“Yep,” Roxie replied. “There’s me, a clinical social worker over in San Sebastian, and the Rev. Erin O’Rourke. Mother Erin is an Episcopal priest who has a master’s in pastoral counseling. She works out of my office one day a week. As some of you know, she’s only part-time due to her part-time church work.”
“So, we have two-and-a-half mental health professionals in total for the three counties.” Gen summed up the situation.
“You can imagine we all work crazy hours. My office is on Main Street, in a multi-use office complex. Rural mental health clients generally balk at going to a freestanding building to see a mental health professional. There’s still a lot of stigma about mental illness out here.”
The doctors around the table murmured about this problem.
Jaime said, “I’ve had a problem getting one rancher to go. He’s adamantly against getting help. I’ve prescribed anti-depressants, but he would be a good candidate for grief counseling.”
The group discussed these issues until eight o’clock, when patients began arriving for scheduled appointments. Bobbi packed up her notes and handouts and placed them in a file folder, grabbed some more coffee, and was about to leave the room, when Gen came up to her.
“Dr. Webster, can I have a second with you?”
Bobbi turned to her. Given Gen’s smile, it must not be bad news, anyway, she thought. “What can I do for you?”
“In looking over your fellowship application, I saw that you had a rotation at a hospice in eastern Oregon during your residency.”
“Yes. It was not much of a challenge, medically. Signing off on palliative care protocols primarily. The nurses and social workers did most of the patient work.”
“Can we talk after clinic today? I have a proposition for you.”
“Okay,” Bobbi answered, wondering what Gen could be offering.
Bobbi worked hard that day, struggling to keep focused after a night of little sleep. Later, after she signed the last patient chart, she leaned back in her chair at the counter outside the patient rooms, sighed, and stretched. She glanced at the clock behind her on the wall and noted it was after six, hoping Dr. Lambert was still in the clinic. Bobbi walked down the hall to the medical director’s office. The door was ajar and light spilled out into the hallway in a thin strip.
“Knock, knock.”
Gen looked up from paperwork at her desk. “Come on in, Bobbi.”
Bobbi stifled a yawn and sat in the comfy chair across from where Gen sat behind her desk.
“You look tired, Doctor.”
“Long night.”
“Ah. I won’t keep you long. Dr. Manning is on tonight I think.” Gen came around the desk, straightening her pencil skirt, and Bobbi tried not to stare at her shapely legs. “I wanted to talk with you about an opportunity that has come up with the Tri-County Hospice.”
Bobbi nodded.
Gen continued. “Their in-house medical director, Michaela Lopez, wants to add more local doctors to their consultant list. I thought, because of your hospice experience, you might be interested.”
“What do they want consultants to do?”
“She, as medical director, can handle the day-to-day patient supervision with nurses, but she needs someone to answer questions during evening hours. You know, of course, there are no emergencies in hospice, so it’s mostly routine stuff from nurses about prescription adjustments for palliative care. You’re familiar with how hospice nurses do most of the care on their own, using the hospice protocols signed off by Dr. Lopez.”
“How many evenings a month?”
“How about you direct your questions to Dr. Lopez? Here’s her card with the contact information. She would like someone to start in March, I believe.”
Bobbi took the card, nodded, and said good night to Dr. Lambert.
On the way home, she pondered doing some hospice work. Gen had been right; it would entail no emergencies. Hospice aimed to give patients a good death, which medically, was about providing comfort care. Occasionally, weird things might happen. A patient may ask to go off morphine. She remembered a case when a daughter of an older man requested she help him die. Of course, she refused. She raised his dosage, reducing both his pain and the daughter’s anxiety. But such calls from hospice nurses were rare. She would call Dr. Lopez tomorrow.
