Page 13

Chapter thirteen

Keala

T he feeling of undeniable exhaustion swept over Keala the next day, and she regretted playing video games with Ikaika and Landon instead of trying to sleep. Though who knows if she would have even been able to.

She sat in the supply closet she often used for breathers throughout the day, finishing the last few carrots she’d brought for lunch. As she tossed the plastic bag into her purse, a couple of beats of choreography floated into her mind, tapping against the door in her head like they did when she had a breakthrough. She clicked record on her phone, setting it on a stool and leaning it against the wall.

From center, step right, hands punch to the right, step left, hands punch left. Circle arms overhead, small C-jump. Left leg crossed over right and chest folded over, torso down. Drag left arm up leg before whipping head up to smile at the crowd. Arms shoot up, then drop back down to sides as—

A knock and then Annie stuck her head in. She didn’t comment on the state of Keala, giving her a soft smile. “Sorry, I know you started your break ten minutes ago, but you have a patient.”

Keala nodded, stopping the recording and tossing her phone into her purse. She was the only NP on shift, and even if that weren’t the case, she didn’t get set lunch breaks. Following Annie to their desks, she placed her purse under hers. “What do we have?”

“The patient in room twenty-six is a seventy-two-year-old presenting with several months of vaginal bleeding despite having gone through menopause twenty-one years ago. They also state they’ve been feeling fatigued.”

Keala thought on that. “Got it. What’s their name?”

“Vivian.”

“Perfect, thank you, Annie.” Keala pulled up the patient’s chart to look through the notes. A lump formed in her throat when she narrowed down the possibilities. She just hoped Vivian had come in soon enough. She headed to the exam room and knocked before entering. After confirming the patient’s name, date of birth, and preferred pronouns, she asked, “How are you today?”

“I’m okay, I guess.” Vivian’s posture was straight, her gray hair cropped close to her head, and she wore a youthful smile despite her surroundings.

“Annie tells me you’ve been having some vaginal bleeding. Tell me about that.”

“Yes, it’s been four months now. I’ve been feeling more tired than normal recently, so I tried to get an appointment with my gynecologist, thinking it might be related. They don’t have anything for a couple of months, so I thought I’d come here in case it’s something serious.”

Keala asked some follow-up questions to better understand Vivian’s medical history and current condition.

The symptoms Vivian described, as well as her history of menopause, aligned with endometrial cancer. Chronic blood loss led to anemia, which could have explained her fatigue. Keala’s heart hurt for Vivian, who appeared so strong. She hated that this always seemed to be the case—the strongest always had to battle the hardest.

Keala put in an order for a CBC to check Vivian’s blood count. “I ordered some lab work, but I’d like to perform a pelvic exam so I can better visualize the bleeding. It can be hard to determine where blood is coming from in the pelvic area without an exam. Do you mind if I take a look? The exam should only take one or two minutes, and I promise to talk you through each step as I go.”

“Okay,” Vivian responded softly.

Keala moved around the room, collecting her supplies, and performed the exam without difficulty. She found a large amount of blood in the vaginal vault, which was clearly coming from the opening of Vivian’s cervix. This furthered Keala’s suspicions, but she didn’t let it show on her face. No use adding to Vivian’s worry just yet. She helped Vivian clean up and get comfortable before taking a seat. “I’m going to go speak with a colleague who works in gynecology and see if they can drop by to consult so we can get you taken care of. One of the nurses will be in to draw your labs, and I’ll be back in a few minutes, okay?”

“Thank you so much.” Vivian smiled, reclining against the seat.

Keala returned to the desk where she’d left her purse, grabbing her phone. She’d made it her mission at her last hospital and at Westfield Methodist to befriend the gynecology staff.

Almost six years ago, Ikaika’s sister Malia had experienced some vaginal bleeding in her third trimester. Knowing she had placenta previa, her obstetrician told her to go to the hospital, and after spending the better part of a day on the maternal and fetal medicine floor with a heart monitor for the baby, she’d been transferred to labor and delivery for further observation.

After they’d run the usual tests and performed an ultrasound, they’d discovered her placenta previa had worsened. The part of the placenta with the blood vessels that connected Malia to her baby girl had shifted, covering her cervix and making it difficult for the baby to be delivered vaginally. The bleeding stopped, and Malia and Ikaika’s family prepared for the possibility of a C-section. After a few days of normal activity, she’d been sent home on strict bed rest and told to return immediately if the bleeding came back or if her blood pressure spiked.

A few days later, she’d been rushed to the hospital in the middle of the night with spiked blood pressure and more bleeding than before. The baby wasn’t moving and her heart rate had dropped. The on-call obstetrician was in an emergency C-section, and the hospital was short-staffed with no advanced practice providers like a nurse practitioner or physician assistant to help in the emergency department. They’d done the best they could, but while waiting for another obstetrician to arrive, Malia had died from blood loss and kidney failure as a result of HELLP syndrome she had developed suddenly.

Her baby girl had barely made it and now lived with the father.

Keala had only been twenty-one at the time, still in college. She had never been close to Malia, who was seven years older—they’d seen each other once or twice a year when Keala’s family went to Hawaii to visit—but the news had still shocked Keala. After two weeks at home with family, Ikaika had shown up in Virginia completely distraught. Keala had never seen him so devastated, eyes glazed, guilt that he hadn’t been there for Malia clear in everything he said and did. Keala had taken a few days off from school, dance, and her shadowing at the hospital to stay with him, her heart breaking all over again while she held him.

Maybe that was one of the reasons she’d decided to work in the emergency department. Either way, because of that, she’d made certain that as long as she was at the hospital, she would do everything in her power to prevent something like that from happening to anyone else. A piece of that was keeping an open line of communication with gynecology.

“Saw the order for room twenty-six’s CBC. I’ll get on that now,” Annie called as she walked past the desk.

“Thank you!” Keala found her friend’s contact information, knowing Genevieve would be able to put her in touch with a gynecologic oncologist.

“Hi, Keala. You doing okay?” Genevieve asked.

“I’m great, thank you. How are you?”

“The usual. Tired beyond belief.” They shared a laugh.

“I wondered if you know anyone in GYN-ONC? I have a patient presenting with postmenopausal bleeding, a family history of gynecologic cancers, and fatigue, and I’d really appreciate a consult.”

“Sounds like it could be endometrial cancer. Glad the patient came in. There’s a PA, Camila. I can call and see if she’ll head down to you.”

“You’re the best. Thank you!” After hanging up, Keala turned to Aaliyah, who sat at one of the desks. “I’m going to follow up with the patient in room nine. Could you let me know when a PA named Camila gets down here?”

“Of course!”

Keala continued her rounds. Although healthcare wasn’t her passion, moments like this made her proud to be here. She was glad she could hasten the process for women like Vivian and Malia to get the care they needed swiftly.