Guarded Prognosis

by Richard L. Mabry MD

  According to the police, no one knew the identity of the shooter, who had fled by the time they reached the scene. EMTs rushed Elvis to the ER at Freeman General Hospital, where Dr. Ann Russell examined him. She immediately arranged to do a surgical exploration of his abdomen—which is where Caden came in.

  An orderly was cleaning up the OR and Caden was still stretching his back when Ann reentered the room. “Well, as I expected, there’s no family in the waiting room. The nursing supervisor says they don’t have an emergency contact or any information on the man beyond what they got off his driver’s license.”

  “I guess we’ll know more when he wakes up from surgery,” Caden said.

  “Or the police will find out. I appreciate your coming out to help me on a Saturday morning. But I’m afraid there won’t be a fee for either of us in this one.”

  “I honestly don’t know why you needed me for the case, but I was glad to help,” Caden said. “I agree this was one we both probably did pro bono, but this is the sort of thing doctors sometimes do. A wise woman once told me that we all choose the brand of misery that makes us happiest. This is the brand of misery I’ve chosen.”

  Ann laughed. She looked up at the clock on the wall. “It’s almost noon. The least I can do is buy you a late lunch. Give me a few minutes to change, and you can choose the restaurant.”

  Caden furrowed his brow. “I plan to call Beth, and if she doesn’t have something else going on, I’d like to go home to her . . . but thanks for the offer.”

  He was surprised by the expression that passed briefly across Ann’s face after he said this. To Caden, it seemed to be like the expression on the face of a comic book villain when the balloon over his head says, “Curses, foiled again.”

  “Well, thanks for coming in to help me. I’ll return the favor someday.” Ann said. Then Ann turned on her heel and left the OR.

  “Excuse me, doctor,” the orderly said. “Can you move? I need to mop where you’re standing.”

  “Sure. Sorry.”

  Caden exited the room, still trying to figure out Ann’s reaction to his turning down her invitation in favor of time spent with Beth. If Caden had been the doctor on call, he figured he’d have inserted a self-retaining retractor and enlisted the help of a competent scrub nurse to assist him. Why did Ann think she needed his help? Surely, she hadn’t asked for his assistance just so the two of them could have lunch together—had she?

  Beth and Caden enjoyed a late lunch together, and now, the dishes cleared, they sat at their kitchen table enjoying the last of their iced tea. After a silence that seemed to last longer than usual, Beth looked at her husband. “You haven’t said much since you got back from the hospital. Was it a tough case?”

  Caden picked up his tea glass, then set it down without drinking. He kept his eyes away from Beth when he answered. “Multiple bullet wounds of the abdomen, but I think he’ll make it.”

  “So that’s good, isn’t it?” Beth suspected there was something more on her husband’s mind. He didn’t say anything further, but she knew it would eventually come out.

  “I don’t know what to make of Ann Russell.”

  Beth moved her chair closer to Caden and took his hand. “What do you mean?”

  She listened as he related the way Ann had acted after the last couple of cases in which he’d assisted.

  Caden looked up at her. “I know this sounds conceited . . . ”

  “What?”

  “It’s almost as though she’s decided that the only way she can have me is to take your place.”

  “I’m flattered,” Beth said, “But don’t you think there’s another explanation?”

  “You mean she’s trying to distract me from paying attention to this DEA investigation?” Caden massaged his chin. “I’ve sort of discarded that theory. I mean, I’ve known Ann since residency. I’m pretty certain she’s doing well financially, so why would she jeopardize that by adding an illegal activity.”

  “How well do you really know her?” Beth asked. “Yes, you were in residency together. She said she was coming here at the same time you did because she wanted to get away from a failed engagement. But did you ever see an engagement ring? Did you meet this almost-fiancé?”

  Caden shook his head.

  “You make a comfortable living, and we live simply. As I recall, Ann has a house all to herself in a nicer part of town. She drives a nicer car. She’s gone on a couple of cruises. Where does she get that money?”

  “I don’t know. Then again, I thought I saw something between her and Holloway the first time the DEA agents met the other doctors in my office. I guess she could be involved in this investigation.”

  Henry Taggart opened his front door and stepped back. “Jean, come in. Thank you for coming.”

  “I’m happy to come over any time,” she said. “But the last time we talked I got the distinct impression that perhaps you didn’t want to see me for a while.”

  “Not at all,” he said. “I just needed to think things over. Besides, I thought you’d probably appreciate some time to yourself.”

  “Well, I’ve certainly had that.”

  Henry didn’t know how to interpret that remark. Was she angry? He hoped not. “Let’s go into the living room and talk.” He ushered her in and pointed toward the sofa. She took a seat, and he sat next to her. Where should he begin?

  It didn’t appear Jean was going to help. She crossed her legs and leaned back. “As they say in the business world, you called this meeting.”

  He’d thought this through. Now if he could only remember how he wanted to say it. “When your husband was killed in that car accident, Nancy offered her support, but I’d like to think I was there for you too.”

  “You were,” Jean said.

  “And then, starting at the time of Nancy’s stroke, all during her time in the nursing home, even when she died, you’ve been there for me to lean on.”

