It was mid-morning when Dr. Woodruff came to see Meghan on Monday. “Hello, Meghan. How are you feeling?”

“Much better, now that I’m back on the hydrocortisone.” She smiled.

“That’s good! That’s exactly what I want to hear. I saw in your chart that they are working to wean you off of the Levophed, too.”

“Yes,” she agreed, “although that’s not as pleasant, feeling like I’m going to pass out at each dosage change.”

“I’m sure,” he sympathized. “So, let’s go over your test results. First and foremost, you have Addison’s disease. Your particular case of Addison’s disease is primary Addison’s, which means that your adrenal glands aren’t working like they are supposed to.” Meghan nodded. “Your body isn’t producing cortisol, which is important for a lot of the body’s functions, such as the ability to regulate your blood sugar, your blood pressure, metabolism, and salt/water balance. By us putting you on the hydrocortisone drip, we’ve raised your cortisol levels so they are back within a normal range. Today, we will be stopping the drip and putting you on an oral dose.

“The other medication you will be going on is fludrocortisone. Your labwork showed abnormally low levels of aldosterone, which is another hormone usually produced by the adrenal glands.”

“Is this a temporary illness, or will I have this the rest of my life?” Meghan asked.

“This is a permanent condition, Meghan, I’m sorry. Now, while you will be on medication for the rest of your life, it is quite normal to expect that you will be able to lead a normal life. I fully expect that you will be able to go back to teaching your EMS classes and working on the ambulance with no problems. However, we do need to get your medications regulated, and we need to discuss about what constitutes a health emergency for you.”

Meghan nodded. “So, I will be able to go back to the truck?” She breathed a sigh of relief. “Not being able to work as a paramedic would have been the hardest thing to deal with.”

Dr. Woodruff nodded. “Yes, that’s what Mitch told me when he asked about it. Now, the biggest hurdle you will need to be aware of is times your body experiences extra stress. By that, I mean a bad illness, a surgery, those kinds of events. Those times demand a higher cortisol load than your body can maintain, and so we supplement with extra dosage of cortisol. The other issue to be on the lookout for is an adrenal crisis.”

“What’s that?”

“An adrenal crisis is much like when you presented to the ER Wednesday night. In essence, your cortisol level dropped to a critical low. So, if you are having any symptoms like severe nausea and vomiting, diarrhea, abdominal pain, are dehydrated, confused, your blood pressure drops low, or you faint, you need to seek emergency treatment. I’ll be writing orders for both a medic alert bracelet for you, as well as an emergency injection of hydrocortisone that you need to keep with you at all times. The sooner you recognize the symptoms and get hydrocortisone administered, the better, but just like someone who uses their Epipen, once you use it, you must get emergency treatment. I always advise my patients to educate people around them as to how to recognize an adrenal crisis and administer the medication, in case you are not able to do it yourself. Do you have any questions?”

Meghan thought for a while. “In what form does the hydrocortisone come, for emergency use, I mean? Is it a vial that will need to be reconstituted, or is there a form of it in an autoinjector, like the Epipen?”

Dr. Woodruff smiled. “That’s a very good question! It is a vial that should be reconstituted. I take it you’re familiar with how to do that?”

“Oh, yes. We carry a few meds like that on the ambulance. And I’m surrounded by medical professionals, so it won’t be hard to explain what to watch for and what to do in an emergency.”

“Good! Any other questions?”

“Good! Any other questions?”

“When can I go back to work?”

“What’s the rush?” Dr. Woodruff was taken aback by her question.

“Well, I have two reasons. First, our department is short-staffed at the moment, and the longer I’m off the truck the bigger the burden is on everyone else.”

“Okay, I can understand that, but I also want you to consider how much of a bigger burden it would be if you had an adrenal crisis while on duty because we don’t have your dosages all figured out,” he replied, quietly. He watched the emotions play across her face as she considered that.

“You’re right,” she said quietly. “I hate that my absence is a burden to the other crews, but my getting sick on shift because I rushed this too quickly would just make things worse. How long do you think I will need to be off, so that everything can be as dialed-in as possible?”

“I’d suggest a couple of months.”

She sighed but nodded. “I’ll talk to my manager today.”

