Medical Judgment

by Richard L. Mabry M. D.

  10

  Bill Larson put down his menu and looked across the table at his pastor. “Dr. Farber, I’m glad you were free for dinner this evening.”

  “Forget the ‘doctor.’ It’s Steve this evening. And I’m glad you called,” he said. “I think most of my congregation feel a bit uncomfortable when they’re around their preacher. You probably get that as well, I guess. They’re ill at ease in the presence of a detective, even when they have nothing to hide.”

  “I think everyone has something to hide,” Larson said. “For instance, I’m an alcoholic. I tried for years to conceal it before I eventually admitted it to myself and began taking steps to fight it.”

  The waiter arrived at their table and asked for drink orders. Both men settled on iced tea. “I hope you didn’t do that on my account,” Larson said, when the waiter left. “You could have had some wine with dinner if you wished.”

  “No I couldn’t,” Farber said.

  He left it at that, but Larson nodded and filed away the information. He’d had suspicions, and Steve just confirmed them. The pastor was fighting the same battle as the detective.

  The conversation was casual until they finished their dinner. Both of them passed on dessert but asked for coffee. After it was served, Larson said, “I wonder if I could ask you a few questions.”

  Farber smiled. “I was curious about when you’d get around to it.” He held up his hand like a traffic cop. “That’s okay. I’ve enjoyed dinner with you. As I’ve said, most people feel uncomfortable around their pastor. The opportunities I’ve had for dinner out since Mary died were mainly church affairs, and those are sort of have-to invitations.”

  “And I don’t go out much either,” Larson said. “So it’s been a nice change for me.” He pulled a notebook and pen from the inside pocket of his sport coat. “But now it’s time to ask you some questions about Sarah Gordon.”

  “Has something new come up?”

  “No, we’re just pursuing all the leads we can find. My question, I suppose, is whether you know of anything that might lead someone to do all this. I mean, the phone calls and even the stalking are one thing, but the fire and the gunshot tell me this is escalating out of control.”

  Farber frowned for a moment, obviously thinking about the question. Then he shook his head. “Sarah Gordon, before Harry and their daughter were killed in that crash, was regular in her attendance at church. Everyone loved the whole family. You’ve heard the expression, ‘Didn’t have an enemy in the world.’ I believe that could have been applied to the Gordon family.”

  The detective asked a few more questions. Sometimes getting at the information needed from a different direction worked. In this case, it produced the same results. Everyone loved the Gordons. No one had any reason to do this to Sarah.

  Larson drank the last of his coffee, caught the eye of their waiter, and motioned to his cup. After the waiter had served both of them, the detective said, “You know, even if you haven’t shed any light on the case, it’s been nice to sit down to a meal instead of snatching some fast food or nuking a Lean Cuisine.”

  “Well, if I think of something, I’ll give you a call,” the pastor said. “And you’ll have to let me treat you to dinner some evening. I think we have a lot in common. And I don’t have many real friends with whom to share.”

  “Same goes for a detective,” Larson said. “But I think tonight we’ve both felt comfortable.”

  “Perhaps that’s because neither of us has tried to hide any secrets,” Steve said.

  No, and now I know you and I share one. Since neither of us has chosen to lean on AA, maybe we can help each other when it’s needed.

  * * *

  Sarah was in the ER, working hard to do what doctors often must: compartmentalize their lives and focus their attention on the situation at hand. When she found her tormenter’s actions creeping into her thoughts, she shored up the wall that kept them from impinging on the attention she gave each patient she saw in the emergency room. The clock on the wall told her she had only another hour until this shift was over. Tomorrow was a day off, but she couldn’t afford to let her focus drift.

  She was just about to say something to Connie, her nurse friend, when the double doors into the ER opened to admit two EMTs pushing a stretcher on which a middle-aged man was actively convulsing. He was restrained to the gurney with straps. A woman walked beside him, holding a padded tongue depressor between his teeth, a worried expression on her face.

