Mercies

"2335."

"The emergency snow plan is invoked as of 2335 hours."

"Here's your radio." The nursing supervisor handed the doctor a walkie-talkie.

J.T. eyed the walkie-talkie and then the nursing supervisor suspiciously and blew out her last drag. "You just ambushed me, didn't you?"

The supervisor snubbed her butt out and smiled, "I caught Skelly on my way down to the ER. He was the one who reminded me of the policy about the chief of service."

They walked inside, "I owe him. The bastard. Well, I'm going to grab some sleep up in the executive room. It is your job to see that I am not bothered for at least four hours, unless it's a bona fide emergency."

"Sure thing, Chief."

J.T. pointed the walkie-talkie's antenna at the supervisor and in mock anger said, "You watch your mouth Joyce."

Joyce saluted, a huge smile on her face. As J.T. walked down the hall to the elevators she casually flipped off the nursing supervisor and her long time friend.

"I'll make all the notifications, J.T." Joyce called after her.

"Thanks, babe."

~~~~~~~~~~~

The executive room was a converted patient room on the seventh floor that senior staff could use if they needed to stay in house.

J.T. pulled the drapes. As she headed to the bathroom she had a vaguely uneasy feeling. It bothered her that she couldn't put her finger on it; it wasn't her patient or the coming snowstorm.

She unlocked her drawer in the vanity and pulled out her makeup remover, toothbrush and toothpaste. Makeup off and teeth brushed she sat on the end of the bed. She thought she'd tempt fate and sleep in her underwear rather than her scrubs. She stripped down, pulled her ash brown hair into a ponytail and crawled under the covers. She was asleep minutes after her head hit the pillow.

Around 3:30AM she sat bolt upright in bed, wet with sweat and breathing hard. She yelled out, "Chris?!"

~~~~~~~~~~

Christopher Dunn slid his keycard into his hotel room lock with a bit of difficulty. He'd eaten too much and had one too many whiskeys after dinner. But the frigid walk from the restaurant to the hotel had sobered him up slightly.

He flipped on the TV and then proceeded to get ready for bed. He brushed his teeth, took his nightly medications for blood pressure, stripped naked and crawled into bed intending to watch some HBO. He knew he wouldn't be able to go home in the morning because of the storm so he thought he'd stay up and get up when he felt like it. But minutes after his head hit the pillow he was out like a light.

Somewhere around 3:30AM Chris woke with a start and had to go the bathroom. He stood, one hand against the wall, legs straddling the toilet and let loose. He shook out the last drops and then turned to go back to bed when the pain hit.

The pain was an incredible burning feeling shooting from both feet up to his knees. He lost his balance and then felt sick. He grabbed the shower curtain and managed to lean back over the toilet to throw up.

Rather than feeling better after throwing up his dinner the pain increased in his legs and he got dizzier. He pitched forward and hit his forehead on the rim of the toilet and then pitched backward and lay on his back, unconscious. After a while he groaned, rolled to his side and vomited again and then lost consciousness again.

He must have been moaning loudly, he didn't know. He just suddenly knew he was lying on the floor; naked, in his own vomit and there were people bending over him.

"Sir? Sir? Can you hear me?"

"Uh...uh, yeah. What...?"

"Do you remember what happened? Do you know where you are?"

Chris had to think for a minute. He wasn't sure where he was or why he was laying on a floor in his current state. Then he tried to move his legs and the pain brought all the memories back.

"Uh...I got up to go to the john and I had this pain hit my legs. I lost my balance, fell, and hit my head and uh...now you're here. That's about all I remember."

"Do you know where you're at, sir?"

It was a paramedic flashing a light in his eyes.

"Uh, the Hampton Inn in Joplin?"

"Very good. We're going to take you to the hospital. Is that okay with you?"

Chris thought for a moment and then mumbled, "Okay," as if there was any real question.

The paramedics got a collar around his neck, placed a dressing on his head injury and rolled him onto a backboard and hefted him onto the stretcher.

Christopher Dunn was a large man. It took two paramedics and three firemen to get him on the stretcher and then all five of them to get him in the ambulance. His head throbbed, his feet and lower legs burned and he felt nauseated.

"We going to Freeman or St. John's?" Dunn half whispered to the paramedic getting settled in beside him.

"Do you have a choice, Mr. Dunn?"

"Yeah, let's go to St. John's please.

