by Nat Burns
I stood in the hallway. White walls, blank, no pictures beyond what had already been installed in the furnished house—and they were landscapes, mostly, with a few generic portraitures. I strode into the den and felt comforted. My books were on an end table. My mother’s crocheted afghan was folded neatly on the back of the easy chair I usually sat in. My older briefcase stood sentinel next to that easy chair.
I thought of my bedroom upstairs, about the dull clothes in my closet, the simple toiletries on the bathroom vanity next to the sink. And I shrugged. I could not change who I was. I had been in school for a very long time and had never taken the time to build a life other than medicine and advanced learning. How could any normal person find that interesting? How could any normal person find me interesting?
I sighed and lifted the TV remote. After kicking off my shoes, I curled in my chair and comforted myself with my mother’s afghan. I switched on the TV and watched the local news as my mind wandered.
I thought wistfully about my mother, Esperida, who I’d had moved here from Brooklyn when I’d decided to stay in Maypearl. I usually went every Saturday morning to visit with her, and I was glad we weren’t leaving until early Sunday. Though it was only a five-hour drive to get to Dothan, I wanted to be there in time to settle in for Monday’s early presentation. I’d go see her the Saturday before I left, even though she would not recognize me. She often thought I was her cousin, Paola. Tonight was one of those nights when I really missed my mami. The mami she had been before, fragrant and beautiful, full of life and fun.
Remembering my mother, how she had been before Alzheimer’s had stolen her away, was painful. I was actually glad that my father had not lived to see her this way. And that he had not been left alone, as I had been.
Chapter Six
Ella
I loved southern Alabama, and I especially liked the town of Maypearl. Claimed from the gulf shore in 1882, a fishing industry had quickly led to an established settlement. It was now just a small town, the fishing industry gone the way of huge commercial ocean trawlers. Yet the town limped along, businesses surviving by providing for human needs and desires. The residents went out of town for factory work, at the Kleune Refinery, thirty miles north on the Mississippi border, or resigned themselves to minimum wage work at the local establishments.
Driving to work, I passed a large grocery and a strip mall offering clothing, a tattoo parlor and a smoke shop. There was also a huge furniture warehouse and a Walmart shopping center with a doughnut shop and a juice bar. Then there was the Four Winds Mall, with its fancy name-brand stores. Oh, and there were two competing drugstores that always seemed to reside on opposite corners from one another.
Living in Maypearl was very different from my life on the Kirtland Air Force base in New Mexico where I’d spent my high school years. My father had been stationed in Germany when I was very young, and I had grown to love Europe with its sense of age and mystery. I dreamed of going back there someday. Then we’d ended up in New Mexico. Not a bad place, but though the people had been warm and welcoming, it was very different from Europe, being somewhat raw and new. The history there was all about the Native American, the fierce pueblo peoples who wrested some type of civilization from an unforgiving desert. In Germany, history was very different, focusing on the music of cathedrals, fine arts and centuries of ancient architecture. In addition, food and drink portions had been small there, relished with others in quiet surroundings. Meals in New Mexico had been huge affairs, riddled with hot or mild chile, and eaten surrounded by groups of people. Unique people, each shaped into a different character by the wind-battered frontier.
I pulled into my slot at The Chase Building where Doctor Maddie’s practice was located. I looked at the sedate one-story brick building. Now, Maypearl was a different coin altogether. Steeped in Southern tradition, the townsfolk, though eclectic and oftentimes unusual, knew the boundaries of diplomacy. And what properly fit into right and wrong. I guessed moving here had been a subtle poke at my parents. They fervently believed that there was no place in the world for the sin of lesbianism, and moving to Maypearl was a chance to prove that I could be accepted anywhere.
I sighed and slid from my car. It was a plan that might have backfired. I’d been here the better part of a year now and had yet to meet anyone open enough to share a life with me. That stung a bit, but it was even worse because I now knew exactly who I wanted.
