He stared past Zadie, eyes fixed on the horizon.
She stood her ground. “It might even bring you some comfort, Boyd.”
His posture grew uncertain. “I don’t think so.”
“I want to hear what she has to say.”
My head jerked together with Zadie’s and Boyd’s toward the speaker, who had silently come up behind me. Betsy Packard took an elegant step past me, not stopping, and alighted beside Zadie. She reached for her husband’s arm.
“For me,” she said. “Please, Boyd. I’d like to try this.”
His head shook in jowly disbelief. “Why?”
Betsy’s lips trembled, belying her straight-backed poise. “I can’t go on,” she said. “I can’t go on like this, Boyd.” She paused and squeezed her eyes shut. When she spoke again, it was to address Zadie. “I trust you,” she said simply.
Zadie reached for Betsy’s hand.
Boyd withered under the unified female assault, raising his arms in surrender. “Okay,” he said heavily. “Okay, if you want this, Bets.”
“I do.”
For the first time, he aimed his glance toward me. “How about tonight?”
“Tonight’s the Arts Ball,” Zadie and Betsy said in unison.
“Hell,” growled Boyd. “Twenty K for ‘performance’ art and a bunch of fa—men in tights, you’d think I’d remember.”
Betsy addressed me. “We aren’t attending this year, but I’m sure you and Zadie are,” she said, her cultured voice warming me. “How about tomorrow after church?”
I was not a church attender, but in the South this registered as a bizarre personal failing akin to owning four hundred cats or having an unusual sexual fetish. You didn’t bring it up in public. “Thank you,” I rasped.
Boyd pointed a finger at Zadie. “Let’s do next Saturday evening instead,” he decided. “A week from today. You’ll come too?”
“Of course,” she said without hesitation, even though I knew she was spending next weekend downtown on a mini getaway with Drew. She clasped his hand. “Thank you, Boyd.”
He offered a small smile to Zadie, then eyed me again. “Okay. Guess we’ll be hearing what you’ve got to say.”
Chapter Twenty-five
TRY NOT TO WORRY
Autumn, 1999: Louisville, Kentucky
Zadie
Abdominal pain.
All charts in the ER had a chief complaint written across the top, and this was one I felt eager to tackle, having recently attended a lengthy lecture on the topic. People who had completed medical school and a three- or four-year residency in emergency medicine, followed by the successful completion of two rigorous and lengthy exams, one oral, one written—actual board-certified ER doctors—tended to approach the chief complaint of abdominal pain with something less-than-keen excitement. There were plenty of chances for things to go awry.
The chair of the Department of Emergency Medicine was the polar opposite of the fearsome Dr. Markham. Dr. Bernard Elsdon was an energetic, possibly manic beanpole with an odd poof of Einsteinesque hair and a flair for teaching. He resembled an agitated Q-tip, often becoming so overwrought during medical student lectures that he required a change of shirts. He was not exactly a fashion plate—it appeared he owned several identical pairs of shirts and pants—and so when he worked himself into a clothes-changing froth, he could quickly substitute one boring button-down for another. He avoided sport coats, probably because another layer of clothing was not helpful when one was prone to torrential sweating, and simply threw a battered, long white doctor’s coat over his ensemble if he needed to look more polished. Like every other medical student who had not yet had the pleasure of being graded by him, I was enchanted. As with all good teachers, his zeal for his topic was infectious; everyone saw themselves as potential ER doctors during this rotation.
I mentally reviewed the differential diagnosis for abdominal pain as I walked toward this, my very first ER patient of my own. I liked the structure of this rotation: daily seven a.m. lectures with Dr. Elsdon, followed by either a twelve-hour day shift or, if I was finishing the overnight shift, heading home to crash into bed. Each student had two days off each week, which meant despite the mental confusion of switching back and forth between working days and nights, the total number of hours worked in a week was going to be significantly less than on the trauma rotation. I also loved the concept of seeing patients on my own before presenting them to an attending or upper-level resident to review together. The key, I thought smugly, was not to get overwhelmed with the dizzying array of possibilities for what could be wrong, and also to remain calm if all hell was breaking loose. After trauma surgery, how hard could that be?
