Rachel gave her friend a one-armed hug. “Me, too. What’s going on?”
Across the room, a young girl lay bonelessly on the sofa.
“We were doing rodeo practice on the bucking barrel. Lena said she wanted to ride and walked over…but then she just sort of staggered and fell down. We carried her in and called an ambulance. And you.”
“Smart thinking.” Rachel knelt by the sofa. One deep breath of the fruity aroma surrounding the patient gave her all the information she needed. “Did she say anything?” From the front pocket of the duffel, she pulled out a glucometer to test Lena’s blood glucose level.
“She was acting kinda crazy this morning.” A tanned, black-haired boy sat in a recliner nearby. “I said she shouldn’t ride, but she wouldn’t listen.” His dark eyes were wide with fear. “Is she okay?”
Caroline came over and put a hand on his shoulder. “We’ve got help now, Justino. Dr. Vale will know what to do.”
“Did she eat breakfast?” Rachel asked. The blood-sugar result was high. And her blood pressure was low.
Justino shook his head. “She’s been sick for a couple of days. Throwing up and stuff.”
“Why didn’t she say something?” Garrett asked. “Why didn’t you?”
Rachel cut in. “She’s quite slender. Has she always been thin?”
“Yeah. But she said her jeans are getting loose, even though she’s been hungry a lot.”
“And thirsty?” Rachel asked.
“Oh, yeah. She drinks all the time.”
Lena fluttered her eyelashes and moved her head slightly.
“There you are,” Rachel said. “Hi, Lena, I’m Dr. Vale. How are you?”
“So thirsty,” Lena whispered without opening her eyes. “So tired.”
Turning again to her bag, Rachel began pulling out materials—an IV bag of saline and tubing, a syringe and a bottle of insulin. “Raise her legs,” she ordered over her shoulder. “Above her heart.”
While the others bustled around to help her, she handed the IV bag to Justino. “Hold this up high.” After inserting the needle into Lena’s arm, Rachel attached the tubing and adjusted the flow. Then she drew up ten units of insulin and injected it into the IV. “You’ll start to feel better soon,” she told the girl. Lena didn’t answer.
“That’s all I can do,” she said, getting to her feet. “She’s got to get to the hospital. How long ago did you call the ambulance?”
“They should be here any minute,” Caroline said. “What’s wrong? Why did she collapse?”
“She’s dehydrated and her blood glucose is very high. With fluids and insulin, though, she’ll start to improve.”
“Thank God,” Garrett said. “And thank you.” He glanced around the room. “These are my brothers, by the way. Ford’s the blond in the green shirt and Wyatt’s the one wearing the back brace.”
Nods were exchanged and hands shaken, but Rachel quickly returned her attention to Lena, noting that her breathing had slowed and her blood pressure had come up slightly. Positive signs.
Finally, she heard the siren they’d been waiting for. “The ambulance is here, Lena. You’ll be in the hospital in just a few more minutes.”
The vehicle stopped in the drive outside, lights flashing. Two emergency medical technicians came across the porch.
Rachel met them at the door. “I’m Dr. Vale, and this is Lena Smith.” She stood out of the way as one of the EMTs knelt by the couch, stethoscope in hand. “She’s in ketoacidosis. I started fluids and gave her ten units of insulin.”
The EMT nodded. “Got it.” The two men proceeded with their standard routine and, in only a few moments, had taken Lena out on a stretcher and put her into the ambulance.
“I want to come with her,” Justino said, following. “Please don’t make her go alone.”
The second EMT shook his head. “Not allowed. Sorry, son.”
The boy staggered, as if he’d been shoved.
Garrett put a hand on his thin shoulder. “You can come with me, Justino. I’ll follow the ambulance. Ford, could you call Lena’s dad to let him know what’s going on? Dr. Vale, I assume you want to come along, as well?” He ushered Rachel toward his truck.
“To begin with anyway. If Lena is part of this community, then I will be overseeing her care to some extent.” He opened the back door for her to stow the duffel on the bench, then held the front door so she could get in.
