by Barbara Ebel
Annabel pursed her lips. She closed her eyes for a moment as a wave of emotion crept over her. She fought back tearing up. This little girl’s chief complaint, her sitting there with symptoms of asthma, affected her personally.
Annabel’s older sister, Melissa, had battled with asthma, and now the memory and what happened to her came to the forefront of her thoughts. She had not zeroed in thinking about her sister’s death for a long time, the way she died, the travesty of it. Like Kellie, her sister lived with asthma as she grew up. She was fragile, pale, and sweet and was the “trailblazer” for her and her other sister. It was Melissa that first started calling their grandfather “Pop-Pop” and the granddaughter that adored biology based on his love of the natural world.
It was impossible to not consider what her sister would have become and where she’d be right now. No doubt a physician, a veterinarian, or a biologist. She was sure the both of them would have been thick as thieves, as opposed to her younger sister, Nancy, whom she hadn’t talked to in months.
Annabel wished she could go off and privately sob the held-back tears that she was harboring, but it wasn’t the time or the place. Dr. Gillespie had put all his examining tools away and was standing to the side of the black table.
“It appears Kellie’s mild asthma has become more persistent,” he said. “What she needs to be on now is a daily controller medication. I’m going to prescribe another inhaler for chronic therapy, but this one is an inhaled corticosteroid. It will reduce Kellie’s hyperresponsive airway and it works differently than the short-acting beta-adrenergic agonist, or albuterol, which rapidly reverses bronchoconstriction.”
“Whatever you say, Doctor,” Mrs. Hill said.
“My nurse will come back in to answer any questions you two may have about using it. Make a follow-up appointment if she doesn’t improve. In any case, I can see how she’s doing when you schedule her school physical.”
Behind the front desk, Stuart waited for Annabel.
“By the way,” Dr. Gillespie said to both of them, “corticosteroids are super anti-inflammatory drugs and can be given by different routes. In Annabel’s last patient’s case, the inhaler will deliver a decent dosage to her lungs and not deliver as many side effects as the oral route. We want to prevent adverse effects on our young patient’s bone mineral density, immune function, and growth.”
“Thanks,” Annabel said without much enthusiasm. “I didn’t know steroids could be inhaled.”
A stout middle-aged woman handed paperwork to a parent through the window and faced the students. “By the way, I’m Becky. Despite what the doctors or their two nurses think, I keep this place afloat.”
“That means you have to listen to her,” Dr. Gillespie said and walked away.
“Since you’re going to lunch, there are basically two selections within a short distance: one trendy with great coffee and the other with melt-in-your mouth pizza and pasta. Usually, we tell students to be back within forty-five minutes.”
Stuart nodded for the both of them. They took off their jackets, went through the waiting room, and out the front door. But Annabel’s heart felt heavy. She was fifteen when her sister Melissa died at seventeen years old and now, years later, she realized that she never adequately mourned the passing of her older sister and best friend.
CHAPTER 2
Annabel was grateful she walked the few short urban blocks with Stuart, who was dependably introverted, quiet, and yet extremely bright. He was quite thin, his weight not budging up or down during medical school, and his head usually hung down as if he absorbed his smartness from something emanating up from the floor. They waited for a utility vehicle to pass and then crossed a street.
It was early summer, Annabel remembered, one of the days that were always special to each member of the family. Their grandfather and parents would break away from their suburban Nashville homes and bring the girls to middle Tennessee. Their destination was the Caney Fork River.
The three sisters were playing, poking sticks between the rocks along the riverbed, around the first bend below the massive Center Hill Dam. Clad in flip-flops, their feet and hands were wet, and occasionally, they’d stare forward at their Pop-Pop. He waded in the river with his fishing pole dangling in front of him. Behind them, both of their parents sat in folding chairs flanked by coolers. A bit of flirting occurred between them and then her father, Danny, leaned over and gave her mother, Sara, a quick kiss.
That summer, Annabel began transitioning to the eventual tomboy she became during her teenage years. She wore a baseball cap while her sisters wore sunhats with wide brims. One of her front teeth had also grown crooked; it would be several more years before braces would become fixtures during her formative teenage years.
The river they played at changed its height, shape, and course depending on the rainfall and the Tennessee Valley Authority’s manipulation of the dam’s gates. That day, a few vultures soared over the forested area, a barely perceptible current passed, and time and again, a rainbow trout splashed at the surface. There was no minimum length to catch and keep those trout, only a maximum daily limit to catch seven. Their Pop-Pop had three in his bucket near the girls and smiled every time another fish jumped up, letting him know its whereabouts.
Melissa, Annabel, and Nancy all squatted around a snail, which made no attempt to move except for its tentacles perched on the top of its head, which quivered back and forth. From the corner of her eye, Annabel noticed a turtle lumbering out of the water. She jumped up and rushed straight over. How she loved turtles and frogs, and most living things, for that matter. The large aquatic reptile had a rough, dark shell mostly covered with mud and algae, but that didn’t hinder her in the least. She reached down to pick him up.
A hand gave her a shove and she almost landed on her butt, but she swung her hands in midair and righted herself before she toppled over.
