Chapter 16
Chapter
Sixteen
T he trauma doors banged open with the familiar urgency that always sent Ava's pulse racing. Reed appeared first, his broad shoulders straining against his uniform as he wheeled in the gurney, already rattling off stats with the practiced efficiency she'd come to expect from him.
“Eighteen-year-old female, Megan Donahue. Parents found her confused and combative in her room this morning. Presenting with tremors, ataxic gait, slurred speech, and peripheral vision issues. No history of seizures or neurological disorders. Vitals are BP 148/92, heart rate 115, respiratory rate 22.”
Ava moved beside the gurney, quickly assessing the girl. Her blonde hair was matted with sweat, eyes darting around the room in obvious confusion. Her hands trembled uncontrollably against the white sheets.
“Any known medications or substances? How long have the symptoms being going on?” Ava asked, shining her penlight into the girl's eyes, noting the sluggish pupillary response.
Reed shook his head. “Parents say no. Room search didn't turn up anything obvious. She complained about numbness in her fingers and toes two days ago, but they thought it was from sitting too long studying for finals. She’s had some anxiety and mood swings, a few incidents.”
Ava noticed the girl's flushed skin, the way her body twitched with uncoordinated movements. “Megan? Can you hear me? I'm Dr. Spencer-Campbell.”
“She's... sunshine... won't stop crawling,” Megan slurred, her gaze unfocused. “Make it stop burning.”
Dr. Joe Salvini, who had been leaning against the nurses' station reviewing a chart, sauntered over. He watched the seizing girl for approximately five seconds before shaking his head.
“No thanks,” he said, already backing away. “I don't need a druggie kid as my patient. All yours, Ava.”
Ava's jaw clenched. Six years of medical school, four years of residency, and she still had to deal with colleagues who made snap judgments before the patient was even fully assessed. She shot Joe a glare cold enough to match even his ice-cold heart before turning her attention back to the girl.
“Let's get a comprehensive tox screen, CBC, metabolic panel, and liver function tests,” she instructed the nurse. “And schedule a CT scan. I want to rule out any structural neurological issues.”
Megan suddenly arched off the gurney, her confusion turning to agitation. She began clawing at her own face, fingernails leaving red streaks across her cheeks.
“Burns! It burns under my skin!” she cried out.
“I need 2mg of lorazepam,” Ava ordered, placing steady hands on the girl's shoulders to keep her from harming herself further. The nurse handed her the syringe and Ava quickly administered the medication. “It's okay, Megan. This will help you feel calmer.”
Gradually, Megan's movements became less frantic as the medication took effect. Her eyes remained wide and frightened, but the violent thrashing subsided.
“I’m going to talk to her parents,” Ava told Reed, stripping off her gloves. “Maybe they can give us more details about what might have happened and any history.”
Reed caught her arm as she stepped outside the trauma bay. His fingers were warm through the thin fabric of her scrubs, sending an unwelcome flutter through her stomach despite the seriousness of the situation.
“This is probably a drug overdose,” he said, his voice low. “The symptoms are consistent with some of the newer synthetic compounds. The parents might not know. Just be prepared.”
Ava pulled her arm free, fighting the dual irritation of his assumption and her own body's response to his touch. “Did you find anything in her room? Any evidence of drug use?”
"Well, no, but she could have gotten something at a party.”
“Did you find pipes, powders, pills, unusual containers, anything that would suggest substance abuse?” she pressed.
Reed hesitated, then pulled out his phone. “Just typical teenage girl stuff. Look. We didn’t have a lot of time to dig around, not that we ever do that.” He swiped through several photos of a messy bedroom with clothes strewn about, posters on the walls, and a vanity table covered with makeup products and skincare items.
Ava studied the images, noting the expensive-looking array of cosmetics. Several had foreign packaging that she didn't recognize. But nothing on the table that indicated medication or drugs, prescription or otherwise. But drug users were savvy at hiding their addiction, from everyone, even their closest family and friends.
