Royal Pains

by D P Lyle

  “He seemed to be in good shape. He’ll heal quickly.”

  “You have more than a couple of fans there. All the nurses and even Dr. Weinberg were very impressed with your patchwork.”

  “Just used what was available.”

  “It worked.”

  “Any news on the clinic?” I asked.

  “Still scrounging for money, but at least we have enough banked to keep the doors open. Barely.”

  “It’ll all work out. I’m sure of that.”

  “Glad you’re so confident. I have my doubts. The board is very good at stonewalling and delaying.”

  “They’ll ultimately pony up the money, because the free clinic is needed.”

  “Maybe I should have you talk to the board.”

  “Probably not a good idea.”

  “Why do you say that?”

  “I’m not on staff there. Have nothing to do with Hamptons Heritage. And I’m new to the Hamptons.”

  “So?”

  “They wouldn’t listen to me.”

  She shrugged. “They don’t listen to me either.”

  “There you go.”

  Jill served the food and we dug in. It was great. Even better than it smelled. I told her so.

  “You’re just saying that to be nice. You’re used to Evan’s cooking and he’s pretty good.”

  “Yes, he is. But this is still delicious. One of the best things I’ve had in a long time.”

  “Do you think complimenting my cooking will get you anywhere?” She raised an eyebrow and smiled.

  “I thought it was the other way around. I thought you were feeding me food and wine to take advantage of me.”

  “Probably.”

  “No complaints on this end.”

  We finished the meal and then Jill served dessert. Strawberry shortcake. Homemade biscuits, bright red strawberries, and fresh whipped cream. It doesn’t get much better.

  I licked whipped cream from the back of my fork and then asked her, “Do you know Julian Morelli?”

  “Yeah.”

  “What’s his specialty?”

  “He’s not a medical doctor. He’s a PhD. Nutrition science. Why?”

  “His name has come up a couple times. Seems that Nicole is seeing him to lose weight, though I have no idea why.”

  “Because women always feel they’re overweight.” She forked a strawberry into her mouth.

  “Apparently Ashley has seen him off and on for years. She arranged Nicole’s appointment. Then while I was jogging, I ran into a couple of my patients who also see him. Seems that everyone thinks he’s the weight-loss guru.”

  “That’s the rumor. I know a couple of the nurses at the hospital go to him and they love him. They say his clinic is unbelievable.”

  “Where is it?”

  “In Southampton. Overlooking the ocean. Prime real estate from what I hear, so he must be doing well.”

  “Weight loss is big business. Just look at the New York Times nonfiction best-seller list every week.” I took another bite of strawberry shortcake. “Maybe I should write a book about it.”

  “Just don’t get any whipped cream on it.”

  “Beautiful and funny. No wonder I’m smitten with you.”

  “Smitten? All this time I thought it was purely physical. But smitten?”

  “You’re getting less funny.”

  “No, I’m not. Besides, you’ll laugh at my jokes anyway.”

  “Why is that?”

  “Because you think it’ll get you into my bed.”

  “Won’t it?”

  Now she licked whipped cream from her fork. “We’ll see.”

  Chapter 21

  The next morning, I followed Jill into town. We stopped by her favorite coffee shop, where I picked up a large dark roast, she a double cappuccino. Much better than hospital cafeteria coffee. Even I thought so. Jill is a bit of a coffee snob—me, not so much. Medical students, interns, and residents spend so much of their lives in hospitals and are so chronically sleep deprived and fatigued that coffee becomes essential for survival. Any coffee. If it’s hot, dark, and caffeine loaded, it’ll do.

  Caffeine in hand, we headed to the hospital. I walked her to her office, where a stack of phone messages had already accumulated on her desk, so I left her to deal with them and went up to the ICU to check on Owen Cooper.

  He was sitting up in bed, two IV lines running to bags of fluids above his head, and a chest tube extending from the right side of his chest to the suction bottle on the floor. He was reading the newspaper, which he folded when I came in.

