Caribbean Heat

by David Horne

  Chapter Three

  “Here,” Graham said. Lawrence watched him from the little desk that had been provided for him, the one in the very back of the clinic. He didn’t think that he would be able to sit there for long periods of time, since Graham had mentioned that the clinic often got busy, but Graham had arrived before Lawrence was supposed to open and was now offering him an unopened bottle of water and two ibuprofens. Lawrence grabbed the water bottle and the two little blue pills, his hands grazing the palms of Graham’s hands. He noted how soft they felt, but mostly, he noted how Graham didn’t jerk away from him. Graham just waited for him to grab the things off his hand, not saying anything as he did, watching him with those gorgeous hazel eyes of his.

  “Thank you,” Lawrence said, flashing him a smile, even though the muscles on his face hurt. “I think I might have overdone it a little last night.”

  Graham smiled back at him. “It happens,” he said. “People arrive here and they are not sure what to expect. Plus, you're American, and everyone knows that Americans can’t hold their drink.”

  Lawrence laughed quietly. “I take offense to that.”

  “You can take offense all you want,” Graham said with a wink. “It's still true.”

  “Fine,” Lawrence said, rolling his eyes. “Is this part of your job?”

  “It’s part of my job to come check up on you,” Graham said. “See how you’re adjusting. So how are you adjusting?”

  “So far so good,” Lawrence replied. “Though I honestly feel like the least sophisticated of everyone here.”

  Graham chuckled quietly. “Everyone here feels less sophisticated than you.”

  “That’s ridiculous.”

  “Well, you’re the only one of us who is a surgeon, so…” Graham let that hang in the air and Lawrence felt his cheeks grow red. “Karen will be here in ten minutes. She takes care of triage, admission, etc. You also have a secretary. Her name is Michelle.”

  Lawrence looked around, wondering where a secretary might sit.

  “Yeah, I know,” Graham said. “For what it’s worth, I don’t think you’re going to be sitting at that desk for long.”

  “That’s fair,” Lawrence replied.

  “Michelle is only here until noon every day,” Graham said, smiling back at Lawrence. “Then she works for me in the afternoon. You don’t have that many patients, but if anything happens…”

  “I know, I can call you,” Lawrence said. He stood up, walked around his desk and leaned against it. “Thank you so much for everything that you’ve already done. You’ve made this a lot easier than I expected it to be.”

  “Of course,” Graham replied. Lawrence expected him to say that he was just doing his job or something of that nature, but he didn’t. Instead, he nodded and set his gaze on Lawrence’s face. His eyes stayed on Lawrence’s own for what felt to him like a good long while, then his gaze fell to his lips. Graham’s mouth tightened, his brow furrowed, and he looked like he was about to say something, but someone burst through the door and interrupted the moment.

  “Dr. Jones,” Karen said in that rich accent of hers, her voice fraught with urgency. “We have a problem.”

  Lawrence looked up at her. There was a teenage boy leaning on her and she was attempting to help him into one of the cots, because they could hardly be called beds. He couldn’t have been older than sixteen. He was pale and his eyes were only half-open when Lawrence looked at him.

  “Excuse me,” Lawrence said to Graham, almost forgetting that he was there, as he went to his patient’s bedside. Karen was right. They had a problem. The boy’s temperature was high, something that Lawrence could feel just by touching his skin when he was helping Karen lift him on to the bed. “Who is this?”

  “His name is Jimmy Hunter,” Karen said. “He’s fifteen.”

  “Get me his chart, please,” Lawrence replied. Karen nodded, and Lawrence watched her disappear. He looked down at the boy before he addressed him. “Hey, Jimmy, my name is Dr. Jones. Going to be treating you today. Do you know when you started to feel bad?”

  “It was only a couple of hours ago,” the boy said, his voice jagged. “I’m only here because my mom made me. She said that I had to come back because of what Dr. Vieux said.”

  Lawrence nodded, as if he had any idea of what Jimmy was talking about, or what Dr. Vieux had said before him. “What did he say? Sit up for me, Jimmy.”