Once in the driver’s seat, he fastened his own belt and started the engine. “So today isn’t a onetime emergency?”
“I’m afraid not.” Rachel blew out a deep breath. “From all indications, this is a life-changing event.”
“What do you mean?”
“Lena will be under a doctor’s care for the rest of her life. She has juvenile-onset diabetes.”
*
THE TRUCK TOOK a sudden leap forward, then slowed as Garrett relaxed his foot. “She’ll be taking insulin shots?” He glanced at Justino in the rearview mirror. The teen was staring out the side window, lost in his own thoughts.
Rachel nodded. “Unless researchers find a cure. They’re always working on it.”
The prospect daunted him. “That’s a real challenge for a young girl.”
“The adults around her will have to help her cope. Are her parents going to be cooperative?”
“Her mother died last year. Since then, her dad has expected Lena to take care of her younger brothers and the house, as well as doing her schoolwork. She’s at the ranch because she’s been picked up for shoplifting several times in Buffalo and Kaycee and even Casper. She was cutting school with some of the older girls who can drive, and they’d spend the day out of town, getting into trouble. Caroline chose her for the camp, hoping it would turn her around so she could focus more on long-term goals.”
“Well, now she has the long-term goal of staying healthy to worry about.”
“I’ll pray for her to develop the strength she needs.”
“I’m sure that will help.” There was no mistaking the sarcasm in her voice.
He sent her a puzzled look. “Why do you say it like that?”
She blew out a breath. “Sorry. I didn’t mean to insult you.”
“I’m not insulted. But I want to understand your reaction. You don’t believe prayer can change events?”
“It might change the person who prays, because I believe in the power of the mind to affect behavior. But otherwise…no. Your prayer won’t call down some unseen power to help Lena deal with her diabetes.”
“You don’t believe in God?”
She didn’t answer for a minute. “I grew up going to church,” she said finally. “I can’t dismiss the possibility of a universal power. But as I observe life on this planet, I don’t detect much evidence of any kind of divine intervention. Good or bad, what happens, happens.”
There was silence as he drove the truck onto the highway exit ramp. “I’d be interested in talking more with you about that,” Garrett said, once they’d merged into traffic. “Meanwhile, we’ll have to work with Lena for the rest of the summer and get her started on the road to managing her condition.”
The doctor shook her head. “A summer ranch camp is probably not the best place for her to do that.”
Her opposition surprised him, but now wasn’t the time for a debate. “We’ll figure that out once she’s better.”
At the hospital, they pulled into the ER parking lot and went to the registration desk. Garrett showed the paperwork that granted him treatment permission, and they were allowed to join Lena in her cubicle. Justino went to the side of the bed and took hold of the girl’s free hand.
“That’s what you need,” Rachel said, nodding at the bag of fluid hanging near Lena’s head. “You’ll feel better soon.”
Lena rolled her head on the pillow. “I want to go back. To the ranch.”
Garrett faced her from the end of the bed. “We’ll take you as soon as the doctors say it’s okay,” he said.
“
Lying around being sick at camp is no fun.”
People wearing scrubs came and went, asking the girl questions and drawing blood for tests. A nurse brought some food and urged Lena to eat a little. Finally, a man wearing a white coat over his scrubs entered the cubicle, a medical chart held in one hand.
He nodded at Garrett but then shifted his attention to Rachel. “Dr. Vale? I’m Brad Stevens, from the medicine service. I understand you’re the new doc down in Bisons Creek.”
She gave him one of those bright smiles. “I just pulled in to town today.”
“And ended up at work. That’s the way it goes, doesn’t it? Good call on the diagnosis.” Then he moved forward to stand beside the bed. “Hi, Lena. I’m Dr. Stevens. We’ve run some tests and I have some news.”
Lena opened her eyes to focus on his face. “What’s wrong?”
“You’ve haven’t been well for a few days, have you?” Lena shook her head. “Well, that’s because your blood glucose is very high.”
“I don’t understand.”
