Terminal Therapy

by Daniel Reinharth

  “OK. So?”

  “So these are signs of a premeditated plan. But when you think about it, it all depends on Singer being on the deck, alone, at a particular time.” Paula raised her eyebrows.

  “So if there's a premeditated plan,” I continued, “it must have included a plan to lure him up there at a particular time. The attempted murderer must have made some kind of appointment with him.”

  “And an appointment might leave some kind of paper trail. Some kind of tangible clue to the murderer that we might be able to track down.”

  “And, if there were any remaining doubts, it clinches the idea that this was an inside job. Someone who could contact Singer and make an appointment with him. Someone who knew enough about the schedule on the boat that evening. Which rules out the Green Panthers, for example.”

  “Really clever thinking, David. I like brains.”

  Had I earned something? I reached out, and stroked the side of her neck.

  “Ooh. I like that, too.”

  I stood up, walked to the window, and closed the curtain. The room became dark, but I managed to find Paula.

  CHAPTER THIRTY-SIX

  Paula and I missed the third of the day's four talks. But when we entered the lecture hall, it was apparent that the conference had managed to go on without us. A few heads stirred when we sneaked into the back row, but the audience's attention quickly refocused on the fourth speaker.

  My attention, however, was everywhere but on the speaker. What had I been thinking? My father in jail, my mother sick, and I was messing around? I broke out in a sweat. But then I looked at Paula and knew it was OK. She must have sensed my turmoil, because although her head maintained its straight-ahead focus, her knee touched mine for just a moment. I patted my damp face with a tissue and tried to listen to the rest of the lecture--but don’t ask me what it was about.

  When the speaker finished her talk and began to field questions Paula grabbed my hand. “Let's get out of here before people start asking us where we were.” So for a change we were the first to leave.

  When Paula turned toward the corridor leading to her room, it was my turn to grab her hand. “Let's go straight to your car. Not give anyone a chance to catch us.”

  We ran to her car, which she started up along with its air conditioner. We buckled our seat belts, laughed, and caught our breaths. “Where to?” she asked me.

  “To the prison, to see my parents. Then to the hospital. And then to Clancy's. If your stomach can hold out, that is.”

  #

  Paula and I sped to the prison like varmints fleeing a posse, with three differences. First, we were heading to the prison. Second, for the sake of the investigation, we wanted our pursuers to catch up to us eventually. And third, there didn't seem to be any actual pursuers. Maybe we weren't quite so important as I imagined.

  Sunshine and clear blue skies above us. Ice cream parlors and pastel-shaded hydrangeas along the roadsides. My heartbeat succumbed to the Cape's magic, and slowed. I took advantage of the mental respite to check out Paula's right side, wavy brown hair to navy blue Reeboks. Until I remembered our afternoon's itinerary. Such is life.

  My mother was sitting alone in the waiting area, staring straight ahead. Her hands were clasped over her knees, a job applicant balancing apprehension and resolution while waiting to be called in for an interview. Her alone-ness struck me. Back in Centreville she was the dynamic hub of social and work-related networks. I knew that she had strength enough for our entire family, but her illness and my father's predicament were certainly testing its limits.

  I took Paula's hand as we approached my mother. She looked up at us and smiled.

  “Thank you for coming, children. Please sit down.” She patted the seats beside her. “How was your conference today?”

  I started, wondering if she’d sensed my liaison with Paula. But as I bent over and kissed her I concluded that it was just her usual selflessness, prompting her to ask first about us. Paula and I sat flanking her.

  “The conference is fine, Mom. But how are you feeling today? Did you eat?”

  She patted my hand. “Oh, I'm all right. I didn't eat much this morning...but I didn't throw up either.” She rubbed her stomach and forced a smile. “I'm actually feeling hungry. And I plan to eat lunch.”

  “I'm going to take you to a doctor today.”

  Her smile vanished. “Thank you, but no. I'm here for your father now. His problem comes first.”

  “What's the latest with Moshe?” Paula asked.

