Guarded Prognosis

by Richard L. Mabry MD

  If he did as his dad had hinted, he’d be carrying out his father’s wishes by helping him commit suicide. But wasn’t that the same as murder? And if Caden somehow decided to do what he’d wondered about on several occasions—to intervene in his mother’s situation—would the fact that he might be helping her escape a prison in which she’d been locked for a year mean he was murdering her? And if he did nothing for either of them, would he be failing to honor his parents?

  Which one takes precedence? Honor thy father and mother? Or thou shalt do no murder?

  The phone rang at three in the morning. By reflex and muscle memory, Caden rolled over and picked up the receiver. Before he could answer, he heard the same electronically altered voice. “Remember what I said about the DEA investigation.” The message was followed by a click.

  He sat on the side of the bed holding the phone, wondering what these two calls meant. Caden didn’t know anything the DEA could use, and he had no intention of talking to the agents more than he had to.

  Beth roused from sleep. “Whuh . . . ”

  “Nothing important,” Caden said. “Go back to sleep.”

  He lay wide-eyed for quite a while, but eventually fell into a restless sleep. When he awakened to Beth’s gentle nudge, Caden rolled out of bed, but not even the smell of the freshly brewed coffee in the mug she held out to him was enough to get him going. He’d once heard “anxiety” defined as “an unreasonable fear of the unknown.” Well, he knew what bothered him, and worrying about it wasn’t unreasonable.

  He wasn’t sure what was the most bothersome—the prospect of the DEA nosing around in his practice, the vague anonymous phone calls about the investigation, the almost certainly lethal diagnosis his father had been given, or the fact that, with his mother in a vegetative state, his father’s nurse might be working toward replacing her.

  Normally, Caden read through the newspaper as he ate breakfast before Beth. This morning he barely glanced at the headlines. There was the usual mess of name-calling in Washington. Locally, the lead story involved two winos being shot on skid row. Nothing meaningful. Nothing that held his attention. He put the paper aside and tried to down his breakfast.

  He managed to eat most of a muffin and drink a glass of orange juice along with a cup of coffee before he headed out. When he reached his office, Caden found that he was the first of the surgeons to arrive. None of the three had surgery scheduled for today, so he’d asked them to meet with him before the day began. Caden planned to explain the presence of the DEA agents. He figured the story he’d come up with was adequate.

  As he sat in his office waiting for his colleagues to arrive, he thought back to how his one-man practice had come to include a second and later a third surgeon. When he came to Freeman to get started, Caden felt that sharing space would be good for both him and Ann Russell, who moved here at about the same time from the residency program they both completed.

  Ann was a knockout—there was no other way to describe her. Because of her grades and talent, she had her choice of surgical training programs, and she chose the prestigious one at Parkland Hospital in Dallas. It was there she met Caden, who got into that residency on the basis of some excellent recommendations that apparently made up for his rather average medical school grades.

  A few months after Caden and Ann opened their practices, Dr. Jim Sparling contacted him about renting the remaining space in his suite. Jim said he’d planned to move from his residency to a faculty position at the Cleveland Clinic, but at the last minute he’d changed his mind and decided on this mid-sized town in north Texas. He said he wanted to be closer to his aging parents, who lived in Fort Worth. When Caden tried to check on Sparling’s background, he found that the surgeon’s work as a resident was excellent, but he was unable to find out whether Jim ever had an offer from the Cleveland Clinic for a faculty position.

  Thus far the arrangement worked reasonably well. They all shared the same suite of offices, but each maintained their own practice. Caden was the man whose name was on the mortgage for the property, while the other two paid him rent and a proportionate amount of the shared expenses.

  Ann and Jim arrived within seconds of each other. Caden beckoned them into his office. “Close the door, would you, Jim?” The two took chairs across the desk from Caden.

  Ann spoke first. “I hear you had visitors last week. The office staff is curious, and frankly, so am I. Care to enlighten us?”

