One Day At A Time




Helen bid Stephanie a good evening, and went on her way to work. It wasn't far by El, and as she waited for her train to come, she reflected on her conversation with Millicent Carter. "Why would she call me, why wouldn't she just go over there and find out what is up?" Helen would never understand the "Carter Family Dynamics." John had always said it just like that, as if it were a book, or code of ethics, if you will, that one must follow in order to bear the illustrious Carter name. John, was obviously, less than enthusiastic about The Code, but he sure as hell followed it. Rule #1 Keep it to yourself. No one, but no one wants to know about or cares about your personal problems. If this is not possible refer to Rule #2. Rule #2 Don't try to take care of anything by yourself. If you do get into trouble hand it over to the 'elder' Carter's. Rule #3 The Family Busin!ess...if for any reason you are unable to fulfill your Carter Family Obligation by performing a meaningful function in the business that enables you to live in the manner to which you are accustomed, do not, I repeat, do not come crying to the 'elder' Carter's when things do not work out. Rule #4 Good luck.

John had gone over these rules one night as they sat outside. Helen was laughing her head off, as he sauntered about, so seriously, putting on the airs of a rich spoiled brat kid...it was really pretty comical. Of course, Helen knew, they weren't really written rules, just an unspoken agreement by all members of the Clan Carter...John just didn't follow them...all...but the part about keeping to yourself, he followed that to the letter, and never went to Rule #2. If he had, maybe things would have turned out differently for him.

Helen had thought that Millicent and John had maintained a good relationship, and the fact that Millicent had called in Helen, who John had so aptly named, The Big Gun, she knew something was going on, and he was strictly adhering to Rule #1. She had every intention of adding a Rule #5 to the list. Rule #5 YOU have FRIENDS who care about you, and no matter what has happened, or what you've gotten yourself into, real friends will always be there for you. She had every intention of letting him know that, of course, given that she could find out what was going on. He was an open book to her for the most part, and the fact that he didn't call her lately, not even at Christmas, kind of hurt her feelings, but he had been working, the entire holiday, according to Millicent, compliments of Kerry Weaver. She was another story. Kerry could be the best of friends, as long as it didn't interfere with her w!ork and her responsibilities to the ER. Unfortunately, for John, his problems often interfered with her work. Maybe she should add a Rule #6 on his list. Rule #6 Stay the hell away from Kerry Weaver if at all possible. Helen smiled to herself. She really liked Kerry, always had, but man she did have a vicious streak of jealousy when it came to John. He only did as she asked him to do. Kerry was one of those people, in Helen's mind, who could fall in a pile of shit and still come out smelling like a rose. John was not so lucky in that respect. When he fell, he fell hard, and he rarely came out smelling like a rose.

Her train arrived, and she boarded, putting her package down beside her. She had bought John a new journal at Marshall Field's. He had begun keeping on over the summer, and thought he could use a new binder by now. It was good therapy. She knew it and so did he. It was a short hop to County and Helen disembarked the train and made her way through the cold, slushy street to work. She loved her job. The ICU was definitely her forte. She was too old to stand for so long in surgery, and one on one patient care was more her idea of nursing. Besides, the ICU was challenging. Most of the docs were pretty decent. Of course, there were a few, there are a few in every crowd, that you would rather choke to death than to listen to for another minute. A few names came readily to mind, but she preferred not to dwell on them.

She entered, as usual, through the ambulance bay doors, and noticed John's jeep parked outside. He never parked there. Actually, no one was supposed to park there. He had taken to parking on the street for a while, but then moved back to the parking garage after his jeep had lost the hubcaps and the stereo, twice. She remembered what she had told Stephanie about curiosity doing to the cat, and tried to think of the reasons why he would be parked there. She could think of none. She made her way through the doors, and noticed there were about 100 people waiting in chairs. The flu had hit Chicago hard, all of the Midwest in fact, and there had been quite a few deaths, mostly the elderly, from it.

Helen glanced at her watch, noting that she had another 45 minutes before her shift began. She tried to get Randi's attention to no avail. She stood by the desk until she saw a face she knew.

****************

"Carter." Mark shook John slightly to try to wake him.

"Maybe we should just let him sleep." Abby said.

