Diagnosis Death pft-3

by Richard L Mabry

  "Sorry, I'm simply relaying the message."

  Elena tried to put the matter out of her mind until time for the meeting, but with little success. It was all she could do to concentrate on her duties for the afternoon. She gave silent thanks that her patients presented straightforward problems: congestive heart failure, early peptic ulcer, migraine headache. She ordered the appropriate diagnostic tests, wrote prescriptions for the proper medications, arranged for referrals to staff specialists when necessary. Somehow she got through the afternoon.

  Next she had to finish her clinic charts, go over some X-rays and lab reports, return about a half-dozen phone calls, and change into a fresh white coat before her meeting. She managed to do all this, even run a brush through her hair and redo her ponytail, before she tapped on the open door of Amy Gross's office at precisely five o'clock.

  "You wanted to see me?" Elena waited for Dr. Gross to look up from the papers she was signing.

  "Oh, Elena. Come in. Have a seat." The woman motioned toward the couch on the far side of her office. "Let's sit down over there so we can talk without the desk between us."

  Elena took this as a good sign. If Dr. Gross planned to deliver bad news, she'd do it from behind her desk, putting a barrier between them.

  Elena sat at the end of the couch. Dr. Gross took a seat beside her and half-turned to face her.

  "I'm sure you're curious about this 'summons.' " She made quote marks with her fingers to set off the word. "But it's good news, I assure you."

  Elena felt the pounding headache she'd experienced all afternoon ease a bit. "Well, I could use some good news."

  "I understand you talked with Dr. Bennett this morning."

  Elena nodded. She didn't think she could have said a word even if she wanted to. Her throat was in a knot at the reminder of the bombshell Helen dropped on her this morning.

  Dr. Gross continued. "Helen called me at home Sunday afternoon, right after she decided to take the job offer from Lincoln Clinic."

  Elena remained silent.

  "You may not believe it, but it caused her a great deal of pain to go back on her offer to you. Both she and I have made lots of calls trying to find something for you. I even looked into the possibility of your working in an emergency room somewhere."

  Elena knew that was a possibility, but not one she wanted to consider. In that situation, there'd be no continuity of care. No way to establish a rapport, a long-term relationship with her patients. That wasn't the way she wanted to practice medicine. She hoped that wasn't what this was about.

  "But I think I have something better for you," Dr. Gross said. "I got a call shortly before noon from one of the doctors who did her family practice residency here at Southwestern. Do you remember Cathy Sewell? She would have been a couple of years ahead of you in the program."

  "I know who she is, but we never had a rotation together and neither of us socialized much, so I don't know a lot about her."

  "She went back to her hometown to set up a solo practice. That's in…" Dr. Gross pulled a pair of reading glasses from the breast pocket of her white coat and consulted the yellow legal pad she held. "That's in Dainger, Texas. She's pregnant, and she's looking for someone to take over her practice while she's on maternity leave."

  "When does she need someone?"

  Amy frowned. "She needs someone right now. She's less than two months from her due date. She had a retired doctor lined up to fill in for her, but he was just diagnosed with colon cancer, so he's not coming."

  Elena felt hope stir in her chest like the flutter of a bird's wings. Then she saw it-the downside. "Does she want someone temporary? Is this a locum tenens situation?"

  "Not necessarily. Bringing in the retired doctor was a stop-gap measure, but I think she'd like to find a younger doctor to take into the practice. There certainly seems to be room for expansion. If things work out well with you, she could offer you an association. That's a bridge you'll have to cross when you come to it." Dr. Gross tapped her glasses on the legal pad to emphasize her words. "But I think this is the best you can expect with such short notice. I wouldn't turn it down if I were you."

  "Did she give you any more details?"

  Dr. Gross shook her head. "She'll do that herself." She tore the top sheet off the pad and handed it to Elena. "Call her. She'd like you to come up this weekend to meet with her. It's only about an hour and a half drive. She'll show you the setup there, talk with you about possible arrangements." She put the pad on the coffee table in front of her and returned the glasses to her pocket. "I've given you a high recommendation. I also told her a bit about your history, about Mark. In fairness, I think you should give her the full story. I believe you'll find her quite understanding."

