Meghan was awakened by a knock on her door. Mitch poked his head in. “Sorry to disturb your slumber, but I’ve been on the phone with Dr. Woodruff.”

Meghan motioned for Mitch to come in and sat up in bed. “What did he say?” she asked, half afraid of the answer.

“Well, he wants to know how you’re feeling, and I need to check your vital signs. Based on those readings, we’ll determine what we need to do.” Mitch smiled reassuringly.

Meghan nodded. “I really don’t want to go back to the hospital,” she said, quietly.

“I know, Meghan. Let’s check your vitals and see what they are. We’ll go from there.”

“Okay.” She yawned. “Mind if I go to the bathroom first? All that soda has run through, I think.”

Mitch chuckled. “Sure. I’ll go grab the blood pressure cuff.” He turned to leave the room as Meghan climbed out from under the covers. She stood up and passed out. Mitch managed to catch her before she hit her head on the nightstand. He laid her down on the floor and elevated her feet onto the bed, pulling off the bedspread to cover her while calling for Kelsey.

“Kelsey! Bring me a blood pressure cuff and pulse-ox, and the phone, too! Meghan’s out.” Mitch kept talking with Meghan, trying to bring her around. She was pale and cool, and Mitch was concerned.

Kelsey rushed in with equipment to get Meghan’s vital signs and the phone. “Here, Mitch. What happened?”

“She stood up, saying she needed to visit the bathroom and just passed out.” Mitch took the blood pressure cuff and wrapped it around Meghan’s arm. Kelsey, meanwhile, placed the pulse ox probe on Meghan’s finger and turned the machine on. Numbers flashed before settling down.

“Mitch, she’s tachy at 146.”

Mitch yanked the earpieces of the stethoscope out of his ears. “Her BP’s down to 70 systolic.”

“Should I call for an ambulance?” Kelsey asked, alarmed.

“I’ll call,” Mitch stated. “Go get me an IV setup, Normal Saline, and bring 18-gauge and 20-gauge IV catheters. We need to get fluids into her! Where’s her backpack?” Mitch looked around the room.

“Here!” Kelsey dragged the bag over to Mitch, who took it and the phone. Kelsey left as Mitch dug in the bag until he found Meghan’s emergency hydrocortisone kit. He dialed 911 and wedged the phone between his ear and his shoulder as he drew up the vial of sterile water, injected it into the hydrocortisone vial, reconstituted the medication, and drew up the full dosage.

911, what is the address of your emergency?

“I need an ambulance to 1991 Montrose Circle. I have a 29-year-old female, unconscious, in shock.”

1991 Montrose Circle. Do you have the person’s legs elevated?

“Yes, and she’s covered. I’m a physician. I’ll soon have fluids going, but we need to get her to the ER.”

Certainly, doctor. I’ve got responders on their way.

“Thank you. Tell them to come through the back door.” Mitch lifted a sleeve on Meghan’s shirt and administered the injection in her deltoid.

I’ll include that in information to the responding units. Is the person still breathing?

“Yes, breathing, but unconscious, shocky, diaphoretic. Listen, I need to call her physician. We’ll be here.”

Okay. Please call us back if you need assistance.

Mitch hung up with little grace and called Dr. Woodruff again. Kelsey came back with IV supplies, and Mitch started searching for a vein, cramming the phone against his other ear.

“Dr. Woodruff? Mitch Branston. Go ahead and head for the ER. Meghan passed out and is shocky. BP is 70 systolic, pulse 148, resps 16 and shallow. I’ve given her emergency hydrocortisone and am trying for an IV now.”

Mitch found a vein and inserted an 18-gauge catheter, hooking it up to the fluids and running the drip wide open. He heard sirens coming nearer in the background.

On my way. Give her a bolus of a liter, but don’t overdo on the fluids. Once you get to the ER, start a hydrocortisone drip and titrate to affect.

