Home Care (Chase Care Book 5) by R.L. Dunn

Author:R.L. Dunn [Dunn, R.L. & Dunn, R.L.]
Language: eng
Format: epub
Published: 2023-09-20T16:00:00+00:00

Leah Shepard stayed after her shift ended and took Darby on as one of her patients. The ICU was over capacity and busy. Billy Ryder was the only stable patient.

Dr. Dickinson and his group of residents proceeded in a pack toward Darby’s room. Leah noticed the addition of a new person on the team. She made it to Darby’s door at the same time as the medical team.

“Dr. Dickinson, I didn’t realize you were accepting patients.” Leah tried to read the new man’s ID.

“Just Miss Kendrick and Mr. Ryder—a favor to an old friend. We practiced in the Gaza Strip years ago. How is she doing?”

Leah frowned. “Fever is up. Difficult to waken. Can we get something more going?”

Dr. Dickinson lasered in on the fellow. “Dr. Jones?”

The young doctor sprang to attention. “Um, add a cooling blanket. Maintain the acetaminophen around the clock. Someone needs to get a history. I’m waiting on the lab work.”

Leah put her hands on her hips. “Someone? Is that the same as somebody? Or some person? Dr. Jones, you, as the physician who wrote the admission order to the unit, needs to sit with the patient and talk to her.” Steam poured from her ears. She hated intentional stupidity.

“Leah, this is Tim Holland. He just joined my service. He’s a physician assistant and is well qualified. Also, Mr. Holland will be assuming care, under my direction, for Miss Kendrick and Mr. Ryder,” Dr. Dickinson advised her.

She wondered where Logan was, and she’d be damned if this new PA was going to screw up these patients. Leah rolled her eyes. Great.

Trying to be polite, she turned to Tim. “What’s the plan for the patient?”

“Isolation precautions. I need to perform a complete physical. Her CBC shows she is severely anemic. Elevated white count, dangerously low platelets. Her CRP shows marked inflammation. Her urine is clean. Blood cultures and immune testing are not back. Brain scan shows no active bleed, but lesions likely from an autoimmune process. Spinal tap has determined fungal meningitis. Mr. Shepard ordered amphotericin B and flucytosine. I’ll follow up with pharmacy and check the delay. My other concern is to get her blood counts up. Until we get them up, she’s at major risk for stroke.

“In the interim, we will continue the fever reduction, the steroids started in the ER, transfuse with two units of packed red blood cells, one unit of fresh frozen plasma and ten units of platelets. I’m concerned that the midazolam she was given in the ambulance has waned. She also received five milligrams of morphine. Is she poorly responsive because this is post-seizure affect or is it something else? Either way, we need to worry about a second seizure.”

A smile lit up Leah’s face. “And Mr. Ryder?”

Tim walked toward his room. “Continuous monitoring. Cardiac MRI in the morning. Electrophysiology consult. Nuclear stress test. My major concern is there is an ectopic site that might need an ablation and a potential insertion of a defibrillator. I need to perform a head-to-toe, continue cardiac bloodwork.

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