of a severe headache, which she hadn’t mentioned during triage or when Kami had done her nursing assessment.
The woman shivered as if she were freezing and looked miserable.
“Can you get her a blanket or something?” her husband asked, looking frustrated that his wife was getting worse.
“She doesn’t need to cover up,” Kami reminded him. She’d intentionally not given the woman a blanket. She directed her next comment to her patient. “It’ll hold heat to your body and you’re already too warm. We have to get your fever under control before we can even consider giving a blanket or doing anything that might make you worse.”
Wincing with discomfort, the woman tightened her arms around her body. “I’m so cold.”
They had to get her fever down and stable. Once they did, then she could possibly have a lightweight blanket. Certainly not before.
“When did the headache start?” Kami asked.
“She had a headache when she got here. It’s just gotten a lot worse,” the husband clarified. “It wasn’t bad enough to mention.”
Apparently not even when Kami had directly asked about a headache. Ugh. She really didn’t like when patients said something completely opposite when the doctor was present than what they’d told her during their assessment. It happened almost nightly.
Gabe ran through a quick examination of the woman. “Some swelling in the cervical nodes and neck stiffness. I want a blood count and a comprehensive metabolic panel on her STAT, and has that strep finished running?”
“Should be. I’ll log in and check.” Kami signed in on the in-bay computer and the test result was back. “She’s negative for strep.”
“Ache all over,” the woman told them, her eyes squeezed tightly shut. “Cold.”
Gabe gave some orders, which Kami turned to do, but stopped when the woman said, “I’m going to throw up.” Then did exactly that.
Gabe was closer than Kami and got an emesis pan in front of Mrs. Arnold just in time.
“Give her an antiemetic IM now.” He named the one he wanted given and the dosage. “Then let’s get a saline lock on her.”
Kami drew up the medication and injected the solution. The woman was shaking and looked much worse than she had when they’d entered the bay.
“Do something,” the husband ordered, sounding worried, as he hovered next to his wife’s bed, gripping the woman’s pale hand.
Gabe sent Kami a concerned look. “Get phlebotomy to draw blood cultures times three and the previous labs I mentioned. It’s off season, but run an influenza test, just in case. Let’s get a CT of her head, too. I’m probably going to do a lumbar puncture.”
He was thinking a possibility of meningitis. Rightly so, given how rapidly her status was changing.
“Let’s put her in isolation. Just in case,” Gabe continued in full doctor mode.
The husband was talking, too. Kami didn’t want to ignore him, tried to answer his questions while she worked, but he continued to fret.
Gabe gave an order to get IV antibiotics started and told her which he wanted. Kami rushed around making things happen. Although she’d really not looked like more than a typical sore throat patient, Mrs. Arnold had gone downhill scarily fast. In case she continued on the decline, they needed to act fast to get an accurate diagnosis as quickly as possible.
* * *
Linda Arnold’s blood count came back showing a significantly elevated white blood cell count with a bacterial shift. Her headache and neck pain had continued to increase and the woman refused to even attempt to move her neck. Her strep and influenza were negative.
Lumbar punctures weren’t Gabe’s favorite things to do as there was always risk, but his concerns over meningitis were too high not to test her spinal fluid. As soon as he had the CT scan results back, he’d pull the fluid so long as the scan didn’t show any reason not to. He didn’t want to risk brain herniation by not following protocol.
From all indications, the woman had meningitis. Gabe needed to know the exact culprit.
He cleared out two other patients who’d come into the emergency department. Then, protective personal equipment in place, he went back to Mrs. Arnold.
The woman was now going in and out of consciousness and didn’t make a lot of sense when she was awake.
Also wearing appropriate personal protective equipment, Kami was at her bedside. She’d already gathered everything he’d need for a lumbar puncture. They needed to move fast.
Hopefully, the antibiotics infusing into her body via her IV line would be the right ones for whatever caused her infection, but if they weren’t, waiting around to see could mean the difference between life and death.
That wasn’t a chance he was willing to take.
“Dr. Nelson?” Mindy stopped him from entering the area where Mrs. Arnold was. “Dr. Reynolds just called with her CT results. He is concerned about meningitis and recommends proceeding with lumbar puncture.”
This was the call Gabe had been waiting for giving him the safe go-ahead.
Checking to make sure his respiratory mask was secure, Gabe nodded, then entered the area where Mrs. Arnold was isolated.
From behind her clear plastic glasses, Kami’s eyes were filled with worry when they met his.
“She has gaze palsy and mild extremity drift now,” she told him. “I thought you’d prefer her husband not be in here for this as he was getting agitated. I sent him to the private counseling room to wait for you to talk to him after we get this done.”
That was one of the things he loved about Kami. She was always one step ahead of him.
Except when it came to the auction.
On that one, he planned to outstep her. Not planned to—he would outstep her, because the more he thought about it, the more he wanted to go on that “date” with Kami.
“WHAT A NIGHT,” Kami mused at the end of her twelve-hour shift that had turned into over fourteen. She couldn’t wait to get home, shower, eat whatever she could find in the fridge, and crawl into bed to pass out until it was time to come back and do it all again for night two of her three in a row.
“You look tired.”
She glanced toward Gabe. “You don’t look like a bowl of cherries yourself.”
He laughed. “Not sure if that was meant to be an insult or not, but I’ll go on record saying I’m grateful I don’t look like a bowl of cherries.”
Kami shrugged. “Too bad. Cherries would be an improvement.”
“A