"St. John's it is."

~~~~~~~~~~

At a quarter to six, the phone in the executive room rang. J.T. was lying on her belly when she grabbed the phone on the third ring. "What?"

"Need you in the E.R. Head injury is on its way in," Joyce said.

J.T. sat up, brushed her bangs from her eyes. "What time is it?"

"0545. We've got 2 inches of snow already. It's coming down to beat hell."

"Do I have time to grab a shower?"

"Make it quick boss."

"Okay, see you in a bit."

~~~~~~~~~~

The ambulance bay looked like a headquarters in a war zone. The ambulance carrying Dunn threaded its way through three National Guard Humvees dropping off "critical" hospital staff. Non-critical staff got to stay home as the biggest snow storm to hit Southwest Missouri in more than 100 years got wound up.

Joyce met the stretcher at the door of the bay and immediately gasped when she saw the patient. "Christopher Dunn! You look like shit!"

Chris twisted his head as much as he could in the restrictive cervical collar toward the voice. "You noticed that, did you Joyce? Attention to detail like that will get you promoted to vice president."

"Always the smart ass, Chris." Joyce Morgan had been Vice President of Nursing Services when Chris was Vice President of Medical Affairs. She quit her executive position to work the graveyard shift as a house supervisor. She wanted to get back to real nursing she said.

The ambulance crew and the E.R. staff heaved Dunn onto the gurney in the trauma room. Chris cried out in pain and then vomited again and started coughing uncontrollably as he choked on some of the vomit.

Just then J.T. showed up, took in the scene and moved to the head of the gurney. "Christ! Give me a Yankauer, STAT!" She shoved the suction cannula into Chris's mouth and began suctioning out the aspirate.

She pulled back the suction cannula and looked at the lead nurse. "What's his SAT?"

"82 on two liters."

"God damn it! He's aspirated." J.T. looked at the paramedic crew still in the room. "How was his neck when you collared him?"

"I think it was okay," said the lead paramedic, "just protocol."

"Okay, let's get him out of it and set him up a little. Up the O2 to 10 liters and put him on a non- rebreather."

"SAT's coming up."

J.T. bent toward her patient for the first time and took notice of the patient's face. "Oh my god! Chris?"

"Ummmm," Chris slurred through the oxygen mask. He was dazed.

"Breathing easier, buddy?"

"Hmmmm huh."

The paramedics gave Monroe the report of what happened.

"Chris, is that it?"

He nodded then grimaced in pain again.

"Get a line in him, start him on LR at 100 an hour. Give him 10mg of Compazine IM now then when you have the line in give him a 100 of Demerol and 3 of Versed IV and ship him to CAT scan with a cardiac and apnea monitor. Get a scan of his head and get a portable chest afterward."

The lead nurse who was writing down orders looked up, "Uh, J.T., he's got a head injury. You want to narc him that heavily?"

This pissed J.T. off; she exaggeratedly looked at her lab coat, "Oh shit! I forgot to wear my 'I'm a Neurosurgeon' button. I know what he's got Jennifer!" J.T. caught herself, "I'm sorry Jennifer, just do it, okay? Take some Narcan along just in case."

"Yeah, sure, J.T."

"We'll get you feeling better, Chris. Just relax."

He smiled weakly under the oxygen mask.

J.T. pulled Joyce aside. "I want him snowed. When they get done with his CAT call me, I want to do a tap. And I don't want him to remember any of this. And would you go with him?"

Joyce looked down at the front of her uniform, "Shit, I forgot to wear my 'I'm a nursing supervisor' button."

"You know Joyce, sometime you can be such a pain in the ass."

Joyce smiled, "I have a good teacher."

"Oh, ha-ha. Uh, I got a very bad feeling about this, Joyce. I can't explain it. I, uh" she hesitated, "don't laugh, I sat bolt upright in bed in a cold sweat around 3:30 and called his name."

Joyce didn't laugh. "Oh, that's spooky. According to the paramedics that's about the time they think he fell. What are you thinking?"

"I'm thinking he's got Guillain Barre and on top of that he's got a helluva goose egg on his head and he's probably just picked up aspiration pneumonia.

"Where's the plasmaphoresis team?"

Joyce bent her head, "Springfield. And unless we can get a Guard unit to make the run, they aren't coming today or tomorrow."

