Did it mean that the massive amount of steroids Patrick was taking would slow down the fast-moving march of that awful disease through his body? That the drugs would give him time? Because he was running out of it.
There was no time to waste, for either Luke or Patrick.
Time.
It dawned on Ruthie that time was the real issue here, the lesson that was trying so hard to be taught. Time was precious, it was fleeting, it was not in her control. She had been wasting time, treating it as infinite. Not valuing the life she’d been given, coveting what she didn’t have. Wasting time. Wasting it! Time should be cherished. Every single day.
Isn’t that what Patrick was all about? Cherishing the life he had, the time he had left. Every single moment.
Ruthie remained at the table until darkness ebbed away outside the kitchen window. Pale red and orange clouds streaked the morning sky, as lovely a sight as she’d ever seen. A strange peace enveloped her, slowly at first, then filled her from head to toe. What was this? It was so real. Nothing she could touch or see, but a certainty that settled into her soul. Everything was going to be all right.
Could this feeling be trusted? Or was she just hoping so much it was true that she had imagined it?
Hope could be like that.
But not without trust in God, her father always said. They’re inseparable, like a man and his shadow.
Over the weekend, the steroids had no impact on Patrick. Dok tried to connect with Ed Gingerich to see what he planned to do next. Her call went to his voice mail after the eighth ring, which was very typical. Why did it take Ed so long to answer his phone when he kept it with him at all times? Today, she had no time to speculate.
Ten minutes later, Ed called. “Hey there!” he said, his voice chipper. “Did I miss your call?”
He hadn’t bothered to listen to her voice mail. So why did she bother to leave them? Perhaps unreasonably, she found this carelessness to be infuriating. “The initial dose didn’t work.”
“What?”
“Patrick Kelly. The steroids aren’t working.”
“Ah. The MS patient.” She could practically hear his mind pulling up the Kelly chart. “Okay. Let’s try another round. I’ll send down the order.”
“Ed, you’re giving him massive infusions of drugs. It’s not even making a dent.”
“I know what I’m doing, Ruth.” He sounded testy. “I’m waiting for a final MS test to see if there’s a certain protein present.”
In the background, she heard a nurse ask Ed some questions and could tell his attention was distracted. “I’ll let you get back to work. Just let me know when the test results come back in.”
He assured her that he would, but she doubted he’d remember. Instead, she called his office manager, Phyllis, his right-hand man—in this case, a woman—who adored her boss but sympathized with Dok over how hard it was to track Ed down, and asked her to call as soon as Patrick’s test results came in.
Dok spent the afternoon researching the latest studies on vitamin B-12 deficiency in every online medical site she could track down. When Phyllis called to give her the test results, she knew she was on to something. “Phyllis, where is Ed right now?”
“At the hospital.”
She drove straight to the hospital and found Ed on the surgery floor.
When he saw the look on her face as she walked toward him, his smile faded. “You’ve got news.”
“I don’t think he has MS,” she said.
“Who?”
“Patrick Kelly. I think he has hypocobalaminemia.”
Ed stopped. “Tell me more.”
“That low B-12 vitamin number—the second test came back with the same result. I did some digging today and I think it might be possible that his low B-12 has precipitated subacute combined degeneration.” She handed him the articles she found.
Subacute combined degeneration, caused by a vitamin B-12 deficiency, was a disorder of the spine, brain, and nerves. It mainly affected the spinal cord, but its effects on the brain and the peripheral nerves were the reason for the term “combined.” At first, the myelin sheath covering of the nerves was damaged. Later, the entire nerve cell was affected. As the disorder progressed, it spread to muscle weakness, abnormal sensations, mental problems, and vision difficulties.
Ed’s face went blank as he skimmed through the articles, then he went into action. “Give me a few minutes to get some supplies, then meet me at my car.” He headed toward the elevator.
“We’re going to see Patrick?”
He pushed the button and turned around as it opened. “We’re going to see Patrick.”
