Unnatural Causes

by Dawn Eastman

  Justin sighed and actually rolled his eyes. Katie sat back quickly in her chair. This wasn’t a prank. He was breaking up with her. She had put Michigan in her top three spots for choice of residency for him. She hadn’t even seriously considered anywhere else.

  “I mean, I think we should see other people,” he said.

  “You mean, date other people?”

  Justin nodded. Katie thought back over the last month or so. Ever since they had talked about where she should do her residency, he’d been asking questions about her work schedule. Justin continued to be shocked that she would have to work twenty-four-hour shifts. During some rotations, she would only get two days off per month. She’d argued that he worked all the time as well. He had seemed to think that that made his point even stronger.

  “Exactly,” he’d said. “Neither one of us can take care of a house or a kid. We can’t even manage to have a dog.”

  Katie had laughed. She’d truly thought he was joking. “I didn’t know you wanted a dog.”

  But he wasn’t joking. It was as if the entire time that they had been together and she had applied for and attended medical school, he had been imagining that she was someone else. As if it had come as a surprise to him that her career would be just as demanding as his own.

  “I need a wife, not a roommate who occasionally makes it home for dinner,” he said and nodded to the waiter when he placed their margaritas on the table.

  Katie had felt dizzy and nauseated. She pushed back from the table and raced out of the restaurant. She had to get away from him. Away from this weird Justin who seemed to be living in another decade, maybe even another century. She started to walk home, then called Caleb to pick her up. Thank God she hadn’t moved in with Justin like he had wanted her to when he finished law school. Katie hadn’t wanted to leave Caleb in the lurch. She made Caleb go to Justin’s apartment to get the few things she had left there and to leave her key behind. She never wanted to see him again, but she couldn’t imagine not ever seeing him again.

  Katie snapped out of her thoughts about Justin and looked at Gabrielle’s impish smile. She’d recently made the mistake of telling Gabrielle that she might be ready to try again. “I wasn’t focused on Dr. Gregor when my patient was in critical condition,” she said stiffly.

  “No, I’m sure you weren’t. But we could focus on him now.” Gabrielle sipped her drink and watched Katie squirm.

  5

  Friday morning, Katie was back in clinic. She had seen a hypertensive truck driver, a second grader with strep throat, two diabetics, and a sprained ankle by ten o’clock. And the stack of charts didn’t seem any shorter than when she had arrived.

  She was standing at the counter outside the patient rooms, writing a quick note to herself about remembering to check the X-rays on the sprained ankle patient, when she looked down the hall and spotted Emmett Hawkins leaving the records room. He was tall and lanky with a full head of white hair that never lay flat. He had a stack of charts in his arms, and there was something about the furtive way he moved that reminded Katie of a shoplifter. Emmett was usually off on Friday mornings. She wondered what had brought him in. He was the reason she’d chosen this practice right out of residency. It was exactly the kind of place where she’d imagined working when she’d decided in high school to pursue medicine. She still felt that her mother would have lived longer if her doctors had paid more attention. Emmett had a gentle way with patients, and his use of practical solutions rather than always running tests and prescribing drugs appealed to Katie. She hoped to learn a lot from him.

  Katie took a deep breath and grabbed the chart hanging outside the next exam room. Lynn Swanson. Again.

  Katie had seen Lynn multiple times in the few months she’d been working in Baxter. Lynn had headaches, stomachaches, back pain, and recently a sprained wrist. At thirty-two, Lynn was only a couple years older than Katie, but she already had four children and a world-weary manner. She looked ancient. Katie had suspected depression on the first couple of visits, but recently she’d become worried about abuse. Previous attempts to talk about it had led to Lynn getting defensive and quiet.

  Katie sighed and knocked on the door.

  She walked in to find Lynn hunched over a People magazine as if it held the secrets to the universe. Her light-blonde hair was pulled back in a ponytail, and she wore jeans, sneakers, and a red plaid shirt buttoned at the neck and wrists.

