Diagnosis Death (3 page)

The patient's name was Chester Pulliam. Elena sat in a corner of the waiting room with his wife, Erma, and explained the situation. "A blood vessel in your husband's brain burst. Usually it's because of a weak place, sort of like a bulging spot on a balloon. This is more likely to happen when there's high blood pressure and hardening of the arteries, and your husband has both these conditions."

The woman looked down at the handkerchief she was twisting. "Can they save him?"

"Dr. Clark is an excellent neurosurgeon. He'll do his very best."

"Oh, I hope so. I couldn't bear to lose Chester. We've been married for forty-eight years. If he died . . . I'd die too."

Elena patted Mrs. Pulliam's hand. "Is there anything I can do for you? Are there any other questions?"

The woman shook her head. "I'm sure there are, but I can't think of them right now." She looked into Elena's eyes. "Thank you for what you've done."

"I'm glad I could be here to help." Elena felt a familiar lump in her throat. She turned and strode away before the woman could see the tears forming in her eyes. Would this happen every time she had a patient with an intracranial hemorrhage? Where was the dispassionate approach she'd been told she had to adopt if she were to survive as a family doctor? Her department chair had put it to her this way, "Elena, Mark's situation wasn't uncommon. You did the best you could. Everyone else did too. The timing was just bad. You can't let that carry over to every patient you see for the next forty years."

In less than a month, she'd complete her training and be out in the world of private practice. She had to get past this. Medicine was all she knew, all she'd ever wanted to do. Surely God wouldn't take that from her after He'd already taken her husband.

Elena's mind was on everything and nothing, churning fruitlessly as she shuffled through the lunch line in the hospital cafeteria. She'd eat, but only because she knew she had to. Her life was coming apart, and she didn't know how to mend it.

"Hey, come join me."

She saw David at a table for two in the far corner of the cafeteria. He stood and waved, as though he was afraid she might miss him. That would be hard to do. He stood a shade over six feet, with a shock of reddish-blond hair above a tan that reminded Elena of a California surfer. He might be quiet, but David was hard to overlook.

She wove her way through the tables and began to unload her tray. She jerked her mind away from the worries that were her constant companion, and struggled for an opening conversational gambit. "Good to see you. I didn't think OB residents ever took time to eat lunch."

"Eat when you can. Isn't that what they teach us as medical students?" David held the chair for her, another of the small things that made her admire him. His bright blue scrub suit and the ring around his forehead from the pressure of his surgical cap told Elena he'd been in the operating room already.

She tried to focus on the man at the table with her, not on the shambles her life had become. "How are things going for you?" she asked.

"Pretty good. I'm on Dr. Cobb's service, and he's letting me do quite a bit. Just finished a case with him." He took a healthy bite of sandwich, chewed, and swallowed. "How about you?"

Elena paused with her fork halfway to her mouth, careful not to drip ranch dressing from the chef's salad she'd chosen. "Right now I mainly divide my time between the FP Clinic and the ER. Sometimes I round with one of the specialists. Good preparation for going out on my own—if I only had a place to practice."

"What's that mean?"

"Are you ready for the next chapter of the Elena Gardner tragedy?" She related the gist of her conversation with Helen Bennett and watched deep concern overshadow David's normally placid countenance.

"I'll add that to my prayers for you," he said. "Be sure to let me know if anything develops."

She nodded before filling her mouth with salad. Doctors learned to eat fast, never knowing when the meal might be interrupted. She noticed David doing the same.

"And did you get a call last night?" David asked.

Elena nodded. "Midnight. A woman sobbing. But I think I recognized the voice."

"You did?"

"I'm pretty sure—but I don't know what to do about it. And until I do, I don't want to say anything—even to you."

"Fair enough. But I'm here for you when you're ready to talk."

Elena dabbed at the corner of her mouth with her napkin. She was opening her mouth to reply when a staccato electronic bleat split the air. Both doctors reached for their belts and extracted their pagers.

"Mine," Elena said. She thumbed the button and read the display. "Dr. Gross's office." She pushed back her chair. "Guess I'd better see what the department chair wants."

The chairwoman's secretary was noncommittal in delivering the message. Dr. Gross would like to see Dr. Gardner this afternoon at five. Could she make it?

Elena mentally reviewed her schedule. "No problem. Can you tell me what this is about?"

"Sorry, I'm simply relaying the message."

Elena tried to put the matter out of her mind until time for the meeting, but with little success. It was all she could do to concentrate on her duties for the afternoon. She gave silent thanks that her patients presented straightforward problems: congestive heart failure, early peptic ulcer, migraine headache. She ordered the appropriate diagnostic tests, wrote prescriptions for the proper medications, arranged for referrals to staff specialists when necessary. Somehow she got through the afternoon.

Next she had to finish her clinic charts, go over some X-rays and lab reports, return about a half-dozen phone calls, and change into a fresh white coat before her meeting. She managed to do all this, even run a brush through her hair and redo her ponytail, before she tapped on the open door of Amy Gross's office at precisely five o'clock.

"You wanted to see me?" Elena waited for Dr. Gross to look up from the papers she was signing.

"Oh, Elena. Come in. Have a seat." The woman motioned toward the couch on the far side of her office. "Let's sit down over there so we can talk without the desk between us."

