In that instant, Kavandor decided.
“Well, there is this insurance company the AMA has been complaining about. I don’t know anything about them, but they seemed to have pissed off a lot of physicians.”
“That’s all you got, an insurance company?” Wiseman groaned. “What’s the name? I’ll look into it, maybe it will cure my insomnia.”
Kavandor immediately regretted his decision. Wiseman was not going to take this seriously. “Kodiak, or something like that. Not sure, it’s buried under this pile of papers.”
“Do they insure people or bears? Email it to me when you find it,” Wiseman said, and he moseyed out of the office.
Chapter 40
Troy arrived at LAX the last week in December, exhausted but motivated. He could hardly believe he’d been gone almost a month. Mack Elberg met him as he came through customs.
“Hey, man, I thought they’d never let you out of there. Good to see you!” He gave Troy a bear hug. “That’s wild, that your dive buddy was murdered! Did they catch the bastard?”
“Thanks, Mack. Not yet. I am glad to be home, you have no idea. I’m coming in to the office today, but leaving tomorrow for New York.”
“You can’t do that! We still haven’t gotten control of these wildfires. Right now, we need your ingenuity and more funding to get the animals to safety and put these flames out for good. What a horrible season it’s been. Haven’t you been reading my emails?”
“Yes, I have, but—”
“Come on, let’s get you back to the office and up in the chopper. You have to see this to believe it. Really.”
Troy frowned. Mack was his closest friend, but even Mack did not know how he had rescued Reuben nineteen years ago. All Troy had told him about this trip and his hang-up overseas was that the owner of the dive shop he used was murdered. He probably could have confided in him, but how could he share the real story with Mack when he had never told Tobi? They went back to the office where Troy always kept a change of clothes. He showered and headed to the roof and their helipad.
The decimation was more than he had imagined. It seemed every year for the last several years, California broke a new record for the largest wildfire in its state’s history. It reinforced their research into the North American winter dipole. The dipole phenomenon accounted for the way in which the melting arctic ice was contributing to, if not causing, freezing cold winters from Minneapolis to New York and creating this excessively dry, windy, hot weather in the west. Prime conditions for sustaining fire.
Now that Troy was here, it would be unconscionable to leave California until the wildfires were somewhat under control. EOE had joined the rescue operations on land both for animal rescue and in assisting the National Guard. Troy had long ago given Mack authority to make major decisions in his absence, and he was glad Mack had thrown their resources in for support, but he had not given unlimited access to the treasuries. Mack had reached his budgetary limit.
By December 30, the fires were finally considered to be contained, and with trepidation, Troy turned his attention back to New York and Tobi. She still had not answered his messages and he was getting cold feet about seeing her, while also feeling desperate that her time was up.
He looked her up again through the New York State Department of Education and found she was still actively practicing medicine and took down her work address. He decided not to show up for New Year’s Eve, as that seemed presumptuous. He booked a red eye flight leaving the evening of January first, and then looked for ways to distract himself while constantly trying to plan what he would say to her. He still loved her, of that he was sure, but he was so filled with regrets, he didn’t know if he could even look at her without falling apart. And what if she wouldn’t speak to him at all?
Chapter 41
It was the morning of New Year’s Eve and Tobi had a sinking feeling in her gut. It was going to be a very busy day. Their rad tech was out with the flu, and when she texted Helen, she replied that they weren’t getting a replacement until 1:00 p.m. They’d have to make it work. They opened at nine, and by ten, there were already twelve patients signed in.
Around eleven o’clock, Teresa came in, having an allergic reaction. She had eaten a muffin just ten minutes before she arrived, which she mistakenly thought was nut free, and was already bright red everywhere, with swelling in her face and neck. Marta rushed her into the cardiac room, and Tobi left the patient she was just finishing examining to tend to her immediately. Theresa required multiple injections, including epinephrine, and Tobi was starting an IV while Marta put her on oxygen and then went to the front desk to call EMS.
While she was on the phone, Stephanopolis came in with his mother. He was eleven years old, weighed about 125 pounds, and was screaming from an injury to his finger, where the nail was partially hanging off. His mother, Mrs. Tacouris, interrupted Marta on the phone with EMS, and demanded that her son be seen immediately because he was in so much pain.
“Give us just a few minutes, we have a serious emergency. We’ll be with you right away,” Marta told her. She went back to answering the endless list of questions EMS asked. “Yes, it’s anaphylaxis. Yes, she is conscious. The doctor is with her now. She is breathing.” Marta glanced backward into the room. “No, she isn’t blue, she’s red. She’s on oxygen. Please, I need to go and help the doctor. Yes, thank you. What is your ETA? Great, thank you.” Marta hung up the phone.
“Wait! You have to help my son first,” Mrs. Tacouris said, “he is an emergency too! Look how he’s screaming!” Stephanopolis howled on cue.
Marta stopped midway back to the cardiac room and looked helplessly at Tobi, who peeked out of the room after taping in the IV. After the first few seconds, Stephanopolis had quieted again, and was standing up, looking around to see who was watching, holding his right index finger out in front of him with his left hand. Tobi quickly noted that he was breathing normally, standing comfortably on his own, and there was no blood dripping anywhere. Screaming kids didn’t scare her, anyway, it was the quiet, listless ones who did. She shook her head subtly at Marta and Marta turned back to Mrs. Tacouris. She very politely asked Mom to sign in and take a seat and promised to be with her next.
