by D. J. Palmer
On Zach’s desk, camouflaged among the tall stacks of papers and stationed near a half-finished cup of coffee long gone cold, was Meghan’s extensive medical history, which he preferred to read in printed form rather than off one of those newfangled tablets. In terms of size, it was the health care provider’s War and Peace. Zach flipped through page after page of doctor’s notes, admission forms, and lab results in search of evidence that would unequivocally refute Nash’s conclusion.
He found nothing.
Zach felt foolish for not having considered the possibility that Nash might leap to questioning Meghan’s mental health. He should have forewarned Becky that it was a risk with these cases. He’d been a doubter himself, with his own son, of all people. But Meghan was not the only one Nash doubted.
Around White Memorial, few were more respected, or more formidable, than the young, brash, beautiful, and brilliant Dr. Amanda Nash, who, in one of the worst-kept secrets at the hospital, was the CEO’s heir apparent to become the next chief medical officer. Her power at White Memorial had no equal, and her nature, for which the word “dogged” did not nearly do justice, made it so whenever she sank her teeth into some cause or issue, it was hard, if not impossible, to coax her into letting go. Zach had a sinking feeling that Meghan Gerard was about to become Nash’s newest cause.
Zach heard a knock on his office door, closed his eyes to center himself, then said, “Come in.”
Amanda Nash entered Zach’s office, maroon blouse peeking out from underneath her white coat, tortoiseshell glasses in place. She looked uncertain where to step as she eyed the overstuffed bookshelves, overflowing wastebasket, and stacks of paper sprouting up from the floor like stalagmites.
“Love what you’ve done with the place,” she said.
Rising from his seat, Zach motioned to the chair opposite his desk. “I’ve got a requisition order for some guide lights,” he said. “Until then, proceed with caution and at your own risk.”
Dr. Nash carefully made her way to the empty chair. She smoothed out her coat as she settled into her seat.
“I’d offer you some cold coffee and a half-eaten protein bar, but I’m selfish,” Zach said, smiling thinly.
“You’re also wrong about Meghan Gerard,” Nash said.
“Not wasting any time, are we?”
“No time to waste,” said Nash. “I’m assuming you got a tongue-lashing from the mother.”
Zach nodded grimly. “She was quite upset when she came to see me. She thinks you’ve sentenced her daughter to death, which could very well be the case if we take your approach, couldn’t it?”
Zach felt good about his retort. It was not too forceful, but carried impact. Then again, rattling Nash was like a wind blowing against a tree—it would take a mighty gust to get her to sway even slightly.
Nash placed a finger to her lips, showing off a strawberry-colored manicure done to perfection. “You’re making this worse for Meghan, for the family,” she said.
“That’s your opinion,” Zach said.
“Did she play you the recording of our conversation?”
“She did,” Zach said.
“And you didn’t find it a bit strange?”
Zach leaned over his desk, arms resting atop Meghan’s hefty medical history. “To be honest, I thought you were a little aggressive with her. Not much bedside manner on display.”
Amanda attempted a smile, but it could not hide the firm set of her jaw. “To be honest with you,” she said, “I was testing her.”
Zach appeared nonplussed. “Testing her how?”
Nash said, “A mother is given news that her daughter might not be deathly ill, that it could be something else entirely, that she may not have a devastating disease for which there is no cure—a disease, by the way, that’s guaranteed to shorten Meghan’s life, perhaps considerably—and it doesn’t even register to her that this could be good news? Why, Zach? Why is that?”
“I don’t know,” Zach said, feeling compelled to take another bite of his protein bar. It was already the end of the day, which meant he was going home to an empty refrigerator and not much of an appetite to do anything about it. He’d probably bang out some sits-ups and push-ups, maybe go for a run, but chances were, he’d put on the TV, grab some journals and his research materials on mitochondrial disease, and read in front of the Red Sox game until he fell asleep on the couch. Rinse and repeat. His mother worried he was losing weight, which he was. Zach worried he was transforming into his father, who had let life’s normal hardships prematurely age him.