  Connie met them a few steps inside the door and steered them to an open cubicle, with Sarah a few steps behind. “What do you have?” she asked the lead EMT, a middle-aged man whom she knew by sight but not by name.

  “According to the patient’s wife, he began seizing right before she called 9-1-1. No known head trauma, non-drinker, no history of recreational drugs. Good general health except hypertension, controlled with meds.”

  She noticed there was no IV running, but before she could comment, the EMT said, “We couldn’t get a vein. I gave him ten milligrams of diazepam IM about . . . ” He looked at his watch. “I gave it ten minutes ago. It didn’t seem to slow his seizures, though, so you may want to repeat it.”

  Sarah moved in, signaling for Connie to hold the tongue depressor. She started her exam with the man’s head. Her fingers found it quickly—an abrasion and area of swelling toward the rear of the skull on the left. She turned to the woman who’d accompanied the patient and said, “Ma’am, are you his wife?”

  “Yes,” the woman said, hovering just behind Sarah as though by her very presence she could help.

  “When did he hit his head?”

  “I didn’t know he had,” the woman said.

  Sarah asked a few more pointed questions, and within a couple of minutes she was pretty certain she knew the cause of the man’s seizures. “Connie, let’s give him another ten milligrams of diazepam IM,” she said. Then she turned to the EMTs, who were still there. “If you guys will try to restrain him long enough, I’ll see if I can get an IV started. I’ll draw blood for electrolytes and a stat blood sugar at the same time. After that, we need to get him to radiology for a CT of the head. My guess is that we’ll find evidence of a subdural hematoma.”

  The hour that followed was jam-packed with action and decisions for Sarah. The IM medication stopped the seizures, although she remained vigilant for their resumption. If seizures went on uncontrolled for as few as twenty minutes, they could result in permanent neurologic impairment. She didn’t want that to happen.

  It didn’t take long to carry out the CT scan of the head, and in the meantime Sarah got back the reports that showed the man’s blood glucose and electrolyte levels were within normal limits. A toxicology screen would take a while, but she was pretty certain the cause of the seizures would be revealed by the radiographic studies of the brain.

  Sure enough, the CT scan showed evidence of bleeding onto the surface of the brain, what was called a subdural hematoma. There was no way to know when the trauma that caused this occurred, although the swelling and abrasion of the man’s scalp seemed fresh. But no matter—he needed neurosurgical intervention as quickly as possible.

  Sarah was on the phone to the neurosurgeon on call when Connie interrupted her. “He’s seizing again.”

  “Hold one second,” Sarah said into the phone. To Connie, she said, “Give him lorazepam, two milligrams slow IV—over about a minute. If he’s still convulsing, give him another two, but slowly.”

  She finished her conversation with the neurosurgeon, who said he was on his way. “Alert the OR, if you would. And good pick-up,” he said.

  Only after the patient, whose name was Paul Murchison, was in surgery under the care of the neurosurgeon did Sarah check the time once more. She found that her shift had ended more than an hour earlier. Well, no matter. No one was waiting for her at home anyway.

  * * *

  Kyle Andrews couldn’t sleep. His phone conversation earlier with Sarah had been painfully short—it was o
bvious she was in a hurry. He’d had a few unexpressed doubts about Sarah having a pistol, despite the arguments he made when he initially recommended she arm herself. When she finally contacted him to say she was ready for a gun, those doubts sprang up in his mind once more. Of course, he’d never let her know about his reservations, and he felt better after spending some time with her on the range as she brushed up on gun safety and the use of a pistol. But still, he lay in bed tonight, wide-eyed, wondering if he’d contributed to her safety or set Sarah up for an encounter that would end with her dead.

  He looked at the bedside clock, and two minutes later found he’d already forgotten the time, so he checked his watch. Finally he rolled out of bed, slid his feet into slippers, pulled the top cover around his shoulders in lieu of a robe, and headed for the kitchen.

  The kitchen clock showed that it was almost midnight. If Sarah’s shift went the way he’d heard her describe it when she and Harry double-dated with Kyle and his fiancée, she was often delayed in leaving the ER. If that were the case, she might still be awake, might just be leaving the hospital. But even if he reached her, would Sarah be willing to talk with him?