23
Rose King met Ed’s and Dok’s cars as they caravaned to the Inn at Eagle Hill, a worried look on her face. “I’m so glad you’re here,” she said to Dok, relief in her voice. “Patrick’s mother wants to take him to the hospital and I think she’s right. He seems to be getting worse.”
“Where’s Ruthie?” Dok asked. She wanted her to be a part of this, for Patrick’s sake.
“Patrick’s mother sent her home. She’s rather . . . protective. A little austere for my liking.”
Patrick’s parents sat in chairs by Patrick’s bed, looking as if they’d seen a ghost. And in a way, they had. Their son was a ghost of his former self.
Even Ed seemed alarmed at Patrick’s declining condition, and he was not easily alarmed.
“What’s happened to our son?” Patrick’s father said, his voice cracking in a way that sounded both sad and desperate.
Ed took the lead. “We think Patrick might have something other than multiple sclerosis. It’s very possible that he has developed a vitamin B-12 deficiency. I’m going to give him a B-12 injection.” He opened his medical bag and pulled out a syringe, then filled it with the vial of B-12.
“Why?” Patrick’s father said. “What would have caused such a thing? A few months ago, he was fine.”
“For some reason,” Ed explained, “there’s an enzyme in Patrick’s stomach that stopped absorbing B-12. We don’t know why it happened spontaneously but the consequences are dire. You can see that for yourself. Your son’s entire nervous system is shutting down. Ceasing to function. He’s on track to die.”
Appalled by Ed’s abrupt bedside manner, Dok hastened to soften his harsh words. “But these injections will hopefully reverse that track. If this works, and we think it will, Patrick will see strength returning. The lesions will heal.”
“Do you mean . . .” his mother asked, her voice incredulous, “he might be all right?”
Dok gave her an encouraging smile. “A full recovery will take months, plus he’ll need physical therapy. But, given enough time, it’s very possible he will be just fine.”
Ed swabbed Patrick’s upper arm with a cotton ball dipped in rubbing alcohol and gave him the injection. “I have to warn you, we’re not sure if this is the answer to your son’s malady. But if we’re right, you’ll know pretty soon.” He disposed of the syringe and packed up his bag, then turned to face Patrick’s parents. “He’ll need injections every two weeks for the rest of his life, but he will be able to live a normal life.” He rose to his feet. “I need to get back to the hospital. Dr. Stoltzfus will take it from here. She can answer any questions you have.”
Patrick’s father, unable to speak, shook Ed’s hand up and down.
“Thank you so much,” Mrs. Kelly said. “You’ve given us hope. We arrived here with no hope.”
“Well, put that way,” Ed said, obviously delighted by the commendation, “you’re very welcome.”
Ruthie waited until a reasonable hour, then hurried over to see how Patrick was doing this morning, to see if the vitamin B-12 injection made a difference. Dok had stopped by the house to update them, but suggested she wait until today to visit Patrick. That wasn’t hard; she was uncomfortable in his parents’ presence. Not so much his father, but his mother. All yesterday, his mother remained stone-faced, processing the news of her son’s sudden and devastat
ing illness. But Ruthie could see herself responding the same way if she found herself in a bleak situation.
Still, her heart sank when his mother opened the door to her knock. “Is he stronger?” Ruthie blurted out.
“Not stronger.”
She shrank back. “Isn’t there any improvement?”
Mrs. Kelly squared her shoulders in a gesture Ruthie was already coming to recognize. A way to indicate that Patrick’s well-being was really none of Ruthie’s business. “My husband thinks he seems more coherent. Less confused. But I think it might be that he feels better in the morning.”
“Is your husband in with him?” She hoped to be invited in, but from the grim, stern look on Mrs. Kelly’s face and the way she was blocking the door, it wasn’t looking like an invitation was forthcoming.
“He went to town to purchase some food.”
Ruthie remained on the doorstep. “I brought Patrick a gift.” She bent down and picked up a birdcage with a black mynah bird sitting on a perch. “His other bird . . . Nyna . . . she had an untimely accident. This is a replacement. I thought it might cheer him up.”
