Medical Judgment

by Richard L. Mabry M. D.

  “We’re checking a lot of people,” Larson said. “That includes Dr. Farber.” He didn’t volunteer any reason.

  Sarah had noticed another name written in at the bottom of the list. She started to ask why Kyle Andrews had now become a suspect, but decided to let it go for now. If Larson wanted to tell her, if he wanted to warn her about anyone, surely he’d say so.

  Larson said, “Well, I guess I’d better let you get on with your day.”

  “Are you making any progress in the investigation?” Sarah said.

  “We’re doing a lot of ruling out. And we’ll eventually find the person responsible for the attacks on you. Until then, I hope you’re taking extra care to be safe.”

  “I am, but I’m a bit more militant than I was,” Sarah said. “Maybe it was because the stalker actually got into my bedroom despite my best efforts to protect myself, but for whatever reason, my attitude has changed.”

  “What do you mean?”

  “After I married Harry, I underwent a subtle change—subtle enough that I didn’t really notice it until after his death. I got used to leaving the decisive, take-charge attitude I’d developed as an ER physician at the door, you might say. I was content to let Harry make the decisions for us, which was fine so long as Harry and I were working together as partners. Unfortunately, that passivity continued—actually, was heightened after Harry’s death.”

  “But that’s changed?”

  Sarah nodded. “Definitely. I’ve decided I’m through being passive. I’m ready to fight back.”

  “Thus your acquisition of a dog,” Larson said. “And I guess you still have the revolver Kyle Andrews gave you.”

  Sarah touched the pocket of her jeans. “Yes, and I’m more careful than ever to keep it with me.”

  “Just remember that you can’t carry it concealed—”

  “I know,” she said. “I plan to follow through until I get my license, but until then I’m at least going to have it with me at home and in the glove compartment of my car. And from now on I’m through running from my attacker. Instead, I want him come after me.” Sarah had heard of someone’s eyes blazing but had never actually seen it. Now she imagined that if she looked in a mirror, that’s what she’d see. “I’ll be ready.”

  * * *

  It was Saturday. To some people it was a day off, but to Kyle Andrews it simply meant working at home instead of at the office. He looked up at the clock on his study wall and fought the temptation to pick up his phone and dial Sarah’s number. About now she’d be changing and gathering things, getting ready to leave for her tour in the emergency room. He wanted to ask her how she was doing. He wanted to see if she was still . . . angry might not be the word for it. But however you wanted to describe it, she seemed to be different when he last saw her. Her attitude—not just toward him, but toward her life in general—seemed to have changed. And, to be honest, he wasn’t really very happy about it.

  Since Harry’s death, Kyle had hung around in the background biding his time. For the past week or so, going back to her phone call right after the fire at her home, he’d assumed the role of someone on whom she could call for help. As things progressed, Kyle was pleased by this new relationship. He wanted to keep that relationship intact. No, that wasn’t right. He wanted to build on it.

  But suddenly things seemed to turn around. Sarah had gone from a dependent widow to an independent woman determined to stand on her own two feet once more. He couldn’t explain why she’d changed or the exact time it happened, but one of the most notable effects of her turnaround was to push him once more into the background. Right now, he didn’t know what to do to get back into her life. But he planned to keep trying.

  He tried to apply himself to the brief he was preparing, but in a few moments he shoved it aside. Kyle decided he might as well face it. He wasn’t going to be able to concentrate until he talked to Sarah. He picked his cell phone up off his desk and pushed the button that would dial her number.

  She sounded out of breath when she answered. “Sarah Gordon.”

  “Sarah, this is Kyle. Did I catch you at a bad time?”

  “No, I just was in the middle of getting things together for work when I remembered I needed to let Prince out in the yard for a bit.”

  “Prince?” The puzzled look on his face was reflected in that one word.

  “Yes. I haven’t told you about Prince, have I?”

  Kyle listened as Sarah explained about the dog. When she finished, he asked, “Have you given some thought to what you’ll need to do to keep a dog?”

