“Do you remember me? The last time I was in, you insisted that I go to the emergency room. I was so resistant, I made your life hell. They took out my appendix, it was about to rupture! It’s a good thing I listened to you.”
“I remember hearing about that,” Tobi said. Look at that, she thought, an unnecessary ED transfer. “I’m glad it worked out. You look good. What can I help you with today?”
“Infected finger. I was scratched by a neighborhood cat, and I guess I neglected it. Now it’s all full of pus and there’s this thing growing over my nail, and it hurts.”
Tobi looked at his index finger. “You have a paronychial abscess—that’s the pus pocket, but you’ve also got a pyogenic granuloma.”
“A pyo-what?”
“It’s just extra tissue that was hyper-stimulated and has started growing over the nail. We’ll have to remove that.”
Peter pulled his hand back. “That sounds painful. Can’t you just lance the pus part and give me antibiotics?”
“I’m going to do both of those things, but that won’t get rid of this extra tissue. Don’t worry, I’ll numb your finger first.”
Esther came in to assist, and after doing a digital block to numb Peter’s finger, Tobi used a finger tourniquet to stop the bleeding, lanced the abscess, and drained it, and cut away the granulation tissue with a scalpel, then cauterized the area with silver nitrate.
“I didn’t feel a thing! Thanks, doc.”
Tobi got Peter’s paperwork together and sent him a script for an antibiotic. Then she documented the history, the review of systems, the exam, the procedure, the billing portion, and the tetanus shot given on the opposite arm to the injury. These days they were required to fill in not just the lot number and expiration date, but also the NDC code on the vaccine. Again, because they could no longer be reimbursed for it otherwise. She tagged the abscess culture to be sent as well.
As usual, the documentation had taken longer than Peter’s evaluation and treatment; it seemed that ninety percent of charting was done for the sole purpose of satisfying the insurance company. At least she felt like she’d done something useful for a change, instead of dodging antibiotic requests for colds. Maybe it would be a rewarding day—if she didn’t have to send anyone to the hospital and start worrying about that now too. Her nerves were on edge.
Chapter 52
Kazi came down the steps of the elevated train, or “el,” as it was referred to, and hopped in Mannfort’s rented BMW on Archer Avenue in Jamaica. He gestured at the street as they pulled into traffic.
“Mannya, this city is disgusting. Trash everywhere, and dirt! It’s amazing, it’s supposed to be such a rich country. But, look, I found connections. The hacker was communicating by email with a couple of places. One looks like the American Medical Association, which could be a big problem for us. The other is an organization called Executors for Our Earth. It’s based out of California, US, and there are a lot more emails between them. Owned by some overgrown hippie type. Look at this guy. Isn’t he too old to have his hair this long? Bloody Americans.” He held up the picture on the website.
Mannfort grabbed at Kazi’s phone. “Let me see that face!”
“Easy, Mannya, you’re driving! The Americans drive like piss. We can’t get stopped for a stupid auto wreck.”
“That’s him! That’s the guy from the dive shop!”
“I thought you killed the guy in the dive shop.”
“No, the other guy. The one who came in crying, the one that divemaster knew. Sokowsky’s friend, I’d have bet on it then. After we’re done here, we have to go to the west coast and find him, find out what he knows, and annihilate him too. The list is getting long, Kazi, too many people involved. It’s becoming a mess. That damn Sokowsky! Didn’t have the grace to just die like we thought. What was in the emails?”
“I haven’t figure that out yet, he encrypted all of them. All I can tell so far is where they were sent to; I can’t read any of them yet.”
“Any emails to the sister?” Mannfort asked as he rubbed his nose where the mask had been irritating him. Even though he’d taken the thing off in the first men’s room he’d found, it felt like he was still wearing it.
“Nyet, I didn’t see any. Mannya, maybe she knows nothing. This could be an unnecessary risk we take. Let’s just knock off the toad and go home.”