  “How are you doing?” I asked.

  “Still hurts but overall not too bad.”

  “It’ll get better day by day.”

  “I’ve already been out of bed. Even to the bathroom. With their help, of course.”

  “I’ll let you get back to your paper. I just wanted to see how things were going.”

  “When I get out of here, I want to hire you to be my doc. My wife’s, too.”

  “I’m flattered.”

  “Flattery’s got nothing to do with it. Everybody here says that if you hadn’t been there, I might not be alive. To me, trust is everything. I trust you.”

  “I appreciate your vote of confidence. Of course I’ll see you and your wife. We’ll talk when you’re up and around.”

  After I left the hospital, I drove to Ellie’s. She was in the parlor, sitting on one of the Louis-the-whatever sofas reading Architectural Digest. I asked how she was doing.

  “Hank, I know you’re not here to see me.”

  “That’s not exactly true.”

  “I’m fine.” She looked out the windows toward the back patio. “She’s out there. Reading.” She looked at me with that mischievous twinkle she so often has. “Just in case you want to wander in that direction.”

  I did.

  Nicole lay on a lounge chair, a book propped on her abdomen, oversized sunglasses on her face. She wore a yellow bikini that looked as though it had been made from a couple of handkerchiefs. Her hair was pulled back into a golden ponytail and a nearly empty coffee cup rested on the table beside her. Below the patio and out toward the garden, several men worked on the new circular dance floor for the wedding reception. Two of the men balanced on ladders as they strung lights from the dozen fifteen-foot poles that surrounded the area.

  Nicole looked up as I approached. She slipped a finger into the book she was reading to hold her place and closed it.

  “Great day, isn’t it?” I asked.

  “A lazy one so far.” She looked out toward the ocean. “I was going to go to the gym this morning but decided to have a cup of coffee and read instead. Maybe I’ll go later, after Ashley gets up.”

  “She’s sleeping in today?”

  Nicole laughed. “She sleeps in every day she can. Except when I wake her up.”

  “How’re you doing?” I asked.

  “I’m fine. Really, I am. I wish you would quit worrying about me. And quit making Ellie worry.”

  “I think she worries on her own. And so do I.”

  “I’ve never felt better. I’ve already lost four pounds in only two days.”

  “On Julian Morelli’s program?”

  She nodded. “He’s a genius. You should see his clinic. Fab-u-lous. Packed. I’ve never seen so many people.”

  “That’s what I hear.”

  She blew a strand of hair from her face. “I just want to look good for my wedding. I know it’s silly, but wedding pictures are forever. You only get one chance to make them and then you have to look at them for the rest of your life. I want them to be perfect. I want to be perfect.”

  “There is a saying in medicine that the enemy of good is better. Anytime you try to make something that is good better, trouble always seems to rear its head.”

  “I don’t understand.”

  “All I’m saying is that you are a beautiful young woman who doesn’t need to change in any way. You do not need to lose an ounce to be perfect.
That’s a myth.”

  “I just want the wedding and the pictures and everything else to be perfect. Is that asking too much?”

  “Everyone wants their wedding to be memorable. I just don’t want you to wreck your health in the process.”

  “Julian Morelli has a great reputation and he apparently had a huge following in the city before he came out here. Many of his old clients drive or take the train out here just to see him. He’s that good.” She slid a bookmark into the book and placed it on the table beside the lounge chair. “I met one woman there who had lost fifty pounds this year.” She rolled toward me, propping herself up on one elbow. “She looked marvelous. Lean and fit. And she’s sixty years old.”

  I nodded but said nothing.

  Nicole continued. “I’ve never seen anything like it. It sure works for me.”

  “Have you had any more of those spells? Where you get confused?”

  She swung her legs off the lounge, sat up, adjusted the bathing suit top, and then said, “I told you. Those are nothing. I’ve had them for years. They only happen when I’m stressed or fatigued.”

  “Like now? With the wedding?”

  “Exactly.”