  “If you mean feeding him, letting him run, stuff like that—Harry’s father gave me a short course in taking care of a dog before Prince and I left the farm. I have food for him. I have a dish for his water and a bowl for his food. I’ve made him a bed with a blanket in the front room and another in my bedroom. I’m going to let him out in the yard before I leave for work and again when I get back. What am I missing?”

  “Nothing, I guess.” He hesitated. “Is there anything I can do for you?”

  Sarah’s voice softened. “No, but thanks for asking. And I’m sorry if I offended you and Detective Larson the other night, but it dawned on me that I was becoming so dependent on you two that it was holding me back from regaining my own independence. If Harry were here—” Her voice broke for a moment. “If Harry were here, he’d set me straight. And if Jenny were depending on me, I’d be strong. So I decided to reclaim myself.”

  Kyle realized he’d effectively been told to back off. Well, she’d need him again. After he ended the call, he sat gazing out the window of his study, wondering how long it might be before that happened and how he could hasten it.

  * * *

  “Okay, Prince. Playtime is over. Time to get back in the house.” Sarah tried to recall the command and gesture Hunter Gordon had used to call the dog back. It had seemed so easy when he did it. Fortunately, Prince responded to the tone, if not the words, of her call and trotted back to where Sarah stood holding open the back door of her house.

  The dog entered, went immediately to his water bowl, and lapped for what seemed like forever. Then he looked, first at the empty food bowl then at Sarah, with an expression that said, more eloquently than words, “There’s no food in here.”

  “You’re going to have to get used to my schedule, boy,” she said. Hunter said to feed him twice a day, but she was going to be gone during the time for his evening meal. Sarah had decided to give him some food when she left this afternoon and the rest when she came home tonight. Accordingly, she opened the large sack of dog food, scooped out the appropriate amount, and dumped it into his bowl. “There’ll be more later, Prince. I promise.”

  She could swear that Prince frowned at his bowl for a moment, but soon he was crunching away. When he’d eaten, he looked up at her. Was he expecting more? Probably, but Hunter had warned her about overfeeding the dog.

  “They’re like children. They don’t always know what’s good for them, so you have to be a parent,” he’d said.

  “More when I get home,” she repeated.

  Prince stared at her for a moment, then trotted to a corner of the room and sat down facing her.

  Now came a decision she’d thought about for a while. Should she put Prince into the backyard where he could run and play or leave him in the house? It was summer, and she figured he’d be more comfortable in the air-conditioned house. Besides, how was he going to guard against intruders if he was confined to the backyard? She hoped he could wait nine hours or so for her return. If not, she’d have some cleaning to do. But that was an acceptable trade-off. At least she didn’t have to worry about someone breaking into her house. Prince was like an alarm system with teeth.

  “I’ll be back soon, boy,” Sarah said. She picked up her backpack, moved to the door that led from the kitchen into the garage, and gave the command to guard.

  The dog sauntered leisurely toward the door where she stood. Then he lay down facing it, seemingly ready to do ex
actly what she’d asked of him. At least, Sarah hoped so.

  * * *

  As Bill Larson climbed back into his car, he mentally checked the last name off his list. He’d interviewed every person Dr. Harry Gordon’s nurse thought might hold a significant grudge against the doctor—significant enough to result in the actions he was investigating. The list now contained an even dozen names, and of those he’d been able to rule out eight through confirming they were elsewhere when one or more of the incidents took place. The remaining four had no alibis for the times of the fire at Sarah’s or the gunshot that greeted her return home from work. That didn’t surprise him, since both these episodes took place in the middle of the night. The individuals in question might all have been sound asleep in their beds, but if there was no one with them it was impossible to establish their whereabouts for those times.

  Larson glanced at the car’s clock. It was six p.m. on a Saturday. A line from a song jumped into his mind: Saturday night is the loneliest night of the week. Well, for him it was. He didn’t want to go home—there was literally nothing there for him. No one was waiting for him to come through the door.

