----------------------------------- Chapter 5 -----------------------------------

As requested, Laura returned to Dr. Sharp's office and was directed by the receptionist to the inner office area where Jo met her at the door. "Have a seat here," the nurse said, motioning to a small row of chairs in the inner office hallway. "Doctor Sharp wants you to wait until we get your test results so he can get you started on a treatment regimen."

Laura nodded her head in acknowledgement, took a seat and once again began thumbing through a magazine.

While she was waiting, Laura tried to eavesdrop on the noises she heard coming from the examining room right behind her back. Her efforts were futile, however. While the sounds were clearly the voices of Dr. Sharp and his patient, the walls muffled everything to the point that she could not discern words. Her attention was so intent on the unintelligible noises behind her, that she almost jumped out of her chair when the door from the waiting area to the inner office opened beside her and a young man came in carrying a folder of papers.

"Hi Jo," he said, "here's the stat reports the doc wanted."

Laura noticed that the young man was wearing a baseball cap with the logo and name "Lab Services" printed on the front. She assumed, and correctly she would find out, that this was her test report.

"Thanks, Tim," the nurse said with a wink in his direction.

"No prob'," replied the lab runner with a little tip of his cap, "Have a nice day."

A few more minutes passed, and finally Dr. Sharp emerged from Exam Room #1, followed closely by a middle aged gentleman. They walked together to a consultation counter, which is an area where the doctor has a couple of x-ray light boxes, prescription pads and PDRs for several different years. Behind the counter is a small closet containing an unbelievable stash of medication samples.

True to form, Doctor Sharp went to the little closet and pulled out several boxes which he handed to the patient. Verbal instructions were given as to how to take the medicine, and the doctor wrote him a prescription. The two of them exchanged pleasantries, shook hands, and the man walked out the door to the outer office.

Laura started listening with some increased interest as the nurse handed Doctor Sharp the package she had received from the lab since she was reasonably certain they would be discussing her test results.

Although the nurse and doctor were speaking in medical terms, Laura was still able to pick up on the discussion. "Her white count is very high," Dr. Sharp stated as he studied over her paperwork. "I would say that the streptococcal pharyngitis has developed into a more involved upper respiratory infection due to the untreated strep infection, and now from the lab results we see some evidence of bacterial bronchitis.

Plus, as I suspected, she has a bladder and urinary tract infection that we verified with the urinalysis and blood work." Turning his attention to the chest film in the light box, the doctor continued, "this dark area on the x-ray is a pocket of infection in the lung, meaning that the bronchitis is starting to develop into possible pneumonia. We must treat that immediately."

The doctor opened a couple of the large books in front of him and began flipping through pages as he continued to speak, "the aggregate of all her varied symptoms and the persistent elevated temp all indicate that she has a combination of potentially severe infections occurring simultaneously, along with some indication of immunosuppression. If we don't get aggressive with it, I believe she would soon start to see broad systemic involvement. I honestly don't know how she's remained as seemingly healthy and active as she has up to now. Her being young and generally in excellent health is a huge point in her favor. Otherwise, I think we would be admitting her to a hospital right now."

As Dr. Sharp spoke, the nurse nodded her head in agreement at his findings.

As she listened, Laura had a fairly good idea what most of the terms meant. She gathered from their discussion that she was actually pretty sick and must have a nasty bad case of the crud.

Doctor Sharp continued his research through the reference books for a couple of minutes and then started writing notes on her chart as he addressed his nurse, "OK, so let's give her 60 of ketorolac IM for inflamation and fever control, and then let's get a 1.5 million loading dose of polymyxin B on board for the UTI and kidney infection. Administer that total dosage IM as two injections of 3 cc each and that should keep the concentration up to therapeutic levels.

That antibiotic alone won't be enough for the respiratory strep and bacterial bronchitis - for that we'll use a high volume penicillin regimen. Let's go with 5 million units of pen G, mixed at a half million per ml. Divide that total dosage and give it very deep IM as two injections of 5ml each. That's a high concentration, but should give the drug enough potency to tackle this infection as an in-office procedure.

"I know that's a lot," the doctor said with a grimace on his face, and I looked at a couple of other options for her. Unfortunately, all her lab results indicate that we really need this initial treatment to be that strong.

