by D. J. Palmer
“So why did you diagnose her with mito?”
“Given the patient’s needle phobia, I opted to rely on my clinical findings and other noninvasive observations to pursue a diagnosis. Oftentimes that’s equally as effective as other diagnostic measures. I was looking at a patient with a progressive disorder that involved multiple organ systems, fitting the disease criteria.”
“But then Meghan got new symptoms.”
“Yes, she did.”
“In your opinion, were those related to mito?”
“Mito is an unusual disease. The symptoms can be extremely variable from person to person, so it wouldn’t be out of the question, but my thought at the time was that it did not seem to fit the disease pattern as I know it.”
“What is the disease pattern as you know it?”
“Mitochondria produce ninety percent of the energy our body needs to function. The symptoms depend largely on which cells are affected, and the range of symptoms can be from mild to severe. Typically, the disease presents with muscle weakness, exercise intolerance, maybe some vision problems, fatigue. There can be GI issues as well, but what Meghan experienced at home was unusual given how the symptoms tend to occur more insidiously over time. But when Meghan came to the ER with sudden severe gastrointestinal issues and equally sudden vision problems, I became concerned.”
“So you referred the patient to Dr. Nash.”
“I did.” Zach flashed Amanda an angry look.
“And she came to a different conclusion?”
“I think that’s obvious,” he answered.
“Please answer the question yes or no,” the attorney stated flatly.
“Yes.”
The attorney scanned her notes. “One more question, Dr. Fisher,” she said. “Has an insurance company ever denied your claim for a mito cocktail with an inconclusive or negative result on a genetic panel for mitochondrial disease?”
Zach swallowed hard. “Yes. On a few occasions.”
“Could it be ten?” the attorney asked.
Zach thought before answering, though he did not need to. “It could be that.”
“And who paid for the continued treatment you prescribed despite the insurance company’s objections? The hospital or the patient?”
“Um—” Zack felt the full weight of Becky’s stare without having to look at her. “I explained to the parents the risks of stopping treatment. In most cases, the parents agreed to cover the cost.”
“But not all?”
“No,” Zach said. “Some of the patients’ parents were not able to meet the cost burden.”
“In that case, who paid?”
“The hospital, I believe, had to absorb the cost.” Zach thought he could see Knox Singer grinding his teeth.
“And why did the insurance companies deny payment for your prescribed treatment?” the attorney asked.
The microphone broadcast Zach’s heavy inhale. “They didn’t believe my diagnosis, because I had made too many of them,” Zach said.
“No further questions, Your Honor,” the attorney replied.
CHAPTER 27
BECKY
Becky and Carl made their way down an austere hallway until they reached the entrance to the Behavioral Health Unit, located in the newly constructed Mendon Building. Becky trembled with excitement. It had been four days since she’d last set eyes on her daughter. Questions of how much Meghan had been eating, how thin she’d be, how frail she’d look gnawed at her. When she thought of the possibilities, she was overcome with sadness and grief.
The door to the unit buzzed open, and there was Nash in her white lab coat, arms folded, waiting. Zach had forewarned Becky that Nash would be running the show, even though the Behavioral Health Unit was Levine’s territory. He speculated, correctly so, that the social workers and Meghan’s new guardian would take a supporting role given how this case had the potential to be high profile—and Nash, who could be as ego-driven as any surgeon, would see an opportunity to raise hers at White even higher.
“She’s going to want to control the situation as much as possible, and she’s got the clout with Knox Singer to do just that,” Zach had said. “So whatever she tells you, best to play by her rules.”
Becky took the advice begrudgingly.
Nash’s penetrating gaze shifted over to Carl, and her forbidding expression softened. Becky felt outnumbered. It was as if those two were in cahoots, having secret conversations about Becky’s unfitness as a parent.
As much as she wanted to, Becky and Carl had not reconciled. There was no big “aha moment” after the trial when rose petals tumbled from the sky, trumpets blared, and all was forgiven. There was only nervous anticipation.