"Oh, God," J.T. whispered and then sucked in her lower lip. This was really not going to be good.

~~~~~~~~~~

J.T. sat beside Chris's gurney in the trauma room looking out the window at the snow. It was nearly a total whiteout.

"Hey sport," J.T. said softly as she caressed Chris's face. Chris fluttered his eyes and tried to focus on the voice.

"J.T.?"

"Yeah, it's me."

"How...how'd I get here? What's happened?"

"Feeling any better?"

"Yeah. Though the last thing I remember is getting up in my hotel room to take a piss."

"Good. I'm glad. You came in very sick. Essentially, the story you told the paramedics was that you got up to piss and then got hit with this pain in your legs, got dizzy, fell and hit your head on the john and then upchucked.

"You were in a lot of pain and then you threw up again and aspirated. Since then, I gave you an assload of drugs, got a CAT scan of your head, a chest x-ray, and some lab work. I tapped your spine and put 15 stitches in your head. I may need to put in a burr hole later, we'll see."

"So, uh, what's the verdict? Food poisoning? Or did I just eat and drink too much last night?"

J.T. ran her hand gently over Chris's forearm and looked at the floor. "Uh, Chris, you remember when Pete Meredith got sick back along?"

Chris starred at J.T. and didn't say anything. J.T. met his gaze and she could see tears starting to well up in his eyes. "Yeah, you remember."

Chris sniffed, wiped an eye with the back of his free hand, "J.T., I remember him, vividly. Are you sure?"

"As sure as I can be. I emailed your scan and lab to Bryce - you know he's still around - and he concurs. And you know for me to ask Bryce for his opinion I was desperate for an alternative diagnosis."

Chris smiled slightly, "You two still not getting along, eh?"

"Like cats and dogs, babe."

"Well, okay, I hear you can pretty well knock Guillain Barre down with plasmaphoresis. When are you going to hook me up?"

J.T. looked pained, gripped Chris's hand, "Yeah, but the plasma team is in Springfield. By the time I can get them here, as fast as this appears to be moving, it's not going to do you a lot of good. And there's not enough immunoglobulin in house to infuse you.

"So...we're just going to have to ride this out. I'm sorry. And keeping you out of agony is not going to be as easy as that night you saved my sorry ass."

"J.T.," Chris said gently, "uh, keeping you alive was not an easy job. You tried to fucking killing me. A couple of times."

Tears welled up in J.T.'s eyes, "You bastard, you're not going to let me forget that are you?" and she broke into a half laugh, half sob.

"Are you kidding me?" Chris smiled. "Never."

"Well, you want me to call Michelle? Let her know what's up so she can come nurse you?"

"Uh, well, I wouldn't mind, but her lawyer would likely object. Bad divorce a year ago. I'm pretty much alone."

"Oh, I'm sorry. Hey, where's the pain now?"

"Almost to the top of my thighs."

"You know, in a couple of hours it's likely to get your diaphragm and we'll have to tube you."

"Yeah. Uh, J.T...I'm afraid. You know what I think of intubation. I've had a phobia about that since those gas passers at KU tubed me while I was wide awake."

"I know sport. But I owe you big time. So try to relax and I'll do everything I can for you, okay? Don't be afraid. Anything major and I'll be here for you. Including when we tube you. Promise."

Chris squeezed J.T.'s hand, "Okay."

"I gotta run for a while. We're moving you to the ICU in a bit so we can monitor you." She pulled a syringe from her pocket; "Here's a little something to keep you comfortable."

Chris's eyes fluttered closed as J.T. pushed the Morphine into his IV.

~~~~~~~~~~

Guillain Barre Syndrome is an autoimmune disease. Suddenly, for reasons not clearly understood, the body's anti-bodies start stripping the protective sheathing off the nerves. It starts at the periphery of the body, most usually the feet, and works its way up the body. Then, as suddenly as it attacks, it goes away. It is rarely fatal. But its severity and duration can vary from short and very mild to long and excruciating. Fatalities are caused by complications in its severe state.

Peter Meredith was a staff psychologist, a friend of both Dunn's and Monroe's, who contracted it five years ago. He was paralyzed from head to toe for 6 months and in excruciating pain. He was on a ventilator the entire time and almost died, twice from pneumonia, once from an infection of the sack surrounding the heart and twice from kidney dysfunction. Once he started to recover it took eight months of intensive therapy for him to learn how to walk, talk, eat, go to the bathroom and dress himself. Still after the therapy he was physically weak for another six months and suffered frequent bouts of panic attacks and deep depression.