  “After I got the cut on my stomach,” Jimmy replied. “He said that if I started feeling bad, I had to come to the doctor straight away.”

  “Okay,” Lawrence replied. “Be quiet for a second.”

  Jimmy obeyed. He wasn’t wheezing when he breathed, not exactly, but Lawrence didn’t like the sound that he was making at all. Quietly, for a minute, Lawrence counted Jimmy’s breaths.

  “Can you show me the cut on your stomach?”

  Jimmy lifted up his shirt. The cut was small, maybe an inch long, but it was red and swollen.

  “Does it hurt?”

  Jimmy shrugged. “Only when my shirt touches it.”

  Lawrence nodded. “When did it happen?”

  Jimmy closed his eyes as he tried to recall. “I’m not sure,” he said. “Oh, no, actually, I do know. Last earthquake we had here was a couple of months ago. I was outside playing soccer with my friends and we got caught in it.”

  Lawrence waited, trying his best to make sure that his patient only saw his poker face. He was telling this story so matter-of-factly that maybe he hadn’t been traumatized at all by what had happened, but Lawrence wasn’t sure how much of it was that he was fine and how much of it was the young man’s bravado. He would have been expected not to think things like these were a big deal, plus kids were bendy and difficult to diagnose. Unlike adults, their pain levels still had to even out. They also didn’t seem to have the vocabulary to speak about it as much as adults did.

  “My shirt got caught in one of the bars on the windows when I was trying to run home,” Jimmy continued. “My mom dressed it and disinfected it, but Dr. Vieux said that it was infected.”

  “Did he give you a course of antibiotics?”

  Jimmy looked away from him.

  Lawrence sighed. “Look, Jimmy, I’m not judging you. I just need to know what treatment you have received up to this point so that I can help you.”

  “He gave us some antibiotics, but my little sister got sick too. She wasn’t getting better, not until we gave her some of my antibiotics.”

  Lawrence nodded. “Didn’t Dr. Vieux tell you that you needed to take your entire course of antibiotics?”

  “He did, but I was fine, and my sister wasn’t.”

  “You have to finish a course of antibiotics,” Lawrence said. “Otherwise, it might not work. Are you struggling to breathe?”

  “A little,” Jimmy said and shrugged his shoulders. “Are you having any abdominal pain?”

  “A bit,” Jimmy replied.

  Lawrence closed his eyes. “Okay, Jimmy, you can lie down again. You can breathe when you’re lying down, right?”

  Jimmy nodded as he did what he was told.

  Lawrence grabbed the chart that Karen was finally handing him. He wasn’t sure where she had gone off to, but then again, he wasn’t sure at all about where they kept the patient charts. He would have to ask her later.

  “Do you feel loopy, confused, depressed?”

  “No,” Jimmy said. “Just annoyed that my mom made me come here. I’m fine.”

  “How’s your urine output?”

  “My what?”

  “When you pee,” Lawrence said. “Is there as much pee as there usually is?”

  “I mean, I guess so? I wasn’t really looking.”

  Lawrence and Karen glanced at each other. “Okay, Jimmy. You're going to have to stay here for a little while. Your mom was right to make you come see a doctor.”

  “What, why?”

  “Let me explain. First, nurse Karen is going to be redress your wound, make sure that it doesn't get
infected again and keep it from being exposed. I have a feeling that didn’t make things any easier on your body.”

  “I don’t understand,” Jimmy said, shaking his head. “I’m fine, I just feel a little sick. I can sleep it off.”

  “No, there’s no way to sleep this off. When your wound got infected, I believe that the infection went to your bloodstream. I think that your body is suffering from something called sepsis.”

  “Sepsis?”

  “It sounds scarier than it is,” Karen offered when she saw his worried face.

  Lawrence nodded along with her. “Absolutely. Sepsis is a serious infection, and while it’s completely manageable at this stage, it needs to be addressed.”

  “What does that mean?”

