=== Trip to Valley Care ====

Jenny continues to get worse over the weekend. Her fever stays up desite the Tylenol and her breathing is wheezier and she just feels lousy. At 8:50AM she is sitting in the sick section of the Valley Care waiting room. It is packed more than normal and she is trying to shut out the noise when one of the assistants calls her name.

Molly brings Jenny back to the little x-ray room in the basement of Valley Care. This is the first time that Jenny has been here although Sam told her about it when he twisted his ankle. "OK Jenny, I just need to take a couple of pictures of your lungs for Dr. Jan. I'm going to need you to breath in deep and hold still for me when I ask, can you do that?"

Jenny nods her head and says yes and Molly replies, "Good now I need you to take your top and bra off and stand over here. You can just put them on the table."

Jenny pulled her top off. She had been just too exhausted to wear a bra today. Molly arranged bare breasted teen in front of the x-ray plate and lined up the x-ray emitter behind her. She then stepped behind a wall with a tick window and said "Take a big deep breath in and hold it." Jenny heard a beep and a buzz. Then Molly changed the plate and had her turn 90 degrees and repeated the process, this time with Jenny's arms above her head. She then told Jenny that she could have a seat on the table while she developed the x-rays and made sure they were good.

Jenny put her top back on and laid out on the table, dozing a bit. Molly woke her 10 minutes later and brought her back up to her mom in the waiting room.

Amy, the nurse who mostly works with Dr. Jan, is looking through the charts of the up coming appointments and sees the file for Jennifer Finch. She sees Lisa reaching for a chart and knows that she views "the trio' as hers, "Lisa, Jennifer Finch is seeing Dr. Jan today for a check to rule out pneumonia. Do you want to switch off to take her? Dr. Jan won't mind. She knows how you feel about the trio."

Lisa takes the offered chart, reading the notes that Dr. Burnes left. "Thanks, Amy. I owe you one. Here's the chart for Tammy Jones, another one of those flu cases. I hope Jenny isn't too bad. Burnes really wanted to get this follow up right away."

Jenny is happy to see Lisa call her name. Lisa had been her babysitter way back in New Jersey seven or eight years ago before heading off to nursing school. She had been pleasantly surprised when Lisa had ended up as a nurse at Valley Care. She was her favorite nurse and remained a friend of the family, kind of like a big sister or a cool aunt.

Jenny brought Mrs, Finch and Jenny back to one of Dr. Jan's rooms. While all the doctors could treat any of the patients (and Dr. Jan had a few older kids who did not want to move on ), she mostly dealt with the younger ones so her exam rooms had colorful wall papers and picture books and such. Otherwise they were the same as the other exam rooms. Normally, Jenny would be a bit put off to be in one of the "fun" exam rooms, but she felt too exhausted to care.

"OK. Jenny, you know the drill, I need you to undress down to your underclothes for the exam." Jenny shook her head and quickly handed her shoes, top, and shorts to mom, leaving her standing in socks and bright green panties as Lisa weighed her.

Lisa was a bit concerned about Jenny. She had expected at least one complaint about the butterflies on the exam table paper or some such. Jenny must really be feeling lousy. Puling a larger cuff from a drawer, she said."OK, honey, on the table so I can get your vitals."

She is more concerned when she sees that Jenny's heart rate is high and her blood pressure is low. She takes a quick listen to her breathing and it is far to wheezy for her to like. "Let's get your temperature now. Slide down your undies and lie on your side facing the wall." She says.

As Jenny does this, Lisa prepares the thermometer using tube of KY Jelly that Dr. Jan prefers to Vaseline. "Pull your knees up a little for me honey", she says. Then she lifts Jenny's right buttock and slips the thermometer in to a little less than half it's length. After checking her watch, she puts one hand on Jenny's hip and uses the other to hold the thermometer against her bottom. While waiting, she questions Mrs. Finch about Jenny.

"She seemed to get better over the day on Sunday. She was feeling a little better and her temperature was coming down a bit. But she seemed go over a cliff this morning or overnight. Her temperature was back up to 102.2 rectal and she seemed so tired."

"OK, I'll make sure Dr. Jan knows that." Lisa said as she lifted Jenny's cheek and pulled out the thermometer. "You can pull up honey."

Lisa read the thermometer. "103.4. It is still going up. Dr. Jan will be in as soon as she can." Lisa said and left the room to find Dr. Jan.

Lisa sees Dr. Jan about to go into another exam room and stops her. "I think that you might want to see Jenifer Finch first." She shows her the chart and explains her findings.

Scanning the chart, Dr. Jan curses under her breath and says, "Thanks for bringing this to my attention. Get me the films for her. You might have to run down to the lab to get them. After you bring them to me see if we have some Corticosteroids in the med locker. Oh and get some Penicillin G." And with that she put on her happy face, knocked on the door of exam room 3 and entered.

As Dr. Jan entered the exam room, the half naked Jenny was reminded of how much she appreciated the curtains. At her old doctor, she would have been at risk of flashing any other patients or parents walking through the hallway.

"I hear from Nurse Lisa that you are not feeling too well Jenny."

"Yeah, Dr. Jan. I started to feel better yesterday. My face even felt better, but I was so tired this morning and I keep feeling hot then cold and it feels like I am breathing soup...." Jenny seemed to run down at that point and started to have another coughing fit.

"Well Dr. Burnes was concerned that you might be coming down with pneumonia, I think that he was right. Do you know what pneumonia is?" Jenny shook her head.

"It's kind of like when an infection or something else gets your lungs inflamed and angry. You have to work harder to breath and that makes you tired. But don't worry, we are going to figure out how to make your better."

