“That was from taking too many over-the-counter headache pills.” The mother insisted on doing all of the talking.
“How long have the headaches been going on?”
Valerie actually opened her mouth to reply, but her mother beat her to it. “A couple of months.”
“Any correlation with the menstrual cycle?”
Mom looked to Valerie, who shook her head, and it seemed even that small move aggravated the pain.
“How long do the headaches typically last?”
“A few hours.” Valerie’s high-pitched, tinny voice sounded younger than she looked. “Sometimes a whole day. Once two days. I woke up with this one today and I think it started last night.”
Lizzie understood that migraines presented differently in adolescents than adults and didn’t usually last as long. So far she hadn’t ruled out migraine.
“Show me where it hurts.” Valerie touched both of her temples. Again, Lizzie understood that migraines in adolescents could be bilateral instead of unilateral as for most adults. “Can you describe the pain?” The teenager gave her a blank look, so she decided to prompt her. “Does it throb or pulsate?”
“Throbs.” Valerie sounded on the verge of tears. “Anything I do makes it feel worse.”
“Have you vomited today?”
“No, but I can’t eat. Just the thought makes me want to barf. Why does this happen to me?”
“I can imagine that these headaches would be frustrating, Valerie. Is it okay if I ask you a few more questions before I examine you?”
The reluctant patient nodded.
After completing a thorough history to establish any symptoms that might precede the headaches like auras, and to help rule out depression and anxiety, since they often coexisted with migraine headaches in adolescents, Lizzie discovered Valerie had pretty classic symptoms. Difficulty thinking, light-headedness, and general fatigue along with the nausea and vomiting and photophobia. Valerie said it even hurt to listen to music when she had the headaches—phonophobia.
With the physical examination Lizzie discovered Valerie also had neck tension and pain, but the rest of the examination, including basic eye exam and neurological testing, proved normal. She still had a hunch her young patient might also be dealing with depression.
Lizzie’s biggest job today would be to make sure these were primary headaches, not secondary to another condition such as a tumor, concussion or sinus disease, or several other potentially life-threatening conditions.
“I’m going to recommend something called a CT scan for now, and once we have that information we can move forward with treatment.”
“Does she have a brain tumor?” Panic sliced through the mother’s voice.
“I don’t believe so, but we need to perform standard protocol testing first. I think your daughter has classic early-onset migraine headaches, and we can treat that.” She glanced at Valerie, who showed the first sign of hope today. “First we have to make sure what’s going on, okay?”
The mother agreed and Lizzie wrote the referral for a stat CT scan at the radiology center the next town over, a forty-minute drive, but well worth it for the concerned mother and daughter. This would buy her time to discuss the medical treatment for adolescent migraine sufferers with Cole tonight in their routine after-dinner meeting.
Now that Lizzie had a car to drop off and pick up Flora from child care at Gina’s every day, she arrived home just in time to nurse her baby and change clothes for dinner. When she showed up at the dining table only Gretchen and Monty were there.
“Cole said not to wait, he had an errand to run,” Gretchen said as she passed a plate of pasta toward Lizzie. “Oh, but he said he’d expect to see you at eight in the library like always.”
Her initial disappointment lessened. “Okay. Thanks.” Lizzie put Flora in her bouncing chair, making sure the sound was off out of respect for Monty. She suspected the elephant and monkey sounds got on his nerves after a while. Flora didn’t seem to notice and immediately started jumping and playing with the attached plastic spinning ball filled with colorful beads.
She helped Monty dish out a few extra meatballs, while wondering where Cole had gone and what he might be doing. She didn’t have the right to any part of him beyond the clinic and what time they shared in his home, but after last Saturday, when he’d bought her the dress with his seal of approval, she’d felt differently about him. Like she might be falling in love. Couldn’t help it. As usual she’d overreacted to his consideration. Was she that starved for attention?
Monty was his usual cantankerous self, complaining about the home-health aide the hospital sent out each day. “Why’d they give me a guy? I can handle letting a woman bathe and dress me. Hell, I don’t even need the help with Gretchen around, and this guy has hands like bears.”
“My condolences to his wife,” Lizzie tossed in drily, hoping to knock Monty off balance and maybe get him to change the topic.
“I doubt he has one,” he grumbled under his breath before shoving in half a meatball. All complaining aside, she was happy to hear him talk so much. Each day his words and strength got better. Such a positive sign.
“Will you let me bathe Flora tonight?” Gretchen made a concerted effort to change the topic, too. “Now that she’s in child care, I miss her so much.” She glanced at the baby and made a silly grandmotherly face.
“You don’t have to do that.” Lizzie missed Flora after her days at work, too.
“I want to. I can get her all ready for you, then you can read her a story and put her to bed. How’s that?”
Lizzie had been making a concerted effort to get Flora in a routine now that she was just about four months old. Bath, nursing, reading a book were all part of her nighttime routine.
“Since you put it that way, I’ll take you up on it, but you have to let me do the dishes.” Lizzie gazed kindly at the silver-haired woman who had stepped in as the matriarch of this ranch, and thought how much she’d miss her when the summer and this job at the clinic ended. She inwardly shook her head, scolding herself for getting involved with everyone and everything in Cattleman Bluff. Especially Cole.
