Royal Pains

by D P Lyle

  “Something like what?” Divya asked.

  “I don’t know. Nothing I could put my finger on. She just didn’t seem her usual self.”

  “What about now?” I asked. “Have you seen anything since she arrived that would raise suspicion?”

  “Honestly I haven’t had much time with her. There’s been so much going on and so many people here that we haven’t had a chance to sit and chat. But to answer your question, I haven’t noticed anything out of the ordinary.”

  “What types of drugs was she using?” Divya asked. “Back then?”

  “I’m certain about alcohol and marijuana. She told me herself. She said all the kids did it.” She took a deep breath and let it out slowly. “Like that made it okay. I suspected more. Maybe even cocaine. I know her father, Mark, used that some. A few years ago. But my Nicole? I prayed she wasn’t using that.” Her shoulders sagged and she sat back more deeply into the sofa.

  I sat down next to Ellie and took her hand. “I could be wrong. Maybe she was just stressed from all the people and the party and her upcoming wedding. That’s a lot of stress for a young woman.”

  “You don’t believe that,” Ellie said, more a statement than a question.

  No, I didn’t. “I’ve been wrong before.” I smiled.

  “Hank, you can’t con a con artist. Remember, I’m from Texas and we’re professionals at that stuff.”

  I laughed. “Okay. I won’t try. Still, I could be wrong. Keep your eyes open and let me know if Nicole does anything odd.”

  “How would you describe odd for a twenty-five-year-old?”

  She had a point. “Just let me know if she has any episodes of confusion or she appears disoriented. Seems out of it. Things like that.”

  “You’re making me nervous.”

  “I’m sorry. I probably shouldn’t have said anything.”

  “No, I’m glad you did. If there’s something wrong with Nicole I want to know about it. Whatever it is.” She laid an open hand across her chest.

  “Are you okay?”

  “Oh, I’m fine. And yes, I’ve been taking my medicines regularly.” The twinkle was back in her eyes.

  “Make sure you do.” I stood. “You call me if anything changes. With either you or Nicole.”

  By the time Divya and I said our good-byes and reached her SUV, my cell phone was buzzing. I pulled it from my pocket and looked at the screen. Jill.

  “I have the lab results on that waitress friend of yours,” she said.

  “She’s not a friend. She’s a patient.”

  She laughed. “I’m just yanking your chain.”

  “Funny.”

  “Actually her labs are not exactly normal.”

  I listened while she went over the test results, and then thanked her, telling her I would swing by her office later.

  I closed the phone, slipped it into my pocket, and looked at Divya. “Got time to go by and see Miranda Randall with me?”

  “Of course.”

  Chapter 10

  I called Miranda. She was at work. When I told her that we needed to go over her lab results, she asked if it could wait until she got home. I told her it would only take a few minutes. She said she had a break due in twenty.

  It took us only ten minutes to get there, so Divya and I sat at Panama Joe’s polished oak bar and sipped iced tea. Behind the bar, extending its entire length and reaching the ceiling, a shelved glass wall held hundreds of bottles of liquor of seemingly every variety. Two waitresses loitered near the far end, chatting, waiting for the two bartenders to complete their drink orders. Sunlight slanted through the open double doors that led to the deck, where we had had lunch the day of the great jellyfish massacre. A warm breeze followed.

  “Has Evan said more about the van?” Divya asked.

  “No. But he will. You know how he is when he gets an idea in his head.”

  “I’m amazed when he has anything in his head.”

  “You know my brother too well.”

  I felt a tap on my shoulder and turned to see Miranda.

  “I only have ten minutes,” she said.

  “Is there somewhere private we can talk?”

  She looked around. The lunch crowd had descended and the tables were mostly filled, the noise level rising by the minute. “We can go outside. Would that work?”

  I paid for our iced teas and we followed Miranda into the front parking lot. Moving away from the entrance, we settled beneath a shade tree near the edge of the asphalt.

