Warning Signs

by C. J. Lyons

  “Amanda, if there’s anything wrong—” It was the first time he’d used her name all day.

  She shook her head vehemently, not sure what to make of the sudden concern. “No. It’s just a routine check. Honest.”

  He narrowed his eyes as if cataloging her missteps. “You’re sure? You’ve seemed a bit on the clumsy side today.”

  “Anyone would with you looking at them like they’re a bug under a microscope. It’s unnerving.”

  A ghost of a smile flitted across his face before he assumed a mock earnest expression. “I will try to avoid looking at you in the future, Ms. Mason. Although I confess it may be difficult.”

  With his last words hanging in the air—did he mean that because he found her attractive? or because she was an annoyance?—Lucas left. Most likely he was making fun of her because he knew she had a crush on him. He was probably used to it, thought her hopelessly naïve. Or worse, gullible.

  Amanda shook her head, glanced at the clock, winced, and hurried out of the ICU. She hated to keep anyone waiting, especially Dr. Nelson.

  LYDIA FINALLY MADE IT BACK TO EMMA GREY just as the tech was finishing her follow-up EKG. Deon stood beside the tech, watching the machine with rapt curiosity.

  “It looks the same,” he said, holding up his copy of the first EKG. “That’s good, right?”

  How was she going to explain the nuances of ST segment elevation to a ten-year-old? “Good eyes, Deon. It is the same.” She took Emma’s hand, felt her pulse. “How are you feeling, Mrs. Grey?”

  “Fine. And call me Emma.” She tugged at her nasal cannula, pulling it free from her nose. “I don’t need all this. I’m fine. We should be going now, let you take care of some sick folk.”

  Lydia watched as Emma’s oxygen level began to drift down, then reached over to adjust the nasal cannula back into place. “I don’t think that would be a good idea. Your oxygen is still low.”

  “Is she having a heart attack?” Deon asked, his voice quavering up an octave. “You said she might be.”

  “Actually, I have good news. Your labs are normal. I’m not seeing any changes that indicate a heart attack.”

  “Great, then we can go back home.” Emma acted as if they had a welcoming committee waiting on them “back home” even though they both knew that wasn’t true.

  “Hold on now. I still don’t know for sure what’s causing the dizzy spells and your low blood pressure. But I have some ideas. I want the cardiologist to see you.”

  “More fancy doctors? Can’t I just go to the clinic like always?”

  If Lydia was right, it was the clinic doctors—although with the best of intentions—who had caused Emma’s symptoms. Which might have saved her life.

  “No.” Lydia perched on the side of the bed, Deon climbing up to lean against her, peering over her shoulder as she showed Emma the repeat EKG.

  “See these bumps here and here?” Emma and Deon nodded in unison. “There’s a rare condition called Brugada syndrome that can cause those changes without a heart attack.”

  “Brugada?” Deon asked, trying the word on for size.

  “You got medicine for that, right?”

  “It was your new medicine, the beta-blockers, that unmasked it.”

  “So I won’t take those no more and problem solved. Let’s go home, Deon.”

  Emma reached to disconnect the oxygen again, but Lydia stopped her with a gentle hand on her arm. “It’s not that simple. We’re lucky we found it in time.”

  “You make it sound like cancer or something.”

  Deon jerked his head up at that, edging closer to his gram, reaching for her hand.

  “It’s not cancer, it’s a heart defect. Something you were born with that over time has gotten worse.”

  “Nonsense, I’m as healthy as a woman half my age—the doctors always say so.”

  “This isn’t something the doctors would have known about—not until you showed symptoms. It tends to run in families, usually hits young men without warning. Is there any history of sudden, unexpected deaths in your family?”

  Emma leaned back against her pillow, her color draining. “Two brothers. One died while playing basketball; the other was just eating dinner. No one ever knew why.”

  “Brugada causes your heart to beat abnormally—there’s no test for it on autopsy.”

  Emma’s face narrowed with concern as she stroked Deon’s back. “If I have this, could Deon?”

  “Maybe. But we need to see if you have it first. Do some tests.”

