Diagnosis Death (6 page)

Since she started medical school, Elena always had a stack of blank three-by-five cards with her. She might use them in class to jot down particularly salient points, later tucking each in her textbook at the appropriate page, handy for last-minute exam cramming. On clinical rounds, she'd pull out one of the cards and make notes about each patient, often flipping through them later in the day to be sure she hadn't missed something. The cards proved invaluable when she presented cases to an attending physician. Notes on three-by-five cards became so ingrained in her life that her pocket or purse generally held cards with grocery lists or reminders to pick up cleaning or have her car serviced.

Today she had to stop herself several times from reaching into her purse for a blank card. Somehow, it seemed almost disrespectful to make notes during her meeting with Cathy. If Elena's observations jibed with Cathy's assessment that the facilities at the hospital were excellent, she accepted that fact and moved on, knowing she could always ask specific questions later. If Cathy told her that night call in her practice wasn't as bad as being on call at Parkland, Elena heaved a sigh of relief, realizing that only time would prove or disprove that assessment. And when Cathy mentioned a salary arrangement that included a generous base salary and benefits, Elena gratefully filed the number away in her head, not on a card.

As they spent time together, Elena warmed to her host. Some of the glow Cathy exuded might be attributable to her pregnancy, but she also had about her a sense of security that Elena envied. Maybe this would be a good match. If only Cathy felt the same.

They wound up their tour in the front foyer of Summers County General Hospital. Cathy extended a hand and turned a half-circle like Vanna White showing a prize. "Well, that's our hospital. What do you think?"

"Frankly, it's more than I expected," Elena said. "You have a very nice facility."

"Here's someone you need to meet." Cathy pointed to a man walking down the hall toward them. A blue dress shirt with a blue and gold tie peeked out from under a spotless white lab coat with creases so sharp they could cut cheese. He was about four inches shorter than Elena's five feet ten inches, but carried himself with the bearing of someone used to being in charge.

The man halted two steps from them, and Elena half-expected him to click his heels as he drew himself up to his full height and nodded once. "Dr. Sewell, good to see you."

"Nathan, this is Dr. Elena Gardner. Elena, Nathan Godwin, our administrator."

Godwin favored Elena with a curt nod. "Doctor, pleasure to meet you. Are you interested in our hospital?"

Before Elena could speak, Cathy said, "That's what we're about to discuss, Nathan. I'm sure you have things to do, so we won't keep you from your rounds."

"Nice meeting you," Elena mumbled.

When Godwin was around the corner, Cathy said, "Self-important little man, but he keeps the place running well."

"He scares me a little."

"Never mind. You won't have a lot to do with him. Now how about some lunch? Since I'm eating for two, it's all I can do to keep my hands off every bit of food I see."

"Cathy, to be in your third trimester, you don't look like you've been overeating."

"That's all right. I don't want the town gossips saying, 'Isn't it too bad she never lost all that pregnancy weight?' Our city is big enough to offer everything you might want, but at heart it's still a small town, and news travels fast around here."

Elena suppressed a shudder. She'd hoped to leave her past behind with the move, to start fresh. But if anyone in Dainger started asking questions about Mark's death . . . No, she wouldn't let that happen.

When they arrived, Will was already inside the restaurant, seated at a table in the back corner. Cathy dropped her purse into the chair opposite him and said, "I'm going to freshen up."

Elena took an empty chair between Cathy's spot and Will. He smiled and said, "So did Cathy convince you that our fair city isn't exactly a medical backwater?"

"Frankly, when she first mentioned Summers County General Hospital, I had a mental picture of a little facility with no specialty care, antiquated equipment, and a scraper outside the front door to clean the barnyard residue off the boots of the patients and doctors alike."

"I'm sure Cathy showed you otherwise."

After the waiter took their drink orders, Will chatted amiably and Elena began to relax. Maybe she wasn't going to get the third degree from Cathy's lawyer husband.

Cathy returned, and Will rose to pull out her chair. Elena recalled when Mark used to do that for her, and as she often did when something brought to mind her loss, she felt herself die a little. She turned away and dabbed at the corner of her eyes with her napkin.

"Did I miss anything?" Cathy eased into her chair and set her purse near her feet.

Will shook his head. "I was giving Elena the third degree, but you got here before I could get out the rubber hose."

