Healer: A Novel

by Carol Cassella

  She opens the front door and hears Addison reading another Web-generated quiz aloud with Jory, leaning over her shoulder and laughing. As soon as he sees Claire his face changes, the playful father replaced by something more serious. Is this the effect she has on him now? How she tips their triangled balance?

  “Hi, guys,” Claire says, shutting the door with her foot. “Smells good. Chicken again?”

  Addison puts his hands in his pockets. “Cook what you know how to cook, I guess.”

  Jory seems exuberant. Oblivious. “Mom, answer these questions and I can tell you what kind of animal you are. If you were an animal, I mean.”

  “Can it wait, honey?” She drops the charts and her purse on the table and kisses the crown of Jory’s head. “I need to talk to Dad about something. Would you mind giving us a minute by ourselves?”

  Jory starts upstairs but stops halfway. “I’m fifteen years old next month. When are you going to make me part of this huge family secret?” Addison gives Claire a frantic look. “I’m going. But would you please look for a house that has more than one shared room—not including the bathroom?”

  After her bedroom door shuts Claire asks Addison, “Where is Miguela?”

  “Out walking. What’s going on?”

  Claire pulls two dining chairs into the kitchen, what has become their unspoken code for an impending argument. Scraping the legs of the chair over the scarred wood onto the cracked linoleum, Claire remembers the parallel tracks from the vacuum that would often mark the thick carpet in their formal dining room for weeks because no one entered it. She sits down; Addison lags behind, then adjusts his own chair a few inches closer to the door before he sits, his legs straddling the laddered back so that it rises like a gate between them.

  “Did Miguela tell you what happened? About the charts?” Claire asks.

  He lifts one shoulder. “It didn’t make much sense to me. She said you went to talk to Dan.”

  “So she didn’t tell you how Esperanza died?”

  Addison cocks his head, as if this unexpected topic upends his defensive wariness. “I thought it was a problem with her pregnancy.”

  Claire rakes her hair off her forehead and starts to say something but stops before any words come out.

  Addison asks, “What? Was it AIDS or something?”

  She takes a breath. “Esperanza was never pregnant. She died of liver failure.”

  He scans her face, blatantly puzzled about the relevance this has for his own family, why Jory shouldn’t be allowed to overhear. “Why did Miguela say she was pregnant?”

  “She must have had ascites—enough fluid to fill her abdomen. It could all look like toxemia—the swelling, the bruising, the confusion. But it was all because of liver failure.”

  “Are you sure?”

  “I saw her labs.” She waves one arm at the dining room table where Esperanza’s chart sits on top of Rubén’s. “It’s all there. Dan remembers her clearly.”

  Addison rocks his shoulders from side to side and leans over the back of the chair, almost provocatively. “Okay. But you still can’t bring her back to life. So, tragic as it is, why are we having this conversation?” He circles his forefinger in between them and hisses, “In here?”

  Claire pauses for a moment, knowing what she’s figured out will sound crazy when she says it out loud. “I think Esperanza was involved in a drug study. I think she died of drug-induced liver damage because she was a volunteer in a new drug trial.”

  Addison looks blatantly skeptical. “Based on what?”

  “I had another patient with liver damage. I got his labs back the day you bought me those earrings, do you remember? I drove all over the valley trying to find him but he’d moved. They had the same phone number listed in both their charts, for a company called Optimus in Wenatchee. I looked it up; it’s a clinical research organization.”

  He pulls his head back and the crease between his eyebrows deepens. “Well, does Dan know the name of the drug? I should have heard something about it if any study volunteers got that sick—that kind of thing travels fast in the industry.”

  “I don’t know if it was ever reported. Dan took Esperanza to the hospital and they put her on a plane back to Nicaragua. Nobody in the U.S. would know she died.” She can see the doubt creeping into his face even before she tells him the rest—the worst. She gets the charts from the dining table and puts them in his lap. “Read the labs yourself. It’s right there—look at the last sections.”

