by Barbara Ebel
Danny knew he had to see an emergency pediatrician as soon as possible yet most of them didn’t work on Saturday. He called anyway and found out Dr. Thomas would close at noon but would work Julia in. He then called Joelle and asked her to come to his office where he planned on waiting for Julia’s appointment; the pediatrician’s office staff had promised to beep Danny in plenty of time.
After he went back into the house with Julia and Dakota, the kitchen stirred with morning activity. Everyone was present except Casey.
“Who wants to come with me?” Danny asked. “I’m going to my office to wait for the infectious disease doc and then take Julia to the pediatrician in the building.”
Mary’s dark blue eyes honed in on him. “Casey’s working three to eleven so he’s still sleeping and I shouldn’t wake him. I’m coming, but I’m not changing clothes,” she said, staring down at her baggy gardening shorts and tee-shirt.”
Nancy stirred butter into two boiled eggs but shot a glance at her sister.
“I wish it was a work day at your office, Dad,” Annabel said, “so I could tail you all. But count me in.”
“It’s not like I don’t have anything to do getting ready for school,” Nancy mumbled.
“Don’t do us any favors,” Annabel said.
“No, I’m doing you a favor,” Nancy said. “I’m coming.”
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Danny’s restless legs wouldn’t let him sit down in his own office. Mary and Annabel sat on the leather couch on either side of Julia who mimicked her father, her little legs and arms busy with movement. Danny stepped around Nancy sitting on the floor and went into the office kitchen to put on a pot of coffee. He came back with two half-filled Styrofoam cups sitting atop a donut box and put them down on his desk.
“Look what I found in the fridge,” he said. “A half box of donuts from yesterday.”
“Awesome,” Annabel said. She left the couch for thirty seconds, selected chocolate, and bit in as she sat down. It didn’t take long for her to pinch off a little piece without the chocolate and put it in Julia’s hand.
Danny’s pager vibrated, the message coming from the pediatrician’s office. “Annabel and Nancy, you stay here, especially if it takes us awhile. Plus, Dr. Lewis may show up. Enjoy the donuts. We’ll be back as soon as possible.”
He settled Julia in his arms, and Mary and Danny walked out. Nancy grabbed a custard donut when he left and the girls talked about school.
The long, narrow waiting room upstairs was dotted with parents, infants and children. Danny nodded to the receptionist when they arrived. Across from them, a baby boy in his father’s lap had a yellow-green nasal discharge; an energetic infant playing with toys was there for shots or a well-baby check; and a small child with a productive cough walked past, taking a book from the rack. He wished Julia was there for a common cold instead of the horrors present under her clothes.
The white door next to the receptionist’s area opened. “Dr. Tilson, you can bring Julia back,” said a young woman wearing puppies on her scrubs. Danny followed her with Julia clinging to his tee-shirt and Mary filed behind him, her right foot toeing in as usual.
After the nurse added information on a form and left, Danny and Mary sat silently in stiff chairs. They heard someone outside take the chart from the plastic bin, the door opened, and the fifty-year-old pediatrician strolled in. Shaking hands, he greeted Danny and was introduced to Mary.
“Saul, thanks for fitting us in. This is my daughter, Julia, who lives in Knoxville with her mother. It’s a long story.”
“I believe I’ve heard the crux of your story, Danny,” he said. “You know how the rumor mill is. Even in the OR, I bet personal news travels like wild fire.”
“Hopefully, you’ve at least heard truthful renditions,” Danny said. “Anyway, this weekend is the first time I’ve been able to have my daughter and there are marks on her that are disturbing. I would appreciate your examining her and giving me your opinion.”
Saul leaned against the examining table listening intently, his arms crossed in front of him. .
“So you’d like me to give her a full examination?”
Danny nodded.
Saul proceeded to sit down across from them and take a history. In the end, he reiterated to Danny. “As far as you know, then, the mother had no troubles during the pregnancy? Julia was born full term and never was on a ventilator? There are no medical problems so far and she hasn’t had any surgeries or allergies to medicines? You also believe that her mother has kept up with all her routine immunizations.”
