The Medicine Man

by Dianne Drake

  Chay was still holding his mother when Joanna returned to the living room. She could feel his eyes burning into her as she walked on through without a word to him, and went directly to the phone. This was the hard part. I’m sorry. He’s in a diabetic coma and he’s had a stroke. Both conditions are killing him. How could she tell them that? Damn, how she hated the bad news.

  At least Leonard would warrant a helicopter. “I’ve got a bad one,” she whispered to the dispatcher, hoping Wenona and Chay wouldn’t overhear. This wasn’t the way they needed to find out. “Rising Sun. Diabetic coma, stroke. He’s holding on, but not for long.”

  “How long?” Chay asked, stepping up behind her.

  She whirled around to face him. “Where’s your mother?”

  “In with my dad.”

  “I don’t know, Chay. His glucose tops out at over eight hundred, and I think—”

  “With a stroke, secondary to his diabetes.”

  He said that so matter-of-factly he could have been reading from a medical textbook rather than enquiring about his father, and that sent an icy chill up Joanna’s spine. “He’s past the point of trying a thrombolytic.” Thrombolytics were commonly called clot-busters because if administered in time they had the potential to break up the blood clot that had caused the stroke, restore normal circulation and in some cases reverse the damage already done. Only, in Leonard’s case, it was much too late. Thrombolytics were effective at the early onset of the stroke and the later after the incident they were administered, the less likely they were to work. Leonard was beyond that stage now because he’d been ill for hours. Actually, she guessed he’d been ill for months, maybe years, and the stroke had merely been his body’s final way of telling him it could no longer endure, that it was giving up.

  “Did you give him insulin?”

  “No, he needs better control with that than anything I can do here.”

  “So you’re just going to let his blood sugar keep going up until, what? He dies?”

  “Normally, you support the stroke first, then deal with the blood sugar. I wasn’t here to support the stroke so there’s no sense talking about that because what’s done is done. And another hour with his elevated blood sugar isn’t going to make him any worse than he already is right now.” She was trying to keep her voice low so Wenona wouldn’t hear. “Too rapid a correction may cause electrolyte and acid-base changes, which will make things worse for him—maybe cause some kind of cardiac episode. And to be honest, I don’t have what it takes to get him back if he goes bad. So he’s hanging in there for now, and I think the best thing to do for your father is wait until we can get him someplace that can manage both situations.” She reached out and took Chay’s hand, half expecting him to pull away from her, but he didn’t. In fact, he pulled her into his arms.

  “I’m sorry,” he whispered. “You know more about this than I do.”

  “I’m sorry, Chay. I wish I’d known. Maybe I could have—”

  “Not with my father you couldn’t have. He’s stubborn.”

  “Just like his son.”

  “Chay?”

  Joanna looked up to see Wenona standing in the door. So solemn and pale, she was still as steady as a rock. “We’re going to take your husband to Billings in just a little while,” Joanna said, pulling out of Chay’s arms. “He’s stable enough for the trip, and I don’t have what he needs here.”

  Wenona nodded, and Joanna suspected she knew, and understood, far more than anyone gave her credit for. Her husband had been sick for a long time, sick and stubborn and holding on to his traditions, and Wenona had been forced to stand back and watch. What an awful thing for her. Watching, knowing, understanding, and not able to help.

  “Chay, is this the best way for your father?” Wenona asked.

  He nodded. “The only way. I promise.”

  Joanna saw the muscle tighten in Chay’s jaw, saw him ball his fist. But she also saw him look at his mother with so much love it brought tears to her eyes. She might have looked at her own mother that way, or her father. She hoped she had. But she didn’t remember.

  “I’m glad you’re here. You will do the right thing.” Wenona smiled, nodding. “And no matter what has happened between you and your father, you have never let me down.” Wenona shuffled past him then returned to wait with her husband until the helicopter arrived.

  “I’m surprised she didn’t ask you to do something like your father did for Michael Red Elk. Could you? Would it help, do you think?”

  “An extraction? I could, but from me it would do him no good. It takes two, and both of them have to believe. My father would believe nothing from me, and my mother knows that. And I’m not sure I believe. Not sure I ever believed in those ways.”

