Chicken Pot Pie

I'd been staring at Mr. Quentin's chart for twenty minutes at the nurses' station, my coffee going cold beside the ancient desktop computer.

The three overnight nurses were doing shift change behind me, their voices a tired murmur.

Dr. Hunt finally swooped in, trailing a pack of med students like ducklings.

The patient had been transferred from County with what looked like textbook sepsis, except nothing about his numbers made sense. His white count was through the roof but his temperature was normal. The cultures were negative but his blood pressure kept crashing. 

"Good morning, Dr. Wright," Hunt said, already reaching for the chart. Her salt-and-pepper hair was escaping from its clip, and there was a coffee stain on her white coat. "Talk me through your differential."

I opened my mouth but one of the students, a eager-looking guy with thick glasses, beat me to it. "Classic sepsis presentation," he announced. "Start broad spectrum antibiotics and—"

"I wasn't asking you, Mr. Wynn," Hunt said without looking up. The student wilted. "Dr. Wright?"

"Actually, his presentation isn't classic at all," I said, trying not to sound smug. "His temperature's normal, cultures are negative, and look at his calcium levels—they're way too high for sepsis."

Hunt nodded, flipping through the pages. "So what's your working diagnosis?"

Before I could answer, a nurse burst through the door. "Dr. Wright, he's crashing again."

We all rushed to Mr. Quentin's room. He was a thin man in his sixties, swimming in his hospital gown. The monitors were screaming—pressure 70/40 and dropping. His skin was gray and clammy.

"Push another liter of saline," Hunt ordered, already at his bedside. "Dr. Wright, what do you want to do?"

My mind raced. The symptoms didn't fit. Nothing fit. The med students watched me with barely concealed schadenfreude. 

"Um," I said.

"We don't have time for 'um,'" Hunt snapped.

Just then, Mr. Quentin started vomiting. Dark liquid splashed across his gown and the sheets. One of the med students gagged and had to leave the room.

"Sorry," Mr. Quentin gasped between heaves. "The wife's beef stew. Never sits right."

I froze. "Wait. Mr. Quentin, when did you eat beef stew?"

"Last night," he wheezed. "Ellen always brings me dinner. Hospital food's terrible."

I turned to Hunt. "He's been NPO since admission. No one's supposed to bring him food."

Hunt's eyes widened. She grabbed his chart again, flipping to the admission notes. "Mr. Quentin, are you taking any medications at home that you haven't told us about?"

He tried to shake his head, but another wave of vomiting hit. When it passed, he said, "Just my calcium pills. Ellen makes sure I take them every day with dinner. Says they're good for my bones."

Fate is resourceful. Sometimes it delivers answers in the form of vomit and contraband beef stew.

"Call poison control," I told the nurse. "And get me his exact calcium supplement dose and brand."

"Already on it," she said, reaching for the phone.

"Talk to me, Dr. Wright," Hunt said. The med students had pulled out their notebooks.

"Hypercalcemia," I said. "He's been double-dosing calcium—his prescription plus whatever supplements his wife's been bringing. The vomiting, the mental status changes, the low blood pressure—it all fits. And the sepsis workup kept coming back negative because we were looking at the wrong thing entirely."

Hunt nodded. "Treatment plan?"

"Stop all calcium supplements, obviously. Start aggressive IV fluids. Monitor his cardiac rhythm. And—" I checked his chart again. "Add furosemide to help him excrete the excess calcium."

"Good," Hunt said. "Let's—"

The power went out.

We stood in sudden darkness, listening to the backup generators whir to life. The monitors flickered and came back online one by one, their beeping even more annoying than before.

"Perfect timing," Hunt muttered. "Wright, stay with Mr. Quentin. The rest of you, with me. We need to check on the other patients."

They left me alone with my hypercalcemic patient and his illegal beef stew. The emergency lights cast everything in a sickly yellow glow.

"Is Ellen in trouble?" Mr. Quentin asked weakly.

"No," I lied. "But we need to talk to her about the supplements."

He nodded and promptly threw up again. I jumped back, but not quite fast enough. The vomit caught the edge of my shoes.

"Sorry," he said.

"It's fine." I'd had worse things on these shoes. "How are you feeling otherwise?"

"Like I got hit by a truck. Then the truck backed up and hit me again."

I was checking his newest set of vitals when Ellen Quentin burst in, carrying what looked like a casserole dish.

"I brought lunch!" she announced. "Chicken pot pie, your favorite."

I moved to intercept her. "Mrs. Quentin, we need to talk about—"

The power went out again. This time the backup generators didn't kick in.

"Oh dear," Ellen said in the darkness. There was a crash, followed by the distinct sound of chicken pot pie hitting the floor.

I fumbled for my phone's flashlight. The beam revealed Ellen standing in a spreading puddle of gravy and vegetables, looking mortified. Behind her, Mr. Quentin's monitors were dark and silent.

"It's fine," I said automatically, though it absolutely wasn't. "But Mrs. Quentin, about those calcium supplements—"

The overhead lights blazed back on, along with every single alarm in the room. Mr. Quentin's pressure had bottomed out again.

I called for help, but the power outage had every nurse on the floor busy with other patients. Ellen wrung her hands while I started another fluid bolus. Mr. Quentin was barely conscious.

"I was just trying to help," Ellen kept saying. "The doctor on that health podcast said calcium was good for everything. Three thousand milligrams a day, he said. I wrote it down."

I wanted to bang my head against the wall. "Which podcast?"

"Oh, Dr. Something. He sells supplements online. Very reasonable prices."

Of course he did.

Just then, Hunt reappeared. She took one look at the situation—the pot pie on the floor, the crashed patient, Ellen's tear-streaked face—and raised an eyebrow.

"Report, Dr. Wright?"

I opened my mouth to explain, but Mr. Quentin chose that moment to have a seizure. His whole body went rigid, then started jerking. Ellen screamed. The remaining pot pie went flying as she stumbled backward.

We stabilized him, eventually. Got his calcium down to something less immediately lethal. Explained to Ellen, very carefully, why getting medical advice from supplement-selling podcast hosts was a bad idea.

I was updating his chart when Hunt found me again.

"Interesting case," she said.

"Yeah." I rubbed my eyes. "At least we caught it before—"

"He's being transferred."

I looked up. "What?"

"Insurance won't cover his stay here. They're moving him to County within the hour."

"But we just got him stabilized! And County's the one that missed this in the first place!"

Hunt shrugged. "Welcome to the healthcare industry. Make sure you write really good transfer notes."

She left me with the chart and my ruined shoes, trying to figure out how to explain everything in a way that wouldn't get lost in translation.

Again.

Somewhere in the distance, I heard Ellen Quentin arguing with someone about whether she could send chicken pot pie in the ambulance.