”

“Just that the sooner we can start the antibiotics, the better.” As she finished speaking, a nurse came into the room carrying IV supplies. As she finished her exam, the nurse prepared to place the IV catheter into the antecubital vein in Mark’s arm.

“Mrs. Kennedy, I’m worried about you and your family. If this is a bacterial infection, as we suspect, it’s highly contagious. You’ll need to wear a face mask to help protect yourself from getting sick.”

The woman paled. “Contagious? What about the rest of my family?”

“I’m afraid they may need treatment, too.” Holly made her tone as reassuring as possible. “The good news is we can treat all of you so you won’t get sick. How many siblings does Mark have?”

“Two younger sisters. They’re only five and seven, children from my second marriage.”

“All right, we’ll make sure everyone gets the medication they need. And we’ll probably need to tell the school too. His roommates may also need antibiotics.”

The nurse placed the IV in Mark’s left arm, the boy barely flinching as she slid the needle into his vein. Once the IV was running, Holly hurried out and grabbed more protective gear for Mark’s mother, helping her to put the items on.

The mask was the most important piece, and Holly reiterated the need to keep the face mask on at all times.

Gabe walked into the room, carrying the mini-bag of IV antibiotics. The nurse took the bag from his hands and hung it on the IV pole, reprogramming the pump accordingly.

“Please, take a look at him. I think his mental status is much worse,” she said in a low tone.

Gabe approached Mark, calling his name just as she had earlier. After a quick exam, concern shadowed his eyes. “He needs to be intubated.” He glanced at the nurse. “Melanie, will you grab the intubation bin?” He turned toward Mark’s mother. “Mrs. Kennedy, I need to put a breathing tube into Mark’s throat to protect his airway. He’s so lethargic I’m afraid he’s going to stop breathing. I’ve already made arrangements for him to be transferred to the PICU.”

Watching Gabe in action, Holly had to admit he was impressive. Especially the way he took the time to explain everything to Mark’s mother. Emergency medicine wasn’t her specialty and she stepped back to stay out of the way and to give him the space he needed to take care of Mark, but Gabe stopped her. “Holly, wait. I’ll need your help.”

“Of course.” Her earlier anxiety returned as she walked back toward the bed, watching Gabe set up his equipment with deft fingers. She placed a reassuring hand on Mark’s arm, hoping and praying that somewhere deep down he’d feel her touch. “Mark, we’re going to place a breathing tube in your throat. It will be uncomfortable for a few minutes, but then your breathing will be much better.” Mark didn’t indicate that he’d heard her but that didn’t mean much. He might not be able to make his muscles obey his commands.

“Help me position his head. With his stiff neck, I’m going to have trouble getting his head tilted to the correct angle.”

She understood Gabe’s dilemma, and moved over to help. The nurse sat next to Mark’s mother, who’d started to cry. Holly wanted to cry right along with her but focused instead on helping Gabe place the lifesaving breathing tube in Mark’s throat. Gabe’s face was close to hers, the worry in his eyes contagious.

“A little more,” Gabe said urgently, as he tried to slide the breathing tube down. “I can’t quite get it.”

Mark’s neck muscles resisted the movement as she struggled to tilt his chin toward the ceiling. She met Gabe’s eyes over his face mask. “I can’t move his head back any more without hurting him.”

Gabe nodded. “All right, then, we need a paralytic. There’s some succinylcholine in a vial on the table. Give him a milligram and see if that helps.”

Holly’s hands were shaking as she tried to draw up the medication. She hadn’t been this involved in an emergency situation since she’d been a resident. The medication would help relax Mark’s muscles, but it would also stop him from doing any breathing on his own. She injected the medication and shot an apprehensive glance at Gabe. “How long before it works?”

“Not long.” He met her gaze, as he gave Mark several deep breaths, using the ambu-bag. “Are you ready?”

She nodded. After the third big breath, Gabe set the mask and ambu-bag aside and she helped tilt Mark’s head back to the correct angle. This time she was able to give Gabe the extension he needed. He slid the breathing tube into place, and pulled out the stylet. “Hurry. Hand me the ambu-bag.”

After disconnecting the face mask from the end, she handed him the bag. He clipped a small device to the end of the endotracheal tube before connecting the ambu-bag, giving several deep breaths. The end-tital carbon-dioxide detector turned yellow, showing the tube was in the correct place. “Listen for bilateral breath sounds, just to make sure,” he told her.

She tucked her stethoscope into her ears and listened as he gave more breaths. She nodded and folded the stethoscope back in her pocket with a sigh of relief. “Sounds good.”

“Melanie, call for a portable chest X ray,” Gabe directed. “And get a ventilator in here.”

“We have the breathing tube in place, Mrs. Kennedy. Mark’s breath sounds are good. I know this is scary, but Mark is better off now with this breathing tube in place.” Holly did her best to reassure her.

“We’ll give him some sedation too, so he doesn’t fight against the breathing tube,” Gabe added.

“Thank you,” Mrs. Kennedy whispered.

Holly was glad to help. She reached over to hold the ET tube while Gabe secured it in place. “Nice job,” she said in a low tone. Gabe’s quick action had helped to save Mark’s life.

His eyebrows rose in surprise and his gaze warmed, lingered on hers. “Thanks.”

For a moment the years faded away, the easy camaraderie they’d once shared returning as if it had never left. She’d missed him, she realized with a shock. She’d missed Gabe’s friendship.

And more? No. What was she thinking? Taking a quick step back, Holly decided it was time to leave.

“I’ll check on the LP results,” she murmured, before leaving the room. Glancing back over her shoulder, she saw Gabe was watching her with a speculative glance.

Her stomach tightened as she let the door close behind her and began stripping off her protective gear. She and Gabe had grown close in those months up until her wedding. But that had been nearly six years ago.

She’d learned two hard lessons since then. Men couldn’t be trusted and never, ever mix personal relationships with professional ones.

Unfortunately, Gabe lost on both counts.

Gabe instructed the respiratory therapist on the vent settings he wanted Mark to be placed on and spent a few minutes reassuring Mark’s mother that they were doing everything possible for her son. He took the time to make sure Mark was comfortable and that his vitals were stable before he left the room. While stripping off his protective gear, he glanced around the ED arena, disappointed to realize Holly was gone.

He opened Mark’s electronic medical record and read her note. She recommended changing the antibiotics now that the LP results were back, confirming streptococcal meningitis. She went on to recommend prophylaxis to any exposed staff and for all of Mark’s immediate family.