  He opens both folders, turns through the few pages, skimming over the numbers. Then he flips them closed and hands them back to her. “You’re right. It looks like liver failure. But where are you coming up with the theory about a drug study?”

  She opens Esperanza’s record again and shows him the demographics page. “This phone number; it’s the same for both of them. Call it now, if you want. Look it up on the Internet—they have a Web site.”

  Addison’s eyes flick back and forth across Claire’s. She sees the small muscle in his cheek twitch. After a long-evolving silence he sighs. “I’ll find out what I can. If any patient died they would have stopped the study, Claire.”

  “Sure. If they knew about it.” He makes a move to stand up and Claire puts her hand on his arm. “Addison, both Esperanza and Rubén worked for Walker’s Orchards before they went to Optimus.”

  Addison settles back into his chair again, waiting, a hint of defensiveness creeping back into his face. “What are you suggesting now? That Ron is funneling illegal immigrants into drug studies?”

  “No. I don’t know.” Then, almost in a whisper: “Maybe.”

  Addison gets up so fast the chair falls over backward with a loud clap. “I thought you were as excited about this deal as I am. Are you looking for a way to make it fall through? You like living this way?”

  “No. This has nothing to do with the deal. I just… Walker told you he had other biotech companies. Even a research organization. Didn’t he imply you could run the trials on vascumab there? In his own CRO? I like Ron. I want to like Ron. But if he’s doing something illegal I want to find out now. Before.”

  “His holding company owns some CROs. Along with about thirty other businesses. And there’s nothing illegal about enrolling undocumented workers as volunteers in a drug study, Claire—just for the record. As long as they fully understand the consent. They probably get better food and better housing than they do on a farm or in a factory.”

  “Well, how ‘voluntary’ can it be when half of them have no other place to live? And would be too terrified to call the police if something goes wrong?”

  Addison leans against the refrigerator, his head resting on crossed arms. Claire sees his ribs expand under his T-shirt with each deep, slow breath. Finally he says, “Okay. All right. I’ll ask Ron.”

  “Ask him what, exactly?”

  He turns to face her, his cheeks blotched with emotion. “I’ll ask Ron if he’s intentionally poisoning the same people he supports at your clinic!” His voice is full of sarcasm, but something more distressed, too. Doubt. Teetering on the edge of a lost dream.

  “That’s not what I’m saying!”

  He raises one hand toward the ceiling, like it might catch the thread of Claire’s unspoken thoughts. “Then what are you saying? Just tell me. What do you want me to do?”

  And suddenly it is clear to her what she wants, for the first time since she’d seen the same phone number in both Esperanza’s and Rubén’s charts. “I want you to find out who owns Optimus. I want to know if it’s Ron’s CRO.”

  He puts his hands on his hips and stares at the black square of the kitchen window. When he faces her again a shiver runs over her skin. “Fine, then. I’ll go to Seattle tomorrow and talk to Ron. I’ll talk to his lawyers, too. But even if he does—even if the worst of what you’re suggesting is true, Ron has done nothing illegal. I explained this to you that night at the Mayflower; it’s legal to invest in the contract research organization that’s testing the drug you
are funding, and it’s legal to have the whole shebang ethically reviewed by the IRB you own, as long as you don’t vote. It’s also legal to enroll migrant farmworkers as drug study volunteers with informed consent.” He crosses his arms and pauses an instant before he goes on. “And it’s legal for the hospital to buy a migrant a ticket home before they get so sick they are required to admit them and pay for a month in the ICU.”

  He goes upstairs. The house is unusually quiet for a long time, and then she hears another door open. Jory is standing at the top of the stairs with her hands on the banister. She looks like a Dickens waif, with her hair dangling in a tangled mess over her faded nightgown. “You’re fighting again. Aren’t you?”

  Claire shakes her head, but then pinches the bridge of her nose and holds her hand out. “Come down. Sit with me awhile.”

  Jory walks down the stairs so slowly Claire can tell she’s considering going back up with every step. Claire pulls out the nearest chair, but Jory sits in the farthest and hunches forward over her knees, wrapping her arms around her body as if it were still winter.