  “But you’re a shaman.”

  “Yeah, well, what’s in a title? It wasn’t my choice, Joanna. When I was sixteen and my father determined that I was a shaman, the next in the lineage, he took me to the sweat lodge to initiate me. Inipi. The rite of purification. It’s supposed to utilize all the powers of the universe in order to make you a better person. The earth and the things that grow from it—water, fire, air. There’s a round fireplace in the center of the lodge, and we were supposed to sit around it and contemplate how all those elements related to the universe. But you know what? All I could contemplate was a date with Mary Lejeune. She was gorgeous, I was young, horny, and so close to getting it from her. And I didn’t give a damn about much of anything else. Including contemplating the mysteries of the universe. But you’ve got to contemplate those things if you want to purify yourself, because the belief is that the power of any thing, or any act, is found in understanding it. We sat in the sweat lodge, a sauna, if you will, with its fire going, and contemplated and prayed. Sweat, prayer, and some peyote from time to time. That was the cool stuff, because it made the hours that came after it bearable. And I hated it, Joanna. My father’s prayers were for worthiness. Mine were for finding a way out of there.

  “When it was over my father said I was born a new man, but I think he knew. He took me through the rituals, and I think he hoped for me, but I also think he knew.”

  “And you never believed in some great power or whatever it was your father was trying to teach you?”

  “In the sweat lodge?” He laughed bitterly. “You’ve got to be kidding. They took my grandfather in there when I was ten, to heal him through purification. Then they buried him. After that, the sweat lodge scared the hell out of me. And the only thing that got me through it was thinking about Mary Lejeune. That, among an awful lot of other impure thoughts.”

  “But you respected your father enough to sit with him through it, maybe even fake it.”

  “Yeah, I did. And you know what? He didn’t respect me enough to stand by me when I went to medical school.”

  “There are a lot of ways to heal and be healed, Chay. Whether it’s through medicine or surgery, an extraction, a purification, or simply talking. You’re dad’s a sick man and I certainly wouldn’t rule out any of them for him.”

  Joanna stood on tiptoe to kiss Chay gently on the cheek, then she went back to wait with Wenona and Leonard.

  Chay stayed in the kitchen and fixed himself a cherry cola.

  Joanna hated helicopters. The only thing she’d actually ever enjoyed off solid ground had been her little tryst up on the butte. And already that seemed so long ago. Especially right now as she snapped on her helmet and fastened herself in for the ride.

  Flying in a helicopter was a lot like riding in one of those great express elevators in the fifty-story hotels. First came the trip straight up, and that was never too bad because she imagined a beautiful penthouse at the top of her journey. But then eventually that elevator would start to move forward as well as continue its ascent, and that’s where the fantasy stopped for her. Because at about a thousand feet off the ground, that smooth-riding elevator started careening through the air at a hundred miles per hour. Nothing in her life ever went that fast, including her hea
rt after her evening on the butte, and in the creek, with Chay. And if ever there was a time that something in her life should have been flying that fast, that had been it.

  Now she was a thousand feet up, flying over nowhere in the dark, praying that Leonard would remain stable for the trip, because if he didn’t, the casual-looking paramedic sitting across from her eating his dinner might actually expect something from her. Something other than panic, which was the only thing she would ever guarantee when she was forced into one of these flights.

  Chay was driving to Billings, taking his mother and his grandmother. She thought about him for a moment as she reached to take Leonard’s pulse. Chay tried so desperately to act dispassionately. On the surface it was a good front. But she’d seen the look in his eyes when he’d found out about his dad, and there had been no dispassion there. None at all. “You’re a stubborn man,” she whispered to Leonard, despite the noise of the helicopter motor and even though he probably couldn’t hear her. “So is Chay. And you’re both wrong. Do you hear me, Leonard? You’re both wrong.”

  The flight medic smiled over at her, acknowledging something that he, like Leonard, hadn’t heard.