  I heard someone behind me and turned to see Jackie walk out. She wore white slacks and a white shirt, and had a white cable-knit sweater draped around her shoulders. It was her gold sandals that caught my eye.

  “What’s going on here?” Jackie asked.

  “Just enjoying the day,” I said.

  “Dr. Lawson, did I not make it clear that I do not want you bothering my daughter?”

  “He’s not bothering me, Mother. We were just talking about books.” She glanced at me with a conspiratorial smile.

  “Are you sure?” She walked over and picked up the book. It was the latest Lisa Gardner thriller.

  “We were just talking about her books. Seems that Hank is a big fan, too.”

  Jackie dropped the book back on the table and stared at me.

  “I’ve read just about everything she’s written,” I said.

  Jackie ignored me and looked back at Nicole. “I’m going into town to do some shopping. Want to go? Maybe pick out a dress for the party this weekend?”

  Nicole stood. “Let me go wake Ashley. I’m sure she’ll want to go. Then I’ll jump in the shower. Say half an hour?”

  “That’s fine.”

  Nicole picked up her book and towel, said good-bye to me, and headed into the house.

  “Look, Dr. Hank, I meant what I said. Stay away from my daughter.”

  I wanted to say that Nicole was an adult and could make her own decisions, but instead I said, “We were talking about books.”

  “That better be all.”

  Chapter 22

  After Jackie delivered her ultimatum, she blew past me and back into the house. I stood on the patio, looking out toward the flat ocean.

  Was I out of line?

  Nicole wasn’t my patient, so what right did I have to stick my nose into her life? Why was I making a curbside diagnosis when the evidence was flimsy at best? So she acted a little strange at a party. And did a disappearing act after drinking in a bar. She wouldn’t be the first twenty-something to pull a stunt like that. Maybe Ashley read things incorrectly. Maybe I did, too.

  No doubt Nicole was under pressure. Wedding pressure. Psychiatrists have long said that life’s great stresses revolve around birth and death, a change of residence, a new job start, an old job loss, a major change in health status, and divorce and marriage. Nicole might simply be reacting to such pressure.

  Still, it could be something else and it was that feeling I couldn’t shake. By far, drugs would be the most common answer. There is an adage in medicine that says that common things occur commonly. That was likely the case here but . . . maybe not.

  I turned back toward the house. Through the window I saw Jackie and Ellie talking. Ellie sat on the sofa, Jackie standing over her, looking down, hands waving animatedly. I assumed the conversation was about me. I could almost hear it. Jackie telling Ellie, in not so bashful terms, that I was not to have any contact with Nicole.

  Time to leave.

  As I pulled open the door, I heard a crashing sound behind me and turned. One of the workers lay on the newly constructed dance floor beneath an aluminum ladder. He was holding one side of his chest and grimacing. Two of the other workers yanked the ladder off him as I ran down the stairs.

  I knelt next to the man. Rhythmic grunts accompanied his shallow breathing. Beads of sweat dotted his face. I assumed he had fallen from the ladder, since he was one of the men who had been stringing lights earlier, but I asked anyway.

  “He was reaching out, trying to wrap the light strand around that pole, and the whole ladder came down,” one of the men said.

  “I’m Dr. Lawson. What’s your name?” I asked the injured man.

  He managed to grunt out, “Jesus.”

  “Okay, Jesus, let me take a look.”

  I tugged his hand away from the ribs he was holding and lifted his work shirt. A three-inch-wide red welt slashed diagonally across the left side of his chest. He had not just fallen off the ladder but fallen on one of its side rails.

  I reached out and touched his chest. He winced.

  “I know this hurts, but just bear with me a second,” I said.

  He nodded.

  I continued my examination, palpating along his ribs, and located the truly painful area along his seventh and eighth ribs. At least bruised, possibly fractured.

  I stood. “I need to run to my car. Don’t move him until I get back.”

  As I headed back up the stairs toward the patio, I saw that Ellie and Jackie had stepped outside.

