Secondary Impact

by Barbara Ebel

  “The nurse said something about your daughter knowing this young man,” she said.

  Danny nodded, realizing he’d written an order for Penny’s consult but that he had not filled her in on the personal nature of his patient.

  “David is my daughter’s boyfriend. The one in college. You may have read my original history and physical on him. The first blow to his head occurred at a home basketball game. The second one happened while he was supposed to be on head and body rest.”

  “So much for that,” Penny said, then speared a piece of cantaloupe and put it in her mouth.

  “It’s a tricky age. They’re old enough to drink and drive and pick out their career choices for the rest of their lives but their common sense isn’t yet grounded. And advice from older adults is perceived as lecturing.”

  Penny smiled. “I have yet to have one that old but there are exceptions, I’m sure.”

  “Yes, there are. But my daughter is being sulky and partially blaming me for not being more forceful about David’s orders to rest with no physical activity.”

  “Danny, in that respect, you can’t win. Take heart. This too shall pass.” She swung her long brown braid behind her shoulder and smiled. “So, being that David’s two seizure medications should have therapeutic blood levels by now and he’s still having them, it looks like this regimen is a failure. There is a new pharmaceutical release which I’ll start him on tomorrow. Let’s see how he does on it.”

  “In the meantime,” Danny said, “I can’t consider moving him out of the ICU.”

  “I understand. But statistics show that the majority of patients around the world who suffer from epilepsy can be treated by anticonvulsant drugs. And there are 50 million of them. Pessimistically, however, a handful of patients do not respond to standard treatments.”

  Danny grimaced as the two of them locked eyes.

  “And that’s where you’d come in,” Penny said.

  “Yes, that is where I’d come in. And we both know what that means.”

  -----

  Having not been on call, it was late for Danny to arrive home. Only the dull light over the stove guided him through the hallway where he stopped outside the bedroom door, hearing the low volume of the television. A few steps later, there was only quiet from Julia’s room. Nancy’s door was slightly ajar; she faced the wall with a sheet strewn over her shoulders.

  Danny went upstairs and stopped at the landing facing the closed door. Although he heard no voices on the other side of the door, he heard the low hum of the dishwasher. Turning it on was often the last thing Mary or Casey did before going to bed. In any case, he realized he wouldn’t have been in the mood to talk and he headed back downstairs.

  At the bottom, the shrill of his cell phone on his belt startled him. Almost nine o’clock. He wondered if it was Annabel with a problem but, on unclamping his cell, Rachel’s name appeared.

  “Hi, Danny. It’s Rachel.”

  “Is everything all right? It’s late to speak to Julia. She’s fast asleep.”

  “Then I wouldn’t think of having you disturb her. I bet she’s having the most angelic dreams.”

  These days, Danny didn’t think so. He waited a moment during her silence. “Yes, then?”

  “I rarely request extra visitation which I am entitled to. But can I pick up Julia Thursday night and bring her back Saturday night?”

  “Do you have safe arrangements for her when you work on Friday?”

  “Actually,” she said, “I have no commitments on Friday and I’ll be spending the day with her.”

  “Sorry, I didn’t mean to imply …”

  “Yes you did,” she snapped. “It will be a lovely day,” she added, softening her voice. “As you know, she’s growing so fast. We have to capture the memories while we can. They are but fleeting and must be savored.”

  Danny blinked. Sounded like a bunch of malarkey since it came from her. “I don’t see a problem with that. You can come by Thursday evening.”

  When he hung up, Danny entered the bedroom. The TV was now off and Sara seemed to be sleeping so he avoided turning on the overhead light. He took off his shirt and tossed it in the bathroom hamper and showered. Before getting under the light covers, he sat and leaned over with his head in his hands. A soft hand touched his shoulder.

  “Are you okay?” Sara asked quietly.

  He turned his head. “The question is are you?”

  “I asked you first. I’m wondering if you’re the one being burdened with too much.”

  “It’s not the first time.” He took her hand in his.