  “Hello, Lynn. How’s the wrist?” Katie sat on the wheeled stool by the small desk.

  “I think it’s almost better,” Lynn said. “I’ve been taking the brace off for longer and longer every day like you said, and it feels okay. I forgot to bring it with me.”

  “That’s probably a good sign if you don’t feel you need it.” Katie scooted forward on her stool and took Lynn’s hand. She turned it over and felt along her wrist for swelling and tenderness. “Where are the kids today?”

  “The oldest ones just started school, and my little one is at my neighbor’s house.” Lynn flinched a bit when Katie pressed on her wrist. “That part is still sore.”

  Lynn had always brought at least two of her children to every visit, adding to the chaos and diminishing any chance of confrontation. Katie decided to try again.

  “It seems much better, though,” Katie said. She scooted back to the desk to give Lynn some space. “I’m glad you came alone today. I’d like to talk about your frequent headaches and injuries.”

  Lynn looked at the floor. “I’m sorry about last time. I didn’t know what to say when you asked me if I felt safe at home.”

  Katie waited. Silence was often the best way to keep a patient talking.

  “That’s why I left Austin with my neighbor; I didn’t want him to hear. Not that the kids can’t see what’s happening.” She cradled her sore wrist. “My oldest in particular—he’s so protective of me. But he’s only a boy . . .”

  “Are you saying you don’t feel safe? I can help you, but I need to know what the problem is.”

  Lynn looked at Katie then. Her eyes were red and wet.

  “I don’t know what to do. It’s been going on for so long that I started to think it was normal. But after this”—she held her wrist up—“I know I have to do something. For my kids’ sakes.”

  Katie nodded to encourage her to continue.

  “I’ve been with Eric since high school. He was so romantic and kind.” A sad smile flickered on her face. “But even then he was real jealous, not just of other boys, but of anyone who took my attention from him. After we got married and had the kids, things stabilized for a while. I had to keep the kids quiet and cater to Eric when he was home, but things were okay. I thought I was lucky to have a husband who wanted me around and didn’t want to share me with anyone.” One large tear slipped down her cheek. Katie handed her the tissue box.

  Lynn took a tissue and wiped away the tear. “Anyway, about a year ago, he lost his job at the garage. So Eric picked up work wherever he could. He was home more, and it was harder to keep the kids out of his way and harder to calm him down when one of them broke something or they started bickering. He started drinking more. It got so I hoped he wouldn’t come home and would just sleep it off somewhere. He started picking fights over anything.”

  Lynn took another tissue and blew her nose. Her hands shook as she dabbed at her eyes.

  “The first time he hit me, I thought it was an accident. But then it became a regular thing. He’s always careful not to hit me where a bruise would be noticeable. But the kids know.”

  Lynn took a shaky breath. “I have to do something. Ellen Riley was helping me to make a plan, but now she’s . . .”

  “Were you seeing Ellen as a client?”

  Lynn shook her head vehemently. “No, I couldn’t afford to pay her. She volunteered at the women’s clinic where I go for my birth control pills. They can usually give them to me for free or for only a few dollars.”

  Katie scooted forward and put a hand on Lynn’s shoulder. “I can
help. I’ll get in touch with people who can help you.” Lynn nodded and tried to blot her tears, which only made her makeup smear.

  “I’ll be right back,” Katie said. “I’m going to contact a women’s shelter. I want you to talk to them before you leave.” As she stood, Lynn grabbed her wrist.

  “Don’t tell anyone else in the office, please,” Lynn said. “They all know me and Eric. My mother-in-law works here. It has to stay a secret.”

  Mother-in-law? She must mean Marilyn. Was she worried that Marilyn would find out about the abuse or that she would tell her son what Lynn was planning?

  Katie nodded and squeezed Lynn’s hand. “I’ll be right back.”

