After a rough first day, Meghan’s second day in the hospital didn’t start out very exciting. Her patient assistant, Jordan, helped her up out of the bed and into a reclining chair later in the morning. Her linens were changed, and she received a sponge bath, being careful not to get her incisions or the steristrips wet. Meghan was pleased to get all of the monitoring equipment removed. Her blood pressure, while still a little low, was deemed to not be an issue. She was glad to help Jordan pull cardiac stickers off her chest.

“I don’t know why, but these things get itchy after a while.”

Jordan smiled as she wrapped up the cables and stowed them in the basket attached to the monitor. “Yes, and then you’ll have to deal with the adhesive sticking to everything. I’ll bring in some alcohol pads later and we’ll see if we can get most of the adhesive off.”

Later, respiratory therapy came in. The therapist helped Meghan with her spirometer and gave her a breathing treatment. Meghan could see that the therapist wasn’t exactly thrilled with the way her lungs sounded, but when asked, shrugged it off. She was thankful to learn that bracing her stomach with a pillow when she coughed and laughed helped tremendously with pain!

Meghan was worn out by the time her lunch tray came. She had transferred back to her bed by this time, so cracked an eye open to glance at the tray that was brought up to her. “More Jell-O,” she sighed.

“I’d bring you a steak, but the nurses would’ve had my butt, Squirt,” Jerry quipped, pushing the door open.

“Jerry! What brings you by?” Meghan maneuvered herself to sit up a bit more in the bed.

“Oh, just needed to assure myself that you were being good,” he replied, setting down a handful of cards and, in imitation of Dave, pulling up a chair and settling in it backward. He sighed. “How are you feeling?”

“Like I’ve survived a slasher movie,” she replied. “One long incision and 5 others.”

“Pretty sore, then, huh.” He assessed everything she was hooked up to. “I see you’ve got a juice pump.”

She glanced at the PCA pump. “Yeah, it’s been a godsend. Last night started off pretty bad, but this is helping a lot.”

“I’m glad to hear that. We want you to do a lot of resting and a lot of healing so you can get back to duty. I’m tired of covering for your butt!” He winked and chuckled.

“I think Bill’s right – you’re just frustrated that I’m cutting into your bar nights. Hard to pick up chicks when you’re at work,” she teased back.

“Well, it beats the dating sites,” he joked.

Meghan reached for the Jell-O with a sigh. “At least it’s red. It was yellow this morning.” She spooned a cube into her mouth.

Jerry chuckled. “Well, red is a step in the right direction.”

“It tastes better,” Meghan mumbled, mouth full of Jell-O.

A knock sounded at the door. “Hey there, Meghan!” Mitch entered the room.

Jerry stood. “Hey, Dr. Branston.” He held his hand out.

Mitch took his hand and shook it. “Hey there, Jerry. Don’t get up on my part.”

Jerry sat back down. “Has she been behaving, doc?” he asked.

Mitch looked at the amused expression on Jerry’s face. “Absolutely not! I think we need to get her feeling better so I can hand her back to you to keep her in line.” He winked at Meghan.

Jerry held up his hands in mock surrender. “You’re welcome to keep her for a while longer. I’m not anxious for any more gray hairs.” He ran his hand over his buzz cut and smiled.

Meghan rolled her eyes. “Why do I put up with you two?” Mitch chuckled.

Jerry checked his watch and stood. “Well, Squirt, I need to get on to other things. It was good to see you. Let me know if you need anything. Books, chocolate, music…”

“An escape vehicle?”

“Nah, you’re on your own there. Later!” He waved and headed out the door.

Meghan waved goodbye as he left and coughed. Mitch shot her a questioning look. “When did that cough start up?”

She gave a nonchalant wave. “Sometime this morning. Respiratory Therapy did a breathing treatment, and my mouth has seemed dry all day.” She punctuated this by taking a big drink of water out of her water jug. Setting down the jug, she eyeballed the spirometer, sighed, and reached for it. Pointing it at Mitch, she warned, “Don’t ask me about this thing. I’m doing it every couple of hours as instructed.” She put the mouthpiece in her mouth and slowly inhaled.

Mitch chuckled… until he heard her cough again. He frowned and was about to say something when a knock came on the door.

“Aha! Caught you in the act!” The respiratory therapist entered the room, closing the door behind him. He came to Meghan’s bedside. “How many have you done this set?”

“Three.”

“Try for ten. Hi,” he said, turning his attention to Mitch. “I’m Michael, one of the hospital’s respiratory therapists.”

Mitch shook his hand. “Dr. Mitch Branston, ER attending. I’ve worked with you occasionally.”

“Ah, yes, that’s where I’ve seen you. You looked familiar.” Their pleasantries were interrupted by more coughing from Meghan, who was clutching a pillow to her stomach for all its worth. Michael frowned. “I’m not liking that cough. Lean forward for me so I can listen to those lungs.”

Meghan leaned forward while Michael put his stethoscope in his ears. “Deep breaths for me now.” He listened carefully to all areas of her lungs, frowning as he did so. He removed the stethoscope, cleaned off the earpieces with a prep pad, and handed it to Mitch. “Doctor, you might want to take a listen.”

Mitch nodded and accepted the scope. He listened intently to Meghan’s lungs, his frown matching that of Michael’s. Meghan looked between the two men’s faces. “Okay, what?”

“You’ve got some crackles with a bit of wheezing going on,” Mitch stated, concerned. Michael nodded as he accepted back his stethoscope.