Cathy picked up a menu. "Well, there'll be none of that now. Let's have a relaxing lunch."

During the meal, the two women shared anecdotes and discovered mutual acquaintances. Will chimed in from time to time with comments and stories of his own. Both women declined dessert. Will asked for coffee, and Elena decided to join him.

The waitress left the bill, and Cathy slipped a credit card into the folder. She waved off Elena's attempt to cover her own lunch. "This is definitely a professional expense. I hope we can come to an arrangement. If we can, the cost of a chef's salad and iced tea is a pretty small price to pay for finding someone to watch over my practice while I'm on maternity leave."

Elena felt her lunch creeping back up into her throat. She'd hoped for something permanent, a move to somewhere she could put down roots. Now she wasn't sure. "So you're looking for someone on a temporary basis? A
locum tenens
arrangement?"

"Not necessarily." Cathy looked around. "Wouldn't you be more comfortable talking about this in my office?"

Elena wasn't sure she could wait one more minute to hear Cathy's offer— if there was to be one. "I'm fine doing it right here if that's okay."

"Sure." Cathy looked around the nearly empty room. "RJ's a friend of ours, and we eat here a lot, so they shouldn't mind if we keep this table a bit longer." She beckoned to the waitress. "Peggy, we're going to discuss a little business. Would you top off everyone's beverages, and then ask Darlene not to seat anyone near us?"

Even though there was no one within earshot, Cathy leaned a bit closer to Elena. "This is a two-part deal. What I need now is a
locum tenens
to cover my practice while I'm on maternity leave. I've told you about the salary and benefits. Do you have any questions there?"

Elena shook her head.

"But I'd like the contract to include an option for a permanent association." Cathy said.

Elena was afraid her dry throat could only emit a croak. She sipped from her cup. "The option would rest with you?"

"No, with both of us."

"Is the practice big enough to support two doctors?"

"I think there's room for another primary care doctor here in town, but I'll have a better idea about that later. First I have to fill the
locum tenens
position."

Elena had to concentrate hard on the words as they came through the high-pitched hum in her ears. It was happening. She had a place to practice.

"So far as your capabilities, there's no question there," Cathy said. "And I think you and I would be a good fit. There's only one thing."

Elena felt the muscles in her shoulders tighten like a violin string.
She thought it was all behind her, but here it came again.
"What's that?"

"Amy hinted that your husband's death is still affecting your professional behavior. Let's clear the air about that."

The sound of breaking glassware from the kitchen split the air. The noise might as well have been the sound of Elena's composure shattering. She squeezed her eyes closed in an unsuccessful attempt to stop the tears she already felt forming there.

C
athy was sorry to trigger the emotional display, but Amy had made it clear that Elena still carried some baggage after the death of her husband. Cathy had to know the extent of that baggage.

Will, bless him, was unflustered. Most men didn't know how to react to a woman's tears, but his reaction was immediate and unembarrassed. "Elena, let's go over to my office for this conversation. We can all ride together, and I'll bring you and Cathy back here to pick up her car afterward."

He didn't wait for a response. He shepherded the two women out of the restaurant and helped them into his pickup truck. Once inside the building, Cathy showed Elena to the restroom and suggested she splash some water on her face and repair her makeup. "We'll be here in Will's office."

As Elena disappeared down the hall, Cathy said, "So there's something there."

"I sort of figured there was. Why don't you let me see if I can get it out of her? In this situation, I think it would be better if you just provided a comforting female presence."

Cathy recalled a time when she'd sat in this office and poured out some significant secrets to Will. She hadn't intended to, but at the time it had seemed so easy, so natural to confide in him. She wasn't sure whether the knack came from his training as a lawyer or his growing up with a pastor for a father. In any event, she decided to go along with him.

"I'm so sorry I broke down like that." Elena eased through the door and took a seat on the sofa that occupied one wall of Will's office. She appeared to be holding herself together by a supreme effort.

"No problem," Will said. "Would you like some water, a Coke?"

Elena shook her head. "No. Really, I'm okay." She rummaged in her purse, pulled out a tissue, and dabbed at her eyes.

Will rested one hip on the edge of his desk and said, "We know you've had problems since Mark's death, and we need to understand what they are."

"It's sort of complicated," Elena said.

"It usually is," Will said. "Start at the beginning."

Cathy took a seat on the sofa beside Elena and turned halfway so she was facing the woman. She tried to make her expression and her body language nonjudgmental and encouraging.