  6

  Fortunately, Katie was only in the clinic for a half day on Fridays. She wanted to reach out to Beth Wixom to see how she was doing since her mother’s death. She buzzed Debra and asked her to find Beth’s phone number. Within seconds, Debra was in her office with a phone message slip. She was short and curvy with bouncy blonde curls and a sweet smile set off by dimples. Despite her propensity for gossip, she was a great receptionist, combining her love for people into a bubbly charm that kept the front office running smoothly.

  “She called about ten minutes ago, wants you to call when you get a chance.”

  “Oh, great. Thanks, Deb.”

  “Are you okay?” Debra tilted her head to get a better look at Katie. “You don’t seem quite yourself today.”

  “Just tired.”

  Debra sniffed and went back out front. Katie knew Debra didn’t believe her. Debra could usually tell right away what kind of mood Katie was in. At first, it had been almost spooky. She wasn’t used to someone paying such close attention to her every move.

  Debra had explained once. “If my doc is in a bad mood, the whole office is in a bad mood and nothing gets done right. If my doc is in a good mood, the day flies by and all the patients are happy. I make it my business to know what kind of a day we’re going to have. Kind of like a weatherman.”

  Debra was more accurate than a weatherman. She claimed that she could tell what Emmett was thinking just by the way he hung up his coat. It was an amusing parlor trick when someone else was the target. But Katie was annoyed that she could be read so easily. Especially on a day like today when she just wanted to be left alone to do her work and then go home.

  She dialed Beth’s number and waited while it rang and rang. She expected voice mail to answer, but it didn’t pick up. Katie checked the number and tried again with the same result. She was about to call Debra to check the number when Emmett poked his head around the corner.

  “My first patient is tricky,” he said. “I could use a second opinion.”

  Katie knew Emmett didn’t need assistance, his grin betraying his desire to cheer her up.

  She rolled her eyes at him and followed him down the hall.

  Mr. Kazinsky and his daughter, Sheila, sat side by side in the small examining room. Katie had seen Sheila for a routine physical a few weeks before. She remembered Sheila telling her that her father was coming to live with her because the family was worried about him living alone.

  “Why don’t you explain the problem to Dr. LeClair, Mr. Kazinsky?”

  “Well, ma’am, I’m not really sure there is a problem, see. My daughter, Sheila, she wanted me to come in and have my heart checked out, but as far as I can tell, it’s just fine. I just need to give it a jump-start in the morning is all.”

  Katie looked at Emmett. “Jump-start?”

  “Show her, Dad,” Sheila urged. “He just moved in with me, Dr. LeClair, like I was telling you. But he does this thing in the morning. Says he has to get his heart started.”

  Mr. Kazinsky sat straight in his chair, crossed his arms over his chest, uncrossed them and slapped his knees, moving back and forth and gaining in speed until he was stopped by a coughing spell.

  “I have a little cold right now, but that’s all it takes to get it going.”

  Katie looked at Emmett again. “Chest pain? Angina? Shortness of breath?”

  Emmett smiled. “No, he just needs a jump-start.”

  Katie grinned. “How about a stress test?”

  “That’s a great idea! What do you think, Sheila? We’ll do a stress test and see how he tolerates it. Would you feel more comfortable that way?”

  “Whatever you think is necessary.” Sheila held her hands up. “But Dad doesn’t like to go to Ann Arbor. He thinks there’s too much traffic. Can you do a test like that here?”

  “Sure, we can do a modified version right here,” Emmett said. He turned to his patient and held out his hands. “Mr. Kazinsky, I’ll have you stand up and take my hands. Let’s just start running in place, okay? Just go at your own pace. Let me know if you feel short of breath or have any pain.”

  Katie watched as her sixty-five-year-old partner ran in place with his eighty-year-old patient. After about four minutes, Emmett slowed. Mr. Kazinsky kept on jogging.

  “Okay, that’s pretty good there.” Emmett held up his hand and stopped jogging. “I think we better stop before I embarrass myself. Sheila, his heart is in better shape than mine. If he needs to jump-start it in the morning, that’s fine. Maybe I’ll start to do the same just so I can keep up with him.”