“Your cells use the glucose, or sugar, in the food you eat to produce energy and to function normally. There’s a chemical in your body called insulin, made by the pancreas, which helps release glucose into the cells so it can be used. But sometimes there’s not enough insulin. The glucose doesn’t get into the cells and instead stays in your blood. Your cells are starved and you become sick.”
“How do I get better?”
“We’re giving you insulin, and that will make a big difference.”
“Then I can leave?”
“Not right away. We want to watch you for a couple of days, ensure your system returns to a more normal state. And we have to talk about the changes you’ll need to make to manage your health. You see, Lena, your condition is known as diabetes. And you’ll have it for the rest of your life.”
Tears welled up in Lena’s big brown eyes and spilled over to run down her cheeks. “My mother had diabetes. She died.”
Rachel stepped up beside Dr. Stevens to put a hand on the blanket over Lena’s knee. “But that doesn’t have to happen, sweetie.” Her tone was gentle but reassuring. “You’re going to learn how to control your condition so you can be happy and healthy and live a long, wonderful life.”
“Can other people catch this diabetes from me?” Lena looked at Justino.
“Don’t worry, it’s not that kind of disease.” Dr. Stevens closed the chart. “First, we’re going to get you feeling better, then we’ll explain how you can keep yourself that way. I’ll talk with you again in a little while.” He left the cubicle.
A moment later, a nurse parted the curtains. “Lena’s father is here.”
Garrett led the way to the waiting room, where a Hispanic man in work clothes came toward them. “Lena is sick?” he said. “What’s wrong?”
“This is Dr. Vale,” Garrett told him. “She’s the new doctor in Bisons Creek and she can explain—”
“No, you are responsible for Lena,” Mr. Smith interrupted. “You explain.”
“Let’s sit down.” Garrett led the way to three chairs. “Lena has diabetes,” he said when they were seated. “Like your wife.”
Mr. Smith’s expression didn’t change. “She is going to die?”
“No,” Rachel said. “She can get treatment that will keep her alive for a long time. But she will have to take care of herself.”
He didn’t respond to her. “How did this happen?” he demanded, glaring at Garrett. “You are supposed to keep her safe.”
“This is not something anyone could predict or prevent.” Garrett braced his elbows on his knees and gripped his hands together. “But we can work with Lena as she learns to handle her condition.”
Mr. Smith nodded. “You will see that she knows what to do.”
“Yes, but you should also understand—”
The other man stood up. “No. You are responsible. I signed papers. You will make sure she gets well and can do what is necessary when she comes home. That is what must happen.”
Without allowing Garrett to utter another word, Lena’s dad stalked out of the waiting room toward the parking lot.
“He didn’t go in to visit her,” Rachel said in a hollow voice.
“No.” Garrett wiped a hand over his face. “And he treated you with disrespect. I’m sorry about that.”
She shrugged. “He doesn’t seem to value women very highly.”
“I guess not. It’s no wonder Lena was getting into trouble. She was crying out for attention.”
“A kid needs her parents at a time like this,” Rachel said fiercely. “Who’s going to look after this abandoned teenaged girl?”
Garrett swallowed hard. “You heard her father. He made me responsible.”
But the doctor shook her head. “Being a teenager with diabetes is tough—physically, mentally and emotionally. Lena has to have a stable support system to help her understand the healthy life she should try to live. You can’t possibly accomplish that on a ranch in the middle of a summer camp!”
Chapter Two
Spine straight, shoulders square, Garrett met her gaze with narrowed eyes. “I think you’re jumping to conclusions. With your help—”
“Even with my help,” Rachel said before he could finish, “it would be quite a challenge, especially when you have so many kids to deal with. These first few weeks are going to be confusing for Lena, but also very important. She’ll have to absorb a lot of information very quickly.”
“I’m sure there are resources available. We do get the internet out here in the wild, wild West.” His grin invited her to smile with him.
But she didn’t cooperate. “Lena will need appointments with a team of doctors and nurses who’ll supervise her treatment on a regular basis. That’s a significant time commitment.”
