Guarded Prognosis

by Richard L. Mabry MD

  She moved a bit further away from him. “You’re scaring me, Claude. This sounds like you’re about to confess something horrid. Are you having an affair? A midlife crisis?”

  “No affair. Maybe sort of a midlife crisis, but not one that a new red sports car will solve.”

  “Well, tell me what’s going on.”

  “Last night I went back to our building, wanting to check something in Henry’s office. He was there, sitting at his desk, going over some papers. I couldn’t see everything, because he shoved the work into his desk drawer as soon as he saw me. But I saw enough.”

  Nelda looked at her husband. “And I guess you’re going to tell me what this means and why it’s important.”

  Claude inched closer to her. “It’s not just important. It may be the answer to all my problems.”

  He’d been married to Nelda for years. They’d been through ups and downs over the course of their marriage, and Claude didn’t think she’d shy away from what he was about to share with her. But the only way to find out was to tell her.

  Caden looked at his image in the motel room mirror. Beth had insisted she could go to Freeman alone to bring back clothes for the funeral, but he hadn’t been about to let her. He guessed he didn’t want to be left alone with his father and Jean. She seemed to have things well in hand, so he might as well be gone for a few hours.

  At home, he’d pulled his dark brown suit out of the closet to wear for the service, but Beth gently vetoed that in favor of his dark gray one, with a white shirt and conservative tie. When Caden looked at himself, he had to agree that Beth’s decision was the right one.

  He looked at his watch. The limo provided by the funeral director would be arriving at Henry’s home in another half hour. At least Jean had the decency not to ride with the family to the service.

  Beth emerged from the bathroom. “About ready?”

  Was Caden ready? How do you get ready for your mother’s funeral? “I guess.” He took his keys off the table and dropped them in his pocket. “It should take about ten minutes to get to Dad’s house.”

  “Don’t worry. We have plenty of time.”

  “Should we have moved from this motel to Dad’s house?” Caden asked. “I just thought—”

  “A lot of people might have done that, but I think you read your father correctly. I think Henry prefers to be alone.” She checked the contents of her purse, nodded, and took her husband’s arm. “Of course, that works out well for you. It’s fairly obvious that you don’t want to be there with Jean around.”

  “It’s hard for me to accept the role she’s taking right now.”

  “I realize that,” Beth said. “But Henry needs all the support he can get—from you and from Jean. Try to put your differences with her aside for the moment. This will be tough enough for him to get through without your adding to the difficulty.”

  “I’ll try.”

  Caden opened the door of their SUV and Beth climbed in. He then walked to the other side and slid under the wheel. She waved to Henry, who was standing on the front porch of his house.

  Beth fastened her seat belt. “The funeral was just yesterday, and you already want to go back to Freeman? Are you sure you don’t want to stay longer?”

  Caden buckled in and started the car. “No, Dad doesn’t need me here, and he probably wants me to go as badly as I want to head home.”

  “I can’t believe that.”

  “I know my father, and I imagine he’d like to be alone. Besides, if he needs someone to talk with, there’s always Jean.”

  Beth heard the emotion in her husband’s voice but decided now wasn’t the time to argue with him. She needed to talk with Caden about his resentment of Jean, but not so soon after Nancy’s death. She’d steer around the subject for now. “I’m glad my folks came up for the funeral.”

  Caden didn’t take his eyes off the road. “Yeah, I guess. Of course, they didn’t stay very long.”

  “Would you rather they stayed longer? Both you and your father seemed to want them gone.”

  He thought that over. “No, I appreciate the gesture, and there wasn’t anything they could have added.” Caden glanced over at his wife. “Look, I’m still processing some stuff. And traffic is pretty heavy here. Why don’t we talk about this later? Okay?”

  After they’d cleared the Dallas city limits and were on the highway back to Freeman, Beth asked her husband, “When did your father think he would have his endoscopic ultrasound and biopsy?”

