Die Before Your Time (Elia Christie / Luis Echevarria medical mysteries)

by Polonus Mucha, Susan

  “We'll see you when you…” The doors closed before Elia could finish the sentence.

  Chapter 3

  Elia and Luis had made their way through the hospital following exit signs. Luis pushed open a heavy door and hand-in-hand the two walked up a gravel path behind the hospital and sat together on a stone bench overlooking a bay. The sun was setting behind angry clouds, which appeared out of nowhere. The sky was pink and orange with slices of soft white peeking through a gray cover. The bay reflected the sky. The water was a slate of peach and blue marble.

  “Is it serious?”

  Luis put his arm around his bride and pulled her close. “He'll be fine.”

  “He's really anxious.”

  “That's common. He's lost blood and is confused. Everything's blown out of proportion. We'll see him when he's moved to his room.” He traced her collarbone with his fingers. “Then, Mrs. Echevarria, we've got a wedding to celebrate.”

  “Vicente.” Luis reached for Vicente's hand. “Vicente, it's okay. The doctors say you'll be fine.” Elia and Luis had been waiting in Vicente's assigned room in the intensive care unit for half an hour when he was wheeled in from the ER. They stood aside as a nurse and an aide helped him get into bed. Vicente lay still, but his eyes followed the nurse's movements as she checked the heart monitor and recorded his vital signs. He looked up at the bag hanging on the IV pole; dripping blood slithered through tubing. He put his hand to his face and felt the naso-gastric tube that had been threaded through a nostril. A thin piece of adhesive tape secured the tube to the tip of his nose. He traced the tape on his nose with his index finger.

  “Did you hear me? You're fine,” Luis repeated, as the nurse and aide left the room. “That tube you're playing with will come out soon.”

  Vicente continued to run his hand up and down the tube; he pulled up the slack to stare at it. It was a clear tube and tiny clots of blood mixed with a clear solution ran through it.

  “It emptied your stomach. You had quite a bit of blood in your belly.” Luis put his hand under a section of the tubing. “This clear stuff is ice cold saline. It's flushing you out; you're almost clean as a whistle.”

  “My ulcer bled.”

  “We're waiting for the gastroenterologist, a Dr. Ramsey, to do an EGD. Then we'll know more.”

  Elia looked at Luis with questioning eyes.

  “They're going to do an exam with a flexible tube so they can see the lining of the esophagus and stomach.”

  “I'm feeling better. Maybe we can forego the test.” He spoke slowly sounding drugged.

  “The only way to treat you is to determine the cause of your bleeding. The procedure can do that. You know all this, Vicente.”

  Luis turned to Elia and said, “This procedure will show any abnormalities, any tumors, or ulcers, or inflammatory disease.” Luis turned back to Vicente and laid a hand on his arm. “You want to know, don't you?”

  “I know you're right.” He put a hand under the tubes and lifted them in a sign of surrender. “Medicine seems so different from this position, flat on my back.”

  “I talked with the doctor in the ER who treated you. He doesn't expect anything life threatening,” Luis said. “In the future, watch your diet and alcohol consumption.”

  Vicente made a face. “Bland. Now that I remember. Baby food tastes better.”

  “Not necessarily,” Luis said. “Listen to the dietitian when she gives you instructions. There are some clever ways to prepare food.”

  “I don't cook. Neither does my girlfriend.”

  “I'll call your doctor later this evening to see what the test showed. But I have no doubt you'll be fine.”

  It had begun to rain and sheets of water streaked the glass. Palm fronds blown by the wind slapped the window like the chamois strips in a car wash. Vicente's room, like all the others on the floor, was glass enclosed. Nurses could walk by and take quick peeks without opening a door. Tan draperies hung at the edges of the glass walls, ready to be drawn for privacy. A large picture window was off-center on the only solid wall. The view from the window served as art work by the Master: to the right the fourth floor room overlooked the town of Hamilton with its sherbet-colored buildings. Grooved whitewashed roofs topped every dwelling. The grooves guided the falling rain water into specially designed containers that saved it for daily use.