Concentrating intently, I almost collided with some people flying down the hall, carrying a limp figure. I caught a quick glimpse of a dangling corpse white arm—a man’s arm—as they skidded into one of the trauma rooms, a vivid trail of blood in their wake. Curious, I stood for a moment—where were the EMTs? Were they coming from somewhere else in the hospital?—but then I shook it off. I was here to tackle abdominal pain, not trauma.
I knocked on the door of room 22 and entered. Occupying a metal chair in the corner was a stringy woman of about fifty-five, sitting ramrod straight with her arms crossed in hostile fashion. Perched next to the chair on the exam table sat a massive lady with a face squinched up into a thunderous scowl. Before I could extend a hand and introduce myself, the lady—Mrs. Goodhouse, according to the chart—shifted her ponderous bulk and emitted a room-shaking blast of wrath.
“One hour and forty-five minutes! One hour and forty-five minutes! Like I ain’t got nowhere more important to be. Like I don’t have things I need to get done. And what happens if I up and die in here? How’s anybody gonna know? What kind of hospital just lets you die on them?”
“I’m so sorry, Mrs. Goodhouse. My name is—”
“Sorry! Don’t be thinking ‘so sorry’ gone make anything okay,” interrupted Mrs. Goodhouse. “What happens if I just go ahead and die on you? You gone just keep saying ‘so sorry’?”
“No, I—”
“Well, I’ll tell you about ‘so sorry.’ ‘So sorry’ gone be the fool who did this to me. I am sick. I need something for this now. You best get to stopping this sick and doing something to fix my weave.”
The woman on the chair, still seated with militaristic rigidity, nodded knowingly and fixed me with a stone-cold stare. “Mmmm-hmmm!” she said, her voice rising significantly on the second syllable.
This was not going according to my mental image of my first patient encounter, but I gamely plowed ahead.
“Can you tell me about your abdominal pain?” I asked.
“Abdominal pain? Woo Lord. What in the world you talkin’ about, ab-dom-i-nal pain? Can’t you read? I never said nothing about no abdominal pain.”
“Ah, well, it says here, ‘Patient states she is sick to her stomach.’”
“Why, yes, I am sick to my stomach. Who’s not gonna be sick, they have their hair burned off their head? That not gonna bother you? Uh-huh. I am sick.”
The other woman backed her up again. “Mmm-hmm. That’s right.”
Now thoroughly bewildered, I asked, “You’re here for something about your hair?”
“Are you blind too?” screeched Mrs. Goodhouse. “Look at my head!”
I looked. There was indeed something wrong with Mrs. Goodhouse’s hair. The scalp appeared normal but the hair itself was radiating out from her head in teeny shriveled corkscrews, like the corona on an angry dandelion. There was also a . . . scorched appearance, an impression bolstered by a distinctly unpleasant odor.
“What happened?” I wondered.
“What does it look like happened?” barked Mrs. G. “This damn fool working on my weave put some chemical on there and done burned it near off! What I want to know is how you aim to fix it. I ain’t w
aiting no one hour and forty-five minutes to hear ‘so sorry.’”
I was literally speechless. Chemical damage to one’s weave had not yet been covered in any lecture I’d attended. Was there even a diagnosis for this? And what kind of shoddy triage had led to this being described as “abdominal pain”? It seemed sharing this sentiment with the unhinged Mrs. Goodhouse would be unlikely to result in commiseration.
“I’m just going to consult with a . . . hair doctor,” I blurted. “Be right back.”
The ER was abuzz. People scurried every which way, and several ambulance gurneys tied up traffic in the hall. I wanted to locate the third-year ER resident, a blustery guy by the name of Micah Abbott, although it seemed unlikely he’d be much help in soothing the aggrieved Mrs. Goodhouse. He was even less likely to be fruitful regarding a solution to the hair crisis, since he was blindingly white and bald as a snake. But presumably he’d seen chemical burns to the scalp before and would know how to write a quick note while effecting an expedient, if unsatisfactory, dismissal. After searching every part of our assigned hallway, I finally caught sight of him standing in a crowd outside the closed curtain to one of the trauma bays across the ER, where the noise from some tremendous ruckus was emanating out.