  Katie excused herself and smiled on the way out the door. She could always rely on Emmett to share the “difficult” medical problems with her.

  She glanced into the staff room on her way back to her office and saw Debra sitting alone and scraping the last of her yogurt out of the container. Katie hated to interrupt her during her lunch break, but she decided to take advantage of Debra’s vast knowledge of gossip.

  Debra smiled as Katie entered the room.

  “You look better,” Debra said. “What happened?”

  “Emmett and Mr. Kazinsky.” Katie sat across from Debra.

  Debra nodded. “He’s a character.”

  “Emmett or Mr. Kazinsky?”

  “Well, both I guess.”

  How could she turn this conversation in the direction of Ellen without setting off all Debra’s alarm bells?

  “I couldn’t get in touch with Beth Wixom—she didn’t answer, and there was no voice mail,” Katie said. “Do we have a different number for her? Was there any other family besides her mom?”

  Debra shook her head. “I don’t think she has anyone else, poor thing. From what I hear, they were very close. I can check the number for you.” Debra pushed her chair back.

  “Debra, wait,” Katie said.

  Debra scooted her chair closer and leaned her elbows on the table.

  This wasn’t going well. She had the same look she got when discussing the latest Hollywood divorce.

  “Do you know if Ellen Riley had any close friends in town?”

  “Are you trying to figure out if she confided in someone about her suicide plan?”

  Katie’s shoulders slumped. There was no way to be circumspect with Debra. Her brain automatically jumped to conclusions. Unfortunately, this one was on the nose.

  Katie nodded. “Beth doesn’t think her mother would have killed herself, and I thought I could talk to some of her friends. Maybe they would be more open with me than with Ellen’s daughter.”

  Debra pursed her lips. “You could be right. Let’s see.” Debra looked to the ceiling as if the list of friends could be found there. “I didn’t want to say anything, because once people are gone, it’s best to let their trouble go as well. But she was very close to Cecily Hawkins when they first moved here. Something happened between them.” Debra held her hand up. “I don’t know what, but they haven’t been as close for a few months. Patsy Travers is probably your best bet.”

  “How can I get in touch with her?”

  “She lives across the street from the Rileys. Well, from Mr. Riley now. I can get her phone number if you like.”

  “Thanks, Debra. That’s a good place to start.”

  Debra leaned forward and lowered her voice even though they were alone in the
room.

  “She’s a bit . . . unusual. Try not to get distracted by the exterior. I’ve never been able to tell whether it’s an act or the real deal, but her woo-woo persona disguises a very smart lady.”

  Katie returned to her office to finish her charts. Because part of her brain was mulling over what she had learned—or, more accurately, not learned—about Ellen Riley, it took twice as long as usual. At three o’clock, she brought her completed pile of charts to the medical records room, grabbed her bag, and headed out the door. She was on call this weekend, so the elation that usually accompanied a Friday afternoon was dulled a bit.

  Katie had one stop to make before she was done for the day. One of her nursing home patients had been transferred to hospice care the evening before with urosepsis. He was ninety-two years old and frail. The urinary tract infection had rapidly led to a much more severe infection, and he wasn’t expected to live.

  The double doors whooshed open as she approached. She wound her way along the dark, low-ceilinged hallway toward the patient care unit. While an ICU was noisy with the muted beeps and gurgles of the machinery designed to keep the human body alive through any number of assaults to its functioning, a hospice unit was often strangely quiet, a place where the regular routines were allowed to run their course.

  Katie greeted the two afternoon-shift nurses who were busily charting vital signs, consciousness, and various indicators of the patients’ statuses. They pointed her toward Mr. Foster’s room.

  He was asleep when she entered and would likely stay that way. Katie briefly examined him, recalling the first time she had seen someone who was about to die. A medical student on rotation in her third year, Katie had been on an overnight call with a junior resident. They had been called to a patient’s room to evaluate the reddish-purple blotches appearing on her face and hands.