Diagnosis Death pft-3

by Richard L Mabry

  "Will he be all right, Doctor?"

  In Elena's mind a scene played out, one she knew as certainly as if she'd written the script. Chester would never recover from his coma. He'd go to a rehab facility. Despite decent care, he'd get contractures and bedsores. Eventually he'd get pneumonia or an overwhelming urinary tract infection with sepsis, and that would be his terminal event.

  Tell her what's coming, Elena. She took a deep breath. "Every day he remains in a coma makes it less likely that he'll regain consciousness. And if he does begin to react, we can't know how much permanent damage there is, how much function he'll have." Elena surprised herself with her next words. "But there's still hope."

  Mrs. Pulliam dabbed at her eyes. "Thank you, Dr. Gardner. That's all I want-to know that there's hope." She eased out of the chair with obvious effort. With one hand still grasping that of her husband, she reached with the other and took Elena's arm. "Thank you for giving me that."

  Why did you lie? You know what's ahead. Elena swallowed hard. "There's always hope."

  David wasn't sure why he felt the need to call Elena. Call it a premonition. Call it a divine prompting. Call it a surfacing of his suppressed desire to spend more time with Elena. For whatever reason, as soon as he reached his car to start the drive home, he pulled out his cell phone and punched her speed-dial number.

  "Dr. Gardner." The tone of those two words painted a clear picture, and David was glad he'd called. Elena was really down. Time to step in.

  "Elena, it's David. Can you talk right now?"

  "Oh, right. Yeah, I guess so. I'm on my way to pick up my dry cleaning and buy a few groceries."

  Run with the hunch. "Why don't you meet me at the El Fenix on Lemmon Avenue? I'll buy you some good Tex-Mex and we can talk."

  "Oh, I couldn't-I mean, that's not…" He could hear a car honking in the background. Elena was probably working her way through the same type of traffic he was. "David, do you really want to do this?"

  "Why not? We both need to eat. I'll bet you're too tired to cook, and I'm really not in the mood for a bologna sandwich tonight." He grinned, thinking there was no need to let Elena know about the pot roast simmering in the Crock-Pot at home. No need to puncture that "men can't cook" myth. "So, what do you say?"

  "Why not? I'm probably about half an hour away. Will that work?"

  "Whoever gets there first gets a table," David said.

  Twenty-five minutes later, he was munching on tortilla chips when Elena walked in. He rose and gave her a brotherly hug. "Bad day?" he asked.

  "Not great, but not as bad as it could be. At least it's not Tuesday."

  The waiter approached, but before he could speak Elena said, "Diet Coke with lime. Chicken taco salad."

  David added his own order. When they were alone, he said, "So you expect another phone call next week?"

  "I'm not sure. It's possible that she's escalated the action."

  He listened as she related her story of the note and its cryptic message. "And you think it's from the same person?"

  "It all fits together. Mark's birthday was four weeks ago-on a Tuesday. That's when the calls began. The message reached me Wednesday, but it was mailed on Tuesday."

  David dipped a chip in salsa and crunched it, then took a sip of iced tea. "I'm hearing you say this is all related to Mark's death-the calls, the note, everything. Is that right?"

  "I think so. Mark's mother…" She shook her head.

  "You don't have to talk about it if you don't want to."

  "No, I need to. You see, Mark's mother didn't like me from the get-go."

  "What about Mark's father?"

  "He died when Mark was in his teens. Left the family comfortably fixed, and Lillian never let anyone forget that. She's spent most of her life parading her social status."

  David nodded. "So Mark's mother opposed the marriage."

  "Actually, 'marrying beneath him' was the way she put it, because, to her at least, I was a Mexican, born in Monterrey. Never mind that Mama was a U.S. citizen, the daughter of an American diplomat, that she was cultured and sophisticated, spoke flawless English, came from an upper-class background. Forget the fact that she married a wealthy Monterrey businessman."

  A waiter deposited more salsa and a fresh basket of chips on the table. Elena murmured, " Gracias," and he padded away. She pushed the chips toward David. If she was hungry for anything, it was conversation, not food.

  "If you were born in Mexico-?" He left the question hanging.

