by D. J. Palmer
I knew I shouldn’t be drinking at all, and I didn’t do it much. I had to be careful how much I sneaked. I’d definitely watered down more than one bottle of vodka and tequila. And when that extra bottle of wine Mom thought she had in the liquor cabinet went missing, she was kind enough to blame herself instead of asking me. Mom had never found my hiding place in my bedroom where I kept a fifth of vodka. I liked the buzz I got from the booze. It helped me cope with things that I wished I didn’t have to cope with. Were my covert trips to the Gerard liquor cabinet what made my stomach sick and my vision go all blurry? I didn’t think so, but I did have a couple swigs from my secret stash before I got sick and ended up in the ER. Either way, I wasn’t about to find out if it was a possibility.
“No. I don’t drink,” I said.
Dr. Nash wrote something on her paper. I couldn’t tell if she believed me. Not sure I cared.
“Do you go to the bathroom regularly?”
“Yes,” I said, stammering, feeling a bit caught off guard.
What does that have to do with anything?
“What about your bowel movements?” She tossed out the question nonchalantly, like it couldn’t possibly be an embarrassing topic.
“Um, yeah, sure.” I gripped the edge of the table, crinkling the paper underneath the palm of my hand.
“Are your bowel movements firm?”
God, lady! “Um, yeah, I guess. I don’t always look.”
And that was the truth.
Her pencil scratched something out on her paper. “And are your periods regular?”
Clearly, this doc was not into boundaries. My face went hot and I knew I turned red with embarrassment. I didn’t know why that happened. I shouldn’t have been embarrassed to talk about my periods with another woman. She had them, too, but I had only a few bits of privacy left, and I wasn’t prepared to let another piece go. But away it went.
“Yeah, my periods are regular.”
I resisted the urge to add: Just like my poops.
“Do you ever have cramping?” she asked.
I nodded slightly.
“Do the cramps happen at school or home more?”
“School, I guess,” I said. “When I go.” I heard my voice getting softer.
“What about when you’re out with friends?”
“Maybe … sometimes … but I don’t go out much these days.”
“That must be hard on you.” Dr. Nash gave me a genuinely sympathetic look, and I relaxed a little. I reminded myself that she was just doing her job.
“It’s not fun.”
That wasn’t much of an answer, but I couldn’t think what else to say. When in doubt, I usually went with as few syllables as possible. Adults seemed to expect it, or at least they accepted it.
“Have you done any traveling lately? Gone anywhere exotic?”
Maybe she thought I’d just come back from the Caribbean and picked up some bug while I was there. Didn’t she see how pale I looked? I had the coloring of an envelope. Didn’t I just tell her that I barely left home? I could see the tablet that stored my medical chart on a desk in the exam room. There were probably reports from a hundred doctor visits (and I’m not exaggerating the number) in there. There must be some report about how much school I’d missed, or how I didn’t play sports anymore, or how I hardly did anything that didn’t involve my phone.
I again explained to Dr. Nash how boring my days had become since I got really sick, and she seemed genuinely sorry to hear that, but still, I was surprised she didn’t know. Then again, those charts told only part of my story—the part that could be explained in numbers and test results, but they didn’t tell the whole story of me.
In a way, it was a relief to share the more personal details with Dr. Nash. It made me feel like a whole person and not just the sum of my lab results. I liked this new doctor. I really did. I felt like she might be onto something, that she was going to have some big breakthrough because she was taking a different approach.
I didn’t get into the whole mitochondrial disease thing with her. I didn’t really understand what it meant anyway. Conceptually, I got it. My cells sucked at making energy. But that was all kind of abstract. This conversation felt more real. For no reason at all, I was overcome with this rush of joy, an uplifting feeling of pure elation. I had a premonition that Dr. Nash, this Wonder Woman, was going to unravel the mystery of Meghan in ways that nobody was expecting.