“If you can’t see him right now, call me an ambulance!” Mrs. Tacouris said. Stephanopolis started screaming again, although his hand had not moved, and there was nothing around him that might have jarred his finger.
“Ma’am, you’re welcome to take him to the ED, or call an ambulance for him, but we have a more pressing emergency at the moment.”
“What could be more pressing than my son?”
When EMS arrived, they had to physically move Mrs. Tacouris aside. Tobi gave them a quick assessment and they rechecked Teresa’s vital signs, put her on a stretcher, and transferred the IV and the oxygen to their own equipment. The lobster look was beginning to fade a little from the epi and diphenhydramine Tobi had injected. Once they took over, and she could see her patient was stabilizing, Tobi went back into room four to complete the discharge of the patient who’d been interrupted, while Marta brought Stephanopolis into another room for triage.
Another patient protested immediately. “I’m just here for my flu shot, do I really have to wait? I came in before that woman on the stretcher, and there were already two people in front of me, and now you just took that boy ahead of me too. I thought this would be quick.” Visions of zeros danced over Tobi’s head.
When Mrs. Tacouris saw Tobi giving discharge paperwork to the patient whose visit had been interrupted, she again demanded they call an ambulance if her son could not be seen instantly. If I’d had time to call an ambulance, Tobi thought, I’d have had time to look at his finger—which was not EMS worthy in the slightest.
Sometimes the hardest part of her job was to quietly make her triage assessments and follow her gut, no matter how many people were screaming at her. Besides, by definition, screaming
patients were fully conscious and were never in respiratory distress.
She gave her patient his paper work, grateful that he had been understanding, while Marta tried to assure the flu shot lady that they would be with her as soon as possible. Tobi walked into Stephanopolis’s exam room next. He had cut the line of four other patients.
“I’m Dr. Lister. What happened?” she asked without the usual formalities. His vital signs were normal, and he was quiet for the moment. He appeared to have yanked the nail halfway off his right index finger, but there was no active bleeding and the finger looked otherwise intact.
“He caught his finger in the door while he and his sister were fighting. He was trying to shut her out when she was trying to get into his room,” Mrs. Tacouris reported. Stephanopolis nodded frantically and whimpered.
Tobi examined his finger, and Stephanopolis held his breath with his mouth open, prepared to scream again at a moment’s notice. There was only minimal blood where the nail had partially detached, and he had full movement and normal sensation. “I’m going to remove the nail the rest of the way, which will stop his pain, and we should x-ray it. I don’t have a tech here right now, but I can send you to our sister site to make sure nothing is broken.”
“What do you mean, you can’t x-ray it here? He needs an x-ray! His finger is probably broken. And you’re going to hurt him by taking the nail off.”
“Whether or not it is broken, the nail has to come off. It’s the movement of the nail on his exposed nail bed that is causing his pain; the edge is sharp where it was torn and the nail bed is very sensitive. I’m going to spray his finger with a freezing agent, so he won’t feel anything when I cut the nail off. What I want to do will take less than a minute.”
At this news, Stephanopolis became hysterical, crying and screaming again so much that Tobi began to wonder if there was an undisclosed psychiatric diagnosis. There was no mention of it in the chart.
“You mustn’t hurt him! Don’t hurt him! Can’t you see he is in pain?” his mother cried.
Tobi stayed firm, revising her assessment: the mother was the problem. “If you want me to fix his nail, it will be uncomfortable for about a minute or less. Stephanopolis is too big for us to hold down, and it is too dangerous for me to attempt using a sharp instrument on a patient who is thrashing around. It will make him feel much better, but you have to decide if you want me to do it, and then he has to stay still.”
“Can you sedate him?”
“We don’t do that here. If that is what you want, you will have to take him to the hospital.”
Mom reluctantly conceded. “Only a minute?”
“Less than a minute.”
Marta brought in the ethyl chloride and some betadine and gauze to clean the area, and a suture removal set. Mrs. Tacouris held her son in a great bear hug. “It’s all right baby, it’s all right, I won’t let them hurt you,” she cooed at him.
She let him hide his head in her chest and cry while Marta pinned his wrist and hand to the table. Tobi sprayed his finger with ethyl chloride, and eight seconds later, the nail was off. Stephanopolis hiccupped once and then smiled, completely transformed.
“Mommy, can we get ice cream now?”
Tobi left Marta to put a dressing on his finger while she wrote up the chart. Then, Marta called down to their other office, to give them a heads up about who was coming to visit for an x-ray. If there were a fracture, he would need an antibiotic. Mom glared at everyone as she left, and Tobi sent an SOS text to Evelyn.
We are getting killed. Can anyone come sooner?
She went into room three to administer the flu shot.
“I don’t understand,” the patient said. “Your website advertises in and out in less than an hour, and that’s for an illness. This is just a shot, so you should have taken me first! Why do you promise it will be quick if we have to wait around?”