He’d insisted his plan to take her to the charity event was to make sure she had a solid future, but deep inside she wondered if it was just to get rid of her. The sooner, the better.
That thought melted away some of her happy feelings for Gretchen and grouchy Monty as she removed the dishes from the table and walked into the kitchen just in time to see Cole come in. Then a whole new wave of mixed-up feelings took over.
“Hi,” he said, looking steadily at her, his demeanor calm.
“Hi.” Her heart got flighty but she recovered quickly enough. “You need some dinner?”
“I grabbed a bite at the diner in town.”
Why did he need to do that? Had he been as shaken by their moments in the dress boutique the other day as she’d been? He’d been nowhere to find on Sunday, and had seemed to only slip in and out of his office like a ghost all day today.
He kept walking. “I’ll see you at eight.”
She dipped her hands in warm dishwater and stared at the window, hoping to follow his reflection on the glass, but it was summer and still too light out. Instead she turned and watched his broad back as he continued on into the house, those big shoulders she’d come to rely on, then she tried to read the closed-down vibes lingering in his wake.
Fortunately she had a lot to do between now and eight, so she couldn’t stand around smelling the lemon dish soap wondering what was up with Cole, even though she doubted she’d be able to get him out of her mind no matter what.
*
Eight o’clock, Lizzie came prepared for their meeting with a specific goal in mind—how best to treat her new patient. Plus she brought her own mug of tea tonight.
As always, Cole had beat her there and sat reading a medical journal while waiting, the light bulbs casting a yellow tint, making his skin almost golden. He glanced up and smiled, and she thought h
ow much she loved the grooves along his cheeks whenever he did.
“I caught you being good today,” he said.
What part of the day was he referring to? The clinic? The kitchen earlier? “Why does that make me think of grammar school?”
He went thoughtful, his glance downward. “Maybe because my mother used to say that to me.”
“When you were ten?” She was touched by the memory of his mother, but didn’t have a clue what was going on so she took the smart-aleck route.
“Probably.” His smile settled into more of a pensive expression. “But I was talking about your holding your tongue with Lotte at the clinic this morning, and again later in the day when she insisted her way of teaching asthmatics how to use inhalers wasn’t out of date.”
Now she laughed. “Ah, so you could tell I had to zip my lips both times, but mostly for her being so judgmental about my patient.” She put down her mug and stood beside her usual chair.
“Your body language is pretty easy to read.” He shifted forward in his chair, put his forearms on the table. “Yes, that’s exactly what I’m talking about, and I thought you wanted to deck her.” His brows tented and his gaze drifted toward hers. “I especially liked how you explained to her, after the appointment, how sometimes teenagers really are sick. I think she got your point without your blowing up or her feeling reprimanded. Anyway, nice job. Shows me you can learn and change.”
Now his smile came back full force and she decided not to keep being a wiseacre. “If you don’t mind, I’d really like to discuss Valerie’s case with you. Especially the treatment.”
“Of course. We can learn together because teenage migraines are definitely out of my wheelhouse.”
Instead of sitting across from Cole, as she always did, she put her books next to her mug and pulled the chair next to his. “We can read together,” she said, enjoying the scent of his masculine soap. She could sit and stare into his mesmerizing eyes all night, but that wouldn’t help her form an assessment and plan for her newest patient. Sitting beside him would actually help her focus…once she got used to how good he smelled. As if that would ever happen.
She opened the textbook on adolescent health and read about the similarities and differences between adult and adolescent migraines.
“I’ve sent her for a CT scan, which I’ll bet my next paycheck will be negative. But I get the feeling she has some emotional issues going on, too. I think she might be depressed, as well. Can we refer to mental-health clinics?”
“You can. Might be a good idea. But it would be up to her mother to get her there and whether or not to pay for the extra psychiatric care. And the best place would be Cheyenne.”
“I know some people have a stigma about that, but I want to make sure Valerie knows that teenage depression is more common than she thinks. I don’t want her to feel like she’s a freak or anything.”
“Do you think she might open up one-on-one with you? Maybe you could feel out her situation more that way before you refer her to psych.”
“Good point. To her credit, Lotte did fill me in on a few things. Evidently Valerie’s mom and dad got divorced last year and there were some nasty accusations being flung around by the Mrs.”
“So it was a lousy divorce.”
“Aren’t they all?”
“Wouldn’t know, haven’t been married. My parents adored each other.”
Is that why you’ve never married? Afraid you can’t duplicate what your parents had?
He opened his laptop and, rather than discuss marriage anymore, they went to several pharmaceutical websites and studied up on medical treatment for teenagers.
“Jeez,” Lizzie said. “So many of these migraine drugs aren’t approved for adolescents. Our choices are minimal.”
“Well, you don’t want to go too crazy with meds right off. Looks like treatment should be multimodal with nonpharmacological interventions and modifications in daily living first.”
“Agreed. I need to get her on board about noticing triggers and keeping track of what to avoid. That’s another reason I’d like some one-on-one teaching time with her.”