  Her mouth opened, then closed. Finally she nodded. “Do them. Do whatever it takes. You gotta promise me one thing, though.”

  “What?”

  Emma clasped Lydia’s hand with a strength that surprised her. “You gotta promise that you’ll look after Deon. He’s all I have left and I’m all he has. You understand what I’m saying?”

  Emma’s eyes blazed so intensely that Lydia had to fight to meet them. Deon watched, statue-still, holding his breath. Lydia forced herself to face Emma’s gaze and nodded, swallowing hard.

  “Yes, ma’am, I do.”

  NINE

  Thursday, 10:58 A.M.

  “MOSES HAS A PLAN?” GINA WAS PRACTICALLY sputtering with anger and shock, but LaRose was smiling and nodding her head as if Gina had just agreed to relinquish her future to her parents’ control. As if she were ten years old again.

  “When he saw the media coverage of how you rescued those children this summer, he put things in motion. I’m so excited to tell you that he just learned that the city will be presenting you with their highest civilian honor, a Carnegie Medal. Congratulations, Gina! You’ve made us so very proud.”

  Damn if LaRose didn’t pat away a few tears. Gina was stunned, didn’t even feel the cold air hit her bare foot as the nail technician pulled it out of the whirlpool and dried it. She couldn’t feel anything, as if she were drifting outside her body, far away from all this.

  “Mom, that wasn’t me who saved those kids.” Well, she’d helped a little, but that was just being in the right place at the wrong time. Ken Rosen, another doctor at Angels, was the real hero. He’d risked getting shot to save half a dozen kids. All Gina had done was carry one to safety.

  “Of course it was, dear. Don’t be so modest—your picture was all over the papers and TV.”

  “Yeah, but—”

  “No buts. The presentation will occur at the Winter Gala in December. Which of course I’ll be presiding over, since I’m chair of the foundation. It will be lovely—even more so when you accept the award and announce your retirement from the ER in order to work with me at the foundation, raising money for charity.” LaRose clapped her freshly manicured hands in delight. “What could be more perfect? Finally, an opportunity for you to pursue a meaningful career and meet the right kind of people.”

  “I can’t—leave the ER?” Gina hated to admit that ever since the shooting she’d spent sleepless nights wondering if she was cut out for emergency medicine. But to just walk away? She looked around, spotting the nearest exit. Damn, she’d kill for a cigarette. A cigarette and ten minutes alone to think. “I’m not sure.”

  LaRose patted her arm. “Of course you are, Regina. You know this is the perfect opportunity. And your father—” She batted her eyes, tilted her head back as if sunshine were bathing her face, smiling. “Your father, I’ve never seen him so proud. It will mean the world to him. And to me, to see you two patch up your differences. Think what it will mean to our family.”

  To Gina’s amazement, LaRose actually began to weep. “Oh dear. Please excuse me, I’ll be right back.” She accepted the attendant’s hand, stepping delicately from the chair, and made her way to the powder room, the gold-colored robe fluttering around her.

  Gina swallowed against a wave of bile, feeling trapped. Something in the perfumed air was making it hard for her to breathe. She shook her other foot free of the whirlpool. “Please, just finish. I don’t need two coats. I’m in a hurry, I need to get out of here.�
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  AMANDA WAS PRACTICALLY JOGGING THROUGH the empty tunnels leading to the research wing where Dr. Nelson’s clinic was housed. Not because the dimly lit, spooky tunnels frightened her. Not at all. She just hated to keep anyone waiting—it was rude.

  Casting a guilty glance as she passed the pathology lab—no time to stop now, she’d have to get Becky’s results on her way back—she rushed around the corner, crashing into a linen cart parked against the wall. She pushed off before it could topple and kept on going, eventually leaving the damp and musty tunnels for the sun-filled atrium of the research wing.

  She patted her hair and smoothed her lab jacket as she waited for the elevator. She was perspiring in a most unladylike fashion, so when the elevator arrived empty she took the opportunity to fan her lab coat in the hopes of drying off before sweat stains marred her dress.

