Chapter Text
6:45 AM
Robby walked into the emergency department with his normal thermos of coffee and checked the board. The emergency department had people in more beds than there were empty, but overall, it didn’t seem like it had been too bad of a night.
“Anyone I need to keep an eye on?” he asked Jack.
“Little girl in Central 6, here with her mom,” Jack responded, handing over the tablet. “They came in an hour or two ago. Fever that spiked to 104.2, even with repeated doses of Motrin. She’s been sick since Tuesday. Mom’s been working with a pediatrician, but standing advice was to find an ER if the fever got too high.”
“Smart call,” Robby said, looking through the notes. “Have labs been drawn yet?”
“Happening now, but it’s not going to be easy with her age and the fever.” Jack frowned and rolled his shoulders, a common habit when he was concerned. “Dehydration is going to make getting blood and urine harder.”
“But we got it anyway,” Dana chimed in. “Poor dear. She’s a sweetheart.”
“Alright, I’ll go check on her.” Looking around, Robby saw Mel and Whittaker in the hallway – Whittaker signing in, Mel already on the computer. “Mel, Whittaker, with me.”
When the three of them walked into the room, they saw a woman holding a vaguely child-shaped bundle of pink unicorn blankets in her arms. The bundle of blankets sniffed, and Robby smiled, walking in and bending over to get a better look.
Shelly was a clearly-loved child, but also clearly miserable. Her light tan skin was flushed, contrasting with the rainbow unicorn-themed pajamas she was wearing, and her dark black hair was mussed around her, some stuck to her face with spittle where Shelly had been drooling.
“Oh, hi!” Elena shifted her body to face the doctors, which caused Shelly to fuss – and brought her mother’s attention back to her. “Shelly, baby, can you turn around? The doctors are here.”
Shelly stubbornly refused to. She dug her face into her mother’s armpit even more, clutching a small unicorn stuffie.
“I’m sorry, she’s not normally like this,” Elena said. “She’s a happy girl, wants to be friends with everyone.”
“Aww,” Robby said, and tapped Shelly on her arm. Shelly shifted on her mother, turning away even more, but Elena used the moment to turn the girl around.
Immediately, Shelly tried to shrink away.
“Shelly, I’m Dr. Robby, and these are my friends, Dr. King and Dr. Whitaker,” Robby started. “Can you tell me what you’re feeling right now?”
“No,” Shelly pouted, fighting again to be closer to her mother. Elena laughed a little, half-exasperated, as Shelly squirmed her way back into hiding.
“She hasn’t been feeling well for a couple of days now, but her dad and I thought it was just something she picked up at the playground,” Elena explained. “We’ve been giving her Motrin, just like her pediatrician said to, but he told us to go to the ER if her fever got too high.”
Robby pulled up the chart on a nearby computer as Shelly whimpered, causing her mom to gently shush her again in an attempt to comfort.
“It’s good that you came in when you did,” Robby said, looking through the records. Shelly was on-schedule for all of her shots, and she was registered with a pediatrician in the hospital’s group, so all of her appointments were already linked to her chart. She was an active child, according to her doctor’s notes, and was hitting all of her milestones well. “Why here and not the children’s hospital? Our pediatrics department is great, but they’re the specialists.”
“To be honest, I didn’t even think of the children’s hospital,” Elena admitted. “Shelly and her little brother were both born here, in the women’s center upstairs. I’m not sure I even know where the children’s hospital is.”
“Well, we’re glad you came,” Mel said. “Can you tell us a little more about how she’s been behaving since she got sick?”
Elena sighed. “She’s gotten fevers before, but nothing like this. She’s been completely drained for days now. Her dad and I have been doing everything we could think of – cool baths, popsicles, Motrin, letting her sleep, keeping her home – but it’s just been awful.”
“And her dad is?” Whitaker asked.
“Home with her little brother, Hunter,” Elena said.
Robby pulled out his tools and started examining Shelly. “Hi, Shelly. I need to check a couple of parts of your body to see if they’re making you sick. Can you help me check?”
Shelly paused for a moment and then nodded sullenly. The nod was short and stiff, like even moving her head hurt her.
“That’s it,” Robby smiled, and pulled out his penlight. “I’ve got to shine this in your eyes for a second, but then you can look away, okay?”