  “What happened?” Jackie asked.

  “Jesus fell off the ladder. He might’ve broken a rib or two.”

  Ellie’s hand came up to her throat. “That’s awful.”

  “Don’t let him move,” I said. “I’ll be right back.”

  It took me only a couple minutes to grab my medical bag. I also called Divya. She said she was on the way. When I walked back onto the patio, I saw that Ellie had settled into a chair, Jackie hovering next to her. Ellie’s eyes glistened with tears.

  “What’s the matter?” I asked her.

  Ellie sniffed back tears. “What’s going to happen next? First poor Jim Mallory falls down the stairs and now this. I’m starting to believe this wedding is cursed.”

  I squatted next to her so I could look her in the eye. “No, it’s not. Things like this just happen. Don’t get yourself all worked up.” I checked her pulse. Regular and not too fast, considering.

  “Don’t bother with me. Take care of Jesus.”

  I walked back down the steps to where Jesus was now stretched out on his back, one hand pressing over his injured ribs. His breathing was easier but obviously still painful.

  Falls such as this are similar to automobile accidents. The most obvious injury is not always the end of the story. There can be other, less apparent but often more serious injuries bubbling beneath the surface. A broken leg, or in this case a rib, might be the focal point of the victim’s symptoms while occult injuries to the head, neck, or abdomen go unnoticed. One thing you learn in emergency medicine is to never assume anything. Always look for the devil that hides in the details.

  I checked his blood pressure, normal at 120 over 80, and his pulse, slightly elevated at around 110. I then did a quick head-to-foot examination. His neck was supple and nontender and his neurological exam was normal. His lungs were clear, but as I laid my hand over his chest, I could feel a slight pop with each breath. No doubt he had broken at least one rib. I moved on to his abdominal examination and detected some left-upper-quadrant tenderness, not an unexpected finding with left-sided rib fractures. But he was in so much pain that he tightened his abdominal muscles every time I touched him. It’s a situation we call guarding and it makes a reliable examination very difficult. The concern was that something was going on in his abdomen, but hi
s reaction to the pain was preventing my uncovering it.

  As I pressed my fingers into his belly, I said, “Take a deep breath and let it out slowly.” As he did, he grimaced. “Sorry. Let’s try it one more time.” Again he took a breath and again he grimaced, tightening his muscles each time.

  “Something for the pain,” Jesus said.

  “It’s coming. As soon as my assistant gets here.”

  Divya arrived a few minutes later. “What happened?”

  I told her the sequence of events and then said, “Looks like a couple rib fractures on the left side. Might be something going on in his belly, too.”

  “Should I call nine-one-one?” Jackie asked. She stood at the edge of the patio, looking down at us.

  “No,” Jesus said. “No hospital. No insurance.”

  “You hush up, Jesus,” Ellie said. “I’m paying for this.”

  “That might not be necessary,” I said. “If it’s just a couple of broken ribs, we can treat it here. We can get a portable X-ray out here to make sure.”

  “No hospital,” Jesus grunted.

  “Draw me up some lidocaine,” I asked Divya. “A nerve block will knock out the rib pain and then maybe I can do a better examination.”

  Divya filled a syringe with lidocaine and handed it to me. We removed Jesus’s shirt and rolled him up on his right side. The movement caused him to moan.

  “Can you Lie in this position for a couple minutes?” I asked.

  “Anything. Por favor. Make the pain go.”

  “I’m going to inject an anesthetic drug that should block the pain.”

  He nodded but said nothing.

  “It’ll sting a little.”

  “Is okay.”

  Divya opened a pack of Betadine-soaked gauze, and I cleaned the area just to the left of the spinal column where the seventh and eighth ribs originated.

  “Hold still.”

  I eased the needle into the area just beneath the seventh rib where the bundle of intercostal sensory nerves lies. These transmit pain signals from the ribs to the spinal cord and on to the brain. Blocking them would relieve Jesus’s discomfort. I repeated the process along the eighth rib.