“Meghan, I’m going to go ahead and do your breathing treatment, then get in touch with your doctor. I’m going to request a consult with Pulmonology, see if we can nip this in the bud early.” He pulled out her nebulizer, squirted meds into the chamber, and handed it to her as he hooked it up to oxygen and turned it on. Mist started coming out, and Meghan put the mouthpiece in her mouth, taking deep breaths.

Mitch stood. “Do you have to be with her during administration?” Michael shook his head. “Meghan, we’ll be right back. Let’s see if we can find the doctor on call.” They left Meghan to her breathing treatment.

Michael returned to Meghan’s room ten minutes later. “Good news. We had a chat with your doctor, and Pulmonology has been consulted. Someone will be coming to see you later this afternoon.” Michael disconnected the nebulizer and packed it away in its bag.

Meghan coughed again. “Okay. The last thing I want to deal with is pneumonia.”

“Keep up with the spirometer every hour. I’m going to recommend increasing your breathing treatment schedule from twice a day to three, but we’ll see what Pulmonology wants to do.” He patted her arm reassuringly and left.

Mitch and Kelsey entered her room a few minutes later. The sisters greeted each other, chatting about hospital life and the latest scuttlebutt. Mitch, who had retrieved his stethoscope, sat on the edge of his chair like a tiger waiting to pounce. Meghan could see he wanted to focus on her health but was trying to be fair to Kelsey. Meghan motioned Mitch to come close. “You won’t relax until the doctor hat comes off. Do what you’re itching to do.” Kelsey laughed.

Mitch smiled guiltily. He got up and brought his stethoscope to his ears. “I want to listen to you since you just had that breathing treatment.”

She leaned forward and he brought the bell to her back. He listened intently as she took deep breaths. Finally, he removed the scope from his ears. “I’m still hearing crackles, but the wheezing is greatly improved.”

“Doing my job, Mitch?” Dr. Cooper entered the room and shook Mitch’s hand. “Hi there. I’m Dr. Cooper with Pulmonology. They tell me your lungs are trying to get sick and requested a consult. How are you feeling right now?” He pulled over the rolling stool and took a seat.

“Well, I’m starting to have a cough, and maybe feeling a little tight sometimes.” Mitch gave her a look, which she ignored. “And I’m keeping up with the spirometer every hour.”

Dr. Cooper nodded approvingly. “How many times a day is Respiratory Therapy coming by to do breathing treatments?”

“Twice a day, the last two days.”

“Have you ever had any lung injuries or illnesses? Any chronic respiratory problems? Do you smoke?”

“I’ve never smoked and prefer not to be around those who do. I know I had a few bouts of bronchitis growing up.” She broke off to cough, and Dr. Cooper’s frown matched that of Mitch. “I had a bout of smoke inhalation a couple of years back. Other than that, just colds and the flu.”

Dr. Cooper nodded and stood, putting his stethoscope in his ears. “Let me listen to your lungs. Deep breaths, please.” He listened carefully to her lungs, then moved the bell to her chest. “You can breathe normally. I’m going to listen to your heart.” He listened to all of the chambers of her heart before removing the scope from his ears. He flipped up the covers from her feet. “You’re not getting any breaks, are you?” he remarked, seeing the cast on her left leg. He felt her pedal pulses and checked for edema, which was nonexistent. He pressed the call button.

Can I help you?

“This is Dr. Cooper in 311. Could someone bring in a portable pulse ox, please?”

A tech came in moments later. “Here you go, Dr. Cooper. Need anything else?”

“No, thanks.” He accepted the machine and the tech left. He placed the clip on Meghan’s finger and watched the numbers read and stabilize. “Pulse looks good, but your O2 saturation is on the low side of normal.”

“What is it?” Mitch asked.

“She’s showing 96% on room air,” Dr. Cooper replied. He removed the clip and turned the machine back off. He sat on the stool again. “Here’s the deal. I’m hearing a few wheezes and some crackles, which tells me that your lower airway is constricted and you’ve got some fluid buildup in your lungs.” Meghan nodded.

“I’m suspecting that despite efforts so far, you’ve got an infection trying to set in. I’m going to order a chest x-ray, have Respiratory Therapy get a sputum sample, and bump you up to three breathing treatments a day. I’m also going to change your antibiotic. We might need to adjust it again, based on the sputum culture growth, but let’s try to stop you from developing pneumonia.”

Meghan nodded, seeing Mitch relax with Dr. Cooper’s care plan. “Sounds like a plan!”

Dr. Cooper looked at Mitch. “Care to discuss out in the hall?” Mitch nodded and stood. “We’ll get you tip-top in no time, young lady.” He and Mitch headed for the door.

“What antibiotic are you planning to switch her to?” Mitch asked as they made their way to the nurse’s desk.

“I was planning on switching her to Rocephin. Why?” Dr. Cooper asked the unit secretary for Meghan’s chart.

“Just curious, but she’s already on Rocephin.”

“That’s right. Darn it. I’m assuming she’s receiving 1 gram daily?” Mitch nodded. Dr. Cooper thought for a moment. “I have two options then: increase the Rocephin to 2 g per day, or switch her over to ticarcillin and add in clavulanate. Do you know if she’s allergic to anything?”

Mitch shook his head. “No allergies that we’re aware of. I would recommend the switch to ticarcillin based on her working on a lung infection while already on Rocephin.”

Dr. Cooper nodded in agreement. “I think you’re right. We’ll see what her sputum sample grows, just in case we need to switch gears for a different bug.”