  This had been a stressful week, and he didn’t see an end in sight anytime soon. But the stress wasn’t just from the case. The majority of it was personal. And Larson was tired of fighting it.

  He should head for home, but he decided he didn’t want to go there. Not now. What he really wanted was to find a dark bar, sit down at a booth toward the back where no one would pay any attention to him, and order a boilermaker—a shot of straight bourbon with a mug of beer to chase it. And keep ’em coming.

  He could almost taste the liquor flowing across his tongue and down his throat, feel the warmth in his chest as the whiskey found its way into his stomach. He knew that not long after he’d drunk the first shot, he’d start to feel the effects of the alcohol. Oh, it was probably too soon for it actually to work, but Larson knew from long experience that once that first one went down, once he knew there was more on the way, things would look so much better.

  Maybe he should eat. That was one of the rules alcoholics learned when they tried to stop drinking: don’t get too hungry or too tired. But even thinking about food made him feel queasy. Larson knew of something he could do, though. He could seek out the company of someone who might understand. If you’re tempted to take a drink, call your sponsor. Well, he didn’t have a sponsor, but he knew someone he could call.

  Of course, the person he had in mind was on his list of four people who were still suspects—at least, theoretically—in the Gordon case. But somehow, that didn’t matter. Right now it was more important to Larson to deal with the urge he felt, one that had become almost undeniable. It wasn’t just his need for a drink that was making his heart hammer in his chest. He had to talk with someone about the reason all this had finally overtaken him tonight.

  He pulled his car into an almost-deserted strip mall. Larson parked in front of a huge plate glass window covered with “For Lease” signs listing the name and number of a realtor. He withdrew his cell phone from his pocket, scrolled through the names and numbers there, and pushed a button to make his call.

  “Steve? Bill Larson. I hope I’m not disturbing you.”

  “Not at all. I was just putting the finishing touches on tomorrow’s sermon. Then I was going to eat some of the casserole I have reheating in the oven. How can I help? Do you need to make an official visit?”

  “No, this isn’t official, but I’d appreciate it if I could come over.” He hesitated. “This one is personal.”

  “Come on over,” the pastor said. “We can talk while we eat. There’s enough of the casserole for two. I’d appreciate the company.”

  “I’ll see you in a few minutes.” Larson put the car in gear and turned toward where the pastor lived, fighting the urge to turn on the flashing lights behind his grill because, so far as he was concerned, this was an emergency—a personal one.

  15

  Slow Saturday evening so far,” Sarah said to Connie as the two women passed each other in the ER of Centennial Hospital.

  Connie swiped a stray lock of silver hair away from her face. “Just wait.”

  “I know,” Sarah said. “About eleven they’ll start rolling in: domestic disturbances, motor vehicle accidents, heart attacks.”

  Connie glanced at the clock on the far wall. “We’ll be lucky to get away without staying over at least an hour. Tell you what. I’ll stick around if it’s necessary. You can leave on time.”

  “No need,” Sarah said. “I don’t have anyone waiting for me at home.” Then, as Connie hurried away to check another patient, Sarah realized that statement was no longer true. She did have someone waiting at home for her. Prince was waiting.

  Would the dog know if she was late getting home? Did dogs have a sense of time? Or did they simply move from situation to situation while trusting in their humans to provide food, shelter, and a nurturing environment? She guessed that, in that sense, they were like children. As that thought flashed through her mind, Sarah felt tears start to stream down her cheeks. She turned away, hastening to wipe them away before anyone saw. I had a daughter. Now I have a dog. There were implications there that Sarah needed to consider—but not now. Now she had work to do.

  When she pulled aside the curtains of the next cubicle, she saw a young woman, perhaps in her early twenties, perched on the edge of a gurney. Although she was sitting quietly when Sarah peeked inside, as soon as the doctor entered, the patient squeezed her eyes shut, put both hands to her temples, and began a rhythmic rocking back and forth accompanied by moaning like the keening of a mourner at an Irish wake.

