Diagnosis Death

by Richard L Mabry

  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?"

  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."

  "No surgery?"

  "No, did someone suggest that?"

  Mrs. Gunderson ducked her head. "Well, I saw another doctor last month about this. He said I probably needed surgery. I guess now he meant surgery on my thyroid. But when he found out I didn't have insurance, he sent me here to the charity clinic."

  Elena fought to keep her voice level. The surgeon might have made a diagnostic mistake. Then again, he could have decided that, in the absence of insurance, a referral would be a good idea. "If you'll tell me the name of that doctor, I'll call him. I'm sure he'll be pleased that no surgery is necessary." And if he punted this poor woman because there was no fee in sight for him, he's going to get an earful.

  Elena struggled upward from sleep like a diver returning from the depths. She opened one eye and frowned at the strident tones that assaulted her eardrums. Phone? She lifted the receiver and was rewarded with a dial tone. Pager? Her frontal cortex slowly ground into gear and returned the message: nope, different sound, not the same cadence as her pager. She reached across her body, pushed down the pillow in which her head was nestled, and saw the flashing red numerals on the bedside clock: 6:01.

  She slammed her palm down on the bar to silence the alarm and tried to recall why she had to get up. Did she have early morning rounds at the hospital? Was there a conference at the medical school? No and no. What is today? It had to be . . . Saturday. Then it all came tumbling back.

  Today she was driving to Dainger to meet Cathy Sewell. Driving to Dainger? No, if anything, she hoped she was driving away from danger. Away from the midnight phone calls, leaving behind the notes with the threatening messages, trying to flee the guilt that enveloped her every time she came near the ICU at Zale Hospital. Surely no danger awaited her in Dainger—only the hope of a better tomorrow.

  Elena rolled out of bed, scuffed her feet into slippers, and hurried to the kitchen. She needed coffee, lots of it. She flicked the switch to set the already-prepared pot brewing and padded off to the bathroom, thankful she'd stopped at the store and bought yet more coffee last night.

  Back in her bedroom, she chose and rejected three outfits before settling on a blouse and slacks that seemed casual yet professional. Wasn't that coffee ready yet? Elena walked through the kitchen door in time to hear the coffeemaker give one last gurgle and fall silent. She poured a cup and burned her tongue with the first sip.

  She stumbled to the bathroom and risked a glance at herself in the mirror. She recoiled when she saw her eyes—a network of red lines turned the whites into a roadmap. She recalled a movie based on the life of dancer Bob Fosse, a man who burned the candle at both ends on a regular basis. Scene after scene portrayed him gazing at his dissolute face in the morning mirror and murmuring, "It's showtime." Eye drops and a stimulant pill and he was off for another day.

  Well, there'd be no Dexedrine, but some eyedrops and a bit of wizardry with makeup wouldn't hurt. It was indeed showtime.

  "If you don't like that rug, tell me," Will said.

  Cathy turned to where he sat in the living room, newspaper in hand, coffee at his elbow. "Excuse me?"

  Will lowered the paper and gave her a smile. "If you don't like that rug, tell me. Don't keep pacing,
trying to wear it out." He looked at his watch. "It's ten-twenty. Dr. Gardner said she'd be here about ten-thirty. She's not late. Does everybody have to be early, simply because you always are?"

  Cathy shrugged. "I guess I'm nervous about this interview. I want it to work out—I mean, I need someone to cover my patients while I'm out with the baby—but I don't want to take her into the practice and then regret my decision." She resumed pacing, caught herself, and stopped to rearrange the magazines on the coffee table.

  Will gestured toward the easy chair that sat at right angles to the one he currently occupied. "Get a cup of coffee. Sit down and relax."

  "You know I can't have coffee," Cathy snapped.

  "Sorry. I forgot. Maybe some herbal tea. But—"

  The sound of the doorbell put an end to the conversation. Will's eyes followed his wife as she made her way to the door. Cathy stopped, took a deep breath, and admitted the visitor.