“Hey, Dr. Abbott,” I said, waving at him across the hall as I hustled in his direction. “I have a lady who—”
“Ah, there you are!” someone said, interrupting me. I found myself grasped by the elbow so I was pivoted in the opposite direction. A little rustle went through the crowd outside the trauma bay, many of whom appeared to be staring at me. I opened my mouth to protest but shut it abruptly as I realized the elbow grabber was none other than Dr. Elsdon himself. “Let’s head into my office for a second,” he said.
“But I . . . Shouldn’t I tell Micah about room twenty-two?” I asked, bewildered. Had I screwed up somehow? Surely they didn’t have video cameras in the exam rooms.
“We’ll let him handle that one,” said Dr. Elsdon, walking quickly. We turned down the long corridor outside the emergency department entrance. I remembered Dr. Elsdon’s office was actually located in a separate building connected to the hospital by an underground pedway. This was probably a ten-minute walk. What had I done to warrant such an intervention, and from the chair of the emergency department, no less?
Dr. Elsdon had only one speed: snappy. We hurtled around a corner, where a grim-faced blond woman dressed chest to toe in a startling shade of purple was waiting. I recognized her as Dr. Elsdon’s administrative assistant. Oddly, she was standing next to Emma, who had also been placed on the ED rotation this month—this meant she and I would have alternating shifts—along with James DeMarco, our class president, who was one of the other third-year students on the rotation. James was a tenderhearted guy who carried out his responsibilities as class president in an avuncular fashion, being a few years older than most of his peers. He was the only bearded dude in our grade, and he was gawky and earnest and people absolutely loved him. Our classmates went to him with a litany of troubles: financial, romantic, academic, even, in a couple of disturbing instances, sexual. But he was that kind of guy: people knew they could trust him.
Neither Emma nor James was currently working; Emma had just finished the first night shift, and James was off today. So whatever was going down was not Zadie-specific, then.
“Ah, Mrs. Lukeson,” said Dr. Elsdon. “Excellent. I will turn our third years over to you for the time being. Kids, I’ll see you in a few. Hang tight and try not to worry.” With that admonishment, which was of course the most worrying thing yet, he spun around and strode back toward the emergency department.
“What the heck’s going on?” I whispered to Emma and James as they timidly trailed Mrs. Lukeson. Unlike her boss, she was not endowed with hypersonic energy; her pace was glacial. She glanced backward and gave us a poker-faced appraisal before she said, “Dr. Elsdon said you can wait in the conference room. He wants you to go through some of those old papers in there.”
We waited until she deposited us, along with the threatened stack of journals and xeroxed papers, in a rectangular carpeted room containing a medium-sized table before we began conferring again in heated whispers.
“What exactly are we supposed to do with these?” Emma muttered, flicking aside something entitled A Decision Rule for the Use of the D-dimer Assay in Suspected Pulmonary Thromboembolism.
“Right,” I said. “We can’t read all these. And how did you guys wind up in here? Did anybody say what was wrong?”
“No. We finished the lecture with you, and then we went back into the ED because I had to finish some charting,” Emma contributed. “James went with me because he wanted to observe before his shift tonight. So we were sitting at the doctors’ area behind the main ED desk, and she”—she motioned toward the open conference room door, through which Mrs. Lukeson could be seen at her desk presiding over the entrance to the department’s offices—“came up to us and said we had to follow her. No explanation at all.”
James looked pensive. “There was a lot of commotion over by the trauma room. Even for the ER, I mean.”
“Oh yeah,” I remembered. Micah had been standing there, looking up—guiltily?—when I beckoned to him, a faint impression, which I’d attributed to him being so hard to find. But why was he lurking outside a trauma room?
“Well, why in the world would they want to hide a trauma from us?” wondered Emma. “Zadie and I were on the trauma service a couple months ago. We were in and out of those rooms constantly.”
