A Doctor's Reunion, page 7
Staying away from Holt who lived just down the hall would not be easy. Especially after that kiss.
She closed her eyes, reliving the moment. Holt’s kiss had been incredible, not just because she’d always been attracted to him, starting back when she was seventeen to his eighteen, but because he’d kissed her as if he’d cherished her. With a mixture of wanton need and sweetness that was oh-so-tempting.
Nothing even close to the way Greg used to kiss. As if he saw kissing her as a means to an end.
Enough. She pushed away from the door and abolished thoughts of Greg Zeman from her mind. She put the leftovers away in the fridge, then headed to bed.
Being physically exhausted helped her sleep, and the following day she decided to finish unpacking the boxes Holt had helped her move. Normally she liked working alone, listening to music as she unpacked, but her thoughts kept straying to Holt.
His adorable smile. His husky laugh. His passionate kiss.
When her phone rang, she almost dropped the glass bowl on her tiled kitchen floor. Setting it on the counter, she reached for her phone, recognizing the number as coming from Lifeline.
“Hello?”
“Hey, Kristin, it’s Jared. Ivan called off work tonight, I was hoping you’d be able to cover for him.”
“Sure, that’s fine. I hope Ivan is okay?”
There was a slight hesitation before Jared responded, “Me, too. He didn’t say much, so I’m not sure if the issue is with him or his daughter. Either way, I’m glad you can cover. Thanks a lot.”
Jared quickly disengaged from the call. She set her phone aside, thinking about whether or not she should try to take a nap before going in, when she remembered Holt was also working tonight.
If she didn’t know better, she’d think God was pushing them together on purpose.
Her attempt to sleep a couple of hours was a dismal failure. A cold shower helped wake her up, and as she headed out the door of her apartment, she ran smack into Holt.
“Oh, hey.” She hoped he didn’t notice how flustered she was. “I’m heading to work, too.” As if he wouldn’t figure that out while she was wearing the same one-piece navy flight suit he wore.
“I know, I heard you agreed to cover Ivan’s shift. Figured I’d give you a ride. No reason for both of us to drive.”
Carpooling for a ten-minute trip? She suppressed a sigh, knowing it would be petty to refuse. “Sounds good.”
There was no sign of the red Corvette this trip, and as Holt drove past the spot where they’d gone off the road, she could see deep tire tracks in the gravel.
“This will be my first night shift.” Holt’s voice cut into her thoughts. “Hope I can stay awake.”
“We’ll keep each other awake.” His smile widened, and she flushed when she realized how that might sound. She hastened to add, “I play a mean game of cribbage.”
“Never played. You’ll have to teach me.”
“It’s not difficult, but we can play gin rummy, too.” She hoped they would get enough calls that they wouldn’t be forced to chat all night. There wasn’t enough small talk in the world to fill thirteen hours.
“I wouldn’t mind learning cribbage.” Holt pulled into the parking lot, choosing a space close to the building.
“Great.” As they walked into the hangar together, it occurred to her how others might think they’d spent the day together.
And the night.
Ugh. The last thing she wanted was to be the subject of the Lifeline rumor mill. When they entered the debriefing room, Reese was there, along with the new pilot, a woman named Megan Hoffman. Kristin had flown with her a couple of times and was impressed by her ability.
“Hi, Kristin, Holt.” Reese nodded at them. “Thanks for coming in.”
“I hope Ivan is okay,” Jenna said with a frown. “It’s not like him to call off, other than for his daughter.”
“I know.” Kristin liked Jenna Reed, too. She was a great paramedic and engaged to one of their former residents, Zane Taylor. Their wedding was scheduled for April of next year. Jenna was also going back to school to pursue her nursing degree, attending college at the same university as her younger sister, Rae. Kristin gave Jenna credit, it wasn’t easy to work full time, attend classes, and plan a wedding.
Overall, Kristin liked everyone she worked with, it was the residents who rotated in and out that added a very different dimension. Like Holt. And Paulette. “Hopefully Ivan will be back soon.”