“So no actual evidence of drug use, but you and Dr. Salvini immediately jump to that conclusion?” She handed the phone back to him, not bothering to hide her disappointment. “Don't make assumptions, Reed. Let me do my job.”
His expression shifted from confidence to something more sheepish. “I’m just trying to help narrow things down.”
“I know,” she said, softening slightly. “But premature diagnosis is dangerous, especially when it comes with judgment attached. That girl deserves our best efforts, not our biases.”
She turned toward the waiting area where Megan's anxious parents would be filling out paperwork, but paused to add over her shoulder, “And if you're still convinced it's drugs, explain to me why a teenager with a supposed substance abuse problem would have over three hundred dollars' worth of imported skincare products.”
Reed blinked, clearly caught off guard by the observation.
“Exactly,” Ava said, not waiting for his response. “So let's withhold judgment until the tox screen and other tests come back.”
As she walked away, Ava couldn't help but think about how quickly he had dismissed the patient as "just another teen drug case." Sure, the expensive skincare products meant she had disposable income, which could mean she had money to spend on drugs, but Ava didn’t think so. If Megan was doing drugs, she would spend most of her money on drugs, not on other things. A stereotype, definitely. But it was the kind of lazy thinking she fought against every day in the ED—the quick labels that could mean the difference between proper treatment and a missed diagnosis.
She wouldn't make the same mistake. Something more was happening with Megan Donahue, and Ava was determined to figure out what it was before it was too late.
A va found the Donahues huddled together in the waiting room, a crowded space with vinyl chairs that had witnessed more awful news than comfort. Mrs. Donahue sprang to her feet when Ava entered, her mascara smudged beneath red-rimmed eyes.
“How is she? Can we see her?” The words tumbled out before Ava could even introduce herself.
“Why don’t we speak privately, okay?” She led them to a family consultation room just inside the emergency department, a quieter space with tweed chairs that were only slightly more comfortable than the waiting room.
“I’m Dr. Spencer-Campbell,” Ava said, after they all settled into chairs. “Megan is stable right now. We've given her something to help with the agitation. I need to ask you some questions that might help us understand what's happening.”
Mr. Donahue wrapped an arm around his wife's shoulders, his knuckles white. “We told the paramedics everything we know.”
“I understand, but sometimes details that seem unimportant can be crucial.” Ava leaned forward, smoothing out her expression to one of concern. “Have you noticed any changes in Megan's behavior before today? Even small changes in the last few weeks or months?”
The parents exchanged glances. “She has been more irritable lately,” Mrs. Donahue admitted. “Snapping at her younger brother, getting frustrated more easily. But we thought it was just senior year stress—finals, college decisions, all of that.”
“She had a complete meltdown at the airport two weeks ago,” Mr. Donahue added. “We were flying to visit my mother in Arizona, and TSA confiscated some of her makeup for being over the liquid limit. You'd think they'd taken her firstborn child.”
“We ordered it right away so it would be waiting for her at home, but she was so upset. She said her skin would be destroyed by the sun in Arizona.”
Mr. Donahue rolled his eyes. “Megan wants to be an influencer or something ridiculous like that. We’ve told her that she needs something more stable.” He paused and glanced at his wife. “Maybe I pushed her too hard with school, putting too much pressure on her. Maybe I caused this.”
His wife made a noise and rested her head on his shoulder. “No, it wasn’t your fault.”
Ava made a note. “I’m sure it wasn’t. How was she during the trip?”
“Actually, she seemed fine,” Mrs. Donahue said, after a pause, sounding surprised at her own observation. “More like her old self.”
“But when we got home, the irritability came back,” Mr. Donahue finished. “Within a day or two."
Ava's medical mind began sorting through possibilities, cataloging symptoms against potential diagnoses. “Does Megan use any recreational drugs that you're aware of? Or has she ever been treated for any mental health conditions?”
Both parents shook their heads emphatically.
“Absolutely not,” Mrs. Donahue insisted. “She's on the honor roll. Has a volleyball scholarship for college. She wouldn't risk that.”
