Mitch and Rick instantly responded. Rick threw open her door and shouted at the staff that they had an emergency; Mitch, coming to Meghan’s bedside, saw her face swelling and flushed as he reached over her bedside to push the Code Blue button. “I’ve got you, Meghan. I’ve got you." He lowered the head of her bed as medical personnel flooded into her room. He heard the intercom overhead: Code Blue, 311. Code Blue, 311. Code Blue, 311.

“Anaphylactic reaction. I need a laryngoscope, 5 blade, ET tube 7.5 mm STAT!” He caught and eased Meghan back flat on the bed, having flung her pillow elsewhere. He positioned her head back as a laryngoscope was slapped into his hand. “Administer epinephrine, 1 mg, and someone hang an epi drip, 1 amp in 1000 ml Normal Saline.” He inserted the laryngoscope into Meghan’s mouth and tried to visualize her vocal cords and insert the tube, but her throat had already swollen past the point of insertion.

“Too swollen. I need a scalpel. I’m doing a tracheostomy.” Nurses nodded and one opened a trach pack. One nurse went to carefully swab Meghan’s neck. “No time! Just pour it over.” She upended the packaging from the betadine swabs and poured the liquid over Meghan’s neck and laid a sterile towel over it.

Mitch hurriedly donned sterile gloves, glancing up at Rick, who was already gloved and standing on the other side of Meghan, ready to assist. “Okay? Here we go. Time?” A nurse answered with the current time as Mitch brought the scalpel to Meghan’s throat. He made a vertical incision, and Rick separated the skin to reveal the trachea. Being careful not to nick the arteries nearby, Mitch then made a horizontal incision into the trachea. Rick handed Mitch the trach tube, and Mitch inserted it and inflated the balloon. Rick was prepared with gauze squares to pack around the tube, and he applied these as a nurse hooked up the tube to an Ambu bag and started bagging.

“Has Respiratory Therapy been paged? Let’s go ahead and administer Diphenhydramine 25 mg IM.” He then gazed up at the IVs. The pump that held the antibiotics hadn’t been stopped. “Someone get that antibiotic unhooked, now! I think that’s our allergen.”

Hands scrambled to stop the pump and unhook the medication from her IV. The bag of saline solution was run wide open to flush the line from the antibiotic.

“Respiratory Therapy is here,” someone announced, as Michael pushed his way through to the head of the bed. He quickly assessed the situation, noting Meghan’s face had swollen so much her eyes were shut. He listened to her lungs, confirming that the trach tube was effectively providing oxygen to her lungs. He took over bagging from the nurse, pausing for a moment to see if Meghan was breathing or not. She did try to gasp, but it was ineffective. He resumed bagging.

Conversation flowed around Meghan as the doctors and staff did what they could to stabilize her and bring her out of the crisis.

It was well over an hour before Mitch was finally confident enough that Meghan was over the worst of her crisis. Her airways were still really tight, but they estimated that the antibiotic was probably out of her system by now. Unnecessary personnel had already been released back to their normal jobs, but two nurses and Michael, the respiratory therapist, were keeping a careful eye over their patient. A portable ventilator had been brought down and now breathed for Meghan while they waited for an ICU bed.

Meghan wasn’t recognizable at the moment. Her arms and legs were covered in large hives, and her face was swollen and red, her eyes swollen shut. Wires and tubes were everywhere, with them hooking her back up to telemetry and starting two new IVs after deciding to go ahead and pull the original one.

Mitch glanced at the telemetry monitor. Her heart rate was good, a sinus rhythm in the 70s, but her blood pressure was still rather low, 90/42. “I’ll be just outside,” he told the staff as he stripped off his gloves, tossing them into the wastebasket close to the door. Rick followed Mitch’s lead and followed him into the hall.

The first thing Mitch did was search for Kelsey. He found her seated in a chair at the nurse’s station, sobbing. One of Kelsey's nurse friends, Jackie, was comforting her as best she could. Jackie spotted Mitch and Rick heading their way and said a quiet word. Kelsey got up and stepped into Mitch’s embrace, sobbing into his shoulder. “Shh, shh, she’s okay, Kelsey. Meghan’s going to be okay.” He tried to comfort her as best as he could.

“What happened, Mitch? She was fine just a few minutes before…” Kelsey sobbed.

“She had an anaphylactic reaction to the antibiotic, hon.” Mitch winced as he felt a headache coming on.

“I saw everyone working on her from the room window. I thought she was gone.”

Mitch kissed her forehead and held her tight. Truth be told, his mind was reeling from the incident. Concern, worry, and fear were balling up together to form a new emotional response: irritation and anger. Anger over the issue with the antibiotic chosen, and irritation that he was the doctor responding to everything, not her assigned doctors.

The unit secretary cleared her throat. “Sorry to interrupt, but there’s a call on Line 1 for you, Dr. Branston.”

