by Dianne Drake
“Well, I think the bag of cookies under the blanket is probably a start.” He held it up for her to see. Empty. Totally empty, without so much as a crumb left. “Who knows what else he’s been sneaking?” He looked down at Scotty, who hadn’t gone exactly limp but who wasn’t fighting the fight any longer. “Scotty, what else?” he asked. “I need to know what else you were eating all night.”
“Nothing,” the boy insisted. “They’re not mine.”
“Look, son. We want to help you. I’ve got to give you medicine and it would be better if I know what you’ve eaten.”
Scotty’s eyes welled with tears and it seemed to Angela that he might have just made the connection with the way he was feeling to the foods he’d eaten. She hoped so, anyway.
“She made me eat them.” He nodded toward Angela, who’d finally let go of the boy but hadn’t left his bed, just in case. “She said it was OK.”
Mark glanced at Angela then back at Scotty. “You’re not in trouble. We’re not going to punish you, but you have to be honest with us.”
Scotty refused to say anything more. Big tears were rolling down his cheeks, and he was sniffling. His eyes were also fluttering shut, and not so focused when they were open. “We’ll figure it out later, Scotty,” she said, pulling the boy back into her arms. “First thing we need to do, though, is take care of you.” Looking up at Mark, she said, “We’ll be fine while you make whatever arrangements you have to make for his treatment.”
“Actually, I don’t want to leave him here. He’s obviously got quite a tolerance for high blood sugar, but just in case something happens, I can’t leave right now. What I need for you to do is go to the clinic, ask Walt for fast-acting insulin and tell him I need his help down here.” They traded places, he on the bed, holding Scotty, she standing up.
“He’s on the hike with the children and the Galbraith family.”
“Then you’ll have to get it.” He told her the brand name, instructed her to get a syringe. “And the portable EKG machine. “I want to monitor him while I bring his blood sugar back down, and for a myriad of reasons, including cardiac complications, I don’t want to bring it down too slowly. So I need to keep him monitored. But before you go, can you take his blood pressure for me?”
“Sure.” The procedure was easy enough. While she’d never done it before, she’d seen it done dozens of times. So first she picked up the cuff.
“Wrap the cuff around his upper arm,” Mark instructed, moving over a little to let her in as Scotty started to struggle again, though not as hard this time. “Shut off the valve, pump up the bulb.”
“What do I listen for?” she asked.
“Put the bell of the stethoscope over the pulse point in his arm then pump up the cuff. When it meets with enough resistance that you can’t pump it easily, open the valve just a little, then listen. You’ll hear two distinct things. The first will be the beginning of his heartbeat. Note the number on the meter when you hear it. Then the next thing will be the end of the heartbeat. Note that number, too.”
She understood what the numbers meant. Had studied that after she’d learned the word sphygmomanometer.
“Don’t touch me!” Scotty cried as she tried slipping the cuff onto his arm.
“Whoa,” Mark said, motioning for Angela to stop for a moment. “You’ve got to let her do this, Scotty.”
“No, I don’t!” he yelled. “It hurts!”
“A little bit. But I’ll let you do it to me twice, if you hold still long enough to let me do it to you once.”
Scotty didn’t respond. He was beginning to fade out. So Angela stepped back up and took a second try at it, but the instant she got the cuff on the boy’s arm, he revved up once more, but not with so much fight in him this time. “You promise?” he mumbled.
“I’ll even let you listen to your heart,” Mark said as Angela finally succeeded in getting the blood-pressure cuff pumped up. She listened. Listened…. heard nothing for a moment, wondered if she’d failed. But then there it was. A distinct thudding. An amazing thing. “Systolic is…one fifty.” She continued listening… “Diastolic is one hundred. Want me to take it again to make sure?”
Mark shook his head, smiled. “I trust you.”
I trust you. Those words rang in her ears while she ran to the clinic to find the insulin and EKG machine, and she was still clinging to them when she came back to the room, only to find Mark sitting on the side of the bed, looking at a very listless little boy.
“What happened?” she asked.