Why, indeed, Tobi thought.
For a split second, Tobi fantasized about putting a “closed” sign on the door, but God must have been watching over her, because Shari walked into the office. She was a rad tech and the staff lead for her own office and theirs. She ordered supplies, changed out their radiation badges, and did some problem solving. She was actually more of a manager than Evelyn, although she needed Evelyn’s approval for expenditures.
“Hi, guys, I’m just here for an hour to do inventory. I know, it’s New Year’s Eve, but they keep begging me to cover other shifts, and I haven’t had time to do my administrative stuff.” She looked around the overcrowded office. “Geez, you guys giving something away? Where’s Jackie?”
“She has the flu,” Tobi gave her a hug. “Someone is coming at 1:00 p.m., not sure who it is. If you’d been here five minutes sooner, I’d have asked you to shoot an x-ray on that kid’s finger, the one who just walked out.”
“Wow. I’ll help you guys out. What do you need? I can bring back a few patients. This place looks like a tornado hit it. What happened in the cardiac room?”
“Anaphylactic reaction,” Marta said. “And then a crazy mom with a spoiled kid in room five. She thought her son should be seen before a life-threatening emergency.”
Shari shook her head. “How typical. Some people think the whole world should revolve around them.”
With Shari’s help, they got the office put back together, the patients in rooms, and then out with their appropriate treatment. Most of them had simple sore throats or stuffy noses, several for less than a day. By 12:45 p.m., it had slowed down enough to breathe.
Tobi’s phone beeped with a text from her wireless service.
Free Message: You’re paying per-minute rates on international calls. See how to stay in touch for less with the Unlimited Together plan.
Great, she thought. Why do I always have to find out like this? Numerous times, she had discovered Ben’s whereabouts only after getting a text from Verizon, or sometimes from Citibank, informing her that her credit card had been used outside the United States. She copied the text, and below it, she wrote:
Where are you?
... and sent it off.
She went in to the next patient, who was thankfully, a straight forward urinary tract infection. Before she even finished, she heard the “popcorn” sound she had assigned to Ben’s texts.
She opened the text, and time slowed to a crawl.
We found a last-minute deal to Nicaragua for the New Year’s holiday so decided to jump on it. $300 airfare and hotel! Definitely a little seedy but worth the price and the food is great.
Below that was a picture of him in a blue button-down shirt, jeans, and flip-flops with Rachel in a white summer dress. They were holding hands on a lit-up tile path near some palm trees. There was more.
Apparently, the city government has a deal with the cartel where there’s no violence between Christmas Eve and New Year’s.
Tobi stared at the phone. Really? Nicaragua? The last time she “accidentally” discovered he’d gone away, it was only to Canada, and before that he’d gone to Mexico. But … Nicaragua? And who would’ve told her if something had happened? She wouldn’t even have known in what country to look for him! She had no words to answer, and she needed to take a breath first and think it out. She went into the next patient’s room, an uncomplicated strep throat, but she could barely focus.
Ben did these things! He had this attitude about life, that somehow everything would work itself out. She often said that was his middle name: “Benjamin ‘I’ll-figure-it-out’ Lister.” The infuriating part was, he usually did. She tried to remember if her text went as an iMessage, as a clue to if he were even in a place with internet access. She couldn’t remember if it had sent in green or blue. As if it mattered, it was just to keep her mind off drug cartels in Nicaragua.
Ben had been all over the country and all over the globe, eastern and western Europe, Iceland, Hawaii, Australia, Colombia, and Is
rael. These days, he usually told her when he was going somewhere. Eighteen months ago, Rachel had taken him to Athens, Greece, for the long Memorial Day weekend, to celebrate his finishing his first year of med school at Columbia University. The two of them often traveled to exotic places that Tobi had barely even dreamed about. Ben was like Troy that way, always ready to hop on a jet.
She discharged the patient with strep on some amoxicillin and set to answering Ben’s text. She wanted to shake him—scream at him—What were you thinking? But what if something happened down there, and those were the last words he ever heard from her? She wouldn’t be able to live with herself. Instead she wrote:
Great. Truce ends tomorrow. Way to give me a heads up. Guess I can’t talk to you tonight to wish you a happy New Year. So, happy New Year. You’re going to owe me for the Verizon charges.
Popcorn sound.
Are you at work?
Tobi typed back.
Yes. It’s crazy
I’ll be home tonight
All night
Popcorn.
Ohh Mom, I feel bad then. The Verizon text was because I called Dad in Israel. I was on the phone less than a minute and called back to the 516 number. I’m not in Nicaragua, lol, I was just kidding.
Tobi became aware of her heart pounding and the sweat on the back of her neck. She remembered she was supposed to breathe. Shari was staring at her.
“Are you okay? What just happened? You look … green.”
She swallowed and showed Shari all the texts.
Shari shook her head. “Geez, is this what I have to look forward to when I have kids?”
“I hope not, for your sake. The thing is, it would be completely within character for Ben to have done that. He’ll go halfway around the world on an hour’s notice, if he gets a good deal and the mood hits him. He’s always been like that.
Code Blue Page 19