  “That’s what friends do.”

  “But it seemed to me you went beyond that. When my diagnosis of pancreatic cancer first came up, you were the one I turned to for support. If Nancy had been alive, she would have been there for me. But that was impossible, so you stepped in and did what my wife would have. You were there for me at every turn, and it helped. It was important to have someone to talk with, someone to tell me things would be okay.”

  “I was simply there with what you needed,” Jean said.

  “I know you thought you were acting as a friend,” Henry said. “But recently it’s become pretty clear you’re more than a friend to me. I’ve developed feelings for you. I shoved those aside while Nancy was alive, but now she’s gone.”

  Jean looked at him but remained silent.

  Henry wiped his palms on his trousers. “In a few days, I’ll undergo radical surgery. After that will come radiation or chemo, maybe both. And there’s only a small chance that treatment will stave off the inevitable end.” He swallowed a couple of times, but the dryness in his throat wouldn’t go away. Here goes. “Jean, I’m afraid to be alone for the journey.”

  “Caden is still here. So is Beth. And you have your friends.”

  “My son and daughter-in-law are wonderful, but they have their own lives,” Henry said. “And as for friends . . . they were mainly Nancy’s. I know now that I’ve spent too much time with my practice and not enough with the people who cared for me.”

  “It’s not too late to change that,” Jean said.

  “I hope not, and I plan to start now.” Henry drew a deep breath. “I know that my future is clouded at best and dim at worst. But over the past several weeks I’ve come to realize that I care for you—more than just as a friend. And I think you care for me.” He paused, like a man at the edge of a high diving board. “Jean, I love you. I want you to be a part of my life . . . whatever’s left of it.”

  Jean’s lips moved, but no words came out of her mouth.

  He’d hoped she’d say it back to him, but she hadn’t . . . yet. Once he’d spoken t
he “L” word there was no turning back. Henry hurried on before he lost his nerve. “Jean, I have a tough road ahead of me, but I’ve made up my mind to fight the cancer all the way. And I want you by my side.” He took a deep breath. “Will you marry me?”

  21

  Caden sat next to Beth in their usual location at the back of the sanctuary of Freeman’s First Community Church. All around them, people were talking to the folks next to them, some stood in the aisles and visited, but Caden didn’t feel like interacting with anyone. He sat with his head bowed, not so much in prayer as in hopes that no one would bother him.

  As he continued to sit there quietly, an island of silence in the midst of the crowd, his thoughts turned to the problems facing him—problems he’d finally decided he couldn’t solve, couldn’t even get through, without God’s help. It was a shame that these events had brought him to his knees, but he recalled what President Lincoln was purported to have said. “I have been driven many times upon my knees by the overwhelming conviction that I had nowhere else to go.”

  “Care to share your thoughts?” Beth whispered as though she were hesitant to interrupt her husband’s silence.

  He raised his head and tried to manage a smile. “Just thinking about everything that’s going on. It’s been almost a month since the DEA agents appeared in my office. They promised to be gone soon, but they’re still around, even though I can’t contact them.”

  “That’s—”

  Caden continued. “My mother has died. I’m still not sure his nurse didn’t have a hand in that, so she could marry Dad. And, of course, I’ve been locking horns with him to fight this diagnosis he’s been given rather than giving up and ending his own life.”

  Beth looked around her before she spoke again. “You’re not going to change any of that for the next hour or so. Why don’t you lose yourself in the service? Maybe God will speak to you and give you strength and wisdom. Maybe not. But at least give Him a chance.”

  Henry Taggart lay in bed on Sunday evening—or, more properly, Monday morning. He didn’t look at the clock on his bedside table. The last time he’d glanced that way, it showed 2:00 a.m., and he hadn’t slept since that time—or before, for that matter. Then again, there was no need for him to know exactly how long he’d been in the grip of insomnia. The simple answer was “all night.”

  He had to admit that his proposal to Jean had been affected by his fear. He was afraid he’d die alone, with no one to comfort him, to hold his hand as he slipped from this life to the next . . . or to oblivion. True, there were Caden and Beth, but as he’d told Jean, they had a life of their own.

  Oh, he knew all the reasons Jean might be cozying up to him. If she were his wife she’d have financial security, status as a doctor’s wife, freedom from work. And he’d picked up on the signals his son exhibited, signals that Caden resented Jean, fearing she was trying to replace his mother.

  But none of that stopped Henry from asking Jean to share what life he had left. He knew what lay ahead—he was a surgeon, after all—and he decided there was no way he could face it alone. But Jean’s reaction surprised him.

  “Henry, I’m flattered that you asked. Would it be terrible if I asked for a day or so to consider this?” She’d smiled. “I know it’s trite, but ‘This is so sudden’ actually describes my feelings right now. I need to think about this—actually, I need to pray about it.”

  “Of course. I started to tell you to take all the time you need,” he’d said. “But, considering that I need to get started in my battle against this cancer—don’t take too long.”

  Well, you’ve done it, Henry. If she says yes, you’ll have to tell Caden and Beth, which may not be pleasant. And if she says no . . . I don’t even want to think about that. I have too many unknowns in my life already.