“Maybe Becky felt threatened by you,” Zach offered.
“Spare me. That woman knows as much medicine as we do, which I might add should be a red flag for you.”
“Or maybe she’s convinced her daughter is sick because she is sick. You have no proof of anything, Amanda. You’re making a very serious accusation based on some misguided test you devised in your office. I think that’s unfair to Becky and to Meghan.”
If that barrage flustered Nash even in the slightest, she did not let it show. “I think you may be too blinded by your past, Zach, to see things clearly.”
Zach’s eyes narrowed. “Watch your step here, Amanda.” There was a low rumble to Zach’s voice, and he wondered if his warning tone and glowering look might have gotten to her.
Nash shifted uncomfortably in her chair, her eyes flaring momentarily before they cooled. Zach understood he was taking the hard-line approach with Meghan’s case. If he were even a little more open-minded, he’d have to give some credence to Nash’s thinking. In fact, Zach would bet a million dollars he knew what accusation Nash was about to make next.
“It’s Munchausen by proxy, Zach. I’m sure of it.”
Zach suppressed a gloating expression. In essence, Nash had fired the first volley in the coming war for Meghan Gerard’s future. Munchausen syndrome by proxy, aka medical child abuse, was about to become Becky Gerard’s new nightmare—and Zach’s, too, because he was not about to abandon Meghan to Nash, not by a long shot.
Unfortunately for the Gerard family, mitochondrial disease, with its array of puzzling and hard-to-predict symptoms, often aroused doubts and suspicion in the medical community. With a case like Meghan’s, a medical history as long and perplexing as hers, any physician worth their license would be on high alert. Maybe some would think Meghan was after the attention, but the majority would probably focus on the mother, just as Nash was doing.
Zach knew the etymology of the name was a nod to Baron Munchausen, a literary character from the 1800s who told fantastical stories about himself, lifting the art of exaggeration to new and impressive heights. Nash did not have to be aware of the origin of Munchausen syndrome to accuse Becky Gerard of exaggerating Meghan’s complaints or inflicting illnesses upon her daughter for the attention.
As for Zach’s diagnosis of mitochondrial disease, his reputation at White would work against him. The belief around the hospital was that Zach, because of his son’s death, saw mito where others did not. It was understandable that Nash would think he was too biased to call out a case of Munchausen by proxy even if he walked in on Becky injecting Meghan with poison.
“You have no proof.”
“Maybe not, not yet anyway, but I wanted to tell you what I thought to get your take on it.”
“Why?” Zach could see the ambush laid out in front of him. Nash was up to something.
“You know the patient better than I do. I want your take is all.”
Zach turned his head and bit the inside of his mouth to keep from blurting out the first thing that popped into his mind, which would not have been polite.
“I told you what I think. It’s mitochondrial disease.”
“Are you sure, Zach?” Nash asked, looking skeptical. “We have a duty to protect this child if she’s in danger.”
“I don’t believe she is. Are you suddenly a psychiatrist?” Zach asked. “I haven’t checked on your credentials lately.”
Zach knew Nash was
too smart to take that bait.
“I feel strongly enough about this case that I’m going to get Meghan seen.”
Zach shook his head in dismay. Her teeth were sunk in. No letting go now.
“Is it a GI issue you’re worried about, Amanda? If so, fine, go get that second opinion. But if not, you and I both know you’re stepping way over the line here.”
“Am I? What line are you standing near, Zach? Because mine has everything to do with the patient, and yours, I’m concerned, has everything to do with your past.”
Zach felt his face heat up. “That’s unfair and uncalled for.”
“I’m not trying to steal your patient, if that’s your worry.”
“You could have fooled me,” he said, his brow furrowing as he forced himself to look at Nash.
“Then you do it. Call in a consult. Get that second opinion. For everyone’s sake, you have to be sure.”
Zach looked down at Meghan’s medical records, which took up a good portion of his available desk space. He wished more than anything that he had found something in those pages to refute Nash’s claims.
