Meghan’s night was restless, with all of the comings and goings of the staff, but she still felt better than she had when the doctors rounded that morning at 7:30. Drs. Woodruff, Anderson, and Kline, the in-coming internalist, made their way into her room.

“Good morning, Meghan! How are you feeling?” Dr. Anderson asked.

“Tired, but a lot better than I have in a while,” she replied, smiling.

“That’s good to hear!” Dr. Woodruff moved closer to the bed. “The plan for today is to wean you off of the cortisone drip, and we’re going to try to wean you off of the Levophed, as well. It’s not imperative that we have you weaned off of that for the tests, though, so don’t be surprised if you’re still on the drip for a while longer.” Meghan nodded. “I’ll be sending you for that CT and the MRI today.”

“Any questions for us while we’re here?” Dr. Anderson asked.

“Could you tell me more about these challenge studies?”

“Sure. They all have a similar procedure, but what we’re looking for is different in each one. We’ll draw a baseline cortisol level, and then inject a medication. After that, it’s another two to three blood draws to see how your body responds to the medication. The first one – the ACTH stimulation study – will confirm if this is indeed Addison’s disease. The others will help us to pinpoint what is the causation of the Addison’s, telling us which type you have. This will help us to determine the medications to give you,” Dr. Woodruff concluded.

“Sheesh! Sounds like you should just put in a tap!” Meghan joked.

“Actually… Give us just a minute, Meghan.” Dr. Kline pulled the other two doctors from the room. Meghan could see them conversing just outside her room through the window.

After a few minutes’ discussion, the doctors filed back into her room. “Meghan, we discussed it and I would recommend us putting in a central line. With all of the testing coming up, it would save your arms from so many sticks, plus I’d rather be running your meds and fluids through a central line vs peripheral IVs.”

“Sure, if you advise it. Is the insertion painful?” She asked.

“You might feel some discomfort, but we numb the insertion area beforehand to make it as easy as possible for you,” Dr. Kline explained.

“Okay, then. Let’s do it,” Meghan declared.

Dr. Kline chuckled. “I’ll have the nurse bring in the authorization forms, and we’ll get it put in this morning.”

“Any other questions before we head out?” Dr. Anderson asked.

Meghan thought for a moment. “No, but I know I can always pass a message through the nurses if I think of something.”

The doctors left her room, and Meghan shifted in the bed, trying to get comfortable. Soon, Meghan’s nurse for the morning, Carol, came in with paperwork and a pen. “Meghan, Dr. Kline has written orders for a central line to be placed later this morning. I need to have you sign a consent form before we do so.”

Meghan read through the form and signed her name on the bottom. “How long does it take to place a central line? I was already sedated the last time I had one.”

“Well, it generally takes about 20-30 minutes total. They’ll probably transport you down to radiology to do it, especially since you’re awake.” Carol went around the room, checking monitors and making sure things we straightened up.

“Guess this means no breakfast,” Meghan sighed.

Carol looked at her sympathetically. “I’m afraid not. But I’ll be sure to have a snack ready for you when you come back, if the lunch trays aren’t on their way up.”

“Thanks.” Meghan turned to look out of her window. “Sure looks dark and gloomy outside today.”

“Be thankful you’re inside – the wind is rather brisk this Thursday afternoon,” Rick Brant said, as he knocked on her door frame and entered.

“Rick!” Meghan’s features lit up. Carol made her way out of the room to give them some privacy. “How’d you find out I was here?”

“Mitch called me this morning,” he said, simply. “I brought you a card. I would’ve brought flowers, but they’re a no-no in the ICU.”

“Well, the thought is appreciated too.” She accepted his careful hug. “Have a seat!”

“Thanks.” Rick pulled one of the visitor chairs over and sat down. “How are you feeling?”

“Well, I’m still not great, but I’m feeling ever-so-much better compared to how I was feeling. I am optimistic that we finally know what’s going on, although it sounds like I’ve got a few days of testing ahead to confirm everything.”

Rick nodded. “What do they think is causing the health problems? And what exactly have you been dealing with? We haven’t had much of a chance to chat lately.”

“Well, the bouts of low blood pressure have been causing lightheadedness and sometimes syncopal episodes, which you’re aware of.” Rick nodded. “In trying to figure that out, Mitch did another exam and a lot of labwork. Apparently, a lot of the chemistry panels were abnormal. I was supposed to come in for more labwork this morning, but then things kinda came to a head last night before class ended.” Meghan made a face.

“What happened during class?” Rick wanted to know.

“I was pretty sure my blood pressure was low, and I was feeling lightheaded, but we only had one more hour of class, so I sat and let students practice vitals on me as a station for their practice. Found out my blood pressure was indeed low,” she laughed wryly.

“What was it?”

“Somewhere in the mid-80s systolic. Fred was kind enough to not make a big deal about it until the students left. He wouldn’t let me drive home or to Mitch’s house. I called Mitch to see if he’d pick me up, but when Fred took my BP again and it had dropped further into the 70s, he called an ambulance. I passed out on the fire guys,” she remembered.

“Were you scared?”

“No,” she replied, shaking her head. “More embarrassed than anything, and feeling really out of it.”

“Did they determine what’s going on with you, then?” Rick asked, jumping to the heart of the matter.