  Elena took a deep breath. She was tired of explaining this, but she'd brought it up and David deserved to know all the details. "My parents wanted their only daughter to be raised in the U.S., so they moved to Texas when I was an infant. I don't know how it happened-some law or other-but anyway, I was a U.S. citizen because of my mother. My father got his citizenship later." She lowered her head. "After my parents were killed in an auto accident when I was eight, my mother's sister and her husband raised me. There was no Spanish spoken in that home. I grew up like an Anglo. But none of that mattered to Lillian. All she cared about was my name, the color of my skin, the appearance of my features."

  David paused with a chip halfway to the salsa. "So there was an uncomfortable relationship there."

  "There was no relationship. We saw Mark's mother when we had to, but it was obvious she disapproved of our marriage."

  "And this continued?"

  Elena shook her head. "It got worse. You see, when Mark had his cerebral aneurysm, Lillian figured the dumb Mexican should have been smarter. I was a doctor. I should have seen it coming. I should have gotten him to the hospital more quickly. I should have pulled strings to get him a better surgeon." She bit her lip. "I should have saved his life-instead of ending it the way I did."

  "What do you mean?"

  Elena shoved her plate away. Score another one for the widow's diet. "To Lillian, so long as Mark's heart was beating and that monitor hadn't flat-lined, even though it took a respirator and a bunch of IV medications to keep him going, he was alive."

  "And when you stopped all that?"

  "Lillian is of the opinion that when I discontinued life support, I murdered her son."

  Dr. Milton Gaines laid his half-specs on the desk and looked across at his colleague and patient. "You're doing fine, Cathy. In another few weeks you'll give birth to a healthy baby. Sure you and Will don't want to know whether it's a girl or boy?"

  "No. We've decided to wait and be surprised." Cathy shifted in her chair, seeking a more comfortable position and finding none. "I appreciate your seeing me this late in the day, Milton. It's tough for me to get out of the office."

  "Glad to do it. And I know how it feels to be swamped with patients."

  Cathy felt a foot bury itself in her side. "Are you about ready to take on an associate?"

  "I hadn't planned to quite yet, but some things have changed. This is going to come out at the hospital staff meeting next week, and I suppose you can keep it to yourself until then. Arthur Harshman's retiring. He and his wife are moving to Florida."

  That surprised Cathy. Somehow, she'd pictured Arthur Harshman as sort of an ageless icon in the medical community, always here, always the same, holding sway in hospital staff meetings because most doctors didn't dare disagree with him. He had the bedside manner of Attila the Hun, but there was no question about his competence in obstetrics and gynecology. She was surprised to realize she'd miss him. "So, what about-"

  "About someone to fill in when I can't be here? For now, Tom Denson in Bridgeport has agreed to drive over to cover if I have to be away, which won't be often. And I have an associate who'll be starting soon. He's finishing his residency June 30."

  "Good for you, Milton. I know that practicing OB can wear you down. I'm glad you've found someone to help with the load."

  Gaines frowned. "What about you? I hope you're not expecting to work right up to the day you deliver. What are you going to do for coverage? Can Emmett take up the slack?"

  "Emmett
has offered to help, but… well, some of my patients have balked at seeing him. Then I lined up a retired doctor from the temp agency, but he's developed health issues so that's off."

  "What will you do?"

  "I have a young woman coming in for an interview this weekend. I hope she'll be a good fit for the practice."

  "Will this be to fill in temporarily?"

  "Originally, I wanted a locum tenens, but if things work out between us I might want to take her on as an associate. You know, the town is growing."

  Gaines chuckled. "So are you, Cathy. So are you."

  Her footsteps echoed in her ears and her pulse raced as Elena negotiated the dark sidewalk leading to her apartment door. She fumbled in the depths of her purse to retrieve her keys. Get a grip.

  With the lights on and the TV pumping out Wheel of Fortune, she felt the knots in her neck unwind a bit. Elena collapsed in her usual chair and thumbed through the mail. She caught her breath when she spotted the square envelope, but it was only an invitation to a bridal shower. She tossed it back onto the table and made a mental note to send a gift. She had no money for bridal gifts, but she'd squeeze out enough to do something. She wouldn't be at the shower, though, even if her schedule allowed it.