Peter Meredith's predicament made a huge impression on Chris Dunn. Now Dunn had it. And Dunn was frightened beyond words.

~~~~~~~~~~

"Give me just a tad of suction just north of my knife," J.T. ordered her P.A. "There. Thank you."

J.T. was in surgery, inside an 87 year old woman's head, going after a leaking cerebral aneurysm.

A surgical nurse stuck her head in the operating room, "Dr. Monroe?"

"That's me," J.T. called out from behind her operating microscope.

"ICU called. Says to tell you Mr. Dunn's O2 SATS are dropping. They're at 87 right now. They said to tell you he's starting to use his accessory muscles. He's getting tired."

"Shit! It's progressing quicker than I expected. Uh, tell ICU to put him on nasal CPAP at 15 centimeters pressure with 6 liters of O2 and I'll send anesthesia down. Tell them to get ready for an emergency trach. And hey! Tell them NOT to let Mr. Dunn know what's going on; either anesthesia or I will break the news to him; he'll be frightened and upset."

The surgical nurse left to relay the orders and J.T. looked at the clock. "Uh, Khali," J.T. said to the anesthesiologist, "Damn it! We're going to be at this at least another hour. Uh, I got a problem maybe you can help me with."

"You want me to go and trach that guy?"

"Yeah, but that guy is Christopher Dunn and he's got rapid moving Guillain Barre and he's scared shitless."

"Chris? Our Chris?"

"One and the same. I told him I'd be with him when we tubed him. And now I'm elbow deep in Mrs. Bonner's brain. He had the hots for you, as I recall. I was wondering if you could go be with him. Keep him company. Trach him if you have to but try to keep him off the vent until I can be there. Keep him comfortable, you know?"

Khali smiled under her surgical mask, "Not a problem, it will be my pleasure." She called an assistant in to take her place in the surgery and headed for the ICU.

Khali Kumar was a stunningly beautiful Indian anesthesiologist that Christopher Dunn did indeed have the hots for. Despite both of them being happily married when he worked at the hospital they flirted shamelessly almost daily.

When she walked into the ICU cubicle she could see Chris was struggling to breathe. His O2 level was holding at 92 percent but he was sweating profusely and breathing irregularly. She didn't know if he could wait until J.T. made it to him.

"Chris?" She ran her fingertips lightly over the side of his face. His eyes fluttered opened. "Hey, you're not doing too well, eh?"

Chris smiled weakly and affectionately and shook his head.

"J.T. sent me to be with you until she can get here. She's in surgery." She kept slowly and gently caressing his face.

Chris pulled the CPAP mask off and tried to take a full breath. "Khali! God, you are still a vision!"

She giggled coyly. "A vision? Not a wet dream like I used to be? I'm crushed! Hey, ummm, I'm really sorry but I don't think you're going to be able to wait for J.T. You're looking pretty bad. Your heart rate's up, you're getting very tired." Khali pulled his hospital gown to his belly and traced her fingers down his chest. "Tell me when you can't feel my fingers."

"There."

Khali's fingers were just above his navel. She turned to the ICU nurse and whispered an order. "Get me the trach tray and call ummm, Dr. Michelson STAT. Also, tell RT to get their vent in here. We need to move."

Khali put a hand gently on Chris's forehead while the other hand continued to roam lightly across his upper belly and chest. "It won't be long, Chris. Then you'll feel better, okay?"

"If you say so," he husked, trying to smile, to be brave. "I don't suppose you would let me cop a feel?"

"Why Mr. Dunn!" Khali said in mock amazement, "Just because I am caressing your chest and belly, hopefully making your body shiver with pleasure, you think you can take advantage of my sympathies? I am shocked!"

She took both hands off him for a moment and looked over her shoulder. With no one in sight she quickly reached under her scrub top and undid the front clasp of her bra. And then, as if she'd scratched her nose for a second, she laid her hands and fingertips back on Chris.

He reached out to touch her at the waist, his fingers snaking under her scrub top and when his fingertips met the warm, soft skin of her belly he closed his eyes and appeared to be transported away.

Just then, Dr. Rick Michelson, an ear, nose and throat specialist came into the cubicle along with two nurses and a respiratory therapist pushing a ventilator. No one said a thing as Chris's hand roamed underneath Khali's top. Khali's attention was focused solely on Chris though she acknowledged the presence of the staff with a quick nod. Michelson, a droll, urbane British expatriate, stood on the other side of the patient, opposite Khali. He cocked an eyebrow at her. "You are planning on giving the poor chap anesthetic aren't you, my dear? Or is this a new form of anesthesia: allow the patient to feel your breasts and belly whilst I cut a hole in his throat?"

Khali looked up and beamed what Chris used to refer to as "the most dazzling smile he had ever seen on a woman." "Why Richard, if you had gotten me a job and put me and my children up in your house until the money started coming in and I could get a place of my own, I'd let you fondle me if you were as sick as Chris."

"Ah, so this is Mr. Dunn, the legendary former Medical Affairs V.P. that everybody's a titter about, what?" Michelson glanced at the pulse oximeter, showing Chris's oxygen saturation was headed for the 70's. "Khali, we need to do this."