  Will didn't listen to the conversation. He already knew what it would be like. "Dr. Sewell?" "Call me Cathy." "And I'm Elena." "Now I remember you." "You haven't changed a bit." Instead, he focused on Dr. Elena Perez Gardner.

  Will was happily married, rarely looked at another woman, but Elena's appearance was more than enough to get his attention. Mid-length, black hair was pulled back into a ponytail to frame a beautiful oval face with high-set cheekbones and flawless skin the color of honey. Will decided her body would be the envy of most women and definitely merit a second and third look from almost any man.

  Then Will looked into Elena's eyes. If, as some poet said, the eyes are the windows of the soul, this woman's deep brown eyes clearly showed that her soul was troubled. Maybe it was the aftermath of her husband's death, maybe something else. Will hoped they'd know the answer to that question before the day was out.

  Will realized Cathy was saying something to him. "Excuse me?"

  "I said, 'Elena, this is my husband, Will Kennedy.' You know, I hope you pay better attention when you're in the courtroom."

  "Sorry. My mind was a million miles away." He extended his hand. "Elena, it's a pleasure to meet you."

  "Likewise." Elena's grip was firm, but he noticed that when he withdrew his own hand it was moist. Well, he couldn't blame her for being nervous. If she only knew how nervous Cathy was as well.

  Cathy reached for her purse and keys. "I'm going to show Elena my office and the hospital. We'll probably break for lunch about twelve. Want to join us at RJ's?"

  Will turned to Elena. "Okay with you? You won't think we're ganging up on you?"

  "Not at all," Elena said. "Cathy, I'd like to freshen up before we leave, if you don't mind."

  "Of course. Just down that hall."

  As soon as the door closed, Cathy turned to Will and raised her eyebrows. "Well?"

  As he advised his witnesses to do, Will hesitated before he answered. "She's nervous, but that could be the pressure of a job interview on top of what she's already been through. Let's see what we find out after we get to know her better."

  Since she started medical school, Elena always had a stack of blank three-by-five cards with her. She might use them in class to jot down particularly salient points, later tucking each in her textbook at the appropriate page, handy for last-minute exam cramming. On clinical rounds, she'd pull out one of the cards and make notes about each patient, often flipping through them later in the day to be sure she hadn't missed something. The cards proved invaluable when she presented cases to an attending physician. Notes on three-by-five cards became so ingrained in her life that her pocket or purse generally held cards with grocery lists or reminders to pick up cleaning or have her car serviced.

  Today she had to stop herself several times from reaching into her purse for a blank card. Somehow, it seemed almost disrespectful to make notes during her meeting with Cathy. If Elena's observations jibed with Cathy's assessment that the facilities at the hospital were excellent, she accepted that fact and moved on, knowing she could always ask specific questions later. If Cathy told her that night call in her practice wasn't as bad as being on call at Parkland, Elena heaved a sigh of relief, realizing that only time would prove or disprove that assessment. And when Cathy mentioned a salary arrangement that included a generous base salary and benefits, Elena gratefully filed the number away in her head, not on a card.

  As they spent time together, Elena warmed to her host. Some of the glow Cathy exuded might be attributable to her pregnancy, but she also had about her a sense of security that Elena envied. Maybe this would be a good match. If only Cathy felt the same.

  They wound up their tour in the front foyer of Summers County General Hospital. Cathy extended a hand and turned a half-circle like Vanna White showing a prize. "Well, that's our hospital. What do you think?"

  "Frankly, it's more than I expected," Elena said. "You have a very nice facility."

  "Here's someone you need to meet." Cathy pointed to a man walking down the hall toward them. A blue dress shirt with a blue and gold tie peeked out from under a spotless white lab coat with creases so sharp they could cut cheese. He was about four inches shorter than Elena's five feet ten inches, but carried himself with the bearing of someone used to being in charge.

  The man halted two steps from them, and Elena half-expected him to click his heels as he drew himself up to his full height and nodded once. "Dr. Sewell, good to see you."