  To the left and docked at the shore was a cruise ship, the only blot on the landscape. In the distance was the Atlantic blurred by the rain and dotted with a small armada of sailboats headed home.

  “Tell us about your girlfriend,” Elia said.

  Vicente smiled. “Angel. Angel Carter. She's a physical therapist at the hospital.” He looked at Luis. “I told her I was going to get your advice.”

  Elia was frowning. “Advice? So you knew you were sick?”

  He shook his head. “No, it's not about me.”

  “Dr. Pereda?” A nurse pushed the door open. She carried a cloth-wrapped package, the size and shape of a dinner tray. “I'm Dr. Ramsey's nurse. He's on his way to do the EGD.” She smiled at the patient and set the tray on a table.

  “Can't it wait?” Vicente asked.

  “As a matter of fact, it can for a few minutes, while he sees another patient. You have visitors; I'll send them in.”

  Raf stuck his head in the door. “I brought company, Vicente.” Raf held the door open for his grandparents. “They're giving us five minutes. They said you're moving to a private room in a few hours, so we'll be able to stay longer tomorrow.”

  “We'll stop back later tonight,” Elia said. She kissed Vicente on the forehead and hugged her brother and grandparents.

  “Oh no you don't,” Raf said. “Go. We'll take it from here.”

  “Listen to the priest,” Luis said. He put his hand on Vicente's shoulder. “We'll see you tomorrow.”

  Vicente tried to sit up. “I have to present my paper. It's important.” He collapsed onto the bed and caught his breath. He shook his head and reached for Luis. “Tomorrow, Luis? I need your advice.”

  “Tomorrow.” Luis patted his shoulder. “Get some rest. We'll talk tomorrow.”

  Luis and Elia closed the door on Vicente and stood outside his room.

  “What do you think?” Elia asked.

  “I wonder what's on his mind.” Luis sounded puzzled.

  They peered through the glass and took one last look at Vicente Pereda.

  Chapter 4

  Elia slid off Luis. He reached out and pulled her closer, and cradled her in his arms while he caught his breath. The ringing of the telephone broke the spell.

  Luis rolled away from Elia and focused on the bedside clock. “Seven-fifteen?

  “Hello?” He said a quick, “Raf?” and swung his legs over the side of the bed sitting on the edge. He listened to his brother-in-law on the other end. “No.” Luis turned to look at Elia, while he held the phone to his ear.

  “Vicente?” Her eyes had opened wide in fear.

  Luis nodded. He asked his brother-in-law some questions. “Thanks Raf; I'll call the doctor. I'll let you know.”

  Luis sat with the phone in his hand, staring into space.

  Elia crawled across the bed and hugged her husband. “Tell me.”

  He laid the phone down, and turned to his wife.

  “Vicente died early this morning.”

  Luis held her while she wept. “He was always so excited to see us when we spent our vacations in Perú. He lived down the street from my grandparents and we did everything together.” She stopped to take a breath. “I think it was our friendship that brought the families together. You know how it is in Perú — everyone lives behind a gated wall, so it's not that easy to get to know your neighbors.”

  Elia smiled through her tears. “I used to think it was Raf he was happy to see, but — oh never mind.” She looked at Luis and frowned. “But he wasn't that sick.”

  “No, he wasn't. Raf said he talked with the doctor last night after the EGD. The test showed erosive gastr
itis.” He reached across the bed for Elia's robe. “Here, honey, put this on. I'll make us coffee.”

  Elia slipped into her robe, and Luis put on a pair of gym shorts. He threw some water on his face and brushed his teeth then rustled around in the kitchenette. He had the coffee dripping when Elia came out of the bedroom.

  “What does that mean, erosive gastritis?” Elia had scrubbed her face to wash away the tears. She ran her tongue over just-brushed teeth.

  “Vicente had a lot of diffused erosions in the mucosa of his stomach. That's not as serious as an ulcer. The bleeding was from the erosions, but the condition wasn't life threatening.” He grabbed a cloth and wiped up spilled coffee grounds. “It's a self-limiting disease, meaning if it was caused from alcohol, for example, or too many aspirins, once those precipitating factors are out of the picture, the patient should improve.”

