Royal Pains

by D P Lyle

  “What might our needs be?” I asked.

  “A medical clinic on wheels. We can bring more equipment and meds to our clients. It can even have a workstation where you can type up your notes on the fly and not wait to get back home to do them.”

  “That would be nice,” I said. Divya tossed a frown at me, indicating I shouldn’t encourage him. Good thought. “But I don’t think we need a . . . how much does one of these cost?”

  “Depends on how it’s tricked . . .” He glanced at Divya. “Equipped. Maybe a hundred and fifty.”

  “We don’t have that.”

  “That’s what banks are for.”

  “We just got out of debt. Why would we want to get back in the red?”

  “It’s an investment. And excellent advertising.”

  Evan scrolled through a few more pictures, finally stopping on an intricate graphic design. A black rectangle with “HankMed” in gold script. The script had so many loops and swirls it took a minute to decipher it. Beneath that, block lettering read: “Bringing health care to your door.” Our phone number stretched across the bottom.

  “My own design,” Evan said.

  “You propose this for the side of the van?” I asked.

  “It’ll be a rolling billboard.”

  “Don’t you think our patients might find that inappropriate?” Divya asked.

  Evan glanced at me and then back to Divya. “I don’t see the problem.”

  “We offer health services,” she said. “Private, discreet health services. I don’t believe our clientele would appreciate the Hamptons grapevine knowing every time they had a doctor’s appointment.”

  “She has a point,” I said.

  Evan persisted. “To build a successful business, you have to advertise.”

  “Which would be fine if we were plumbers,” I said. “In case you haven’t noticed, we aren’t.”

  Miranda returned with our food. She glanced at the computer. “Cool. Did you do that?”

  “Yeah.”

  “Very cool.” After she distributed the plates, she asked, “You guys need anything else right now?”

  We said no and she turned to leave, saying she’d check back in a few minutes. She suddenly stopped and wavered slightly, one hand clutching the back of the empty chair for support. Her knees seemed ready to buckle, so I jumped up and wrapped a supporting arm around her.

  “What’s the matter?” I asked.

  She pressed a palm over her chest. “I’m fine.”

  Her face was flushed, not fine. “Sit down.”

  “I’m okay.”

  “Sit here.” I pulled the empty chair away from the table.

  “It’ll pass. It always does.”

  “Do you have these episodes often?” I asked.

  “Just recently.” She offered a half smile. “I’m not pregnant, if that’s what you’re wondering.”

  “I wasn’t.”

  “My friend Robin thinks I am.”

  I checked her wrist pulse. Fast. Regular, but fast.

  “It’s just something that happens,” she said. “No big deal.”

  “What do you feel when it happens?”

  “Warm and light-headed. And sometimes my heart does a little butterfly thing.”

  “You need to be examined and have some tests run.”

  “I don’t have insurance.”

  “That’s okay,” I said. “We’ll do it. No charge.”

  She looked at me suspiciously. “Why would you do that?”

  “It’s what we do.” I looked around. The tables were filling as the lunch crowd began to arrive. “Is there somewhere we can do a quick exam and draw some blood?”

  “Not here.”

  “I didn’t mean right here. Somewhere private. An office or a staff locker room?”

  Worry gathered in her eyes. “I need this job. If my manager thinks there’s something wrong with me, he’ll fire me.”

  “He can’t do that.”

  “Really? Tell the last girl he fired. Of course with her it was drugs and alcohol and not showing up, but still she had something wrong.”

  “Being a drug user isn’t the same as being ill. You aren’t using anything, are you?”

  “No. Never.”

  “We can do this at your home. Later. After you get off work.”

  “I work until four.”

  “We’ll come by after that.”

  She hesitated as if deciding what to do.

  “Don’t ignore this,” I said. “It could be important.”

  “Or it could be nothing. Right?”

  “Do you believe that?”

  She sighed and shook her head. “Probably not.” She opened her pad and scribbled her name, Miranda Randall, address, and phone number on it. She tore the page out and handed it to me. “See, I feel better now. It’s probably just stress.”