“At this point, it is irrelevant. They all have to go. You really think Sokowsky did not talk to her in all these years? At the very least, now she knows someone wants her dead, even if it is just a miserable, incompetent fool. She will start asking questions that we cannot afford.”
Chapter 53
The next patient was Linda in room three. She was wearing skin-tight blue jeans and a heavy, brown cable sweater. Her boots were made of fake fur and came to her midcalf, and she looked uneasy as she sat on the exam table.
“Hi, I’m Dr. Lister. How can I help you today?”
“Hi, doctor. I found a spider walking on my hand last night. I have a phobia of spiders, they terrify me.”
Tobi pulled on some gloves and walked over to her. “No worries, we’ll fix you up. Let’s see your hand. Did it bite you?”
“No, I screamed and shook it off.”
“Oh,” Tobi was puzzled. “Do you have any bleeding or itching?”
“No.”
“Did it leave any marks?”
“No.”
“Do you have any pain?”
“No.”
So much for a rewarding day. Tobi struggled to find her compassion. This person was obviously suffering, it just wasn’t from a spider bite. “So, what brought you in today?”
“I told you. I saw a spider on my hand, and I’m deathly afraid of spiders.”
Tobi took a deep breath. She examined Linda’s hand carefully and there was no evidence of anything amiss. She also listened to her heart and lungs and looked in her mouth.
“Well, Linda, it’s good news. No problems from the spider. You’re going to be fine.”
“Are you sure, doctor?”
“Yes, everything is fine. The spider didn’t bite you and everything looks normal.”
“Oh, thank God! What do you think I should do?”
“About the spider? If you see it, kill it. But you may have scared it as much as it scared you, so it may hide from you now. I wouldn’t worry about it.”
“Okayyy, if you’re sure ….”
“I’m totally sure. Don’t worry.”
The day passed in much the same way. It seemed like the neurotics were out today, coincident with the full moon, but Tobi didn’t have the patience she ought to. She was having difficulty concentrating, and she guessed it was a blessing she did not have anyone who was truly sick. Troy had brought bagels, lox, and cream cheese for the whole office, which made him quite the hero, and it irritated her. She had not yet decided if she was going to forgive him, or if she wanted him to have any part in her life after this was all over, but there he was, playing up to her staff. They would no doubt soon be gossiping behind her back about the doctor’s “friend.”
Her phone beeped with Reggie’s text.
Hey, kiddo. Just checking in on you. Any spooky noises going ‘bump in the night’? Let me know you’re okay. Holler if you need anything.
Tobi smiled. Reggie always made her feel like she wasn’t alone. She felt guilty not telling him about Ismar’s attempted break in, but the thought of starting that conversation was exhausting and she certainly didn’t have time to answer all his questions while seeing patients. She’d apologize and fill him in later. Besides, she’d have to explain Troy, and that would be an even longer conversation she wasn’t ready for. She hadn’t explained it to herself yet.
Nikolai was the next patient. Esther brought him into a room and triaged him and then gave Tobi a summary of his problem.
“
So, he was at the dentist this morning for a procedure,” Esther reported, “and they numbed him up. Now his ear feels funny, and he noticed blood coming out of it.”
“Hi, Nikolai, my name is Dr. Lister. How can I help you today?”
“Hello. Yes, I had a tooth filled this morning, and now my ear is bleeding.” Nikolai had a Russian accent but seemed very comfortable speaking English. “He gave me two shots in my mouth, isn’t that too much?”
“Not necessarily,” Tobi shrugged, “sometimes it takes more than one to make the area numb. Was it just a filling, or was it an extraction or root canal?”
“No, just a filling.”
“And now your ear hurts?”
“No, I actually can’t feel my ear well at all, it feels strange, but I touched it, and there was blood. He had to have done something to it.”
“The strange feeling is probably from the novocain.” Tobi couldn’t imagine how a dental procedure could produce tympanic rupture. She asked him all the standard questions. Was there fever? Sore throat? Sinus congestion? Had he been swimming or flying recently? He answered no to all.