  “That’s what I wanted to talk with both of you about. The two men were Dr. Darren Neilson and Dr. Jerry Harwell. Dr. Neilson was an assistant professor at the Wash U medical center, and Dr. Harwell was in private practice in Seattle. They’re internal medicine specialists who are thinking about setting up practice here. They were intrigued by our cost-sharing situation and wondered if it would be okay for them to see how our little group functions.”

  Caden was surprised at how easily the lies flowed and how well they were accepted.

  “Are they both going to be looking around?” Ann asked.

  “As I understand it, one will concentrate on how our office is set up, while the other checks out things like the hospitals and pharmacies. I don’t know exactly how they’ll do it but let them have free rein.”

  “How long will they be here? Do we need to take them out to dinner?” Jim said.

  “Not at all. I think they’d prefer to be left alone, so no dinners or anything.”

  Ann nodded. “Should we feel free to tell the staff what’s going on?”

  “I intend to let the staff know, but if you two would spread the word that would help. I’m sure the two men want to keep things low-key.”

  The meeting broke up and the surgeons headed for the door, but when Caden started to follow his colleagues out of his office, Donna was standing in the hallway with the two DEA agents.

  There was an awkward silence before Neilson spoke. “I’m sorry. Did we interrupt a conference? We can wait.”

  “No, we were just heading out.” Caden went around the group making introductions, careful to use the titles and histories he’d just manufactured.

  Ann spoke first. “Please let us know if there are any questions we can answer.” Then she walked away.

  Jim nodded at the two men and followed her.

  “Want to come into my office for a minute?” Caden said. He’d gotten so involved in the cover story he’d given Ann and Jim that he’d almost forgotten the real reason behind the presence of his visitors. But his first glance at Neilson and Harwell brought him back to reality. Their look was anything but cordial. And he remembered the words of the anonymous phone caller.

  Without being asked, the agents took chairs.

  “Ready for this?” Neilson said.

  “Yes. Here’s the cover story I came up with to explain your presence.” Caden outlined what he’d told his colleagues that morning. “They seemed to take it okay.”

  Neilson looked at Harwell, then nodded.

  Harwell lowered his voice, even though the door was closed. “My brother-in-law is in orthopedics in Seattle, and I’ve spent some time in his office, so between what I’ve picked up there and in conversation around our dinner table, I think I can carry off my role as a private practitioner. I’ll look around the office.”

  “And I’ll check out the town, visit the pharmacies and hospitals, that kind of thing,” Neilson said. “We’ll switch later if we need to.”

  Caden had no problem with that. What he did have a problem with was how he’d noticed Harwell’s eyes follow Ann down the hall when she left. He glanced at the agent’s left hand and didn’t see a wedding ring. He hoped Harwell’s presence in the office wouldn’t cause complications.

  As the agents rose, Caden said, “By the way, I was wondering why agents from the Dallas field office weren’t leading this investigation. It seems strange to send you all down here from Seattle.”

  Neilson spread his hands, palms-up, in a “What are you going to do?” gesture. “The higher-ups wanted unfamiliar f
aces, so they sent us.”

  “Exactly what are you looking for?” Caden asked.

  Neilson shrugged. “Just let us do our thing. If we have questions, we’ll come to you—unless what we find implicates you.”

  6

  When Beth heard Caden’s car stop in the driveway that night, she dried her hands on her apron and moved toward the front door to meet her husband. Like many of the families in the community, their garage had gradually been taken over by things for which they had no immediate need but didn’t want to throw away. They’d tried to keep at least half of the space clear for their Subaru Outback, but the older car—the Ford Fusion—sat outside. For now, Caden drove the Ford. The Subaru was newer and reserved for trips . . . and Beth’s use, especially whenever their family grew.

  Caden barely had time to toss down his backpack, which he’d carried since his days in med school, before Beth gave him a kiss and hug. Kitty twined around his ankles, but Caden’s attention was on his wife. When they pulled apart, she said, “Tell me about it. How did the meeting with the DEA agents go?”

