Diagnosis Death (4 page)

The man leaned down to her eye level. "Is there anything I can do?"

There was nothing anyone could do. What was done was done. But there was no reason to go into that, either. "Thank you, but no. I need to sit here a moment and collect myself."

It seemed that he might be ready to start a conversation, and she steeled herself to rebuff any efforts to get her to open up about her problem. No one needed to know about it, because no one could help. Instead, he nodded and straightened.

She had the window halfway up when he turned back and said, just loud enough for her to hear. "I'll pray for you." Then he disappeared between the parked cars.

Elena entered her apartment that night to the accompaniment of pounding pulse and jangling nerves. As she crossed the threshold, she asked herself once more, "What's wrong with me?" She was an intelligent woman, a trained physician. There were no demons waiting in the darkness. True, once this apartment had been a home, and now it was only a place to sleep and eat and mourn. But that was no reason to let her grief take over her life.

Then again, it wasn't just the grief. There were the phone calls. If she'd heard heavy breathing or a torrent of obscenities, she'd know what was going on. She could handle that. Any single woman living in the city knew such things occurred. But these calls were more than that. And she thought she finally knew what they represented.

Elena dropped her backpack, slammed the door, and turned on the TV for company. The mail went onto the small table beside her armchair. It could wait. First, a shower and a cup of tea.

Clean, but in no way refreshed, Elena dropped into the easy chair and considered the mail. There was never anything good there anymore. The condolence cards and letters had dried up. She had no family to send her cheery notes. Only her creditors and the people wanting her to spend money she didn't have now accounted for the handful of mail she received.

The envelope was there between her MasterCard bill and an ad for a new textbook. The envelope was a cheap, self-sealing one, addressed by hand in block capitals using blue ballpoint. Two different stamps were affixed to provide the proper postage. The blurred postmark gave no indication of the city of origin.

Elena ran her finger under the flap and pulled out a single sheet of paper from a lined tablet.

The message was printed in the same block capitals. At the end, the writer had pressed down hard enough to penetrate the paper. Elena read the message twice, at first unable to understand and then unwilling to believe it.

I KNOW WHAT YOU DID AND YOU'LL PAY.

She dropped the paper onto the table and pressed both hands to her temples.

"M
rs. Gardner, you really need to make arrangements to clear this entire balance." The woman's voice was level and calm. No threats. No pressure. But, nevertheless, the words made Elena's stomach roil.

As it had so many evenings for several months, Elena's phone rang at about 8:00 p.m. When she checked the Caller ID, she knew what the call was about. This was the collection agency for the ambulance that took Mark to the hospital. Other nights the call would be about the balance due for Mark's hospital care or his funeral. There'd been so much expense, and his insurance coverage wasn't the best. The doctors caring for him discounted their fees, often writing off the balance. But there were other expenses—so many other expenses.

Elena took a deep breath and made a conscious effort to loosen her death grip on the phone. "Not that it makes any difference to you, but it's Dr. Gardner. I'm well aware of the situation, and I have no intention of letting this debt slide. But right now I'm in residency training, working eighty hours a week. The pay's not much, certainly not what you'd expect a doctor to make. Then there are deductions for taxes and Social Security. Some of what's left goes for utilities, groceries, rent, car payment. You know, living expenses, although I don't know if you could call what I'm doing living. I've tried to pay something on my debts every month since Mark . . ." The words trailed off. What was the use? Elena leaned forward onto her desk and watched her tears drip onto the blotter.

"Mrs. Gardner?" The woman might have been a robot for all her response to the emotion in Elena's voice. Maybe she was. Maybe they used robots for this. Certainly, it seemed to Elena that the people she'd talked with so far had no living, beating hearts.

"I'll keep paying you as much as I can," Elena said. "My employment situation is sort of up in the air right now, but you can rest assured that this debt and my medical school loans will be the first things I repay." Elena took a deep breath. "Now please stop calling me. I know how much I owe. I know where to send the payments. I know all of it. Actually, I can't seem to get it out of my head."