  “But each scenario is different. It doesn’t mean you have to stand up like the Rock of Gibraltar every time you have multiple problems at the same time. You’re only human, Danny.”

  “So what do I do about how I feel?”

  “How do you feel?”

  “Despondent.”

  “Well that’s a start.”

  “What’s a start?”

  “Telling me how you feel. Men are notorious for not sharing their feelings.”

  A silence ensued. “I have an idea,” Sara said. “How about going to the lake house this weekend? Maybe we could leave Julia here with everyone and have a peaceful retreat.”

  Danny squeezed her hand. “We could go Friday night and come back Sunday morning. Since Julia will be with her mom until Saturday night, everyone here would only have to put her to bed when she gets back.”

  “See, sometimes things do work out,” she gently reassured him.

  Chapter 12

  Casey loaded the last plate into the dishwasher and glanced at his watch: 8:30. He knew Danny hadn’t been on call and he hadn’t heard his car pull in. It was rare for them not to talk for a few days. They’d seen each other at dinner when Mary sprang her pregnancy news and then when Casey introduced his new partner outside the ER but, other than that, nightly talks had diminished.

  He closed the door and pressed the power button. Mary had gone to bed and, not wanting to disturb her as she fell asleep, he waited awhile before heading upstairs. He sat in the recliner, book in hand, as the sound of streaming water filled the dishwasher and made background noise.

  With an easy maneuver of each foot, he slipped off each deck shoe and moved the ottoman under his legs. He settled back into the leather chair and spied his paperback. Instead of opening it, he placed it on the adjacent table. He closed his eyes and folded his hands on his lap, aware of the absence of a distal digit.

  At first, thoughts roamed to Danny. He knew him too well and his friend and brother-in-law didn’t seem his usual optimistic self that week. Sara had even mentioned that Danny’s laughter seemed to have gotten scarce. He decided to be more attuned to Danny as far as watching for signs of depression. Sara’s miscarriage had been a sad loss and dealing with Annabel and her boyfriend as a patient, and Julia and her mother, were a handful. And he couldn’t imagine the stress of his practice and cases. Although he always handled those well, they were enough in and of themselves for anyone to deal with.

  Casey began drifting to sleep, caught between wakefulness and the blackness of not being aware. He still had the ability to choose his thoughts so he allowed his mind to shift far back to when he was a boy of eight years old; his younger brother, Tommy, was six.

  Around home, it wasn’t unusual for Casey and Tommy to be stuck to each other as if one belt surrounded both their waists and was cinched with a buckle. It was inevitable as the Hamilton household didn’t function that smoothly, something more obvious to Casey when he spent time over at the Tilson’s residence with Danny.

  Most of the time, Casey’s father Wendell was away from home. His career as a salesman, Casey had learned, was different than what people called a ‘traveling salesman.’ He didn’t lug products around in his car and go door-to-door pitching them; instead he had ‘areas’ where he had to market farm equipment and often went to meetings in distant cities. His father was but a brief visitor in their home, someone who wasn’t good
with kids but stood as a decent authority figure and had the respect of the two boys.

  It was Elizabeth Hamilton, Casey’s mom, who stayed at the house especially since working had been out of the question. Besides the fact that Tommy was a far cry from being a healthy child, she suffered from frequent migraines which often made her hide away in the upstairs bedroom, isolating herself from activity, sound and light. The only escape from her headaches was sleep - the ultimate refuge from the pressure in her head, the tense grimace on her face and the nausea which forced her to the toilet to throw up her last meal.

  With the scant inclusion of his parents in their lives, Casey was not only Tommy’s big brother but he watched and protected him. So he fended for himself at an early age and also learned early on how to be a caretaker.

  Within the first year of Tommy’s life, his parents suspected a problem with his health. The baby lagged behind in weight gain and growth and had two lung infections almost back-to-back. After the pediatrician sent them to a specialty clinic, sweat and genetic testing confirmed the diagnosis of cystic fibrosis.