Elena took a deep breath. "Mark and I met right after I graduated from med school. One of my classmates was dating his roommate, and she fixed me up on a blind date with Mark. I know it sounds hokey, but it really was love at first sight. We were married six months later, halfway through my first year of residency."

"What did Mark do for a living?" Will asked.

"He started out as a computer programmer. Then, after we were married, his company made him sort of a troubleshooter. You know, if a company was having IT problems their in-house staff couldn't solve, Mark was the guy they called."

"Did he travel a lot?"

"Not really. I was the one who was always gone." She looked at Cathy. "Not travel, of course, but you know how it is. Nights on call at the hospital. And when I was home, I barely had time to keep things going. Mark did his share—more than his share, I guess—of the housework. We . . . we had a great marriage."

Cathy noted the hesitation and filed it away. Most marriages weren't great a hundred percent of the time, and she was willing to bet Elena's hadn't been, either. But she guessed it was normal to remember things as perfect once they were out of reach.

Will's voice was so soft Elena had to lean forward to hear him. "Then what happened?"

"It was almost seven months ago. He woke me sometime after midnight. He had a terrible headache. His speech was sort of fuzzy. I turned on the light and saw his eye was drooping." She swallowed hard. "I called 911. He was unconscious by the time the paramedics got there. I rode with him to the hospital. He stopped breathing halfway there, so I intubated him and kept him going with an Ambu bag. At the hospital, I pulled every string I could think of to get a neurosurgeon there stat."

Cathy felt herself drawn into the story, first as the clinical picture unfolded, then as Elena told about her relationship with her mother-in-law. Her heart was touched by the enormous responsibility thrust on Elena when Mark's prognosis became obvious.

"And how did Mark's mother react to all this?" Will asked.

"She thought I should have noticed symptoms earlier and gotten Mark to the doctor."

Cathy couldn't help herself. "But he had a berry aneurysm." She looked at Will. "A weak spot in the wall of an artery in the brain. Most often there aren't any symptoms. The first you know of it is when it ruptures, like this one did."

Elena nodded. "Makes no difference. She was convinced I'd missed the diagnosis, that I should have somehow gotten him better treatment. But the thing that put the final barrier between us was that she kept holding on to the idea that, if Mark were kept on life support long enough, he'd eventually recover. I think she had visions of his being moved into her home where she could nurse him back to health—and get him away from me."

Cathy spoke softly, but still her voice seemed too loud for the circumstances. "How did it finally play out?"

"The neurologic damage Mark sustained was extensive. There might have been a chance—a very slim chance—that he could be weaned off the respirator, but he'd remain in a coma. He'd never function as a sentient human again."

"So it was up to you to withdraw life support," Will said.

"That's right. But Lillian kept arguing." Elena paused and chose her words carefully. "After two weeks, Mark came off life support and—" The words seemed to hang in her throat.

"I understand how you must feel." Will's voice was calm. "I know a little about survivor guilt, not from firsthand experience, thank goodness, but from counseling with lots of widows and widowers when we prepare to probate wills."

"Oh, there's that," Elena said. "I live with survivor guilt every day. But I know that I'll get over it eventually. What I can't get away from are the phone calls that come at midnight every Tuesday."

Elena told them about the phone calls and the card, and explained why she thought Mark's mother was behind them. She told them about the financial morass in which she was trapped because of Mark's final expenses. More and more came rushing out. She appeared not so much to finish as to simply run out of steam.

Cathy exchanged glances with Will. He gave a faint nod. Elena appeared to be telling the truth.
Now for the big question.

"Elena," Cathy said, "I realize how this must have weighed on you. I need to know how this affects your ability to function as a physician."

"Of course, it's made it more difficult for me to see stroke patients. I guess I tend to identify more with their families, but that's probably not all bad. It makes me work harder to make sure the patients get the best possible care."

"And you have no problem functioning in an ICU environment?"

"I'll admit, there were some flashbacks early on, but it's never interfered with my clinical performance, never affected my judgment that I can tell. Actually, I have a patient in the ICU at St. Paul Hospital right now who's postsurgical after an intracranial bleed. I don't think he's going to make it, and I believe my experience has made me more empathetic, better able to counsel his wife."