  “Maybe, but we need to be sure.”

  She nodded and walked away.

  “Any idea what she could have?” Divya asked.

  “Anemia, stress, anxiety, hypoglycemia, thyroid. A ton of other things.”

  “I think she thought my idea was so cool that it gave her palpitations,” Evan said.

  “I imagine you do that to most people,” Divya said. “Just not for the reasons you think.”

  “Still, she liked the idea.”

  “Then maybe Panama Joe’s should buy the van,” Divya said. “Not HankMed.”

  “Why not?”

  “Because it’s—what’s the word?—cheesy.”

  “The word is cool,” Evan countered. “Just like Miranda said. And you’ll feel way cool when you pull up in the HankMed van.”

  Divya aimed her fork at him. “Only if cool means embarrassed.”

  We ate in silence, wonderful silence, for a moment. Only a moment, though.

  “Just go by and take a look,” Evan said. “Smell the leather. Check out the plasma screens they put in these things.”

  “Plasma TVs sound very practical,” Divya said.

  Evan paused a beat as if her tone took a minute to absorb. “Oh, sarcasm.”

  She looked at him, one eyebrow raised. “Surprised you caught it.”

  “Look,” I said. “We can’t afford a van and we don’t need one.”

  “It’s not far. Just over in Westhampton. I’ll drive.”

  “We have two follow-up visits and two new patients to see this afternoon,” Divya said. “You know, make money rather than spend it, Mr. CFO.”

  “You have to spend money to make money.”

  “Not that kind of money.” I popped a clam in my mouth and spoke around it. “Who are the patients?”

  Divya retrieved her notebook from her purse and shuffled through the pages. “The two follow-ups are up in Sag Harbor. The new patients are an elderly couple—Clifton and Lucy Lovell—in East Hampton.” She closed the notebook. “Want me to do the follow-up visits?”

  “That’ll work. I’ll visit Lucy and Clifton,” I said. “Then we can meet at Miranda’s.”

  “What should I do?” Evan asked.

  “I’ll lend you one of my medical books. One with pictures. Maybe you can learn something.”

  “Funny.”

  “Better than a sitcom.”

  “Maybe I’ll go with you,” Evan said.

  “Me?” Divya asked.

  “Sure. If you have to drive all the way up to Sag Harbor, wouldn’t a little company be welcome?”

  “Company, yes. You, no.”

  “It’ll be fun.”

  “For whom?” Her eyes narrowed. “Wait a minute. Are you planning on tricking me into a detour by the van company?”

  “I’m offended you’d think I’d be so devious.” Evan laid a palm over his chest. “I’m just trying to be helpful.”

  Divya raised an eyebrow. “It must have slipped my mind that helpful is your middle name.”

  “You guys knock it off,” I said as I stood. “Let’s go get some work done.”

  Outside, Divya opened
the rear door of her SUV. “I’ll give you the charts I’ve started for the Lovells.” She handed me the two folders.

  “I almost forgot,” I said. “We’re invited to a party at Ellie Wentworth’s tonight.”

  “Is this part of her granddaughter’s wedding?” Divya asked.

  I nodded and then to Evan said, “Is Paige still in town? She’s invited, too.”

  Paige Collins. Evan’s current girlfriend.

  “I took her to the airport this morning. She’ll be in California with her parents for the next two weeks.”

  “You can go with us,” I said.

  “Or we could hire a babysitter for you,” Divya said. “Make sure you don’t urinate on anyone.”

  Sarcasm again. By the look on Evan’s face, he caught it right away this time.

  Chapter 4

  Clifton and Lucy Lovell proved to be a wonderful elderly couple whose private doc had recently retired. They were referred to me by Ms. Newberg, one of my more difficult but fiercely loyal patients.

  The couple sat on a patterned silk sofa, holding hands throughout my history taking. Cute, but the anxiety I saw in their eyes revealed a dynamic I had seen all too often. Elderly couples who fear disease and death. Who fear a doctor, particularly a doctor new to them, discovering some awful medical problem. Who fear the possible loss of their life partner. What would the other one do if left alone?

