Chapter Text
It was a usual busy day at the Pitt when the paramedics rolled the patient through the ambulance bay doors.
“Twenty-six-year-old female,” one of them reported while jogging alongside the stretcher. “Sudden onset of high fever, progressive weakness, vomiting, dizziness. Syncopal episode at home. Blood pressure’s been soft the entire transport, we’ve given a liter of fluids.”
Whitaker fell into step beside the stretcher as it was wheeled into Trauma Two.
Perlah was there first, snapping leads onto the patient. “BP is 82 over 48. Heart rate 124. Temp is…” she paused, checking again as if the number might have changed, “104.2.”
“Alright,” Whitaker said, leaning in. “I’m Dr. Whitaker, we are going to take care of you. What’s your name?”
“Alexis,” the patient replied. Her voice was thin, almost swallowed by the noise around her. Her eyes were open but unfocused, frightened.
Dr. Robby stepped in a moment later, already gloving up, eyes scanning before he even reached the bedside.
“What’ve we got?” he asked.
“Twenty-six-year-old Alexis,” Whitaker answered quickly. “Acute high fever, hypotension, tachycardia. No clear history yet.”
Robby nodded once, then turned to the patient. “Hi Alexis, I’m Dr. Robby. When did this start?”
“Like… four hours ago,” she said. “It just hit me. I went from fine to… like this.”
Whitaker stayed beside her. “Any other symptoms?”
“My whole body hurts. I feel nauseous. I threw up twice. I fainted for a second at home and after that I called my roommate to get help.”
“Good,” Whitaker said, focused. “That was the right call. Any medical problems? Medications?”
“No.”
“Allergies?”
“No.”
“Recent hospital stays or surgeries?”
“No.”
“Travel?”
“No.”
“Anyone around you sick? Any drugs, recreational substances?”
“No… and no.” She hesitated, then gave a weak, almost apologetic smile. “I feel like I should have more interesting answers.”
Whitaker let out a short laugh. “Boring is good in medicine, trust me.”
He continued. “Any cuts, wounds, anything like that? Even small?”
“No.”
“Dental work? Injections? Anything invasive recently?”
“No.”
“Animal exposure?”
“No…” Her voice was getting weaker, eyelids fluttering.
Whitaker exchanged a brief look with Robby, his face unsure.
Robby stepped slightly back with him. “Thoughts?”
Whitaker did not answer immediately. He watched the monitor, then the patient. “She’s septic,” he said. “But I don’t have a source.”
Robby nodded. “So what’s your plan?”
“Uh, blood cultures, urinalysis. Fluids, broad-spectrum antibiotics. And keep hunting for the source?”
“Sounds good,” Robby said simply. “Do it.”
Perlah already had two IVs going within minutes, drawing labs as fluids ran wide open.
Robby remained at the bedside for a moment longer. He was usually pretty good at sussing out what was going on, but with this case he still had no clue.
Then he noticed a diffuse, almost sunburn-like redness creeping over the patients arms. Not quite a rash at first glance, but wrong enough to notice.
He leaned closer. “Alexis, did you spend any time in the sun recently? Sunburn?”
She blinked slowly. “No…”
“We need to do a full exam, okay? We’re going to check your skin head to toe. That means we’ll need to remove your clothing.”
Her eyes widened, fear cutting through the fever. “Is it… bad?”
“It means we don’t know yet,” Robby said. “We’re trying to find out before it gets worse.”
Perlah quickly and carefully removed the skirt and t-shirt, respectfully placing a blanket immediately on her patient. But they could not find anything external, no bite, no wound, no obvious entry point. Just the worsening rash and heat radiating off her skin.
“Nothing,” Whitaker exhaled under his breath. “So what could it be?”
Robby rubbed a hand over his forehead. “Excellent question. No answer for that at the moment.”
Thirty minutes later, labs came back.
Inflammatory markers elevated. Low platelets. Kidney function beginning to drift in the wrong direction. Evidence that her body was under significant stress.
But still no source.
Alexis looked worse. Sweaty, pale under the flush, breathing faster now. Her answers had slowed into fragments.
Robby stepped in again. “Alexis, I need to ask you some more specific questions, okay?”
She nodded weakly.
He went methodically. “Food that didn’t taste right. Standing water. Swimming. Parties. New sexual partners. Any substances. Anything out of the ordinary at all.”
Each answer came back negative.
Robby paused. Then he glanced at Whitaker, a thought forming in his head.
Robby turned back to his patient, voice calm, almost conversational. “Alexis, are you currently on your period?”
A pause.
“Yes,” she said quietly.
“Do you use tampons or pads?”
“Tampons.”
Whitaker’s posture shifted slightly, attention sharpening without interrupting.
Robby continued. “When did your period start?”
“Three days ago.”
“And have you accidentally left a tampon in longer than you meant to?”
Her face tightened with sudden embarrassment. “I… yeah. Two days ago, I forgot for most of the day. I was at work, really stressed, and I only noticed in the evening.”
“Any unusual discharge or odor since then?”
“I don’t know… maybe? Hard to tell,” she murmured.
Robby nodded once, assembling it. Rash, fever, hypotension, GI symptoms, multi-system involvement.
He looked at Whitaker. “Diagnosis?”
Whitaker did not hesitate long. “Toxic shock syndrome.”
Robby gave a small nod. “Most likely. We’ll confirm with cultures and swabs, but we treat immediately.”
He turned back to Alexis. “We’re going to start targeted treatment right away, you’re very sick right now.”
Tears filled her eyes immediately.
“I’m sorry,” she said, voice breaking. “I didn’t mean to, I forgot, I just—”
“No need to apologize.” Robby said firmly.
“I left it in too long, I’m so stupid.”
“Stress makes people forget things,” Whitaker added quietly. “This is not uncommon.”
Alexis shook her head slightly, unconvinced. “Am I going to die?”
“You came in early. That’s good.”
Robby nodded. “We’ve got antibiotics in you now. You’ll go to ICU for close monitoring, fluids, vasopressors if needed. You have a good chance.”
Her breathing steadied slightly, though fear still sat in her eyes.
“Thank you,” she whispered as they prepared to transfer her. “For being kind.”
“Of course.”
Perlah guided the bed to the elevators.
Whitaker exhaled once the doors closed. “That one was close.”
“Yeah,” Robby said. “Walk with me.”
They stepped out into the corridor just far enough from the noise of Trauma.
Robby kept his hands in his pockets, voice lower now.
“You had the right differential,” he said. “Sepsis workup was appropriate. You didn’t miss labs, you didn’t hesitate on antibiotics. That’s good.”
“But I didn’t think tampon until you asked.”
Robby gave a small nod. “When you’ve got septic physiology on a young, healthy patient and no source after initial screen, go more intimate sooner, even if that seems uncomfortable. Skin, gynecologic, oral, devices.”
Whitaker nodded, absorbing it.
Robby turned back toward the department. “You did fine with management. Now we work on pattern recognition, alright?”
He squeezed Whitaker’s shoulders once, briefly, and moved on to the next incoming emergency.