  My mother turned to her. The part of her smile that I could see seemed more genuine. “Thank you for asking. Things are looking up. His attorney is in with him now. He said that the police have no case, and that he'll try to get him released today.” Good to hear, but it could have been mostly pep talk.

  “I know you'll be happy to have him back again,” Paula said.

  My mother's face brightened. “Yes, yes. You're right.” She turned back to me. “That will help my stomach more than any doctor.”

  I knew she hadn't meant it as a dig against my profession, but I didn't understand. Why did Paula's support work better than mine?

  “Since Dad’s talking to his lawyer,” I said, “it's clearly not a good time for us to visit him. So we'll check back with you later. Maybe we can get together for a celebration dinner.”

  “Your father and I plan to attend the Board of Selectmen meeting tonight.”

  “Right.” I couldn't believe that she actually remembered the stupid meeting, with everything else going on. “I know,” I said. “I promised to come, too. Now about lunch. What can we get for you?” She didn't answer. “Soup?”

  “No. I'm sick of soup right now. But how about a nice grilled cheese sandwich?”

  “Perfect,” I said, thrilled that something, anything, sounded enticing to her. “We'll get one right away.” Before she could change her mind. “Is there anything else we can do for you?”

  She pursed her lips in thought. “No. I've been keeping in touch with Griselda and Rachel by phone. They're fine. Just keep in touch with us. Don't let this ruin your vacation.”

  Right, Mom, I thought.

  “I know,” Paula said. She went to the counter and spoke to the officer, who raised her finger in the air, nodded, and left.

  Paula returned. “She's going to bring you a pillow.” My mother smiled.

  When we reached her car in the lot I spoke. “Thanks for being so good to my mother.”

  “She’s my second mother,” Paula replied.

  I closed my lips and shook my head. “I try to do what you do, but it doesn't come out the same.”

  “But you're not trying to do the same.” I opened my mouth. “Don't deny it,” she said. “You seem more interested in solving people's problems than in validating their feelings. I know you care. But you don't always show it.”

  I squeezed and released her hand. “When you're right...but enough of silly feelings. Let's get back to solving problems.” Paula laughed.

  “I’m being serious,” I said. “I'm glad my mother wanted a grilled cheese sandwich, but I have no idea where to get it.”

  “How about Hallett's? I think it's near here.”

  I slapped my forehead. “Perfect! Why didn't I think of that? You're amazing.”

  “You noticed?”

  I couldn't believe how reassured I felt having Paula on--and at--my side. The map I spread out on my lap was out of date, but Hallett's is a hundred-year-old fixture, and only half a mile away. I directed as Paula drove.

  After ordering, we perused the Cape memorabilia in the tiny museum on the second floor. Tomorrow would have to be another day for the gourmet ice cream.

  Paula waited in the car while I dropped off the sandwich with my mother. I promised to stay in close touch, and got her to promise that she'd eat the sandwich. A smile and a kiss were my rewards.

  CHAPTER THIRTY-SEVEN

  No sooner had I rejoined Paula in her car then she raised one hand to silence
me. The other pulled her cell phone from her pocket. Vibrate mode, I told myself. I'm still startled when someone answers a call with no audible ring. I missed hearing Paula's ringtone, Debussy's Clair de Lune.

  “Hello?...Oh. Hi, Tracey” (Paula grimaced) “...No, nothing for us to report either...We're too busy, too. Just finished visiting David's parents. Yes, he's still in jail, but we're hoping he'll get out later today...Get together? I don't know” (she looked at me and shrugged her shoulders. I shook my head. No, no, no) “...Oh, that sounds good...See you later.”

  Paula flipped her phone closed. “So was that our new pen pal?” I asked. “She’s starting to really annoy me-”

  “You know I had no choice-”

  “I know,” I said. “She’s probably just trying to be helpful.” I took a deep breath. “So what arrangements did you make?”

  “That part worked out well,” Paula said. “There's another get-together scheduled for after dinner tonight-”

  “Am I invited?”

  “I don’t know. But I can’t imagine that anyone would mind. After all, who livens up a party more than you?”