“It’s catching up with him. He’s going lethargic.”
“Not a coma?” she gasped.
“No. I think he just finally ran out of energy. Blood-sugar swings can really be exhausting. Our little fighter here has dozed off.”
“Before or after he took your blood pressure?” She handed Mark the vial of insulin.
“Before, but I’ll make good on my promise. Maybe even turn him into a junior doctor of sorts. Training him in a couple of procedures might make him think about his own situation.” He held out the syringe to her. “Care to be the one?”
“I don’t want to hurt him,” she said, looking down at the syringe.
“What will hurt him is not giving him that insulin. Scotty’s got needles in his future, probably for the rest of his life if he doesn’t get himself under control. And if you’re going to work around diabetic kids, you’ve got to learn to do this because there might not always be a doctor around when you need one. Saving a child’s life could be up to you, and you alone, Angela. And after you’ve learned this end of a diabetic crisis, you’re going to have to learn what to do on the other end when the blood sugar drops so low that a sugar snack won’t get it back up fast enough.”
“OK, then, where does he get it?” she asked, stepping up to the bed, feeling the full impact of Mark’s words. He was right. She did have to learn. But he hadn’t offered to teach her and she felt the sting of his rejection once more. Not good enough for his class, not good enough to teach. It hurt, but she bit back the emotion. This wasn’t the time to get into it.
“Arm’s as good a place as any. So is the belly or the thigh. Choose your site. And don’t jab it deep. It’s meant to be…”
“Subcutaneous,” she said, trying to sound resolute even though she still felt stung. “A subcutaneous injection, also called sub-cu, is administered as a bolus into the subcutis, which is the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis.” She gave Scott the shot then stepped back. “And a bolus, by the way, is from the Latin for ball. It’s the administration of a medication, with the purpose of raising its concentration in blood to an effective level. The administration can be given intravenously, by intramuscular or subcutaneous injection.”
“Very good,” he said, standing. “An admirable body of knowledge.”
“Go ahead and say it,” she snapped, finally not able to hold it in.
“What?”
“That it’s an admirable body of knowledge for someone who doesn’t know anything, as I don’t…except for my little bits of book learning, which you probably think is silly. That’s what you were thinking, wasn’t it?”
Mark glanced down at the child, who was now fast asleep. “Look, I know we messed things up between us with that kiss, but we’ve got to work together.”
“That kiss isn’t what messed things up. Like you said, it was…nothing.” A simple word that had stabbed her even more than she’d realized. “What’s messed us up is us. I don’t know why, don’t care to spend time trying to figure it out. You’ll be getting involved in your course soon, I’ve got my program to look after. And there really shouldn’t be too many times in the future when our paths will cross. That’s the way it is, and it’s fine by me.”
He didn’t answer her right off. Not until he’d taken another blood-sugar reading. “Three-eighty.”
She nodded, pleased he was doing better. “Does he need to go to the hospital?”
/> “Not now. If I can’t get his blood sugar down sufficiently then, yes, we’ll take him. But I want to watch him for a while because I think he’s going to respond to treatment pretty well right here, and the hospital can be traumatic. I want to spare him that, if I can. So, what I’d like you to do is go get his mother down here. Someone’s enabling this child, and she’s likely to be the one. Now would be as good a time as any to have a serious talk with her, because he’s too young to be going through this.”
“You really think Helen gave him the cookies?” It wouldn’t surprise her, but it did make her wonder why his mother would do that. Didn’t she understand what could happen? Had she never seen the dire consequences of long-term, uncontrolled diabetes—complications heaped on other complications? It suddenly occurred to Angela that the parents needed a boot camp, too. Maybe a day or two tacked on when the parents came, stayed, took classes with their children. Or, at the end, maybe the children could teach a class to the parents. It was only a kernel of an idea, but she liked it, thought it worth developing. Actually felt excited about it. But felt overwhelmed by all the things that could go wrong.
Sighing heavily, she took the failure on herself. “I’ve got to do better.”
“You?”