****
Two days later, Bobbi finished rounds on four Ryan Delaney Clinic patients who were hospitalized. Everything looked good on the heart patient and a patient with a flare up of cellulitis. The rancher with a compound fracture of the tibia was resting comfortably and would be released later that morning. However, a mother and her newborn were both recovering from a difficult delivery. She called in a neonatologist from Denver for the baby. The mother had received blood transfusions, but seemed to be getting her strength back. When she finished around noon, she decided to pick up some quick lunch at the hospital’s small cafeteria before heading to the clinic, where her first patient wasn’t expected until two p.m. As she walked in, she noted that Erin, The Elf, sat at a far window table overlooking snow-covered plains. Bobbi went to the counter, ordered her BLT and a coffee, and stood to the side until the counter worker called her.
After she paid for her lunch, she balanced it all on a tray and walked uncertainly over to Erin’s table, not knowing what welcome she might receive. Erin’s attention intently focused on the horizon. She didn’t notice Bobbi until Bobbi spoke. Erin’s head snapped up. “Oh. Dr. Webster. What a nice surprise.”
Bobbi hoped Erin truly felt it was nice. She’d been grumpy around her since they met, so Bobbi wouldn’t begrudge her being less than welcoming. Bobbi inhaled when she realized Erin wore a green sweater over her clerical shirt that was the same color as one Stephanie used to wear. She admonished herself that she would look past the sweater. “Do you mind if I join you?”
“No, please do.” Erin swept her hand to the open chair. “I was checking my email, then got caught up in the scenery. I stopped for some coffee after I visited a client of the mental health clinic who was admitted last night.”
“Hospitalized for mental health issues?”
“Sorry, Doctor, I can’t talk about my patient.” Erin sat back, crossed her arms over her chest, and slapped a smug look on her cute face.
Bobbi grinned lopsidedly. “Touché.” She held her coffee up in a salute to Erin.
They looked at each other for a moment with laughter in their eyes.
“Sorry. I shouldn’t have asked that. I know better.” Bobbi began eating her sandwich.
Erin took a moment, seeming to ponder something, then spoke. “I don’t want to pry, Doctor, but I noticed at our Sunday dinner that you checked out of the conversation. I wondered if you were okay. I hope none of us offended you or spoke out of turn.”
Bobbi chewed thoughtfully, wondering how to respond. “I, uh…I’m fine, more or less. You talking about problems in relationships hit a sore spot with me, unfortunately. It’s certainly not your fault. It took me down a rabbit hole. I’m sorry it came across so rudely—”
“Not rude. No, we didn’t think it rude. We were concerned about you, is all. You seemed far away and, well…sad.”
Bobbi looked on Erin and her astute assessment of the situation. “You could say that, yes. But I’m good now. No harm, no foul.”
Erin didn’t look convinced. “Did we call up something from your past?”
“Yes.” Bobbi took a big bite of her BLT.
Erin waited for her.
“Yes,” Bobbi repeated, inhaling deeply before she added, “I don’t want to talk about it today. I hope you understand.”
Erin waited, her eyes softly watching Bobbi, a small frown crinkling her forehead. “I don’t want to push, Doctor.”
Bobbi swallowed. “You’re not pushing. And, could we get to first names? We’ve run into each other quite a bit lately. I hope you’ll call me Bobbi. Doctor sounds a bit off-putting.”
“Sure, no problem, Bobbi.” Erin smirked. “You can drop the Mother,
too. Just plain Erin.”
“Okay, plain Erin.” Bobbi smirked in kind, while she finished the last of her sandwich. She gathered her leftover wrappers and napkin onto the tray. “I need to run. Good to see you, Erin.”
“Likewise, Bobbi.”
Bobbi nodded in Erin’s direction, then left. Erin had been pleasant and seemed concerned about her. Nice. Despite the stupid sweater.
Chapter Thirteen
That afternoon, during a lull between patients, Bobbi talked with Dr. Lopez at the hospice office, agreeing to be a consultant for one year.
Three days later, after having agreed with Dr. Lopez’s request for medical help, Bobbi had a message from her to come to a patient conference today at five-thirty.
She grabbed her diet coke and headed out into the cold winter wind with her hood up and gloves on.
When she arrived at the hospice office, the receptionist guided her to the correct room. She walked in to see three people—two women she didn’t know, and The Elf. Was the woman stalking her?
Bobbi stood in the doorway briefly to gird her loins, then nonchalantly made her way to the remaining empty seat around the small round table.