  It was around the house or outside that Elizabeth asked her older son to “mind your brother.” Casey loved his curly-headed sibling who had a sweet disposition and he learned the skills to become a caretaker of someone ill. He became used to his brother’s breathlessness with exertion and his constant stuffy nose, always carrying the tissues Tommy may need.

  It was a pleasant early summer day when Elizabeth Hamilton forced herself to make the boys a late breakfast of boiled eggs and toast, sent them outside to play, and retreated back upstairs with a growing migraine. She closed the bedroom door and struggled to keep down the small amount she had eaten. She reclined in a chair instead of lying back in bed, hoping the migraine pill would settle her stomach; luckily, she slept for a while.

  Outside on the porch, Casey picked up a blue plastic ball from a rocking chair, and he and his brother sat down on the top step in front of the walkway. The sun was bright but not hot, the small lawn was neatly mowed, and honeybees hummed in the bushes flanking the front porch.

  “If Mom left the dishes in the sink, I’ll help you wash them when we go back inside,” Tommy said.

  “Maybe you can dry them,” Casey said, scrutinizing him. “Your nose looks sore. Were you blowing a lot this morning?”

  “Yeah,” he said shrugging his shoulders. He leveled the bottom of his sneakers on the top step and hugged his legs below his knees. “Whaddya wanna do today?”

  Casey stared at his shoelaces. “If you’re feeling okay, we can play ball for a little bit. But I have a piece of chalk in my pocket. Do you want to play tic-tac-toe on the sidewalk instead?”

  “Okay,” Tommy said, rocking back and forth. But neither boy made an attempt to move. The quiet of the morning was broken up by the slamming of a distant house door and a car radio blared for a few seconds and then became faint.

  “Look,” said Tommy, “there’s Pumpkin. Is she afraid of something?”

  Casey saw the deep-orange neighborhood cat slink out beneath the parked car in front of their house. From the other side of the vehicle, a rangy-looking mutt appeared and hightailed after her.

  Both boys stared and their eyes widened as the two animals darted along the sidewalk, the dog gaining ground in hot pursuit.

  “Here,” Casey said, “hold this.”

  He rose, dropped the ball into Tommy’s hands, and took off. Three houses down, the cat ran between houses, the dog practically on its tail. Since Pumpkin had one lame leg, Casey worried for her safety. He also knew the nasty reputation of the stray dog.

  The three of them cut through a backyard, passed a swing set and several more yards, and ended up facing a porch from a house on the street behind them. Which was fine with Casey because it was where Pumpkin lived. The cat scampered up an apple tree while the dog planted itself at the base of the trunk and barked incessantly. Barely out of breath, Casey ran through the thick grass right up to the scrubby dog.

  “Go away,” he yelled. “Scoot!” He waved his arms and, within a few minutes, his efforts paid off. By intimidation, the dog finally grew weary and put some distance between them.

  Casey sat on the nearby picnic table looking up at Pumpkin who sat on the lowest branch. Her tensed-up hair started to look less raised and she fixed her eyes on him with approval.

  “Come on down,” he pleaded. He stood up and reached for the branch but he wasn’t tall enough so he pulled the picnic bench over and climbed on top.

  “It’s okay, girl. I’ll rescue you from that mean dog.” He cupped the side of her head and stroked behind her ear. Seeming to have her trust, he grabbed the cat and cuddled her close, then got off the bench and walked between the rose bushes to the back door of the McKinley’s house. After knocking several times, the door opened.

  “Why, if it isn’t Casey Hamilton,” Kelley McKinley said, “the best and most grown up boy in the neighborhood.” As she spoke through the screen door, she opened it up and smiled at him. “Is Pumpkin okay?”

  “Not so much, Mrs. McKinley. A dog chased her up your apple tree. I got him to leave her alone while I rescued her. But he’s not too far away. Here,” he said, extending his hands to give Pumpkin to her owner.

  The elderly woman pointed into the kitchen with her wrinkled hand. “Please come in and set her down in here where it’s safe.”

  With the soft feline in his arms, he followed her inside and she shut the door.