An answer to that question—an unpleasant answer—was pushing itself into the margins of my consciousness, but I shoved the thought away, reluctant to give voice to it. Emma must have been thinking along the same lines, though, because she said, “Unless it was someone we know.”
“Well, how would they even know who we know?” I asked, realizing a split second too late the answer was obvious. One thing bound the three of us together; since this was our first day on the rotation, Dr. Elsdon and the rest of the ED staff had very little knowledge of us personally.
But of course he knew we were all third-year medical students.
We thought about this silently for a moment, and then James said, in an inappropriately positive tone, “It might be somebody on the faculty. Or somebody famous, even.”
Of course it was possible some celebrity had been cruising around Louisville unheralded and managed to get bashed up in some fashion. But why would such an event require the hasty removal of only the third-year students, leaving everyone else to gawk away? This seemed unlikely.
We amused ourselves for the next hour as best we could, largely ignoring the option of reading the elderly emergency medicine journals, although we did thumb through some of them to look for gruesome photos. At last we heard the phone ring in the outer chamber of the ED offices, and unlike with previous phone calls, Mrs. Lukeson gave this one away by flicking a quick glance in our direction as she lowered her voice to answer. We could not discern much.
“. . . yes, yes, fine, still sitting . . . How did . . . ? Oh no. Oh, poor . . . Yes, I’ll . . . Oh dear. Okay. Yes. Yes, of course.”
She hung up the receiver and stood, smoothing her purple skirt, and then ambled in her poky fashion down the hall toward us. For once, she did not look fussy. She looked . . . sad.
“Dr. Elsdon is on his way to get you,” she said, not meeting our eyes. “He’ll be here in five minutes.”
Chapter Twenty-six
NO EASY WAY TO SAY THIS
Autumn, 1999: Louisville, Kentucky
There were two ways to reach the academic offices of the Department of Emergency Medicine. Most people—employees, civilians, visitors, mailmen—used the front entrance, a set of glass doors facing a large foyer with elevators and fake ficuses and directories to all the various other medical departments in this building. Mrs. Lukeson reigned at her desk in an open space with severa
l carpeted hallways branching off behind her, one of them leading to the conference room in which the three of us waited. The less conventional means of approach to the department involved the subterranean tunnel coming from the main building of the hospital. It was ancient, with a concrete floor and tenuous fluorescent lighting, and seemed to narrow imperceptibly as you traveled it, so by the time you neared the end, you were somewhat panicked even if you’d not previously considered yourself claustrophobic. In the million years or so in which it had been in existence, no one had ever thought to attack it with a duster, so the ceilings were festooned with creepy swaths of cobwebs. It was one of a series of tunnels referred to as the “Catacombs.”
The entrance to the Catacombs from the academic building was right next to the conference room in which we sat, so we could hear Dr. Elsdon approaching well before he pushed open the door to the reception area. He had a characteristic canter that did not seem to be diminished by today’s events, whatever they might have been. And since he generally barreled around with an entourage, it was impossible for him to sneak up on anyone. It sounded like they might have been charging in on horseback. As the footsteps got closer, it was plain he was in fact not alone; judging by the noise level, there were at least a couple of people trying to keep up.
When he finally did appear, he was quiet, pausing at Mrs. Lukeson’s desk to murmur something to her and to introduce his companions. Emma, who had a better view through the open conference room doorway than I did, stiffened in surprise. “It’s Dr. X,” she hissed.
I craned my neck. It was indeed Nick. Unlike us, he was still on the trauma service, since the chiefs did their rotations in three-month blocks. He must have caught sight of my movement, because he turned and looked directly at me. His face was unreadable. There was also a woman with them whom I did not recognize. She had frizzy gray hair and was evidently unconcerned with fashion; she was wearing a dress resembling a bathrobe made from some bluish pilled material. Dr. Elsdon turned and saw the three of us staring in his direction, and he at once made for the conference room, sweeping in with Nick and the bathrobe woman behind him. Nick closed the door.
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