“If you want, have her call me. I’ll be happy to talk with her, explain everything, and answer any questions she might have.” He smiled.

“I’ll pass along your contact info,” Meghan agreed.

“You said you have two reasons. What’s your other reason?”

“Well, I must be at school on Saturday. We’re hosting the EMT testing.”

“So, you’re wanting to be there for your students, is that it?” he asked.

“No, you don’t understand. I’m the site coordinator. I have to answer to the state office for everything that happens during that testing event.” Meghan was suddenly starting to feel defensive.

“Isn’t there anyone who can cover for you?”

“Only if I’m lying in the hospital in a coma,” she retorted. “Listen, I have to be there. It’s important.”

“What are your duties for this?” Dr. Woodruff asked. He was understanding that this was important to her, but was hesitant to agree.

“I have to collect the test scores from the judges and make certain that all scoring paperwork gets back to the state office. I’m also responsible for overseeing the quality of the judging, making sure the volunteers are okay and getting breaks, make sure there’s no problems with the facilities…”

Dr. Woodruff chuckled. “It sounds like a lot of running around and managing to me.”

She nodded. “Yeah, it’s a lot of clerical headache, to be sure, but I’m glad to do it. The National Registry tests are pretty much mandated in most states to become an EMT-Basic or paramedic, and all the levels in between. Some states only offer the testing a couple times a year. I’m glad that having our test site allows the state to offer the exam every two months.” She looked at him. “I’m sensing you’re still hesitant to say yes, though.”

“I am,” he agreed. “Right now, your health is fragile. You’re feeling better, I know, but this test is only 5 days away. We need to finish weaning you off of the Levophed, and need to know that your body can handle not having a lot of extra medical support. That may or may not be doable in 5 days. And even if you are able to leave the hospital in that time frame, I’m concerned that it might be too much stress too soon.”

Meghan thought hard, her mind racing to come up with solutions. “What if I had a doctor or two onsite who knew what to look out for and what to do? Would that make it more doable? I can also see if I can get a helper for myself for the day, although the responsibility still would ultimately be mine?”

Dr. Woodruff shook his head, but smiled. “You don’t give up, do you? Okay, I’ll make you a deal. If you will get someone to help you during the exam, and you can get at least one physician to be on site who can check on you regularly, then I’ll allow it, provided you’re healthy enough to discharge home. But I want to see you on the following Monday!”

“Deal!” Meghan replied.

“Any more questions for me before I go?” he asked, getting up from his chair.

“No, but I know who to call if I do.” Meghan shook his hand before he took his leave.

**********

Tuesday was a very productive day for Meghan. She had been weaned off the Levophed fully Monday night, and with her blood pressure holding steady, they weaned her off of the hydrocortisone drip as well.

Rick and Mitch stopped by Tuesday mid-day to visit. “Hey Meghan! How are you feeling today?”

She lit up when she saw them! “Hi! I’m doing well. See? No drips!”

Mitch chuckled. “Well, look at you! If you’re not careful, they’ll be kicking you out of here so they can have the bed space.”

“That’s the plan,” she grinned. “I’m supposed to be transitioning to a regular room later today.”

“Oh, Meghan, that’s great!” Rick grinned. “Any idea as to what unit you’ll be going to?”

“Not a clue,” she confessed. “I’ll text you when I find out.”

“Please do,” Rick requested.

“Actually, I have a favor to ask both of you,” Meghan said.

“What do you need?” Mitch asked.

“Do either of you have plans for this Saturday, from 8 am until around 2 pm?”

Both thought for a moment. “No,” Mitch replied slowly, as Rick shook his head. “Why? What do you need?”

“Well, I’ve got the National Registry testing going on Saturday. I’m the test site coordinator, so I have to be there. Dr. Woodruff has agreed to let me do it, provided I have at least one doctor on site to check in on me occasionally. I also have to have someone help me with the site responsibilities. Fred will be there, and he usually helps me out unofficially anyway, so I’m covered there.”

“So, you are just needing us to hang out for several hours?” Mitch was confused.

“I wouldn’t put you up to something that boring,” Meghan retorted. “No, I was wondering if you’d like to be volunteers. We always need a few good patients.” She smiled.

