Guarded Prognosis

by Richard L. Mabry MD

  He didn’t answer for a few minutes. Finally, Caden said, “I don’t know. What I do know is this visit confirmed what I already knew—Dad will do what he wants to without my input.”

  “You mean his medical care?”

  “That, of course. But his personal life, as well—Mom’s care, Jean’s status, his finances, his practice, everything. My father is a willful individual, and he doesn’t want advice from me.”

  Beth shook her head. His son is pig-headed too. God, help me change that.

  After a few miles, she broke the silence. “Did you talk about how his patients will be cared for when he has to be away from the practice for tests and treatment?”

  “That’s another area where he and I disagree. Dad hasn’t mentioned his problems to his partner yet.”

  “His absences are bound to have generated questions.”

  Caden shrugged. “He apparently deflected them. Dad said that, when the time is right, he’ll sit down with Dr. Horner and lay it all out.”

  “But—”

  “I get the impression that my dad is playing this pretty close to his vest.”

  “Did he ask you not to tell anyone?”

  “Not in so many words,” Caden said. “Of course, he knew I’d tell you. I haven’t decided yet whether to tell my partners or the office staff.”

  “Any more talk of suicide?” Beth asked. “Where does that stand?”

  “I tried to talk him out of even considering it, but he wouldn’t commit. Like I said, my dad will do what he wants to, and we’re not going to change his mind.”

  Beth waited until she was sure Caden was through talking about the subject. “I’d like to share this with our pastor and ask for his prayers.”

  She expected a quick response, but instead her husband furrowed his brow and remained silent. A few moments passed before he said, “My first impulse is to say no, but I guess you wouldn’t ask if it weren’t important to you.”

  “I think the more people praying for your father, the better. We can keep the number of people who know about this small, but surely we can let Dr. Pearson know.” She put her hand on Caden’s shoulder. “I know you sometimes think I’m too focused on religion, but right now there are two things that affect the outcome of your dad’s case—the medical care he receives, and the prayers offered up on his behalf. And if the diagnosis is carcinoma of the pancreas, medical care can only help so much—sometimes not at all. I think prayer is important.”

  “I suppose it’s okay,” Caden said. “I’m sure Dr. Pearson will keep this confidential.”

  “We can emphasize that when we tell him tomorrow after church.”

  “We?” Caden turned toward her. “I thought you’d tell him.”

  “We’ll decide who tells him when we see him in the morning,” Beth said. She planned for him to accompany her to church this Sunday, and he hadn’t argued. It wasn’t much of a victory, but it was a victory. And she thought it might be important in the days ahead.

  Caden relaxed behind the wheel of the car. They were within a couple of miles of the city limits of Freeman, and he was enjoying watching the last of the fields roll by before farmland gave way to houses and then to shopping centers. That was one of the things both he and Beth enjoyed about living here—it was possible to drive just a few miles outside of town and see pastures with cattle and horses. He wondered how long it would be before they’d be selling their home in the city to move to one a bit farther out, one that would be perfect for their children. That is, if his practice took off and he could afford to make the move. And if they had children.

  Caden glanced in the rearview mirror and noted that a black pickup was approaching from the rear. He moved slightly toward the shoulder, just to give the vehicle some extra room if it needed it. When the vehicle passed them, he could see two teenaged boys in the truck, whooping about something. They were just two kids out joyriding, not a care in the world. Caden wished he could go back fifteen years or so and be carefree again.

  Beth’s yell came at the same time Caden saw what was happening in front of them. The white Lexus in the oncoming lane swerved a couple of times, then gradually but inexorably drifted to the right and off the road. The vehicle hardly slowed as it took down the wire fence around the field before hitting one of the hay bales there. It stopped with the driver leaning over the steering wheel and the motor still racing.

  Caden pulled to a stop on the opposite shoulder. “Call 911. We need police and paramedics stat. I’ll see what I can do.”