  “So why didn't he improve?” She sounded as though Luis should know the answer.

  He shook his head. “I don't know. Something went terribly wrong. One thing I do know — he'll have an autopsy.” He set Elia's cup of coffee on a table in front of the sofa, and began prowling around the small living area. “I don't think the doctor could have missed something after the EGD.” Luis poured himself a cup of coffee, brought it to the sofa, and sat down beside Elia. “I wonder if he'd let me look at the chart.”

  Elia paused after taking a sip of coffee, placed her coffee cup on the table, and sat up straight. “We should have stayed with him.”

  Luis nodded. “Hospitals are dangerous places. I encourage all my patients to have a family member or friend stay with them.”

  “Dangerous?” Elia asked. “What can you expect a friend to do? Study medicine?”

  “I tell my patients’ families to think of themselves as advocates — and consumers. If they suspect something isn't right, they should speak up. Call the nurse, and make sure he gets there, pronto.”

  Luis cradled his coffee in his hands. “It's important to ask questions. When the nurse comes in with a medication, especially a new one, ask about it. Make sure the doctor ordered it for you and not the patient next door.”

  “Vicente was a doctor. And he was lucid. I would have thought he could have spoken for himself. Don't you think?” Elia asked, in that tone that begs agreement.

  “I didn't think Vicente needed anyone. You're right, honey, he was lucid. It's not as though he had surgery and was drugged from anesthesia.”

  “But he was drugged. He sounded drugged when we were there.” Elia had tucked her feet under her and was sitting sideways on the sofa facing him.

  “But he didn't have anesthesia. Besides, I'm sure Raf would have stayed with him.” He was silent a moment. “I could have asked him.” Luis paused again. “I should have asked him.”

  “What do you think happened? A relapse ?” Elia paused and said again in a sad tone, “We should have stayed.”

  Luis was silent. He had treated many patients with ulcers and erosive gastritis, the same as Vicente. Ulcer patients can hemorrhage and die. “Maybe. But there must have been an underlying problem.”

  “Heart? Maybe he had a heart attack?” Elia asked. “He seemed excitable.”

  “I had my eye on the monitor all the way to the hospital, and his heart waves were normal. I didn't see any changes. But I didn't see his electrocardiogram in the ER. That would have shown even an old myocardial infarction.”

  “A heart attack?”

  Luis nodded. He got up and started prowling again then leaned against the kitchen counter and looked over at Elia. “I'll never get used to death; doesn't matter that I'm a doctor. I know I just met Vicente, but I see your sadness and I know what it feels…” He didn't finish the thought, but slowly shook his head.

  There was a soft knock on the door. Luis opened it to Raf, who looked drained. “Come in, brother.” Luis gave him a hug. “I'm so sorry about Vicente.”

  Elia stood and held her arms open to her brother. Tears welled up in her eyes. They said nothing for a few minutes, but just held each other.

  “Sit down, Raf,” Elia said. She poured her brother a cup of coffee.

  “I won't stay long.” They sat in silence sipping their coffee. Finally Raf spoke. “What could have happened, Luis? I wasn't given any details.”

  “Who called you? And how did they know to call you?” Elia asked.

  “Dr. Ramsey called me about four because he knew you were on your honeymoon, but he didn't tell me anything. Just that Vicente had died.”

  “We'll go to the hospital and talk to him,” Luis said. “In fact, I'll call him right now.” Luis reached for the phone book and looked up the number of Queen Mother Hospital. He placed the call and was put on hold, then was told Dr. Ramsey would be at the hospital at noon.

  Raf looked apologetic. “I hate that you have to do this, Luis.” He looked at Elia. “And you, Elia.”

  She put her arms around her big brother. “Don't worry about us. It's Mamama and Papá.” Her eyes glistened with tears. “Oh, Raf, how are we going to tell them?”

  Raf grimaced. “I'll do that. I worry about Vicente's parents. I'll call them after I talk with los abuelos.”

  He stood. “Go to the hospital; find out what happened. I'll take care of things here.” He paused for a slight second. “I know this puts a terrible damper on your important day, but there's nothing you can do for Vicente. Try to have a memorable honeymoon. I'm talking good memories. Not this one.”

