“I don’t feel like you’re taking this seriously.”
“Why? Because my eyes are closed?” He rolls up on his side, props his cheek on the angle of his wrist and stares at her. “I really am. Listening. I’m trying to figure out what part of this has you so upset—her daughter’s death or the fact that Jory knows more about it than you do.”
“I just… I wouldn’t have thought she could lie to me.”
He gives her a thoughtful, questioning look. “Well, did she lie to you? Or just not tell you the whole truth.”
“Why would she hide it from me, though?” Claire falls onto her back now. “This story about her daughter being poisoned in some house… do you think she could have been part of a prostitution ring? On drugs?”
“That’s not unimaginable given the stories you bring home. Maybe Miguela’s hiding it because she’s scared. It sounds like she thinks someone in Hallum is responsible.”
“Addison?”
“What?” he finally asks.
“Walker’s not the type to do something like this, is he? Get a teenager pregnant and send her out of the country? Or worse—send his workers into prostitution?”
He lofts the sheet and turns onto his stomach, pulling his pillow under his chest. “This is the same man who funds your charity clinic. As far as I know he’s happily married.” His eyes are blinking heavy and slow, they drift closed for a moment.
“Since when does money and power keep a man from taking advantage of people who work for him?”
He rouses again with this, “It’s two AM, Claire. You’re not making sense.” He blinks again, waiting for her to answer or go to sleep. “You want to believe her, don’t you? That’s why you’re so upset.”
Claire nods. “Yeah. I want to believe her. Believe in her. I feel responsible for her. But it’s him, too,” she says.
“Him who?”
“Walker. I need to believe in him, too.”
• 31 •
Anita is due to deliver any day, and her sister, Rosa, has been coming in most afternoons just to lighten her load. When the volume picks up in the afternoon the four women fall into a rhythm of patient triage and flow—symptoms and vital signs, medication lists and wound care pass between them like relay batons, each of them kindly, efficiently cutting to the quick of the complaint. Even the patients seem to catch on that there can be no unessential requests or the last in line will get no care at all. They all go forward as if Dan might come back to work any day, because none of them can imagine this place surviving long without him.
Other than putting an advertisement in the newspaper, Claire hasn’t brought it up. She and Frida are at the clinic until after eight thirty each night, dividing up Dan’s messages and lab reports, trying to guess what his patient care plans would have been, delaying as many follow-ups as possible so they don’t have to call him at home.
“So, where would they go?” Claire finally asks, her lap filled with crisscrossed stacks of pathology slips and radiology reports and pink phone call memos. “Would Kit or Hale or the hospital take up the slack?”
“How could they? They already see plenty of people for free,” Frida answers. Then she dumps every paper on her own lap into her black plastic in-box and puts on her windbreaker. Buttoning it up quite deliberately, she circles her chin around the room, at the dangling lightbulb, the cracked window over its flimsy chicken-wire mesh, the broken linoleum squares on the floor. “I don’t know! How much can you worry about where all the water goes after a flood? You just swim harder while it’s high. This place is falling apart as it is.” She walks out through the swinging gates and then walks right back in before they’ve stopped moving, points her finger at Claire and says, “You need to get home to your girl. That’s who needs you most. Don’t you let her daddy raise her without a mother.”
It is an unusually light morning. Frida says it’s because they are starting to harvest; too much money is hanging on the trees for workers to leave the fields for any reason. Anita blames it on La Migra, the border patrol, circulating through town again. Claire listens to them both and says Hallum must be a pretty pure place, because if there’s any season an orchardist would be enticed to bribe the law it would be for the picking of fruit. Half the crop would rot on the ground without the migrants.
An hour after everyone else leaves, Claire turns out the lights in the waiting room and walks to the bank of file cabinets behind the reception area. She has a name, she has a birth date, she knows the season in which Esperanza was seen. There is a grant proposal sitting on her desk right now to hire a part-time person to digitize their files, but Dan had always eschewed any need for more than their one aging computer; all the records in the clinic are still written and filed by hand.