  The elevator stopped at the fifth floor of the research wing. Dr. Nelson had half of the floor all to himself in recognition for the money he had donated to Angels. Amanda turned left and entered his clinic waiting room.

  Despite Dr. Nelson’s wealth—he’d made a fortune about ten years ago developing a new way to encapsulate medications, known as a perle, and quickly became renowned as the physician to the stars for his custom-tailored nutritional regimens—he kept his office space simply appointed. Staff was minimal. His wife, Faith, a pharmacist by training, was his main assistant and handled all the record keeping.

  Dr. Nelson was always asking Amanda’s opinion on new baubles to buy for Faith. In some ways he seemed desperate for material ways to show Faith his affection, even as he’d become obsessed with his research ever since their baby died.

  But Faith didn’t need the fancy jewelry; she was devoted to Dr. Nelson. And to his work. Which was why Lucas’s accusations that Dr. Nelson was just looking to make money were more than unfair—especially after the pain Faith and Dr. Nelson had suffered when they lost their son.

  Amanda had met the Nelsons during the start of her second year in medical school while shadowing a neonatologist as part of her Introduction to Clinical Medicine course. She’d been feeling homesick, but that was nothing compared to the tragedy that had befallen Faith and Dr. Nelson.

  After trying for years to conceive, they had had an extremely premature baby boy who hovered for weeks on the edge of death.

  Amanda had bonded with the couple, stopping by the NICU where they held constant vigil over their son, Joey. She’d tried her best to offer some kind of comfort. Although Faith was only thirty-five at the time, after Joey died she had decided to not pursue their dream of building a family. Instead, she and Dr. Nelson made his research the center of their lives—and had more or less taken on Amanda as a surrogate child, encouraging her to follow her dream of becoming a pediatrician even though that specialty made a lot less money than most.

  “Amanda!” Faith Nelson greeted Amanda before the door to the waiting room closed. Faith was a skinny, intense woman who embraced perpetual motion—a stark contrast to her pudgy but genius husband who would think nothing of sitting and staring at a computer screen for hours on end. “You’re never late. Is everything all right?”

  Faith reminded Amanda of Mama. Only without the guilt.

  “Sorry to be late,” Amanda apologized. “I had a patient—”

  “That’s all right, let’s go ahead and get your vitals.” Faith gently but efficiently hustled Amanda into the exam room and took her blood pressure, pulse, and measurements.

  “Any problems you need to tell us about? Norman’s notes indicate that you had some sort of dizzy spell?” She stared at Amanda with concern.

  “It was nothing. I’ve been making sure I eat better and get more sleep and I’ve been fine ever since.”

  Faith nodded, head bent, as she transcribed Amanda’s answer into the chart. Amanda felt a tinge of guilt and wondered why. She always tried to be scrupulously honest with Dr. Nelson. Not only in appreciation of the two hundred dollars a month he paid her for being a part of his study on a new vitamin and mineral formulation specifically designed for women, but also in recognition of the need to provide accurate data so that his study results would be valid.

  She admired him for doing the research in the first place. The FDA didn’t require it, but he felt his work was about more than making money. Dr. Nelson was convinced that someday he would discover the secret to eternal health—well, if not eternal, at least lifelong health and vitality.

  He wanted to save the world, give everyone a long and prosperous life. “Riches aren’t worth anything unless you share them,” he’d say, usually reaching to give Faith’s hand a squeeze as he did.

  Amanda loved Dr. Nelson’s enthusiasm and zeal. It was inspiring to see someone still excited by his work and not solely focused on the income it provided. She frowned, remembering Lucas’s scorn and derision about Dr. Nelson’s work. He’d acted as if the fact that she was a patient of Dr. Nelson’s were a personal attack on him.

  “Amanda?” Faith was standing now, asking something she had missed.

  “Sorry, I was thinking about a patient.” Should she tell Faith about Tracey Parker—would that be a violation of patient confidentiality? But of all people, Faith would know how to track down which of the many studies at Angels Tracey might have been a part of.

  “I asked if you wouldn’t mind giving us a urine sample now, since we’re running a bit late? By the time you’re done, Norman will be ready for you.”