  “All of your lab tests were normal except, as I expected, your thyroid. It’s overactive. Producing too much hormone. That’s what’s causing your symptoms.”

  “Why is it doing that? Did I do something to cause it?”

  “No. It’s not your fault. You have what we call Hashimoto’s thyroiditis.”

  Her eyes widened. “That sounds scary.”

  “It does, doesn’t it? But it’s not. It’s actually common and easily treatable.”

  “What is it? Some awful Japanese disease? I’ve never been to Japan.”

  I laughed. “It’s not awful and it’s not Japanese. Hashimoto is the doctor who discovered it over a hundred years ago, so it’s not exactly new and exotic.”

  “Then what the hell is it?”

  “An inflammation of the thyroid gland. It’s in the family of autoimmune diseases. Things like lupus and scleroderma. In these, the body builds antibodies against itself. In Hashimoto’s, these antibodies attack the thyroid gland. It becomes inflamed and produces too much hormone.”

  “Am I contagious or anything like that?”

  “No,” Divya said. “You can’t catch it and you can’t pass it to anyone. It just happens.”

  “Oh, lucky me.”

  “We have medications for it,” Divya said. “You will feel much better in just a day or two.”

  “I already feel a little better from the ones you gave me yesterday.”

  “Those helped with the symptoms,” I said. “The new ones will correct the problem.”

  “Are they expensive?”

  “No,” Divya said. “Besides, we might be able to get them through the Hamptons Heritage free clinic.”

  “Free? I didn’t know they had such a thing.”

  “Jill Casey, the administrator, set it up,” I said. “She’s also the one that did your lab testing for free. She’s arranged for an endocrinologist to see you about this.”

  Miranda looked at me. “You know I don’t have insurance, right?”

  “It’s a free clinic,” Divya said. “It’s designed for people in your circumstance.”

  “So what do I need to do now?” Miranda asked.

  “Divya will write you a prescription for two medications,” I said. “One will prevent the thyroid from making so much hormone, and one will block its release into the bloodstream. Your thyroid levels will come down and all your symptoms should improve. Then we’ll have you see the endocrinologist and he’ll pick up the ball from there.”

  Miranda blew a wayward strand of hair from her face. It didn’t stay, so she settled it behind one ear. “I don’t really have time to deal with this. I can barely cover my rent and it seems like I have to work all the time to do that.” She looked up at the sky, took a deep breath, and let it out slowly. “Why does this have to happen now?”

  “Like you said, lucky you.” I smiled. “There’s nothing to be afraid of. This won’t turn your world upside down. You simply have to take some medications and then life will go on as before.”

  She dabbed one eye with a knuckle. “Are you sure?”

  “Of course I am. I’m a doctor.” I smiled again. “Take the medications and this’ll be behind you in no time.”

  She glanced at her watch again. “I have to get back to work.”

  Divya handed her the prescription. “Take this over to the free clinic and they will give you the medications. We’ve already talked to them, so they’ll have everything waiting.”

  Miranda folded the prescripti
on and stuffed it into the pocket of her jeans. “I don’t know how I’ll ever repay you.”

  “You don’t have to,” I said. “Just get better.”

  Again she knuckled a tear from one eye. “Maybe a free appetizer next time you’re in.”

  I laughed. “We never turn down free food.”

  Chapter 11

  After leaving Miranda and Panama Joe’s, I headed back to Shadow Pond. Divya had a luncheon engagement with her parents, something she was not looking forward to, since she was sure they would continue pressuring her to leave HankMed and get back to the life she was born to. She loved her parents but hated these discussions, which she saw as interference in her life. Not to mention the healthy dose of guilt they always dropped on her for not following cultural and family traditions. I told her not to worry, that she was tough and had weathered their lectures before. She gave me a hug, saying that’s exactly what she needed to hear.

  I expected to find Evan at home, but when I got there, everything was quiet. No Evan. I wasn’t sure whether that was a good thing or not. Evan out of sight usually meant he was up to something. My money was on his van scheme, but the possibilities were endless.