  “He hasn’t set a date yet,” Caden said. “He called the oncologist to explain why he had to cancel the biopsy, but so far as I know he hasn’t rescheduled it.”

  “I guess he’ll let us know.”

  Caden shook his head. “I don’t know if he’s going through with it now.”

  “Because of your mother’s death?”

  “We talked about it. He and I both know that if this is really carcinoma of the pancreas the odds of survival for even a year are small. I tried to tell him those odds aren’t zero, though, and he should move ahead.” He passed a slower-moving panel van, then steered back into his own lane. “But I don’t know what his plans are. One thing I’ve learned over the years. You don’t tell my father what to do.”

  And he’s passed that stubbornness down to his son. Beth waited a beat before saying, “I’m glad he has Jean to help him through this.”

  A light mist began to fall, and Caden turned the windshield wipers to an intermittent setting. Then, when he turned to reply, Beth was surprised at the expression on his face—she wasn’t sure if it was anger or sorrow. Perhaps it represented a mixture. “I realize I resent what she’s doing, and I can’t get past it. I’ve sort of pigeonholed Jean as the person who took care of Dad at his office, but she was never a part of our private lives.”

  “And now she is,” Beth said.

  “And now she is,” Caden repeated. “I suppose that’s why I was so shocked when she opened the door for us at my father’s house.”

  “And why you think she had something to do with your mother’s death?”

  Caden nodded, tight-lipped, and kept his eyes on the road.

  They were almost to the Freeman city limits, and Caden was driving by habit and muscle memory. He wasn’t really thinking about where he was going. Instead, his mind wandered over the transition from the death of his mother back to what he considered his “usual” life, which was by no means usual. He glanced to his right and saw Beth was dozing, her head against the window.

  A vehicle approached Caden’s Outback, and he instinctively moved a bit to his right in case they were going to pass. As it drew closer, he saw that it was a black Ford pickup truck. He remembered the teenagers who’d passed him on this stretch of road recently, and idly wondered if this was them. There were probably more pickups in this part of north Texas than there were sedans or SUVs, and it seemed most were black, so it was unlikely this was the same one.

  Caden realized there was something not right about the way this one was behaving. As the truck came abreast of the Outback, it began to edge across the center line, crowding Caden’s vehicle toward the shoulder.

  Only there wasn’t really a shoulder here. Instead, at this point a damaged metal guardrail ran along the right side of the narrow strip of concrete that marked the edge of the two-lane highway. The strips of metal were supposed to protect vehicles from dropping off the side and into the ditch that bordered the farm field to the right of the roadway. But a previous vehicle had flattened the guardrail, splintering the posts that held it, leaving nothing to keep Caden’s vehicle from flipping down the embankment except his ability to steer clear of disaster.

  There was no way Caden was about to get into a contest of strength with the pickup truck. He stomped down hard on the brake pedal and fought hard as he felt his SUV fishtail toward the ditch.

  The pickup gave a final scrape to the left side of his vehicle before pulling away. Caden brought his SUV to a halt about the time Beth awoke with a start.
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  “What . . . what’s going on?” she asked.

  “Are you okay?”

  “I’m fine. But what happened?”

  “Hang on a minute,” Caden said. He left his SUV idling with the transmission in park. A quick check of his rearview mirror and a scan of the road ahead told him there were no other vehicles around. He opened the driver’s side door and climbed out. The mirror on that side was sprung forward, but he was able to snap it back into place. The left front fender had a long crease from the near-collision, and the black paint that streaked it—probably from the pickup’s fender or bumper—made a sharp contrast to the silver finish of the SUV. The crease was unsightly, but the fender wasn’t pushed inward enough to interfere with steering, which was good. By and large, Caden felt he was lucky to get out of the near-collision with no more damage than this.

  He climbed back under the wheel, still breathing a bit rapidly from the experience. “Somebody in a black Ford pickup tried to run us off the road.”

  “Are you okay?”