“How can you be so convinced it’s not what I said?” Nash asked, her voice gentle, almost coaxing. “The blood work was inconclusive, and the girl’s so deathly afraid of needles, I can’t imagine how you’d do a muscle biopsy or EMG.”
“I know the disease.”
“I don’t think that’s good enough.”
“Well, I do.” Zach could not believe how juvenile he sounded. If he was going to help Becky face down this dragon, he most certainly would need to come up with some better retorts.
“Well, I guess if you’ve diagnosed her with mito the biopsy results wouldn’t alter her treatment considerations one way or the other. So go without it if you think it best for your patient, but your case would be much stronger if a psychiatrist supported your diagnosis is all I’m saying.”
“I don’t need a psychiatrist to tell me anything.”
Nash’s expression suggested otherwise.
“I understand that you’re speaking at a mito conference in Cleveland this week,” Nash said.
Zack was surprised she knew his schedule. “I am. And how did you know?”
“I saw the bulletin in the hospital newsletter.”
Zack’s defenses stayed up. “And your point is?”
“You’re the mito guy here, Zach, everyone knows it. You know more about this disease than all of us combined.”
“Which is why I’m confident about Meghan’s diagnosis.”
“You better be, because it’s your job on the line,” Nash said. “If the mother is harming that girl, and you don’t take my advice and try to make the determination, Knox Singer will fire you without batting an eye. You know it, and I know it. We’ve both sworn an oath to protect the patient. You have to protect her. God, Zach, don’t be so devoted to the cause that you’d be willing to risk everything for your crusade.”
Nash was right, of course. Zach was already off Knox Singer’s Christmas list, thanks to the damage his mito crusade had done to White’s P&L from a scattering of denied insurance claims.
The file cabinet taking up most of one wall held files of other cases where Zach had suspected mito to be at the root of a patient’s diminishing health. Not all the cases were confirmed, but all were strongly suspect. Each file represented a child who counted on Zach to keep coming up with answers to make them better. If he made an enemy out of Nash and ended up on the unemployment line, there could be a lot of losers in the end—including Meghan.
“What do you want me to do?”
“Meghan’s your patient,” Nash said. “You have to do what you think is right. I’m just telling you as a colleague and a friend what I would do if she were my patient.”
“Well, she is your patient, too. You examined her. You have your own files on her now.”
“That I do,” Nash said, rising from her chair. “But I wanted to give you the professional courtesy of knowing what I thought.”
“And what are you going to do about it?”
“I’m going to do my job and safeguard the patient’s health. I strongly suggest you do the same.”
Nash did not bother with a handshake goodbye before she carefully made her way across the crowded floor. At the door, she turned back to Zach. “Have a good trip,” she said.
Zach swiveled in his chair to face her. “I really wish I hadn’t involved you, Amanda,” he said.
“And I’m really glad you did,” Nash said with a solemn expression and one foot out the door. “You’re trying to save her from a ghost, Zach—the one haunting you. I’m going to save her from her mother.”
CHAPTER 15
BECKY
The past two days had been emotionally draining. Becky had still gotten in her daily workouts, but even her high-intensity interval training could not keep her from thinking about Nash’s accusations.
She had yet to make an appointment for the endoscopy because the mere thought of the procedure forced her to think about Nash. As for Meghan, she was back to her same old self; no better, no worse. She was still home from school, too tired to attend. The nausea and blurred vision were gone and had not come back, but then again, Becky’s research had told her that mito was unpredictable in that regard. There was still no word on the Elamvia clinical trial, but she held out hope for good news.
She also waited for news of her mother’s passing that did not come. There was no way she could travel now, even for the funeral.
In fact, when her phone rang, she thought it was Sabrina calling. But no, it was Dr. Amanda Nash. She wanted to see Meghan again, urgently, for a second opinion and asked if Becky could bring Meghan to the hospital ASAP.
“What’s the emergency exactly?” Becky asked, hearing the worry worm into her voice.
