by D P Lyle
“Nicole, I want to introduce you to Jill Casey.”
Her gaze remained locked skyward as if she hadn’t heard me.
“Nicole?”
No response.
I touched her arm and again called her name.
She looked at me. Blankly.
“Are you okay?” I asked.
“Who are you?” she asked.
“Hank. Dr. Lawson. We met earlier.”
She stared at me for a beat, but said nothing.
“I’m your grandmother’s doctor. Remember?”
No response. She glanced at Jill and then turned her eyes back to me. “Why are you here?”
Now I was getting concerned. “Your party.”
“Party?” Her gaze again rose to the night sky.
I grabbed her arm and gave it a shake. “Nicole?”
She looked at me, her face expressionless, her pupils slightly dilated but no more so than would be expected in the dim light that filtered down from the patio.
“Are you okay?” I asked.
Nicole’s brow furrowed and her eyes narrowed. “Who are you?”
“I told you. I’m . . .”
“Dr. Lawson?”
I turned to see Sam, standing on the patio’s edge, one hand waving me toward him. “There’s been an accident.”
Chapter 8
As soon as I entered the house, I heard voices, some high-pitched and stressed, others more like moans, even a sob or two. The guests had gathered near the bottom of the spiral staircase that led to the second and third floors. I pushed through the crowd.
An elderly man sprawled on the marble floor, moaning, his face frosted with sweat. His breaths came in labored gasps. An elderly woman sat on the bottom step, near his head, and dabbed his face with a wadded napkin. His left leg was laterally rotated in an awkward position and I knew instantly it was either a hip fracture or dislocation. I knelt next to him.
“I’m Dr. Lawson.”
The man’s head rotated back and forth, grunts and groans escaping his open mouth.
“This is my husband, Jim,” the woman said. “Jim Mallory. I’m Louise.” Her voice broke. “Help him. He’s in so much pain.”
“What happened?”
Jim found his voice and between grunts said, “Stupidity. That’s what happened.” He grimaced. “I was coming down the stairs . . . talking . . . not paying attention. Missed a step.” He swallowed hard. His wife wiped his face. “Must have tumbled down a dozen of them. My hip hurts like a bitch.”
“Let me take a look.”
“You’re Ellie’s doc. Right?” Jim asked.
“That’s right.”
Someone behind me said, “We called the paramedics.”
Divya appeared. “I’ll go get my bag from the car.”
I checked the pulse in his left ankle but found none. “I need some scissors or a knife.”
I heard a click behind me and one of the young men extended an open black-handled switchblade toward me. Normally I’d ask why he carried a switchblade, but right now I didn’t care. Mr. Mallory took priority.
I began at the cuff and worked upward, the knife easily slicing through the fabric. After I divided the pant leg up to the groin, I checked for pulses higher up but again found none. His thigh was neither swollen nor discolored. A good sign. Meant he wasn’t bleeding into his thigh. At least not massively. Of course, that could change at any time.
I unbuckled and removed his belt. Using the knife, I cut his pants completely away and then slit up the side of his blue boxers. Now I could see his hip. A large ugly bump protruded laterally, indicating a hip dislocation. I heard several gasps behind me.
I spun on my heel and looked at the crowd. “Everybody move back and give us some space here.”
Almost reluctantly the curious onlookers began to shuffle backward. Not too far. No one wanted to miss something as exciting as this. I saw Ellie and Sam to my left, near the back of the group. Both of their faces were creased with concern.
I nodded toward Sam and then jerked my head toward the crowd.
He moved to the front of the group, turned, spread his arms, and began herding everyone back toward the great room. “Let’s move back, everyone,” he said. “Give Dr. Lawson room to work.”
Divya appeared with her bag and the portable EKG machine. Evan followed.
“That looks bad,” Evan said.
Divya grabbed his arm. “You’re not helping.”
“But look at—”
I tossed a frown at him, halting him in midsentence before turning back to Jim. “It probably looks worse than it is.” Maybe, maybe not. I wasn’t sure yet. But Jim needed good news about now. “We’ll take care of it.”
“Can you do something about the pain?”
“I’m working on it.”
Divya began setting up an IV system. I inserted a needle into Jim’s arm, secured it with a strip of tape, and connected the IV line. Divya attached the other end to the plastic fluid bag. I didn’t have anything to hang the bag on, so I looked back toward the crowd, found Mr. Switchblade, and motioned to him. He hesitated a beat as if he wasn’t sure what to do, so I motioned again. “Come here.” Sam stepped aside and let him pass. “Hold this.” I handed him the bag.
Divya filled a syringe and inserted the needle into the IV line’s side port. “Dilaudid, two milligrams,” she said. She pushed the plunger. “That should help.”
Jim clutched his chest and began gasping for breath. His sweating increased.
“What is it?” I asked.
“My chest,” he gasped.
“Jim has heart problems,” Louise said. She was rummaging through her purse. “He gets angina whenever he’s stressed.”
This would definitely qualify as stress.
His pain was likely a simple bout of angina, easily relieved with nitroglycerin, but other possibilities lined up in my brain.