  “I can’t let you leave before you get some treatment. Karen here is going to hook you to an IV for fluids and we’re going to start you on some antibiotics, which are going to be pumped right into your bloodstream so that they can start working as quickly as possible. We’re also going to run some other tests.”

  “What tests?”

  “Tell me Jimmy. Do you have diabetes, or any other kind of autoimmune disease?”

  Jimmy blinked. “What's an autoimmune disease?”

  Lawrence smiled at him. “Look, we’re just going to do a few tests, and then we're going to find out why this happened. You're a healthy young man, and you’re not the kind of person who should be vulnerable to this. So if there’s an underlying cause, we need to address it so that this doesn’t happen again.”

  Jimmy nodded. “Okay, Dr. Jones.”

  “Excuse me for a minute,” he said, turning to Karen. “Come find me the very second that you’re done.”

  Karen nodded. “Yes, Dr. Jones.”

  “One gram of ceftriaxone, one gram of azithromycin daily. Fluids too.”

  “Yes, Dr. Jones.”

  “You give me a shout if you need anything,” Lawrence said. “But I guarantee you, Karen will take very good care of you.”

  “Okay, Doctor,” Jimmy said with a smile. Lawrence walked away from them, turning around to look at his waiting room. There were a few people waiting for him, but none of them looked out of breath. He was glad for Karen, that she had identified what was wrong, that she had brought Jimmy in.

  He walked to the waiting room to go greet them all. There was a clipboard with people’s names in order already hanging onto the wall. So Karen had been doing something after getting him the chart, but Lawrence could already tell that this two-person operation was going to get tiresome very quickly, especially when they had a patient like Jimmy.

  After he had introduced himself to everyone, Karen walked up to him again. “You wanted to see me.”

  Lawrence looked around, guiding her to the back behind the screen, trying to make sure that no one could hear what they were saying. “Karen, where is that kid’s mother?”

  “She’s at work.”

  “What about her father?”

  “Abroad,” Karen replied. “Sends them money every month.”

  “Okay, since that’s the case, I need to discuss her kid’s medical history with her.”

  “She’s working, Dr. Jones. She can’t get out of it. The Hunters are my neighbors. I noticed that Jimmy was outside and his mom told me she kept telling him to come to the doctor.”

  “I need to discuss the patient’s medical history with his mother,” Lawrence replied. “Can you make her come in tonight? Sepsis is serious.”

  “I’m aware.”

  Lawrence took a deep breath. “Look, Karen, I don’t doubt your ability as a nurse. You are clearly wonderful at what you do and extremely competent, but it is imperative that this kid finishes the course of antibiotics that we give him and he has already not done that. Otherwise, this might turn into septic shock and you know that would be a tragedy.”

  “You’re right, Dr. Jones.”

  “We need him to go home with antibiotics, so that he's not dead before he reaches legal drinking age. And we need to make sure that his mother makes him take all of them.”

  “Yes.”

  “Get her here once she’s done with work,” he said. “I need to have a serious conversation with her. If the infection isn’t taken care of…”

  “Yes, Dr. Jones.”

  “Okay. We’ll see how he does on the IV, but I’m thinking we’ll give him a course of ceftriaxone at home.”

  “Orally?”

  Lawrence frowned at her tone. “Yes, orally. Why does that seem like a bad thing?”

  She sighed. “You’re going to have to speak to Graham about this.”

  “Wait, what?”

  “The medication supply on the skerry is limited,” Karen replied as she put her hair up in a ponytail. “We try to keep antibiotics stored so that only people who must absolutely have them get them.”

  Lawrence bit his lower lip as he tried not to ask her if she thought he was prescribing antibiotics because antibiotics were fun.

  “I’ll speak to him. When is Michelle coming?”

  “She’ll be here in ten minutes,” Karen replied.

  “I’m going to walk over to Graham,” Lawrence said. “You can take care of the intake?”

  “Yes, Dr. Jones.”

  “I won’t be long,” Lawrence said. “Surely Graham is a reasonable man.”