  I had planned to drag him out for lunch, so I called his cell. No answer. I left a message, asking him to call back. I then called Jill to see if she was free. She wasn’t. Two meetings and a handful of catastrophes. I asked her what catastrophes, but she said she didn’t have time to explain and hung up. I stared at the phone for a minute, considered calling her back, but thought better of it. Best not to rile her when she was already riled.

  I rummaged through the refrigerator and cabinets. Didn’t take long to realize that a trip to the store wouldn’t be a bad idea. I finally settled for peanut butter on crackers and the latest issue of JAMA. I stretched out on a patio lounge chair and began reading. The peace and quiet was wonderful. So wonderful that soon the magazine dropped to my chest and I fell asleep.

  Evan parked next to a fully tricked-out bright blue van at Fleming’s Custom Shop. As he stepped out of his car, Rachel Fleming walked out the showroom door. Tall and thin, she wore tan slacks and a navy blue silk shirt, cuffs rolled to her elbows. The soft curls of her light brown hair framed her face. Her brown eyes sparkled in the sunlight when she smiled.

  “Well, if it isn’t the CFO of HankMed,” she said.

  “At your service.” Evan offered a half bow.

  “Ready to buy that new van?”

  “Actually I stopped by to see you.”

  “Liar.”

  “Okay, so I am here to talk about the new HankMed van, but seeing you is a big bonus.”

  “How sweet of you to say that.” She pulled the door open and held it for him.

  Once inside she led him to one of the vans on the showroom floor. She opened up the driver’s door and let him crawl into the front seat. He settled in and placed his hands on the steering wheel.

  “This one is cool.”

  “Full leather throughout. State-of-the-art navigation system. Bluetooth and iPod connections. Everything voice activated. It even has a hard drive where you can dictate notes while driving.”

  “You’re kidding.”

  “We just finished this one. It’s for a local attorney. He wanted to be able to dictate letters and whatever while behind the wheel.” She indicated a button on the steering wheel. “Simply press the button and start dictating. Press it again when you’re done. You can then wirelessly upload it to a laptop or to a thumb drive through this USB connection.” She pointed to a slot just left of the navigation screen. “This would be perfect for dictating medical notes, too.”

  Evan pressed the button several times, but nothing happened.

  “The ignition has to be on for it to work.” She stepped aside. “Let me show you what’s in back.”

  Rachel swung open the side door while Evan climbed between the front seats and settled into one of the rear captain’s chairs.

  “Look up,” Rachel said. “That’s a forty-two-inch plasma screen that swings down. Grab the handle and give it a tug.”

  Evan did. The screen folded down in front of him. “This is so cool.”

  “You can attach a laptop or DVD or whatever.”

  “You guys are amazing.” He spun the chair around, now facing the rear compartment. The third row of seats had been replaced with a folding worktable on one side and filing drawers on the other. “This is like a rolling office.”

  “That’s exactly what the client wanted. For HankMed this rear area would be configured for medical equipment and storage. We can customize it to fit your exact needs.”

  “You’ve sold me. Now if I can just get it past my brother.” Evan climbed out and walked a lap around the van, ending back where he started. “Impressive.”

  “Want something to drink? Coffee?”

  “Sure.”

  Evan shoved the side door closed. Rachel screamed. Evan froze. Two of her fingers were trapped in the door.

  My lounge-chair nap didn’t last long, but somewhere along the way it must have descended into a deep sleep, complete with a vivid dream. Evan and I were kids. We were at some oceanfront resort with our father. We played on the beach while he sat at an umbrella-shaded table talking with two men I’d never seen before. Dad wore swim trunks and an open shirt, the two men suits and ties. For some reason the table was near the water’s edge and gentle waves lapped at Dad’s feet.

  Somehow I knew Dad was running a scam on the men. Not a big leap. Dad was always running a scam or two. Not sure what this one was, but the men were angry, shouting and pointing fingers, faces red and distorted. Dad stood and tried to leave, but the men handcuffed him and told him he was under arrest.