  He left the car without waiting for Beth to answer. There was not a vehicle in sight in either direction. He sprinted across the highway, went through the opening the wayward vehicle had made in the wire fence, and pushed through ankle-high grass to the car, which was still running, straining against the large cylindrical bale of hay. When Caden opened the left front door of the Lexus, he saw the driver slumped forward and unresponsive. He reached across the man and turned off the ignition.

  The driver was a short, stout, older man dressed in a gray pin-striped suit, blue oxford cloth shirt unbuttoned at the neck, and conservative red and blue patterned tie that had been pulled down. His glasses had been knocked askew when he hit the steering wheel. His receding hair was mostly gray. Beside him on the seat sat two well-worn leather briefcases.

  Caden saw no bullet wound or similar evidence of causative trauma. He placed two fingers on the driver’s neck to feel his carotid pulse. It was faint and slow, but regular, consistent with Caden’s initial impression of a heart attack of some type. But making the diagnosis didn’t help, because he had no medications to give.

  He reached across the driver and undid the seat belt. Then Caden hauled him out of the car, laying him on his back beside the vehicle. He checked the man’s pulse again. Faint, but still regular. The respirations were weak. Was his pressure dropping? Caden didn’t even have a blood pressure cuff. I need those paramedics. Now!

  Caden further loosened the man’s dress shirt collar and tie, then covered him with a blanket he’d found on the rear seat of the Lexus. He needed an oxygen mask of some type, as well as an IV and medications. Was the patient in shock? Caden started to raise the man’s legs but stopped when he thought about the possibility of broken legs. An X-ray would come later, but better not chance it. He was powerless to do more than keep the patient warm.

  Beth hurried up. “Help is on its way. Can I do something?”

  Caden’s reply came through clenched teeth. “Not unless you have oxygen. And maybe some injectable adrenaline or vasopressin.”

  The man’s pulse, when Caden checked it again, seemed to be getting fainter with each passing moment. Then he heard a siren in the distance, growing steadily louder. Help was on the way. The ambulance would have the drugs and oxygen Caden needed to save this patient’s life. . . . he hoped.

  Did he wish he’d just driven on by, maybe used his cell phone to report the accident? No, if he’d done that, the driver would probably be dead by the time help reached him. Besides, this was the life’s work Caden had chosen. Now he had it, up close and personal.

  The vehicle was an MICU, a Mobile Intensive Care Unit. It stopped on the shoulder near where the Lexus had plowed through the fence. The emergency medical technicians hurried up, one carrying a kit with the meds for which Caden had been wishing.

  “What have we got?” the one with the kit asked.

  “He lost control of his car and ended up here. Probably a cardiac event. I’m a physician, but I didn’t have anything with me to treat him.”

  The EMT nodded, and both he and his partner went straight to work. The next few minutes were a flurry of activity. Caden drew up and administered medications, while the other two men took care of getting an IV started and placing an oxygen mask over the patient’s face.

  “Can we get an EKG tracing in your MICU?” Caden asked.

  The lead attendant nodded.

  “Then let’s get going.”

  One of the EMTs ran to the MICU, cli
mbed in, and drove through the damaged fence to stop the ambulance next to the wrecked Lexus. Caden held the back doors open while the two techs loaded the injured man.

  Caden followed the stretcher into the back of the MICU. “I’ll ride with you. Head for the hospital in Freeman, code three.”

  “What about your wife?” the lead EMT asked as he climbed behind the wheel.

  “She’ll drive our car home. Don’t worry about her. Let’s save this man’s life.”

  5

  Beth couldn’t recall the last time she and Caden had been gone for any length of time, but she still remembered the routine. Once she’d closed the garage door, she started in the kitchen and went through the house, checking that everything was secure. When she reached the front door, she found it unlocked. Their front door had a double lock, and both were undone. Had they failed to engage the locks? Beth didn’t think so.

