The Paramedic's Brother-In-Law

Chapter Nineteen

Meghan made her way to the clinic, following the signs that pointed GYN CLINIC. She approached the receptionist and handed her the intake form along with her ID and insurance. She was given some papers to give to the nurse and instructed to take a seat in the waiting room.

Choosing a seat close to the door, Meghan set aside her crutches and wiped sweaty palms on her skirt. She didn’t have long to wait – a nurse called her back within a couple of minutes. She held the door for Meghan to enter, then led her down a corridor to exam room 3. “Right in here, Meghan. My name is Mandy, and I’ll be coordinating your pre-op appointment this morning.”

Once in the room with the door closed, Mandy took the papers from Meghan, glanced at them, and then gestured to the scale. “Let’s get your weight, Meghan. Do you need help on the scale?”

Meghan shook her head. She stepped carefully onto the scale and settled her crutches against the wall while she balanced long enough for the machine to read. She grabbed her crutches back and stepped down from the scale only to be ushered onto the exam table centered in the room, stirrups already out and ready.

“I’m going to get your vitals, and then a tech will come in and do an EKG. After that, the surgeon will be in to chat with you before conducting his examination. After that, someone from Anesthesia will be by to do their paperwork, and then I’ll be back again for lab work and to go over all of the surgery paperwork with you, okay?”

Meghan nodded. “Sounds like a whirlwind morning to me!”

Mandy placed a pulse ox probe on Meghan’s right index finger while wrapping a blood pressure cuff around her left arm. Placing her stethoscope in her ears, Mandy took Meghan’s blood pressure, listening to the beats as air hissed out of the inflated cuff. “Your blood pressure is 126/84, pulse is 68, and oxygen is 98% on room air. All good!” she said, writing down numbers as she spoke. She removed the cuff and the pulse ox probe and put them away in their cart. “What is your pain on a 1-10 scale?”

Meghan thought for a moment. “Right now I’m at a 4, but I had pain meds about 3 hours ago.”

Mandy asked several other health questions, jotting down the pertinent answers. “Okay, Meghan, I’m going to send in Joy to do your EKG. I need you to go ahead and remove your shirt and your bra and put on this gown, open to the front. She’ll be in just a few minutes.” Mandy handed Meghan a hospital gown and a folded sheet. “The sheet will be for your lap. Once Joy has finished your EKG, go ahead and undress completely, with the gown in the back. You can leave your socks on. I’ll send Dr. Meyers in when I see Joy come out.” With that, Mandy was gone.

Left alone, Meghan set out to change as directed. She removed the shirt she was wearing, setting it neatly on the nearby chair, and reached around to unhook her bra, letting her breasts hang free. She folded her bra and tucked it under her shirt, out of sight, and donned the hospital gown so that it opened in the front. She climbed back onto the exam bed and sat on the end, clutching the gown closed in front of her.

Thankfully, she didn’t have long to wait before a knock came at the door. It opened, and a female face popped in. “Ready?” At Meghan’s nod, Joy pushed in the portable EKG machine and closed the door behind her. “Hi, I’m Joy, and you must be Meghan. I’m going to do an EKG on you today. Have you ever had one done?”

Meghan smiled. “Even better – I’m a paramedic and do them all the time.”

Joy chuckled. “Well, then, don’t judge my technique, all right? Let’s have you lie down, and I’ll pull out the extension to the table so your feet don’t hang off.” She pulled out the end of the table and helped Meghan ease down flat. Joy noticed the splint that went from Meghan’s foot all the way up to mid-thigh. “I see that you’ve not had an easy time of it lately with this leg! I’m going to need to pull up your skirt some so I can attach that lower lead just above your splint, here.” She pulled up the hem of Meghan’s long skirt so that it rested just below the panty line of her left leg, keeping Meghan as modest as she could. She started applying stickers to Meghan’s legs and arms and attached leads to the stickers.