As suppressed as her immune system is, I think we should also give her a 5ml IM dose of multi-B vitamin complex. We'll probably administer a NSAID suppository here in the office for additional fever control as well, but we can decide on that after this initial treatment."

Short of a brief hospital admission for IV antibiotic therapy, it seems all the diagnostic references I've consulted here are in agreement that this is the best therapeutic combination to aggressively attack the multiple infections and also provide fairly immediate relief from a number of her more problematic symptoms.

Jo nodded her head. "I agree that's a lot of medicine, but if it allows her to remain as an out-patient then it does seem the best course of treatment. Poor kid, I'll get those ready," the nurse said as she turned and walked away from the consultation counter.

Laura was startled when she picked up on the word "injections". She hated shots; she had always hated shots or needles of any kind. Adding further to her anxiety was hearing the nurse's statements "poor kid" and "get those ready", since she was afraid she knew what they meant; and was fairly sure she knew what was coming next.

"Miss Johnson," Dr. Sharp called as he glanced her direction, "step over here and let me go over your test results with you."

As she got up from her seat and walked towards the consultation counter a fleeting thought flashed through her mind. Laura couldn't help but wonder if the doctor was mentally looking through her clothes and replaying in his mind her examination from earlier in the afternoon when she was naked in front of him and he was rubbing her breasts, and inserting his fingers and other objects inside her vagina and rectum.

Approaching the doctor's counter, Laura caught a glimpse of the nurse at the drug prep area. She could see the cabinets where the medications and supplies were kept. On the countertop in front of her were a number of rubber-capped vials, various boxes, and several syringes and needles in their wrappers.

On the counter, Laura saw two x-rays in a light box and a handful of papers in front of the doctor as he began explaining the test results to her, "This is an x-ray of your chest; here are your lungs." He said, as he pointed to a dark outline on the film. "This dark area is inside your left lung, and it appears to be an area of infection, indicating bronchitis that can develop into pneumonia if untreated.

During my examination, I found your throat to be swollen, inflamed and irritated, with some significant enlargement of the lymph glands in your neck. And your rapid strep test was positive. These are all symptoms of a rather nasty respiratory infection process going on.

We did blood tests to determine the degree of infection and the lab results indicate a high white blood cell count, which is indicative of a high grade infection. Also, your urinalysis, the wet smear culture and your bloodwork indicate that you have a high grade urinary tract and bladder infection. That would definitely explain the foul smell and burning on urination, and lower abdominal pain and cramping you have been experiencing. We certainly need to treat that infection before it could possibly spread to the kidneys.

Having these separate infection processes occurring simultaneously, and especially to this degree, is rather uncommon; but when it happens the infections just seem to keep each other going until we get them under control. Because of the type and severity of these infections and your other symptoms, we need to start you immediately on a fairly aggressive treatment plan."

The consultation area was positioned such that when Laura looked up at the doctor, she could clearly see the nurse working at the medicine prep counter. Laura was nodding her head in agreement with the doctor. She was intently listening to every word he said and understood what he was telling her; but she just couldn't take her mind, or her eyes, off of the work the nurse was doing.

While the doctor was speaking, Laura watched as Jo removed a syringe and needle from its sterile wrapper and filled the syringe completely with the contents from one of the medication vials in front of her. She continued to watch as the nurse removed the needle from the syringe and replaced it with one from another sealed package, and then carefully placed the prepared shot into a rectangular metal dish on the counter.

"I'm sorry Laura," the doctor said in a voice she knew from past experience almost always meant something unpleasant was about to happen, "but we're going to have to begin your treatment with a few shots today." Before Laura could process and react to his announcement, the doctor continued, "I know, nobody wants to get a shot, but we need to get some strong medicine into your system as quickly as possible. I think you realize from what we just went over that you have a nasty combination of infections going on, and I truly believe these medicines are the best treatment for you."

Laura made a sort of involuntary grimace as the doctor confirmed what she had already surmised - and feared - from overhearing his conversation with the nurse. And while she was not at all pleased at the doctor's pronouncement, she was not entirely surprised by it either.