Esperanza Ruiz’s clinic chart is almost pristine, the cream-colored folder unblemished. Claire sits down at Anita’s desk and flicks on the light. From the story Miguela has told her she suspects Esperanza died of some complication of pregnancy, probably toxemia—a poorly understood biochemical backfire between fetus and mother. She had been only seventeen, young enough that toxemia was more likely, and it could also explain the bruising and swelling and confusion Miguela described.
Dan must have seen Esperanza a few months before she went back to Jalapa. The single page inside her chart, dated early October, sketches a typical intake history and physical. Her chief complaint was nausea and vomiting, her physical exam remarkable only for some slight swelling in the ankles, a heart rate a bit faster than expected. Her last menstrual period was reported as August, but there is a question mark beside it, and if Dan did a pelvic exam, he didn’t put his findings on the page. Esperanza’s height and weight show that she was a stout girl, unlike her mother. Dan’s impression, at the bottom of the page, lists a differential of pregnancy, viral gastroenteritis or hepatitis and an order for some blood work—a hematocrit and white cell count, a chemistry panel and pregnancy test. He could have easily gotten a urine pregnancy test in their own makeshift lab, but if he was drawing blood anyway, if she hadn’t been able to give him a sample, he might have just tagged it along with the blood he sent to the hospital lab. For whatever reason there is nothing else in the chart except the typed-out page of demographics that Anita must have recorded. Esperanza’s address was Walker’s Orchards.
Claire closes the chart, disappointed. She had hoped for a definitive answer, some solace for Miguela, if there could be any comfort in pinning a confirmed diagnosis to her daughter’s cause of death. Claire opens the folder one more time and flips to the back of the brass-tabbed pages looking for the lab results. Nothing. Which meant nothing. Esperanza might have walked out the second someone came in the room waving a needle at her. But the fact that Dan had been checking a pregnancy test was enough. The diagnosis of toxemia fit. At least she might convince Miguela her daughter had not been murdered or part of a sex ring.
She tries to imagine Esperanza traveling by bus on rutted dirt roads through the mountains of Nicaragua, pregnant and sick, her illness escalating toward seizures and inevitable death if she couldn’t be delivered. If she had stayed here, she and her baby would most likely be alive.
She waits until Addison and Jory are upstairs to talk to Miguela, tries to ease into it by asking her to repeat what she remembers again, anything that might explain more than Claire found in the single page of Esperanza’s chart. Had she had a fever, any rash, had the baby still been moving? Did any doctor see her before she died? Was she sure Esperanza was pregnant—Dan had not been certain only three months earlier.
Miguela seems worn out by the questions. “The doctor in Jalapa said it was too late.”
“I think, from everything you’ve told me, I think Esperanza had a complication from her pregnancy. It’s called toxemia. Without being in a hospital, without a C-section—cesárea, you understand?—without that there is no way to save the mother’s life.”
Miguela’s face looks like Claire is pronouncing Esperanza’s death for the first time. She
is struggling against such a final conclusion, Claire can see it. As if she’s come too far tracking her daughter’s death to accept it as an unpreventable consequence of nature—needs to identify some perpetrator other than God and poverty. “But what about this house? She told me she was there many weeks.”
“The address in her chart was for the orchard. Toxemia makes the brain swell—I think Esperanza might have been confused. Maybe the house was the orchard office. Or the clinic.”
Miguela is quiet for a long time. Finally Claire asks her if she wants to be alone.
She puts her hand on Claire’s sleeve. It is the first time, Claire realizes, that Miguela has ever touched her. “Doctora… Please. I need to see myself. I want to go to the clinic.”
Claire is used to the clinic on Sundays, a quiet peace that helps her work or study. A sense of time and disease arrested. She locks the door behind them, knowing that the lights might attract any passing patient with a complaint. Miguela seems hushed, intimidated by the vacancy of a place usually filled with waiting patients and the noise of illness and injury. Claire leads her through the swinging gate into the records stacks. Even for so small a clinic they are impressive, with floor-to-ceiling shelves of coded charts on two rolling metal frames. She walks down the row of Rs until she finds Esperanza’s, slips it out and puts it on Anita’s desk.