“Me. It’s my responsibility. I brought the kids here, I promised to teach them, to look after them, and if something like this can happen…” She thought for a moment. “What if one of the other kids had gotten into his stash?”
“You can’t predict these things, Angela. And you can’t make them your fault. Bad things happen and they don’t have to fall on your shoulders, even though you seem to think that’s the way it has to turn out. Scotty got into some food he shouldn’t have had, and you weren’t the one standing there, handing it to him.”
“Maybe I didn’t give it to him, but I should have stopped it. Or found a way to keep this from happening.”
He walked over to Angela, pulled her into his arms. “It’s not about Brad telling you you’re not good enough. It’s about one little boy who found a way to cheat.”
Resisting him, pulling completely away then stepping back to a respectable distance between them, she stiffened up. “This doesn’t have anything to do with Brad.”
“Doesn’t it? Isn’t he always in the back of your mind, telling you you’re not good enough? No matter what the situation, doesn’t he still control the way you act inside it? Like now, when you’re convincing yourself you’re not good enough to run this program?”
“That’s not fair!”
“It’s not about what’s fair, Angela. It’s about what’s happening to you. About your reality. About how you’re still reacting to Brad, the b—” Mark looked down at Scotty, and even though the boy was sleeping, he mouthed the rest of the word.
This wasn’t the time to argue about it. Mark was wrong. Or maybe he wasn’t. She was confused. Angry at herself for not realizing what Scotty might do. Frightened for the boy. And…hurt. At times, Mark seemed to care about her and she felt so much better when he did. But at other times… “It’s about Scotty,” she said, trying to sound decisive, even though she really felt wobbly. “What do we do about Scotty? Send him home so he can’t accidentally cause problems with another child? Keep him here, spend more time with him, try harder to teach him? I mean, right now I’m leaning toward sending him home. He matters so much to me, Mark, and I’ll continue working with him, one on one, at the hospital clinic. But I’m scared to death that if we can’t keep a close enough eye on him…”
“We can’t turn him away, Angela. I think that would be the easiest thing to do, but good medicine isn’t always about the easiest thing.”
That offended her. Of course she knew that. The problem was, she had eleven other children here who could easily give in to Scotty’s temptations if he offered them the very same thing that had made him sick. So what Mark had said about good medicine… “It’s not turning him away,” she argued. “It’s coming up with an alternative that will work for him.”
He held firm. “By turning him away. That’s your alternative.”
She was offended even more this time. “Don’t you get it? I want to help him, but I’m not sure this is the place. Not around the other children.”
“It’s the only place, Angela. It has to be because if it’s not, Scotty could get lost. Think he’s not worth the effort. He could feel the rejection in ways we can’t even anticipate. Which means you have to make this camp the place, not just for him but for other kids just like him. Or kids who’ll be here in the future who’ll be even more inclined to be a problem. It’s something we’ll have to factor into the program and plan for because not all the kids are going to be easy and cooperative. And the worst of them are the ones who’ll need this the most. Rejecting them…” He shook his head, closed his eyes, sighed heavily. “Telling them they’re too bad to be here could only force them to do the things they need to be here to correct. It’s a shaky emotional balance.”
What she saw on his face, heard in his voice…it wasn’t a side of Mark she’d seen before. He cared. Cared deeply. And he still wanted to walk away from it? She didn’t understand that, didn’t understand it at all. But he was right about everything, and the perspective he’d just put in front of her scared her because she knew what it was like to live with shaky emotional balance. She’d spent what had seemed like a lifetime there. So she had to trust Mark in this. Trust his deep insight into kids, like Scotty, who would take more effort. It was a shame, and a terrible waste that medicine was soon going to lose Mark, though, because he had so much to give. Maybe he just didn’t know how much. Maybe, in time, he’d find himself again. “OK, I’ll admit it. You’ve made your point. I’ve got to get myself prepared to deal with kids like Scotty. And not send them away. That was me in panic mode, I think. I’m nervous about the program, Mark, and I don’t feel especially suitable to run it. I mean, what in my life has prepared me for this?”