Danny gestured affirmatively to all his questions. “I believe that sums up what I know. Also, Julia’s mother used to work in an OR as a scrub tech, so I don’t think she’d neglect her routine care.”
Saul’s eyes darted to Danny and he grimaced. “If we’re suspecting child abuse, then there’s no guaranteeing that she regularly took Julia to a pediatrician.” Saul motioned for Danny to put her on the examining table.
When Danny sat back down, he buried his face in his hands. Mary patted his shoulder. The same young nurse as before stepped in to assist in case her boss needed anything.
The pediatrician started with an otoscope and checked inside Julia’s ears. After he finished examining her head area, Mary signaled for Danny to keep sitting as she stood up and took off Julia’s colorful bodysuit and diaper. Saul unwrapped his stethoscope from around his neck and listened to the infant’s heart and lungs and palpated her abdomen.
“She sounds fine,” Saul said, replacing his stethoscope.
Danny looked over as Saul started a peripheral evaluation of Julia’s skin and extremities. The doctor’s toupee was easy to spot and it helped divert Danny’s attention from his daughter’s petrified glare at the doctor. The five-minute examination seemed to drag on for hours.
“I’d like to get some x-rays,” Saul said, spinning around. “Let’s wait until I get those, and then I’ll go through my findings with you.”
“Okay,” Danny said. He felt like a helpless parent.
Saul’s nurse slipped Julia’s diaper back on and the three of them left together; the pediatrician to see another patient and the nurse to help in their x-ray room, taking Julia with her.
“He’s being thorough, Danny,” Mary said. “Let’s keep our fingers crossed, okay?”
Gulping down the desire to get emotional, Danny wrung his hands. “I know why he’s x-raying her. It’s worse than I thought. He suspects broken bones.”
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Mary held Julia after the nurse returned with her. Walking back and forth by the window, Mary rubbed the baby’s back but watched her brother. She worried as much about Danny as Julia. “Fretting isn’t going to help right now,” she said to him.
“I feel like acid is eating away at my stomach. Damn! I just realized I wasn’t supposed to be on call last weekend. I covered what was supposed to be Harold’s day because Bruce and Matthew couldn’t. My damn career got in the way. I would have had Julia, found out about her condition, and maybe prevented something that happened to her then.” He jumped out of the chair, ready to pound his fist into the wall.
Mary confronted him face on, holding Julia tight. “Don’t you dare throw a guilt trip on yourself. You have a responsibility with what you do. Shit happens. You can’t change certain paths, Danny. You should know that more than anyone.”
The pounding pulse in his wrist began to subside as he searched Mary’s eyes; she stared at him, ready to take him on if he gave her or himself more grief. He slinked back into the chair. “I suppose you’re right.”
Mary grinned and resumed cuddling Julia as they heard footsteps outside the door. Dr. Thomas entered and - with one step – went to the examining table where he placed x-rays and opened Julia’s folder to his notes. “Why don’t you both sit down?” he asked.
Saul’s tense facial expression warned Danny and he felt throbbing around his temples as he tried to keep his hands from fidgeting. Mary took a seat.
>
“First off,” Saul said, “your suspicions were correct. There is crystal-clear abuse going on with your daughter. But here’s some good news first. Your daughter seems to be okay from a heart and lung perspective. And this is also good - I don’t see it often if child abuse is suspected, but her weight and length is normal on growth charts. There is no failure to thrive. It makes me think that the primary caretaker is not responsible for the injuries we’re seeing.”
Danny and Mary shot each other a glance. It seemed strange … he couldn’t figure that out, yet he didn’t have a clue about Julia’s life with her mother.
“Otherwise,” Saul said, “I don’t know where to start. The mark on her upper inside right arm that’s circular with the ragged edges is a cigarette burn. As a partial thickness burn, she will probably keep that small scar. The other one on her buttocks is undoubtedly a full thickness cigarette burn and that’s a nasty disfiguring scar which is going to stay.” He paused. “Thank God, it’s not on her face, Danny.”
Danny shuddered. He looked at Julia, all innocence in Mary’s arms.