Miguela seems hesitant to open it. Claire pulls out a rolling stool and sits beside her. “It’s okay. She was your daughter.” Miguela runs her hand over the smooth manila cardboard of the chart. Claire watches her, sees her take in a breath and sit up straighter, then, at last, lift the front cover open. Claire asks her, “Can you read it?”
Miguela nods but stares at Dan’s note without moving her eyes, maybe just absorbing the fact that these words are the closest she will ever come to her daughter’s life in this country. After a few minutes she turns the single page, as Claire had done, looking for more, scanning the typed facts of age and address, the country of origin. Then she pushes the chart away and stands up. “Thank you. You are kind to bring me here when everything is closed.” Claire picks up the chart and walks back along the row of Rs to find its place. She hears Miguela start to leave the waiting room. But then Miguela takes a step back toward Claire and asks, “Why would they not use her whole name?”
“What?”
“Why did they only use part of her name?”
Claire stops, turns the chart sideways to read Esperanza’s name in bold type along the edge of the front flap. She looks at Miguela, puzzled. “Esperanza Ruiz. Isn’t that… Wasn’t that her name?”
“Esperanza De Estrella Ruiz. Her father’s name was De Estrella.”
“Her father’s name was De Estrella?”
Claire knows it is the common custom in Latin America to use both parents’ names—often enough it has caused confusion with their medical records. “Did she go by both names after she left Nicaragua? Do you know?”
Miguela shakes her head. “Will you look? Please?”
Claire pushes one rolling rack down the length of its tracks and stands on a footstool to reach the Es. She flips through them, pressing her thumb against the edge of each chart, saying the names under her breath: “Escada, Escondido, Estonce, Estrella.” There are multiple Estrellas. None is Esperanza. She steps down. “She’s not there. Probably she went by Ruiz in the clinic.”
Miguela takes a hesitant step forward, then walks up to the shelves and scans the letters lining the protruding flaps. She is ahead of the Es, reaches up to push a few charts forward and pulls one slender volume out of the rack. ESPERANZA DE ESTRELLA RUIZ. It had been filed under the letter D.
The date on it is late November, less than two months later. It’s no thicker than the other chart; the two combined are only five pages. It is the contrasts between them rather than the similarities that are disturbing, the numbers marching in a column down the last sheet that refute the diagnosis she was so sure of half an hour ago. Some of the labs could be consistent with toxemia—the elevated liver enzymes, the anemia, the low platelet count—if they had been discovered late in Esperanza’s pregnancy. If Esperanza had been pregnant. Her pregnancy test result in the laboratory section is negative. Claire looks at it twice, even runs her finger across the page from the chemical term, Beta HCG, to the negligible measured quantity. Dan’s note on the lined progress paper consists of a single word scribbled during Esperanza’s follow-up visit, hepatotoxicity, underlined and followed by a bold question mark.
“She wasn’t pregnant. Something was wrong with her liver. Hígado.” Claire translates when she sees Miguela’s confusion. “It can make the abdomen fill up with fluid—enough to make a woman look pregnant.”
Miguela seems almost afraid to open this chart, touches it once and then moves her hand away. “Why? Why would she have this?”
Claire starts to list the possibilities—viruses and cancers and alcohol, toxins and Tylenol, sclerosing ducts and impacted stones—but all the medical words sound coldly clinical, untranslatable even if she knew the Spanish words. “There’s just no way to know from these labs.” She hates the finality she hears in her voice, relaxes her posture so that her face is nearer Miguela’s. “I’m sorry. I’m so sorry.”
Miguela covers her eyes with one hand; the other is pressed into her abdomen like her body might fly apart if she let go. Claire can’t tell if she’s crying. “Can I get you anything? Some tea?” she asks.