“There’s a transfer pending from the Great Lakes naval base, near the Illinois border,” Jenna informed them. She’d been paired to fly with resident Matt Abbot. “The guy took a turn for the worse, so the transfer is on hold, but I suspect they’ll call back soon.”
“What happened?” Holt asked. “Why would we get a transfer from the naval base?”
“Sounded as if one of their new recruits got super sick and is now intubated on a vent, with signs of multisystem organ failure.” Matt shrugged. “They don’t have a good explanation for what happened, other than possibly an autoimmune reaction to receiving the vaccinations.”
“That doesn’t seem right,” Holt protested.
Matt spread his hands. “Hey, I’m just passing along the information we received. Could be they have completely different information by now.”
“Maybe.” Holt didn’t look satisfied. “Anything else?”
“Nope. Overall a good day.” Matt stood. “Hope you don’t get too many calls.”
Secretly, Kristin hoped they did.
Holt was seated opposite from Kristin with the cribbage board between them when their pagers went off. She’d just started explaining the intricacies of the game, which were difficult to concentrate on with her cinnamon scent teasing his senses.
“Great Lakes naval base,” she said, reading their text page. She met his gaze. “Guess this means our guy’s condition has stabilized.”
“Let’s go.” Holt couldn’t deny that he was interested to find out more about their young recruit.
As they settled in the chopper with Megan Hoffman behind the stick, he listened as she spoke to the paramedic base. “Estimated flight time thirty minutes.”
This would be his longest flight so far, and it was only his third shift.
All of which he’d been fortunate enough to have Kristin as his partner.
Flying at night was strange. There was nothing but inky blackness out the windows. He knew their job was to help watch for birds, the biggest threat to a chopper was being knocked off course by a bird strike, but darned if he could see much of anything out there.
“Nervous?”
He glanced at Kristin. There were low interior lights in the hull of the helicopter, but it was difficult to read her expression through her face mask. “Not really. Should I be?”
There was a slight hesitation before she responded, “No, of course not. Megan is an awesome pilot; she can handle night flying just fine.”
In other words, flying at night was more dangerous than flying during the day. Okay, then. Good to know. However, since there was nothing he could do about that, he shrugged it off and tried to focus on their patient.
He cued his mic. “Megan, when we’re ten minutes from our destination, I’d like to speak to the physician on duty to get an update on our patient.”
“Ten-four, Dr. Baxter.”
“Please, call me Holt.” Working with a small team like Lifeline’s, there was no reason to be so formal.
As promised, Megan communicated through the paramedic base to reach the doctor on call within the Great Lakes naval base. “Dr. Richter is on the line for you, Dr. Baxter.”
“Thanks.” Holt cleared his throat. “Dr. Richter, I’d like a report on our patient’s condition.”
“Jason Hicks is a nineteen-year-old new recruit who fell ill two days ago after receiving a multitude of immunizations, which all of our new recruits receive, normally without a problem. Unfortunately, Jason’s condition continued to deteriorate until we were forced to intubate him and initiate vasopressors to stabilize him.”
He glanced at Kristin who was listening in. The poor kid’s condition didn’t sound good. “What vasopressors?”
“Norepinephrine and vasopressin. He’s not maxed out on either of them, yet.”
Yet? “So you’ve been titrating them up?”
“Yes. But not as aggressively as yesterday.”
That wasn’t saying much. “I understand he’s in multisystem organ failure.”
“His labs are getting better, but his kidneys have taken a hit. We have him on continuous renal replacement therapy.”
Kristin gave a slight shake of her head, indicating they couldn’t provide that service in-flight.
“Anything else? I can’t believe all of this is an autoimmune response to his immunizations.”
“We don’t have any other explanation at this point,” Dr. Richter said. “I’d be interested if the team at Trinity Medical Center find otherwise.”
“Understood, thanks. We should be there in less than ten minutes.”