Rick looked at her askance. “Patients? What all does this entail? I’m sorry, but I don’t really want to be an IV guinea pig for a bunch of students.”

Meghan laughed. “No, nothing like that! It’s rather fun, actually. Before stuff starts, you’ll be assigned a different patient category, so you’ll be a patient for one specific scenario during the entire day. You could be the patient for a skills station, like first aid or backboarding, or you could be the patient for either a trauma or medical station. The testing this weekend is for the EMT-Basic, so there’s no needles or sharp objects to worry about. And as a volunteer, I provide donuts, coffee, juice, milk, and water for breakfast and snacks, and we’ll end with pizza and soda for lunch.”

Rick looked at Mitch. “I don’t know about you, but this could be fun! Sign me up, Meghan!”

Mitch laughed. “Okay, Meghan, you talked me into it, on one condition.”

“What’s your condition?”

“I don’t want to be backboarded.”

She laughed. “Okay, Mitch. I’ll keep you off the backboards.”

A knock sounded on the door, and a tech entered, pushing a wheelchair. “Excuse me. Are you Meghan McCoy?”

“Yes.”

“I’m Tracy, one of the transport techs. I’m here to move you down to another ward.” She smiled and wheeled the chair close to Meghan’s bed.

“Oh! Okay. I didn’t know you were coming now.” Meghan floundered.

Mitch stepped outside and spoke with a nurse. Shortly, a nurse breezed into the room. “Apparently they sent Transport up an hour early! Do you mind waiting a few minutes so we can get her packed up?”

Tracy smiled. “I don’t mind at all. Is there anything I can help with?”

Soon, Meghan was packed up and ready to head to her new room. The nurse brought in her chart, handing it to the tech for the new staff. “Meghan, it was a pleasure helping you out. I wish you all the best, and don’t want to see you up here again unless you’re working!”

“Thanks for the care. I really appreciate it. And I hope to not see you again except when I’m on the job!” They chuckled.

“Shall we escape, then?” Tracy asked, and pushed Meghan’s chair through the double doors out of the ICU. Rick and Mitch followed behind as Tracy got on the elevator and took it to the fourth floor. Imagine Meghan’s surprise when she saw June standing in the middle of the hallway, hands on her hips!

“Miss Meghan, now what’ya doin’ back here on this floor? I thought we’d patched you up just proper last time, and here you are back again!” June shook her head in mock disgust, but winked at Meghan.

“I just couldn’t stay away, Miss June,” Meghan replied.

“What room is she going to?” Tracy asked.

“She’s going back to 408,” June replied. “I’ll be there in just a couple of minutes to get you all settled in.”

Tracy wheeled Meghan into the room and helped to transfer her and her IV over to the new bed. “I’ll get your chart dropped off at the nurses’ station. Hope you get to feeling better soon!”

She left, and Rick and Mitch helped get the few items Meghan brought with her situated. “Well, Meghan, it appears that you got your old room back. And as much as I hate to go, I do need to get back down to the ER.”

Meghan smiled at her brother-in-law. “Thanks, Mitch. Will you pass the room number on to Kelsey?”

“Yes,” he agreed. “We’ll probably be back after work. Later, Rick!”

Rick smiled as he watched his friend head from the room. “Are you glad to be in a different room, out of the ICU?”

“Yes, although it’s a little scary as well,” Meghan admitted. “And once I leave the hospital, life won’t be the same as it once was. I’ll have to wear a medic alert bracelet or necklace, and I’ll always have to carry emergency medication.”

“I think you’ll be able to weather the transition,” Rick stated, confidently. “You’re too tough to let this get you down.”

June entered the room at that moment. “Okay, I need to get this gal checked in doctor, so unless you’re examinin’ her, I need you to go.”

Rick chuckled. “Sounds like I need to go, Meghan. I’ll see you later!” He squeezed her hand and left.

Meghan’s nurse for the day came in just as Rick left. “Hi again, Meghan. It’s good to see you, although not as a patient! I just got report from the ICU, and it sounds like you’ve had a time of it!”

“That would be an understatement,” Meghan replied.

“Let me go through the poke, prod, and question routine to get you checked in, and then we’ll let you settle in.”