  Finally, he decided that he’d send a text to her cell phone. If she was asleep, she might or might not waken long enough to read the message, but if Sarah hadn’t gone to bed yet, perhaps she’d call him. He thought about what to say, and finally sent this text: If U R awake, we need 2 talk.

  Kyle put his phone on the kitchen table and wondered whether he should make a cup of coffee. Maybe that wasn’t such a good idea when he was already suffering from a terminal case of insomnia. He’d almost decided on a glass of warm milk when a familiar sound made him look down at his cell phone. Sarah had answered his text. Kyle had thought his message was the soul of brevity, but hers made his look positively verbose. Her message was: Sure. Call.

  He picked up his phone and speed-dialed Sarah.

  “Hello?”

  “Sarah, were you about to turn in?”

  “No. I’ve been tied up in the ER with a patient, and I’m about to leave the hospital. But why are you up? And what’s on your mind?”

  Kyle hesitated. How would Sarah react if he told her he was worried about her? Lately she seemed to resist someone trying to protect her, and that was exactly what Kyle’s motivation had been . . . although not totally out of loyalty to his dead friend, Harry. Finally, he decided on the truth. “I’ve been worried ever since I gave you that pistol. Part of me thinks it will provide security, part of me wonders if it doesn’t just make you more likely to get shot.” She started to say something, but Kyle hurried on. “Look, if you’re still awake and want to decompress with a friend, why don’t you come by for some coffee—decaf if you’d like. I really want to talk with you.”

  “Decaf or regular, makes no difference to me,” Sarah said. “And I guess I can spare another half hour or so. I don’t have to go to work tomorrow, so I can sleep a little later . . . unless my nemesis has something else planned for me tonight.”

  * * *

  Sarah noticed that Kyle had turned on his porch light for her. She pulled her car into the driveway and turned off the ignition. Her hand hovered over the pistol, which she’d kept locked in the glove compartment while she was at work but had removed and placed on the seat beside her for the drive to Kyle’s. Maybe it wasn’t legal to have it out like that, but this late at night she didn’t want to take any chances. Now that she was at his house, she locked the pistol inside the glove compartment once more.

  When she opened the car door, the interior remained dark. Kyle had told her about switching off the dome light so there’d be no illumination to make her a target as she exited the car. Keep illumination to a minimum. Never stand with light behind you. If this situation kept up for much longer, she would be able to give seminars to the staff at the hospital on avoiding being attacked.

  Sarah hurried to the front door, which opened before she reached it. She noticed that the living room was dark. “Light in the room behind you shows your silhouette and makes you a better target,” Kyle said.

  “I know. You told me that.”

  Once she was inside, he closed and locked the door, turned on a couple of table lamps, and pointed to the sofa. “Would you like to sit in here?”

  She answered his question by taking a seat. “Did you make that coffee we talked about?” she asked.

  “Coming right up.” Kyle left the room, but was back in a few moments with a tray that he put on the coffee table in front of the sofa. On the tray were two thick white china mugs, a carafe of coffee, sugar, sweetener, and a pitcher of cream. He poured coffee and handed the mug to Sarah, then helped himself, adding sweetener to his cup before he sat beside her.

  Sarah took a sip, then sniffed the contents of the mug. “Great coffee. What brand is it?”

  “It’s a Colombian blend I get at a little place near my office. I buy the beans and grind them myself. What do you drink?”

  “At the hospital, the coffee in the break room generally stands on the hot plate for hours. I’ve never asked what brand they use, because by the time I get some it’s not recognizable.”

  “And at home?”

  “Whatever’s on sale when I have a chance to buy groceries,” Sarah said. She leaned back, closed her eyes, and almost fell asleep before she jerked awake. “Sorry. Guess I’m decompressing.” She drank more coffee. “What was it you wanted to talk with me about?”