Holt clicked off the mic and drew in a deep breath. The kid’s condition might be somewhat stable, but this would still be a tenuous flight. One he was grateful to be making with Kristin at his side.
Megan dropped the bird on the rooftop landing pad. He and Kristin didn’t have to talk, they knew what needed to be done. Inside the Great Lakes Medical Hospital, the ICU was located on the second floor.
Dr. Richter was a young man, just a few years older than Holt from what he could tell. Richter was dressed in a uniform instead of scrubs, his hair cut military short, and he sported Captain bars on his sleeves.
Jason Hicks looked younger than his nineteen years, surrounded by more equipment than Holt had ever seen. The renal replacement therapy machine looked a bit like a dialysis machine, with a giant filter and four large bags of fluid suspended on various poles. Kristin and the ICU nurse discussed their strategy of how to swap over the equipment, while Richter pulled up the young man’s chart on a large computer screen.
“Here are his latest labs, hot off the press.” Richter gestured to the screen. “You can see the CRRT is helping to correct his underlying acidosis.”
“That’s good, but we don’t have the ability to keep that going during the flight. Have you ruled out all sources of possible sepsis?”
“So far every blood culture has come back negative. We did start him on broad-spectrum antibiotics just to be on the safe side.”
Holt stared at the screen, trying to figure out if he was missing anything. “Okay, anything else you think I should know?”
Richter shook his head. “I wish I had more information for you.”
“Family?”
“We called his mother. She’ll be heading up to Trinity Medical Center, tonight yet.” Richter held out his hand. “I’m sure he’ll do fine. Those specialists at Trinity Medical Center are experts. They’ll figure out what’s going on.”
“I’m sure they will.” Holt felt good about the reputation of the hospital he was training in. He crossed over to Kristin. “Ready to get him onto the gurney?”
Within five minutes, they had Jason Hicks bundled on their gurney and were taking him up to the helicopter. Megan was waiting patiently, and soon they were in the air, heading back toward Milwaukee.
Kristin put the headphones over Jason’s ears, even though the guy was sedated. He wasn’t about to question her methods, he’d learned from the flight with Barbie, their anorexic patient, to anticipate the unexpected.
The first few minutes of the flight passed by without issue. But all too soon, Jason’s heart began having arrhythmias.
“Give a bolus of amiodarone.” Even as he gave the order, he knew that the electrolyte imbalance might be the culprit.
Unfortunately, they couldn’t do any lab testing hundreds of miles in the air.
After the bolus was in, Kristin looked at him. “Which way was his potassium trending prior to being started on CRRT?”
He thought back to the data on the screen. “He’d been trending high, a result of his kidney failure.”
“We could consider giving a bolus of insulin and D50, see if that helps.”
“Good idea, let’s do it.” Again, he appreciated her subtle cues.
Once those infusions were in, they both watched the heart rate on the screen. The premature ventricular beats became fewer and farther apart.
But suddenly, Jason began to cough with such force that the endotracheal tube came flying out. Holt looked at it with horror, then moved so he was positioned behind Jason’s head.
“Get me another size seven tube and the laryngoscope.” He drew gloves over his damp palms as he realized the breathing tube had to be replaced ASAP.
“Here.” Kristin deftly opened the tube, then handed him the laryngoscope. “Would you like me to increase his sedation?”
“Yes.” He focused on getting the breathing tube back into Jason’s trachea. Unfortunately, the poor kid’s throat was inflamed and swollen, making it almost impossible to visualize the vocal cords.
“Pulse ox eighty percent,” Kristin said.
No! He couldn’t lose this kid.
Sweat ran down the sides of his face beneath the helmet. He tried again, silently praying that he had the skill to replace this breathing tube.
He blindly inserted the tube and reached for the small device they used to check for placement. The color metric device on the end turned yellow, indicating he was in the right spot.
After quickly connecting the ventilator tubing, he held the tube firmly in place so Kristin could fasten it in place.