  The truth is that surviving spouses often don’t live many years after losing a long-term companion. Depression is deadly. The survivor quits eating properly. Quits seeing friends. Quits visiting doctors and taking needed medications. Picks up bad habits like alcohol and drugs, usually of the prescription variety, given to help solve depression-induced symptoms such as insomnia.

  I practically had to pry them apart to perform my examinations. Fortunately, both were fairly healthy, more so than most eighty-five-year-olds, and the few meds each of them took were appropriate and apparently working. Their previous doc had done a good job. I told them I’d schedule another appointment in two months but to call if anything changed or if they had any questions. When they walked me to the door, relief that all was well painted their faces.

  When I arrived at Miranda Randall’s apartment complex, Divya and Evan were already there, Divya sitting in her SUV talking on the phone, Evan leaning against the back obviously sending text messages. As Divya stepped out, she snapped her phone closed. I could see she wasn’t happy.

  “What is it?” I asked.

  Divya parked a stray strand of hair behind her ear as she dropped her phone into her purse. “My mother. Sometimes . . .”

  “Want to talk about it?”

  “No.” With Divya no meant no, so I let it go.

  We climbed the stairs to Miranda’s second-floor apartment. It was just before five. She greeted us in shorts and a tank top, barefoot, hair pulled back and bound into a ponytail by a red rubber band. Her apartment was small but not what I expected. Not the usual sterile white walls and secondhand furniture. It was stylish: walls a rich gray, doors and trim a bright white, floors polished hardwood, a pair of patterned area rugs, floor-to-ceiling drapes held open by braided tiebacks, and throw pillows everywhere. A deep-cushioned white sofa with a burgundy throw draped over its back and two matching wingback chairs cradled a glass-topped coffee table, where several interior design magazines were stacked near one corner.

  She saw me looking at them. “I took night classes in design. A year ago. Can’t afford them now. The Hamptons seem to get more expensive every day.”

  “That’s true,” I said.

  “I love your apartment,” Evan said. “It looks like a designer decorated it.”

  “A poor designer,” Miranda laughed. “And just this room. You don’t want to see my bedroom. Or for sure my closet. They’re more Dresden nineteen forty-five.”

  “Even if they’re messy, I’d bet they’re classy,” Evan said.

  My brother the charmer.

  “So, where do we start?” Miranda asked.

  “A few questions,” Divya said.

  “Sounds easy enough.”

  Miranda plopped down on the sofa. Divya and I sat in the wingback chairs. Divya pulled out her notepad.

  Evan sat on a stool at the counter that divided the kitchen from the living room, and began fiddling with his cell phone. Probably checking e-mails. Or maybe following Paige’s flight. He has an app for that.

  “Tell us about these symptoms you’ve been experiencing,” Divya asked.

  “Fatigue mostly. Some soreness in my legs after exercise. And my heart racing from time to time.”

  “Any dizziness or passing out?”

  “Dizzy a couple of times, but that’s about it.” She folded one leg beneath her. “And some sweats. Mostly at night. I thought I had a fever and took my temp. It was about ninety-nine or maybe a little more. Is that too high?”

  “Do you feel warm when others don’t?” I asked.

  She nodded. “Sometimes. I’ve lost some weight, too. I’m eating like a pig, though, and not good stuff either. Mostly junk food.”

  Divya scribbled in her notebook and then looked up at Miranda. “You said you’ve had these symptoms for a month or more?”

  “Maybe even two months. I forget.”

  “But you haven’t seen a doctor?”

  “I told you, I don’t have insurance. I can’t afford it.” She leaned forward, resting one forearm on her knee. “Which makes me wonder . . . how come I don’t have to pay you?”

  “Because you can’t afford it.” I smiled.

  “We have patients who pay us well,” Evan said. “That lets us also see people in your situation.”

  “And you make house calls.” She leaned back on the sofa. “Unbelievable.”

  “Any other symptoms?” I asked.