The object of my desire was getting out of her own car, a large, dark SUV. I glanced at my watch, surprised at her late start. Usually, she was in the office way ahead of any of us.
She beat me to the door and smiled over her shoulder at me as I approached. “Good morning, Ella. How are you today?”
I noticed the circles under her eyes right away. Was she troubled? Or just restless?
“I’m good, Doctor. How are you?”
She paused with the front door ajar, and I almost bumped into her, thinking we were moving forward. “Ella, I think that, since your probationary period has finished…” She paused and cleared her throat. “I think we should be, ah, a little less formal. I think that, I mean, when we are alone together, no patients, I think you should call me…call me Maddie, please.”
I sucked in a quiet, deep breath as my heart thrilled. I managed to keep my voice calm. “Of course…Maddie. Thank you.”
She nodded and preceded me into the waiting room. I shut the door as she made her way quickly through the receiving door. I turned on the waiting room lights and changed the sign on the door, letting Maypearl know we were open for business. I hummed a silly tune as I worked, my handbag and lunchbox still draped over my arm. I passed through the receiving door and went to my station at the desk. Just then, Sandy entered, and I knew my quiet time of glowing pleasure had come to an end.
“Have you pulled the patients for the day?” Sandy asked as she bustled into the receiving office and partially opened the tall sliding glass window that led to the waiting room.
“Not yet,” I responded, dropping my bags and heading to the filing area. “Just got here, myself.”
I checked the master list posted on a clipboard by the entry and began pulling patient files. I was finally able to put names to faces and was excited to see that Abby Hamilton was coming in at ten. Abby was a terminal cancer patient who had been released to hospice, and Doctor Maddie was following her palliative care. Abby, though only twelve years old, had taken her tragic diagnosis with Zen calm, and she radiated that calm and peace to all who encountered her. Her mother, Caroline, certainly destroyed by losing her only daughter, had become Abby’s stoic anchor, and we had all fallen in love with both of them almost immediately.
“Abby’s coming in,” I called to Sandy, though she had been the one to compose the list.
“I know, I can’t wait to see her,” she said quietly. “It’s been two weeks. Caroline sounded frantic. Not sure what that means.”
I frowned at the files I held as my joy diminished. I didn’t know if I was ready to deal with Abby in trouble.
I pulled six other files, wondering at the light load. Usually, we had eight or ten lined up this early in the day. I heard the bell on the front door sound, and I took the folders to the desk and stacked them neatly in the upright holder.
“Hey there, Danny. You don’t look so good,” I said, frowning in concern as I took in Danny Matthews’s haggard appearance.
“Hey, Ella, I ain’t worth much, that’s for sure. Can’t work or nothin’. Glad it ain’t huntin’ season or I’d be really pissed,” he said. “Excuse me, ma’am,” he apologized for his language as he nodded to Sandy.
Sandy waved his apology off, and I grabbed his file from the upright. “Come on back, Danny. Let’s get you settled in.”
I glanced back at his wife, Anna. “You gonna wait out here, hon?”
She nodded and lifted a library book. I smiled and nodded my acknowledgment. Anna was an avid reader, for sure, and I wondered anew how Danny, who obviously had no time for
books, had snagged the tall, Amazon-like reader.
Chapter Seven
Maddie
I checked the chart outside the door, and alarm bells jangled along my nerves. Danny Matthews was a strapping thirty-three year old. There was no reason for him to be suffering from crippling diarrhea that he claimed had persisted for more than a month. He’d also lost too much weight. So many possibilities ran through my mind, not the least of which was cancer or someone poisoning him.
“Get a grip,” I muttered to myself. “It’s probably IBS.”
I opened the door. Danny, a tall, burly man who usually weighed more than two hundred and eighty pounds, sat on the examining table. I looked him over as I shook his hand. His eyes were sunken, proof that he was not resting and that he was obviously dehydrated. Taking a deep breath through my nose, I determined that there was no smell of alcohol on him, so it probably wasn’t due to chronic alcoholism, which could lead to diarrhea. Not that he’d suffered from that disease in the past. I took a seat at the little work surface and reopened the chart.