One of his mother’s stiff eyebrows lifted. “With so much going on yesterday, I didn’t even think about that ridiculous bird. He loved that bird.” A thin smile started, then took on fuller life. Ruthie, in that instant, knew she had made a tiny bit of progress to win her over. “You go on in. The company will do him good.”
Birdy had brought home the mynah bird from the Wild Bird Rescue Center. It didn’t look exactly like Nyna, but close—black as coal, and every bit as noisy. Ruthie barely slept last night for its unceasing racket. She knocked on the bedroom door and let herself in. Patrick had pillows propping him up. His Bible was open and on his lap.
“Am I interrupting?”
“You’re never an interruption,” he said shakily. He tried to give her a smile, but it ended up looking weird. He was so pale, so terribly tired looking. Even his lips were white. His voice, though, sounded a little stronger. Certainly more clear, more distinct than last night. When she had asked Dok why Patrick had trouble enunciating, she explained that his muscle control was affected, and the tongue was the strongest muscle in the body.
“I brought you something.” Ruthie went back to the doorjamb and reached around it to pick up the birdcage. It was heavy and bulky and she needed both hands to hoist it up on the nightstand beside his bed. “Birdy said this mynah bird was brought in to the rescue center. She thinks it’s young, so you can train it.” She looked down at his Bible, with so many verses underlined in it. “Maybe you can teach it Bible verses, just like the other one.”
Patrick’s face was pained. He was silent for a long time.
Had she made a mistake? Too soon? But . . . there was no time to waste. Hadn’t she been learning that very thing from Patrick? If you wanted to do something, you should do it. Don’t wait.
He kept his eyes averted from her, but his Adam’s apple kept bobbing. “Ruthie, thank you . . .” His voice trailed off and she was surprised to see tears fill his eyes.
She sighed in relief. “I’m so glad you want it. I wasn’t sure. I know it’s no substitute for Nyna, but I thought . . . I hoped it might help pass the time while . . .” While what? While he lost more ability to move? To walk? To talk?
She had no idea. All she knew was that this was one thing she could do.
He hesitated, seeming to choose his words with care, slowly and ponderously. “It’s perfect, Ruthie.”
She went to the little kitchen to get a water bowl for the mynah bird. It took her a moment to find the right-sized bowl. She filled it with water and carefully brought it back to Patrick’s room, then stopped abruptly at the open door. Her mind started racing. It was strange how when you were looking hard enough, when you really wanted to seek out information, you could find what you were looking for. Even in a person’s tiniest gesture.
“Mrs. Kelly,” she said softly. “Would you come here a minute?”
Patrick’s mother appeared at the bedroom door. “What is it? What’s wrong?”
“Look.”
“What?”
“He’s holding the bird.”
It dawned on Patrick what he had done. Leaned over, opened the cage—which required twisting the catch—putting his finger out for the bird to climb onto it. “I did it without thinking . . .”
“I’m going to call Dok.”
As Ruthie ran to the phone shanty, a rush of crazy possibilities whirled in her mind. Was Patrick going to be all right? Or was this just a spurt of energy, a path of twists and turns as the disease progressed? There was no way, no way at all, that Patrick could have picked up the bird last night. Or twisted the lock on the cage. Or leaned over to open it without help. No way. Or could he have? She didn’t know! She was shaking as she dialed Dok’s number and blurted out what she’d observed as soon as she answered.
“On my way,” Dok said, all business.
Within minutes, Dok arrived and went straight into the bedroom to examine Patrick, closing the door behind her. Ruthie and Patrick’s mother waited anxiously in the living room. His father returned with a bag of groceries. His mother filled him in on what had transpired in the last thirty minutes. When he finished putting the groceries into the cupboards, he sat on the couch next to his wife and held her hand.
Finally, Dok opened the door. “Come in,” she urged. “Come in.” They surrounded Patrick’s bed, his parents on one side, Ruthie on the other. She realized she was holding her breath.
“Sometimes,” Dok said, “there’s a simple explanation to a complex problem.” At the end of the bed, she smiled at Patrick. “Go ahead. It’s your news to tell.”