  Luis rose and clasped Raf's hand in both of his. Raf hugged his sister, and Luis walked his brother-in-law down the path leading from the cottage.

  Raf and Luis had become good friends when Elia introduced them in Perú. When one of Luis's friends and colleagues was mistakenly murdered instead of Luis, the intended victim, at Augusta National Golf Club during the Masters, he and Elia followed the killer's trail to Perú. Raf traveled to Lima from his mission in Colombia to visit with his sister and meet Luis. Before he returned to Colombia, he became involved in the intrigue, one in which his sister and Luis almost lost their lives.

  “Thanks for coming, Raf; we'll see you when we get back from the hospital.” Luis watched Raf walk toward his grandparents’ cottage, while Elia stood at their open door. As Luis turned to his wife, her chin began trembling. He reached for her, and she fell into his arms and cried.

  “What do you think happened?”

  “ I don't know.” Luis put his face in her hair. “I just don't know.”

  Chapter 5

  “They are two strong people,” Elia said after seeing her grandparents. The Amauros had talked with the Peredas, Vicente's parents, and told them they would bring their son home. “Thank goodness Raf's going with them. The Peredas will need him.” Elia was silent for a moment. “Luis, I'm going to Lima for Vicente's funeral.”

  As she spoke, Luis stared at the sea from their private patio, his shoulders drooping. He took a breath, glanced at his watch, put a smile on his face and turned to his wife. “I guess you're right. And I'm not surprised. You go. I'll fly home.” He kissed her lightly on the cheek. “Now, Mrs. Echevarria, We are going to see Bermuda. Ready to go into Hamilton?”

  Elia put her arms around her husband. “Thanks for being so understanding. I love you.”

  “I'm not crazy about you returning to Perú after our last visit there. Talk about memories — bad ones.” He hugged her tighter. “But you'll be a comfort to your grandparents and to Vicente's parents.”

  “I need to go for myself, Luis.”

  “I know that, too, amor.”

  Elia stood on tip toes and kissed Luis on the cheek.

  “I'm ready for Bermuda. Shall we call a taxi?”

  “We'll probably miss out on the Bermuda experience if we don't rent motor scooters at least for one day, but you look too pretty to ride a bike. Let's at least take the ferry into Hamilton.” He took Elia's hand. “Come here.” He led her to the table where he had spread out a map of Bermuda. “Look, we walk up to the main road, catch a bus to H
arbour Road and meet up with the ferry. What do you say? The ferry will take us into Hamilton and to the hospital.”

  “I'm really anxious to get there, Luis. Why don't we come home that way?”

  “Ramsey won't be at the hospital for another three hours, and I doubt anyone else will give us any information. We can take our time getting to the hospital.” He put Elia's hand to his lips and kissed her fingers. “Listen to your brother. He wants us to have some good memories.”

  He turned back to the table and opened his hands, palms down, and moved them across the map. “This is our honeymoon. We're going to do Bermuda.”

  Chapter 6

  Luis and Elia climbed aboard a pink and blue public bus. The aisle was narrow and space was limited between rows. “A sports car has more room than this,” Luis said. His head was bowed. “At least I can stand up. Sort of.”

  Elia looked at the confined area and spied two empty seats side-by-side. “Mind if I sit on the aisle?” she asked.

  “Sure.” After they were settled in their seats, Luis looked at her and said, “What's wrong?”

  “I don't know. I looked at that tiny spot and I just couldn't go there.”

  “You're claustrophobic?”

  “If I am, it's a new sensation. And not a nice one.”

  “You never felt it before?”

  She wrinkled her nose and seemed to be looking into the past. “Yes. When I was down in the catacombs in Lima. Those narrow walkways. And low ceilings.” She shivered. “Since then, I've been leery of tight places.”

  “Not to mention someone tried to murder you. Almost dying can get to you.” His joke fell flat. In Perú she had been hit over the head, thrown into a bin full of ancient bones, shot at, and chased along a narrow cliff high above the Pacific Ocean.