"He needs to be admitted. Don't you think we should wake him up to tell him?" Mark asked.

"No. This way he can't fight you on it."

"Yeah, and he can't sign admission papers either." Mark countered.

"Good point." Abby said, "But we get patients all the time who can't sign and we admit them anyway, can't you do the same?"

"Technically, yes, I guess so, he's pretty out of it." Mark said.

"Medicine?" Abby asked.

"Yeah, get a medicine bed, and I'll write the admit orders."

Mark left the room to go get a set of admission orders, when he noticed that Helen was standing out by the desk. Mark didn't think anyone had called Carter's family yet. Then, he noticed Helen had her work bag with her, and figured she was just coming by to say hello before going upstairs.

******************

"Dr. Greene?" Helen said a bit louder than was necessary, but she wanted to make sure he heard her, and did not ignore her.

Mark walked over toward the older woman, a slightly perplexed look on his face.

"Where is Dr. Carter?" Helen asked, mincing no words.

"Uh..." Mark stammered for a moment.

"Look, I know he's here, his jeep is parked right outside, and I'd like to just say hello."

Mark thought for a moment, "stay right here for just a second okay?"

Mark went back to the exam room, "Abby did you call Carter's family?"

"No, not yet, remember we decided to let him make that..."

Mark cut her off, "Helen Nussbaum is out at the front desk and wants to see him."

"Oh, well, okay, um...if he'd want to see anyone, I'd imagine Helen would be the one."

"I'll go get her." Mark went back out to the front desk, where Helen stood impatiently tapping her foot on the floor.

"Uh..he's back here." Mark led the way to the exam room. Helen expected that John was with a patient. Her surprise was evident when she realized he was the patient.

"What happened?" She asked Mark.

"Um...it's kind of a long story."

"The short version please?" Helen said a bit annoyed that no one thought to call his family.

"He has a headache, hypertensive episode, altered mental status, tachycardic, dizziness, we just got the CT report back. It's clear. We're going to admit him to medicine to find out what's causing this. Do you know if there's any history of early hypertension in his family? Or early cardiac disease?"

"Believe it or not, no, none. They are all healthy as horses. You'd think with the stress and all...but no...no history of either." Helen stated.

"That helps, we can rule out cardiac causes. EKG was normal, so was the echo." Mark said, "This is just strange. He hasn't been feeling good for quite sometime, did he mention anything to you?"

"No." Helen responded, "but I don't see him every day anymore since he moved back with his grandmother for a while. I was out of town. You've seen him nearly every day though haven't you?"

"Pretty much." Mark replied.

"And he didn't mention anything to you?"

"No, but Kerry Weaver was supposed to be keeping tabs on him." Mark said.

"Oh, not your turn this month huh?" Helen said with all the sarcasm she could muster.

"It's really not like that Helen." Mark said defensively.

"Oh? And what is 'it' like Dr. Greene?"

Abby's head bobbed back and forth like she was watching a verbal ping-pong match. Dr. Greene seemed to be losing.

Both Helen and Mark noticed Abby's rapt attention at about the same time.

"Look guys, I'm his sponsor and he didn't even say anything to me. Now, can we stop trying to place blame. Carter's a big boy and he may have not wanted to say anything to anyone. He's kind of private that way."

"No, that's not exactly true either..." Mark stood in silence for a few moments, Abby and Helen waited patiently for him to finish.

"It seems he took himself off of the Naltrexone."

Abby's mouth dropped as did Helen's, John knew the contract he had to keep to stay on at County. This was not something he would do.

Mark took in the looks on both women's faces, then went on, "he thought he was having some undesirable side-effects, and he just couldn't stand it any more. He was afraid to come to either Kerry or I. Kerry and I haven't exactly been the best allies of late. He most likely wouldn't have told either one of you, you both have too much invested in him right now, he seems afraid to disappoint anyone at this point. Nor, does he trust anyone at this point."

That last sentence struck them both.

"What other workups have you done?" Helen avoided the topic and went right to the heart of the matter.

"CT, CBC, BMP, EKG, Echo...MRI is next." Mark stated.

"Well, I suggest you get him to MRI, and I'll call his family." Helen said. She went over toward John, glanced up at the monitors, gave him a quick peck on the cheek, then left to use the phone.