“Will do,” Mitch promised, and hung up. Kelsey had gone to greet the responders and led them back to Meghan’s room. Soon, three firefighters crowded around Mitch and Meghan.

Tony had responded as part of the crew and took the lead. “What’s going on today?” He recognized Mitch, looked down at the patient, and saw it was Meghan. “Hey, Doc. What’s up… Meghan! How long has she been unconscious?”

Mitch looked at his watch. “About 8 minutes now. She was recently diagnosed with Addison’s Disease. I just got the IV in, and have given her an emergency dose of hydrocortisone. Let’s get her on the monitor and some O2.”

Tony nodded. One firefighter started patching her in, having to wipe her down discreetly with a towel so the patches would stick. Tony placed his stethoscope in his ears and took another blood pressure, using the cuff still on Meghan’s arm. “I’m getting 74/32.”

Mitch nodded. “How long until the ambulance gets here?” Just as soon as he asked, they started hearing the sirens approach. “Never mind.”

Soon, a stretcher was wheeled down the hall, stopping just outside the room. Jerry and Tamara, Fred’s normal partner, stepped into the room. Jerry took one look at Meghan and started barking orders. A flurry of activity ensued: Tony removed the blood pressure cuff and pulse ox and dumped them in Mitch’s arms; Meghan was carefully lifted and carried to the cot and deposited; the foot of the cot was raised so she was in Trendelenburg position; and after being secured to the cot, Meghan was quickly wheeled out to the ambulance.

Once in the ambulance, she was switched to their monitor, her IV hung up, O2 re-established, and covered to preserve heat. Tony asked if Jerry needed a rider, but Jerry shook his head. “Get the doc in here, and let’s go!”

Tamara nodded and hurried around to the driver’s seat while firefighters vacated and Mitch climbed in. Doors shut and they pulled out, lights and sirens going.

“What happened,” Jerry asked, curtly, obtaining a 12-lead and cycling the automatic blood pressure cuff.

“She overdid today,” Mitch stated bluntly. “I’ve spoken already with her endocrinologist, so he knows she’s coming in. I wanted to check her vitals, and she asked to go to the bathroom. She had been sleeping, so when she got up out of bed, she passed out. I’d say she vasovagal-ed, if it wasn’t for the obvious shock.” Mitch accepted the 12-lead printout, read it, and passed it back.

“I’ve already given her the emergency dose of hydrocortisone, but we’ll need to get her started on a drip just as soon as we get to the ER.”

“BP is remaining steady around 74/36,” Jerry remarked. He leaned over Meghan and did a sternal rub. Meghan tried to weakly pull away, but that was all the response they got. Jerry frowned. He pulled the mic from its spot on the radio, called the hospital and gave report. “ETA is 4 minutes.” Placing the mic back, he looked at Mitch. “Do you want a second IV, doc?”

“Do a heplock, and draw a red-top tube if you have it,” Mitch advised. Jerry nodded, and soon had the IV access and blood tube drawn. Jerry looked out the front window. “Pulling up now, doc.”

Mitch nodded. He helped Jerry switch things from the truck supply to portables on the cot, and moved the IV to a resting spot by Meghan’s shoulder.

Having parked, Tamara came around and opened the back doors. Jerry motioned for Mitch to get out, and he followed before they removed Meghan’s cot from the ambulance. They wheeled her in and were directed to one of the trauma bays.

Dr. Shultz was on duty, and Dr. Woodruff had just arrived. Both met Meghan at the ER doors and got a run-down from Mitch. Mitch handed a lab tech the blood tube, who hurried to get a cortisone level for them. Nurses were getting Meghan undressed, into a gown, and inserting a Foley while a tech switched Meghan from the ambulance monitor to the ER’s telemetry.

Mitch scrubbed his face with his hands. “She was so hoping to avoid this,” he told the doctors.

Dr. Woodruff smiled kindly. “I am sure she was, but she has overdone too soon. I was afraid of this.”

Mitch just sighed. “Are we waiting for Pharmacy to send up the hydrocortisone?”