  “Sure, no problem.” No problem except she hadn’t had anything to drink since before coming to the hospital early this morning. Good thing she hadn’t had time to pee either.

  Faith left, and Amanda used the private bathroom in the exam room to collect the specimen and change into a patient gown. Amanda sat back on the exam table, trying in vain to arrange the folds of the gown into a position that would allow some modicum of modesty without creating a draft.

  She was a little disappointed. Usually she and Dr. Nelson chatted first before she changed. She’d even chosen her blue dress today so he could see how much better she looked than last time, when she’d showed up in scrubs, rumpled and dragging after being up all night.

  “Morning, Amanda,” he said as he breezed into the room, wearing a black silk polo shirt and crisp white slacks she was certain Faith had bought him. Left to his own devices, Dr. Nelson was more of a flannel-shirt-and-rumpled-khakis kind of man. “How’s my favorite medical student?”

  He shut the door behind him and sat on a stool. “No more of those dizzy spells, right?” he asked in a low voice as if they were sharing a secret.

  She started to say no, but she couldn’t force the word free. He looked up at her, a concerned and caring expression on his face—just like her dad’s when she’d scraped her knee on the dock or put a fishhook through her finger. She couldn’t do it, she couldn’t keep lying—not to him or to herself.

  Tears welled up in her eyes and she blinked furiously, refusing to give in. Dr. Nelson frowned, then stood, placing a hand on her arm. “Amanda, what’s wrong?”

  “I’m scared,” she finally admitted, knotting the cotton gown in her fist as she spoke. “I had this patient, a few months ago, she had the same symptoms as I did, and she died. Then this morning another patient came in and now she’s paralyzed.”

  “Amanda, calm down, everything is going to be all right.” When he talked like that, his eyes staring into hers, his face so calm, so strong, she felt reassured. “Tell me about your patients and we’ll get to the bottom of all this.”

  She nodded, swallowed back her tears and quickly told him about Becky Sanborn and Tracey Parker. “Now Tracey’s paralyzed—in a locked-box syndrome. What if something like that happens to me?”

  “First of all, you know that these symptoms could be caused by any number of things. Why do you assume that you have the same thing as your patients? If you even do have anything wrong with you?”

  “I don’t know. I’m sorry. It’s just I can’t believe Lucas can’t find
out what’s wrong with them. And since I had some of the same symptoms—”

  “Lucas? Lucas Stone?” Dr. Nelson’s face shut down, lips curling with distaste.

  “Yes. He’s the neurology attending who took care of Becky and now Tracey.”

  He turned away for a moment before speaking. “I would never disparage a colleague, but well, maybe Lucas Stone isn’t the best physician for this case. But that’s not our problem—we need to know if something is happening to you. You told me you would call if you had any more symptoms.”

  She hung her head. “I know. I kept telling myself that it was nothing—just clumsiness, fatigue. But after seeing Tracey, and hearing that we’re both involved in research studies, I guess I panicked.”

  “Let’s put that fear to rest right now. I have no idea which study Tracey was involved with, but you know that this medical center is currently running thirty-two clinical trials as of the last IRB review. And half the patients in each trial are really only getting placebos—so there’s little chance of you and her both getting the same medication. Don’t start jumping to conclusions, Amanda. You’re a smarter scientist than that.”

  “I know, I know.”

  He pulled out his stethoscope, began warming it against his palm. “Let’s check you out, head to toe. I’m sure it’s your imagination run wild. When I was a medical student I thought I had lymphoma, Alport syndrome, cat scratch fever, and Crohn’s disease—all at the same time.”

  “You did, really?” she asked, reassured now that she’d been truthful about her fears.

  “Really. Know what I really had? A severe case of medical-studentitis. My clinic preceptor advised a weekend of reading nothing but Sports Illustrated and Field and Stream. No medicine at all. Worked wonders.”

  He checked her lungs and heart, her abdomen, and her lymph nodes; looked at her retinas; and then had her close her eyes as he tested her sensation and reflexes. Amanda relaxed as he regaled her with tales of being a medical student “back in the old days” and how he and Faith had met one night in the library while he was studying for a pharmacology final.