The two women quickly shook her hand and introduced themselves as the social worker and nurse on her patient’s case.
“Hi,” Erin said quietly. “Good to see you, Doctor…er, Bobbi.”
Bobbi just nodded at Erin, noting she wore another sweater today, totally okay.
The nurse, a pudgy woman with gray streaks in her short, dark chestnut hair, began. “Thanks everyone for coming out in the cold this afternoon. This should be fairly short. We need to finalize the treatment plan for Mrs. Meredith, whom we admitted yesterday.” She passed out a one-page summary and began to read it.
No slouch, this nurse, Bobbi thought. One to get to business.
“She’s a ninety-five-year-old widow with end stage renal failure. She also has COPD and diabetes. She’s no longer ambulatory, completely bed-ridden, with a catheter. Her daughter—”
“Annabelle,” Erin added.
The nurse nodded to Erin, then hurried back to the patient’s information. “Yes. Annabelle has been the primary caregiver and Mrs. Meredith is at her home. We delivered a hospital bed late yesterday. When I did my full admission assessment, her blood pressure was steady but low, pulse low, other vitals okay. Jane, do you want to fill us in on her situation?”
The nurse’s speech had clipped along very fast. Bobbi hoped she’d caught all the important data.
The social worker nodded, and spoke in a much slower cadence. “As you indicated, her daughter Annabelle takes care of her. She is a retired teacher in her early seventies, living in a modest two-bedroom house on one floor, so no stairs to negotiate. Her husband, Pete, supports all this, but is not much help except physically helping to move his mother-in-law. A grown son, Gavin, comes around occasionally and brings his two elementary-school-age daughters. Gavin lost his construction job some weeks ago when he broke his foot and is waiting for disability payments. In the meantime, he’s getting help from his parents. I have applied for medical assistance for Mrs. Meredith, since she’s not got any savings to speak of. That should help in paying for hospice care.”
“My church has been aiding this family for some time. We bring food once a month and help with the heating bill when we can. Several people from the parish visit once or twice a month to bring communion and the day’s altar flowers. The family doesn’t come to church because of the burden of caregiving.” Erin sighed. Bobbi thought she looked sad at this information.
Bobbi looked down at the notes she’d brought from her patient’s clinic chart. “Medically, she’s holding her own. I expect her not to last more than a week, given her kidneys’ functioning. She probably won’t suffer.”
Nurse Hurry-Up answered Bobbi, “I agree; she probably won’t. In the kidney deaths I’ve seen, the patient doesn’t suffer because they often go into a coma until death.”
All around the table nodded with this assessment.
“What can I do?” Bobbi asked.
The nurse produced a typed list. “I have a list of medications she’s currently taking, as I’m sure you do. If we could cut it down to only those with palliative purposes, to keep her comfortable. “
Bobbi took the prescription list and looked it over. She took the pen out of her pocket and began marking the sheet with notes, then, after a few moments, handed it back to the nurse. “This should be sufficient. I am not writing any scripts for pain. Does that sound right to you?”
“Yes, Dr. Webster. If we need anything, we can call you and one of us can run to the clinic for a script, but I don’t think it will be necessary.”
Erin frowned at the nurse then at Bobbi. “No morphine, then?”
Bobbi looked at her. “No. Unless she becomes agitated from the effects of the kidney failure, she will probably be comatose, so she’ll not be feeling pain. But the hospice staff will let me know ASAP if things change, then I’ll write a script.”
“Yes, I understand now. Thank you.” Erin smiled at Bobbi, surprising her.
The social worker asked, “Reverend, will you be visiting the family soon?”
Bobbi inwardly smirked hearing the social worker call Erin the hated title, “Reverend.”
“I’m going over tomorrow. I called and they were happy to have me visit for prayer. I’ll give the family and Mrs. Meredith pastoral care, and I hope to discuss Mrs. Meredith’s funeral arrangements. It’s what I’d do for any parishioner with such a short time left. In other visits with them, Annabelle and Pete seemed somewhat relieved that things were winding down for her mother. She’s been ailing for several years and unable to take care of herself or do the things she enjoyed doing. But in the last weeks, her health has been rapidly going downhill, putting a tremendous burden on Annabelle, both physically and emotionally.”