“Okay, now, here’s when I need to get all up in your personal space. I’m going to open your gown so I can put my stickers all over your chest.” With this warning, Joy opened Meghan’s gown, exposing her chest and breasts. She placed a couple of leads on either side of Meghan’s breastbone along her nipple midline, then one under her left arm. The last three were positioned just under her left breast at equal spacing from her underarm lead to the midline lead. She checked that everything was positioned correctly, then started typing on her machine. “Okay, I need you to lie still and quiet for me,” she warned and pressed a button for the EKG to capture. After a moment, it starting printing. She looked at the paper and returned to Meghan. “Looks good! Let’s get you cleaned up.” She removed the leads from the stickers and assisted Meghan with removing all the stickers, remembering to lower Meghan’s skirt after removing the sticker from her upper thigh. She let Meghan close her gown in front, pushed in the table extension, and helped Meghan back into a seated position.

“There you go! I hope your surgery goes well and you’re back on your feet in no time!” She wound up her wires and headed for the door. “I think the doctor will be in next, so go ahead and get undressed as the nurse instructed you when I’m gone.”

“Thanks, Joy,” Meghan said, and the tech was out the door, closing it behind her.

Once gone, Meghan slid off the table and first removed the gown before putting it back on with the opening in the back. She hopped over to the chair with her clothes and added her skirt, her shoes, and her panties to the pile, hiding her underwear under all the other clothes. She carefully made her way back to the exam table and sat down, shaking out the drape and wrapping her lower half with it the best that she could.

She hadn’t been seated for more than a couple of minutes when Mandy came back into the room. “Dr. Meyers will be a few minutes, so I’ll go ahead and get your bloodwork now. Do you have a preference?” she asked, referring to which arm to draw from. She pulled on some gloves and set out a tourniquet, a butterfly needle, and several tubes on a tray, bringing it by the table.

Meghan held out her right arm. “I’ve got a big AC vein with your name on it.”

Mandy smiled. “So you do!” She wrapped the tourniquet around Meghan’s arm and proceeded to draw blood. Removing the needle, she had Meghan apply pressure while she got a Band-Aid and applied it. Mandy applied patient stickers to the tubes, initialed and dated them, and discarded her supplies. She washed her hands, then pulled the tray over to the cabinets. She laid out a clean towel on the metal tray and started pulling out supplies for Meghan’s exam. She covered these with another clean towel and moved the tray out of the way.

“I’m going to go check on Dr. Meyers. He should be about done with his previous patient.” With that, she left the room.

Meghan had a few minutes to wait. The room was cool, and sitting with only a thin gown to cover her made her shiver. She was about to start counting the ceiling tiles when a firm knock sounded on the door and it opened to admit Dr. Meyers.

Meghan was not expecting her surgeon to be the handsome doctor she had met in Kelsey’s room, and she was sure her face must be red, but the resident made no mention. “Hello, Meghan, we meet again. How is your sister doing?” He held out his hand.

She took his hand and shook it. “She’s doing well. Going home later today, and we’re all excited about that.”

“Great news! Tell her we’d love it if she swung by to say hi before going home, but not if she’s too tired. Visits can always happen later.” He closed the door behind her and sat down on the rolling stool, opening her chart in his hand. “Well, let’s talk about you. Mitch said that you have had this ovarian cyst for a few months?”

“Yes. I first felt some discomfort from it about 3 months ago now, but it would come and go, so I thought it was probably more digestive in nature.”

“Like bowel discomfort or constipation?”

“Yes,” she nodded.

“When did that change, or did it change?”

“It really hasn’t changed much, not until the last couple of weeks when Mitch first felt it. It’s been more of a constant ache since then.” She winced.

“Cyst?” he asked. She nodded.

He referred to her chart. “It looks like the last admissions you had they did an MRI, and it showed a dermoid cyst that is 8.3 cm in diameter. I usually remove a cyst that has reached 5 cm, so I think we should go ahead and remove this one.”

“How will you do the surgery?” Meghan wanted to know.

