A Marriage In Wyoming (The Marshall Brothers 3) (2 page)

While the others bustled around to help her, she handed the IV bag to Justino. “Hold this up high.” After inserting the needle into Lena’s arm, Rachel attached the tubing and adjusted the flow. Then she drew up ten units of insulin and injected it into the IV. “You’ll start to feel better soon,” she told the girl. Lena didn’t answer.

“That’s all I can do,” she said, getting to her feet. “She’s got to get to the hospital. How long ago did you call the ambulance?”

“They should be here any minute,” Caroline said. “What’s wrong? Why did she collapse?”

“She’s dehydrated and her blood glucose is very high. With fluids and insulin, though, she’ll start to improve.”

“Thank God,” Garrett said. “And thank you.” He glanced around the room. “These are my brothers, by the way. Ford’s the blond in the green shirt and Wyatt’s the one wearing the back brace.”

Nods were exchanged and hands shaken, but Rachel quickly returned her attention to Lena, noting that her breathing had slowed and her blood pressure had come up slightly. Positive signs.

Finally, she heard the siren they’d been waiting for. “The ambulance is here, Lena. You’ll be in the hospital in just a few more minutes.”

The vehicle stopped in the drive outside, lights flashing. Two emergency medical technicians came across the porch.

Rachel met them at the door. “I’m Dr. Vale, and this is Lena Smith.” She stood out of the way as one of the EMTs knelt by the couch, stethoscope in hand. “She’s in ketoacidosis. I started fluids and gave her ten units of insulin.”

The EMT nodded. “Got it.” The two men proceeded with their standard routine and, in only a few moments, had taken Lena out on a stretcher and put her into the ambulance.

“I want to come with her,” Justino said, following. “Please don’t make her go alone.”

The second EMT shook his head. “Not allowed. Sorry, son.”

The boy staggered, as if he’d been shoved.

Garrett put a hand on his thin shoulder. “You can come with me, Justino. I’ll follow the ambulance. Ford, could you call Lena’s dad to let him know what’s going on? Dr. Vale, I assume you want to come along, as well?” He ushered Rachel toward his truck.

“To begin with anyway. If Lena is part of this community, then I will be overseeing her care to some extent.” He opened the back door for her to stow the duffel on the bench, then held the front door so she could get in.

Once in the driver’s seat, he fastened his own belt and started the engine. “So today isn’t a onetime emergency?”

“I’m afraid not.” Rachel blew out a deep breath. “From all indications, this is a life-changing event.”

“What do you mean?”

“Lena will be under a doctor’s care for the rest of her life. She has juvenile-onset diabetes.”

* * *

T
HE
TRUCK
TOOK
a sudden leap forward, then slowed as Garrett relaxed his foot. “She’ll be taking insulin shots?” He glanced at Justino in the rearview mirror. The teen was staring out the side window, lost in his own thoughts.

Rachel nodded. “Unless researchers find a cure. They’re always working on it.”

The prospect daunted him. “That’s a real challenge for a young girl.”

“The adults around her will have to help her cope. Are her parents going to be cooperative?”

“Her mother died last year. Since then, her dad has expected Lena to take care of her younger brothers and the house, as well as doing her schoolwork. She’s at the ranch because she’s been picked up for shoplifting several times in Buffalo and Kaycee and even Casper. She was cutting school with some of the older girls who can drive, and they’d spend the day out of town, getting into trouble. Caroline chose her for the camp, hoping it would turn her around so she could focus more on long-term goals.”

“Well, now she has the long-term goal of staying healthy to worry about.”

“I’ll pray for her to develop the strength she needs.”

“I’m sure that will help.” There was no mistaking the sarcasm in her voice.

He sent her a puzzled look. “Why do you say it like that?”

She blew out a breath. “Sorry. I didn’t mean to insult you.”

“I’m not insulted. But I want to understand your reaction. You don’t believe prayer can change events?”

“It might change the person who prays, because I believe in the power of the mind to affect behavior. But otherwise...no. Your prayer won’t call down some unseen power to help Lena deal with her diabetes.”

“You don’t believe in God?”

She didn’t answer for a minute. “I grew up going to church,” she said finally. “I can’t dismiss the possibility of a universal power. But as I observe life on this planet, I don’t detect much evidence of any kind of divine intervention. Good or bad, what happens, happens.”

There was silence as he drove the truck onto the highway exit ramp. “I’d be interested in talking more with you about that,” Garrett said, once they’d merged into traffic. “Meanwhile, we’ll have to work with Lena for the rest of the summer and get her started on the road to managing her condition.”