  Evan began crying.

  I ran to Dad, but before I could reach him, the dream evaporated.

  I woke to the trilling of my cell phone. In my confused state it took several rings before I recognized the sound and answered.

  It was Evan. He talked rapidly, mostly to me, but also to someone else. Took a minute before I realized that he was at the van dealership and the other person was Rachel Fleming. Finally I was able to calm him down enough to understand what was going on. When I did, I told him I’d be right there.

  Traffic was light, so it took only thirty minutes to reach Fleming’s Custom Shop in Westhampton. A salesman led me to a back office where I found Evan and Rachel.

  Rachel’s pictures didn’t do her justice. She was much prettier in person. Of course right now she wasn’t at her best. Her hand lay on her desktop, beneath a plastic bag filled with ice.

  “This is my brother,” Evan said. “He’s the doctor. He’ll fix it.”

  Rachel lifted the ice bag from her hand and I could see that her middle and ring fingers were swollen and purple.

  “Ouch,” I said. “Fingers and car doors don’t mix.”

  “It was an accident,” Evan said. “She was showing me this cool van and I closed the door. Her finger got in the way.”

  “Got in the way?” She shook her head and looked up at me. “I was going to go over to one of those urgent cares or maybe the hospital, but Evan said you could take care of it. Can you?”

  I pulled a chair around, scooted up next to the desk, and sat. “Let me take a look.”

  “It hurts like the devil,” she said. “Throbs like it’s going to explode or something.”

  The middle finger was slightly swollen with a small blood pocket beneath the nail. We call this a subungual hematoma. The ring finger hadn’t fared as well. It had a much larger hematoma and appeared to be slightly out of line near the distal knuckle.

  “It’s not going to explode, but the blood that’s collected beneath the nails makes it feel that way. First thing to do is release the pressure.”

  “That doesn’t sound like fun.”

  “It will only take a minute. Do you have a paper clip and a cigarette lighter?”

  “I’ve got plenty of paper clips, but I don’t smoke. I bet one of the guys in t
he back has one.”

  I looked at Evan. “Go see if you can find a cigarette lighter and a pair of pliers.”

  “Pliers?” Rachel asked. “What are you going to do? Pull my fingernails off?”

  “Yes, and then the wings off a couple of butterflies.”

  She laughed.

  “Maybe I’ll pull out Evan’s nails, but not yours.”

  “I like you,” Rachel said. “I wish my doctor was funny.”

  While Evan was gone, I examined Rachel’s fingers more thoroughly. The nerves and blood vessels were intact, but the middle phalanx of her ring finger wasn’t so lucky.

  “Looks like you have a fracture. Should be simple to reduce, but I’ll have to give it a tug to do it. You okay with that?”

  “Does it hurt?”

  “Only for a very brief second.”

  “Jesus.” She sighed and extended her hand toward me. “Go ahead.”

  I carefully pinched her finger between my thumb and forefinger and said, “Here goes.” I gave the finger one quick pull. She flinched and gave out a soft whimper. I felt the bones settle back into position, the slight off angle now reduced. “There, all done.”

  “It still hurts.”

  “That’s the hematomas . . . the blood pockets. Fractures don’t hurt much. Those do.”

  Evan returned with a pair of well-worn pliers and a yellow plastic cigarette lighter. I unfolded one end of a paper clip so that it extended out at a ninety-degree angle. I grasped the clip with the pliers and began heating the extended tip with the lighter’s flame.

  “What kind of medieval device is that?” Rachel asked.

  “One that works,” I said. “In the ER we have fancy drills for this, but they require applying pressure, which can be painful. This will burn through the nail. No pressure needed.”

  The clip was now heated, so I angled the tip directly down on top of one fingernail. It immediately began to smoke as the hot tip bored through, and when it reached the hematoma, there was a slight hiss and a squirt of dark blood. Startled, she jerked her hand back.