“Well, I plan to remove it laparoscopically, but you should be advised that there is the possibility of needing to turn it into an open removal if the cyst winds up being too large for feasible scope removal. With a dermoid cyst, I don’t want to open it inside the body.” He took a piece of paper and drew a quick sketch of the abdomen. “I’ll be making 5 incisions, here, here, here, here, and here,” he said, drawing a line on the sketch of each incision site. “If for some reason I need to open you up, then I’ll make an incision here, just above your pelvic hairline.” He indicated that as well.

“Like a C-section scar,” Meghan said, and he nodded.

“Do you have any other questions?” Dr. Meyers asked.

Meghan thought for a minute. “How rare is it to have a dermoid cyst, Dr. Meyers?”

He smiled. “They’re pretty common, actually, although most go away on their own over time. And having one makes it more likely you’ll have another at some point, although not usually to the size and extent of having to have another surgery.”

“Okay, thanks.”

He closed her chart and set it on the table behind him. Grabbing his stethoscope from around his neck, he opened the door and stuck his head out. He said something to someone outside, then closed the door and approached her side. “Mandy will be in in a minute. Let’s start by listening to your lungs. Deep breaths for me.”

Meghan took deep breaths while Dr. Meyers listened to her breathe. Mandy entered the room, shutting the door, and looked at him. “Medium, with a small on standby,” he said. She nodded and headed to the cabinets.

While she was rummaging, He looked at Meghan. “I want you to lie back for me. I’m going to lower the front of your gown so I can listen to your heart and do a breast exam.” He extended the table extension and helped her lie back. She brought her arms out of the sleeves of the gown and helped him lower it to her waist. The cool air in the room perked up her nipples, to her discomfort.

Dr. Meyers smiled at her and proceeded to listen carefully to all the quadrants of her heart. Satisfied that her heart sounded fine, he slung the stethoscope around his shoulders and raised her right arm above her head. He started doing a quick but thorough examination of her right breast, then switched sides, instructing her to switch arms. After palpating her left breast, he helped her slip her arms back into the gown.

He pulled the drape into a better position covering her lap and slipped the edge of the gown up from under the drape, raising it to just below her breasts, and then adjusted the drape so it barely covered her mons pubis. He put his stethoscope in his ears again and listened to her abdomen, then stuffed the stethoscope into his lab coat pocket. “I’m going to palpate your abdomen, Meghan. Let me know if anything hurts.”

She nodded as he started palpating lightly, then going deeper. Everything felt fine except when he pressed on her lower right pelvic region. “Ow! There!” she hissed.

Meyers nodded. “Okay, as I would expect. I need to do a pelvic exam now, so let’s get you into a good position here.” He lowered her gown to cover her abdomen again, and Mandy stepped forward. She guided Meghan’s right foot into the stirrup and helped her rest her left foot on the stirrup on that side for the moment. She pushed the table extension back in, then slid the stand with the needed supplies into position for Dr. Meyers. She assisted him with putting on gloves, and Meghan couldn’t mistake the snap of the nitrile as the gloves went on.

“Meghan, I’m going to support your leg while Dr. Meyers does his exam. I need for you to scoot your bottom to the end of the table.” Mandy carefully picked up Meghan’s leg and held it as she awkwardly scooted towards the edge of the table. “A bit more… good.”

Dr. Meyers rolled his stool to be between her legs. He adjusted the gooseneck lamp beside him so it would provide light where he wanted it and snapped it on. Meghan could feel the heat of the lamp through the drape on her pelvis, a contrast to the coolness from the room that caressed her naked buttocks.

He lifted the drape, exposing her, and pushed it onto her abdomen, leaving it pushed down in the middle so she could see him. “Relax your legs for me, just like that. I’m going to be touching your external genitalia now.” She felt him touch her inner thigh before his fingers started feeling her vaginal lips, his touch gentle but sure.