With that, she takes her stethoscope and listens to Jenny's chest. Starting with her heart and then moving to her lungs. She doesn't like what she is hearing. As she is finishing, nurse Lisa drops off the x-rays and goes back to see if they have the steroids Jan asked for in stock.

Looking at the x-rays, it is clear that Jenny has pneumonia. The left lung is mostly inflamed and she can see the start in the right.

She turns to Jenny and Mary. "I'm afraid that Dr. Burnes was right. This has turned into a rather serious case of pneumonia. See all this white on the x-ray. That is inflammation. The sinus infection set it off, but I think that it's a different bug that took advantage of the inflamation. The Azithromycin should have taken out the original infection."

"I'm going to give Jenny some steroids to help her breathing and some more antibiotics, but I think that Jenny needs to go to the hospital for treatment. I want to see her get some extra oxygen and some more powerful steroids than we can manage at home."

At this point, Nurse Lisa reenters the room bringing the drugs that Dr. Jan. Selecting the vial of steroids, she gets a syringe and a couple of needles form the drawer. Using the first needle to draw up 0.2 ml of the steroid, she directs Lisa to draw up the bigger dose of antibiotics and then turns to Jenny after switching needles.

"Jenny, I need to give you this steroid to help you breath better. Do you want me to use your left arm or your right arm?"

"Left? I guess." The choice distracting her from her verious competing fears.

"OK, just let your arm dangle as loose as you can and look that way." Dr. Jan says as she grabs the girl's arm and cleans a section of deltoid. "Just relax and don't move. Little stick and a burn." And darts the needle in. Jenny hardly feels the needle, but winces a bit as the medicine is quickly injected. Dr. Jan puts a band aid over the site and rubs her arm a bit.

"Good job Jenny. The antibiotic is next. I'm afraid that it will hurt more. It's is a bigger injection so it has to go in your bottom. I need you to lay face down and try to relax. Can you do that for me?"

Jenny shakes her head yes, not trusting her voice. It's been a couple of years since her last penicillin shot, but she remembered it hurting, a lot. But she is a senior now, so she is not going to cry. Not in front of the little kids doc. And not in front of Lisa. So she lays down putting her head in her arms and tries to relax as she feels Dr. Jan push her panties down past her knees.

Lisa hands the much larger syringe and needle to Dr. Jan and moves to the opposite side of the table where she can help hold Jenny in place if needed. Jenny usually handles shots pretty well, but these shots hurt.

Dr. Jan cleans off a section of the naked girl's left buttock and cleans it with an alcohol wipe. After bunching up the section of butt that she is targeting, she warns Jenny, "Big stick in 3, 2, 1 " and darts the large needle deep into the girl's glute. As she does, Jenny gives an eep, but remains as still as she can.

Aspirating the needle to check her position, Dr. Jan says "The needles in. Now comes the owie part. Concentrate on your breathing." As she slowly but steadily pushes the medicine in Jenny trembles a little and pants, but does not cry. After an agonizing minute, she withdraws the needle and puts a band aid on the wound.

As she is massaging Jenny's buttock, she says "You were very brave with that Jenny. I've had great big football player screaming their heads off for these shots."

"Yep, she's right. I've had to help hold some of them down for smaller shots. You did good." Lisa adds as she pulls Jenny's panties back into place and helps her sit up.

"Lisa, help Jenny get dressed and then bring her back to room 2. I would like to have her sitting up. And break out one of the O2 bottles." Room 2 was a quiet room off to the side with a couple of reclining chairs and a cot. They used it for when a patient needed to lie down for a bit or a mother needed to nurse a baby.

"Mrs. Finch, I will call the hospital and arrange a stay for Jenny. Don't worry. I know it's scary, but she will be fine after a week or so of treatment."

About about an hour, Dr. Jan comes back to room 2 as Lisa has just finished checking on Jenny. "She a little bit better Dr. Jan. Her pulse is a little lower and her blood pressure is up. Breathing is still wheezy, but the extra oxygen has helped."

"Good. And how do you feel Jenny?" Dr. Jan asked after taking a quick listen with her stethoscope."

"Better. But still real tired. It is easier to breath though." Jenny says.

"That would be the steroids and the extra oxygen. I have spoken with my colleague Dr. Jones and he will have one of the residents ready to admit Jenny. They will meet you in the additions unit. I expect that Jenny will probably have to spend a week to ten days in the hospital and then spend a few days recovering at home. She needs to go in today, but you have time to stop at home and pick up a few books or what not for the stay."

"I know this is all very scary, Jenny, but I suspect that your stay will be mostly boring."

"Mrs. Finch, here are my and Dr. Burnes notes and Jenny's chest x-rays. You will want to give these to doctor who examines Jenny. They will be expecting them." Dr. Jan gives her the x-rays and notes and directions.

Lisa speaks up, "Mary, I am only working a half day today, so I am about clock out. Do you need someone to come with you? Someone to watch over Jenny in the car?"

"Oh Lisa, you don't have to do that, but I would appreciate the so much. This is all a bit overwhelming."

"It's no trouble" Lisa smiled, "You know how I feel about the trio."

As Lisa and Mary help Jenny into the back seat, she winches as her sore bottom hits the hot seat. They head out to the hospital, only stopping briefly at home so that Mary can get her insurance card and a couple of novels from Jenny's room.

Lisa tells Mary as she gets out of the car, "Don't forget to grab Jenny's book bag with her school books."

Jenny manages a weak punch at Lisa's shoulder, "I thought that you were my friend."

Lisa smiles, "Trust me. In a day or two, you'll be happy to have it to break up the boredom."

"Mmm hmmm"