  “Ow, truth hurts,” I said, putting on a mock-pained face.

  Paula smiled, and touched my arm. “I don’t like parties, either,” she said.

  “Thanks,” I replied. We both knew, however, that although Paula shared my dislike for parties, she did not share my amazing ability to silence conversations in an entire room.

  “Where is this party?” I asked.

  “It’s at Jonathan Singer's house. He was supposed to host it. But under the circumstances, Mitchell, who's staying there, will step in as host. I guess it's a ‘show must go on’ kind of thing.”

  “Well, good job. If we have to meet with Tracey, a group setting will help to minimize the pain.”

  “And if our schedules don't allow us to be there, or if we have to leave early, all the better. I have to prepare my talk. And you have your Town Hall meeting.”

  “Board of Selectmen,” I corrected with a smile. “Gotta get hip to Cape jargon, Paula.”

  “Sorry,” she replied. “But anyone who uses the phrase ‘hip to’ isn’t hip to anything.”

  “Good point,” I conceded. “I'm getting hungry,” I detoured.

  “Me, too.”

  “Let's keep to our plan. Hospital first, lunch next.” I figured that avoiding agonizing over new decisions, no matter how minor, was something we’d both prefer.

  “Whatever you say is fine,” Paula concluded. We were finally back in synch.

  #

  People employ a variety of defense mechanisms, mostly subconscious, to cope with the stresses surrounding death. Doctors have the special challenge of being both subjects and objects of these mechanisms. Patients and families may display denial to, or vent anger at doctors. These same doctors must find inner resources to deal with their own feelings.

  My own main defense mechanism in dealing with death is “pre-mourning.” I begin to mourn before the person is dead. But patient welfare is paramount for doctors, and objectivity is essential. Doctors must therefore recognize and deal with their defense mechanisms, for their patients’ sakes.

  So when Paula and I walked into the hospital I felt as if I were entering a funeral parlor. Recognizing my emotional reaction, I repeated the mantra I preach to patients: optimism tempered by realism.

  The silence of trepidation engulfed us as we obtained our visitor's passes and proceeded to the ICU. What would we find out about Singer's condition? A chunky blonde nurse in a sweater jacket was sitting behind the desk at the nurses’ station, picking up doctors' orders from a patient’s chart. We introduced ourselves and asked to see Singer.

  “I'm sorry,” she said, but didn't look it. “You can't go in. Hospital rules limit ICU visitors to three at a time. Two are in with him now.”

  Why is it that so many people in service positions seem to relish saying “no” to their customers? I looked at Paula and saw her gripping the counter, as if to prevent herself from launching a slap. Maybe I could help.

  “We won't be long,” I said. “Can we go in for just a couple of minutes?” My suggestion was apparently worth acknowledging, but nothing more. The nurse cocked her head but didn't speak.

  “What kind of stupid rule is that?” Paula asked. “Whom can I speak to?”

  The nurse stiffened--but not in reaction to Paula's use of the word “whom,” I'm sure. I intervened: “I have an idea. I'll go inside, and ask one of the two of them to leave. We just need enough time for a quick visit.”

  She looked at me, then at Paula, then back at me. Hmm. She stood up and spoke to me. “OK. But I'll do it. I have to check his IV, anyway.”

  When she left I smiled at Paula. “Thanks for taking bad guy, and leaving good guy for me.”

  She smiled back, her annoyance with the nurse subsiding. “Bad guy’s more fun.”

  The nurse returned, shaking her head. “I tried, but neither of them would agree to leave. It's like a war zone in there. It's a good thing he's not awake to see it, if you know what I mean. Maybe you should come back another time.”

  Paula played the doctor card. “Do you know who this is? He's Doctor Calder. As in M.D. doctor. Not only that, he's the one who resuscitated Dr. Singer when they pulled him out of the water.”

  The nurse looked back and forth between us again. She pursed her lips, apparently trying to show us that she was really considering Paula's point. That she really wanted to help us.

