Warning Signs

by C. J. Lyons

  “Patients don’t usually go around insulting and grabbing me.”

  Before Jim could retort, Lucas and another man rounded the corner ahead of them. They were about the same age and height, but there the resemblance stopped.

  Lucas had thick, sandy-colored hair and wore a crisp pale blue shirt, neatly knotted tie, and an even crisper lab coat, free from any stains, pockets empty except for a stethoscope, two pens, and a reflex hammer.

  The man with him wore jeans, a polo shirt, sneakers, and a rumpled lab coat with pockets overflowing with debris. His hair was long, dark, and scraggly, as if he’d tried to trim it himself but had given up halfway through.

  “You two do realize you’re headed the wrong way, don’t you?” Lucas said as they came abreast of her and Jim. Then he stopped to scrutinize them.

  Jim was still pale, barely able to shuffle without a wince, and Amanda knew she looked flustered. She hastily tried to straighten her hair and smooth her lab coat, but it was in vain.

  “What’s going on?” Lucas asked, his voice edged with suspicion.

  “Nothing,” Amanda said at the same time as Jim.

  The man behind Lucas hid a smile behind his hand, rubbing at his face. Lucas assumed a stern expression. “We have patients who need our full attention. Are you two ready to get back to work?”

  Jim glanced at Amanda, his expression one of lethal intent. For a moment she was certain he was going to tell Lucas everything, but instead he stood up straight and gave Lucas one of his shit-eating simpers. “Yes sir. It was just a misunderstanding.”

  “Amanda? If you can’t work with Jim, you can be reassigned to the clinic.”

  “No.” It was so unfair, being the low man on the totem pole, the one most likely to get sent off to the Siberia of clinic-land. She stopped short of begging. But she needed to stay with Tracey, see her case through. She felt like she was close to finding the answer; she just needed a little more time—and fewer distractions from Jim. “No, thank you, Dr. Stone.”

  Besides, Jim was right—nothing really had happened, other than her being frightened out of her wits. She’d overreacted, let her fear and anger take control—some would say she might even owe Jim an apology. Her mother, always aghast at Amanda’s inability to behave like a proper lady, would have been the first to insist on it.

  Adrenaline leached from her, leaving her trembling and feeling a bit sickened by her actions. Last thing she wanted was more questions, more attention.

  “All right. Jim, go up and check on our baby in the PICU. See when radiology can get her in for her MRI and let me know. Amanda, come with us.” Lucas motioned for her to join him and the other man.

  “This is Dr. Ken Rosen.” Lucas introduced him as they continued down the hall to the pathology suite of labs.

  Ah, so this was the mysterious man who had saved Gina’s life. He didn’t look like much, although Gina had said he was some kind of research whiz kid, bringing in almost as much grant money as Dr. Nelson.

  “Ken’s found something interesting in Becky Sanborn’s tissue samples.”

  “Something that might help Tracey?” Amanda asked, hoping there was more to Ken Rosen than his appearance suggested.

  “Not sure. The pathologists thought they might be postmortem changes, not clinically significant.”

  Dr. Rosen moved with an easy lope down the hall, a counterpoint to Lucas’s rushed stride. “I’ve never seen protein deposits like that before,” he said with confidence. “Not premortem or postmortem.”

  “Do you know what caused them, Dr. Rosen?”

  “It’s Ken. We found them in both her striated and smooth muscle tissue as well as in the basal ganglia and on sections throughout the nervous system. If it weren’t for Lucas ordering the extra immunofluorescence stains, we never would have found them at all.”

  “But you know what they are, we can treat them, right?”

  Both men stopped and stared at her. Ken was rubbing his hand over his chin as if he’d recently shaved off a beard and was missing it. Lucas merely shook his head, not meeting her eyes.

  “These tests will take weeks to get results, Amanda. It’s going to take time.”

  The fury she’d felt at Jim returned, only now she had nowhere to direct it. What was the good of getting angry at a disease that you didn’t even have the name for? Her cheeks burned as she blinked back tears. “Tracey doesn’t have time to spare.”