“Not unusual at all,” the social worker added. “Hospice can provide a volunteer to go out and help Annabelle with household chores, maybe sit with her and chat.”
“Sounds great,” Erin answered, smiling at the social worker.
After a short, quiet moment, the nurse said, “I think that wraps up what we needed to discuss today. Anyone have anything else to add?” She looked around the table. “Thank you again for coming. Dr. Webster. Mother Erin.” She shook each of their hands and they all left the room.
Bobbi helped Erin on with her coat. “What’s in the water over at your church?” she teased. “I keep running into your parishioners as my patients.”
Erin quirked her eyebrow. “I know. I didn’t know you worked with hospice.”
“I’m starting a year-long consultation, helping out the medical director. In fact, this is my first case with them. It just worked out that Mrs. Meredith is one of my own patients.”
“Same here. I’ve never had a Holy Spirit parishioner in hospice before, well, except for Mr. Mendes those two days.” Erin blushed. “They knew I was Annabelle and Pete’s priest, so they invited me to the conference.”
Bobbi looked out the front door of the hospice office. “Looks like snow. You going to be okay getting home?”
“Oh, sure. I’m from Chicago, you know.” Erin laughed.
Bobbi thought Erin’s laugh sounded like tinkling music. She wished she heard Erin laugh more. “I didn’t know. Excuse me.” She laughed, bowing slightly. “Then you know more about driving in snow than most, I assume.”
“You got that right,” Erin said. “Well, I’d better get going. I’ve got a whole evening to myself. What a treat. No meetings. My sermon’s done, and tomorrow’s my day off. Hallelujah.”
Bobbi watched Erin’s face brighten and thought for a moment. She wanted to get her past out of her system, despite Erin triggering some anxiety. She certainly felt attracted to her. “Er, if you’ve got no plans, would you like to catch some dinner or something? I’m done at the clinic for today, and thankfully am not on call tonight.” Bobbi went on, deciding to tell the
tale of her woeful household. “My fridge is virtually empty, as well.”
“Doctor.” Erin shook her head and wagged her finger playfully. “Bad on you.” Erin’s pink face drew Bobbi in. “But, another soul sprung from the daily drudge. Good for you.” Erin clapped her on the back, while she seemed to ponder Bobbi’s offer. “Sure. Let’s get something to eat. Where did you have in mind?”
Chapter Fourteen
They decided on a bar and grill that Bobbi had seen from the road only, situated not far from the hospice office’s location. Erin knew the owner, the sister of her hairstylist.
Bobbi followed Erin in her green four-wheel drive without too much sledding around on the snow-packed road. As they arrived at the destination, Kenny’s Tavern looked worse for wear. The “Tav” letters were not lit on the neon sign and the tinted front windows hadn’t seen a cleaner in a while. Dirt stained the white clapboard walls and the roof sank on the left side.
Pickup trucks filled most of the parking lot. When she entered, country music from the jukebox and the smell of greasy fried food assaulted her senses. Cowboys, construction workers, farmers, ranchers, and other blue-collar types stood shoulder to shoulder at the thirty-foot-long bar. Two men in flannel shirts and baseball caps played pool in the area behind the tables, and she noted they were the only women in the place. A couple of the men in denim turned to peer briefly at them, then returned disinterestedly to their desultory beer sipping.
Erin indicated one of the few small, round tables that stood empty between the bar and the pool table. They sat in the one furthest from the jukebox. Erin waved at the bartender. “Hey, Milly.”
“Be right there.” Milly nodded her head amidst filling up mugs from the tap. “Beer?”
Erin looked at Bobbi.
“High Country, if you’ve got one,” Bobbi answered.
“Same for me,” Erin told Milly. “Milly, this is Dr. Webster.”
Milly nodded to Bobbi from behind the bar. “Good to meet ya, Doc.”
Bobbi raised her eyebrows. “They got good food?”
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