  "Dainger?" Elena said. "I'm not sure that's a very reassuring name."

  Dr. Gross chuckled. "I commented on that when we talked. Cathy tells me it was named for some early settler. I don't think you'll find it very dangerous at all."

  "Well, I'll certainly be glad to meet with her. Thanks so much for your recommendation."

  Dr. Gross rose and extended her hand. "Get someone to look in on your hospitalized patients while you're gone. And I really hope this works out for you."

  It was almost seven when Elena pulled out of the medical center parking lot, and traffic had thinned a bit. All the way home, she alternated between elation at the possibility she'd have a position when her residency ended and fear that she was about to jump into a bad situation.

  Who had ever heard of Dainger, Texas, anyway? She had a vague notion that it was somewhere northwest of Dallas. Well, driving directions would be the least of her problems, thanks to MapQuest and Google. What worried her more was not knowing what she'd find when she got there. Other than what she'd learned about how the name came about-and that was pretty vague-she had no idea what the town was like. But it didn't matter, did it? It sounded like a chance to get a fresh start. And she certainly needed that.

  What about Dr. Cathy Sewell? Right now, that was a familiar name, nothing more. She had a vague recollection of a petite blonde doctor who did her work well and seemed pleasant enough. When Cathy finished her residency, she disappeared off Elena's radar screen. Of course, even if she'd still been around, Elena wouldn't have noticed. She was too busy with Mark, first their courtship, then their marriage, and then…

  Elena felt her eyes clouding. Her breathing came faster. The shaking of her hands made the car jitter back and forth. She pulled off the busy street and into a mall parking lot, where she put her head on the steering wheel and let the tears flow freely.

  "Excuse me?"

  She looked up to see an older man, dressed in jeans and a sport shirt, standing beside her car. He tapped on the closed driver's side window. "Ma'am, are you okay?"

  She pulled a tissue from the box on the seat beside her and dabbed at her eyes. She felt her nose dripping but wasn't about to blow it in front of this man. She gave it what she hoped was a lady-like wipe and crumpled the tissue in her hand before lowering the window. "I'm… I'm fine. I just-" She bit off her response. No need to explain. He didn't need to know.

  The man leaned down to her eye level. "Is there anything I can do?"

  There was nothing anyone could do. What was done was done. But there was no reason to go into that, either. "Thank you, but no. I need to sit here a moment and collect myself."

  It seemed that he might be ready to start a conversation, and she steeled herself to rebuff any efforts to get her to open up about her problem. No one needed to know about it, because no one could help. Instead, he nodded and straightened.

  She had the window halfway up when he turned back and said, just loud enough for her to hear. "I'll pray for you." Then he disappeared between the parked cars.

  Elena entered her apartment that night to the accompaniment of pounding pulse and jangling nerves. As she crossed the threshold, she asked herself once more, "What's wrong with me?" She was an intelligent woman, a trained physician. There were no
demons waiting in the darkness. True, once this apartment had been a home, and now it was only a place to sleep and eat and mourn. But that was no reason to let her grief take over her life.

  Then again, it wasn't just the grief. There were the phone calls. If she'd heard heavy breathing or a torrent of obscenities, she'd know what was going on. She could handle that. Any single woman living in the city knew such things occurred. But these calls were more than that. And she thought she finally knew what they represented.

  Elena dropped her backpack, slammed the door, and turned on the TV for company. The mail went onto the small table beside her armchair. It could wait. First, a shower and a cup of tea.

  Clean, but in no way refreshed, Elena dropped into the easy chair and considered the mail. There was never anything good there anymore. The condolence cards and letters had dried up. She had no family to send her cheery notes. Only her creditors and the people wanting her to spend money she didn't have now accounted for the handful of mail she received.

  The envelope was there between her MasterCard bill and an ad for a new textbook. The envelope was a cheap, self-sealing one, addressed by hand in block capitals using blue ballpoint. Two different stamps were affixed to provide the proper postage. The blurred postmark gave no indication of the city of origin.