  TWENTY-FOUR

  Friday, 8:11 A.M.

  AMANDA WALKED INTO PATHOLOGY WITH LUCAS and Ken. The two men were animatedly discussing new variants of FAB staining and which technique gave the best results. They could have been speaking Greek for all the good it did Amanda. Yet again she was reminded that even though she was less than a year away from graduating from one of the best medical schools in the country, there was still a universe of material for her to learn and master.

  Once she graduated, was a real pediatrician, kids’ lives would depend on her not just knowing the facts but knowing what to do with them. And if these two men, both obvious geniuses, were uncertain about what to do next to help their patient … the challenge seemed overwhelming.

  She slumped into her chair between them as they scrutinized some glowing blobs projected onto the video screen by the microscope. They had the lights turned low, casting the path lab into shadows, and the air conditioning was running full blast. Amanda felt her eyelids droop, the sluggish weight of fatigue drawing her into its embrace.

  Lucas’s beeper went off, snapping her awake. He stood and crossed the room to the phone. Ken frowned at the screen.

  “Hate to say it, but the pathologists might be right. These deposits are too irregular, don’t fit any pattern.”

  “So we don’t know anything more than we did yesterday.” She blew her breath out in a sigh so forceful it fluttered her bangs.

  “Some things you can’t rush. We definitely know more than we did yesterday. Just nothing that will help your patient anytime soon.” He paused and pulled away from the microscope far enough to make eye contact with her. “Guess I understand your impatience. But even a medical student should realize how unprofessional it is to consult with another doctor behind her attending’s back.”

  “Excuse me?” Amanda glanced at Lucas, still engrossed in his conversation.

  “Lucas told me you got Lydia Fiore involved, reviewed his charts.”

  “He said I was unprofessional?”

  “No. He was intrigued that she also thought mercury toxicity might play a role. I’m the one calling you unprofessional. And it comes very close to being a breach of HIPAA rules as well.”

  Amanda didn’t know what to say. She couldn’t very well tell him that it was Lydia who had come to her—or about their impromptu brainstorming session last night. Taking medical records out of the hospital had to be a violation.

  “I’m sorry. I was just trying to do what’s best for my patient.”

  “As long as you understand that Lucas is as well. He’s the attending. If anything goes wrong, it’s his responsibility.” He turned back to the microscope, cutting off any further discussion.

  Lucas hung up the phone. “We need to go; Tracey’s boyfriend just got here.” He nodded to Ken. “Let me know if you think of anything.”

  “No problem,” Ken said, fully immersed in the microscopic world of nerve endings and muscle fibers. Then he abruptly looked up. “Nice meeting you, Amanda.”

  Amanda followed Lucas out as he led her through the maze of tunnels back to the elevators. As they rode upstairs, he leaned against the corner in a very uncharacteristic slouch.

  “I apologize if I broke protocol by looking into Becky’s and Michelle’s cases,” she said, hoping to clear the air. He hadn’t seemed upset when she mentioned Lydia this morning, but Ken was right; it was unprofessional not to involve him from the beginning.

  He frowned, as if her words surprised him. “I told you to look into Becky’s case. I should have told you to add Michelle’s to the list my
self. Would have if I hadn’t been distracted.”

  He glanced at her leg, as if checking for more fasciculations, and she shuffled her feet. The door opened before she could think of some way to salvage the situation.

  “Which reminds me,” he continued as they walked down the hall to the family room. “We need to get you tested for mercury poisoning.” He paused, his hand on the door. “Just in case.”

  LYDIA WAS LATE GETTING TO EMMA AND DEON Grey—no time to stop at Child Life and ask for advice or even to pick up a new book for Deon at the gift shop. She rushed in to the telemetry room, still flustered by the idea of a father threatening to sue her over trying to save his daughter. Misplaced guilt; she was certain nothing would come of it, but still it gnawed at her.

  As she skidded into Emma’s room, she felt off balance, anxious to regroup. “How are you feeling today, Mrs. Grey?”

  The older woman looked up with a pinched, worried expression. “You haven’t changed your mind, have you? There’s no time.”