  But no. “I'm sorry, I just can't. Rules are rules.” She raised her eyebrows. “But here's an idea. How about if you go in one at a time?”

  That was my previous suggestion, but I didn't like it. We could visit Singer perfectly well individually, but I thought that our attempted murder investigation would be conducted more effectively as a team. Paula and I looked at each other. “Well...”she said.

  I addressed the nurse. “We know them, you know. Maybe if we go in there we can broker a truce. That would help you, wouldn't it?”

  “Hmmm,” she said. As she considered my latest suggestion, several of her physical features suddenly made sense together.

  “Is your face puffier than usual?” I asked.

  She put her hand on her cheek for a moment, and smiled. “Yes, but I'm just tired.”

  “Have you noticed any changes in your hair texture lately? Drier? Coarser?”

  This time her hand reached only half-way to her hair. “I'm just older.”

  “You're the only one around here in a sweater. Have you been colder than usual?”

  Her smile faded. “Yes, but I'm post-menopausal. I've let you get personal because you're a doctor. But is there a point to all this?”

  Now for the coup de grace. “Just one more question. Have you been pencilling in your eyebrows more lately?”

  This time her jaw dropped, and I thought that Paula's began to do the same. “Now you're scaring me,” the nurse said.

  “No, no. Don't panic. The skin and hair changes, the cold intolerance, and the loss of the outer third of the eyebrows, are all signs of hypothyroidism.” I looked at Paula. “Underactive thyroid gland.” I looked back at the nurse, hoping that my medical explanation wasn’t too condescending. “The first three body changes are easy to explain, all consequences of a slower metabolism. But the eyebrow thing, no one knows the cause of that. It's more specific, though, because it's not found in other conditions.”

  “I can't believe it,” the nurse said. “I really should have known. My mother has the same thing. I just put it all down to menopause.”

  “An easy mistake to make, And you could still be right.” Although I doubted it. “You're also right that there are genetic roots to hypothyroidism, and that it's more common in women.”

  The nurse seemed OK with my medical discourse. She was giving me that upward look. “So you should see your doctor,” I continued, “and get a TSH blood test. I'm sure you know that if you do have hypothyroidism it's easily treated. No one wants t
o take pills, but it's usually one pill a day, and it's as natural as you can get. The pill simply replaces the hormone your body's not making enough of.”

  That was enough to explain, I thought. I didn't add the unappetizing finale that treatment was likely to be life-long. Her thyroid gland would probably never recover. In some people the thyroid inflammation is temporary, but in most it's progressive and destructive.

  The nurse looked both ways. “No one's around right now. Come with me.” As we followed her inside, I basked in the radiance of Paula's smile and nod.

  CHAPTER THIRTY-EIGHT

  Perfume. Not a smell I associate with ICUs. Stephanie Carstens and Judith Klansky were both sitting at Jonathan Singer’s bedside, but the perfume clearly emanated from Stephanie. She had probably not read the ICU etiquette book. But maybe for her the perfume was an affirmation of life.

  I soon picked up the more typical ICU odors of disinfectants and hand wash. I noted the usual steam-engine-like sounds of respirators, pushing like Sisyphus against the ball of mortality. Grim memories intruded, but I also remembered doctors, nurses and therapists--not to mention patients and families--fighting the good fight.

  I dared to look at Jonathan Singer. What remained of his body was covered by tautly-stretched white sheets. His emaciated face was dominated by tubes and tape. I tore my attention back to the two women. They were sullen prizefighters glowering at each other from opposite corners of a ring. Stephanie's eyes were red, and Klansky was knitting, but that didn't make me feel any safer stepping between them.

  “Hello, Stephanie, hello, Judith,” I said, as Paula and I advanced to Singer's bedside. “How's he doing?” My question was, unfortunately, rhetorical.

  Stephanie said “hi” and Judith said “hello,” at the same time. Having verbally collided, they next observed a moment of silence. Stephanie broke it. “It's not good.”

  Judith gritted her teeth at Stephanie, but I guessed that she would have had the same reaction no matter what Stephanie had said. “Don't say that. He's holding steady.”