“Melissa, what did you do that for?” she yelled.
“No, what are you doing?” Melissa’s voice was lower than her sister’s, with a control and authority mature for her age.
“Picking up this turtle. Look how big he is! I want to show him to you and Nancy, Pop-Pop when he stops fishing, and Mom and Dad too.”
Melissa sighed and took a step back, moving her toes further away from the specimen with an ancient history. “I wouldn’t if I were you. That’s a snapping turtle.”
Annabel reeled back with surprise and replied with skepticism, “How do you know?”
“See? It has a large pointed head and a long ridged tail. Pop-Pop explained them to me and he’s the expert.”
Annabel listened but nevertheless picked up a stick the length of her forearm. She poked it in front of the turtle’s mouth, enticing him like the stick was alive. Suddenly, the reptile lurched with a defensive quick and powerful snap.
Both girls jumped. “I told you,” Melissa said.
“Good thing that wasn’t my finger,” Annabel said, peering back at her parents, who weren’t watching. “Otherwise, Daddy would have to sew it back on this afternoon.”
Melissa grimaced. “But Dad said doctors aren’t supposed to treat their own family.”
“I bet you’re going to be like him when you grow up.”
“Not as smart or successful as you, though.”
“What’s that supposed to mean?”
“You may do more stupid stuff than me, but that makes you learn more lessons. You take riskier chances, are more curious, and solve more problems than me.”
Annabel let that sink in. Maybe there was some merit to what she said. Her older sister also doubled as a guardian angel when it came to her and Nancy.
The turtle finally decided to amble off and Melissa and Annabel told Nancy what they saw. Their younger sister stopped playing with the snail and ran back to her parents. No way would she stay in the vicinity of a snapping turtle.
The two girls ignored Nancy as she left and checked out their grandfather’s bucket of fish. The same three trout flip-flop
ped inside, so they glanced out at him, hoping he was ready to reel in another. At their feet, however, water began seeping on their flip-flops and their toes began disappearing under river water.
“Look,” Melissa said with alarm. The serenity of the water had quickly changed; it was gaining speed, especially in the center of the river. As bad, or worse, the water level was rising rapidly.
Annabel’s eyes grew wide, she grabbed the bucket, and both girls sprang back.
“Pop-Pop,” Melissa yelled.
The heartrates of both girls sped up as they stood helpless, their Pop-Pop struggling to stand and fight from being pulled away with the sweeping current. Failing to maintain a strong hold on his fishing pole, it was yanked out of his grip, and drowned in the mayhem of water racing past him.
The girls ran towards Danny and Sara. “Pop-Pop needs help,” Annabel yelled as Melissa lingered behind. A shortness of breath took hold of Melissa and she began to cough.
Danny and Sara bolted up from their chairs. “Oh my God,” Danny said. “The TVA started the generators.”
Because of previous instruction from their parents, the girls understood. Once the dam’s generators came on, they would force a large volume of water into the river.
“Sara, grab me two ropes from the car trunk. The extra ones.”
Putting on a life vest, Danny raced to the shore and scouted the trees close by. When Sara handed him the marine-grade ropes, he knotted one around a small trunk. The other end he circled and tied around himself. Holding the other one, he headed out into the water. Barely in time, since his father could no longer fight the power of the water and his feet left the bottom of the river.
Danny was further down from where his father had fished and the bend worked out in their favor. His father, Greg Tilson, was robust enough to keep his head up and Danny shouted as loud as he could as he threw out the other end of the second rope.
Although Annabel wanted to shut her eyes in fear that her Pop-Pop would soon be gone forever, she watched as he fought with all his might against the current and wrapped his strong hands around the thick rope. Danny held and pulled his end with all his might. His father was a big man and a river in the midst of a man-made onslaught of water would be a challenge for men even stronger and more able-bodied than Danny.
Greg clasped his son’s upper arm as they united in knee-high water. They both ambled out of the water while Annabel’s eyes stayed glued on the situation.
“Pop-Pop,” she yelled, running to him. He leaned over to catch his breath while Danny rolled up the free rope and then untied himself from the tree.
“Annabel!”
Annabel turned quickly. Her mother shouted her name again, so she ran over. Her sister coughed excessively and could only look down at the ground.
“Her coughing won’t stop,” Sara said. “Run quickly. Her inhaler is in the back seat of the car.”
Annabel sped away. Her legs couldn’t have worked any faster. Now it was her turn to come to the rescue. When she returned, she placed the prescription inhaler in Melissa’s hand and waited as the amazing medicine for asthma worked enough magic to bring her sister’s breathing back to normal.
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Annabel and Stuart crossed another street. Her colleague voiced one or two pleasantries while she went back to pondering that eventful day at the Caney Fork River when she was nine years old. She realized what an iconic day that had been and wondered why she had never realized it before. Of course, the patient’s asthma attack in the office had stirred up her memories.
As the family scrambled to pack up their things to prematurely leave the river that morning, Melissa made progress with the dissipation of her asthma attack and the panic she’d felt due to her grandfather’s mishap. Her breathing slowed down and the little bit of wheezing she had experienced also stopped. Six years later, her luck ran out; she died on the upstairs landing of their grandparents’ house. Yet that day on the river, it was as if she’d read a crystal ball into the future and foresaw Annabel’s ability to become someone extraordinary and have a meaningful purpose. It was as if she took herself out of the equation.
