Inside Trauma Two, Meghan had been effectively wired for sound and had a lot of tubes going everywhere. She was awake, but rather out of it. Dr. Branston looked at Bob, the head nurse on duty that evening. “Let’s hang a Levophed drip, 4 mg in 1 L D5W, and titrate it until her blood pressure is in the 100s systolic. See if you can get ahold of Dr. Mark Woodruff in Endocrinology and tell him I need his presence. And let me know when her labs get back. I need to see what that cortisol number is.” Bob nodded and left to retrieve the medication and place a phone call.

Mitch reached over the bed rail to hold Meghan’s hand. “How are you feeling?”

“Like a limp noodle. Very floaty. My back hurts, but whether that’s related to this or just because of the gurney, I don’t know. And I’m cold.” Meghan shivered, and her voice trailed away.

Bob bustled back in with supplies and a vial of medication. He hooked up the tubing to the IV bag, purging the line of air, and hung the bag on an IV pole already holding one IV. He used a syringe to draw up the medication and injected it into the IV bag he had just hung. He then connected the new tubing to a port on the existing IV bag and hooked it up into an IV pump. He programmed the pump and set it into motion, delivering the medication in a controlled manner.

Bob and Mitch watched the monitor carefully, allowing the medication a minute to enter Meghan’s bloodstream before setting the monitor to take a blood pressure. It took about 10 minutes and two dosing adjustments before Meghan’s blood pressure finally was up into the 100s systolic.

Her blood pressure having come up, Meghan was more alert and awake. The pallor in her face had eased, and while it was obvious her condition was still fragile and serious, everyone’s fears calmed down.

Jerry and gang popped into her room before they headed out. Tony glanced at the monitor and smiled. “108/76. That’s a much better blood pressure!”

Meghan smiled. “Yeah, I think I prefer it over the 70s systolic. Those aren’t too much fun.”

“You had me worried, Squirt,” Jerry said softly, coming close to the head of her bed. “This was too close for comfort.”

“I know. I’m sorry.”

“For what?” Jerry looked confused.

“For worrying everyone. I swear we’re trying to figure out what’s causing this. I didn’t want to bother anyone tonight,” Meghan had tears forming.

“Hey, now, no crying. We just want you well.” Jerry smiled.

A radio blared, with tones playing. “Gotta go, guys,” Bill warned.

Meghan gave a weak smile. “Get outta here and bug someone else. Thanks again.”

They hurried out of her room. Having seen them leave, and no one else around at the moment, the tears that kept threatening to fall, did. Big, fat tears rolled down Meghan’s cheeks as she sobbed. Bob, hearing a noise as he passed by her room, entered to investigate.

“Hey, hey, Meghan! What’s wrong, darlin’?”

“Everything! I’m just so tired of everything!” She hiccupped through the tears.

“What, being sick, or being transported by your own crew?” Bob asked.

“Both! First it was the car wreck, then two surgeries, and now this! All I want is to be healthy and have life go like it did before!” She sniffed into the Kleenex Bob brought over.

“Your life hasn’t been easy the last several months,” Bob agreed, “But you’ve really been hanging in there, and that’s not an easy thing to do. It sounds like Dr. Branston is really digging in there to find out what’s going on, and he’s like a dog with a favorite bone when he comes across something like this. Just be patient, and we’ll have you on the mend soon.” He reached over and gave her a hug, careful of the wires and tubes everywhere.

Mitch reentered Meghan’s room as Bob broke off the embrace. He smiled kindly. “Bob, could you check in on Curtain 3? I’m about to discharge him.”

“Sure thing, Doc. Meghan, if you need a shoulder to cry on again, just page me.” Bob headed out of the room.

“Doing okay, Meghan?” Mitch asked, hands stuck into the pockets of his lab coat.

“Not really, but I’ll manage.” She wiped at the tears clinging to her cheeks.

“I called in a consult for you, Meghan.” He motioned for someone to join them. “Meghan, this is Dr. Mark Woodruff. He specializes in Endocrinology. I talked to him earlier about your symptoms and labwork, and when you came in, I had him paged.”

“Hi,” Meghan said, weakly.

“Hello, Meghan.” Dr. Woodruff smiled. “How are you feeling right now?”

“Well, better than I did earlier. I don’t think I’m going to pass out now, and the nausea’s gone down quite a lot.”

“I see. Are you having any back pain?”

“A little, in my low back. I’d ask for the bed to be set up some to help, but I don’t want to risk passing out again.”

Dr. Woodruff approached the gurney. “Mind if I do a quick exam?”

Meghan gave a weak thumbs-up. “Be my guest.”

Dr. Woodruff listened to her heart and lungs and looked in her eyes, ears, and mouth. He felt along her lymph nodes before looking at her hands and abdomen. Finishing up his exam, he pulled over a rolling stool while Mitch leaned against the wall. “Meghan, how long have you had these darker patches on your hands and elsewhere on your body?”

“Hmmm. I’m not sure, really. I figured the hands were some kind of tanning from all the sun exposure while driving or something. Months, I guess.”

“And how long have you noticed the fatigue or lightheadedness? What about the nausea?”

“Several months. I had an accident about what, Mitch, 7-8 months ago now?”

“Yeah, around that,” Mitch confirmed.

“I’d maybe had a few bouts of lightheadedness if I stood up too quickly, that sort of thing. It became more common after the accident, though.”

“What kind of accident are we referring to?” Dr. Woodruff asked.

“She got hit by a vehicle moving at highway speed: car vs. pedestrian,” Mitch replied. Meghan nodded.

“Mitch, have you sent blood down to the lab tonight?”

Mitch nodded. “Yes. I went ahead and ordered a random cortisol level too, although I do have orders for an 8 am cortisol level that she was going to get done tomorrow morning.”

Bob entered the room then. “Dr. Branston, lab’s calling up to talk to you about some abnormal values.”

Mitch pushed away from the wall as Dr. Woodruff stood. “We’ll be back, Meghan, after we look at your labs.”

“Okay,” she replied, and the doctors filed out and headed for a computer at the nurse’s station. Dr. Branston pulled up the lab results while putting a phone to his ear. He listened as the lab detailed out several abnormal results with blood chemistry, but the kicker was her cortisol level. Dr. Branston thanked them and hung up the phone.

Dr. Woodruff, who had been looking over Mitch’s shoulder sat down. “Her cortisol is only 2.2. Normal levels are 7-20. We need to do the ACTH stimulation study, but not tonight. For now, we need to get her cortisol levels up.” He waved Bob over. “Give hydrocortisone 100 mg IV, followed by an infusion of 200 mg over the next 24 hours. I’ll be admitting her; I’ll get some admissions paperwork started in a few minutes.”

“So, you’re thinking this is adrenal crisis?” Mitch asked.

“I do believe it is. We’ll see how she responds to the corticosteroids, and I’ll still have the ACTH study done, but she’s showing a lot of the signs and symptoms, enough to make me go ahead and treat for it.” Dr. Woodruff sighed. “I’m glad you called me in.”

“Me too!” Mitch tapped his hands against his lap in excitement.

Dr. Woodruff looked at him, amused. “Happy?”

“Relieved. Knowing what’s going on means we can treat it, and hopefully help her to get back to feeling better.”

“That’s true. Well, let me get her admit orders filled out. My wife would like a couple of hours with me before I pass out tonight,” Dr. Woodruff chuckled.

“I’m going to go pass this news on to Meghan, if you don’t mind.” Mitch stood, and Dr. Woodruff shook his head.