“Megan's always been anxious about performing well in school, but nothing that required treatment,” Mr. Donahue added. “No depression, no diagnosed anxiety disorders.”
Ava nodded, careful to keep her expression neutral. Parents often didn't know everything about their teenagers, but the Donahues seemed genuinely bewildered by their daughter's condition.
“What about her friends? Any new relationships or social changes recently? Has she gone to any parties recently?”
Mrs. Donahue hesitated. “She's been spending more time alone, actually. Says she's working on her 'online presence'—whatever that means. Growing her follower count or some such nonsense.” She twisted her wedding ring nervously. “We've tried to discourage it, but you know how it is with kids this age.”
“One more question,” Ava said. “Has Megan complained about any physical symptoms before today? Headaches, numbness, vision problems?”
“She mentioned her hands and feet feeling numb about a week ago,” Mr. Donahue said. “But she's always sitting cross-legged with her phone, and we thought it was just poor circulation.”
Ava rose to her feet. “Thank you. This is helpful information. We're running some tests now, and I'll update you as soon as we know more.”
“Dr. Spencer-Campbell?” Mrs. Donahue caught her arm as she turned to leave. "It's not drugs, is it? Because I swear, if someone gave her something?—”
“We're testing for everything,” Ava assured her. “Try not to jump to conclusions. I'll be back soon.”
When Ava returned to the nurses' station, Sara was waiting with a tablet in hand.
“Tox screen came back negative,” she reported. “No common drugs of abuse detected. The comprehensive metabolic panel shows mild liver function abnormalities, but nothing dramatic. CT scan is next up in about twenty minutes.”
“Thanks, Sara.” Ava took the tablet, scanning the results herself and making mental notes. No drugs ruled out one major possibility, but the liver function tests suggested something systemic was happening.
“Dr. Spencer-Campbell.” Dr. Ciponelli's voice came from behind her, making her shoulders tense instinctively. The department head had a way of appearing precisely when she was trying to think.
She turned, keeping her expression professionally neutral. “Dr. Ciponelli.”
“We have a lot of patients today. Why are you sending this patient for a CT scan without scheduling a psych consult first?” He gestured toward Megan's exam room. “The presenting symptoms suggest either substance abuse, which has been ruled out, or a psychiatric issue.”
“I’m considering the possibility of a neurological problem,” Ava explained, keeping her voice even despite the heat rising in her cheeks. “The physical symptoms—tremors, ataxia, peripheral vision disturbances—point to something organic.”
Dr. Ciponelli's expression remained unmoved. “This is an emergency department, Dr. Spencer, not a diagnostic puzzle competition. We triage. We stabilize. We determine what specialty they need, and we move them out.” He tapped the counter for emphasis with each point. “You're spending too much time with individual patients again.”
Ava bit the inside of her cheek, all too aware of the nurses and staff within earshot, including the smirking Joe Salvini. “I believe thorough assessment prevents missed diagnoses and readmissions.”
“What it prevents is efficient patient flow.” His voice lowered, meant only for her. “If you want that permanent position, you need to demonstrate that you can handle the pace. Be more decisive, more confident, and move on. The neurologists can play detective if that's what's needed.”
The familiar knot of frustration tightened in Ava's chest. This was the problem with modern medicine—everything measured in minutes and dollars rather than outcomes and care.
“I’ll order the psych consult,” she conceded, knowing that battling him would only reinforce his concerns about her judgment.
“Good.” He nodded curtly. “The ED needs doctors who can make decisions and stick to them. Remember that.”
As Ciponelli walked away, Ava allowed herself exactly three seconds of indignation before refocusing. The patient came first, politics second.
“Sara, can you add a psych consult to Megan's orders?” she asked, hating the taste of the words. “But let's keep the CT scan scheduled too.”
When Ava returned to Megan's room, the scene had changed considerably. The girl was sitting up now; the lorazepam having calmed her while wearing off enough to leave her coherent. Rachel was checking her vitals, and the two were deep in conversation.
“So you mix the powder with rose water?” Rachel was asking, her tone conversational as she wrapped the blood pressure cuff around Megan's arm.