There was also the situation with her grandfather, who had forgotten the day before to visit the Tennessee Valley Authority website and consult the generation schedule for the next day. Danny had reminded his father to do so, and yet perhaps his failure to check was a forerunner of what eventually happened. Her Pop-Pop, in the end, had dementia. Maybe it was not all related to the stroke he’d had. There may have been more “forgetful” incidents those preceding years so as to not lump all his forgetfulness into a “vascular dementia” etiology. Sadly enough, she thought, her grandmother had already passed years before from cancer.
Annabel and Stuart stopped in the front of the small restaurant that the office manager, Becky, had mentioned.
“Let’s go to this one,” he said. Not waiting for a response, he opened the door.
Inside, the tables were all round with two or four chairs. The colorful place mats matched the paint colors on the walls; it was a cheery atmosphere. When a waitress seated them, both students studied the menu and soon gave their order.
For once, Stuart spoke before Annabel. “At least they’ll be springing us from that small office for lunch every day. It will give us a break from kids with runny noses and sore throats.”
“It is a bit claustrophobic in there, isn’t it?”
“I agree, but I am glad to be paired with Dr. Clark. She’s energetic, the kids seem to like her, and she’s quick to teach.”
“Good for you, Stuart, especially since you disliked OB.”
“I’m not saying peds is my thing, however.”
Annabel unwrapped her utensils from a paper napkin and stared out the window.
“You’re awfully pensive since we left the office,” Stuart commented, “and you look sad.”
“Hmm. I didn’t know it showed.”
Stuart focused on her and raised his eyebrows.
“Dr. Gillespie and I just saw a young girl with asthma. She hit too close to home. A half-buried memory of my older sister’s death from asthma has blasted itself into my thoughts. I can’t shake it, but I will.”
Stuart kept his arms on his lap but leaned in closer. “Annabel, I bet that’s the worst thing to do. I heard you mention your sister once during our internal medicine rotation. Don’t block her out. I bet you two were close.”
“We were inseparable. Close as twins, or at least that’s my perception of our relationship now. She would have gone into biology or medicine or something like that. Along with my parents and grandfather, she probably steered me to where I am now.” Annabel fidgeted with her spoon as the waitress placed down two glasses of water and left. A pool of moisture gathered in her eyes again, and she swiped at both of them.
“If she was diagnosed with asthma, how did she die?”
“She had an attack at my grandfather’s house while no one else was there. Her inhaler had run out and she was getting a new one that day. She called for help. My Uncle Casey, who’s a paramedic, raced with his colleague to the house, but they wasted time. Melissa hadn’t mentioned that she wasn’t at our house. When they finally arrived at our grandfather’s home, the front door was locked. Anyway, long story short, she didn’t survive; they found her dead inside.” Annabel swallowed hard and focused on the place mat in front of her. “And to make matters worse, for some time, my dad was angry at Casey because he initially went to the wrong house. But it wasn’t his fault.”
“Especially being a young girl, that was a lot to process. No wonder a similar patient brought all the memories back. I can understand why you’re feeling the void of your sister.”
Annabel wiped away a tear. “And my parents. How on earth did they get through the following days, or month, or years? I hear that losing a child is the worst thing imaginable.”
“They suffered in silence. They still had two girls to look after. I bet they still grieve and think about her just like
you’re doing today. You should have a talk with them about it someday. Not a decade from now, but in the near future. I bet your mom would especially like that.”
“You’re right.” She managed a chuckle. “I sure didn’t mean to lay my family drama on you.”
The waitress placed down their sandwiches and, noting their subdued conversation, left right away.
“Thanks, Stuart. I guess I needed to talk about what was bothering me.”
“Don’t mention it. You know, crying is therapeutic. It looks like you’ve been storing tears for your sister in a hidden closet.”
She nodded. “You still are planning on a psychiatry residency, aren’t you?”
“Absolutely.”
“You are going to be the best.”
“Maybe. Or close to it,” he said and grinned.
Annabel continued to feel better as she polished off a burger and then smiled at her classmate. “Stuart, did you ever attempt to play with a snapping turtle when you were a kid?”
CHAPTER 3
A few weeks before eleven-year-old Toby Owens’ medical appointment with Dr. Gillespie, he and his friend, Jonathon Harmon, rode a wave onto shore and scrambled out of the crystal-clear water. They hated to leave the sugary white Destin, Florida beach for the time being, but the day was early and there was plenty more fun on their agenda. Besides, they would be back later. The two youths were not finished swimming for the day.
The boys had spread a blanket down on the sand on which to place their things. They picked up their towels and dried themselves off. “I’ll race you to the room,” Toby said.
Without hesitation, Jonathon slipped into his sandals, jammed his towel under his arm, and followed. When the boys made it off the beach, they ran around a fenced-in-pool and several zigzag-edy paths around gardens and arrived at the ground-floor rooms of the hotel their mothers had booked.
Toby wore a proud smile. “Beat you again.”