************

Mark glanced over at Abby over John's still-sleeping form, "I guess I've been duly chastised."

"I guess so." Abby stated the obvious. "Wonder where she'll catch Dr. Weaver at?"

"I guess I should warn Kerry that hurricane Helen is in the house." Mark stated with a wry smile.

"No, I wouldn't. It'll be more fun this way." Abby smiled.

"Didn't realize you had a sadistic streak Abby."

"There are a lot of things you don't know about me Dr. Greene."

Abby glanced up at Mark and smiled, "you want to call to schedule the MRI or shall I?"

"I'll do it."

Mark picked up the phone, and after several minutes of waiting, finally got the tech on the line. After a few minutes of debate, Mark hung up. "They can't get him in until late this evening or tomorrow morning. The tech said realistically, it'll be tomorrow."

"Think he'll stay that long?" Abby asked.

"With hurricane Helen in the house? Yeah, he'll stay." Mark said.

Randi stuck her head in the door, "Dr. Greene, they have a room for Carter ready in medicine."

"Thanks Randi."

They moved him upstairs, as John slept on, oblivious to the fact of where he was or what was going on, nor did he particularly care at this point. He hadn't physically moved in over an hour. Abby checked to make sure he was still breathing as they waited for the elevator.

"How much Ativan did you give him?" She asked.

"Enough." Mark evaded the question. He knew it wasn't enough to hurt him, but enough to knock him out for a while, besides, it had brought his blood pressure down, and you can't have a headache while you're asleep.

***************

"Millicent Carter please?" Helen said when the phone was answered.

"Hello?"

"Mrs. Carter, this is Helen Nussbaum, I just wanted you to know that John is at the hospital."

"But he wasn't scheduled to work today."

"No, not as an employee, as a patient."

"A patient?"

"Yes, apparently, his headache got worse and his 'friend' Mark Greene decided to bring him in for some tests. They admitted him. I don't have the room number yet, but as soon as I get it, I'll call you back."

"No, that's all right Helen, thank you, I'll be right in."

Millicent Carter hung up the phone, lines of worry creased her forehead. "I should have brought him in myself," she thought.

She grabbed her purse and her keys, and quickly exited toward the garage. She left word with the staff that she'd be out for the rest of the day, and for someone to please go clean the guest house. John was very neat and tidy when it came to his work, but a hopeless slob when it came to house keeping. She would take the opportunity, in his absence, to straighten up his place.

************

They moved John over from the gurney and onto the bed, he didn't move to try to help at all. He just rolled back into a ball on the bed as Abby put the covers over him.

"Man he is really out." Abby said.

"It's good for him, he needs the sleep." Mark replied.

"I'm going back downstairs, I'll be back up to check on him later." Abby announced.

"I'll be there in a minute, I'm going to leave orders. Do me a favor, if Kerry asks where I am, tell her I'm in medical records, and I'll be back, I don't know...soon."

"Sure, no problem."

Abby left and Mark sat in the chair by Carter's bed filling out the paperwork and writing basic floor orders. On a hunch, he decided to order a 24-hour urine collection, he was sure Carter wouldn't appreciate that one, but with all of the trouble he had had with his kidney of late, it didn't hurt to look at everything. After all, this could be vascular, and with Helen's attentive eye, he didn't want to miss anything. He finished up with the orders, and peeled back John's eyelids, noting the pinpoint pupils, still reactive, but he'd definitely be out for a while. Mark rubbed John's shoulder absently, "I'll see ya later Carter, sleep tight."

John did not respond, nor did Mark expect him to. He made sure the IV was free, in case he did wake up, he didn't want him to accidentally pull it out. Then, he told the nurses to wait on the admission history. He had left the Dynamap in the room, with the alarm setting turned all the way down. He told them to let him sleep, undisturbed, and just check every 15 to 30 minutes to make sure his blood pressure did not elevate. Mark made sure the lights were turned off, and the curtains pulled, then exited the floor to return to the ER and Kerry. He hoped Helen had already visited her by the time Mark returned. He so enjoyed watching Kerry squirm every so often. Helen had the tendency to treat them as if they were errant children when it came to Carter. She was like a lioness. He was glad Carter had such a great advocate, and an obviously great friend, but man, she could make them feel a!n inch tall when she started in on them. Not that it was undeserved, or an over-reaction on her part. It wasn't and that was the point. They, Mark and Kerry, had been the ones to ask, no demand, that Carter adhere to their rules, and they were the ones that said, "We'll do everything in our power to help you with this," then proceeded to do nothing. They deserved what they got from Helen, Mark knew that. He intended to make good on what he had said to Carter that day in May. What Kerry did was her problem, he could only vouch for himself.