  “When are you going to give up whatever it is you’re doing out there and come practice real medicine?” Greg Reynolds, the emergency department attending physician slid his arms around Joanna’s waist—a familiar advance she was used to from him, and more often than not ignored. “I’ve got a spot open for you any time you want it.”

  “I’ll just bet you do,” she replied, disengaging herself from him. Greg had been trying for some sort of relationship almost from the moment she’d stepped foot in Montana. He was a good doctor, but terrible in the personal relationship department. Rumor had him sleeping with most of the emergency nurses and female doctors at one time or another. Maybe some women found the fair-haired, slick-looker attractive, but lately she’d been much more interested in the dark, rugged, brooding kind. “And I still like what I’m doing out there. I will the next time you ask me, too.”

  “Joanna and the coyotes. You’ll be changing your mind about that, and I’ll be waiting right here with open arms when you do.” He tossed her a sly little wink. “And I’ll guarantee that I’ll be much better company than the coyotes.”

  Actually, she’d prefer the coyotes, but she needed to stay on Greg’s good side because over the months he’d become an ally to her. He took care of her emergencies, and as often as not looked the other way when the paperwork and regulations threatened to get in the way of patient care. He bent rules for her, and she needed that. Her patients needed that. “You just keep those arms open for me, Greg, because you never know.” She blew him a mock kiss then scooted on into the cubicle where Leonard was hooked up to a slow infusion of insulin. An hour in treatment now, and he was looking better. Not so gray. Vital signs stable. Last blood-sugar reading, however, had shown him on the decline.

  “He’s not responsive,” the nurse told her. “His pupils are equal and reactive, but he’s not coming round.” The nurse, a cute, tomboyish brunette who looked more like a kid than an adult, hooked the chart over the foot of the bed and left the area.

  Joanna picked it up and read. CAT scan negative for bleeding. That was good. Blood gases within normal range, and except for his blood sugar the rest of his labs were essentially within normal limits, too. Actually, except for the fact that Leonard Ducheneaux had let his diabetes go so badly out of control that it had caused a stroke, he was fine. Well, fine enough under the circumstances, since the kidney work-ups were yet to be done, and kidneys often suffered minor to total damage from unchecked diabetes. Leonard, she noted, was puffy in his extremities, which meant his kidneys might be fighting him on top of everything else that was wrong.

  “Could it have been the flu vaccine that brought this on?” she asked Greg, who’d stepped into the cubicle with her.

  “Probably not. This guy’s been dodging the big one for a long time, from the looks of his lab work. A1C’s skyrocketing at twelve, meaning the guy’s averaging three times his normal blood-sugar level. Which leads me right to the neuropathy I found on his right leg.” Neuropathy meant the circulation in Leonard’s legs was compromised and some of the tissue and nerve function were essentially dying. Best-case scenario was surgery to restore normal circulation, worst case came in two varieties. Gangrene, if not treated, which would lead to amputation or death. And amputation, if treated and circulation still could not be restored.

  “How bad?” Diabetic neuropathy scared her. She’d already seen two below-the-knee amputations since she’d been on Hawk, and twice that many amputated toes. Just the word “neuropathy” made her blood run cold.

  “It’s not severe yet, and I think we can probably take care of it with surgery. I hope. But if he’s not careful he’s going to be up for some chopping. And about his kidneys, well, heaven only knows what’s going on there since we’re not getting enough normal urinary output at present to judge. We’ve got him on some Lasix to kick out the fluid, but if that doesn’t work then we’re going to look at some kind of dialysis maybe. Hemodialysis if it’s bad, peritoneal if he’s lucky. So, could it have been the flu vaccine? I doubt it. If you gave it to him today, I’d say it was a coincidence on top of someone who was going to crash anyway. Oh, and I’m going to line him up for vascular, neurology, nephrology and endocrinology consults later today.”

  For someone who avoided modern medicine, Leonard was about to see more than his fair share of it. Poor Leonard, Joanna thought, pulling Greg into the hall. “Even with all that, is he going to make it?”