“Okay…”
The moment the light shined in her eyes, she pulled her head away. Her pupils were equal size and reactive, but the reaction was more severe than he would have expected, even with a sick kid.
“Does your head hurt, sweetheart?”
Shelly made a small sound that the adults in the room understood as ‘yes’.
“Thank you for letting me know,” Robby said. “I’m sorry that wasn’t fun, but that’s the last time this visit that I’ll have to do that.” He held up a small otoscope and put a plastic cover on the instrument. “Do you see this funny looking thing?”
She nodded, another small, stiff movement.
“It goes into your ear so I can see inside. Have you ever had an ear infection, Shelly?”
“Noooo,” Shelly whined.
“She has, last winter,” Elena corrected.
The ears were clear. Robby took off the plastic covering and reached for a wooden tongue depressor. “Has Hunter gotten sick at all?”
“No, but we’ve been keeping them separate ever since she started acting sick,” Elena said. “Hunter sleeps in our room, and Shelly has her own room for now, but that’ll change once Hunter starts sleeping through the night.”
Robby hummed. Shelly wasn’t making it easy to examine her – he’d gotten a good look at her ears, but only a quick peek at her throat. Even for a sick four-year-old, this was miserable. “How old is Hunter?”
“Five months.” Elena shook her head. “One sick kid is bad enough, but a sick kid and a sick baby?”
“No one needs that,” Robby responded. Her lungs sounded clear, and he put away his stethoscope. “Alright, the fever means her body is fighting off something fierce, but I didn’t see any signs of strep or an ear infection. Even so, I’d like to get her started on antibiotics and corticosteroids, just in case it’s something nasty we can’t immediately see. Is she potty trained?”
“During the day, yes, but we’re still working on keeping her dry at nighttime,” Elena said. “She wears a pull-up at night. Do you think it’s something urinary? I haven’t noticed any redness or tenderness when I’ve changed her.”
“Possibly,” Robby said, “although until the labs come back, we just don’t have enough information. Have there been any changes with her night diapers or her toilet trips in the day?”
Elena frowned, thinking back. “She’s been going to the bathroom less and less frequently since she got sick, although I’ve been chalking that up to the fever. It’s been getting harder and harder for her to keep fluids down. She barely had anything to give for the urine test, and that’s even with a dry pull-up.”
“Well, we’ll want to give her some saline to help fix that anyway.” Robby stood up, feeling every one of his 53 years, and heard his back pop as he did. “I’ll put the orders in and check back in on you guys in a little bit, okay?”
Elena nodded.
“Did you want us to lower the lights and close the door?” Mel asked. “If she hasn’t slept much, the ER might be making it harder for her.”
“If you could, that would be incredible,” Elena said, obvious relief on her face.
Robby left the room with Mel and Whitaker in tow, Mel hitting the lights on her way out. As soon as they were away from the door, Robby looked to the two younger doctors. “Thoughts?”
“High fever, reactive to light, lethargic, dehydrated,” Mel listed off. “That’s a pretty classic presentation of meningitis.”
“And how would we treat that, Whitaker?”
“IV ceftriaxone and vanco,” Whitaker responded.
“When meningitis is suspected, do we wait for labs to come back?”
Whitaker shook his head. “Meningitis moves too fast. We administer antibiotics first.”
“But there’s also viral meningitis,” Mel pointed out.
“Viral meningitis is usually less severe, and more common in the summer.”
“Correct,” Robby said. “But if it is viral, how to do we treat it?”
“Supportively,” Whitaker said. “Antivirals, maybe some anti-emetics to make her more comfortable and help her keep fluids down.”
Robby nodded. Whitaker’s confidence had grown in leaps and bounds since his first day, four months ago, and his instincts were spot-on. “Whitaker, go put in orders for saline, ofirmev, dexamethasone, ceftriaxone and vanco,” he said. “We’re also going to need a spinal tap to confirm or rule out meningitis, either bacterial or viral. With her age, meningitis is likely, but it’s not nearly the only possibility here. And keep monitoring her – kids can crash fast, especially if she’s already been fighting this for a couple days.”
“Got it,” Mel and Whitaker both said. Whitaker went to go put in the orders, and Mel and Robby were both pulled away to meet an ambulance pulling into the bay. Medics were already opening the doors when they got out there; they’d called in the stroke as it happened en-route.