New hope blossomed inside me. Not only did I think Dr. Nash was going to find a cure, but she was also going to become my friend. More than that, I felt she was going to be someone in whom I could eventually confide my secrets.
CHAPTER 13
BECKY
Becky stepped into Dr. Nash’s tidy office, which was tucked in a corner of the GI floor. Meghan was on her phone in the waiting room, perfectly occupied, but she should have been with her father. Becky simmered over the fact that Carl was not at the hospital with them, but no, he had too much work and could not bear to pull himself away for even a few hours to talk with a doctor about his daughter.
Damn him!
Their fight had lingered. His accusations continued to sting. Veronica had been right to question Carl’s transformation into the man she needed him to be.
Becky purged Carl from her thoughts in order to give Dr. Nash her full attention. She planned to record this conversation on her phone, with Dr. Nash’s permission, of course. The audio recordings were extremely helpful when needing to recall information verbatim.
In the back of her mind, Becky thought about the experimental mito drug, Elamvia. After this appointment, she had plans to meet Dr. Fisher to inquire about Meghan’s place in the line of patients eager to begin the clinical trial. She wondered if Dr. Nash’s diagnosis might bring up the possibility of a new experimental drug or treatment for them to consider.
For some reason—wiliness when it comes to mind games, age, a natural competitiveness—Becky had a harder time working an angle with young female doctors. It was not a question of ability, but her usual approaches often did not have the same effect. Making matters worse, Dr. Nash gave off all the warmth of an iceberg. Becky searched the doctor’s pretty face, peered into her muted brown eyes, but could not pinpoint a single trace of empathy or compassion.
She felt a niggling concern that Dr. Nash held her in some kind of contempt. She brushed away the worry as paranoia and nothing more. After so many setbacks, it was easy to see the worst in nearly every situation.
Becky searched the office for a picture of Dr. Nash’s family, a husband smiling in a silver frame, maybe two or three gorgeous kids—clearly, they’d be gorgeous. She wanted something that would give her some insight on the woman, not the doctor, but there was nothing to be found. A few small houseplants were the only clue that Dr. Nash cared for something other than her patients.
“Do you mind if I record our conversation?”
Becky explained the value of the recording to Nash, who had no hesitation in giving her consent. Becky put her phone on the desk, launched her dictation app, and gave a nod to indicate that she was ready.
“I’m going to recommend that Meghan have an endoscopy, specifically an enteroscopy,” Dr. Nash began. She took off her glasses, cleaning the lens with a white cloth retrieved from a desk drawer.
Becky felt a stirring of surprise, but not because the procedure was unfamiliar to her. Meghan had already had an enteroscopy last year—certainly Dr. Nash had read that in her medical history. Becky wondered why she wanted to use the specialized instrument to view Meghan’s small intestine again.
“Do you think she has giardia?”
Becky knew without having to ask that the parasite was one common reason to order that particular test. It could explain Meghan’s stomach cramps, but did it address complaints of blurred vision?
“No, I don’t think she has giardia,” Dr. Nash replied coolly.
“Well, what, then? Why that test?”
Dr. Nash sighed aloud. “I’ll be c
andid with you, Mrs. Gerard. The test is more for my benefit than for Meghan’s.”
“Your benefit?”
“Yes, it would be irresponsible of me not to rule out all possibilities. So I’ll order the test, knowing in advance that it’s going to be negative.”
A hot streak raced up Becky’s spine. “And how do you know the results without first performing the test?” she asked.
Dr. Nash paused before answering.
Becky folded her arms low on her lap, a defensive posture.
“Mrs. Gerard—”
“Please, call me Becky.” Amanda Nash may have been younger, but Becky was not going to be ma’amed by her.
“Becky, then. What I’m going to say may be rather difficult for you to hear.”
The spurt of anger Becky had felt was quickly replaced with a fresh stab of fear. It’s cancer … it’s going to be cancer.
“I’ve spent considerable time reviewing your daughter’s … how to put it … rather extensive medical history, and there is a problem, but it’s not one I think you’ve considered.”