  Now her social activities consisted of an occasional meal with David. She'd miss him when they left for their respective practice locations. That thought brought to mind her trip to Dainger in a few days. She'd promised to call Dr. Sewell and confirm her visit. Elena looked at her watch-half past nine. Too late to call? Not for a doctor.

  She located the number, punched it in, and listened through four rings. She expected to hear a voice mail message. Instead, a soft voice answered. "Dr. Sewell."

  "Dr. Sewell, this is Elena Gardner. Dr. Gross told me you're looking for someone to help out in your practice."

  "Elena, thank you for calling. And please, call me Cathy. I was so sorry to hear about your husband."

  Elena had learned the best response, and she gave it. "Thank you, Cathy." She paused a beat, inserting a verbal paragraph mark. "Dr. Gross says you'd like me to come to Dainger this weekend to talk with you."

  "Yes, I'd like to show you around, talk with you, see if we can work out an arrangement."

  They talked for about ten minutes, and Elena was glad to find that Cathy was as detail-oriented as she was. Most of the questions she had would be answered during the interview, but Elena had a good feeling about the situation as Cathy described it. She hung up with a smile on her face.

  Had Helen Bennett been right? Was God behind this opportunity? Or was it a random set of circumstances? She'd withhold judgment for now.

  Elena fired up her computer, deleted a mountain of e-mail spam, read the two or three messages that were actually significant, and finally opened Google maps.

  She plugged in the address Cathy gave her and, after a few minutes, found that the drive to Dainger, Texas, would take her about ninety minutes, maybe less if traffic was light. She printed out the directions and put them in a manila folder labeled "Dr. Sewell." Elena left the folder on the desk in plain sight, where its presence could remind her that there was hope for her future.

  For about the millionth time after his death, Elena wished Mark were here so she could talk with him about the practice opportunity. That led to another crying spell. Should she call David? No, she'd seen him only a few hours before this. She had to learn to get through these times on her own.

  She read for a while, or at least she turned the pages of a book. When she put it down, she had no idea what she'd read.

  Elena channel-surfed long enough to decide that the guy-she couldn't recall who-was right. Television was indeed a barren wasteland. She left the set on for noise.

  She wandered into the kitchen, opened the refrigerator, stared into it as though waiting for some secret to be revealed, then closed it again.

  Elena showered, laid out her clothes for tomorrow, and crawled into bed, where she lay and stared at the ceiling for what seemed like an eternity. She must have fallen asleep, although she didn't know how or when. She was struggling through a nightmare where she defended herself in court on some unspecified but terribly serious charge when the phone woke her. She squinted at the bedside clock and was immediately wide awake, one nightmare replaced by another. Midnight.

  What day was it? Was it Tuesday? She snatched up the phone and whispered, "Hello?"

  "Are you all still open? I want to order a pizza."

  Elena sighed. "No, I'm sorry. You have the wrong number."

  She returned the phone to its cradle and sat up on the side of the bed. Might as well have a glass of milk and read. Sleep was probably going to be a long time coming. A long time.

  4

  Elena turned off the alarm well before it was time for it to sound, swung her feet over the side of the bed, and wondered how she could face the day. Her head pounded. Her mouth was dry. Sweat plastered her pajamas to her. She had never been drunk, but this had to be what the mother of all benders produced.

  Had she slept at all? She wasn't sure. Last night's wrong number had been innocent enough, but the dreams that followed it were nonstop torture. Elena wondered if they represented the guilt that filled her subconscious, boiling to the surface like the bubbles in a witches' cauldron. They'd all been there-her late husband, her mother-in-law, her colleagues- all asking the same question. "Why did you do it?"

  She stumbled through some semblance of morning ablutions, threw on the clothing she'd laid out the night before, and headed for the kitchen to make coffee. Thank goodness she'd bought more. It was bad enough to face another day. Doing it without coffee was unthinkable.