“No, it comes premixed, though I have something else I mix with rose water for my legs,” Megan answered, her words clearer but still slightly slurred. She was looking at herself in the phone camera and fixing her hair. Yup, feeling better. “It's from South Korea. Way better than the American stuff. It literally cleared all the acne in my skin in, like, two weeks.”
Ava approached the bedside, relieved to see her patient lucid. “How are you feeling, Megan?”
“Better, I guess? But everything still feels weird. Like my skin's too tight.” She held up her phone with shaking hands. "I was just showing your nurse my before and after pictures.”
Rachel smiled at Ava. “Megan's been telling me about her skincare routine. She's quite the expert.”
Ava took the phone Megan offered, swiping through several selfies. The first few showed a girl with fairly significant teenage acne, clearly a source of distress for someone her age. The later photos showed remarkably clear skin, almost unnaturally so.
“Impressive results. Did you see a dermatologist?” Ava acknowledged, handing the phone back.
Megan snorted. “Several. None of them helped me at all. One of them told me to give it time. Yeah, clearly, he didn’t remember high school.”
Ava smiled. She remembered high school and girls back then very well. “When did you start using these new products?”
“About two months ago. I found them through this beauty influencer I follow. She has, like, two million followers, so I knew they had to work.” Megan's pride was evident despite her trembling hands. “My parents don't get it, but I'm going to be an influencer too. I already have three thousand followers.”
As Megan talked, Ava noticed something she'd missed earlier—peeling skin around the girl's palm and between the fingers, like a sunburn shedding its dead layers. Acting on instinct, Ava glanced down at Megan's bare feet protruding from beneath the hospital gown.
The same peeling was evident there too, more pronounced on the soles and between the toes.
Something clicked in Ava's mind. The irritability that improved during vacation, the neurological symptoms, the skin peeling at the extremities. It wasn't drugs. It wasn't psychiatric. It was toxic exposure.
“Megan, can you show me which product helped with your acne? The miracle one?”
The girl brightened. “It's called Lumina Bright. It's, like, sixty dollars for a tiny jar, but totally worth it.” She scrolled through her phone and showed Ava a picture of a pearlescent jar with Asian characters and English text claiming Ancient Beauty Secret .
“Do you mind if I write down the exact name?”
“Sure, but good luck finding it. It's always sold out. I had to get mine from this special website.”
Ava stepped away from the bed, pulling out her own phone. A quick search revealed what she suspected. The FDA had issued warnings about Lumina Bright and several similar products for containing undisclosed mercury.
The puzzle pieces fell into place. Mercury poisoning explained all of Megan's symptoms: the neurological issues, mood changes, peeling skin. The improvement during vacation occurred because she wasn't using the product. The elevated liver enzymes, the negative tox screen, everything aligned.
“Rachel, can you order a blood test for heavy metals, specifically mercury? Priority stat.” Ava kept her voice calm, not wanting to alarm Megan, but Rachel's eyes widened in understanding.
“Right away, Doctor.”
N inety minutes later, Ava studied the lab results with a mixture of concern and vindication. The numbers on the screen glared back at her, stark and undeniable. Megan's blood mercury levels were eight times the normal range—high enough to explain the tremors, the brain fog, the dizziness. High enough to be dangerous, though thankfully not yet teetering into life-threatening territory.
A tightness eased in Ava’s chest. She hadn’t been wrong. The gnawing doubt that had settled in her gut when Dr. Ciponelli dismissed her concerns now unraveled, replaced by the steady pulse of purpose. Megan wasn’t having a psychiatric episode. She was being poisoned. And now, finally, she could be treated properly: chelation therapy to remove the mercury, supportive care for her symptoms, and a full environmental assessment to ensure she wouldn’t be re-exposed.
Still gripping the tablet, Ava turned on her heel and strode out of the lab. The weight of responsibility pressed heavier on her shoulders now—Megan’s parents deserved answers. And an apology. No, not from her. From the system that had nearly sent their daughter to the psych ward instead of saving her life.