Louise retrieved a small bottle of nitroglycerin and fumbled with it, the obvious arthritis in her hands making it difficult. Before she could open it, Divya handed me the nitro spray she keeps in her bag.
“Open wide,” I said to Jim. He did and I pumped two quick sprays into his mouth. “Close your mouth.”
Divya began hooking up our EKG machine.
“Feeling better?” I asked.
He took a couple of deep breaths. “My chest does. Can’t say the same for my leg.”
While Divya ran the EKG, I took a closer look at his hip. Still no swelling, still no pulses, and now the leg appeared paler and felt much cooler. I couldn’t be sure without X-rays, but it looked more like a dislocation than a fracture, which meant the out-of-position bone was pressing on the femoral artery, blocking blood flow. It needed to be reseated and it probably wasn’t wise to wait for the medics. With little or no blood flow to his leg, time was critical.
Divya handed me the EKG. Sinus tach about 120 but otherwise normal. No evidence of an acute MI.
I explained the situation to Jim and his wife.
“How can it hurt and feel cold and numb at the same time?” Jim asked.
“The dislocation hurts. The coldness and numbness are because the dislocated bone is compressing the artery and the nerves.”
“So what does that mean?”
“It means I need to pop it back in place.”
“Sounds painful,” Jim said.
“Only for a minute and then it’ll feel much better.”
“Then do it.”
I looked at his wife, confusion and fear on her face. “It’ll be okay,” I said.
If this worked, that is. Reducing a dislocated hip is sometimes impossible without general anesthesia. The muscles around the hip are very powerful and they react to injury by contracting and resisting movement. It’s a self-protective mechanism. The muscles seem to know they should immobilize the injured hip. To reduce it, I had to overcome this contraction. Not an easy proposition. The fact that Mr. Mallory was old and had the muscle atrophy that comes with age would help
. Hopefully enough.
Divya gave him another two milligrams of Dilaudid.
Jim lay slightly rotated toward his right side, so I eased him flat on the floor and then looked at Evan.
“Get over here and hold him so he won’t slide across the floor while I do this.”
“Me?”
“Yes, you.”
A young man stepped up. “I’ll help.”
“Good. You and Evan each grab him under his arms and hold on.”
Mrs. Mallory moved out of the way so that Evan and the young man could kneel near Jim’s head. Each grabbed an arm, high, near his armpit.
“Ready?” I asked.
Jim nodded.
I raised and flexed Jim’s left knee. He grimaced.
“I’ll have this done in a minute,” I said. The words hopefully and with luck came to mind, but I kept them to myself.
I wedged my left forearm behind his bent knee and then grabbed his ankle.
“You guys ready?”
“Got him,” Evan said.
“Jim, take a deep breath.”
With my forearm, I pulled his knee toward me while I also tugged and slightly rotated his lower leg. I felt the ball of his hip slide downward. He moaned. I twisted his leg inward sharply and released the traction. I felt the ball snap back into the socket.
Jim let out his breath. “Oh, that’s much better.”
“Told you,” I said. “Now we need to get you to the hospital for some X-rays.”
I checked for pulses, finding that his popliteal and pedal pulses were now strong. “Everything looks good.”
“Is it broken?” Mrs. Mallory asked as she hovered behind me.
I looked up at her. “I don’t think so, but the X-rays will tell us if I’m right. Looks more like a dislocation.”
Her eyes glistened with tears. “That’s better, isn’t it? Better than a fracture?”
“Yes, it is.”
She sobbed.
I stood and gave her a hug. “He’ll be just fine.”
She laughed and cried at the same time. “Thank you.”
I turned back toward Evan and the young man who had helped. “Good job.”
“Don’t tell Evan that,” Divya said. “He’ll be insufferable.”
Evan looked at her. “This PA thing isn’t all that hard. Maybe we should swap jobs.”
Divya gave me a look that said, “Told you so,” and then began packing things back into her medical kit.
I shook hands with the young man. He was tall, handsome, with thick dark hair. He wore a tan suit, a white shirt, and a red tie, loosened at the collar. “Thanks.”
“No problem. Glad I could help.”
“Who are you?”
“Robert Woolrich.”
“The groom?”
“That’s right.”
Nicole appeared and hugged him. “There you are.”
He kissed her cheek. “I just got here. Walked in and saw this.”
“And he saved the day,” I said.
“No, you did,” Robert said. “I just helped.”
“But you’re my hero,” Nicole said with a laugh as she hugged him.
She seemed completely normal now. Had I misread things outside on the patio? Had she simply been distracted? Being the center of attention at a party and a wedding closing in can do that, but deep down, I didn’t buy it. Something was going on with Nicole. I just hadn’t figured out what yet.
I heard sirens approaching and looked down at Jim. “Sounds like your chariot has arrived.”
Chapter 9
The next morning Divya and I got an early start. We saw a new patient and three follow-ups before stopping for coffee. The plan was to head back to Shadow Pond and update some of our medical records, but on the way we stopped by Ellie Wentworth’s. I couldn’t shake the image of the confused and disoriented Nicole I had seen in the garden last night. I wanted to believe that it was nothing, but that little voice that says all is not well kept whispering in my head. I learned years ago to never ignore such murmurings.