  “Don’t know, Jo. It’s too soon to tell, and there are so many elements here that can go wrong. But even if he recovers, he’s going to need a lot of physical therapy. I mean, your patient has a damn long road ahead of him if he pulls out of the crisis. I’m not sure he’s going to, and if he does, who knows if he’s going to work hard enough to keep himself alive?” Greg took a deep breath, regrouped and continued, “Sorry. That came out the wrong way. I want him to recover, of course. I want him to go home and live a long and happy life, and I shouldn’t have said what I did, but it’s so damned frustrating. You fix them up, send them home, then the next time they come back in worse condition than they were in the time before. I see it every day. Same faces, same conditions. Makes me mad as hell, Jo.”

  “Me, too, Greg. Believe me, I fight it as hard as you do, and I still lose.”

  “Is he more than a patient? A friend or something?”

  “A friend of a friend.” She glanced down the corridor behind Greg at Chay, who was heading toward them. “And it’s OK, what you said. I’ve been on Hawk six months and Leonard never once came to me even though he knows he’s been sick.”

  “Tough job. I hope they’re not all like that out there.”

  Joanna smiled. “You mean stubborn? Thank God, no. Most of the people want more medical care than I can give them, and they try hard, within their means, to do what they’re supposed to. Leonard just happens to be one of the very few stubborn ones who stick to the old ways. Look, do me a favor here and let me talk to his family. OK? I know Leonard’s under your care now, but…”

  Greg gave her a sly wink. “I’ll just put it on the list of things you’ll be owing me for later on.” He leaned in close to her ear, whispering, “And how about we make that sooner rather than later? You and me, someplace dark and cozy like my—”

  “Dr Ducheneaux,” Joanna interrupted as Chay stepped up. Just in the nick of time! “This is Dr Reynolds.” She forced a sweet smile on Greg. “Dr Ducheneaux is Leonard’s son.”

  The handshake between the men was curt, then as Greg pulled away, he asked, “Doctor, as in what? Medicine?”

  “Voodoo,” Chay snapped, slipping into Leonard’s cubicle.

  “Orthopedic surgeon,” Joanna said, seizing the opportunity to get away from Greg and follow Chay. She stayed at the entry for a moment, watching them—Leonard on the bed, so still and helpless, Chay standing over it
, staring at the monitors and not his father. “He might be able to hear if you talk to him,” she said.

  “He hasn’t wanted to hear me for half my life, and I don’t think that’s going to change now.”

  As Chay spoke, Joanna saw a barely detectable increase in Leonard’s heart rate blip across the cardiac monitor. Just a few beats more per minute, and once Chay quit speaking, Leonard’s heart rate dropped back down to where it had been. “He’s sick, Chay. That changes things.”

  “With others maybe. But not him.”

  Leonard’s heart rate went up and down again. “And not you either, apparently.” Chay spun around to face her and for a moment she thought she saw a flash of anguish cross his face, but if she had, it disappeared almost as quickly as it had appeared. What was left was the stone-cold expression she saw only when it came to his father. “How about we go outside and talk while they move him to MICU?” she suggested. The medical intensive care unit. “I’d like to see Wenona and Macawi for a few minutes, too, and let them know what’s going to be happening to Leonard throughout the night.” She motioned Chay over to her, then whispered, “Before you leave, go tell your father that you’ll be back to see him in a little while. Will you do that for me?”

  He shrugged his blatant indifference, then returned to Leonard’s side. “Look, they’re going to get you settled into a room, so I’m going to go wait with Mom and Macawi. But I’ll be back later.”

  Joanna’s eyes were fixed on the monitor. Leonard’s rate went from sixty-eight to eighty-two. “He can hear you, Chay. He knows you’re here and he’s listening to you.”

  Two hours after Leonard was admitted to the MICU and Wenona and Macawi were settled into the hotel across the street from the hospital—settled in with great protest since MICU visiting hours were ten minutes every other hour and wouldn’t start up again for several hours—Joanna and Chay were heading back to Rising Sun against the backdrop of the rising sun. It was a magnificent view, Joanna thought, driving and sipping coffee to keep herself awake while Chay slumped in the seat next to her and stared out the window. Magnificent, awe-inspiring. This place called the Big Open was deep in her heart now. Maybe it was the only place in which she’d ever been truly happy.