  Kyle leaned back, cradling his coffee in both hands as though he were cold and needed the warmth. “A couple of things, I guess. First, I wondered if you’d had second thoughts about owning a gun. I don’t want anything to happen to you, but at the same time I want you to realize that a pistol isn’t the final answer. I guess I’m ambivalent. Frankly, I’m hoping you don’t have to use it at all.”

  “I’m fine with the gun, Kyle. You didn’t talk me into it. The person who’s been harassing me, whoever it is, made me change my mind. And I’m grateful that you gave me one and made certain I know how to use it safely.”

  Sarah waited for Kyle to respond, but he just sat staring into his coffee cup. It was obvious to her that he had something more to say, but for some reason he was having trouble taking the conversation in that direction.

  “More coffee?” he asked, lifting the carafe and gesturing with it.

  “Sure, you can warm mine.” She held out her cup.

  Kyle poured for both of them, put down the carafe, took a deep breath, and looked at Sarah. “I don’t know how to say this, so I’ll just blurt it out. You know I was Harry’s friend. He didn’t ask me to watch out for you if something happened to him—it wasn’t necessary. That was understood between the two of us. And I’m happy to continue to help as long as you’ll let me. But I think I may have overstepped my boundaries.”

  Sarah’s mind churned as she recalled Kyle’s actions since Harry’s death. Had he done something specific for which he was now apologizing? Was he talking about his actions then or more recently? Her memories of the weeks immediately after Harry and Jenny died were still hazy. But as she recalled, Kyle, like everyone else, had been nothing but helpful during the time following the death of her husband and child.

  Was he talking about his behavior the past few days? She’d called him right after the fire, asking help because of some sense, probably gained from TV or novels, that a lawyer should accompany anyone giving a statement to the police, even someone against whom the crime had been committed. Of course, after that he’d begun to come on a bit stronger than she was comfortable with. Had Kyle gotten the wrong idea? Or was he apologizing for trying to go too far? Maybe that was what he wanted to talk about.

  Kyle had paused during this time, apparently thinking how he wanted to convey his message. Now he broke his silence. “I talked with Steve Farber.”

  “Our pastor,” Sarah said. That reminded Sarah that she probably should talk with the pastor about her efforts to get back on speaking terms with God. She raised her eyebrows, wa
iting for Kyle to continue. “And . . . ”

  “And he made me see that I was sort of pressuring you to react to the deaths of Harry and Jenny the way I did when my fiancée was killed in a freak accident. You know, trust God and move on. Instead, you’ve been up and down, fragile at times, and sort of estranged from God because you still blame Him.”

  Sarah simply nodded, but said nothing.

  “Dr. Farber told me that everyone reacts differently to tragedies like that,” Kyle said. “For instance, he told me how, after his wife, Mary, died of a cancer that their family doctor missed, it took him a long time to get over being angry with God.” He set down his cup. “I’m sorry if I’ve pushed you, Sarah. I promise that from this point forward, I’ll try to let you adjust in your own way and your own time. I just want to be there to help if you’ll let me.”

  Sarah realized that Kyle’s words carried a subtext, a message left unexpressed. Yes, he’d shown, by his attitude if not his words, that he thought she should get over her resentment that God let Harry and Jenny die. But, more than that, maybe these latest attempts by the unknown person had brought out another emotion that Kyle had kept hidden for some time. And she was going to have to be careful not to encourage that particular feeling in him.

  “Kyle, I appreciate your making a point to tell me all this. I’m glad for the help you’ve given in so many ways. And it’s nice to have someone I know I can call on. But let me make something clear to you now. I need to get back to being in charge of my own life, without leaning on Harry . . . or on you.”

  “But if there’s something I can do—”

  “If I need anything, I’ll call.” But it’s too soon after Harry’s death for me to be open to any kind of relationship, so I need to be careful of the signals I send. Sarah looked at her watch. “Look at the time. I can sleep late in the morning, but I’ll bet you have a busy day ahead of you.” She put her cup on the tray. “Thanks for the talk. I think maybe it was good for both of us.”

  “Would you like me to get in my car and follow you to your house?” Kyle asked.