The emotionless voice was saying something when Elena hung up. It was just too much. She put her head on the desk and let the tears flow unchecked.

"Good dinner."

"Will, the worst meal you ever ate was wonderful." Dr. Cathy Sewell grinned. The way to her husband's heart might not be through his stomach, but it certainly represented an easy shortcut. "Coffee?"

She poured coffee for Will, herbal tea for herself, and followed him into the living room. "Good news," Cathy said. "I got a call from Amy Gross today."

Will put down the paper. "Did she find someone?"

"Dr. Elena Gardner, one of the residents who's finishing in less than a month, had her practice offer fall through. Amy thinks she might be a good fit here. She'll drive up this weekend to talk with me."

"Do you know her?"

Cathy sipped her tea. "Vaguely, although I didn't recognize her name at first. Apparently she took her husband's name when they married." Cathy smiled. "Personally, I'm glad you were okay with my continuing to practice as Cathy Sewell. Can you imagine the hassle of changing the name on all those documents?"

Will grinned. "Yeah, and I'm glad you didn't make me take yours. 'Law offices of Will Kennedy-Sewell, how may I help you?' "

"Amy said Dr. Gardner has had some problems recently."

"Professional problems?"

"No, Amy says she's the sharpest resident they've had since I graduated. I waved that off as flattery, but if she practices the way I do that'll be good."

Will got up from his chair and moved toward the small kitchen adjacent to the living room. "I want a couple of cookies to go with my coffee. Want anything?"

"No, I'm good," Cathy called. She waited for him to return and settle into his chair. "You mentioned professional ability, and I guess it does affect that, although indirectly. Her husband had a ruptured berry aneurysm—" She caught herself and corrected her doctor-speak explanation.

"A little over six months ago, a blood vessel in her husband's brain burst, and by the time they got him into surgery, the damage was too great for him to recover. He was left in the deepest level of coma. He could be kept alive, but he was never going to recover. Elena struggled with the decision to take him off life support. Apparently she finally agreed, but I get the impression there was some irregularity about the way it was done. Amy says Elena has had problems since then."

"Such as . . . ?"

"I tried to get details from her, but she said I'd have to ask Elena about them."

Will took a sip of coffee, winced, and blew across the surface of the cup. "I'll be glad to sit in on the interview if you'd like my opinion, but I'm pretty sure you can trust your own judgment."

Cathy began to run through the things she wanted to discuss with this new doctor. She took a deep breath and blew it out slowly through pursed lips. She smiled. Could it be that she was unconsciously practicing cleansing breaths to help her through labor?

"Earth to Cathy? Where'd you go?"

"Sorry. I was wondering how my patients might relate to Dr. Gardner. It won't be a problem for me, but I'm afraid it might be for a few of them."

"Sorry," Will said. "I'm not following."

Cathy pushed aside her cup and saucer. "I didn't recognize her from her married name, but when I heard her maiden name I remembered her."

"Okay, I'll bite. What was Elena's maiden name?"

"Perez."

"And you think this might present a problem?"

"As I said, not for me, but the potential is there. Since Doc Gladstone retired, I trade call with Dr. Brown. You and I know that Emmett Brown is a competent doctor, but there are still a few of my patients who refuse to see him because they're uncomfortable being treated by an African American."

Will pushed his cup and saucer aside. "And you think they might feel the same way about this Dr. Gardner?"

"I don't recall a lot about Elena, but I do remember what she looks like. And I remember you could take one look at her and know she was Latina—a very beautiful one, by the way. Whether she uses the name Gardner or Perez, people are going to know her heritage."

Will watched as Cathy clenched her jaw. He knew that look and felt sorry for anyone who stood in her way when she displayed it. "But it's not going to sway your decision, is it?"

"Not in the least."

"Come in." The response to Elena's light tap hardly carried through the closed door of the ICU room.

Elena had dreaded this visit all morning. After talking with the neurosurgeon, she was more certain than ever what was ahead for the patient and his wife. Now she owed it to Erma Pulliam to share her knowledge. Elena steeled herself and pushed through the door.