  She left the door unlocked—she might have to make a rapid exit—and hurried to the kitchen, where she armed herself as best she could, choosing the longest knife from her cutlery drawer. Then she went stealthily from room to room, her adrenaline level hitting the top of the meter. She held the knife in one hand, cell phone in the other, with 9-1-1 already dialed, ready to press “call.” Finally, satisfied that nothing was missing and that no one was in the house, she backtracked to the front door and engaged both locks. Only then did she return the knife to the kitchen.

  Beth started to phone Caden but didn’t know how tied up he would be with the emergency case. Should she call the police? Would they send someone to investigate, or was it even worth it? She decided to wait a bit on that. Next, Beth called their neighbor, the widow who’d offered to care for their kitten while they were gone.

  “I’m so glad you’re back,” Mrs. Westwood said. “I think Kitty missed you. I’ll bring her right over.”

  In a few moments, the neighbor was at the door, cuddling the playful tan ball of fur. “Are you sure you don’t want the leftover cat food you brought over?”

  “No, we have enough. Just leave it and the extra litter box over at your house if you would.” Beth knew they might be gone for Henry’s funeral at some time in the future. She didn’t say it, but she thought it. “Did you happen to see anyone around the house while we were gone?”

  “No. Were you expecting someone?”

  “Not really. I just found the front door unlocked.”

  Mrs. Westwood shook her head. “That was probably me. I couldn’t find the food you brought over for Kitty, so I used the key you gave me. I guess I neglected to lock the door when I left.” She frowned. “Did someone get in? Is there anything missing?”

  “No. No harm done, I guess.”

  She put the kitten down, told Mrs. Westwood thank you again, and double-locked the front door after her. Beth still didn’t feel secure, but at least there was an explanation for the unlocked doors. No need to call the police or bother Caden.

  It was a couple of hours later when Beth heard the front door open and Caden’s voice. “Beth, are you home?”

  She could hear a diesel engine pulling away, and assumed the MICU crew had driven her husband home.

  “In here.” She headed for the kitchen to warm the supper Caden had missed. She was putting the dishes into the oven when he entered the room. Beth turned to exchange hugs and kisses with her husband.

  He sniffed the air. “Smells good. Have you already eaten?”

  “No, I wanted to wait for you. It will be heated in a few minutes.”

  Beth poured a glass of iced tea and put it on the kitchen table. Caden sat down and drained half of it before he put it down.

  “You look wrung out,” Beth said. “Was it a heart attack?”

  “Yes. The man—Nolan Sewell is his name, by the way—Mr. Sewell sustained an almost total occlusion of the left anterior descending coronary artery.”

  “In other words, a heart attack.” Beth stirred sweetener into her glass of tea. “How was he when you got to the hospital? When the attendants loaded him into the MICU, it looked like he was barely hanging on.”

  “He responded to the meds I gave him on the ride. And I was able to monitor him all the way to the ER.”

  “So, your treatment kept him alive,” Beth said.

  “It helped, I guess,” Caden replied. “The cardiologist on call was Joe Ogle. He saw him in the ER and took over his care. When I left the hospital, they had just finished the angiogram. Sewell needed two stents, but he should pull through.”

  “When you bless the food, don’t forget to pray for your patient.”

  “He’s not really my patient,” Caden protested. “I just stayed with him until we got him to the hospital.”

  “And saved his life,” Beth said. “I think it’s fair to call him your patient.”

  “I guess.” After a brief blessing—in which Caden included Nolen Sewell and his caregivers—he picked up his fork and began to eat.

  Beth decided Caden probably needed to know what had happened with the lock, although it didn’t appear to be important. “When I got home, I found the front door unlocked. Mrs. Westwood dropped off Kitty and said she must have left it that way when she came over for more cat food.”

  “Have you looked around to check?”

  “I went through the whole house right after I got home. There’s nothing to suggest that anyone has been in here.”

  “I guess the logical explanation is that Mrs. Westwood is right, and she left the door unlocked,” Caden said. He looked through the kitchen doorway and saw the blinking red light on the living room phone. He pointed. “Did you see that?”

