by Dianne Drake
“It’s all I have on hand, and I wouldn’t have even had that if not for the generosity of someone who passed through the village a month ago and left their bottle of it behind. Unopened, and well in advance of its expiration date, in case you’re interested.”
“Is it working?”
Damien shook his head. “Nope. Which is why Padre Benicio calls me over to the rectory every couple of nights. He keeps hoping we’ve got some relief for him.”
“Which you don’t.” Juliette frowned. “Damien, you can’t just let him go untreated, especially if he’s really suffering from this. And, judging from what I saw of him outside, he is.”
“I’m not going to let him go untreated. In fact, I’m going into Cima de la Montaña sometime this week, and when I’m there I’ll get on a computer and order something that might work better for him. Maybe a steroidal nasal spray and an inhaler for his wheezing.”
“How long will that take?”
“After I get it ordered, it’ll probably take a week or so to get it to Cima de la Montaña, then another few days for me to go pick it up. So probably going on two weeks, total.”
“That’s too long. Let me pick up something in San José when I go back, and bring it with me next week. That’ll shave off a week, which isn’t great, but it’s better than him having to wait for two.”
She’d bring it back with her? Meaning she was coming back again? That gave Damien another week to get it right with Juliette. Another week to fret over how he was going to do that.
* * *
“Your gout is acting up again, Señor Mendez?” Juliette showed him into the clinic and pointed to the exam table. “Go ahead and have a seat, then take your shoe and sock off.” Once again, the man didn’t seem quite right, and her first inclination was to ask him about it. But she thought back to what Damien had said about treating the patients as they came. That was the hospital policy, so she’d follow it.
“Hurting bad tonight. I thought you could give me something for the pain so I can sleep better.”
“You’re not sleeping well?”
“My legs shake. They keep me up.”
She wasn’t getting a good feeling about this. “Can you take your trousers down so I can look at your legs?”
“Could el doctor Damien look at my legs?” the man asked.
“He’s not going to be back for a while.”
“I can wait,” Señor Mendez said.
But she couldn’t. She’d been on duty two hours already, and still hadn’t gotten around to doing a general patient assessment. And there were other things that had to be attended to, so a shy patient was the last thing she needed right now.
“Maybe I can just rest on this table. It would feel good on my back.”
“Your back hurts, too?” That plus the fact that his speech was definitely slurred tonight.
“Sometimes when I get tired. But it goes away after I rest.”
“Do you ever feel any tingling in your face, or arms, or legs?” This was sounding even worse.
“Yes, but it always goes away.”
“Do you get dizzy?”
“When I stand up too fast. Sometimes when I stand in one place too long.”
Alarm was beginning to prickle up her spine. “I really need for you to take your trousers down. Just your trousers, nothing else.” If she’d made an error in diagnosing him the first time, she wanted to be the one to correct it. “This will only take a minute.”
Reluctantly, Señor Mendez slid off the end of the exam table, unfastened his belt and let his trousers drop to the floor. Juliette noticed that the man was staring intently at the ceiling. “Can you get back up on the table now?”
Exhaling a heavy sigh, Señor Mendez crawled back up on the table, and still stared upward. He clearly didn’t like being in this position in front of a woman.
“I’m going to poke you in the leg, in several places, and I want you to tell me if what you feel is sharp or dull.” She pulled a probe from a supply drawer and went to work. “OK, sharp or dull?” she asked, taking her first poke at the man’s leg. When he responded that it felt dull, she went onto another site, then another and another, until she was pretty well convinced that he had an overall numbness in both legs. “You can pull up your trousers now,” she said, as she dropped the probe back into the drawer, feeling totally discouraged by what she suspected.
“Am I sick?” he asked her.
“Do you smoke ganja?”
“No. Never.”
Too bad he didn’t, because she was now hoping he did. That would have been an easy diagnosis. This, unfortunately, wasn’t going to be easy. “Do you still work?”
“Every day. I work on a farm, tending the cows. Sometimes I go to pick coffee beans.”
“And the tingling you get, or your occasional dizziness, does that ever stop that?”
“No. I work hard every day. But it tires me out now that I’m getting older.”
“How old are you?” she asked.
“Thirty.”
Younger than her! All the other symptoms, plus gout—meaning compromised immune system—Juliette felt as if she’d just swallowed a heavy lump of dough that had plunked right down in the bottom of her stomach. “Look, I’m going to give you some ibuprofen for the pain.” From the bottles she’d brought to donate to the drug supply. “That should help you tonight, but I want you to come back to the hospital tomorrow. Will you do that?”
“Early, señorita. Before I go to work.”
“That’s fine. I’ll be here, and el doctor Damien should be back by then.” She hoped.
Actually, it was two hours later when el doctor Damien finally wandered through the door. “Anything happen while I was out?” he asked, heading straight into the exam room and dropping down onto the exam table, laying back and cupping his hands under his head.
“Señor Mendez came in for his gout again.”
“What did you do for him?”