They had arrived at lunchtime. Becky observed a large food cart parked near the secured entrance. A group of young people, as diverse as any city high school, dressed in comfortable street attire, retrieved trays of hot food from one of two open compartments below. A stout woman, her dark hair stuffed inside a hairnet, oversaw the self-serve process, repeating that the mac and cheese was in the left compartment, and turkey and gravy in the right. Everyone called her Loretta. She was friendly and greeted each patient by name. She called them “dear” and “sweetheart” and “darling.”
“Meghan’s very excited to see you,” Nash said. “I’ll take you to her in a moment, but first, I have to ask if I can see what’s in your purse. You do understand that you can’t give your daughter anything, no gifts, no items from home, nothing of the sort, unless it is approved.”
Becky snarled in disgust, and even Carl looked mildly annoyed.
“It’s utterly ridiculous,” she scoffed. “Do I need to go through a metal detector as well?” Becky asked, her voice drenched in sarcasm. “Want to pat me down for weapons?”
“No need for that,” Carl said, addressing Becky reproachfully.
“It’s a safety issue,” Nash answered, taking the high road there. “I apologize.”
“You have the soup ready?” Becky asked.
Attorney Leers had found out during a conversation with a social worker that Meghan had not been eating much, so at Becky’s urging, she requested that Judge Trainer grant Becky permission to bring chicken soup from home—a food that Meghan was certain to eat.
Judge Trainer, citing safety concerns, had denied the request, but made a concession to have the kitchen staff at White Memorial prepare the soup to Becky’s exacting recipe. The soup was then to be served in a metal thermos that Becky had provided to Attorney Leers so as to give it the appearance of coming from home. Becky worried that Meghan might reject the meal if she thought it was not homemade, but secretly she did not want her daughter to know that her mother was not permitted to give her anything from the outside—including soup. Thankfully, Judge Trainer had agreed to this further concession.
“Yes, we do,” Nash said. “But you know we do serve three hot meals a day.” Nash directed her attention to Loretta’s food cart. “Meal times are eight A.M., noon, and six. We offer two choices for hot meals and can accommodate special diets.”
“That’s all well and good, but Meghan is a very picky eater,” Becky said softly. “And her disease has diminished her appetite considerably.”
“I understand.”
“I’m afraid as a policy we need to search your purse, or to make it even easier we can just keep it at the nurse’s station until your visit is through.”
Becky held on to her purse a beat too long, as though clinging to the last shred of her dignity.
“Give it to her,” Carl said snippily.
“I can’t believe this is happening,” Becky said as she handed over her purse, which Nash took with all of the fanfare of a TSA screener.
“Meghan is waiting for you in Charlotte’s Web.”
“Charlotte’s Web?” Becky said.
“Yes, we named all our meeting spaces after famous children’s books,” Nash explained.
“Are we going to be alone?” Becky sounded a hopeful note.
“So, a big family reunion, is that it?”
Nash seemed unmoved. “Please, if you’ll follow me,” she said with a wave of her hand.
Nash led them down a hallway painted sky blue—a color chosen perhaps because the children kept here were not permitted access outside—to Charlotte’s Web.
Becky paused at the door to exhale her anxiety. She turned to face Carl, biting her lower lip. “We’re here for Meghan,” Becky said. “Whatever we’re going through, we have to put it aside. We have to be united for her.”
Carl said nothing. He opened the door.
Becky stared into a big open space with comfy chairs scattered throughout, a television, artwork on the walls, and that distinct hospital smell clinging to the air.
When Meghan saw her parents, she sprang up from a green armchair and came running, though at a far slower pace than she could have done if healthy. Becky quickened her strides, and soon she and her daughter were locked together. Meghan broke into tears, clutching her mother, sobbing. Becky was crying as well, caressing the back of Meghan’s head, while Carl wrapped his arms around mother and daughter as though sheltering them underneath a cape. When they finally broke apart, Becky and Meghan were dabbing away tears with their fingers.