"Two more questions and we'll let this go," Cathy said. "First, can we help you stop those harassing phone calls? Will is an attorney. Maybe he can get some kind of injunction or something."

Elena was shaking her head before Cathy finished. "I hope a move will be all it takes. I plan to have my Dallas number disconnected, no notification of the new number. I want it to be a dead end."

"How about your cell number?"

"To my knowledge, Lillian doesn't have it. I called her from my cell a couple of times when Mark was in the ICU, but I doubt she'd be savvy enough to check her call logs that far back."

Will said, "If you change your mind, let us know. I think the other thing Cathy intended to ask was whether you'd like some counseling to help you get past this more quickly."

"As usual, my husband has read my mind," Cathy said. "There's an excellent therapist in Fort Worth. Maybe a half-hour, forty-minute drive from here. Close enough to be relatively convenient, but far enough away that no one here in town will know about any visits you make."

"I guess I'd have to think about that."

"Well, I can highly recommend him. I saw him myself when I first moved here and was working through some issues."

Elena forced a smile. "Thanks. I'll give it some serious consideration."

Cathy had the sense that Elena wasn't about to consider seeing a therapist. But things could change. She'd be certain the option remained open.

Will drew a line through the last string of words on his legal pad. "I think we've covered everything. That's the gist of the contract. I'll print it out and send it to you, and I'd suggest you have your own attorney read it over before you sign."

"Do you have any questions?" Cathy asked.

Will let the exchange that followed wash over him, taking one final stab at sizing up Elena Perez Gardner. Her brown eyes still bore the evidence of deep inner turmoil. The furrowing of her brow might be explained by concentration, but he was willing to bet there were some deeply troubling thoughts running through Elena's brain.

He tuned back in to the conversation in time to hear Cathy say, "Call me next week. Meanwhile, I guess that's it."

"One second," Will said. "Elena, we might be able to save you a trip back to Dainger. It occurs to me you'll need someplace to live. Do you want to drive around and look for a place to rent?"

It was obvious Elena hadn't thought this far ahead. Will opened his mouth to make some suggestions, but Cathy beat him to it.

"Why don't I make a phone call? I know a wonderful couple who have a spare room they'd probably be glad to make available until you've been here long enough to know what you want."

Without waiting for an answer, Cathy picked up the phone and punched in a set of numbers she obviously knew well. The conversation lasted only a couple of minutes, and when she hung up she was beaming. "Let's go meet these people. This is a very special couple, and I think you'll really enjoy living with them."

"Well . . ." Elena stammered. "I don't . . . I mean, I suppose . . ."

"Don't worry. I stayed with them myself a few years back before Will and I were married. You'll love them, and they'll love you."

Will frowned. At this point, he was pretty sure Cathy still had designs on getting Elena to open up. That's why she was setting her up to stay with his parents, Matthew and Dora Kennedy, in the parsonage of the First Community Church.

"Matthew, Dora," Cathy said, "This is Dr. Elena Gardner."

Elena studied the couple who stood in the doorway. Matthew Kennedy was whip-thin and sinewy. When she took the hand he extended, she found it slightly callused but the grip gentle. His white hair was thinning a bit. Blue eyes sparkled behind rimless glasses. Elena had the feeling she was looking at a preview of Will Kennedy thirty years hence.

Dora Kennedy wiped her hands on a plain blue apron and stepped past Elena's outstretched hand to enfold her in a hug. Dora was a bit plump, a head shorter than her husband, but her twinkling eyes and white hair matched his. "Oh, Dr. Gardner. We're so thrilled that you're going to help Cathy. And when she called to ask if we'd put you up in the spare room, why that was the frosting on the cake." She stepped back and gestured the group inside. "And speaking of cake, I just took a peach pound cake out of the oven, and I have some fresh peaches to go on top of it. Let's go into the kitchen."

"I don't really—" Cathy's faint headshake made Elena stop in mid-sentence.

"Thanks, Dora. We'd love to," Cathy said. "I suspect a few days of your cooking will do wonders for Elena. I don't think she's felt much like eating the past few weeks."

As the group trailed Dora and Will through the living room into a cozy kitchen, redolent with the enticing smell of fresh cake, Will whispered in Elena's ear, "My mother is the best cook in seventeen counties. I know we've just eaten, but I've learned it's better to take whatever she offers than argue with her. Besides," he added, "I'll bet you finish a piece and ask for seconds."