“We want to run more tests,” Dr. Nash said. “I reviewed my findings with a colleague, Dr. Peter Levine, who is also a specialist in pediatrics, and he had some very specific concerns, ones we need to rule out with another exam.”
“What kind of concerns?” Becky asked, feeling that familiar tightness returning.
“There could be the possibility of another disease, one we hadn’t considered.”
Worse than mito, Becky thought.
“Is it cancer?” Becky asked, her voice cracking slightly.
It’s cancer … it’s going to be cancer. Like Cora, it’s in our family. It’s our curse … we fake sickness and get a real disease as punishment.
“We won’t know until we examine her,” Nash said. “We can do this initial exam without any needles, but if it’s necessary, we may have to draw blood. Of course, we’ll need your help to get Meghan’s cooperation.”
“What kind of cancer?” Becky asked.
“Let’s take it one step at a time, can we?” Nash asked. “Bring her in now, if you can, and we’ll take it from there.”
“What about Dr. Fisher? I should call him?”
She didn’t say it wasn’t cancer, thought Becky, now gripped in a full-blown panic.
“Of course,” Dr. Nash said. “But he’s away at a conference; you can try his office, maybe his receptionist can get a message to him. But just so you know, he and I have discussed Meghan’s case.”
Becky did not need a receptionist when she had the doctor’s cell phone number. Zach did not answer when she called, so Becky left him a message to call her when he could. She was not going to wait for his okay, not if there was a real concern to address.
Then she called Carl at work, expecting he’d hem and haw, or complain again that they were on the never-ending medical crisis treadmill. Still, she wanted him to go with her to the hospital for obvious reasons. If Meghan had some rare type of cancer, as she believed would be the case, she needed her husband, her rock (or former rock, as she sometimes thought of him) at her side.
“It’s Meghan,” Becky said when Carl answered her call. “Dr. Nash spoke with another doctor at White about Meghan’s case, and she�
��s concerned. Carl, I think it might be cancer.”
Tears sprang to Becky’s eyes. She clutched the kitchen counter, bracing herself against waves of painful emotions.
“Did she say cancer?” Carl asked. “Did she say that specific word?”
“No, no,” Becky said. “It was obvious she didn’t want to alarm me over the phone. But I know … I just know.”
“Try to relax,” Carl said, his voice bringing her a measure of calm. “I’ll be home shortly, and we’ll go to the hospital together.”
All her upset and anger at Carl for not fully supporting her fell away. She would need to lean on him harder than ever in the coming days. Twenty minutes later, Carl honked the horn to signal his arrival home. He left the car idling in the driveway while he entered through the front door. He went upstairs and got Meghan, who had been resting in her room. She was ready to go. Becky had already told her they were headed back to White for another exam. Meghan protested until Becky assured her there’d be no needles involved.
“What’s it all about?” Meghan had asked.
“The doctors are a little concerned about something, and Dr. Nash would like you to see another specialist.”
Meghan showed no emotion, which was not entirely a surprise: she’d acclimated to medical uncertainty. As they made their way down the walkway, Meghan pulled away when Carl reached for her arm. Becky noticed the odd exchange but was quick to brush it off. It was tough enough to connect with a typical fifteen-year-old girl, at least according to Becky’s friends who had healthy daughters that age. But when you combine teenage hormones with a spirit-crushing disease, you get a profoundly different sort of isolation of parent from child.
For Becky, Meghan’s illness had come between mother and daughter like a controlling boyfriend. It tainted everything they did together and it lurked everywhere they went. Fatigue invariably cut short shopping trips to the mall. Tickets for shows were bought and then sold when Meghan could not muster the strength to attend.
Three years ago, Becky had gotten Meghan into scrapbooking. The hobby was far craftier than their skills and imagination warranted, but it was a great way to spend quality time together. They had made collages of vacation photos complete with felt palm trees that had aqua-colored leaves and polka dot–covered bark. There was a page devoted to sports, decorated with an oversize soccer ball and the words STAR PLAYER IN THE MAKING displayed in fanciful letters. The last time Becky had looked at that book, she’d had to brush away the dust.