“Did you stick anything in your ear?” she asked. Also, a standard question, usually aimed at eliciting a history of an overly vigorous use of cotton swabs.
“Well, yes, I stuck my key in it.”
“Your key? Why did you put your key in your ear?” Tobi had seen all kinds of things land in ear canals, but keys were a first for her.
“I had an itch,” Nikolai said, as if people did that every day.
“Oh,” Tobi said. “Did you use the key before you noticed the blood?”
“Uh, yes,” Nikolai answered, but he still didn’t seem to understand where the questions were going.
Tobi took the otoscope and looked in his right ear. Sure enough, there was fresh blood on the floor of the ear canal, just inside his ear. The bleeding had stopped, but the ear canal was pretty scraped up.
She stepped back. “Nikolai, you cut the inside of your ear with your key. It’s lucky you didn’t go all the way in, you might have damaged your ear drum. Umm, it’s really not a good idea to stick things—especially sharp things—into your ears.”
Nikolai stared at her. “It wasn’t from the dentist?”
“No, not at all. Except that you probably didn’t feel yourself doing it because of the anesthesia the dentist used. But no … you did this to yourself.” Nikolai’s face was impassive. “You should let the shower water hit the side of your face to rinse your ear, and I’m going to give you an antibiotic cream to use, called mupirocin. Just put a little bit barely inside the ear canal a few times a day for two to three days, so it doesn’t infect.” She was about to describe the use of the cotton swab for this, then checked herself. “I only want you to apply it with your little finger. Do not use anything else but your finger, okay? And just a tiny bit. Oh, and wash your hands first.”
Give this guy a cotton swab, Tobi thought, and he’ll be back with a perforated eardrum tomorrow for sure. Anyone who had ever worked urgent care or emergency medicine believed in the moon’s influence, and today was a flawless testimony.
Chapter 54
Mannfort picked through the contents of his emptied suitcase on his bed and went through the door to Kazi’s adjoining room. Mannfort had wanted to make it look like they did not know each other, but there was no other way to get adjoining rooms and neither of them was going to carry weapons parts through the hallway. Kazi had already started reassembling his equipment.
Between them, they had brought two semiautomatic rifles, two Makarov pistols, and the ingredients to make a variety of explosives with just a few local purchases. Somehow, they’d managed to avoid the dogs sniffing around at customs. Mannfort had wanted to mail ammunition ahead of time, but Kazi told him it was not needed. There was a sporting goods store down the road from the hotel, and it was easy to buy bullets in America. Kazi had been right; a quick stop had gotten all the ammo they would need.
“What’s that?” Mannfort asked, pointing at a knife lying on the bed. “How’d you get that through security? Kazi, you could have jeopardized this mission.”
“It’s Grivory, I had it pinned to my leg under an air ankle brace. I just bought it.”
“Never heard of it.”
“It’s a synthetic, Mannya, you need to stay up to date with progress. It’s a polyphthalamide. Strong, weather-resistant, holds an edge nice, and it’s not metal, so gets past security, especially if you bury under a plastic brace. I don’t go anywhere unarmed. I just haven’t had time to practice with it yet; it’s lighter than my usual blade.”
“Well, don’t miss if you throw it,” Mannfort said.
Chapter 55
The Lenman’s were in the next room. Mrs. Lenman was there for a bad cold this time.
“Happy New Year, Dr. Lister. Look, my hand is all healed up! I was so happy to see your name on the board.”
“That’s terrific. How was your Thanksgiving?”
“It was wonderful. And Harry finished the soup for me, so we were able to bring it along.”
“It’s the first thing I’ve cooked in years,” Mr. Lenman said.
Tobi chuckled. “Well, then it was a good growth experience, but I’m sure you would have had a great time even without it. I can’t imagine there was a shortage of food.”