Mitch let go of his wife and reached over for a phone. “Dr. Branston.”

Hey Mitch, it’s Cooper. I got a page. What’s up?

“We just pulled Meghan through anaphylactic shock.” He was a bit curt on the phone but tried to remind himself that he shouldn’t be mad at Dr. Cooper.

What? I thought you said she had no allergies.

“Now she does.” Mitch sighed, took a deep breath, and forced himself to calm down. “Her airway closed off too quickly to intubate, so now she has a tracheostomy. I’ve got her on a vent, and am waiting on a bed in ICU. I would appreciate you or a colleague coming to make whatever changes you feel are needed to vent settings and such.”

Sure thing. I’m in the hospital now. Is she in ICU at the moment, or still on the 3rd floor?

“She’s still in 311.”

I’ll be there shortly. Dr. Cooper hung up, and Mitch stood there for a minute before the dial tone broke him of his reverie. He hung up the phone and moved back towards Kelsey’s seat. Before he could sit down, though, Dr. Meyers came running onto the floor. He saw Mitch and Kelsey and hurried over to them.

“What happened? I got an emergency page from the answering service.” He looked very worried, and Mitch’s level of irritation at everything lowered a notch.

Mitch gestured to Meghan’s room. “Anaphylactic shock. She’s still alive, thankfully. We’re waiting for a bed in ICU.”

“What?!” Dr. Meyers shook his head. “Let me go get my stethoscope.” He hurried away to his office. He was back within a couple of minutes, having paused just long enough to retrieve his lab coat and stethoscope. Mitch gestured towards Meghan’s room and was about to follow Kevin there when Dr. Cooper arrived. He joined the other doctors and headed towards Meghan’s room.

Dr. Brant had already re-entered Meghan’s room and stood when the three came in. They were shocked to see how much the edema had affected her face. Dr. Cooper was the first to listen to her lungs. “Her lungs are still rather edematic. We need to get that down before taking her off the vent. I’m assuming her larynx was too swollen to pass the ET tube?”

“Yes. She had massive laryngeal swelling. I wasn’t even able to visualize her vocal cords.” Mitch ran a hand through his hair.

Dr. Meyers looked at the notes made in Meghan’s chart. “What meds does she have on board?”

“Epinephrine 1 mg and she still has an epi drip going. We also gave her 25 mg of diphenhydramine. I’m concerned about her blood pressure. I’m not sure if Lopressor would be a good option or not.”

“Lopressor? Perhaps you mean Levophed?” Dr. Brant said, softly.

Mitch looked at him for a minute, then his eyes widened. “Oh, boy! Yes! Levophed.”

Dr. Cooper gave him a sympathetic smile. “Levophed would probably be a good idea. I’d also recommend adding a corticosteroid and maybe a diphenhydramine drip. Let’s get the edema under control first, and then we’ll see about switching the antibiotic.”

They discussed a little more, coming up with a care plan for the next few hours. As they left Meghan’s room, Dr. Brant looked at his best friend. “Mitch, you need to go home and rest. Take Kelsey for some dinner, and go home. Let the others take care of Meghan: she’s in good hands.”

Mitch sighed and found a wall to lean against. “I know, Rick, but it’s hard to let go. She’s my sister-in-law, but she’s also a friend and a patient.”

Rick nodded. “She’s my patient too, you know. And someone I very much want to get to know better when she’s no longer my patient. I was scared today; I know you were too.” He hung his head, sighed, and raised it again to look at his friend. “I think we should go get some food. Where’s Kelsey?”

Mitch looked in the direction of the nurses’ station and spotted her. “She’s at the desk.” He headed her way.

Dr. Meyers was at the station already, making notes in Meghan’s chart. “Mitch, ICU just called down. They have a bed available and will be ready for her in 30 minutes. Room 742.”

“Thanks, Kevin. Rick here is shooing me out of the hospital. Please call or page me if there’s any change to her condition.” Mitch saw Rick talking with Kelsey, who nodded and picked up her purse.

“I’ll do that, and will make notes in her chart to that effect. I’ll also mention it to the attending when I give her report – in person. I’m not leaving until she’s safely up in ICU.” Kevin gave him a look of steely determination.

“Thanks, Kevin. You don’t know how much I appreciate that.” Mitch shook the man’s hand and went to stand at his wife’s side. “They have a bed for her in ICU, room 742. She should be going up there in half an hour.”

Kelsey gave her husband a hug. “I’m glad to know that. Rick said something about kicking us out of the hospital and going for some dinner.” She stood and rested her good arm in the crick of his elbow, allowing him to guide her down the hall.

Mitch glanced at Rick. “Oh, he did, did he? As much as I’m loathe to leave, I think he’s right. I need to get away from here for a little while.” His stomach rumbled, and he laughed. “And apparently my stomach thinks it needs food.”