  He moved to the living room and eased down onto the sofa. When Beth had assumed her usual position beside him, he said, “Sort of a mixed bag, I guess. The agents switched the roles I’d envisioned for them, with Harwell—he’s the younger one—hanging around the office. Because he’s familiar with an office routine, he felt like he could carry off the role better than Neilson, who’ll be checking out pharmacies, hospitals, all that stuff.”

  “Did your colleagues and the staff seem to buy your story?”

  “Yeah, they did. But I didn’t like the way Harwell looked at Ann Russell when they met.”

  Beth frowned. “I thought Ann was like the flower—you know, ‘touch me not.’”

  “She’s always been that way in the past, but I hope Harwell doesn’t make a play for her. If he gets too close to her, or to any of the staff, he may blow his cover.”

  “You’re not jealous, are you? Wish your wife were a good-looking blonde instead of someone drab like me?” Beth said it in a joking tone, but underneath was a bit of truth. When she was working as a nurse, she got her share of compliments from male doctors about her brunette good looks and slim figure. Did she miss them? She wasn’t sure.

  Caden kissed the tip of her nose. “The first time I saw you, I knew you were the only woman for me, and that hasn’t changed. I just hope Harwell doesn’t foul up this thing. I want the DEA investigation to be over.”

  “But what if they find some connection to you?”

  “Someone may be using my name and DEA number, but unless the agents find evidence that I was directly involved, I think I’m in the clear.”

  Beth stopped and sniffed, then rose from her seat on the sofa. “Come on to the kitchen and help me. I’m glad you like the wife you have, but it’s probably best if I don’t put a burnt offering in front of you this evening.”

  Caden had only one consultation request at the hospital on Tuesday morning, one that was reasonably easy. While he was there, he decided he’d look in on Nolan Sewell, the patient he’d helped treat for a heart attack. He doubted that Sewell had already been discharged, and when Caden inquired at the information desk, he was told that Mr. Sewell had gone from the CCU to a private room.

  When Caden entered Sewell’s room, he found the patient lying quietly in bed, a tube delivering oxygen into his nostrils, an IV running into his left arm. The monitor at the head of the bed showed vital signs within the normal range.

  A man about Caden’s age sat at the bedside. He wore a dark blue suit and a white dress shirt with a conservative tie. Horn-rimmed glasses sat low on his nose. He read out loud from a multi-page document, occasionally stopping to add a comment.

  When the visitor in the chair realized Caden was standing in the doorway, he turned and half-stood. “Do I need to get out of the way? Are you here to examine my father?”

  “No,” Caden said. “I’m not officially his doctor. I’m Dr. Taggart. I pulled your father out of his car and rode with him in the ambulance to the hospital.” He took a tentative step inside the room. “I just wanted to check on him, but I see I’m interrupting. I’ll leave you folks.”

  The younger man popped out of his chair and covered the distance to Caden in three long strides. He extended his hand. “I’m Mel Sewell. My dad and I were wondering how we’d get in touch with the man who saved his life. And here you are.”

  “Doctor,” the man on the bed said in a quiet voice. “Come here and let me thank you.”

  “No thanks necessary,” Caden said. “I’m just glad you’re okay.” He approached the elder Sewell and took the offered hand.

  “I’m not well, although they tell me I will be. But I’m okay enough to realize that I’ve been working too hard.” The man released Caden’s hand. “I’ve already told Mel that I need to pull back. Soon the law firm of Sewell and Sewell will rest squarely on his shoulders, and I’ll simply be a name on a letterhead.”

  Caden was a bit embarrassed. He’d obviously walked in on a family conversation. “I’ll leave you two to continue your conversation.” He pulled two cards from his wallet. He gave one to Mel Sewell and laid the other on Nolan Sewell’s bedside table. “Let me know if I can help in the future.”