  -----

  Little Tommy watched his brother beeline after the dog and cat like his legs were in flight. The three made a riotous sight especially due to their small, medium and large sizes. Even cartoons weren’t as entertaining as that. Several houses down, they made a sharp right turn and fled through the dark green grass where Pumpkin appeared lower in her surroundings. The cat’s orange color bobbed up and down from the verdant lawn until he couldn’t see them because the three of them disappeared between two houses, headed for backyards.

  Tommy’s amused look faded and he glanced down at his shorts where the ball was lying in his crotch. He swiped his annoying nose, picked up the ball and rolled it around in the palms of his hands. After some thought, he decided it would be more fun to play ball with Casey when he came back, especially since his breathing at the moment wasn’t too bad. He stopped making circles with the ball, tossed it lightly into the air, and caught it effortlessly on its return. On the third attempt, he gathered more confidence and threw it higher. It spun farther out, he missed catching it, and it bounced on the path in front of him. It began rolling and picked up speed on the decline; faster and faster it rolled as the youngster got up and followed its course down the path and across the sidewalk.

  The ball dropped off the curb into the road between two parked sedans and stayed on its straight course beyond the trunk end and front grill of the two cars. Tommy stepped down and between the vehicles. He had to get it before it rolled under the cars across the street.

  With the ball now in the middle of the road, the youngster was out in the open as he hurried to scoop it up.

  A pickup truck was coming and, seeing the rolling ball, the driver slowed to avoid it. But he didn’t fully apply his brakes as a child lurched out from between parked cars.

  As he leaned forward trying to hurry, Tommy saw the large bulky grill of a moving vehicle came at him before it impacted his small frame, throwing him to the ground. With smashed internal organs, his head also crashed on the tar road.

  As Tommy looked straight up from where he lie on the pavement, his view of the clear blue sky faded as well as his thoughts and consciousness … and then his beating heart stopped.

  -----

  Upstairs in her bedroom, Elizabeth Hamilton propped her elbow on the tall dresser and rested her head into the palm of her hand. She closed her eyes. Better than any meteorologist, she could predict weather changes with accuracy as significant fluctuations of barometric pressure signaled the onslaught and continuation of her migraine. An
d today she was in for a doozy.

  She opened her strained lids and spied the prescription bottle in front of her. After taking care of the child-resistant cap, she dropped a pill into her hand, walked to the bathroom, filled a cup with cold water, popped the drug into her mouth, and swallowed.

  Thoughts turned to the rest of the day as she walked back out into the room. Spying the unmade bed, she figured it was where the remainder of her day was going to be spent. On the nightstand there was a novel she had recently started but she doubted if any pages would get read today. She stepped over to the closest off-white blinds and closed them; walking around the dresser, she went to the other window to do the same.

  She looked out and spotted a blue ball rolling along the path between the two patches of their small front lawn. Her precious Tommy rose from the front steps and, in his own lanky style, hastily followed it. But as he slithered between cars, her view was better than her own child’s. A jet black vehicle headed down the street as the ball kept rolling. She gasped, realizing the inevitable was about to occur. As she watched, her fingers tightened into her hand, her nails piercing her flesh.

  The driver quickly slowed but not enough as it slammed into her son and tossed him forward like it had hit a dog.

  With no recollection of it later, Elizabeth Hamilton was out of the bedroom, down the stairs, and at Tommy’s side so quickly she almost beat the male driver to the carnage. She knelt, pulled at her son’s shoulders, and leaned back with him in her lap. In complete shock, she rocked back and forth like he was a babe in her arms and softly repeated, “Tommy, Tommy, Tommy.”

  The distraught driver knelt beside her. Trembling, he looked up and down the street to ask someone, anyone, to call the police. When he saw a middle-aged man taking out his garbage, he shouted, “Please, call the police! There’s been an accident!”

  Chapter 13

  After stroking her one more time, Casey put Pumpkin down on the floor and Mrs. McKinley motioned for him to sit at the round kitchen table.