“Oh, no, God forbid! But we did get some news of our oldest grandson. I don’t know if I’ve ever told you, he has a drinking problem––”
“Had a drinking problem, Mildred, the boy has really turned himself around.”
“Yes, Harry, you’re right. He’s been going to those ‘As’ and it seems to be working. He’s coming up on one year completely sober. We’re so proud of him.”
“That’s fantastic!” Tobi said. “That takes a lot of self-discipline and major life changes.”
“Yes, yes, and that’s not even the best part. You see, he did a lot of damage to his liver, and he’s been very sick. How long was he drinking, Harry?”
“Over twenty years, Mildred, he started in his teens. None of us even knew!”
“Yes, twenty years. So, he has a liver that doesn’t work so good. But a nice man came to him and told him that now that he’s been sober almost a year, he’s going to try to get him on the liver transplant list. They wouldn’t even consider it before, but now that he’s been so successful and hasn’t had a drink—”
“So, we’ve decided to mortgage our house to help him pay for this program,” Mr. Lenman said. “They will help get him to the top of the transplant list, and then they cover the surgery and all the medication and rehabilitation afterward, and homecare too. His Medicaid will never cover all that.”
Tobi’s head jerked up. “What’s the name of the program?”
“I don’t remember, but the man was so nice,” Mrs. Lenman said. “Of course, our grandson doesn’t have the money for it, he hasn’t even been able to work the last few years, poor dear. But that’s where we come in. Right, Harry?”
“Yes, Mildred, it’s the least we can do for him.” He turned to Tobi. “So, we can finance it or pay it all up front. Either $15,000 a month for three years, or we can give them a lump sum of $400,000 and it covers him forever. That’s a huge discount!”
“Do you know, Dr. Lister,” Mrs. Lenman said, “he’s the one who’s always been the nicest to us, no matter what he was going through. He always remembered his grandmama and grandpapa.”
Tobi wanted to scream. “What is this company called? Have you checked them out?”
“Oh, yes, we will,” said Mr. Lenman.
“I think it’s called Kodiak.”
“No, Mildred, that’s a bear. It’s got something with a cat in its name.”
Tobi didn’t think anything could put her into shock by this point, but she struggled to breathe. Not the Lenmans! She stood up and walked over to them
and took each of their hands.
“You mustn’t do this, not with these people. It’s ‘Kordec,’ right? Is that the name? It’s a—a scam. And worse. They’ll take your money, and your grandson—he won’t be safe. Please, do not do this.”
Mrs. Lenman looked near tears. “We thought you’d be so happy for us.”
“I’m ecstatic about your grandson’s sobriety! But this company … I’ve heard terrible things about them. They’re not good at all. They’ll take your hard-earned money and you won’t be happy, please trust me on this! Have you had a lawyer look at their contract?”
“Both our son and daughter-in-law are lawyers. They poo-pooed it, but they don’t like us much. That’s why we have to bring soup for the holiday.”
“Then you must show it to someone else.” Tobi felt frantic and for a moment considered hiring a separate lawyer for them herself. She suddenly realized that by talking to the Lenman’s this way, she was nailing the target to her back, but there was no way she was going to let them go through with this. “Please, promise me you won’t mortgage your house, at least not without a lawyer.”
“The nice man has a lawyer for us, just to make sure everything is fair,” Mr. Lenman nodded.
“No, you must get your own lawyer!” Tobi realized she was shouting and the Lenmans looked distraught.
“Please, trust me,” Tobi said to them. “These people are not good people, they will just take your money, and your grandson … he could end up getting hurt. You know I only want the best for you.”
The Lenmans looked bewildered as they shuffled out of the office, and Mrs. Lenman dabbed at her eyes with a tissue.
Tobi wished the office would slow down for a few minutes so she could talk to Troy. This was worse than they had thought. The Lenmans’ grandson wasn’t even on a donor list yet. But there didn’t seem to be a moment when there was no one waiting to be seen; it was a steady stream all day, and she found herself going through the motions while her mind raced a million miles a minute.
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