  "Nathan, this is Dr. Elena Gardner. Elena, Nathan Godwin, our administrator."

  Godwin favored Elena with a curt nod. "Doctor, pleasure to meet you. Are you interested in our hospital?"

  Before Elena could speak, Cathy said, "That's what we're about to discuss, Nathan. I'm sure you have things to do, so we won't keep you from your rounds."

  "Nice meeting you," Elena mumbled.

  When Godwin was around the corner, Cathy said, "Self-important little man, but he keeps the place running well."

  "He scares me a little."

  "Never mind. You won't have a lot to do with him. Now how about some lunch? Since I'm eating for two, it's all I can do to keep my hands off every bit of food I see."

  "Cathy, to be in your third trimester, you don't look like you've been overeating."

  "That's all right. I don't want the town gossips saying, 'Isn't it too bad she never lost all that pregnancy weight?' Our city is big enough to offer everything you might want, but at heart it's still a small town, and news travels fast around here."

  Elena suppressed a shudder. She'd hoped to leave her past behind with the move, to start fresh. But if anyone in Dainger started asking questions about Mark's death . . . No, she wouldn't let that happen.

  When they arrived, Will was already inside the restaurant, seated at a table in the back corner. Cathy dropped her purse into the chair opposite him and said, "I'm going to freshen up."

  Elena took an empty chair between Cathy's spot and Will. He smiled and said, "So did Cathy convince you that our fair city isn't exactly a medical backwater?"

  "Frankly, when she first mentioned Summers County General Hospital, I had a mental picture of a little facility with no specialty care, antiquated equipment, and a scraper outside the front door to clean the barnyard residue off the boots of the patients and doctors alike."

  "I'm sure Cathy showed you otherwise."

  After the waiter took their drink orders, Will chatted amiably and Elena began to relax. Maybe she wasn't going to get the third degree from Cathy's lawyer husband.

  Cathy returned, and Will rose to pull out her chair. Elena recalled when Mark used to do that for her, and as she often did when something brought to mind her loss, she felt herself die a little. She turned away and dabbed at the corner of her eyes with her napkin.

  "Did I miss anything?" Cathy eased into her chair and set her purse near her feet.

  Will shook his head. "I was giving Elena the third degree, but you got here before I could get out the rubber hose."

  Cathy picked up a menu. "Well, there'll be none of that now. Let's have a relaxin
g lunch."

  During the meal, the two women shared anecdotes and discovered mutual acquaintances. Will chimed in from time to time with comments and stories of his own. Both women declined dessert. Will asked for coffee, and Elena decided to join him.

  The waitress left the bill, and Cathy slipped a credit card into the folder. She waved off Elena's attempt to cover her own lunch. "This is definitely a professional expense. I hope we can come to an arrangement. If we can, the cost of a chef's salad and iced tea is a pretty small price to pay for finding someone to watch over my practice while I'm on maternity leave."

  Elena felt her lunch creeping back up into her throat. She'd hoped for something permanent, a move to somewhere she could put down roots. Now she wasn't sure. "So you're looking for someone on a temporary basis? A locum tenens arrangement?"

  "Not necessarily." Cathy looked around. "Wouldn't you be more comfortable talking about this in my office?"

  Elena wasn't sure she could wait one more minute to hear Cathy's offer— if there was to be one. "I'm fine doing it right here if that's okay."

  "Sure." Cathy looked around the nearly empty room. "RJ's a friend of ours, and we eat here a lot, so they shouldn't mind if we keep this table a bit longer." She beckoned to the waitress. "Peggy, we're going to discuss a little business. Would you top off everyone's beverages, and then ask Darlene not to seat anyone near us?"

  Even though there was no one within earshot, Cathy leaned a bit closer to Elena. "This is a two-part deal. What I need now is a locum tenens to cover my practice while I'm on maternity leave. I've told you about the salary and benefits. Do you have any questions there?"

  Elena shook her head.

  "But I'd like the contract to include an option for a permanent association." Cathy said.