Miguela looks at her like she hasn’t understood this, either. “It’s because of the medicines they gave her, isn’t it?”
Claire flicks on the small desk lamp beside Anita’s computer. “Miguela, there’s nothing in her chart that indicates she was given any kind of medicine. Dan’s note doesn’t…”
“Other people lived in the house with her. She told me. If we could find them they would remember.”
Claire studies her face for a minute, notices the shadowy hollows underneath her eyes, the grim set of her mouth. Every smile Miguela has shared in the last month seems like a sad, strained pretense now. She lowers her voice, trying to hide her frustration. “Her address was the orchard. Walker’s Orchards. Where you worked. She was confused. You said that. Remember?”
“Yes. She worked at the orchard. But then someone took her to this other place, where they hurt her.”
Claire doesn’t know what to say anymore. Logic, reason, any rational counter is doomed because it will always end with the same tragic fact of Esperanza’s young death. She opens the chart again, ready to show Miguela anything more measurable than her grief-tainted memory. “These numbers, here: Esperanza’s INR and her pro-time. They measure a protein made in the liver that helps blood clot. They were too high. It means her liver was very sick. That is why she had bruises.”
Miguela looks bewildered; maybe Claire’s explanation has been too complicated. But something in Miguela’s unashamed, questioning gaze cuts to the mother in Claire, begs her to admit she would do the same—push and push until she found an answer. “Let’s go home. We’ll eat something and we’ll talk about everything you remember. Maybe we can find someone in Hallum who remembers her. Maybe I can talk to Dr. Zelaya.” She opens the back flap of both charts side by side on the desk, unclasps the brass tabs that hold the pages together.
Miguela watches her intently, possessively. “Why are you taking them apart?”
“To combine them, so everything will be together.” Claire stacks the pages of Esperanza Ruiz and Esperanza De Estrella Ruiz into their new order, thinking it all through one more time: a young girl living in a house where someone was giving her medicine or drugs, using needles on her. How many thousands of immigrants ended up trafficked for sex, or addicted through choice or coercion? If that had been Jory’s irremediable fate she might not even want to know about it.
She aligns the punched holes and slides the pages onto the opened brass flanges. But now the front page, the one with the factual demographics in Esperanza’s mistaken name, is wrong—should, in fact,
be torn up, Claire decides. She lifts it off the tabs and the two pages with their two different names are side by side in front of her. And for the first time she sees that the name is not the only difference in the typed data that Anita must have taken from Esperanza at this very desk.
Miguela has obviously noticed her reaction. Claire feels caught, wishes she had just left the charts as they were.
“What is it?” Miguela asks.
Claire hesitates, then turns on Anita’s computer and opens the patient database they keep, little more than an Excel spreadsheet; scrolling through the Rs and then through the Ds she finds the same duplication—two Esperanzas. With two different addresses.
Miguela sweeps the pages into her lap, scanning the boxes of information. “The addresses are different. She is in Wenatchee here.”
Claire sees the change in Miguela’s face, sees her back away from releasing all of this—almost relieved that her obsessive hunt can résumé and delay the insurmountable fact of Esperanza’s death. “Miguela, there could be another reason.” Claire starts talking, tempted to take the pages away from her. “I’ll ask Anita on Monday. She might remember something.”
“Call the number.”
For a moment Claire thinks that Miguela wants her to call Anita right now. “Call?”
Miguela picks up the desk phone and holds it out to Claire. “Please. Call the number in Wenatchee.”
Claire dials the number and waits through six rings, about to hang up when a woman answers. She listens for a moment and clicks the receiver down.
“What is it?” Miguela asks.
Claire shakes her head. “It was some company. A business.” She brushes her hand across the page, as if the numbers might magically appear more clearly or change altogether into an obvious solution she should have put together from the start. At least, she thinks, it’s unlikely a brothel or drug house would hire such politely professional office staff. “Maybe I dialed wrong. Or the phone number could have changed since Esperanza lived there.”
Healer Page 27