As she approached the nurses' station, she spotted Dr. Ciponelli reviewing charts, his posture relaxed, utterly unaware of the storm about to hit him. Joe Salvini leaned against the counter across the center, his dark eyes glinting with interest. He didn’t even bother to hide his smirk as Ava approached the attending. All he needed was a bowl of popcorn to make his enjoyment complete.
The patient came first. Always. And no permanent position was worth forgetting that.
Ava stopped in front of Dr. Ciponelli and held up the results. “Dr. Ciponelli? Megan Donahue’s lab work came back. Mercury poisoning.” She kept her voice even, controlled, but her pulse hammered in her throat. “It came from a skin cream she bought online. A heavy metal test confirmed it.”
Dr. Ciponelli’s thick white eyebrows drew together as he took the tablet from her and skimmed the results. His mouth tightened. “Nice catch, Dr. Spencer-Campbell.” Then he flicked his gaze back up at her. “But I thought we agreed you were getting a psych evaluation on her?”
Salvini let out a low chuckle, clearly enjoying the show. Ava didn’t spare him a glance. “I canceled the order once I saw the results,” she said, her voice firm. “She isn’t suffering from a psychological issue. It’s a chemical one. A treatable one.”
Ciponelli studied her, his expression unreadable. “They could have caught it just as easily upstairs.”
Ava squared her shoulders, her spine straightening like a steel rod. She was keenly aware of the audience forming—the nurses glancing up from their stations, a few residents pretending not to listen as they scribbled notes, the hum of the emergency department slowing just slightly.
“Maybe,” she admitted. “But what damage could have been done in the meantime? Her life, her dignity, her peace of mind—what if she’d been admitted to psych, labeled as unstable? What if no one had thought to test for heavy metals? We don’t just shuffle patients along like paperwork, Dr. Ciponelli. We owe them more than that.” Her voice was steady but fierce. “We owe them our best.”
Something flickered in the older doctor’s gaze. The noise of the ED swelled around them—the beeping monitors, the rolling gurneys, the murmur of voices discussing treatment plans. Finally, after what felt like an eternity, he nodded.
“You’re absolutely right, Dr. Spencer-Campbell,” he said, his voice quieter now, but firm. “We have to balance treatment with compassion.” He glanced down at the results again before meeting her eyes. “You did an excellent job gathering a thorough history of your patient. You saved her untold stress, unnecessary medical treatment, and possibly much worse. Excellent work.”
The breath whooshed from Ava’s lungs; the tension she hadn’t even realized she was holding finally releasing. “Thank you, Dr. Ciponelli.”
He turned slightly, his gaze sweeping over the small group of medical staff who had been eavesdropping. “This is exactly what we’re here to do,” he told them. “We’re a community hospital, not some impersonal, big-city machine. Our patients aren’t numbers. They’re our neighbors, our friends, our family members. It’s our job to make sure we treat them as such.” He paused before adding firmly, “But that doesn’t mean we can let the ED grind to a halt. So let’s keep moving, people.”
Ava barely stopped herself from smiling. Praise from Ciponelli was rare. She’d take it.
But Salvini wasn’t as lucky.
“Dr. Salvini?” Ciponelli turned to him, and Joe straightened, his smirk slipping just slightly.
“Yes, sir?”
“I heard you were cherry-picking patients again.”
Joe flashed one of his cocky grins. “Just ensuring my skills are put to the best use for top patient care.”
Ciponelli gave him a pained grin. “Excellent. In that case, I have the perfect patient for you. Room two. Abscess on the posterior. Be gentle. And remember, patient satisfaction is key.”
Joe’s grin vanished. His mouth opened like he wanted to protest, but then snapped shut. He shot Ava a dark look before stomping off, leaving the nurses snickering behind him.
Ciponelli clapped his hands once, regaining everyone’s attention. “Alright, people. We have a full house. Back to work!”
The staff scattered, the energy in the room noticeably lighter. Ava took a deep breath, rolling her shoulders.
Today, she’d won. And more importantly, so had Megan.