Having been a long-time patient of Doctor Sharp, Laura could remember a few painful office visits that ended with her having red, teary eyes and rubbing the sting out of a very sore rear end. In fact she was quite certain the doctor felt strongly, perhaps due to his "old-school" mindset, that if injectable medications were available to treat a particular illness, shots were almost always the preferred route to begin treatment.

Although it had been quite some time since she had received a shot, the doctor's announcement that "a few" would be needed today immediately brought on a churning feeling in the pit of her stomach; and her mind drifted off into unpleasant childhood memories of how she would cry and kick and fuss every time she had to get a shot.

Laura also recalled how, as a kid, she was convinced, and was fairly sure her hiney would agree, that with every shot she got the doctor truly believed that the more medicine there was in the syringe, the bigger the needle used to give it, the more it hurt and the harder she cried while it was being given, and the longer her bottom stung and ached afterwards, the more effective the shot would be at treating the illness.

Dr. Sharp's voice snapped her back to reality, "I'm giving you two very effective antibiotics today that should quickly start to treat the infections. We'll follow that with a ten day course of oral antibiotic therapy along with a short course of steroids for the inflammation in your lungs and bronchi. I'm also going to write you a prescription for an oral decongestant, a cough syrup you can use as you need it, and some antiemetic suppositories to ease any nausea you might get from the high dose antibiotics."

With her eyes glancing between the doctor speaking and the nurse at the drug prep area, Laura continued to watch with some degree of horror as Jo continued preparing what she now knew for sure were shots for her.

As the doctor was speaking, the nurse proceeded to draw a measured amount of medicine into two more syringes from the various vials in front of her. As each syringe was filled, she replaced its needle with what appeared to be a longer one; and then placed each prepared shot in the metal container.

Laura merely nodded her head as the doctor continued, "I've ordered an antibiotic for the urinary tract infection plus a dose of a quick-acting analgesic to relieve the pain and burning in your lower abdomen. Since we have to treat the respiratory infection a little differently, I'm going to give you a big dose of very strong penicillin. Since your immune system is already suppressed, we can't take a chance on weakening it further with the medicines, so I'm going to give you a large volume dose of a vitamin supplement that will give you a nice boost and make you feel better.

Jo is preparing your shots now, and will be ready for you in just a few minutes. After you two have finished, I'll go over these other prescriptions with you."

As the realization of what the doctor was telling her started to sink in, Laura looked him in the eye and in her best pleading voice said, "can't you maybe, uh, just give me some pills or something, does it really have to be shots? Please doc, I really hate needles."

Laura was begging with her eyes, but her begging was met with a firm counter from the doctor. "No, I'm afraid not. Your lab work tells me that you're much sicker than you appear, young lady; and the infection processes you have going on are just too strong to be sure that oral antibiotics would attack them completely. And besides, oral therapy could not act quickly enough to attack multiple infections of this type. We need the initial dose to be a strong punch targeted to each type of infection. After that, the oral meds for you to take at home should finish the job.

Quite honestly, If you weren't so young and in otherwise good health, I would very likely be admitting you to a hospital right now for a couple of days of IV antibiotic therapy. But, hopefully this treatment regimen will be strong enough. If it isn't, and the infection process doesn't start to break in a couple of days, we may have to repeat an antibiotic shot in addition to the oral meds. Hospitalization would be a last resort; but I really don't think that’s going to be necessary - if you take it easy for the next few days and do what I ask you to."

With that said, Dr. Sharp gave her a little reassuring pat on the shoulder, smiled, and as he walked away to see his next patient told Laura, "Be brave, Jo will take good care of you and be real gentle. I'll see you when you all are finished."

Well, these words certainly took her by surprise. She figured that she'd best leave well enough alone. Besides, she could see the doctor's mind was made up. She was getting shots, no way out of that; and she had a sinking, sickening feeling from what the doctor had just told her, and the way he said it, that these were going to be awful.

Moving rather stoically, Laura returned to her chair and, in somewhat of a daze, stared with rapidly increasing anxiety as the nurse continued her work. As a final preparation, Jo loaded two, what looked to be, huge syringes - each with a large amount of white medicine. She exchanged the needle on each syringe, placed them both in the dish and finally placed a lid on the metal container.

Laura had lost count of how many shots she had seen the nurse prepare.