  Elena ran her finger under the flap and pulled out a single sheet of paper from a lined tablet.

  The message was printed in the same block capitals. At the end, the writer had pressed down hard enough to penetrate the paper. Elena read the message twice, at first unable to understand and then unwilling to believe it.

  I KNOW WHAT YOU DID AND YOU'LL PAY.

  She dropped the paper onto the table and pressed both hands to her temples.

  3

  "Mrs. Gardner, you really need to make arrangements to clear this entire balance." The woman's voice was level and calm. No threats. No pressure. But, nevertheless, the words made Elena's stomach roil.

  As it had so many evenings for several months, Elena's phone rang at about 8:00 p.m. When she checked the Caller ID, she knew what the call was about. This was the collection agency for the ambulance that took Mark to the hospital. Other nights the call would be about the balance due for Mark's hospital care or his funeral. There'd been so much expense, and his insurance coverage wasn't the best. The doctors caring for him discounted their fees, often writing off the balance. But there were other expenses-so many other expenses.

  Elena took a deep breath and made a conscious effort to loosen her death grip on the phone. "Not that it makes any difference to you, but it's Dr. Gardner. I'm well aware of the situation, and I have no intention of letting this debt slide. But right now I'm in residency training, working eighty hours a week. The pay's not much, certainly not what you'd expect a doctor to make. Then there are deductions for taxes and Social Security. Some of what's left goes for utilities, groceries, rent, car payment. You know, living expenses, although I don't know if you could call what I'm doing living. I've tried to pay something on my debts every month since Mark…" The words trailed off. What was the use? Elena leaned forward onto her desk and watched her tears drip onto the blotter.

  "Mrs. Gardner?" The woman might have been a robot for all her response to the emotion in Elena's voice. Maybe she was. Maybe they used robots for this. Certainly, it seemed to Elena that the people she'd talked with so far had no living, beating hearts.

  "I'll keep paying you as much as I can," Elena said. "My employment situation is sort of up in the air right now, but you can rest assured that this debt and my medical school loans will be the first things I repay." Elena took a deep breath. "Now please stop calling me. I know how much I owe. I know where to send the payments. I know all of it. Actually, I can't seem to get it out of my head."

  The emotionless voice was saying something when Elena hung up. It was just too much. She put her head on the desk and let the tears flow unchecked.

  "Good dinner."

  "Will, the worst meal you ever ate was wonderful." Dr. Cathy Sewell grinned. The way to her husband's heart might not be through his stomach, but it certainly represented an easy shortcut. "Coffee?"

  She poured coffee for Will, herbal tea for herself, and followed him into the living room. "Good news," Cathy said. "I got a call from Amy Gross today."

  Will put down the paper. "Did she find someone?"

  "Dr. Elena Gardner, one of the residents who's finishing in less than a month, had her practice offer fall through. Amy thinks she might be a good fit here. She'll drive up this weekend to talk with me."

  "Do you know her?"

  Cathy sipped her tea. "Vaguely, although I didn't recognize her name at first. Apparently she took her husband's name when they married." Cathy smiled. "Personally, I'm glad you were okay with my continuing to practice as Cathy Sewell. Can you imagine the hassle of changing the name on all those documents?"

  Will grinned. "Yeah, and I'm glad you didn't make me take yours. 'Law offices of Will Kennedy-Sewell, how may I help you?' "

  "Amy said Dr. Gardner has had some problems recently."

  "Professional problems?"

  "No, Amy says she's the sharpest resident they've had since I graduated. I waved that off as flattery, but if she practices the way I do that'll be good."

  Will got up from his chair and moved toward the small kitchen adjacent to the living room. "I want a couple of cookies to go with my coffee. Want anything?"

  "No, I'm good," Cathy called. She waited for him to return and settle into his chair. "You mentioned professional ability, and I guess it does affect that, although indirectly. Her husband had a ruptured berry aneurysm-" She caught herself and corrected her doctor-speak explanation.