  Karen watched him, her brown eyes wide, her mouth clasped shut. Lawrence wanted some reassurance, but he knew that she wasn’t going to give him any, and he knew that it was probably for good reason. Still, he couldn’t just let this go. Jimmy Hunter’s very life was in his hands.

  Graham's office was open. He could see that when he left the clinic, when he was standing across the street. With a deep, calming breath, Lawrence took a few steps toward the clinic, looking around to make sure that he wasn't going to get in the way of any cars. It was just a habit, Lawrence was sure that he would have heard some if there had been any cars approaching. There were barely any cars on the barely paved street. Lawrence wasn’t sure when they had done the work, but the hot Caribbean sun was doing its very best to undo it, and there were holes everywhere. Lawrence didn’t know much about cement, but he knew that he had never seen it look that pale and thin before. Still, by standing there and staring at the street, he also knew that he was only putting meeting with Graham off. He had sensed that Karen was serious, that resources were extremely limited, but he couldn’t think of anything worse than not giving Jimmy Hunter antibiotics.

  Lawrence crossed the street. He knew that there weren’t many cars he had to worry about, the only one that he had really noticed was one of the mayor used, other than the one that Graham had given him a lift in. It was parked right outside his office and Lawrence did his best to ignore it. He didn’t want to think about being in the car with Graham, about the way that he smelled, about the way that he looked when he was sitting right next to him, and the way the lines looked on his arms. Lawrence shook his head. The last thing that he should have been thinking about right then was how good-looking Graham was. It was only going to weaken him in front of Graham and it might make arguing for what Lawrence knew was right even harder.

  He knocked on the open door, peeking inside to have a look, and saw Graham sitting at a wooden desk, a pile of papers next to him. There was also a little laptop in front of him and Lawrence wondered, for a second, what Graham needed all the paper for.

  Graham only looked up for a second before he gestured for Lawrence to come in with his hand. He didn’t get up from his desk and when he looked up, Lawrence noticed that he was wearing glasses, which he hadn’t seen Graham wear before. They made him look sophisticated, stylish, somehow even better looking than he had been before.

  “Jones, how can I help you?” he said, his voice rich and deep, resonating through the narrow dark walls of his small office.

  “Hi,” Lawrence said, smiling at the way that Graham had addressed him. “Do you have a minute?”

  “Sure, what's going on?”

 
“There's this kid, a patient,” Lawrence replied. Graham gestured so that he would sit in front of him. Lawrence pulled the chair up, trying to stop it from scraping on the floor. It was clear that Graham was expecting something and that something would necessarily be pleasant.

  “Okay.”

  “He needs a course of antibiotics,” Lawrence said. “I mean, we’re already giving him some intravenously, but he’s going to have to take some when he gets home.”

  Graham watched him, his head cocked. “Right.”

  “Karen told me to come over here because she said that we might not have enough antibiotics?”

  Graham licked his teeth, sitting back and crossing his arms over his chest. “There's an allotment of antibiotics for every family per every fiscal calendar year. Which patient is it?”

  “His name is Jimmy Hunter.”

  “Hang on a second,” Graham said. He turned to his computer, typed a few words and continued holding his hand up as he kept quietly asking Lawrence to wait. Lawrence fidgeted in his seat. He needed to get back and tend to his patients, but he couldn’t do that if he didn’t know what would happen to Jimmy Hunter.

  “Is there no pharmacy on the skerry? I was led to believe the population was adequately provided for.”

  “There is a pharmacy, but it is small, and they tend to only have the stuff that you would need for first aid or for family planning,” Graham replied as he continued typing on his computer. “They have some antibiotics, yes, but the medicine can be expensive and the islanders usually don’t have insurance.”

  “So what does that mean?” Lawrence asked, his voice shaky. “I know it’s different depending on the system.”

  “Well, the people who can afford it, we try to get our medicine privately so that the islanders’ stash isn’t affected. There is also emergency medicine, for after disasters, but we get some more then. You said Hunter, yes?”