“Well, Danny. I see you’ve lost more than twenty pounds this month. That’s not good.” I turned to face him.
He smiled tremulously and spread his hands. “Well, Anna said I needed to lose a few,” he joked. I could see his underlying fear and wished I had the wherewithal to reassure him.
“Not the healthiest way,” I said as I pulled a diarrhea history template from the stack of forms on the clipboard from the hook next to my work area. “Let’s see if we can get to the bottom of this. These questions may seem kind of personal, but they’re important if we’re going to help you get better. Okay?”
I waited for his nod.
“So, you said this has been going on for about a month? Is there anything that you can think of that might have contributed to this? Started it off?”
I could see he was really thinking it through. Finally, he shook his head. “I’m sorry, Doc. I just have no idea.”
I hastened to reassure him. “That’s okay, Danny. It’s not unusual for this kind of thing to be a mystery.”
He returned my smile even as his hands rubbed his thighs nervously.
“So, tell me this. Have you changed anything in your diet recently?”
He shrugged. “No, eat pretty much the same. I’m eating a little less ’cause I don’t wanna be runnin’ off to the bathroom all the time, though. Maybe that’s why I’m losin’ the weight.”
“Hmm, could be. So you’re eating…?”
“Well, burgers, roast beef. The wife has me on chicken three times a week. Says it’s healthier.”
“And vegetables?” I frowned slightly.
“Oh, sure, sure. Potatoes and peas and stuff. Carrots.” He shifted uncomfortably.
I smiled again as I checked to make sure the whites of his eyes were clear. “So, you’ve never had a reaction to any of these foods before, have you?”
He fiddled with the front ties of his gown. “No, no. Been eatin’ this way all my life.”
I sighed, mentally ruling out irritable bowel. I made a note on the template. Next on the list. Artificial sweeteners.
“You say you’ve been trying to lose weight. Have you been eating any diet foods? Diet sodas?”
“Lord, no.” He chuckled, seriously amused by the question. “I told Anna no way on those. I hate them diet sodas. Taste like medicine to me.”
“No diet or sugar-free candy?” I watched him closely.
He shook his head. “I ain’t much for candy of any kind, Doc. I have a nut bar every now and again but not much candy at all.”
I made a notation ruling out a sugar-alcohol reaction. These questions were to determine whether his diarrhea was in the category of watery, fatty or inflammatory as each had its own treatment plan. So far, so good.
Next, sexual congress.
“Don’t you get mad about this, but I have to ask. You and Anna have a pretty normal sex life, correct? I mean, no anal play, or anything like that?”
We both blushed as I awaited his response.
“Gosh, no, Doc. I’m pretty old-fashioned when it comes to, you know, sex.”
“So, no contact with other men either?”
He looked horrified. I checked the no box and continued quickly.
“Does bread bother you? Or cereal?” I asked, crossing my legs and laying the clipboard on my knee. I studied him as he answered.
“I don’t think so,” he answered thoughtfully. “Though it seems like everything I eat sets this off, Doc. I even tried some of them medicines like pepto and that over the counter ’modium stuff. Didn’t even touch it,” he added.
I made another note. “It hurts, too, doesn’t it? The gas and bloating?”
“Well, yeah. And my bottom is raw, to boot. It’s just awful,” he admitted. “Awful.”
I studied him again. These symptoms were too soon to be something like amyloidosis, and he wasn’t presenting with any of the other symptoms. He was a regular patient and his baselines had all been normal before this, so it likely wasn’t anything congenital. He’d always been clear on STDs and HIV, and he hadn’t been out of the country.
I double-checked. “You haven’t been on any cruise ships, have you? Or out of state?”
“Nope.” He spread his hands again, showing his helplessness.
I nodded and continued to study him with my eyes. He squirmed under my scrutiny, but I could tell it was discomfort. Not subterfuge. I looked back at the list. Parasites were next.