He felt along her labia majora, then her labia minora. A quick movement exposed her clitoris for a brief moment, and then he felt along her urethra before separating her buttocks for a peek. His fingers returned to her vulva, one slipping inside her vaginal canal and milking the glands there. He removed the finger and turned to the tray of instruments. He picked up a medium Graves speculum, lubricated it, and positioned it at her vaginal entrance. He inserted one finger, applied some downward traction, and inserted the speculum in a vertical position, rotating it horizontally until it was fully inserted. He opened the bills somewhat until he was able to visualize her cervix, then opened the bills fully and screwed them open. Meghan felt stretched open and a little uncomfortable, but didn’t say anything. He grabbed a swab and inserted it through the opened blades of the speculum, taking a cervical sample. He removed the swab, rubbed it on a slide, and set it aside. He loosened the screw on the speculum, closing the blades most of the way, and withdrew it from her vagina.

Setting the instrument aside, he lubricated two fingers and brought them to her vulva. “You’re doing well, Meghan. I’m going to insert two fingers to do a bimanual exam now. Let me know if anything hurts. I’ll do the non-painful areas before feeling that cyst.” She nodded, and he inserted the lubricated digits, bringing his other hand to her abdomen. His fingers inside her reached for the pelvic organs, and his outside hand made sweeping motions down, bringing the structures closer for his fingers to palpate. “There’s your cervix and your uterus… Left ovary feels a bit big, but not a problem. Okay, right ovary now.” This brought a gasp from Meghan, and she squirmed a bit, although she was trying her best to hold still. She was very glad when he moved his hands away from her abdomen.

Dr. Meyers removed his fingers from her vagina and switched gloves. He lubricated three fingers this time and brought the hand back to her bottom. “Bear down for me,” he instructed and inserted two fingers back into her vagina while introducing one into her rectum. He carefully felt along the wall between her vagina and her rectum, as well as conducting a posterior sweep of her uterus. He removed his fingers and removed his gloves.

Mandy helped Meghan back up to a comfortable sitting position on the exam table and proceeded to start cleaning up. Dr. Meyers had switched off the lamp and swung it back out of the way, then sat back on his stool. “I think everything is looking and feeling how we thought it would. I’d say you’re a good candidate for having that cyst out, and I’m going to try to get you scheduled as soon as we can.” He grabbed her chart and opened it again, looked in it, and jotted a couple of notes. “Dr. Harper will be in soon to do his pre-op check, and will go over some of the precautions we intend to take with this surgery since it’s been rather recent you had another operation,” he said, nodding to her leg. “Any questions?”

She shook her head. “No, but I know who to reach out to if any crop up.” She smiled.

He shook her hand again. “Okay, then I’ll leave you with Mandy and I’ll see you soon.” Dr. Meyers left her with one last smile and left the room.

Mandy turned to Meghan when she finished cleaning up after her exam. “Okay, so now let’s see if I can hustle Dr. Harper along to see you. You can get dressed if you wish, just have a seat back on the exam table when you’re done.” She helped Meghan down from the table and quickly removed the pad and paper from where she’d been sitting, pulling more paper down to cover the table. Throwing the waste in the trash, she exited the room.

Meghan retreated to the comfort of her own clothes and quickly dressed again, except for her shoe. She was trying to figure out how to balance and tie her shoe at the same time when a knock came to the door and Dr. Harper appeared. “Miss Meghan! Here, sit down before you fall down,” he instructed, gesturing to the exam table. She sat down, the shoe still untied, and he sat down on the rolling stool, bringing it close. He picked up her foot, set it on his knee, and tied her shoe.

“Thanks. I was having trouble managing that.”

He winked at her. “No problem. Don’t want you tripping over untied laces and winding up with a splint on the other leg, do we?”

She chuckled. “No, I think I have enough falling apart with my body at the moment.”