“Gave him ibuprofen and sent him home.”
“We have ibuprofen now?”
“Ibuprofen and another supply of penicillin. One of my hospitals donated it to me.”
“Then you come with some advantages. I’m impressed.”
“Well, if a few drugs impresses you, prepare yourself to be wowed, as I also come with a new diagnosis for Señor Mendez.”
Damien frowned. “He doesn’t have gout?”
“Oh, he has gout, all right. But he’s thirty years old, Damien. Remember when we talked over our concern about him being too young for it?”
“Absolutely. But he denied having anything wrong with him when I did his physical. So with this gout—there’s nothing else we can do except treat him for what he presented with. And hope that if he does start having other symptoms he’d tell us.” He paused for a moment, then frowned. “Are there other symptoms now?”
“Now, and probably for quite some time. He has dizzy spells. His legs are marginally numb. He has slurred speech—the slurred speech I attributed to marijuana use. He gets tired too easily for someone his age, and his legs get too jerky for him to sleep.”
Damien sat up and sighed heavily. “Damn,” he muttered. “He never mentioned any of this. Not a word of it.”
“My sentiments, too,” she said, clearly frustrated by the situation.
“Well, we’ve got to take care of it,” Damien said. “And I sure as hell don’t know how we’re going to go about it, since this isn’t going to get fixed with a gut reaction and a penicillin pill. Any suggestions?”
“We need to get him into a hospital in San José, and I’m not going to be the one to convince him to do it. The man didn’t even want to drop his trousers for me to take a look at his legs.”
“Then I’ll just tell him he has to go.”
; “And get him there, how?”
“Any number of the villagers will loan me a truck or a car.”
“You mean you’d drive him in yourself?”
“I made the original mistake, didn’t I?”
“It’s not a mistake when a patient holds something back. We’re only human, Damien. We can only see so much. And when a patient doesn’t tell you what to look for, doesn’t tell you what else is going wrong with him, how can you be expected to diagnose him with multiple sclerosis, or anything else, for that matter?”
“But he told you.”
“I had to pry it out of him. But I’m used to prying it out of patients. That’s a good bit of what a family practice is about. As a surgeon, you don’t have to do that prying. The diagnosis has already been made by the time the patient reaches you, and all you have to do is patch, fix or remove something. So don’t beat yourself up over this, because it was his choice not to disclose.”
“Ugly diagnosis, all the same,” Damien said, sliding off the exam table. “And how the hell am I supposed to treat that condition out here?”
“There are drugs...”
“Which no one can afford.”
“And there are therapies we could do right here to treat some of the underlying dysfunctions that will occur. You know, exercises for cognition, various disciplines for weakness, those sorts of things.”
“None of which I’m qualified to do.”
“Come on, Damien. I’m trying to look on the bright side here. Señor Mendez isn’t without hope.”
“Hope comes in the form of convenience, Juliette. Which we’re fresh out of here.”
“So what do you want to do? Just sit back and watch him deteriorate because there’s no hope? Oh, and feel sorry for yourself in the process because you have limitations?” She knew how he was feeling, as she was feeling the very same way. But this hospital needed Damien to function normally and, right now, she was the only one who could snap him out of his frustration.
“I don’t feel sorry for myself.”
“Then you’re angry with yourself.”
“Don’t I have a right to be?”
“Damien, you chose to work in a very limited hospital. You knew, coming in, that you wouldn’t have any kind of modern medicine at your disposal, yet you stayed here because you wanted to help. Give yourself some credit for that. Most doctors would have walked away because it was too difficult. But you stayed, and you do make a difference.”
“Couldn’t prove it right now.”
“You know what? We need to pick up from right here and move forward, because that’s what Señor Mendez needs us to do. No matter how he was diagnosed prior to this, and no matter how he’ll be diagnosed after this, he’s got a tough life ahead of him and you and George and I are the only ones who are going to get him through it.”
“You say that like you intend on being in it for the long haul.”
“Honestly, I don’t know what I intend for my own personal long haul, but I’m in it right now and I intend on doing everything I can to help my patient. Which includes making arrangements at one of the hospitals for all the proper tests to be done. So, how are we going to accomplish that?”
Damien ran a frustrated hand through his hair. “You make the hospital arrangements this week and I’ll bring him into San José next Friday, drop him off for the weekend to have his tests. Then I’ll pick you up and bring you back to Bombacopsis to save you the drive, and take you back to San José Monday morning, when I go to fetch Señor Mendez.”
Juliette was relieved that Damien was finally beginning to turn his inward guilt into the outward process that would accomplish what Señor Mendez needed. She appreciated the effort it took to do that.
“Look, Damien. Neither of us has really made a mistake yet. Señor Mendez is in early symptoms, and his condition might well have gone unnoticed for years. What we did was just treat what we saw, which is, really, all we can do when we don’t have the proper facilities to do anything more. I feel horrible that I mistook his symptoms for drug use, but I can’t let that stop me from moving forward with a different treatment. And you can’t let it stop you because all you saw was gout. You diagnosed that properly.”