The doctor continued, “Basically the differences with skin damage from burns depend on the depth of injury to the skin layers of the epidermis, dermis, and subcutaneous tissues. A superficial burn to the outermost layer of the epidermis has the best healing. In this case, we’re not so lucky.”
“This is so evil,” Mary said. “I can’t take it when I hear about animal abuse … but I’ve had no exposure to this.”
“Well, I have more to tell you. As Danny knows, at the bottom of your sternum is an end plate called the xiphoid process. Julia’s has been fractured.” He took the two x-rays from the table and slid them into the viewing box behind them as they both stood and got out of the way. He pointed to the bottom of Julia’s breast plate.
“No, no, no,” Danny whispered.
“How did that happen?” Mary asked, then cringed. “Was she punched or something?”
“Not necessarily. It can be done with finger or thumb pressure. An outright punch would more likely also cause internal organ damage.”
He pointed to the adjoining film. “This is Julia’s left arm. She has a spiral fracture of her humerus. In an infant, it’s indicative of someone jerking the baby’s limb. As Danny knows, shaking a baby can result in severe head trauma but I don’t see evidence of that.”
Saul hesitated. He hated giving such information to any parent but pediatrics wasn’t always a joyous specialty.
“Julia’s arm also has a bruise,” he added, “Like a handprint.”
After giving Danny and Mary a few seconds to absorb his findings, he forged ahead. “Luckily, Julia’s arm fracture is healing. The bone is coming together nicely and there is nothing further to do for either break. I hope you can take her out of harm’s way.”
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Their heads hung low, Danny and Mary brought Julia back to Danny’s office where Joelle sat with Annabel and Nancy in the waiting room. “Well, I see you’ve all met,” Danny said. “Joelle, this is my sister, Mary, and my other daughter, Julia.”
“Nice to meet you, Mary, and I’ve enjoyed talking with your daughters, Danny. Annabel’s been picking my brain about my specialty. I told her if she’s going to go the med school route, neurosurgery and infectious diseases are equally rewarding.”
Danny laughed, feeling like a release from the morning’s tension. “I won’t arm wrestle you over that one.”
“Are you a runner?” Danny asked, noticing the airy black shorts and a purple top she wore.
“I try,” she replied, swiping a wristband across her upper lip.
“My colleague - Matthew Jacob - is an avid runner, too.” Danny said. “Why don’t we all go back to my office? Annabel, would you mind giving Julia some milk and the baby food we brought?”
“I’ll do it,” she said with a small smile to hide her braces. She took Julia from Mary and went to the kitchen as Nancy followed.
“Joelle, I hope you don’t mind if I make an emergency phone call,” Danny said. “I have somewhat of a crisis going on with my baby.”
“Not at all. Is there anything I can do?”
“You already have your hands full with our epidemic.”
“I’ll have to fill you in; however, I don’t bear good news today either.”
Danny looked through his contacts for Mark Cunningham’s number, one he should know by now. He didn’t expect to find his attorney in the office on a Saturday so he tried his cell phone. The way he saw it, Julia was supposed to go back to her mother the very next day but that seemed out of the question now … it would be like putting a fawn in front of a cougar.
On the other hand, Danny had continued to learn from family court. He knew an order was an order and his documents spelled out visitation rules. He’d be breaking the judge’s order if he didn’t take Julia back to her mother. This had to be worked out legally but how could that happen in one day? His thoughts spun as he placed the call, only to get a recorder.
“Mark, this is Danny Tilson. Sorry to bother you on a Saturday but its imperative we talk. I’m having my first visitation weekend with my baby girl, but I just had her seen by a pediatrician. He’s confirmed she has multiple injuries indicative of child abuse. I really need your help. Certainly we can’t send her back tomorrow to her mother.”
Danny put the phone down while Joelle gasped.
Chapter 18
“You seem to live life in the fast lane, Dr. Tilson,” Joelle blurted. She placed her water bottle on the coffee table and crossed her legs. “I hope your baby is going to be all right.”
Mary joined her. “Julia is littered with cigarette burns and broken bones,” she said, gritting her teeth in disgust.