  “Are you and Dad getting a divorce?”

  “Sweetheart, it’s not…”

  “Will you just answer me? Are you?” Jory asks, tears making her voice hoarse.

  Claire hears Addison moving around in their bedroom, the closet door creaking open and something hitting the floor. She walks around the table and kneels with one hand on Jory’s back, the other on her knee, feels her body tense. “That’s not what either of us wants.”

  Jory’s lips are in a tight straight line. She nods her head once. “So then you won’t. If you don’t want to, you won’t.”

  There is such a decisive tone in her voice Claire knows she doesn’t want a verbal answer. After a moment, Jory goes up to bed without even looking at her mother.

  When Claire goes upstairs Addison’s suitcase is open on the bed. He comes out of the bathroom with his shaving kit and puts it on top of the dry cleaner’s bag holding a freshly pressed suit.

  “Can we talk about it more before you go?” she asks.

  He doesn’t answer, moves past her to the closet, close enough to brush the sleeve of her robe and—does she imagine it?—pull ever so slightly away. She sits on the bed, watching him move from the suitcase to the dresser, into the bathroom again and back to the closet. She discovers she’s counting the items he’s packing to guess the days he’ll be gone; irrationally, ridiculously, she tells herself, but then she watches for his heavy fleece robe, his bulky electric razor, his favorite stereo headphones—items he has always left at home. After enough silent minutes she can’t even remember who should be apologizing first. She grips his wrist as it wrestles the zipper around the overstuffed case. “Addison?”

  He doesn’t answer at first, maybe waiting for her to go on. But after he latches the metal prongs on the lock he looks at her face and his shoulders sag. He sits down beside her so his own weight shifts her body against his.

  “Yes, Claire. I’m coming back.”

  • 34 •

  Claire had not appreciated how rapidly the clinic would swell with patients once the cherries began to ripen. The stream of human hands required to pick and pack the delicate fruit flowed north from the citrus groves of Texas and the California vineyards and the Oregon strawberry fields to saturate the orchards around Hallum. Almost overnight her patient population changes. More men come to see her now, not because Dan is gone but because this seasonal wave of transient pickers often left their wives and girlfriends behind when they crossed the border. They crowded into rusting cars and one-room cabins and trailers, eager to work the fourteen- and sixteen- and eighteen-hour days offered them before the fruit fell worthless onto the ground. Over the winter Claire had been primarily a gynecologist and obstetrician, a pediatrician and marriage counselor. Now she is an orthopedist and surgeon, treating the strains and stress fractures of hard labor, the sprains and broken bones of ladder falls and cracking branches, the lacerations of saws and pruning shears. She is a pulmonologist and dermatologist, diagnosing the asthma induced by inhaled pesticides and the rashes inflamed by fertilizers.

  By five o’clock on Thursday Claire has already seen thirty-eight patients and every exam room is full. Frida looks like she has burned through her last inch of patience. The crush always comes at the end of the day because no worker wants to forgo paid hours, and so they have hobbled on after being injured until the pain or wheezing or immobility drives them out of the trees. By that time their wounds are encrusted with dirt and sweat and the makeshift bandages of torn T-shirts are more a source of infection than protection.

  She is examining an ankle, so swollen she is almost certain there is a malleolar fracture, hunting down the X-ray order forms they can’t keep in stock. Frida opens the door without even knocking. “Would you come to the urgent care room, please. Now.”

  When Claire walks in she takes in several facts immediately: the young man with blood all over his T-shirt and torn jeans is looking at her like she alone in the world knows the only magic that might save him; he is breathing too quickly; he is perspiring in a room that is cool. She can tell he has nearly consumed the last breath of energy a body reserves for escape—knows this from the way his face changes as soon as he sees her white coat. It makes her want to look over her shoulder to find Dan standing behind her with his reassuring and unflappable calm.