He shrugged. “There’s no other option. Without a family, who else will take care of her?”
“That’s for us to figure out.” Rachel got to her feet. “For the moment, let’s see how she’s doing.”
In the emergency room cubicle, Lena looked better—her eyes had brightened and a rosy color tinted her cheeks. “Where’s my dad?”
Garrett cleared his throat. “We talked, but he couldn’t stay.”
“He doesn’t handle it when other people are sick.” The girl shook her head. “He wouldn’t pay attention to my mother, either. And he wasn’t at the hospital when she passed.”
“Well, I’m here,” the minister said after a stunned pause. “Dr. Vale is here. And you’re getting better. That’s good enough for me.”
Later in the afternoon, Lena was moved to a bed in the acute care ward of the hospital. Dr. Stevens reappeared when she had settled in. “Sorry about all the tests,” he said. “We have to acquire as much information as possible so we can plan your treatment.” He brought forward a woman with short white-blond hair who’d accompanied him into the room. “This is Kim Kaiser. She’s a nurse who specializes in diabetes education. She’ll help you understand how to deal with diabetes.”
“You should sit in on this,” Rachel told Garrett. “If you’re responsible for her, you have to understand her medications.”
He made a wry face. “I’m suddenly wishing I’d paid more attention in biology class.”
Kim’s visit lasted about an hour. She explained the cause of diabetes, much as Dr. Stevens had done, but then proceeded to discuss the treatment, which would involve Lena taking enough insulin through the day to balance her blood sugar. Fortunately, she’d brought printed materials along, and Rachel loaned Garrett a pen so he could make notes on the pages.
“The doctors are still working out what kind of insulin you’ll need,” Kim told Lena. “So I’ll be back tomorrow and we can go over that. But are there any questions you want to ask now?”
Lena nodded. “Is that all I have to do, take pills?” She glanced at Justino. “That doesn’t seem so hard.”
“I’m sorry to say that insulin can’t be made into pills,” Kim said. “I
t’s a liquid that has to be injected under your skin. With a needle.”
“Shots?” Lena’s dark eyes went round with horror. “I have to take shots?”
Justino looked equally distressed. “She hates needles.”
Kim took the protests in stride. “Then maybe you will want to use an insulin pump, which is similar to the IV you have right now. With a pump, the needle goes in once and stays for several days.”
“For how long? How long do I have to do this?”
“For the rest of your life, Lena.” A gentle voice, but a harsh piece of news.
The girl shook her head. “I can’t. No way.”
With a glance at Rachel, Garrett took a deep breath and stepped over to the bed. “Try not to get upset, Lena.” He grabbed the end rail with both hands. “We’ll figure out how to make it all work for you. Maybe the pump is what you need. Or…or maybe you’ll have to get used to taking shots. But not right this minute. Right this minute all you have to do is relax.”
She glared at him through the tears running down her cheeks. “It isn’t fair!”
He shook his head. “No, it’s not. You shouldn’t have to deal with diabetes. Nobody should.” He shrugged. “But it’s happened. And in the long run you will be happiest and be able to enjoy your life if you learn to take care of yourself.”
Lena had broken into sobs. Justino put his arms around her but looked at Garrett. “I think she wants to be by herself.”
“We’ll step out for a few minutes.” He picked up his hat, held the door for Kim and Rachel, and then followed them into the hall. “I guess you have to expect an emotional reaction. It’s a pretty serious diagnosis.”
“Yes, it is.” Kim gave him a calm smile. “As her father—”
He cleared his throat. “I’m not her dad. I’m acting in his place.”
“Oh.” Her brows drew together as she turned to Rachel. “Are you her mother?”
“No, I’m the physician in Bisons Creek, where Lena lives.”
“I just assumed…” The nurse took a breath. “Well, if you are Lena’s guardians, you’ll have to help her overcome her resistance. Her very life depends on it.”
A Marriage In Wyoming (The Marshall Brothers 3) Page 2