  “I’m fine. Are you sure you’re not hurt?”

  “Just a little scared, I guess,” she said. “Do you think it was an accident?”

  “Well, to me there’s no other explanation than the driver wanted to run us off the road,” Caden said. “Alcohol? It’s a little early in the day for the driver to be drunk. Did the rain leave the pavement slick, so the pickup skidded into us? It wasn’t so wet I had trouble stopping.” Caden touched Beth’s arm. “No, I think this was deliberate.”

  “That brings up another part of the question,” Beth said. “Who’s behind this?”

  “I don’t know, but I think I’m going to start looking behind me more.” Caden pulled out his cell phone, made certain he had reception, then dialed 9-1-1.

  “Taggart’s engaged a lawyer. Apparently, he’s no longer content to stay out of the way and let us do what we came for.”

  “Is he digging into your credentials? Wanting to see what you’ve found? Getting in the way?”

  “He’s curious, but he hasn’t done anything that will interfere with what we’re doing.”

  “You don’t think it’s time to go to Plan B, do you?”

  “Not yet, but if he keeps fighting back we may have to consider that.”

  “Meanwhile?”

  “Just a few more days and we’ll disappear. He may be curious for a while, but soon he’ll forget it. And the whistle-blower threat will go away.”

  “If not?”

  “Then we go to Plan B. We lay the blame on him and everyone will mourn him for a bit. We shut things down here and move on to another center. Either way, we’re safe.”

  Henry’s friends and acquaintances all told him to take a few days off—go somewhere, take his mind off recent events. His answer was to tell Jean to go by the office this weekend and make certain he had patients to see on Monday. If their appointment had been cancelled, call them—even though it was Sunday—and get them in. He wanted to stay busy.

  His first patient was a case where a second opinion was required before the third-party payer would pre-authorize the surgery. The material the patient brought with her didn’t fully support the need for surgery, but a phone call by Henry to the other doctor elicited some points not well documented in the records.

  After he hung up, Henry thought a minute about something the other doctor said to him. “Sometimes it’s good to get a fresh pair of eyes on the subject.” Maybe he should take that advice in his own case. Perhaps he should . . . Henry shook his head. He wanted to think about that some more.

  He went back to the exam room and tapped on the door before entering, carrying the chart he’d taken with him when he made his phone call. “Mrs. Williams, I needed some more information, and your surgeon is sending a couple of supplemental statements about your treatment and what he’s observed. With those, I think I’ll have no problem documenting my agreement with his decision to operate.”

  The woman frowned. “So, you really think he’s doing the right thing?”

  “Yes, I do,” he said. “It’s just that sometimes you need a second set of eyes on the problem in order to be certain.”

  As the patient left, Henry stopped Jean and said, “We’ll be getting a fax from her surgeon. Put that, along with her chart and paperwork, on my desk.”

  “Very good, doctor.” Then, in a much softer voice, Jean said, “Henry, how are you doing?”

  “Not bad,” Henry said. Then he thought of the option that had been percolating in the back of his mind for the past fifteen minutes. “Not bad at all.”

  He turned away, and Jean said, “Your next patient hasn’t shown up, so you have a little free time.”

  “Good. I have something I need to do, and I don’t want to put it off any longer.”

  In his office, with the door closed, Henry called several colleagues. He framed his questions as though his search was being made on behalf of a patient. After half a dozen calls, he checked out the website of the winner of his informal survey and decided that Dr. Bradley Ross was the person he wanted to see for a second opinion. He hadn’t asked his son, even though Caden had trained at UT Southwestern and knew a lot of specialists in Dallas. Henry wanted this to be his decision and his alone. After all, it was his life that was at stake.

  Gershwin was an oncologist, a specialist in cancer. Henry decided his second opinion would come from a practitioner of a different specialty. A well-trained gastroenterologist should be competent to establish the diagnosis of pancreatic cancer if it were present. As for treatment . . . Well, one step at a time.