Carl gave his daughter a close inspection the way he might a rental car, checking her over for dents or dings. “You look well,” he said.
You look well? Is that all he can think to say?
Becky sent him an irritated glance as she took hold of Meghan’s hand. In fact, their daughter did not look well at all. She was too thin. Her gorgeous blond hair lay flat against her head, dull, without luster. She wore gray sweatpants and a blue top that Becky had sent from home. Her sleeves were rolled up, and Becky could see bruising on her arms—along with marks that looked like needle punctures. Had they been drugging her?
“Sweetie, I can’t tell you how good it is to set my eyes on you,” Becky said, wondering when the tightness in her throat might ease.
It was then Becky noticed her audience, seated nearby at a round table, coffee mugs set out in front of them like it was a teachers’ lounge: Levine, Mendoza, and Annabel Hope—three of the four horsemen of the apocalypse.
“Can we have some privacy, please?” Becky asked in a curt, albeit pleading, tone of voice.
Mendoza approached. She was a stout woman with dark hair and dim brown eyes. Her manner was detached—not discourteous; not congenial. “We’ll stay out of your way,” she said, “but I have to remain in the room.”
Meghan looked confused. “Why? Aren’t I going home?”
“Baby … let’s sit and talk,” Becky said, taking hold of her daughter’s too-thin arm, feeling the bone in her grasp.
Becky led Meghan to a table on the opposite side of the room, as far from the hawks as she could get. The only thing missing to make it a scene out of a prison visitor’s lounge, thought Becky, was a glass partition.
Just as they were getting settled in their seats, Dr. Nash came into the room. Becky got up to meet her before Meghan could see what Nash held in her hand—she wanted to be the one to give Meghan the soup, not Nash. Taking the thermos from Nash with a perfunctory thank you, Becky returned to the table where her daughter and husband sat.
“Look, sweetheart, I made chicken soup for you,” Becky said, grinning through the tears as she unscrewed the lid. “Your favorite.”
Meghan took the thermos, seeming pleased with the familiar smell wafting upward, and said again, “I’m going home today, right?”
Becky and Carl looked at each other like two people worried about drawing the short straw.
“Right?” Meghan repeated, more a statement than a question.
“Sweetheart—”
“No! No!” Meghan vigorously shook her head from side to side. “I’m leaving. I’m getting out of here today. Today!” She pointed at the air, putting an invisible exclamation mark on her decree.
“We had a hearing with the judge about your case, and she’s decided to give it some more time to investigate what to do next.”
“More time to investigate what?” Meghan said. She got up from her chair and drew worried glances from the observers, who held their ground.
“Some of their concerns,” Becky answered slowly, searching for the right words.
“What concerns?” Meghan’s sweet face crumpled. Tears flowed down her face.
“Please sit, baby,” Becky said as she coaxed her daughter back into her chair. “They want to make sure that you’re … that you’re—”
“They want to make sure that when you come home with us, you’ll be safe,” Carl said with a whiff of disdain.
Meghan looked utterly confused. “That’s—that’s ridiculous,” she stammered. “Of course I’ll be safe. It’s home.”
“The judge isn’t so sure,” Carl said.
“What judge?” Meghan said, her voice rising with anger. “Who do they think is going to hurt me? Mom? You?”
Meghan’s eyes flared when she looked at her dad, and Becky picked up something unexpected in her daughter’s face, her voice. What was that? Was there something between him and Meghan she didn’t know? Some secret between father and daughter? She had noticed the distance, but shelved those concerns to focus on more pressing issues.
“It’s complicated,” Carl said.
“I don’t get it,” Meghan snapped at him. “I want to go home. I want to go home now!”
Levine was up in a flash, approaching with quick strides. Mendoza came over, as did Nash.