Becky braced herself. Again, the word “cancer” tumbled about her head like a wheel coming free of its axle.
“I’m postulating that there’s nothing wrong with Meghan. Nothing physical, anyway.”
Becky’s eyes narrowed, her expression incredulous. “What are you talking about? You said yourself that you read her file.”
“Yes, I read a lot of symptoms that don’t have any correlating explanation in terms of Meghan’s biology. Her labs, her blood work, all of it is fine.”
Becky heard Carl’s voice in her head: I’m not saying you’ve done it intentionally. I’m asking if we’ve created a self-fulfilling prophecy here.…
“No, no,” Becky said, shaking her head, her body trembling with anger. “Dr. Fisher has diagnosed her with mitochondrial disease.”
“Those labs were inconclusive,” Dr. Nash said in a matter-of-fact tone. “I understand Meghan is taking a variety of vitamins and supplements as part of her treatment.”
“Yes,” Becky said. “Dr. Fisher called it a mito cocktail. And she’s on a waiting list to be part of a clinical trial for Elamvia, a new drug to treat mitochondrial disease.”
“That’s all well and good,” Dr. Nash said. “But I believe all those treatments are going to perpetuate the problem, which is that Meghan believes she’s gravely ill.”
“But she is sick!” Becky almost jumped to her feet. “Dr. Fisher—”
“Dr. Fisher’s diagnosis, as I said, was inconclusive. I’m the head of GI at White, and very experienced in pediatric care, and my read of Meghan’s medical history and my exam of your daughter tells quite a different story. I would think this would be welcome news, to hear that it’s not something physical.”
“It’s … it’s … not something that I believe.”
“Have you ever heard the term ‘functional disease’?” Dr. Nash asked.
Becky, who thought she’d read about every medical condition under the sun and felt confident she’d do well on a medical school entrance exam if she had to take one, confessed to never having heard the term before.
“What about ‘psychosomatic’?” Nash inquired.
Now, that was a word Becky knew quite well, and the implications made her blood burn. “What are you saying? That it’s all in my daughter’s head? That she’s not sick in the slightest? That I’ve been wasting my time and Meghan’s, shuttling her from doctor to doctor? Is that it?”
Carl’s voice again: I’m not saying you’ve done it intentionally.…
Dr. Nash pulled her lips tight. “She’s not making it up like a lie,” Dr. Nash eventually said, “but I think there are some deep inner conflicts here that need to be explored.”
Becky blinked rapidly. “‘Inner conflicts’?”
“I believe Meghan is exhibiting subconscious behaviors. Because of some external stress, those behaviors are manifesting as bodily symptoms,” Nash explained. “That’s what we mean when we say ‘functional disease.’ There’s a symptom—say, for example, upset stomach or blurred vision, weakness, fainting, general malaise—with no inducer stress, and by that I mean no biological component to explain the symptom.”
Becky strained to get her mind around the implications. Countless doctor visits, innumerable tests, endless worry—all because it was in her child’s head? She refused to accept that Carl could be right, or that her own self-doubt was anything other than wasted worry.
“I’ve never for one second questioned my daughter’s mental health.”
“Well, it’s not something you’d have a window into,” Dr. Nash said. “Which is why I’m recommending Meghan see a pediatric psychiatrist. Quickly, too.”
“A psychiatrist? After she came into my room clutching her stomach, complaining she couldn’t see right, you want her to see a shrink?” Becky’s voice rose sharply.
“It could help us identify the stress that’s causing your daughter’s symptoms,” Dr. Nash explained.
“It’s just your opinion that it’s stress, but you’re stating it like it’s a fact.”
“I’ve read her medical file, and I’ve examined your daughter.”
“And so did Dr. Fisher, and he came to quite a different conclusion.”
“No surprise there,” Dr. Nash retorted with a look and tone that implied some secret history with Dr. Fisher.
