by Harry Kraus
Claire leafed through the old record on Lena, something she hadn’t had a chance to do when she’d treated her the first time. She’d been treated two times before, once for a lip laceration, and once for fractured ribs. Each time, Billy Ray came with her. Each time there was a story of a fall or accident. The pattern was similar, both occurring on Mondays. Probably Billy Ray got paid on Friday. He gets a little cash, then spends some on booze on the way home. But yesterday was Thursday. Billy must have been doing a little celebrating before the weekend.
She shivered, thinking about what tonight might bring for Lena. She signed her dictated note and thought about calling Lena. She won’t listen to me anyway.
Claire busied herself in desk work, eating only a few packaged cheese crackers for lunch. She’d perfected eating on the run during her surgical internship, following the advice of her chief resident, affectionately called the O-man: “Eat when you can. Sleep when you can.” But now, she ate on the run only because she didn’t want to stop and eat anything that would prevent her from her work, because right now, work was the only thing stopping Claire from thinking about John and the morning fiasco at the genetics clinic.
The door opened after a soft rapping. “Knock, knock.” Her nurse Lucy always said that after she knocked. Lucy was close to retirement and knew everyone in Stoney Creek on a first-name basis. The room wherever Lucy was always smelled of roses, from the hand lotion she applied after every handwashing. “You’re being pretty quiet back here.” She leaned forward, her hand on the desk. “Does that mean you got bad news?”
Claire had told only one person at the clinic that she was getting tested for the HD gene. That one person was Lucy. Claire knew her nurse had kept a thousand patient confidences, and Claire knew her secret was safe. She looked up at Lucy’s large brown eyes and shook her head. “I chickened out at the last minute. I just couldn’t go through with it.”
Lucy patted Claire’s hand, leaving a floral scent and cool moisture behind. “Don’t be too hard on yourself, Claire. Not many of us would be ready for a glimpse into our own futures.”
Claire stayed quiet and turned her eyes to the work on her desk.
“How’s John? Upset?”
“Not that he’d admit, but we barely talked on the way home.” She shrugged. “Not that I felt like talking.”
“I didn’t mean to pry.”
“No, I know that. It’s not like I go around sharing this load with too many people.” Claire pushed the charts away and drummed her fingers on the desk. “I just didn’t feel like talking to John about it.”
Lucy raised her eyebrows in an unspoken question.
“If I know John, he’ll go away for a few hours and think it through, then come back to me with a rational argument with six points on why I should read my test results.”
“It’s a man thing, honey. Half the time I spill my guts about some problem to Lee, he immediately suggests three ways to fix it, when all I really wanted was someone to listen. They do it because they want to help.” She reached for Claire’s hand again. “John really seems to love you. I think he’s as interested in your future as you are.”
“It’s my future.”
“And his as well. You can’t blame him for wanting to know what he’s up against.”
Claire couldn’t voice her fears about John’s motives. John had easily popped the question last year before he knew about HD, but now he seemed to be dragging his heels. She smiled politely at Lucy. “Maybe.”
Lucy’s eyes narrowed.
“John has been the best friend I could ever want. And ever since he came to Stoney Creek to be near me, I was sure we had a future together, but . . .”
“But?”
“I don’t know. I guess I’m sensing some reluctance on his part.” Claire looked away. “I don’t think he can stand to think of living with me if I end up like Wally.”
Lucy stood up straight. Her response was quiet. “Oh, my.”
“John’s picking me up after work. He’ll probably be upset.”
“Or maybe just a little disappointed.”
Before Claire could process Lucy’s response, Lucy changed the subject.
“I hope it wasn’t a mistake to schedule patients this afternoon.”
“I’ll be fine. I need to stay busy.”
“That shouldn’t be a problem,” she said, pointing at a list of scheduled appointments. She took one step back, then added, “But problems don’t just disappear if you ignore them. If you want me to have the receptionist reschedule, everyone would understand. We could—”
Claire silenced her with an uplifted hand and a raised voice. “I said I’ll be fine.”