“Is everything all right?” Dr. Levine asked in that boyish, high-pitched voice of his.
“Yes,” Becky said sharply. “Meghan is just going to have some soup. Isn’t that right, honey? You’re going to relax so we can talk.”
Under the table, Becky gripped Meghan’s leg, forcing her daughter to meet her gaze. With her eyes, Becky pleaded for Meghan to calm down. She did not want to give the doctors any more ammunition, and certainly did not want Meghan dragged away to have Lord knew what done to her. What are those pinpricks in her arm anyway? Becky had planned to confront Mendoza and Levine about Meghan’s treatment, but not now. She bristled at the thought of losing even a minute with her daughter. They were only giving her an hour as it was.
Meghan picked up on her mother’s cues and managed to regain her composure. She sipped the soup, which seemed to soothe her.
“We have help coming our way,” Becky said after Levine and the others moved away to let them talk privately, but still remained in the room.
“Help how?” Meghan said, her lower lip quavering. “I don’t belong here. I should be home with you. They stick me with needles.” Meghan showed her mother her marked-up arm.
“What are they putting in you?” Becky asked. “Carl, what the fuck are they doing to her here?”
Carl seemed horrified. Finally, a reaction from him. He bolted from his chair, stormed over to Dr. Nash, and gruffly pulled her aside. He spoke to her close enough to whisper in her ear. He returned to the table, glowering. “I’m going to speak with Dr. Nash in private,” he said. “I’ll be back in a minute.”
Meghan watched Carl and Nash depart Charlotte’s Web for the hallway beyond.
“It’s so weird how they name these rooms after children’s books,” Becky said, turning her attention back to Meghan, wanting to change the subject until Carl returned with more information. “Why ruin my memory of them? I used to read that book to you when you were little. You loved it so much.”
“Well, I don’t have any friends here; no spiders looking out for me,” Meghan said, offering Becky a little flash of the spirited girl she loved and treasured.
“What’s it like here?”
Meghan fell quiet. Then she said, “I haven’t had much interaction with the other—what are we? Patients? Prisoners? But I’m guessing they’re all crazy because this is a locked flo
or, after all. Did you know that? Like, I can’t just walk out the door.”
“How do you spend the day? What have you been doing to keep your mind off things?”
A thoughtful look came over Meghan’s face. “Everything here happens like clockwork,” she said. “I have room checks every fifteen minutes.”
“What for?” Becky asked.
“To make sure I’m breathing. And I get off easy. The suicidal kids get checked every five minutes.”
Becky had noticed a big chart out front near the nurse’s station and realized it was a running record of each room check.
“Most of the time it’s like I’m living in a dream,” Meghan continued. “I’m fuzzy and tired all the time.”
Becky looked again at her daughter’s arm. Were they keeping her sedated? Maybe Carl would have some answers when he came back.
“When can I get out of here?” Meghan asked again.
“There’s a woman, a special investigator the judge has appointed, who’s going to help make that happen. Her name is Kelly London. Your father and I are scheduled to meet with her very soon. She’s going to help us prove that you have mitochondrial disease, and then the judge will let you come home with us.”
“Why can’t I go home now?” Meghan’s watery eyes were pleading.
Even though there was hope Kelly London could rule in their favor, Becky decided now was not the time to reveal the outcome of the seventy-two-hour hearing. Meghan had found her appetite at last, and Becky worried she’d stop her daughter from eating.
The truth would be much harder to swallow. According to Attorney Leers, they may have lost the hearing, but they’d won a decisive part of the ongoing battle. Not every case gets appointed a court investigator, and Kelly London’s impartial opinion would go a long way to swaying the judge’s decision. There was a chance they’d get Meghan home before the next hearing on the merits of the petition, which could be some months away, but a lot depended on what the investigator had to say.
“It’s a process, sweetheart,” Becky said, reaching across the table to stroke her daughter’s hand, hating how dry her skin felt. “Are you showering, baby?” she asked.