  Mel Sewell pulled a pigskin card case from the inside pocket of his suit. He uncapped a gold pen and wrote on the back of one of the cards, then handed it to Caden. “That’s the card for the law firm. I’ve written the number of my cell phone on the back. Call me if I can ever help you with anything.”

  Caden took the card and put it in his wallet. He took his leave of the two men, happy that he’d been able to save Nolan Sewell’s life, yet a bit embarrassed at their reaction to his actions. He’d just done what he felt he should do under the circumstances.

  He glanced at his watch and found that he had time to drop by the surgeons’ lounge. Maybe there’d be one of his colleagues there who wanted to talk. There often was, but this time the room was empty.

  Caden drew a cup of what he’d already decided was the world’s worst coffee, added cream and sugar to mask the bitterness, and sipped. How could coffee that had been made only an hour or so earlier taste like it had sat in the urn overnight? He decided that was one of the mysteries he’d never solve . . . that and why his father had been diagnosed with cancer. The world wasn’t fair. Just let it go at that.

  As he was halfway through his cup of coffee, Dr. Ann Russell came through the door. She headed for the coffee urn, where she stood staring at it for a few moments. Then she shrugged, took a Styrofoam cup, and half-filled it.

  “Tough case this morning?” Caden said. “Sit down and tell me about it.”

  “Emergency case last night. Woman with a ruptured aortic aneurysm.”

  “I’m surprised you didn’t call me to assist.

  “No time,” she said. “Jim Sparling had just finished an emergency appendectomy, so I asked him to help me. I did most of the work.”

  “When’s the last ruptured aneurysm you did?”

  “Probably not since residency, but I guess it’s sort of like riding a bike. If I’d sent the patient to a specialist in Dallas, she wouldn’t have made it. She was literally bleeding to death internally. This way, I managed to save her.” She took a sip from her cup, made a face, and tossed it untouched into a nearby wastebasket. “Will you look in on her tonight?”

  “Sure.” Caden wrote down the patient’s name and room number.

  “Right now, I’m off for home. It was a long—and sleepless—night. I guess I should have listened to Dr. Barfield when he tried to talk me into psychiatry.”

  “Let’s face it,” Caden said. “You wouldn’t be happy doing anything else.”

  Ann nodded. “You’re right. We all choose the brand of misery that makes us happiest, if that makes any sense at all.” And with that, she headed for the women’s dressing room.

  Caden took a sip of his heavily doctored coffee, then followed his colleague’s lead and
tossed the partially filled cup in the trash. Ann was right. When he determined he’d practice general surgery, Caden knew he was in for some emergency cases that would keep him up all night, situations that would challenge his skills, even some heart-wrenching scenarios. But this was the path he’d set out on, and he wouldn’t trade.

  We all choose the brand of misery that makes us happiest. And he’d chosen this particular brand of misery. He’d do his best for his patients and hope those caring for his father would do the same thing. As he headed toward the door, his shoulders were a little less slumped. Thanks, Ann. I needed that.

  The tech tapped on the door and entered the room where Henry Taggart sat. “You’ve taken all the contrast solution?”

  “Of course,” Henry said. “I took it quite a while ago. Then I sat around for what seemed like forever, wearing a gown that left my back end exposed, waiting for you to get things going.” His emotions vacillated between resentment at being treated like any other patient and anger that proliferation of some random cells inside his belly made the procedure necessary.

  The technician was apparently no stranger to patients—even medical professionals—who vented their emotions while undergoing procedures like this. Henry’s comments didn’t elicit a reply from the tech. Instead, he asked, “Now what kind of music do you want to listen to while we do this?”

  “Can’t I just lie quietly and relax without having music blaring in my ears?”

  He knew why he was being offered earphones and piped-in music. The CAT scan involved a lot of noise and required the patient to lie still for half an hour or so. Something to keep the mind (and brain) occupied was undoubtedly a good idea. The truth of the matter was that he simply didn’t want to be here in the first place.