Dr. Shultz nodded. “I put in the orders as quickly as I could. But it may be a 10-minute wait. Did you give her an emergency dose?”

“One hundred mg IM,” Mitch confirmed.

A phone rang at the nurses’ station, followed by an overhead page for Dr. Woodruff. He went to the station and came back a few minutes later. “Her cortisone was 2.6. It’s good you were there, Mitch.”

Rick came rushing into the ER. Spotting the group of doctors, he headed towards them. “How is she?”

Mitch pulled his friend aside, a little way from the others. “She’s unconscious right now, and her cortisone levels are low. We’re just waiting for the pharmacy to send up a hydrocortisone drip so we can get her stabilized. She’s going to be okay.” Mitch studied his friend. “How’d you hear about this?”

“Kelsey called me after the ambulance left,” Rick explained. “She’s going to be okay, right?”

“She pushed too hard today, and she’s depleted her cortisol levels in the process. But I’m certain that with getting her back up with a cortisol drip she’ll be fine. I’m afraid we’re going to have to ground her for a month or two,” Mitch stated.

Rick sighed. “That’s not going to be easy for her. Thankfully she’s already on FMLA with the ambulance, and has a couple of months until classes start up again.”

“I think that the classes themselves aren’t the big concern, especially since Fred co-teaches. She’s going to have to learn to calm down and relax some more, take it easy for I’m guessing a month, at least. Then she might be better able to start slowly ramping up her activities and be more stable.” Mitch looked pensive.

“May I go see her?” Rick asked.

Mitch nodded. “C’mon. She’s in Trauma 2.” Rick followed Mitch into Trauma 2. They were both surprised to see Stan in the room, hanging the hydrocortisone drip.

“Stan! I didn’t think you worked today,” Mitch remarked.

“I wasn’t supposed to, but Sandy called and asked if I could come in and finish her shift. Her son apparently threw up this morning, so she was going to head for the pediatric Urgent Care with him.” He connected the IV tubing to Meghan’s heplock and hooked it up to a pump, set the pump, and started the infusion.

“She overdid today,” Stan stated. “A lot of us were worried about how she was looking as the morning wore on.”

Mitch just nodded. Rick wandered to the side Stan wasn’t on and reached down to stroke a strand of hair out of Meghan’s face. “Meghan, you need to wake up for us.” His hand reached down and held hers, giving it a reassuring squeeze.

Mitch smiled. You’ve got it bad, my friend! He glanced at the telemetry above her. Her pulse had come down a little bit into the 120s, but her blood pressure was still in the 70s, showing 78/42.

Dr. Woodruff came in. “Drip just start?”

“Yes. Stan just hooked her up a couple minutes ago.” Mitch saw Rick pull over a chair to sit by Meghan’s bed and smiled.

“She’s going to have to take it easy – and I do mean easy! – this next month. After that, we can start letting her be a bit more active and working back towards the activity level she was used to. But she can’t overdo like this again for the next month. Her health is too fragile at the moment.”

Mitch agreed. “Rick and I were just discussing that. A lot of the volunteers were getting worried about her as the morning wore on. She refused to rest or go home until everything was done.”

**********

The drip had been going for over an hour before Meghan finally stirred. Rick had been holding Meghan’s hand off and on, and felt her fingers twitch in his palm. He looked at her face and saw her eyelids flutter. Rick pressed the call button, and stood up, leaning over the rail. “Meghan? Meghan, open your eyes for me. C’mon, it’s time to wake up.”

Mitch, Dr. Woodruff, and Dr. Shultz came into the room. “What’s up, Rick?”

“I think she’s starting to wake up.” He turned his attention back to Meghan. “C’mon, sweetheart, you need to wake up for me. You have people who want to say hello.”

Her eyelids fluttered again, and Mitch glanced at telemetry. Her blood pressure’s back in the 90s systolic. That’s good. His eyes narrowed for a minute. Wait – did Rick just call her ‘sweetheart’?