“Thank goodness,” he murmured.
“Pulse ox is still hanging around eighty-two percent.”
“What FIO2 is he on?”
“Fifty percent.”
“Turn it up to sixty percent.”
Sweat continued to roll down his face as the kid’s pulse ox refused to budge. He tried not to panic. “Maybe we should go up a little more to sixty-five percent. Just until he recovers.”
Kristin obliged, but still, Jason’s pulse ox remained about 85%.
Holt stared at the young man, trying to figure out what he was missing. Then he saw the way the right side of his chest looked puffy compared to the left side. “Hand me an eighteen- gauge needle. I think he has a spontaneous pneumothorax.”
“From losing the ETT?” Kristin opened the needle for him, then moved the kid’s gown to scrub his chest.
For the second time in a handful of days, he inserted the needle into the space between the fourth and fifth intercostal space.
Within seconds, Jason’s pulse ox improved to 92%. But then his heart rate went into full-blown ventricular tachycardia.
A life-threatening heart rhythm. They were going to lose him!
“Get the defib.” He pulled the kid’s gown all the way off so Kristin could place the patch on his chest, then turned him to put one on his back. She dialed up the defib.
“All clear?”
She shocked him once. Then twice, then a third time. Jason’s heart converted into a normal sinus rhythm, but for how long?
“Megan, what’s our ETA?”
“Fifteen minutes.”
Holt tried not to wince. Fifteen minutes to keep this kid alive. No easy task. He resorted to praying again.
Losing this patient en route was not an option.
Chapter Eight
Kristin stared down at the young navy recruit whose life hung by a whisper of thread. Nineteen was too young to die, especially when it was clear the providers didn’t know what exactly was wrong with him.
A car crash or some other type of trauma was one thing. A mystery disease causing multisystem organ failure was completely different.
Tension radiated off Holt, and she knew he was concerned about what might happen if the Lifeline team lost another patient. Even the most highly skilled doctors and nurses couldn’t save everyone, but if this young man died, she knew Holt would take it personally.
“Pulse ox stable at ninety-four percent, pulse one ten, and BP ninety-two over fifty-eight.” She rattled off Jason’s vital signs, mostly to help Holt relax a bit.
“Give a bolus of amiodarone.” Holt’s expression was grim. “I want to be sure we support his heart as much as possible.”
She nodded and began preparing the medication. A couple of premature ventricular beats skipped across the small EKG monitor. Her stomach knotted. Suffering a spontaneous pneumothorax could have been the cause of Jason’s V-tach, but seeing the ongoing irritability in his heart rhythm, she was concerned there was something more going on.
“Amiodarone infusing now.” Her gaze went between the medication infusing into Jason’s IV and the heart monitor. The premature beats continued, not frequently enough to require a shock, but more than she liked.
“I’m concerned he has cardiomyopathy from whatever is going on with his immune system.” Holt’s green gaze caught hers. “I need to talk to the cardiology team at Trinity.”
She nodded and listened as he spoke to the paramedic base. Within two minutes, Holt was connected to the cardiology fellow on call at Trinity Medical Center.
“You should be prepared to place this kid on an intra-aortic balloon pump,” Holt was saying. “He’s already gone into V-tach once, which we were able to convert, but he’s still showing signs of heart damage.”
“Understood, I’ll call the cardiac perfusionist in and have the IABP on standby for when you arrive. Thanks for the heads-up.”
“No problem. See you soon.” Holt disconnected from the call, and she sensed his tension easing a bit.
“ETA eight minutes,” Megan informed them.
More premature beats fluttered across the screen. His blood pressure dipped a bit farther, and she found herself holding her breath.
Come on, Jason, she silently urged. Hang in there for just a little while longer.
“When the amiodarone bolus is finished, start continuous infusion,” Holt said.
“What dose and rate?” She prepared the infusion even though the bolus should run for fifteen minutes. She didn’t want it to run out while they were unloading him from the back of the chopper.