  “No. I guess I was too preoccupied with the front door being left unlocked.”

  “Let’s see what it is. Probably some spam call.” Caden put down his napkin and moved to the living room, where he punched the button to retrieve the message.

  It was a short one, delivered by a voice that appeared to have been electronically altered. “Don’t believe everything you hear from the DEA agents.”

  On Sunday morning, Caden pulled his Subaru Outback into a space in the parking lot of the First Community Church of Freeman. He turned off the engine, then looked at Beth. “I still wonder about your finding our front door unlocked. Doesn’t that make you feel a bit vulnerable?”

  “Yes, but that doesn’t necessarily mean someone was in the house. Mrs. Westwood admits she may have left the door unlocked.”

  Caden unbuckled his seat belt. “I suppose you’re right. I looked at the door and didn’t see any scratches on the lock plate or gouges on the wood. And I doubt the police would find any meaningful fingerprints.”

  “Stop worrying about it.” Beth climbed from the car. “We won’t call the police—mainly because there’s nothing to see. We simply need to be cautious for a while.”

  Inside the church, Caden stopped at a vacant row of pews toward the back. “Let’s sit here. I’ll take the aisle seat in case I get a call.”

  After they were seated, Beth leaned over and whispered to her husband. “You aren’t on call this weekend. You just like sitting on the aisle.”

  He felt sheepish when he realized he’d been caught. He figured he accompanied Beth to church less than half the time she went, and when he did he liked to choose a seat on the aisle toward the back of the church. That way, he could stretch his legs from time to time. There were very few seats in this church—or any church for that matter—built to accommodate a six-foot-three man like him. The excuse for his choosing the location apparently hadn’t fooled his wife, but this was the first time she’d called him on it.

  Caden had been a Christian since making that decision at age twelve. But, like a lot of his generation, as soon as he left home one of the first things he dropped was church attendance. This began when he started his pre-med college work and continued while he was in medical school. His justification was that his time was taken up with his studies. After graduation, Caden’s schedule during his surgical residency was intense, so church at
tendance took a back seat to sleeping in when he could. That didn’t change when he and Beth were married, but he vowed it would be different after he entered private practice. He would get back to praying, to reading the Bible, to making God a part of his life—later.

  Before his mother had the brain bleed that changed her life and that of her family, she’d gently urged him to get back on track. His answer was always, “I’ll do it soon . . . but not yet.” As he thought about it, Caden couldn’t recall his father ever saying anything to him about church. That was his mother’s thing.

  During the offertory prayer Caden found his thoughts drifting. Despite what his medical training told him, he kept hoping the tentative diagnosis of his father’s illness would be wrong.

  As for his mother, Caden wasn’t sure what he wanted to ask God for. She had been comatose for longer than a year, but because she was otherwise in good health, there was no telling how much longer she’d live in a vegetative state. Would death be a blessing for her?

  Then it occurred to Caden that it wasn’t so much what he wanted as what God decreed. In other words, the phrase he’d heard so many times: “Thy will be done.” Now he understood some of the anguish that went with those words—the anguish Jesus felt when he laid down his life, and for that matter, the pain that the Father experienced when He sent his Son to the cross.

  Caden stood up at the end of the service. He was about to step into the aisle when Beth touched his sleeve. “We’ll wait here until the crowd has thinned before we talk with Dr. Pearson.”

  “You’re still going to tell him about Dad? I’m not certain I feel comfortable doing this,” Caden said.

  “But I do. The pastor needs to know about the problems you and I are facing—all of them. He’ll pray for us, but he might also have some suggestions about what we should do.”

  “Well, he didn’t make things easier for me with today’s sermon.”

  The message had been based on the Ten Commandments, and as Dr. Pearson read the passage from Exodus where they were set forth, Caden’s thoughts were centered on two of them. His father had asked for his help if needed to escape suffering by taking his own life. His mother was locked into a vegetative state from which there was no hope of return.