Elena took this as a good sign. If Dr. Gross planned to deliver bad news, she'd do it from behind her desk, putting a barrier between them.

Elena sat at the end of the couch. Dr. Gross took a seat beside her and half-turned to face her.

"I'm sure you're curious about this 'summons.' " She made quote marks with her fingers to set off the word. "But it's good news, I assure you."

Elena felt the pounding headache she'd experienced all afternoon ease a bit. "Well, I could use some good news."

"I understand you talked with Dr. Bennett this morning."

Elena nodded. She didn't think she could have said a word even if she wanted to. Her throat was in a knot at the reminder of the bombshell Helen dropped on her this morning.

Dr. Gross continued. "Helen called me at home Sunday afternoon, right after she decided to take the job offer from Lincoln Clinic."

Elena remained silent.

"You may not believe it, but it caused her a great deal of pain to go back on her offer to you. Both she and I have made lots of calls trying to find something for you. I even looked into the possibility of your working in an emergency room somewhere."

Elena knew that was a possibility, but not one she wanted to consider. In that situation, there'd be no continuity of care. No way to establish a rapport, a long-term relationship with her patients. That wasn't the way she wanted to practice medicine. She hoped that wasn't what this was about.

"But I think I have something better for you," Dr. Gross said. "I got a call shortly before noon from one of the doctors who did her family practice residency here at Southwestern. Do you remember Cathy Sewell? She would have been a couple of years ahead of you in the program."

"I know who she is, but we never had a rotation together and neither of us socialized much, so I don't know a lot about her."

"She went back to her hometown to set up a solo practice. That's in . . ." Dr. Gross pulled a pair of reading glasses from the breast pocket of her white coat and consulted the yellow legal pad she held. "That's in Dainger, Texas. She's pregnant, and she's looking for someone to take over her practice while she's on maternity leave."

"When does she need someone?"

Amy frowned. "She needs someone right now. She's less than two months from her due date. She had a retired doctor lined up to fill in for her, but he was just diagnosed with colon cancer, so he's not coming."

Elena felt hope stir in her chest like the flutter of a bird's wings. Then she saw it—the downside. "Does she want someone temporary? Is this a
locum tenens
situation?"

"Not necessarily. Bringing in the retired doctor was a stop-gap measure, but I think she'd like to find a younger doctor to take into the practice. There certainly seems to be room for expansion. If things work out well with you, she could offer you an association. That's a bridge you'll have to cross when you come to it." Dr. Gross tapped her glasses on the legal pad to emphasize her words. "But I think this is the best you can expect with such short notice. I wouldn't turn it down if I were you."

"Did she give you any more details?"

Dr. Gross shook her head. "She'll do that herself." She tore the top sheet off the pad and handed it to Elena. "Call her. She'd like you to come up this weekend to meet with her. It's only about an hour and a half drive. She'll show you the setup there, talk with you about possible arrangements." She put the pad on the coffee table in front of her and returned the glasses to her pocket. "I've given you a high recommendation. I also told her a bit about your history, about Mark. In fairness, I think you should give her the full story. I believe you'll find her quite understanding."

"Dainger?" Elena said. "I'm not sure that's a very reassuring name."

Dr. Gross chuckled. "I commented on that when we talked. Cathy tells me it was named for some early settler. I don't think you'll find it very dangerous at all."

"Well, I'll certainly be glad to meet with her. Thanks so much for your recommendation."

Dr. Gross rose and extended her hand. "Get someone to look in on your hospitalized patients while you're gone. And I really hope this works out for you."

It was almost seven when Elena pulled out of the medical center parking lot, and traffic had thinned a bit. All the way home, she alternated between elation at the possibility she'd have a position when her residency ended and fear that she was about to jump into a bad situation.

Who had ever heard of Dainger, Texas, anyway? She had a vague notion that it was somewhere northwest of Dallas. Well, driving directions would be the least of her problems, thanks to MapQuest and Google. What worried her more was not knowing what she'd find when she got there. Other than what she'd learned about how the name came about—and that was pretty vague—she had no idea what the town was like. But it didn't matter, did it? It sounded like a chance to get a fresh start. And she certainly needed that.

What about Dr. Cathy Sewell? Right now, that was a familiar name, nothing more. She had a vague recollection of a petite blonde doctor who did her work well and seemed pleasant enough. When Cathy finished her residency, she disappeared off Elena's radar screen. Of course, even if she'd still been around, Elena wouldn't have noticed. She was too busy with Mark, first their courtship, then their marriage, and then . . .

Elena felt her eyes clouding. Her breathing came faster. The shaking of her hands made the car jitter back and forth. She pulled off the busy street and into a mall parking lot, where she put her head on the steering wheel and let the tears flow freely.

"Excuse me?"

She looked up to see an older man, dressed in jeans and a sport shirt, standing beside her car. He tapped on the closed driver's side window. "Ma'am, are you okay?"

She pulled a tissue from the box on the seat beside her and dabbed at her eyes. She felt her nose dripping but wasn't about to blow it in front of this man. She gave it what she hoped was a lady-like wipe and crumpled the tissue in her hand before lowering the window. "I'm . . . I'm fine. I just—" She bit off her response. No need to explain. He didn't need to know.