  Henry fidgeted as he sat in the office of Dr. John Markham on Monday, waiting for the man to return. He had come to this appointment alone, but he already wished he’d called Jean and asked her to accompany him. Not because this visit with Dr. Markham was so terrible. He liked the consultant, and thus far he’d gotten along well with him. Yet he thought that Jean’s presence would make the visit even more tolerable. But he and Jean were in a no-man’s-land right now about their relationship. And that made him long for her reassuring presence even more. It really did help to have someone to lean on for comfort.

  Henry’s idea of a surgeon at the medical center—any faculty member for that matter—was an individual who was aloof and cold. But that wasn’t the case here. Markham was warm, understanding, and collegial. He’d treated him as an equal, pointing out technical details on the studies and talking about what he’d need to do to perform successful surgery. It was as though they shared a common goal—and, come to think of it, they did.

  Markham walked in and closed the office door, putting an end to Henry’s daydreams. “Sorry to keep you waiting. I had to talk with one of the residents about a case.”

  “No problem,” Henry said, although his time waiting had increased his anxiety level until he felt he was about to jump out of his skin. He went right to the question that was foremost in his mind. “Do you think I’m an appropriate candidate for a Whipple?”

  “Yes,” Markham said. “Usually, pancreatic cancer is diagnosed late—too late for us to do more than palliation. Yours is early. I know you’re a surgeon, but I’ll ask what I ask of all my pre-op patients. Do you understand what’s involved in the surgery? How extensive it is? The risks and consequences?”

  Henry said he did, but still Markham extracted a ballpoint pen from his white coat and used a pad to show exactly what he planned to do. Then he listed the possible complications. “Knowing all this, are you still willing for me to perform the surgery?”

  “Yes.”

  Markham smiled. “It’s amazing how often people decide not to proceed with surgery when I start detailing the possible complications and the hoped-for results. But I think it’s best to get it all out in the open now rather than having them back out once we’ve scheduled the procedure.”

  Henry decided that now was the time to ask the other question he had. “My son is a surgeon—trained here, matter of fact. And it would be a tremendous favor if Caden could be with me in the pre-op area and in the recovery room.”

  “We may be able to arrange that,” Markham said. “I think I remember Caden. Good surgeon. I’ll be glad to see him again.”

  “Would it be possible for him to be in the OR during the procedure?”

  Markham screwed up his face. “Since he doesn’t have privileges here, the usual answer would be no. But let me talk with the department chairman, maybe the president.” He held up a finger as though emphasizing his point. “If we make the exception, though, he’ll have to stand back and be quiet. There’ll only be one surgeon in charge of this case. It’s not a matter of ego. It’s just the way things should be.”

  “I appreciate your checking, and I’m sure Caden will abide by your wishes,” Henry said. “Now when can you do the operation?”

  “I’ve got everything cleaned up. Last night I took care of the last person involved in what we do. The only people left are you and me. Now it’s time to execute the final stage.”

  “Are you certain there’s no other option besides what you call Plan B?”

  “Look. I’m in charge. This is the best way to wind things up. You just do your part. By tomorrow night, it’ll all be over.”

  Beth was standing with Caden in the hall outside an exam room as he was about to see his first patient. “Today looks to be pretty quiet.”

  Before he could reply, one of the receptionists, Donna, hurried up and spoke to Caden. “Dr. Taggart, I just got a call from Dr. Russell. She seems to have come down with the flu and won’t be in today. She’s scheduled to see a couple of post-op patients and wondered if you’d take care of them for her.”

  “Sure. Beth, I can handle a couple more patients, can’t I?”

  She thought a minute. “Shouldn’t be a probl
em.”

  Caden turned to Mona. “Just let the other receptionist know what’s going on. How about surgical cases tomorrow? If Ann really has the flu, I doubt that that she will be well in one day.”

  “She has a couple of fairly straightforward elective cases in the morning, and Dr. Sparling said he’d do those if the patients agree. Gary is calling them now.”

  “Let me know if she calls again. I’d like to talk with her.”

  “I don’t think she’s going to want to talk much,” Donna said. “Her voice was sort of a whisper when she called me. But I’ll let you know if she phones.”

  Mona started to leave, then turned back. “Dr. Taggart, I guess this is none of my business, but something seems a little off about all this.”

  “What’s that?”

  “When I told Gary about Dr. Russell’s call, he got the strangest look on his face. Nothing specific—just an expression like you’d get if you thought something was wrong.”

  Caden looked at Beth, who shrugged. “Thanks for telling me. I’ll keep an eye on things.”

  When Caden stopped for a breather mid-morning, Beth followed him into his office and sat down. She handed him a Diet Dr Pepper and opened the one she’d brought for herself. “Any word from Ann?” she asked.

  “No. I thought maybe I’d go over there at noon and see if I can do anything for her.”

  “Why don’t I go with you?”

  Caden took a sip from his cold drink and set the can aside, carefully placing a coaster under it and earning a nod from his wife for remembering. “I suppose so.”

  Beth grinned. “I know this might not have crossed your mind, but it’s probably a good idea to have another female present when you see her.”

  “No, actually I’d already thought of that. Thanks for volunteering to go with me.”