“What’s that supposed to mean?” Becky’s pulse spiked. She felt protective of Dr. Fisher, the one person she believed could help, and took Dr. Nash’s tone personally.
“The stress could be from anything,” Dr. Nash said. “Your marriage, for instance.”
“My marriage?” Again, Becky found herself having to tamp down her anger.
“Is everything all right at home?”
“It’s fine,” Becky said, hoping she came across convincingly.
“No issues?” Dr. Nash made it sound like that was impossible.
“Yes, of course there’s stress around Meghan,” Becky said. “Her health and all we’ve been dealing with, but we’re fine. We’ve been together a long time.”
“Length of time doesn’t necessarily translate into a happy marriage.”
“Pardon my candor, but I don’t really think my marriage is any of your concern,” Becky said. “That’s certainly not why I took Dr. Fisher’s advice to have Meghan come see you.”
“No, that happened because Meghan’s symptoms don’t fit with Dr. Fisher’s diagnosis. In fact, they don’t fit with any diagnosis—except mine.”
“That it’s in her head.” Becky made it sound ridiculous.
“Precisely. Which is why we need to stop her vitamin therapy and all supplements she’s taking immediately. In Meghan’s mind, it’s reinforcing the notion that she’s gravely ill. In the meantime, I’ll advise Dr. Fisher to remove Meghan’s name from the Elamvia clinical trial consideration. She needs a psychiatrist, Mrs. Gerard, not another drug or treatment.”
In a flash, Becky was on her feet, hands clenched into fists at her sides. “That’s utterly ridiculous,” she said, seething. “We haven’t even given the vitamin therapy a chance to work.”
“It will never work, because there will always be something until we get to the source of her stress.”
A sharp, piercing tone flooded Becky’s ears. All other sound in the room—the click of Dr. Nash’s nails on her desk, the humming white noise of the hospital—dipped to a nearly imperceptible level. She heard Dr. Fisher’s dire warning about early treatment helping to slow the progress of mitochondrial disease; recalled the personal story he had shared about his son, Will—not to frighten her, but to emphasize the importance of early intervention. And now this Dr. Nash, this prissy know-it-all, this god-awful poseur, was making outlandish claims about Meghan’s mental health and her marriage, of all things. How dare she! How dare she!
No! No! No! the voice screamed in Becky’s head. This is unacceptable, utterly and completely unacceptable.
Beck
y snapped back into herself, fixing Dr. Nash with the kind of angry look Carl had helped her perfect. Of course, Becky was not going to say anything to Nash about her husband’s concerns, because the two of them were too closely aligned. She already felt alone in this battle and did not need Carl to have an ally working against her.
“I appreciate your time,” Becky said in a calm and even manner. “But I’m not taking your advice, and I don’t want to leave here giving you the impression that I might. As for the endoscopy, I do want that done, but I’ll find another doctor to perform the procedure. From what you’ve said, I wouldn’t trust you to be—well, let’s just say I’d be more comfortable with another doctor, and we’ll leave it at that.”
Dr. Nash exhaled loudly. “I can see your position. However, I have an obligation to be involved, for your daughter’s sake.”
“Well, I’m sorry to be rude, but I don’t want your help.”
Dr. Nash fell silent for a time, making Becky extremely uncomfortable. “I understand how you feel,” Dr. Nash eventually said.
With that, Becky collected her things and left the office.
CHAPTER 14
ZACH
Zach inhaled half a protein bar after ending a call with the parents of Baby Sperling, the young infant he’d correctly diagnosed with Ondine’s curse. They were doing surprisingly well, given the circumstances, and were relieved to finally have a diagnosis to go along with a treatment plan. This fueled Zach more than any protein bar ever could. It was a reminder that every day brought with it the possibility of making a difference in another person’s life. But he knew better than to think he could help everyone in the way he had helped Baby Sperling.
He checked the time, anticipating Amanda Nash’s imminent arrival. She had called an hour earlier requesting an urgent meeting to discuss Meghan Gerard.