Lucy retreated with a shrug and a tight smile. “Okay, then, let’s get started,” she responded. “Brittany Lewis is in ‘A.’ Bellyache after the Ruritan dinner last night.”
Claire pushed back from the desk, thankful for a reason to stop talking about John. “I’m on it.” She walked down the hall and picked up the chart from the rack. Other than for routine childhood checkups, Brittany had been in good health. Now, at nineteen, this would be her first appointment with Claire. Claire pushed open the door and addressed the patient by her first name, something she did routinely with patients under twenty. “Brittany,” she said, holding out her hand, “I’m Dr. McCall. Lucy tells me you’ve got a stomachache.”
The patient nodded. “About an hour after eating sausage and pancakes. Right here,” she said, pointing to her right upper abdomen.
Claire finished taking a complete history and decided that gallbladder disease headed the short list of diagnostic possibilities. She was just finishing the physical examination when a rap on the door, followed by “knock, knock,” signaled Lucy’s arrival. She pushed open the door to reveal the old ultrasound machine in the hall. “Thought you might want this.”
Claire nodded. Sometimes she felt like a puppet. Lucy had done this for so long, she knew all the workups. “Good thinking.” She squirted some ultrasonic gel on Brittany’s abdomen and picked up the probe. Dr. Jenkins had bought the hospital’s used machine when they replaced it with one with more bells and whistles. He used it on his patients, half of whom wouldn’t follow through and go to Carlisle for an ultrasound if he ordered it. Claire had learned to use ultrasound to evaluate trauma patients up in Boston during her internship.
She placed the probe on Brittany’s firm abdominal wall, pressing gently to get a good look at the liver and gallbladder. “There,” she said, “see that? There’s your gallbladder.” She adjusted the probe. “The wall is thickened.”
Brittany winced. “Ow.”
“And here is a cluster of gallstones. Are you sure you’ve never gotten sick with this before?”
The patient denied it. And when Claire recommended referring her on for surgery, Brittany balked. “Isn’t there anything else? Can’t you give me a pill? My grandmother took some pills for her gallbladder and she didn’t need surgery.”
“Surgery is really the best way. The procedure can be done up in Carlisle as an outpatient.”
“With that laser thing?”
Claire didn’t feel like explaining it. Removing the gallbladder wasn’t commonly done with a laser, but it made no difference to the patient. Claire understood that Brittany was referring to removal of the gallbladder using a laparoscope. She nodded. “Right. You probably won’t even need to spend the night.”
“I don’t have insurance. I can’t afford it.”
She felt her patience wane. She didn’t have time to argue with patients who came seeking her advice, and then didn’t want to do what she’d ask. “I’ll send you to Dr. Branum. I’m sure he will work out a deal.”
“I really am feeling better than last night.”
“Fine!” Claire snapped. “You be the doctor, then! Do what you want to do. But remember, I warned you—” She stopped short as the door opened and her eyes met Lucy’s. Her nurse’s gaze interrupted Claire’s outburst, but not her building emotional stress.
She looked at her index finger which was still wagging toward Brittany’s wide eyes. Claire slowly folded her fingers into a fist and pulled them to her chest. She dropped her gaze to the floor and proceeded with her voice monotone and soft.
She warned her patient of delaying too long, sighting the possible complications of her disease if left unchecked.
The patient looked down and played with the silver stud piercing the skin above her umbilicus.
Claire sighed and attempted to get her young patient to refocus. “Brittany.”
The patient looked up, meeting her doctor’s eyes for a fleeting moment.
“This could be serious.”
“I took some Tums last night. I feel better now. I’m not even sure why I came,” she added, slipping down from the examining table. “I can’t miss work right now. Alice McMillan lost her job when she had to have surgery.”
“If you have surgery, at most you’ll need to avoid heavy lifting for a week or two. Most people can do light work a few days after having the gallbladder removed. If you keep having attacks, you’ll end up missing more work.”