“Well, let’s see what we can do to get you back together in one piece, shall we?” He picked up her chart and flipped to his section of the paperwork. “Let’s take a look. You had surgery a couple of weeks ago for that leg, I remember. I don’t recall any anesthesia issues then.” He glanced at his previous surgery notes. “Nope. The big concern that we have is that you’ll be going under again in a short amount of time from the previous surgery. There’s a lot of things that we can – and will – do to help your body handle this second round with minimal issues. First, you’ll be receiving IV antibiotics starting in Pre-op and continuing through the first day of recovery. Second, I’m going to order some breathing treatments with corticosteroids to help your lungs. So expect to see Respiratory Therapy while you’re recovering. And are you familiar with an inspirometer?” Meghan nodded. “You’ll need to use one of those several times a day to keep your lungs strong.”

Dr. Harper stood up. “Let me take a listen to you.” He put his stethoscope in his ears and came around beside her. Slipping the bell of the stethoscope under her shirt, he instructed her to breathe as he listened to her lungs. Removing the stethoscope from her shirt, he brought it to her chest and listened to her heart.

He slung the scope around his neck. He felt along her jawline and her throat, then had her tilt her head all the way back, then touch her chin to her chest. Grabbing a tongue depressor and a penlight, he looked down her throat and then at her teeth and tongue.

“All right, Miss Meghan, I think you’ll be fine. I’ll see you when you have your surgery scheduled! Take care.” He grabbed her chart, patted her hand, and headed out the door.

Meghan stayed seated on the table for a few minutes until Mandy returned. “Almost done, now! I have some papers to give you that talk about privacy practices, hospital visits, and patient rights and responsibilities. And then these papers talk about your surgery. And these… yes, these talk about the surgery prep.” Mandy handed Meghan a folder with all the paperwork, then handed her another sheet of paper. “You are to have nothing by mouth after midnight the day of surgery. If you need to take any medications, you can do so with just a sip of water. The evening before and the morning of surgery you are to take a shower. Be sure to wash your hair is my advice because it’ll be a couple of days before you’ll probably feel like doing so.

“Also, you will need to go to the pharmacy and fill this prescription. As a precaution with your surgery, you need to get your bowels cleaned out. You’ll take the two laxative pills, then drink a bottle of mag citrate. This will soon have you going to the bathroom. And then you’ll also need to pick up a Fleet’s enema and do that to get yourself the rest of the way emptied. Any questions?”

Meghan shook her head but wasn’t too sure that she was looking forward to the surgery prep. “No, I don’t think so.” She chuckled. “If I do, I have my sister right there to answer any and all questions. Kelsey,” she added, seeing Mandy’s puzzled expression.

“Ah! I didn’t know you were Kelsey’s sister. Yes, she’ll be an excellent resource for you, and you can always call the clinic here with any questions you may have.” Mandy grabbed up Meghan’s folder. “I need to get a few signatures here for consent forms, and then we’ll get you to the scheduler so we can set a surgery date!”

Mandy explained the paperwork to Meghan, who felt like she was signing her life away. Finally finished with the last form, Meghan slid off the exam table, tucked the folder of paperwork into her large purse, and placed the crutches under her arms. She followed Mandy down the hall towards the clinic exit, stopping at the receptionist’s desk. Mandy excused herself, and Meghan started chatting with Brenda, the scheduler.

“Your name, dear?” Brenda asked.

“Meghan McCoy.” She gave the woman her date of birth and passed over her ID and insurance cards as requested.

Brenda scanned the cards and returned them to Meghan. “So we are scheduling you for an ovarian cystectomy, surgeon will be Kevin Meyers. Let’s see when we have an opening.” She tapped keys on her keyboard and brought up Dr. Meyers’ surgery rotation. “Let’s get you in for an early morning appointment… I’ll put you down for Thursday next week. You’ll need to be here at 5 am for pre-op. You’ll be the first case of the day!” She wrote down all of the information and handed it to Meghan, along with another small stack of papers to read. “Good luck, dear. I hope it all works out well for you and you feel better soon!” Brenda smiled.

Meghan returned her smile. “That’s the goal! Thank you, and have a great day.”

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