Finally, Meghan opened her eyes. She saw Rick first, as he was in her line of vision, but then glanced around the room, trying to get her bearings. Sudden realization had her struggling to sit up, and doctors were soon all over her, getting her to lie back.

“Easy, Meghan, you’re okay. We’ve got you. Just lie back and rest.” Stan hurried into the room in case help was needed, followed by a tech and Bob.

Bob went over to the monitor and pressed a button to obtain a new set of vital signs. Meghan calmed down and rested back on the gurney. She weakly looked at Rick before focusing on Mitch. “I didn’t want to come here,” she said, her voice soft.

“I know,” Mitch sympathized. “What’s the last thing you remember?”

“Being in bed, you woke me up and said you needed vitals, and I needed to pee. Why? What happened?”

“You stood up from the bed and passed out, narrowly missing the nightstand with your head. I caught you, lowered you to the floor. You were in shock and your blood pressure was barely 70s systolic. I gave you your emergency hydrocortisone, started an IV, and got you here by ambulance.” Mitch tried to be gentle, but his expression was a mixture of concern and grimness.

Meghan didn’t say anything, just turned her head away and closed her eyes. Rick could see a tear escape.

Dr. Woodruff cleared his throat. “We’ve got you back on a hydrocortisone drip, Meghan. I’ll be admitting you back to the ICU for a couple of days until you’re stabilized. We’ll talk later about a better action plan for your care, but right now we just need to get your body stable on the cortisone again.”

She nodded, not opening her eyes. Rick could see the tears flowing down her cheeks as she cried.

People filed out of the room, leaving Rick and Meghan alone. Meghan’s tears increased, and soon she was sobbing. Rick lowered the bed rail on his side and gently eased her over so that her head was resting on his shoulder. He comforted her as best he could.

“Shh, Meghan, it’ll be okay. You’re going to get through this, and soon everything will be back to the way it should be.” Meghan’s sobs started to abate, although those were replaced with hiccups. Rick chuckled as he helped her ease back onto the gurney. “Want some water?” Meghan nodded. “I’ll be right back.”

Rick left the room and headed for the nurses’ station. He spied Mitch and Dr. Shultz conversing. “Would it be okay if Meghan has water?” he asked.

“I don’t see why not,” Mitch replied. “She was crying?” He gestured to the obvious tearstains on Rick’s shirt.

Rick nodded. “Hard, for a bit, and now has the hiccups. Hence, the water.”

Stan appeared next to Rick with a Styrofoam cup. “Here’s some ice water for Meghan. I overheard. Can I get you anything, Dr. Brant?”

Rick accepted the cup. “I’m fine, Stan, thanks.” Stan nodded, smiled, and left.

Rick headed back to Trauma 2. “I got you some water.” He helped Meghan sit up enough to drink some of the liquid, and her hiccups abated.

“Thanks,” she sighed. She settled heavily back against the gurney. “I’m so wiped. All my body wants to do is sleep.” She yawned.

“Rick nodded. “That’s understandable. Go ahead and sleep. I’ll be here if you need anything.”

Meghan gave him a weak smile, then closed her eyes. She was soon asleep again. Rick quietly got up and left the room.

He headed to the nurse’s station and took a seat next to Mitch. “She’s asleep. What’s the next move?”

Mitch ran a hand through his hair. “We’re waiting on an ICU bed at the moment. Once she’s admitted, it’ll be fluids and hydrocortisone, and letting her body get back to a homeostatic level. Dr. Woodruff says he anticipates her staying a couple of days in the ICU, followed by a couple on a regular ward before being discharged back to my place.”

“Going to keep a close eye on her?” Rick asked, chuckling.

“Best way to keep her from doing something she isn’t supposed to,” Mitch retorted. “Although if today was supposed to be a good example of care, I didn’t do such a good job.”

“She was hemodynamically stable when you did do vital signs earlier, so don’t blame yourself.”

Mitch sighed and just shook his head.