Ruthie heard a little high-pitched gasp escape from her own throat. There were more emotions swirling around inside her than she could hold back. Her heart was pounding so hard it hurt. It actually hurt. She felt as if her heart might just explode.
Patrick laughed, then gulped in air, then laughed, then gulped in air. “Mom, Dad, Ruthie . . . Dok thinks the vitamin B-12 is working. She says everything’s going to be all right.”
A bubble of unbridled joy, of sheer relief, rose up inside Ruthie, but she pushed it down, was almost afraid to let herself feel happy quite so soon. It was a quietly miraculous moment, a moment she knew she’d never forget for as long as she lived. “I have chills,” she said, half laugh, half sigh.
“Me too,” Patrick’s father said, as a rush of breath left him. He was struggling to contain his emotions.
From the other side of the bed, Ruthie could see the sheen of tears in Patrick’s mother’s eyes, tears she was doing her best to hide. She was a private person, not comfortable with showing her feelings. Something else they had in common.
Dok felt no such compunction. She looked jubilant. Victorious. Triumphant. “This,” she said, “is why I love medicine.”
Two days later, Dok stopped by the cottage to check on Patrick and was amazed to find him standing in the kitchen with his dad, working on a crossword puzzle together. She had warned his parents that it was going to take a while for Patrick to get back on his feet. And there he was, on his feet! She was astounded by his rapid recovery, by the return of his physical strength, by his healthy appearance. Gone was the look of utterly debilitating fatigue, the dark circles under his eyes, the countenance as meek as a lamb. Today, Patrick was radiant.
This one went into Dok’s Miracle Box. She’d seen a few over her years in medicine, but this might be the best one of all.
Ed mocked her Miracle Box, insisting that everything had a scientific explanation. Even vitamin B-12 deficiency. Maybe, she agreed, but what about the timing of the discovery? Not a day to spare. That credit, she knew, belonged to God alone. That was a direct answer to heartfelt prayer.
And wasn’t it also a miracle to see the ravaging effect on the body from the absence of one vitamin? Just one vitamin. Without the absorption of B-12, Patrick could very likely have been dead by now. Instead, he was standing i
n the cottage kitchen, chewing over a crossword puzzle, trying to find a six-letter word for consolation.
“Relief!” Dok blurted out, struck by its irony.
Patrick and his father had a good laugh over that. Even his mother offered up a rare smile. It was a word that should have been on the top of everyone’s mind.
As Dok drove away from the cottage, she let her mind drift over the intricacies of the human body. They never failed to enrich and expand her faith. It was what made medicine so meaningful to her—it drew her to a genuine awe and delight in the Creator.
That afternoon, with Ruthie’s help, the last few boxes in Dok’s office were unpacked and everything was good to go. All Dok needed now was more patients.
Each day, more and more Amish called the office to make appointments or to ask Dok to swing by their home for a house call. It was going to take time, but she had the time to give it. The time and the patience, two qualities she’d never experienced together.
Ruthie stood at the doorjamb of the one exam room with a big box in her arms. She lifted the box. “Cotton balls and tongue depressers. The UPS driver said he wished all boxes were this light.” She set the box on the counter. “Patrick is improving leaps and bounds each day.”
“Funny, I was just thinking about Patrick. I couldn’t be more pleased about the outcome.”
“Dr. Gingerich was certainly pleased. I noticed he didn’t bother to correct Mrs. Kelly’s assumption that he was the one who had discovered the correct diagnosis.” Ruthie fixed her eyes on Dok. “You figured it out.”
Dok waved that concern away. “Getting credit is unimportant. And Ed did play a part. He ordered the tests, he tried to help manage or relieve Patrick’s symptoms. In the end, Patrick got the help he needed before it was too late. That’s all that matters.”
“Jesse is taking Mrs. Kelly on a buggy ride later this afternoon.” Ruthie smiled. “We’re trying to show her the best of Amish life, to soften her up a little.”
“She’s as sour as a pickle, isn’t she? But I can’t blame her. She’s almost lost her son twice—once to a culture, once to a disease. I think I’d be a mama bear too.”
The Devoted Page 24