  The man is sitting up on the gurney with his interlocked hands supporting his quivering thigh. His left foot has been severed across the metatarsals, cleaving off all but the great toe, which juts at an unnatural angle. Someone, a friend—hopefully, please God, not his boss—has tied an elastic band around his ankle to stop the blood flow, but Claire can tell from the doorway that this is strangling what remains of his foot. It is colored a dusky blue-gray. A fine red spackle fans over the white paper stretched across the vinyl mattress.

  “Buenas noches, señor. Me llama Doctora Boehning. ¿Cómo se llama?” She walks up to him as if this were the most normal of days for both of them, the most typical of injuries. She puts her right hand over his right hand and then slides her first two fingers over his radial pulse—his heart rate is decidedly over 100, probably a combination of blood loss and dehydration and pain. “¿Habla ingles?” He shakes his head and she continues in Spanish. “¿No será más cómodo acostado? ¿Cuántos años tiene?” She is hoping that he will tell her he is under eighteen and eligible for Medicaid.

  Frida brings over IV supplies and a bag of lactated Ringer’s solution and puts a blood pressure cuff around his arm. “How did he get here?” Claire asks, just as glad now that the patient can’t understand her.

  “Two guys carried him in through the back door and got out as soon as they saw me. Ambulance is already on the way.”

  “Great. Can you get the ER on the phone for me? Even better, the surgeon on call. I think it’s Perry.”

  Claire slips an elastic tourniquet around his arm just below his elbow and looks for veins. He is so dehydrated they are slow to fill. But his youth, his lean build, his years of manual labor have blessed him with easy targets for her IV. “Veins thick as steel pipes,” Dan would have said. She scrubs his skin with alcohol, hits the bright red flash almost as soon as she enters the skin, advances just far enough to withdraw the needle and slip the flexible catheter into the lumen of the largest vein running along his forearm. Then she moves down to his ankle and slowly loosens the constricting band. He whistles with a sharp intake of breath and his leg goes rigid.

  Frida hands her the phone. “Ambulance says five minutes. Perry’s on hold here. How much morphine do you want?”

  “Start with two. Put some oxygen on him. Thanks, Frida.”

  Steven Perry doesn’t seem fazed. It is, he says, just the beginning of the picking season and the accidental intersection of farm equipment and human flesh will keep him busy until late fall. By the time the medics come the patient is somewhat comfortable and his pulse is down to 70, but his foot is still an ug
ly color from the ankle down. Frida has already started clearing out the waiting room when Claire comes back; it’s almost seven o’clock. Rosa has rescheduled anyone who wasn’t urgent, and sent anyone who looked too sick, or even just too anxious, off to the emergency room, where they could wait all night to be seen.

  Claire sits in one of the empty chairs while Frida locks the doors. It occurs to her that she has never actually sat in a chair in this waiting room; she’s never looked this closely at just how scarred the walls are and how pitiful the faded health education posters look tacked up to the walls. “These chairs are really uncomfortable,” she says when Frida sits down in the orange plastic chair next to her. “We should get some with cushions. Well, after we pay last month’s electric bill.”

  Frida pulls her stethoscope off her neck and coils it in her lap. “So when are you going to tell me who this ‘we’ is? For real, I mean.”

  Claire searches Frida’s face for a clue about how much information she’s ready to hear. “What do you mean, ‘for real’?

  “I mean, who exactly is going to be working here by the time they’re harvesting apples and we have twice the patients we saw today. Are you still planning to hire someone?”

  Claire raises her eyebrows and sighs. “Sure.” She looks at Frida with a wry smile. “Why? You see a line of applicants somewhere?”

  “Course! That ad we put in the local paper has the phone ringing all day long.”

  Claire nods, too tired to put all the pieces together and laugh. “I’ve got another one ready to go in the journals and medical bulletins. Offering the same whopping salary we get. Maybe I should troll the mortgage foreclosure list looking for homeless docs, huh?”

  Frida doesn’t laugh this time, fiddles with the stethoscope in her lap for a moment before she says, soberly, “You know what I’m asking you.”

  “Yeah.” Claire pushes up from the chair and starts shutting off the lights and the computer. “Let’s go get some dinner. Can you?”