His mind was elsewhere as the elevator doors opened in the ER. He was instantly brought to full attention by the sound of female voices at the admit desk.

"Hey what's going on here?" Mark asked.

Both women instantly shut up, looking sheepishly down at the floor. Neither realized how loud their "discussion" had become.

"Um..we were just discussing some things..." Kerry stammered.

Helen gave her a disgusted look and said, "No Dr. Weaver," Helen emphasized the Doctor part, "we were arguing."

Mark knew Helen was as honest as they come, as she had once said of herself, "I calls em' as I sees em'" and that is just what Helen was doing, much to Kerry's dismay.

"Well, why don't you take your uh...'discussion' into the lounge." Mark suggested.

"No, I think we're finished here." Helen said, "Aren't we Doctor Weaver?" Again the emphasis with the Doctor part, which seemed to annoy the hell out of Kerry, much to Helen's delight.

"Uh..yeah, I guess we're done here." Kerry said looking back down at her paperwork.

"Good. Everything settled?" Mark ventured to ask.

"Yes, perfectly." Helen said grinning, grabbing her bag and making her way toward the elevators. She still had 15 minutes before her shift. She'd sneak in to make sure John was settled in, then go to work.

**************

"What was that all about?" Mark asked after Helen was safely on her way.

"Uh...I think I was just reprimanded." Kerry said.

"You don't say?" Mark was busying himself with some meaningless papers, and trying not to laugh.

"So, I assume she got you first." Kerry said.

"Yep."

*****************

John appeared to be sound asleep when Helen opened the door. He stirred a bit when the door creaked shut. She sat in the chair that Mark had vacated earlier. The Dynamap sprang to life, reading out his blood pressure and pulse, as the pulse oximeter light blinked steadily. The floor nurse walked quietly in the door, placing the brown 24-hour collection container in the bathroom, as well as, the usual signs above his bed. Helen thought, "he'll love that one." She leaned over and gave him a peck on the cheek. His skin felt cold. She retrieved an extra blanket from the closet and placed in over his sleeping form, "I'll be back later, why don't you get some rest?" She laughed to herself at her own lame joke. It was about time he got some sleep, even if it took enough Ativan to take down an elephant. His vitals were fine, blood pressure was a little on the low side, but! he was sound asleep.

Helen left as quietly as she had entered and tried to clear her head for the shift ahead. She hoped it was a slow night so she could keep an eye out on John, and hopefully, be close at hand when he woke up.

Hours later...
John's eyelids fluttered open. He glanced around the darkened room, confused. He had no idea how he had gotten here or why. The last thing he remembered was the teakettle whistling incessantly, demanding his attention. He rolled over and pulled the covers up to his chin, realizing he was only wearing a gown, he looked around for his clothes. He wanted to get up to use the bathroom, but he was attached to the IV, the Dynamap, the pulse ox..."good Lord," he thought, "what the hell? Was I in an accident?" He moved his hands over his head, and lifted the covers to inspect the rest of him, nothing..no bumps, no bruises, nothing...now he was really confused. He removed the BP cuff and the pulse ox, and removed the IV bags from the post on the bed to inspect their contents. The puzzle didn't solve for him. He didn't have an IV pole so he held the bag above his head and made his! way into the bathroom. He turned on the light, the glare stabbed at his eyes, momentarily causing a wave of dizziness to wash over him.

