Meghan crashed as soon as Mitch started driving. He glanced over at her and she was out, head back, mouth open. He chuckled to himself and did his best to drive carefully. He pulled into the driveway and touched her shoulder. “Meghan, we’re home.”

Meghan woke up and looked at him sleepily, blinking, before it registered what he said. “We’re home? Oh. Okay.” She unbuckled her seatbelt and grabbed her backpack before getting out of the car.

Kelsey took one look at Meghan as they entered the house and shook her head. “You need sleep.”

“I know. I passed out in the car,” Meghan replied, yawning.

Mitch kissed his wife. “Hon, could you go grab a BP cuff and stethoscope? Meghan, I want to check your blood pressure before you go sleep, just to be of the safe side.”

Kelsey went to retrieve the requested items. Meghan nodded. “Let me go put this in my room, and I’ll be back out.”

Meghan made her way to the guest room and dropped off the backpack. She took advantage of the time to also pull off her boots. She made her way back to the living room and sat down on the couch.

Kelsey came back in with stethoscope, blood pressure cuff, and a pulse ox machine. She handed the cuff and scope to her husband and placed the pulse ox probe on Meghan’s finger herself. She sat down by her sister and brushed hair out of Meghan’s face. “How are you feeling, sis?”

Meghan sighed. “Like I way overdid.”

“That’s an understatement,” Mitch remarked, wrapping the BP cuff around her arm. He pumped up the cuff and let it deflate. Removing the cuff from her arm, he glanced at the pulse ox numbers.

“What’s the verdict, Mitch?” Meghan asked.

“You’re 96/48. Pulse and oxygenation look good.” Mitch shook his head.

“So, what do we do? Let me sleep and see if things improve?”

Mitch looked uncertain. “I think that sleep would be a good idea, at least. I’ll contact Dr. Woodruff and see what he says. He might want you to take another dose of the hydrocortisone, or push some fluids. If so, we can run an IV here.”

Meghan nodded slowly. “I really don’t want to have to go back to the ER if I can at all avoid it.”

“I know, Meghan. I can’t guarantee anything, but I’ll try to keep that as a last resort for you. Why don’t you go ahead and go to bed? I’ll wake you if Dr. Woodruff has any orders for you. Of course, if you’re not up by 6 pm, we’ll wake you up.”

Meghan smiled sleepily. “Thanks Mitch. I’m really wanting sleep.” She got up and headed for the guest bedroom. She changed into a sleep shirt and house pants, made a quick stop at the bathroom, and tucked herself into bed. She was out within minutes.

Mitch, meanwhile, headed down to his office. He stopped by the exam room to put the equipment away, but then walked to his office and took a seat behind his desk. Picking up the phone, he dialed Dr. Woodruff’s number. Mitch wound up leaving a message with the doctor’s answering service, requesting a call back.

Kelsey came in as Mitch hung up the phone. “Answering service?” she asked. Mitch nodded. “You might want to wash up a bit while you wait. You’ve got something blue on you around your ears.”

“Still?” He went to touch his ear, but Kelsey stopped him, giggling. “What is that, anyway? Makeup?”

“Yes,” he said, leaving the office and heading for their bedroom. He looked at his reflection in the bathroom mirror. “Yes, some around my ears. And in my hair! Good night!” He pulled out a washcloth from the cabinet and washed his face thoroughly.

“Why were you wearing blue makeup?” Kelsey asked, perching on the counter.

“I wound up being a patient at one of the skills stations. I apparently was a cyanotic respiratory distress patient. It was rather fun, but the makeup was a little annoying.” Mitch rinsed off his face and toweled it dry. “Ah, so much better!”

Kelsey chuckled and kissed her husband again. “So, what did you think of the testing? Meghan has described it before. A lot different than the NCLEX.”

“It was interesting. I worked with an adjudicator named Brad, who apparently also teaches the Fire Academy classes at the school. He said that the students have a written test they have to pass, plus all of the skills stations, in order to be certified. Considering the possibility of an academy-style course, they may only be in school for a month and then be eligible to test. It’s a lot of information to learn and regurgitate in a short period of time!” Mitch settled in his favorite armchair after they moved into the living room.

He sighed and smiled. “As if I didn’t already admire Meghan a lot, today was such a huge confirmation of that. From what I gather, she pulled off a logistics miracle yesterday, getting everyone and everything in place for the test site today. People were happy, they were organized; I heard a lot of compliments and stories during down times and breaks. Meghan even managed to get a bunch of volunteers from the fire academy students, who frankly look at her with awe after the rescue of that trainee in the burn building.”

Kelsey nodded thoughtfully, and was about to ask a question when the phone rang. “I’ll get it,” Mitch said, getting up. “Hello?”

Is this Mitch Branston? Dr. Woodruff here.

“Yes, this is Mitch. Thanks for calling me back.” Mitch took the phone and headed for his office.

I received the message from the answering service. I’m assuming this is in regards to a patient?

“Yes. Meghan McCoy. She was just diagnosed with Addison’s.” Mitch sat down at his desk, pulling up his chart on Meghan.

Ah, yes. She had some kind of school event today, didn’t she? How is she responding to it?

Mitch cleared his throat. “Well, she struggled through it. She overdid it,” he clarified. “We’ve got her at home, and she’s sleeping now. We took vital signs a couple of times, and the last blood pressure was…” he glanced at his handwritten notes, “…96/48. I wanted to run it by you and see what we need to do, if anything.”

Hmmm. Well, right now it sounds like she’s still a little depleted, but not dangerously so. Let’s do this: give her a couple hours to rest. Check her vitals again. If her blood pressure is still about the same, give her a liter of fluids. If it’s dropped lower, she needs her emergency dose of hydrocortisone, bring her in to the ER, and get her started on a drip. Otherwise, have her double her dosage of hydrocortisone tonight and tomorrow, and I will see her in the office on Monday.

“Okay. So double up on the hydrocortisone through Monday, give fluid bolus if still under 110 systolic, and if under 90 systolic give emergency dose of hydrocortisone, bring to the ER and start on hydrocortisone drip,” Mitch confirmed, typing the orders into Meghan’s chart.

Yes. Either way, please call me. I will meet you at the ER if she needs to go back in.

“Will do,” Mitch promised. “She’s been down for about an hour. I’ll check on her in a couple hours if she isn’t up by then.”

Sounds like a plan. No worries, Mitch. This is a normal progression as we figure out the right dosage for her, although she pushed the envelope a little soon.

“I’m sure you’re right. This goes beyond my limited experience with patients with Addison’s. I’m usually starting a hydrocortisone drip and passing care on to you and your colleagues,” Mitch replied.

Well, like I said, give me a call with her status after she wakes up. We’ll get her back on her feet soon. Mitch could hear a pager going off in the background. Sorry, Mitch, I need to answer this. Talk to you later.

Mitch said his goodbyes and the call disconnected. Mitch added a final note to Meghan’s chart and shut the computer down. He picked up the phone and headed back into the living room to put the phone back in the receiver.

“Dr. Woodruff?” Kelsey asked.

Mitch nodded. “I at least have a plan of action for Meghan. I’ll let her sleep for a couple more hours and then check on her. Depending on how her vital signs are will determine the rest.”

Kelsey got up from her chair and came to give Mitch a hug. “She isn’t going to need to go back to the hospital, is she? She didn’t seem to be that bad when she got home, just tired.”

Mitch shrugged. “I hope not, although Dr. Woodruff gave parameters that might include another trip to the ER. But I’m hoping not, too.”