  Elena spooned coffee into the pot, daydreaming about her future, when the open can slipped from her grasp and bounced three times on the tile, rolling to a stop against the refrigerator. The entire contents, almost a full can of coffee, formed a dark brown trail across the floor. Elena wanted to scream. She wanted to cry. But instead, she laughed. One more thing had gone wrong, so how many more could there be? Maybe she could use up all her bad luck before she left the house today. Meanwhile, she'd stop at the convenience store on her way to the hospital. Maybe some caffeine would help. Then again, maybe nothing could help.

  Whether it was the tall cup of coffee she drank or the fresh air blowing into her face through the wide-open car window as she drove, by the time Elena wheeled into the doctor's parking lot at St. Paul Hospital, she felt almost human.

  Elena made her way through the hospital, following signs to the Family and Community Medicine Clinic. Funny, the medical center had changed the name to keep up with the times, but everyone still called the department Family Practice. Well, that was what she wanted to do in her own practice-help families. If she just had the chance.

  She took particular comfort that today was Friday. Not because it marked the start of the weekend, though. Illness and accidents don't observe a calendar, and physicians are as likely to be called upon for their services on a Saturday as on a Tuesday. But this weekend was different. Tomorrow she would meet with Dr. Sewell.

  By now Elena wasn't feeling particularly nervous about the meeting. Maybe she'd felt disappointment so many times the possibility of one more held no terror for her. Then again-

  "Dr. Gardner, are you ready to see patients?"

  Elena turned. Mary, the pert, dark-haired clinic nurse, held out a chart.

  "Thanks, Mary. Yes, I'll start."

  For Elena, the patients in the family practice clinic presented the same challenge as a Sudoku puzzle-except the stakes were much higher. She opened the chart and scanned the notes Mary had made. "42 y/o WF. 3 mo. Hx vague aches, lack of energy. BP 110/60, P 68."

  "History of vague aches and lack of energy." Could be something, could be nothing. Elena tapped on the door and entered. "Hi, I'm Dr. Gardner." She extended her hand.

  "Emily Gunderson." The woman's handshake was lukewarm, matching her expression.

  "How can I help you?"

&nb
sp; The woman perched on the edge of the exam table appeared to be closer to 55 than 42. Her eyes were dull. Her voice was husky and soft. She picked at a broken nail as she spoke. "I'm tired all the time. I feel like I've got a lump in my throat. I ache all over. I.. . I feel terrible."

  A century ago, doctors would have attributed these symptoms to emotional problems and called the condition "neurasthenia." Elena gave thanks for the strides medicine had made since then. "When did this start?"

  "Maybe three or four months ago."

  Elena moved behind the woman and placed her fingers lightly on her neck. "Swallow for me, would you?" She increased her pressure slightly. "Again."

  Elena continued to ask questions as she examined the woman's chest, heart, abdomen. Finally, she took a rubber-headed reflex hammer from the table and tapped gently at the bend of the woman's elbows and below her kneecaps. Reflexes diminished, no doubt about it.

  "Mrs.-" She checked the chart. "Mrs. Gunderson, I'm going to order a couple of blood tests. If they confirm what I'm thinking, we should be able to get you back to your old self pretty quickly."

  For the first time since the exam began, there seemed to be a spark in the woman's eyes. She leaned forward, apparently eager to catch Elena's words. "Did you say what I think you did? You can do something about this?"

  "I think you've had an episode of what we call thyroiditis-an inflammation of the thyroid gland. It left part of the gland unable to make thyroid hormone, which is why the rest of your thyroid enlarged to compensate." Elena ran her fingers over the area to demonstrate. "But it still isn't making enough thyroid hormone. That makes you tired. It causes you to ache all over. Does cold bother you? Do you have trouble in an air conditioned building?"

  The woman looked at Elena like she'd pulled a rabbit out of a hat. "How did you know?"

  "It's my job to know that, Mrs. Gunderson. No trick to it." Elena ticked a few boxes on the lab request sheet clipped to the front of the chart. "The nurse will draw some blood for tests. I want to see you back in a week. If I'm right, we'll start you on a medication called levothyroxine. It may take a bit of dosage adjustment, but I think you'll soon feel like your old self."