“We think so. They believe that I have Addison’s disease. I’ve got a couple of imaging studies scheduled for today, and the next three days will be different bloodwork challenges to pinpoint the cause, I guess.”

Rick sighed. “Well, I’m sorry it’s been so rough for you, but I’m glad that you’re okay. Want me to hang around for a little while? We can chat, or you can sleep, whatever you prefer.” He smiled.

“Sure, I’d like that.”

Rick hung around for about an hour before they came to get Meghan to bring her down to Radiology. “I’m going to head out, Meghan. I’ll come back later to visit.” He watched as they wheeled her out of the room and down the hall before heading down to the cafeteria. He got a large cup of coffee and a bottle of chocolate milk. Holding the hot beverage carefully, he made his way up the stairs to the first floor and headed for the ER.

Rick scanned the unit when he walked through the double doors into the ER, coming in the back way. He spotted what he was after and headed for the nurses’ station. He set the cup of coffee down by Mitch, who spotted it and looked up to see who was the saintly soul for bringing it.

“Rick, you read my thoughts. Thank you!” He gratefully took the cup, cautiously sipping the hot brew.

“Considering you said you didn’t make it home until after two this morning and you were back on shift at 7 am, I figured you’d need a pick-me-up.” Rick smiled, taking a swallow of his milk.

“Did you go up to see Meghan?” Mitch asked, walking around the station to sit down. Rick followed, pulling out a chair next to him and plopping down in it.

“Yeah. Stayed for an hour before they took her down to Radiology. Her nurse said that they were going to put in a central line, and then she was supposed to go for an MRI right after that. Meghan said they also had her scheduled for a CT sometime today too.”

Mitch nodded. “She’s probably going to be here for a week, I’m guessing. Dr. Woodruff seemed pretty certain that last night’s ordeal was an Addisonian crisis, but we need all of this testing to confirm it. He’s having to take her off of the cortisone today so he can do the blood stimulation tests without false readings. It leaves her more susceptible to a recurrence until she can go back on the cortisone.” He sighed.

“Feeling bad that you didn’t catch it earlier?” Rick asked softly, knowing his friend.

“No, but that’s only because I had just spoken with Dr. Woodruff earlier yesterday to get his opinion. Nah, I’m just tired. This body isn’t as young as it once was!” Mitch heard the EMS radio come to life, and heard a trauma alert being requested. He turned to his buddy. “You’d better get out of here if you don’t want overtime.”

Rick laughed as he stood. “Nah, I prefer to enjoy my days off. Take care and keep me updated.”

“Will do,” Mitch promised, taking a final swig of the coffee before heading towards the trauma bay.

**********

By the time Meghan returned to her room, she had a bad headache and was ready for peace and quiet. The process of placing the central line had worn her out, and following that with the noise of the MRI plus her head being secured in place was a recipe for one heck of a migraine.

Carol noticed that Meghan wasn’t feeling well when she returned to the unit. “How are you feeling, Meghan?”

“My head’s pounding, and I’m rather queasy,” Meghan replied, turning her head away from the bright light coming in from the hallway.

“Let me get ahold of Dr. Kline and see what we can do about that,” Carol replied. She pulled the curtain over the hallway window to help darken the room a bit. “I’ll be right back.”

She was back in a few minutes with a couple of syringes. “Dr. Kline will be in soon – he wants to be here when we switch the Levophed drip over to your central line. In the meantime, let’s get you hooked up with some Zofran and some Toradol to try to knock that headache out.” She cleaned off a port on the central line and injected the medications.

Meghan felt the medications start to work and sighed in relief. “Better?” Carol asked.

“Much,” Meghan agreed. She yawned. “I’m so glad that CT scans are relatively quiet!”

Carol chuckled. “I know what you mean!”

Dr. Kline entered the room. “Knock, knock! How are you feeling, Meghan?”

“Better now that I’ve got some meds in me.” Meghan gave a weak smile.

“That’s good. Listen, we need to get the Levophed drip switched over from your peripheral IV to the central line. While that doesn’t take but a couple of minutes to do so, there is still a chance your blood pressure may drop significantly. I like to be around when we do these kinds of changes for that reason. You probably won’t notice much of anything, but wanted you to know, just in case. Okay?” he asked.

Meghan nodded, and Carol started switching over the tubing.

The next thing Meghan knew, she was lying down flat with someone calling her name. “C’mon, Meghan, open your eyes for me. That’s it. Hey there!” She finally focused on Dr. Kline’s face.

“What happened?” she asked, disoriented.

“Your blood pressure dropped a little more than I would have expected it to,” he explained. She was suddenly aware of several people crammed into her room. The crowd started to disburse, seeing she was awake again.

“How far are we talking here?”

“Let’s just say that I’ve not seen a blood pressure drop into the 60s systolic that fast in someone who didn’t code,” Dr. Klein said, glancing at the monitor. “Carol, increase the drip to about 1.5 ml per minute.” He looked at Meghan again, smiling reassuringly. “Still a little low, but we’ll get you back up where you need to be in a minute.”

“Well, you should get the name of that driver and fire him. That was one heck of a rollercoaster ride.”

Carol chuckled.

“I guess that answers one question,” Dr. Klein remarked.

“What’s that?”

“You’re definitely not ready to come off the Levophed yet.”