“And you went from there and diagnosed multiple sclerosis.”
“Because, in my specialty, I have to connect the dots. I look at a broad spectrum of symptoms to figure out what’s going on. Relate one thing to another until I get it worked out. As a surgeon, you don’t do that so much. You fix the specific thing you were called on to fix.”
“But I’m not a surgeon here.”
“Sure you are. Once a surgeon, always a surgeon. You were trained to think like a surgeon, and you were trained to act like a surgeon. That’s what saved Maria Salas and her baby last week.”
“Why are you trying so hard to cheer me up?”
“Because I have something else to tell you. Something you’re not going to like. And I wanted to soften the blow.”
He frowned. “What?”
“I didn’t get around to doing patient assessments. I’ve been too busy.” She knew it really wasn’t a big deal, but she hoped her little distraction from Señor Mendez would defuse the moment.
“That’s it?” His face melted into a smile. “You’re confessing that you didn’t follow my orders?”
“Something like that.”
“Should I fire you?” he asked.
“That’s an option. Or you could go help me do it now.”
Damien laughed. “In spite of my bad mood and your naïveté, we’re pretty good together, aren’t we?” He stepped toward her, reached out and stroked her cheek, then simply stared at her for a moment. A long stare. A deep stare.
For an instant she thought he might kiss her and, for that same instant, she thought she might want him to. But he didn’t. He simply smiled, stepped back, then walked away. And she was left wondering where a kiss might have taken them.
CHAPTER SIX
“NICE OFFICE,” DAMIEN SAID, twisting around to see Juliette’s entire suite. It was in a newer building, in a posh neighborhood, surrounded by other posh buildings and, for a moment, he almost envied her all this civilization. But only for a moment. He’d bought into this kind of a trap once before, and learned his lesson the hard way. “And you’re in charge?”
“Just the United States division. I have five people working directly for me, and the office has another couple of recruiters who have their own staff.”
“I’m impressed. But you ran a family practice clinic in Indianapolis, so how does that translate into this?”
“It’s where I got my administrative experience. I recruited doctors and other medical personnel to my clinic, and it was a large practice, with thirty-six doctors on staff, as well as the associated professionals needed to fill the other positions.”
“Sounds like a big job.”
“On top of my own practice, it was. But it was necessary to maintain the quality of the care we offered. The best care coming from the best professionals.”
“So, does your position here entail a lot of paperwork?” Personally, he hated paperwork. Hated all those details that had nothing to do with the actual medicine he was practicing. Which was why his jungle hospital was turning out to be a nice relief. With the exception of charting patient notes, there was no other paperwork involved. No insurance claims to fill out, no requisitions or vouchers to deal with. No nothing. And it was nice. So nice, in fact, he wondered if he could ever go back to a proper hospital and deal with all the superfluous things outside the actual patient care.
“Paperwork!” She snorted a laugh. “About half my job is the paperwork.”
“And you like that?”
“No. I hate it. But I have to do it.”
So she was diligent in her job, in sp
ite of hating part of it. That was an admirable quality, one he, himself, didn’t possess.
You have a week of charting to catch up on, Damien. Fill out the correct requisitions, Dr. Caldwell. Did you forget to submit an insurance justification for the treatment you prescribed?
Yep, he sure did hate all that. “Which makes a jungle hospital seem all the more attractive.”
“Who are you trying to convince?” she asked.
“Don’t need to convince anybody but myself, and I’m already convinced.”
“As in staying there forever?”
“I don’t commit to forever. Not in anything. A couple years is about as far as I’ll go.” And that was a year longer than it used to be. Of course, he was getting older. Not quite so eager to pick up and move so often.
Damien walked over to a fish tank that encompassed one entire wall, and stared in at the emerald catfish, a particularly shy little creature that was trying its best to hide from him. “So, how often do you get out of here?” he asked, as he was already beginning to feel a little shut in by his surroundings, a condition, he expected, resulting from spending the past year in the wide-open spaces.
“Every day. Sometimes several times in a day, going back and forth between the various hospitals. The job keeps me on the move.”
“And you like it?” He turned around to face Juliette, taking particular note of the feminine way in which she dressed—a long crinkly cotton skirt in tones of green, blue and purple topped by a gauzy white blouse. Nice look. One he wasn’t used to seeing on her.
“Actually, I do. I wasn’t sure about it at first, since it’s so different from anything I’ve ever done. But once I got really involved in the work—All I’m doing is dealing with the means to provide outstanding patient care, Damien. It’s really quite gratifying, especially when you get to see the results of your work the way I do.”
“Meaning, you follow the people you place?”
“For a little while. To make sure they’re the best fit for the job, to make sure they’re adjusting to their new position.”
“Then why work for me? I mean, it’s a long drive, and you get no rewards for doing what you do. Wouldn’t it have been easier to take a part-time position here, in San José, in one of the hospitals you work with?”