“I don’t have kids,” Joelle said, staring ahead. “Yet how could anyone do that?”
Danny made a feeble attempt to camouflage his apprehension as he moved from behind his desk and sat across from them. “I don’t know, Joelle. I swear, it has to stop and I’m sorry to dampen your day about it. Anyway, I better mention why I called you. Mary’s fiancée - who is my best friend and a paramedic - remembered an event which may be useful. It may be nothing but some people may consider it strange. And it’s certainly perplexing why I haven’t gotten sick like the others, especially after coming in contact with all that saliva.”
Joelle clasped her hands together and leaned forward. “I’m dying to hear anything. And I have to tell you something, too. I spoke to Peter and Ralph today. But go ahead first.”
“Well, excuse me if this story sounds crazy, but, two weeks ago from tomorrow - the day after Michael Johnson had his accident - I had off that Sunday. I was cutting down tree limbs, missed the branch, and cut my left hand instead.” Danny turned his hand over, showing her his palm although he remembered she had seen it briefly at one of their meetings. “We debated whether I should get stitches. Casey and Mary were there. We all live together in my deceased parents’ large house, but I digress. The point is that the cut was quite bad and bled substantially. My dog was there and I let him act as the lap sponge despite the advice of my sister.” He shot a glance at Mary who nodded.
“Danny trusts the dog’s saliva,” Mary said. “He says Dakota has a clean mouth.”
“Sounds like a lot of loyalty going on between you and your dog, Danny,” Joelle said. She slumped back into the sofa. “Hmm, an open wound treated with dog saliva which then ended up in your bloodstream. And since twenty percent of your cardiac output goes to your brain, your brain cells got a dog bath, too.”
Danny laughed. “Not mainlined like an IV because I’m not a druggie, but probably the next best thing.”
“We’re up against something unprecedented for these modern times,” Joelle said. “I’m willing to hear and research any possibilities. I’m spending the afternoon in the lab so dog saliva will be put on my agenda.”
“Are there still research dogs in kennels on the roof?”
“They’re still there,” Joelle sa
id, “and used for med student class demonstrations by the physiology professor.”
“What do they do with them?” Mary asked.
“I saw my first demonstration of what a muscle relaxant does using a dog,” Danny replied.
“How awful,” Mary said.
“Not exactly. They are the same drugs we use on people, be it during anesthesia or in the ICU and other areas of the hospital.”
“And these dogs,” Joelle said, “come to us from kennels where they were slated for euthanasia.”
Danny looked at her. “So what’s the bad news from this morning?” he asked. “What does our southern CDC partner have to say?”
Joelle took a drink from her water bottle, then put down the empty container. “Ralph and his colleagues did a total headcount this morning from all sources around the country. The total number of PAM cases is up to eighty-nine, with thirty-two deaths.”
Shock registered on Danny’s face and Mary froze.
“Peter Brown and Timothy Paltrow are doing an excellent job with our patients here. Michael Johnson continues to be the youngest. He is in a full-blown coma but at least Peter is not battling waning vital signs with him compared to the older patients. Bill Patogue doesn’t look like he’s going to make it and the word from Kentucky is that Michael’s mother passed away yesterday. His father won’t be able to hang on much longer either.”
“Unbelievable,” Danny managed to whisper. A morbid, oppressive feeling came over him. The little optimism he had felt about the day upon awakening was swallowed up and lost.
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Joelle filled her water bottle from the kitchen sink before leaving Danny’s office and then jogged back to her apartment several miles away. She nodded to the security guard at the gate as she sprinted past the fountain along the circular brick drive in front of her condominium. She moved aside to let a young couple wearing high-end running gear exit the elevator and rode to the top floor where she owned one of the four units.
All she wanted for a residence she had found in her present condo. A large bedroom and bath, a shiny kitchen, and a big room with a hardwood floor that sometimes creaked. For furnishings, she’d kept it sparse because she disliked rooms with cluttered furniture. She was orderly and exact in both her professional and personal life and her greatest comfort at home - besides her flat screen TV which ran news coverage or movies - was Bell, a six-year-old Siamese cat.