As his eyes adjusted, he noticed the brown container with his name on it. "Neat." He thought. He hung the IV bag on the hook conveniently placed by the door and did as he knew he was supposed to. He washed his hands and splashed cool water over his face. He was groggy as hell, and needed to wake up some. He hated this feeling, this floating, out of body feeling. He left the bathroom, leaving on the light and leaving the door open a crack. He thought about turning on the call light to see where the hell his clothes were, but noticed a 'Patient Belongings' bag on the floor by the end of the bed. He had to have something in there to wear. He leaned over to inspect the contents, when a wave of dizziness and disorientation threatened to overtake him. He remembered...my head, I had a hell of a migraine. They admitted me for a migraine? With the Naltrexone, that was why they ad!mitted him. He couldn't really take anything for the migraine that would work while the Naltrexone was still in his system, that's why they admitted him. He re-inspected the IV bags. That had to be it. He didn't really understand the Labetolol, but he had heard that it sometimes was used for migraines, although, he had never personally tried it nor had he ever used it for a patient. Maybe they had tried other drugs, and this was the one that worked. He couldn't remember talking to anyone, the IV, he should have remembered that...nor did he remember his clothing being removed.

He steadied himself by holding onto the end of the bed, and brought the bag up on the bed with him. He retrieved his sweat pants out of the bag, as well as his T-shirt and proceeded to dress himself. The T-shirt posed a problem as they had not put the IV on a pump yet. He couldn't easily disconnect it to pull it over his head without compromising the site. He decided to let the shirt go, and just get his pants on. He about had them up to his waist when the door opened.

"Well, good morning sleeping beauty." His grandmother said.

"Hi Gamma." John returned her greeting.

"I was starting to think you'd never wake up."

"How long was I asleep?" John asked.

"Well, Helen called me at 2:15 in the afternoon, that's yesterday afternoon technically..."

"Yesterday afternoon?" John asked incredulously, "What time is it now?"

"It's 1:45 a.m." Millicent announced consulting her watch.

"What did they do, knock me out!"

"Well, technically, I'd say yes." Millicent said, "Your blood pressure was sky high, they had to get it down, and unfortunately, you were not cooperating."

"What do you mean? I don't remember any of this."

"Mark Greene, your doctor friend, came by this morning, well, technically yesterday morning..." Millicent started.

"I remember having a headache...then I remember Dr. Greene talking me into coming in to get some blood work done...after that...I have no idea."

"Well, I'll give you the short version. Your blood pressure was sky high, they tried to get it down and it just would not cooperate, so basically, they knocked you out so you'd maybe relax and help your body help itself." Millicent said.

"And?"

"It's better, but you're still on the drugs to make it better. They need to find out why it got that high. Dr. Greene, who, by the way, has been very thorough, doesn't think the migraine would have caused your blood pressure to get that high."

"Oh."

"They asked me all kinds of family health questions, and there is no high blood pressure in our family, well, your Uncle Branch is the only one who has any kind of a health problem, and I don't think being a hypochondriac counts."

John smiled at her, "Nope, neither does a lot of things that run in our family...like being a pompous ass, or being a womanizer, or living on wine and valium."

"Now John, just who are you describing?" Millicent gave him an 'innocent' smile. "couldn't be anyone we know."

"No, of course not." John said sarcastically rolling his eyes.

"So what's the plan." He asked.

"From what I understand, you are to get an MRI this morning, they tried to get it in yesterday, but scheduling conflicts and all, it didn't happen."

"MRI of what?"

"Your brain dear."

"My brain." John said, "Why?"

"Well, I suppose to find out why you keep getting these headaches."

"Didn't they do a CT? They should have done that when I came in."

"Don't play doctor John. Yes, they did do a head CT and it was negative. They did a lot of other tests too, all negative."

"I'm starved." John said.

"I'll bet! Let me try to find you something to eat."

Millicent left the room, her mood much lighter as John was awake, talking, and seemed to be in a very good mood. He hadn't complained of his head hurting either, nor had he given her too much trouble about being admitted. She wasn't sure what drugs Dr. Greene had given him, but whatever it was, she wondered if a daily dose was available.

John let his head fall back onto the pillow. High blood pressure? Just where the hell had that one come from? He thought back, the Naltrexone...that had to be it...if it was from the Naltrexone why all the tests? He was only 29, you don't get hypertension at 29..unless you have some other chronic health problem, which, to his recollection, he did not have...his head was beginning to hurt. He figured he was just hungry, and he was, that right there could give you a major headache, at least it did with him.

He kept his eyes closed, again, trying to use the relaxation techniques he learned in rehab. He was almost asleep again, when the door to his room opened.



Part 9
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