In spite of Claire’s best arguments, the patient stood her ground.
Claire wanted to scream, but the patient wasn’t going to take her advice, so she saved her breath. She handed the patient the billing sheet and recommended that she avoid eating fried or greasy foods. You’ll be back.
She pushed past her nurse and into the hall. She had only taken one step toward her office when she felt a hand on her shoulder. She knew the gentle touch to be Lucy’s before she turned, determined not to let the older nurse make her feel any worse about her actions than she already did. She didn’t want a motherly reminder to see things from the patient’s perspective. To avoid the lecture, she launched into a tirade. “Fat, fertile, forty, fair, and flatulent!”
Lucy’s face reflected her shock. She lifted her hand. “What?”
“The five F’s of gallstone patients. Certainly you’ve heard of them,” Claire added with a wave of her hand. “But why should I even bring up typical characteristics that the medical texts teach?” She raised her voice and kept her eyes locked on her nurse’s. “Because no one in Stoney Creek is anything close to typical! And none of them want to take my advice anyway! All they want is some white-haired man with a white coat to give them some antiquated advice.” She twirled and left Lucy with her mouth open.
She stomped down the hall to her office and plopped into her desk chair. She opened Brittany’s chart and prepared to dictate an office note. Why can’t I have just one patient who will take my advice? And why can’t anyone present like I was taught during my internship?
She looked up and gasped as Cyrus Hensley rose up from the other side of her desk.
Cyrus winced, an action which dimpled his reddening cheeks. “Sorry, Dr. McCall.”
She nodded and studied him a moment, observing his hasty retreat to a standing position against the wall. He was young, midtwenties, she guessed, and he would have been a real hunk if it wasn’t for his need for a haircut. His hair was dark and curly, hanging to the bottom of his collar. He flipped his bangs away from his eyes with the back of his hand.
He looked down. “I, uh, need a haircut. I just haven’t had a chance to get up to Carlisle to get it done.”
He had read her mind exactly. “Don’t worry about it. What were you doing on the floor?”
“Lucy asked me to hang an X-ray viewbox on this wall. I was just looking for the closest electrical outlet.”
Claire sighed and tried to quiet her runaway heart. “Oh.”
Cyrus shuffled his feet. “What were you talking about?”
She squinted and leaned forward. “When?”
“You said something about fat.”
“I was talking about gallstones.” His expression told her he wasn’t getting it so she continued. “People with gallstones are supposed to be fat. Fat, fair, forty, fertile, and flatulent.”
He nodded, but didn’t move on. “My mom was sixty when she had her gallbladder out.”
“Well, she must have been from Stoney Creek.”
“Why?”
“Because every patient here seems destined to be different from the way they are supposed to be.”
He nodded again silently.
Claire continued to vent. She knew her maintenance man couldn’t care less, but he just happened to have the only other set of ears in the room. “The patients in Stoney Creek never seem to typify the patients in my textbooks.” She picked up the chart. “Take this young woman. She has only one characteristic which typifies gallstones.”
“She’s fat?”
Claire smiled, amused that Cyrus had actually listened. “No. Not fat at all. She’s fair. Very fair, beautiful in fact, but she’s not fat, not fertile, and nowhere close to forty. She’s only nineteen. I wanted to refer her for surgery, but she has every excuse in the book.” She paused. “What is it with these folks? No one wants to do what I tell them.”
“Hey, don’t look at me, Dr. McCall. You’re the one from Stoney Creek, not me.”
“I’ve been gone too long. I’ve forgotten how self-sufficient these people are.” She glanced at her maintenance man. “Where are you from?”
“All over. My father was military. His last assignment was just over the mountain in Sugar Grove. I loved it there.” He shrugged. “Coming to Stoney Creek felt as much like coming home as anywhere.” He stepped toward the doorway. “Don’t let these folks get to you, Dr. McCall.”
She sighed. “Thanks.”
He nodded and turned to go.
“Uh, Cyrus, where do you get your hair cut?”