  “A sore throat sometimes.” She touched her neck. “Not like with a cold or the flu. More like when I turn my head or sometimes when I swallow.”

  Divya ran an EKG. It showed Miranda had sinus tachycardia, a rapid but normal rhythm. I then did a physical exam, finding nothing abnormal except that Miranda’s thyroid was enlarged and tender.

  “That’s it,” she said, as my fingers pressed over the front and sides of her neck. “That’s the sore area.”

  I asked her to swallow. She did.

  “That hurts.”

  I nodded and then glanced at Divya, who was making notes. “Thyroid diffusely enlarged and tender. No nodules or masses.”

  “What does all that mean?” Miranda asked.

  “It means that your thyroid is acting up. Probably inflamed and putting out too much hormone. That would explain your symptoms.”

  Her eyes widened. “That sounds serious.”

  I smiled. “Probably not and probably easily fixed.”

  “You sure? It couldn’t be cancer, could it? I had a friend in school whose mother died of thyroid cancer.”

  “No, I don’t think it’s cancer. It might be what we call thyroiditis.”

  “That sounds worse.”

  I laughed. “Not even close.”

  “Hmmm.” She gave me a skeptical look. “I don’t like big scary words I can’t pronounce.”

  “Relax. We’ll do some blood tests and get you started on a medicine. A beta-blocker. It’ll slow your heart down while we get the labs done and see what we’re dealing with.”

  “I’m not big on pills.”

  “You’ll like this one.”

  “Will it fix this ‘itis’ thing?”

  “Thyroiditis,” I said.

  “Yeah, that.” She touched her neck.

  “No. But it’ll make your symptoms better while we decide what it is and what we need to do to correct it.”

  She nodded.

  “Ready?” Divya said. She held a rubber tourniquet and a syringe in her gloved hands.

  “I hate needles, too.”

  “It’ll only take a minute.”

  While Divya drew blood, I wrote Miranda a prescription f
or fifty milligrams of metoprolol. I handed it to her.

  “One each day,” I said.

  “Do I have to take this forever?”

  “Just until we cool down your thyroid.”

  Divya placed the blood vials into a plastic bag and labeled it.

  “I can work, can’t I?” Miranda asked. “I have a double shift tomorrow.”

  I nodded. “You should be fine. Maybe a little tired.”

  “I’m tired already.”

  “Call us if anything changes. Otherwise we’ll call when we get your labs back.”

  “Cool.”

  Chapter 5

  Jill Casey is beautiful. Dark hair, dark yet bright eyes, brighter smile, and killer body. Everything I like. She’s my on-again, off-again girlfriend. Right now we’re on. I like that better than off.

  Today, she appeared frazzled. She looked up from behind her desk as I came through her office door. She had the phone plastered to her ear. A strand of hair fell across her face. She raised a finger toward me and mouthed, “One minute.”

  I sat in the chair across from her.

  After we left Miranda Randall’s, Divya took Evan back to Shadow Pond and then headed home to prepare for Ellie’s party. I drove over here to Hamptons Heritage Hospital to deliver the blood samples we had collected. Normally, I would’ve dropped them by the lab, but since one was a freebie, I brought them to Jill so she could smooth the path.

  Besides, I wanted to invite her to the party.

  “I understand,” Jill said into the phone. “It isn’t really that much.” She hesitated, listening. “But if you look at the entire budget, a hundred and fifty thousand isn’t that big. And the free clinic is important. It helps the community and our reputation. A win-win.” Another pause. “Don’t you think the community goodwill this program generates is worth the costs?”

  Nearly a year ago, Jill had set up a clinic for the poor and uninsured. Yes, the Hamptons have regular folks, too. Not just the superwealthy. Jill’s a fierce advocate of the clinic. Why wouldn’t she be? It’s her baby. Something that would never have happened had she not pried open a few sticky doors and butted down the many unforeseen obstacles that cropped up almost daily. Obstacles that were mostly ego-driven by several staff physicians protecting their individual turf—and wallets.