We found Ellie outside, supervising the workers who were preparing the dance floor for the wedding. She was more casual than I had ever seen her. Blue jeans, a blue work shirt, untucked, and a floppy hat to protect her from the sun.
“Hank. Divya. What are you doing here?”
“Checking on you,” I said.
She said something to one of the workers and then waved a hand toward the garden as she climbed the steps up to the patio. “I’m doing just fine, but I’m glad you stopped by anyway.” She rubbed her hands together as if knocking off dirt, but I noticed that her hands were clean. “How about some lemonade?”
By the time we returned to the parlor and sat down, three glasses of lemonade appeared, carried by one of the kitchen staff. It was cold and perfect.
“So you’re doing okay?” I asked.
She looked at me over the rim of her glass and gave a sly smile. “Yes, but that’s not why you’re here. Is it?”
One thing you can say about Ellie is that very few things get by her. She seems innately able to read faces and body language, and sometimes I believe she has a cosmic antenna dialed in to thought waves.
“I want to talk with Nicole.”
“About what?”
“I should talk with her before I say anything.”
“Hank, are you trying to scare me?”
“No. It’s probably nothing.”
“That’s not waylaying my concern.”
“Sorry. Is she here?”
Ellie sighed and shook her head. She picked up the phone and buzzed Nicole’s room. When she hung up, she said Nicole would be right down.
Nicole appeared in less than a minute. She wore jeans, hems frayed, no shoes, and a pink T-shirt, its hem tied in a knot, exposing her tanned abdomen.
“What’s up?”
“Hank wants to talk with you,” Ellie said.
“About what?”
Ellie nodded to me.
“Let’s step outside.”
Nicole followed me to the patio. I led her down to one end, away from the men who were working in the garden.
“Do you remember seeing me last night? With Jill? Right down there?” I pointed toward the area where we had run into her at the party.
Her brow furrowed, but she didn’t say anything.
“You seemed confused.”
“Probably too much champagne.”
“I don’t think so.” I smiled, trying to relax her. It didn’t seem to be working. She wound one finger in the knotted T-shirt and stared toward her bare feet. “Did you take anything else last night?”
“Of course not. Why would you think that?”
“You looked disoriented. You didn’t remember me and yet we had met just thirty minutes earlier.”
“I’m not good at remembering people.”
“And you didn’t seem to know where you were or what was going on.”
“I’m fine.”
“You didn’t take anything?”
She rolled one foot up on its side. “I told you I didn’t.”
“Have you ever had periods where you were confused or disoriented or maybe dizzy before?”
“I don’t want to talk about this. I’m fine. I just have a lot on my mind.”
That was possible, of course. I just didn’t believe that was the whole story.
“You sure?” I asked.
“Of course. Now I have to get cleaned up. Ashley and I are going shopping.”
“What if I arranged a time to examine you and draw a few blood tests?”
“I don’t need any of that.”
“Probably not, but it would make me feel better.”
“I don’t have time to deal with all this. I’m getting married and I have a whole list of things to get done.”
“Like shopping?”
“Of course. There are a half dozen parties to go to. Before the wedding.”
“Will you at least think about it?”
&nb
sp; “No. I told you I don’t have time to deal with this.”
She turned and walked inside. I followed. Nicole headed for the stairs without saying a word to Ellie and Divya on the way by.
“What was that all about?” Ellie asked me.
I hesitated. Should I tell Ellie anything? Worry her needlessly? Would Nicole consider our talk confidential? Of course she didn’t really say anything, so I had nothing to reveal anyway. She wasn’t my patient, so expressing my concerns to Ellie wouldn’t be a breach of any kind. But was it fair to Nicole? Or was it fair to Nicole if I ignored my concerns? If something was wrong with her and I ignored my gut, how could I ever justify that? I decided that saying too much was better than saying too little. “I’m worried about Nicole,” I said.
“Why?”
I told her about Jill and me running into Nicole in the garden the night before and how her behavior had been odd.
“She seemed disoriented,” I said. “Confused. She didn’t know who I was and yet she had met me just a half hour earlier.”
“With all the excitement and people here last night it probably slipped her mind. Not that you aren’t memorable, but you know how young people are.”
That sounded reasonable. I would have bought it had lines of concern not appeared in her forehead. I could read people fairly well, too.
“You don’t really believe that, do you?” I asked. “There’s something else, isn’t there?”
Ellie sighed and placed her lemonade on the coffee table. She stared at the glass but didn’t speak for a minute, as if trying to sort out what to say and how to say it. Finally, she nodded slowly. “Yes, there is something else.” She looked at me. “A couple of years ago Nicole got into drugs and alcohol and some other bad behaviors. Mark and Jackie got her help at one of those clinics up in the Finger Lakes region. When she left, I thought it was all behind her. But when she was here a couple months ago, I saw hints of the old behavior. I confronted her about it.” She picked up the lemonade and took a sip. “She didn’t take it well and we had a big fight. Of course we made up later and she promised that she wasn’t using anything, but I could tell something wasn’t right.”