  "A little over six months ago, a blood vessel in her husband's brain burst, and by the time they got him into surgery, the damage was too great for him to recover. He was left in the deepest level of coma. He could be kept alive, but he was never going to recover. Elena struggled with the decision to take him off life support. Apparently she finally agreed, but I get the impression there was some irregularity about the way it was done. Amy says Elena has had problems since then."

  "Such as…?"

  "I tried to get details from her, but she said I'd have to ask Elena about them."

  Will took a sip of coffee, winced, and blew across the surface of the cup. "I'll be glad to sit in on the interview if you'd like my opinion, but I'm pretty sure you can trust your own judgment."

  Cathy began to run through the things she wanted to discuss with this new doctor. She took a deep breath and blew it out slowly through pursed lips. She smiled. Could it be that she was unconsciously practicing cleansing breaths to help her through labor?

  "Earth to Cathy? Where'd you go?"

  "Sorry. I was wondering how my patients might relate to Dr. Gardner. It won't be a problem for me, but I'm afraid it might be for a few of them."

  "Sorry," Will said. "I'm not following."

  Cathy pushed aside her cup and saucer. "I didn't recognize her from her married name, but when I heard her maiden name I remembered her."

  "Okay, I'll bite. What was Elena's maiden name?"

  "Perez."

  "And you think this might present a problem?"

  "As I said, not for me, but the potential is there. Since Doc Gladstone retired, I trade call with Dr. Brown. You and I know that Emmett Brown is a competent doctor, but there are still a few of my patients who refuse to see him because they're uncomfortable being treated by an African American."

  Will pushed his cup and saucer aside. "And you think they might feel the same way about this Dr. Gardner?"

  "I don't recall a lot about Elena, but I do remember what she looks like. And I remember you could take one look at her and know she was Latina-a very beautiful one, by the way. Whether she uses the name Gardner or Perez, people are going to know her heritage."

  Will watched as Cathy clenched her jaw. He knew that look and felt sorry for anyone who stood in her way when she displ
ayed it. "But it's not going to sway your decision, is it?"

  "Not in the least."

  "Come in." The response to Elena's light tap hardly carried through the closed door of the ICU room.

  Elena had dreaded this visit all morning. After talking with the neurosurgeon, she was more certain than ever what was ahead for the patient and his wife. Now she owed it to Erma Pulliam to share her knowledge. Elena steeled herself and pushed through the door.

  "Mrs. Pulliam, I'm Doctor Gardner. I took care of your husband in the emergency room."

  The lines in the woman's face were etched more deeply than Elena remembered. Her eyes carried a sadness that seemed beyond utterance. She sat at her husband's bedside, one hand covering his. "I remember you." Mrs. Pulliam's voice cracked. She cleared her throat. "You came out to the waiting room and told me what was happening. I appreciate that so much. I guess… I guess Dr. Clark's a busy man, but I keep missing him. I spend most of my time here. Just go home to change clothes and catch a nap. The nurses have trays sent to me, so I don't have to leave the room to eat. But still, I've only seen Dr. Clark once in the past two days. And when I ask him how Chester's doing, he just says, 'All we can do is wait.' "

  Chester Pulliam lay pale and still. A large bandage covered his head. A ventilator puffed oxygenated air into his lungs via a tube into his windpipe. The monitor at the head of Chester's bed displayed blood pressure and pulse readings in the high normal range. IV fluids dripped slowly through a tube into a needle in the back of the man's right hand. The plastic bag hanging off the bed rail told Elena a urinary catheter was in place.

  Elena lifted Chester's eyelids. His eyes were fixed straight ahead, the pupils midsize. She grabbed his Achilles tendon and squeezed. No reaction. She ran her thumbnail along the sole of his foot. The toes splayed and flexed upward. She frowned.

  "Mrs. Pulliam, your husband had a very serious episode of bleeding inside his skull. That put a lot of pressure on his brain. Dr. Clark relieved that pressure and sealed off the blood vessel that burst, but the damage that was done has left Chester in a very deep coma."