  Lydia was having second thoughts. What if something happened while Deon was in her care? Or worse, what if she was being set up for a lawsuit or some kind of blackmail—hustling on the street with her own mother, she’d seen worse. And the one thing Lydia had always vowed was to never be a patsy, a rube.

  “There’s still time for me to call social services. Maybe one of the nurses or doctors is on the emergency foster care list—”

  “No.” Emma’s voice cut through Lydia’s with authority.

  Lydia straightened and glared at the old lady—she was the one who usually used that tone; she wasn’t accustomed to being on the receiving end.

  “No, please. You promised. I trust you; I don’t trust any of those others. They’ll take him away from me and I’ll never see him again.”

  Deon remained silent, his gaze fixed on a spot between his purple-and-green-checkered dollar-store sneakers.

  “Maybe we should discuss this in private,” Lydia hedged, still unsure about the whole situation. It was against all the rules—a physician taking a patient home to spend the night? An unaccompanied minor at that?

  “There’s nothing to discuss.”

  Lydia rocked on her toes and forcibly relaxed her clenched fists, spreading her fingers wide. Trey was always saying she needed to learn to trust—hell, that’s what all the men she’d been involved with said. No time like the present.

  “You’re right.”

  Emma sank back, looking relieved. Lydia crouched down so that she was at Deon’s level. “What do you want to do today?”

  Before he could answer, the nurses came to transport Emma up to cardiology. Emma pulled Deon into a fierce hug, kissing him on top of his head, then placed his hand into Lydia’s. “You take care now. Both of you.”

  “Yes’m,” Deon mumbled, swiping a tear from his cheek with his free hand.

  He and Lydia stood, side by side, as they wheeled Emma out. Suddenly the room felt cavernous, overwhelming with the vacancy she had left behind.

  Too late Lydia remembered that she’d meant to ask Emma to put something in writing—small protection against wagging tongues and the rule-mongers, but at least it would give her some credibility if anything happened.

  “She’s going to be all right, isn’t she?” Deon asked, still gripping her hand.

  Lydia couldn’t restrain herself. She pulled him close into a hug. “She’s going to be fine. Everything’s going to be fine.”

  Making promises she couldn’t guarantee. Breaking her own rules. Getting involved. What the hell was she doing?

  TWENTY-FIVE

  Friday, 8:26 A.M.

  JARED WAS WAITING FOR AMANDA AND LUCAS IN the ICU waiting room. “They wouldn’t let me go in to see Tracey this morning.” He leaped up from the sagging and dispirited couch. “What’s happened? Something went wrong, didn’t it?”

  Lucas motioned to Jared to sit back down. The couch sighed with his weight. Lucas pulled up a straight-back chair to sit opposite. Amanda hovered in the background; she was never sure how much she should contribute to these family meetings, and it still felt weird, knowing Jared and being privy to the intimate details of Tracey’s treatment.

  “Tracey’s stable but in serious condition,” Lucas began. He leaned forward but kept his hands folded on his lap, giving him the appearance of an older man. “We’re doing everything we can, but any information you can give us could make all the difference.”

  “Anything,” Jared said. “What do you need to know?”

  “Has Tracey been sick at all lately? Maybe a rash or complaining of numbness or tingling in her hands and feet?”

  “No rash. I remember a few times she said her foot fell asleep, but it was after she was sitting for a while, seemed normal. Oh, and she started doing this kicking thing at night, like she had that restless leg thing.”

  “Headaches, nausea, vomiting?”

  “No, I told you all this yesterday. Nothing like that.”

  “How about you? Have you been sick at all?”

  “Me? No, I’m fine. Haven’t been sick since spring when my allergies always act up.” Jared stared at Lucas. “Why are you asking about me? Does Tracey have something that’s spreading?”

  “Did Tracey go to the boathouse often?”

  “The boathouse? What’s that got to do with any of this?” He turned to glance at Amanda. “I told you Tracey hated the water—she was a runner. She couldn’t even swim.”

  “Did she come visit you there?” Amanda asked. “Maybe use the exercise equipment or something?”