"Mrs. Pulliam, I'm Doctor Gardner. I took care of your husband in the emergency room."

The lines in the woman's face were etched more deeply than Elena remembered. Her eyes carried a sadness that seemed beyond utterance. She sat at her husband's bedside, one hand covering his. "I remember you." Mrs. Pulliam's voice cracked. She cleared her throat. "You came out to the waiting room and told me what was happening. I appreciate that so much. I guess . . . I guess Dr. Clark's a busy man, but I keep missing him. I spend most of my time here. Just go home to change clothes and catch a nap. The nurses have trays sent to me, so I don't have to leave the room to eat. But still, I've only seen Dr. Clark once in the past two days. And when I ask him how Chester's doing, he just says, 'All we can do is wait.' "

Chester Pulliam lay pale and still. A large bandage covered his head. A ventilator puffed oxygenated air into his lungs via a tube into his windpipe. The monitor at the head of Chester's bed displayed blood pressure and pulse readings in the high normal range. IV fluids dripped slowly through a tube into a needle in the back of the man's right hand. The plastic bag hanging off the bed rail told Elena a urinary catheter was in place.

Elena lifted Chester's eyelids. His eyes were fixed straight ahead, the pupils midsize. She grabbed his Achilles tendon and squeezed. No reaction. She ran her thumbnail along the sole of his foot. The toes splayed and flexed upward. She frowned.

"Mrs. Pulliam, your husband had a very serious episode of bleeding inside his skull. That put a lot of pressure on his brain. Dr. Clark relieved that pressure and sealed off the blood vessel that burst, but the damage that was done has left Chester in a very deep coma."

"Will he be all right, Doctor?"

In Elena's mind a scene played out, one she knew as certainly as if she'd written the script. Chester would never recover from his coma. He'd go to a rehab facility. Despite decent care, he'd get contractures and bedsores. Eventually he'd get pneumonia or an overwhelming urinary tract infection with sepsis, and that would be his terminal event.

Tell her what's coming, Elena.
She took a deep breath. "Every day he remains in a coma makes it less likely that he'll regain consciousness. And if he does begin to react, we can't know how much permanent damage there is, how much function he'll have." Elena surprised herself with her next words. "But there's still hope."

Mrs. Pulliam dabbed at her eyes. "Thank you, Dr. Gardner. That's all I want—to know that there's hope." She eased out of the chair with obvious effort. With one hand still grasping that of her husband, she reached with the other and took Elena's arm. "Thank you for giving me that."

Why did you lie? You know what's ahead.
Elena swallowed hard. "There's always hope."

David wasn't sure why he felt the need to call Elena. Call it a premonition. Call it a divine prompting. Call it a surfacing of his suppressed desire to spend more time with Elena. For whatever reason, as soon as he reached his car to start the drive home, he pulled out his cell phone and punched her speed-dial number.

"Dr. Gardner." The tone of those two words painted a clear picture, and David was glad he'd called. Elena was really down. Time to step in.

"Elena, it's David. Can you talk right now?"

"Oh, right. Yeah, I guess so. I'm on my way to pick up my dry cleaning and buy a few groceries."

Run with the hunch. "Why don't you meet me at the El Fenix on Lemmon Avenue? I'll buy you some good Tex-Mex and we can talk."

"Oh, I couldn't—I mean, that's not . . ." He could hear a car honking in the background. Elena was probably working her way through the same type of traffic he was. "David, do you really want to do this?"

"Why not? We both need to eat. I'll bet you're too tired to cook, and I'm really not in the mood for a bologna sandwich tonight." He grinned, thinking there was no need to let Elena know about the pot roast simmering in the Crock-Pot at home. No need to puncture that "men can't cook" myth. "So, what do you say?"

"Why not? I'm probably about half an hour away. Will that work?"

"Whoever gets there first gets a table," David said.

Twenty-five minutes later, he was munching on tortilla chips when Elena walked in. He rose and gave her a brotherly hug. "Bad day?" he asked.