  “My head! My head hurts so bad!” She raised her eyes to look pleadingly at Sarah. “Please give me something for it!”

  Sarah looked at the clipboard she held. “Darla, I’m Doctor Gordon. When did this headache start? Describe it to me.”

  “My head! It hurts all over! Please, I need something to make it stop hurting.”

  Sarah watched the young woman, who continued to sway left and right as she repeated her litany. There was no pallor. She wasn’t sweating. Although the overhead spotlight was shining directly in her eyes, the woman didn’t look away from it—she had no photophobia. Her words of pain didn’t match what Sarah was seeing.

  “Have you had these headaches before? Do you have a doctor you’ve seen?”

  “I’m from out of town. My doctor is in Oklahoma.”

  “What town? Give me your doctor’s name. I’ll call him.”

  “You can’t,” the woman said. “It’s Saturday night. I doubt he’s available. Please, just give me something to relieve the pain.”

  Before Sarah could speak, the patient continued. “But I can’t take aspirin, or NSAIDs, or codeine. Oh, and I’m allergic to some of the narcotics. What they usually give me is Dilaudid. That works. It generally takes two milligrams IM to stop the pain.”

  The warning bells that had been sounding in the distance rang louder now in Sarah’s mind. A patient coming to the emergency room with a story of pain that couldn’t be documented by most tests wasn’t uncommon—people did have migraines and other headaches, and sometimes they needed emergency treatment. But in this case there were things that made Sarah suspicious: things like complaints that weren’t backed up by physical signs of distress and a physician who was unavailable to confirm the patient’s story. The clincher was the woman’s claim of allergy or intolerance to almost every common analgesic. Instead, she specified the narcotic and dosage she needed—or, at least, wanted.

  Sarah had encountered this many times before, and she’d developed a way to handle situations like it. “I can’t give you a narcotic right now. First I need to do some tests, probably starting with a lumbar puncture—what a layperson would call a spinal tap. After all the tests are completed, I’ll call one of our specialists, a neurologist, who may admit you to the hospital for a workup and treatment.”

  The hands went away from the head
, the swaying stopped, the moaning went silent. “But I need something right now for pain.”

  “After the tests, maybe I can order something like ketorolac, if it’s needed.”

  “Oh, I can’t take that, either.” This came out in a normal tone of voice. All the patient’s mannerisms that indicated severe pain seemed to have stopped.

  Sarah said in an unemotional voice, “I’m going to get the nurse and a lumbar puncture tray. After I finish with that procedure, you’ll need to lie flat for half an hour. Then we’ll send you to X-ray for a CT scan of your head. Wait here.”

  She eased out of the cubicle and stood off to the side, certain of what would come next. Sure enough, in less than a minute the patient, showing no signs of pain or any other problem, eased out from between the curtains, looked around until she saw an “Exit” sign, and hurried toward it.

  Like most emergency room doctors, Sarah had a constant fear of turning away a patient with a true need. She’d given narcotics to patients in pain before and would again. Maybe she’d been conned a few times, but her ability to discern between patients who were genuinely hurting and those looking for a “fix” was by now well developed. She was pretty certain she’d gotten it right this time as well.

  * * *

  “Thank you for seeing me like this,” Bill Larson said when the door opened.

  “No problem,” the pastor said. “I’m ready for a break from sermon preparation, and that casserole smells awfully good. I hope you don’t mind eating in the kitchen.”

  “Sometimes I eat standing beside the kitchen sink, wolfing down whatever I’ve microwaved and hardly tasting it,” Larson said. “Sitting down, even at a kitchen table, is sort of like fine dining for me.”

  Farber opened the oven, donned two oven mitts, and removed a covered casserole dish. “If you’ll put one of those pot holders on the table, I’ll set this on it.”

  Larson complied. “No problem. What can I do to help?”

  “Dishes are in the cupboard to your left, silverware in the drawer beneath it. Paper napkins are in a holder on the table.”