  He frowned, considering. “Maybe once or twice last winter when the weather was bad. Not in a long while. Except to shower and change after a run if we were going out.” He rocked back. “Oh my God. Does she have the same thing Shelly had? Is she going to die, too?”

  Amanda had no idea what to say, but thankfully Lucas took over. “Jared, we’re looking into every possibility. That’s why we need to check everything.”

  “Okay. I guess. I brought all her medicines and stuff,” Jared said, nodding to a brown paper bag sitting on the side table. Amanda began to go through it, handing off anything interesting to Lucas. “I grabbed everything, didn’t know what might be important.”

  “Birth control pills, acetaminophen, ibuprofen, antacids—”

  “Those last are mine,” Jared put in. “But you said bring everything.”

  “What are those?” Lucas asked as Amanda pulled out a prescription bottle with a bar code across the label. He took it from her, frowned, and shook out a few shiny golden perles into his palm. “She was in one of Nelson’s studies.”

  “No. I asked,” Amanda said. “Tracey dropped out months ago, right after she started.”

  Jared was shaking his head. “She told me she went every month. Loved those pills, said they were helping her train for her next marathon. Called them her Energizer Bunny food.”

  Lucas twisted the bottle in his palm, reading the numbers beneath the bar code. “The date is four months ago. Maybe she’d found something else to give her energy.” He looked at Jared. “You said Tracey is a serious athlete. Has she ever taken steroids? Sometimes they’re found in natural health supplements or herbal preparations?”

  Doubt crept over Jared’s face. “Maybe. She was into natural healing. I’m not sure.” He didn’t meet Lucas’s eyes as he asked, “If Tracey wasn’t going into the city to see the doctor every month, who was she seeing?”

  Lucas was still focused on the bottle in his hand. He stood, and Jared mirrored his movements. “When you go home, maybe you can check her appointment book, see if she had found someone else to help her with her training. Maybe a nutritionist. If you find anything, let me know.” Jared nodded. “In the meantime, wait here while I talk to the nurses and see if I can get you in there to see Tracey.”

  Amanda followed Lucas out into the hallway. He stalked a few steps toward the ICU, then spun on his heel, turning on her. “You knew she was a patient of Nelson’s but you didn’
t tell me?”

  “All I knew was that she was in a study. It didn’t seem important, not after I found out she’d dropped out.”

  “That’s not for you to decide. I decide what’s important about my patients. What else haven’t you told me?”

  “Nothing.” She remembered her episode when she was down in the tunnel and realized she was lying. No matter, Lucas wasn’t her doctor; it was Dr. Nelson she needed to call.

  “I want you to send those pills down to the lab. Make sure they test for mercury contamination as well as other heavy metals.”

  “Lucas, that’s ridiculous. There are thousands of people around here in Dr. Nelson’s studies. If there was something wrong with them, we wouldn’t have three patients, we’d have dozens.”

  The glare Lucas gave her could have sliced through a diamond. “I didn’t ask your opinion, Amanda. Just do it. And while you’re at it, go home. Get some rest. I don’t need you back here until tomorrow morning.”

  “What about Alice’s MRI? I want to be there—”

  “Jim can handle it. You go home. Now.” Before she could protest, he turned and stalked away, hands thrust deep into his pockets.

  NORA CHECKED IN WITH RACHEL, WHO WAS covering the ER for her. “It’s pretty quiet,” Rachel told her when she called. “Take your time. I’m stuck here finishing the schedule anyway.”

  “Thanks, Rachel. I’m just going to grab some breakfast and I’ll be right down.”

  As a supervisor, Rachel was very understanding. She knew that her nurses routinely put in unpaid overtime, and she didn’t hound them when they needed to take a few minutes of personal time. Nora was still jumpy after her confrontation with Seth—kept expecting him to come up behind her, wanting to talk. Worse still was anticipating the new bout of gossip that would soon be humming through the hospital grapevine.

  She grabbed a sausage biscuit and cup of coffee, then added a chocolate chip cookie to her tray. Protein to get through the shift, caffeine to keep her awake, and chocolate to soothe her tattered nerves. Breakfast of champions.