He shrugged. “Haven’t really found a place I liked.”
“I’ll do it for you.”
“You?”
“Sure. I used to cut my brother’s hair all the time.”
Cyrus wrinkled his nose.
“Don’t worry. I think I’m qualified. I can do it after work.”
She turned back to Brittany’s chart, not waiting for Cyrus to answer. She read Lucy’s handwritten note, something she hadn’t bothered to do before entering the room because she liked taking the history herself. “Patient’s father died after gallbladder surgery. Patient is very afraid of surgery.”
The words cut like a fresh scalpel. She had taken her frustrations about her own problems out on her patient and her nurse, and hadn’t even realized what Lucy already knew: the patient would likely avoid surgery at every cost, not because of lack of insurance, or losing her job; she was afraid, and Claire had been too preoccupied to notice.
Claire shook her head. God help me.
Lucy’s voice interrupted her prayer. “Knock, knock,” she said as she tapped the doorframe.
Claire looked up at Lucy, half expecting an I-told-you-so, but knowing her nurse was above rubbing her nose in her problems. And also smart enough to know when to give Claire space when she was creeping close to the edge. Lucy didn’t smile. At least she wasn’t the type to be plastic. If Lucy didn’t feel like smiling, she didn’t. “Marge Nichols has her son in room B.”
“Another earache?”
“You got it.” Lucy straightened. “And don’t even mention the word surgery. Her mother just entered Crestview Adult Home, and Marge and Dan are giving every spare dime they can scrape up just to make the payments.”
“And just what if the right answer is ear tubes?”
“Sometimes we have to modify the book answers to fit the real world.” She shook her head. “And you’re not going to believe what I’ve got for you in room C.”
“Try me.”
Lucy shook her head. “Have a look for yourself. Better go there before you see the Nichols boy.”
Claire smiled. “An emergency?”
“Yep,” Lucy said, as she led the way back down the hall. “What is it with you surgery types? You like emergencies?”
Claire shrugged, knowing Lucy couldn’t see her. I used to love emergencies. But that was before I was ou
t here on the front line on my own. She kept up the surgical bravado. “It’s the adrenaline that keeps me coming back for more.”
Lucy gestured toward the exam room and stood aside. “Be my guest.
Your emergency beckons, Doctor.”
Claire’s pulse quickened as she reached for the doorknob. Why would Lucy stand aside? What would she see inside? Blood? Active labor? Acute abdominal pain? She paused and listened to the muffled sounds coming from behind the door. Someone was in distress. And the noises sounded like those of someone with a severe hearing or speech impediment.
She pushed open the door to see a grade-school boy sitting on the exam table holding a glass bottle up to his mouth. The boy’s eyes were wide open, and darted quickly between an elderly woman standing at his side and Claire, whose first thought was that it couldn’t be a very big emergency if the patient was sitting here enjoying a beverage. But that was before she heard him speak.
The patient mumbled indistinct gibberish without sharp consonant sounds, clicking his teeth against the glass bottle neck. He gripped at the old woman’s arm and ducked his head, never lowering the bottle. He began to shake his head and lifted his hand up to halt Claire’s progress, at the same time releasing the bottle and pinching it between his teeth. He turned away from Claire and lowered his hands around the bottle. It was still half full of what appeared to be chocolate milk.
The woman wore a blue flowered dress with a grease stain over her ample stomach. She lifted her hand toward Claire, revealing a scar mid way up her arm above the wrist. “I’m Edna Shaffer, Stevie’s grandmother. Can you help him?”
Claire accepted the firm handshake. “I’m Dr. McCall.” She leaned toward the boy.
Edna pried her grandson’s fingers from her arm and pulled his other hand away from the bottle. “You’re going to have to show her if you want any dinner tonight.”
The boy shifted enough for Claire to see something dripping from the bottom of the bottle, which was hanging on the end of his tongue. “Eeth sthuh!”
Edna translated. “It’s stuck.” She nudged the boy’s shoulder. “Let the doctor see.”