  Caden entered his office a bit later than usual on Monday and found the two DEA agents waiting for him. They were sitting in the patient chairs on the opposite side of his desk, so at least they hadn’t taken over his office. He eased down into his swivel chair, leaned back, and said, “Well, gentlemen. Where do we stand?”

  “We have some questions for you,” Agent Neilson said.

  Caden shook his head but didn’t say anything.

  “Perhaps you didn’t hear us,” Agent Harwell said.

  “I heard perfectly, but I don’t plan to say anything else to you unless it’s in the presence of my attorney.”

  “Look,” Neilson said. “We don’t think you’re at fault here. We just want some more information, so we can wrap this up.”

  Caden acted as though he hadn’t heard a word the agent said. He pulled his patient list for the day toward him. “I’ll contact my lawyer and see if we can set up a meeting at his office. If he has an opening late today, I can be there at four this afternoon. How shall I contact you?”

  Harwell’s face turned red. “We’re the federal agents here, and we expect your cooperation. How would you like it if we marched you out of here in handcuffs?”

  “I’d call my attorney, who’d have me out in a matter of hours. Then he’d file suit for false arrest and a few other things I’m certain he’ll think of. Of course, he’d include your bosses in any such suit. And you could kiss any further cooperation on my part good-bye.” He looked at Neilson, whom he’d pegged as the point man in this investigation. “I’ll try to make this as painless as possible. Give me a cell phone number where I can contact you, and as soon as I talk with my attorney we’ll set this up.”

  Harwell opened his mouth, but Neilson stopped him with an upraised hand. He reeled off ten numerals, which Caden entered into his cell phone. “I’d appreciate it if you’d try to set this up for later today.”

  Caden nodded. “I’ll call you as soon as I know something.”

  Both agents rose and were about to leave when Neilson turned back from the partially opened door. “The other day you were anxious to cooperate. Now your attitude has changed. What happened?”

  “I decided that I should stop worrying about your investigation and start being concerned with what was best with me.” He smiled. “I highly recommend it.”

  10

  Beth remembered an errand she had to run and decided to call Ca
den to see if he would like to meet her and eat somewhere after he got off work. The receptionist told her that her husband had left early for a meeting. No, she didn’t know where the meeting was, or with whom, or how long it would last. Did she want to leave a message?

  “No, that’s okay.”

  “Wait a second. Here’s Dr. Taggart’s nurse. Let me see if he told her more about where he was going.”

  “Wait—.” But it was too late. Beth heard the murmur of two voices, then a new one came on the line.

  “This is Rose, Mrs. Taggart. All I know is that Dr. Taggart said he had an important meeting at his lawyer’s office, so he absolutely had to leave by 3:30. Of course, he got away late—probably about 3:45. Did you want me to tell him something if he comes back here before we leave?”

  “No, that’s fine.”

  Beth could almost hear the concern in Rose’s voice. “I was hoping this was the agency calling. I’d mentioned this to Dr. Taggart, but with all that’s been going on he apparently forgot. We put out the information today, so I suppose it’s unrealistic to expect someone to be applying for the position already.”

  “Applying? Position? What’s that about?”

  “Didn’t your husband mention anything to you about this? I told him over a month ago. My husband is being transferred to Tulsa, so I’m leaving this position in just a few days.” She sighed. “I reminded the doctor about it, but he seemed preoccupied.”

  I’m a trained and credentialed nurse. I’ve only worked in a hospital, but I’m intelligent enough to learn the duties of an office nurse. And I do so want to get out of the house.

  “Rose, who’s in charge of hiring your replacement?”

  “I guess Dr. Taggart is.”

  “Well, don’t fill the position until I have a chance to talk with him,” Beth said.

  “If Dr. Taggart comes by here after the meeting, shall I tell him you called?”

  “No, don’t say a word until I can talk with him. I think I have an idea about who your replacement will be.”