I tried to take a mental step backward, a diagnostic tool I’d been taught by Richard. “Look at the big picture,” he’d told me often. “It’s crucial to family practice.” A silence fell as I let my mind wander across Danny’s life.
“Anna told me a couple months ago that you’d been away. On a hunting trip.”
He nodded. “Oh, yeah. Me and the boys go up little Tombigbee every fall. There’s a ranch we like up there. We always come home with a deer or two.”
“Any beaver?” I leaned forward and supported my chin in one palm.
“Randy Coltraine got one up there one year, but I ain’t caught none. Can’t see goin’ after killing beaver. I just go with deer, sometime squirrel,” he answered indignantly.
“And you cook the meat all the way through before you eat any of it, right?”
“Yes, ma’am, Doc. My daddy warned me about that. He says some wild animals have diseases in their blood. That’s why we drain them deer all the way too.” His tone was proud.
“How about fish? You cook those well done?”
“Yes, ma’am. I don’t care much for that sushi.” He smiled at me, and I smiled back as something niggled in the back of my mind. I glanced down at the sheet. I stood slowly and set the clipboard aside.
“Well, Danny, let’s have a quick look at you,” I said as I pulled on gloves.
I slowly palpated his abdomen to make sure there were no masses. I checked his lymph system. His entire system was definitely irritated, but he still seemed in good shape. I decided not to subject him to the embarrassment of a rectal exam or stool sample.
“Okay, my friend.” I helped him sit up, noting the trembling weakness of his arms.
I pulled off my gloves and took my seat again. I made an entry onto the diarrhea diagnostic sheet and then pulled off that top sheet from the clipboard. I slid the page into his folder before I sat back and addressed him.
“You need to promise me one thing.”
His eyebrows raised. “Yeah, Doc?”
“That you will always, I mean always, pack in enough fresh bottled water for the whole trip. There will be absolutely no drinking of river or stream water and no washing of any food there either. And you need to tell all your hunting and fishing buddies about it.”
“Yeah, yeah, I will. But why? What’s wrong with the river water?”
I opened a drawer in my work surface and fumbled about. I pulled out a pamphlet and opened it. I stood and showed it to him. “See this little bugger here? I bel
ieve this is your new best friend, Giardia lamblia. It lives all over and especially in water around beaver. Sometimes it goes dormant, into little eggs, cysts. When these get inside a nice warm body like yours, they hatch out and cause all kinds of havoc. Or you may have ingested one of the little swimmers in the water and it proceeded to reproduce inside you.”
He lifted his eyes and stared at me, a look of shocked disgust on his face. “These…these things are living in me?”
I nodded sadly. “A big bunch of them, by now. If it was a mild infection, your body would have fought it off by this time. Yours is pretty, well, persistent.”
Abject terror crossed his face. “You gotta get ’em out, Doc. You can do that, right?”
I patted his shoulder. “Relax, Danny. No need getting yourself all upset about it. It—”
A soft tap sounded at the door. Ella stuck her head in. “Doctor Maddie, sorry to disturb, but Connie Wells is waiting outside for these scripts. Can you sign off for me?”
“Be right back, Danny,” I said as I gently extricated the pamphlet from his clenched hands. I stepped into the hallway
“Is Danny okay?” Ella asked, eyes searching my face as I signed off on Connie’s regular blood pressure meds.
“Remind her that it’s only for one month and make her an appointment to come in for renewal. Danny’s okay. It’s Giardia infection. Caught it sort of early, so we will be able to deal with it successfully. Can you print off some generic stuff from the web for him? Make sure it’s nothing too nasty. He’s a little freaked out. But his wife needs to know how to keep herself from being infected, if she’s not already.”
I handed her the prescription printout absently as I turned, and my hand brushed against her soft, firm breast. An unexpected shock passed through my body and electrified the tender flesh between my legs. I know I blushed four shades of crimson. I was about to mutter an apology, but she thanked me breezily and headed back down the hall. I stood with my hand on the doorknob for a few seconds composing myself before I reentered the exam room.