“If you can address her stressors and any potential mood disorders, that’d be a big help, too.”
“We can start her out on nonsteroidal anti-inflammatories and acetaminophen, see how that goes, but the key is to catch the headache early. I’ll have to really drive that point home to Valerie and her mother.”
“Maybe hold off on triptans for now. See how early treatment works, first?”
“Yeah, that makes sense,” she said. “Especially since there’s only one or two of those serotonin-binding drugs FDA-approved for teens, plus she’d have to be able to inject it at school if needed and that’d be a whole other learning curve.”
“Let’s wait for the CT results and go from there. I think you’ve got your plan mapped out well enough for now.”
“Thanks, I feel better discussing it with you.”
Once the business-as-usual portion of their meeting was wrapping up, Lizzie recognized tension rolling back into her. If she’d known how life-altering the simple act of trying on a dress could be on their relationship, she’d never have agreed to do it.
Cole kept looking sideways at her as if there was something he wanted to bring up, and suddenly she needed to move her chair back to the other side of the table. How could one man wreak such havoc with her mind?
He reached into his shirt pocket and pulled out a small black velvet pouch cinched together by a ribbon. “I got to thinking about the charity ball and your dress, and, like Carol said, you need a necklace and earrings to go with it, so I went by the town jeweler’s after work and found this.” He reached for her hand, since her mind was too boggled by his statement to think about physically responding, then he dropped the velvet pouch into her palm. “If you don’t like them, take them back and get something else.”
“I…I can’t accept jewelry from you.”
“Well, you can’t very well wear that dress without a necklace and earrings either.”
“Why’d you do this?”
“How much explaining do you want? Because I haven’t got all night. Now open it and try them on.” His attempt to imitate Tiberius Montgomery fell far short, but it did get across the fact she needed to check out the gift. Or was it a gift? Might he expect something in return?
Nah, they’d been through that already and he’d proved to be the perfect gentleman. Something else that was aggravatingly appealing about him.
She loosened the black satin ribbon and shook out a huge aquamarine teardrop on a braided silver chain, with matching drop earrings, and forgot how to breathe. “This is gorgeous. It’s perfect for that dress. But I can’t accept this gift.”
“Seriously?”
“This seems so personal and we hardly know each other…um, that way.”
“Then let’s be practical. I’m dragging you to a function that requires a certain level of sophistication. It’s my responsibility to make sure you fit in. Trust me, this necklace won’t compare to the jewelry you’ll see there, but it will definitely look good on you. I want you to have it and feel confident.”
She dared to look into his eyes and realized something serious was whirling around behind those dark lashes. This meant something more than going to an upscale job-placement fair, and she wasn’t ready to figure out exactly what that was. Because then she’d have to fully examine all the confusing feelings she’d been carrying around about Dr. Montgomery, and it might set her up to get hurt. “Can I just borrow them for the night?”
He laughed and patiently glanced around the room before answering. “The Cattleman Bluff jewelry store isn’t in the business of loaning necklaces. I bought it for you. Keep it. Hawk it. Return it. Your call. But wear it this Saturday night.”
“Now I’ve ticked you off, and I’ve taken ungraciousness to a new low. Please forgive me, Cole, I’m just not accustomed to a man giving me a dress and a gorgeous necklace. And earrings. Oh, and
shoes. No one has ever done that before and it’s just, well, I don’t know how to describe it.” She’d melted down to the babbling stage trying to explain how big a deal this was, and he’d obviously had it with her.
He stood, leaned over the table and took her by the shoulders. The last time a man had been upset with her and had taken her by the shoulders she’d been shaken up pretty good. She tensed. Cole immediately saw the fearful reaction in her eyes and let up, moving one hand from her shoulder to her jaw, gently cupping it. He bent and moved in and, as delicately as a butterfly, kissed her.
“Do me a favor,” he whispered next to her ear. She felt the shell of his ear lightly on her cheek. His woodsy aftershave still noticeable on his throat. “Humor me and keep the necklace and earrings. I want to enjoy seeing you in them, and I want to know you might remember me whenever you wear them.”
She switched from hard-headed to a puddle of emotion; her hands flew to his cheeks. She kissed him more purposefully than he’d kissed her, and she enjoyed every warm and moist moment. She’d missed his lips. They took their time with the gratitude kiss, but she had no intention of taking it to a different level. Not now anyway. “Thank you. I’ll always treasure this necklace and the earrings because you gave them to me.”
Wisdom must have kept him from kissing her again, even though she hoped he would. But, perhaps more intimate than any kiss could be, they continued to stare deep into each other’s eyes for several more heartbeats. Her gaze flitted around his face, settling on his strong chin and back to those rich brown eyes, searching for some clue for what was happening between them, until it was time to tuck this moment away with all the others and say good-night.
*
Friday afternoon, Lizzie’s last two patients cancelled and she got back to the ranch early. Cole hadn’t been so lucky and was still at work. Once again, she was glad for the independence of using Tiberius’s car. She’d finished nursing Flora, who’d fallen asleep, and she wandered into the living room.
Father for Her Newborn Baby (Cowboys, Doctors...Daddies) Page 11