“Everything you’ve done, everything you are. Neil and Eric wouldn’t have approved you if they hadn’t believed you were the one. As much as they like you personally, they wouldn’t have offered you this opportunity if they hadn’t trusted you with these kids. The thing is, you’ve got to quit letting your ex-husband get to you. He’s a loser. An idiot for walking away from you and Sarah. And that’s got to become your mantra. He’s an idiot…he’s an idiot.”
Angela laughed. “Do you know how nice it is to hear someone say out loud what I’ve been thinking all this time?”
“Doctor’s prescription—say it loud once every hour and soon you’ll start believing it.”
She watched him walk over and take Scotty’s pulse, then check his blood pressure. She was the one who did a finger stick on the boy for his blood-sugar reading. “Two-eighty,” she said, in obvious relief. “It’s amazing how fast he’s responding.”
“We work well together,” he said, almost offhandedly. Then he squeezed her shoulder, let his hand linger a moment longer than it should have, then slid it down her arm when he removed it.
They did work well together. Which made her feel sad for the opportunity she wouldn’t have learning from him, because Mark Anderson was a good teacher. More than that, he was a good doctor and a good person. And temporary. She had to remember that. At moments like these, when her pulse was galloping thanks to one little touch, she had to remind herself that he was leaving and she was staying.
“And about that kiss…”
Her breath caught in her throat. “I think you said everything you wanted to say about it.”
“I need to apologize. Afterwards, what I said…”
“That it was a mistake?”
“It was, but not in the way I think you took it. What I meant to say was that it was nice, but that we shouldn’t be getting involved on that level. You have your plans, I have mine, and neither of us should put ourselves in a position that what we want could be jeopardized.”
“You think that one kiss would jeopardize our fut
ure plans?” Now, rather than being offended, she was almost flattered.
“I said the wrong thing again, didn’t I?”
“The kiss wasn’t a mistake, Mark. Maybe to you it was, but it wasn’t to me. It was nice, we let ourselves get carried away… I’ll admit that when you said it was nothing I felt a little hurt. But I didn’t dwell on it.” Such a lie. She’d dwelt on it to the point of emotional weariness.
“You didn’t? I did. More than I should have, or wanted to. Dwelt on the kiss, my reaction to it… You tempt me, Angela, and if I were in a place right now where I could give in to temptation…” He stepped closer to her. Ran a gentle thumb over her swelling eye. “You need some ice,” he said. “And you need to quit being so hard on yourself. The people here in White Elk, the children in your program…they need you. Need all of you, including those pieces your ex-husband is still taking away.” He nodded toward Scotty. “He needs you, too, in ways you probably can’t even understand yet.”
Everybody needed her but Mark. She knew he didn’t, but it was nice fantasizing, for a moment, that he’d told her he was the one who needed her most. Those would have been wonderful words to hear. But she’d never hear them. She knew that. Had to face facts and move on. “I understand that,” she said, her voice barely above a whisper as she looked over at the child lying in bed, his face angelic, like he hadn’t a care in the world. The truth was, he had so many cares…dire ones, like she did. “OK, we start a new program just for Scotty. It’s called being on watch, twenty-four-seven.”
“I’ll start by checking his room, look for his hiding places, several times a day.” He grinned. “And every time he turns around, I’ll be standing there with a lancet, ready to do a test if I think he’s been cheating. He’s a smart kid. He’ll catch on pretty fast. And something we do here will save his life, Angela. That’s what it’s about. Saving his life.”
Those were the words she couldn’t ignore. Save his life. That’s all she wanted to do for any of the children. Save their lives by teaching them how to take responsibility for themselves, for their condition. “I’ll go and talk to Scotty’s mother. I’ll be the one to tell her what he’s done and how we’re going to deal with it. You can have her when I’m finished, and tell her the dire medical consequences if we don’t get her son under control. Paint a grim picture, Mark. She needs to hear it. And in the meantime, I’m going to start putting together a plan for more parental participation in the camp. Maybe even some classes at the hospital for significant others only.”