The doctor shook her head. “A summer ranch camp is probably not the best place for her to do that.”

Her opposition surprised him, but now wasn’t the time for a debate. “We’ll figure that out once she’s better.”

At the hospital, they pulled into the ER parking lot and went to the registration desk. Garrett showed the paperwork that granted him treatment permission, and they were allowed to join Lena in her cubicle. Justino went to the side of the bed and took hold of the girl’s free hand.

“That’s what you need,” Rachel said, nodding at the bag of fluid hanging near Lena’s head. “You’ll feel better soon.”

Lena rolled her head on the pillow. “I want to go back. To the ranch.”

Garrett faced her from the end of the bed. “We’ll take you as soon as the doctors say it’s okay,” he said.

“Lying around being sick at camp is no fun.”

People wearing scrubs came and went, asking the girl questions and drawing blood for tests. A nurse brought some food and urged Lena to eat a little. Finally, a man wearing a white coat over his scrubs entered the cubicle, a medical chart held in one hand.

He nodded at Garrett but then shifted his attention to Rachel. “Dr. Vale? I’m Brad Stevens, from the medicine service. I understand you’re the new doc down in Bisons Creek.”

She gave him one of those bright smiles. “I just pulled in to town today.”

“And ended up at work. That’s the way it goes, doesn’t it? Good call on the diagnosis.” Then he moved forward to stand beside the bed. “Hi, Lena. I’m Dr. Stevens. We’ve run some tests and I have some news.”

Lena opened her eyes to focus on his face. “What’s wrong?”

“You’ve haven’t been well for a few days, have you?” Lena shook her head. “Well, that’s because your blood glucose is very high.”

“I don’t understand.”

“Your cells use the glucose, or sugar, in the food you eat to produce energy and to function normally. There’s a chemical in your body called insulin, made by the pancreas, which helps release glucose into the cells so it can be used. But sometimes there’s not enough insulin. The glucose doesn’t get into the cells and instead stays in your blood. Your cells are starved and you become sick.”

“How do I get better?”

“We’re giving you insulin, and that will make a big difference.”

“Then I can leave?”

“Not right away. We want to watch you for a couple of days, ensure your system returns to a more normal state. And we have to talk about the changes you’ll need to make to manage your health. You see, Lena, your condition is known as diabetes. And you’ll have it for the rest of your life.”

Tears welled up in Lena’s big brown eyes and spilled over to run down her cheeks. “My mother had diabetes. She died.”

Rachel stepped up beside Dr. Stevens to put a hand on the blanket over Lena’s knee. “But that doesn’t have to happen, sweetie.” Her tone was gentle but reassuring. “You’re going to learn how to control your condition so you can be happy and healthy and live a long, wonderful life.”

“Can other people catch this diabetes from me?” Lena looked at Justino.

“Don’t worry, it’s not that kind of disease.” Dr. Stevens closed the chart. “First, we’re going to get you feeling better, then we’ll explain how you can keep yourself that way. I’ll talk with you again in a little while.” He left the cubicle.

A moment later, a nurse parted the curtains. “Lena’s father is here.”

Garrett led the way to the waiting room, where a Hispanic man in work clothes came toward them. “Lena is sick?” he said. “What’s wrong?”

“This is Dr. Vale,” Garrett told him. “She’s the new doctor in Bisons Creek and she can explain—”

“No, you are responsible for Lena,” Mr. Smith interrupted. “You explain.”

“Let’s sit down.” Garrett led the way to three chairs. “Lena has diabetes,” he said when they were seated. “Like your wife.”

Mr. Smith’s expression didn’t change. “She is going to die?”

“No,” Rachel said. “She can get treatment that will keep her alive for a long time. But she will have to take care of herself.”

He didn’t respond to her. “How did this happen?” he demanded, glaring at Garrett. “You are supposed to keep her safe.”

“This is not something anyone could predict or prevent.” Garrett braced his elbows on his knees and gripped his hands together. “But we can work with Lena as she learns to handle her condition.”

Mr. Smith nodded. “You will see that she knows what to do.”

“Yes, but y
ou
should also understand—”

The other man stood up. “No. You are responsible. I signed papers. You will make sure she gets well and can do what is necessary when she comes home. That is what must happen.”

Without allowing Garrett to utter another word, Lena’s dad stalked out of the waiting room toward the parking lot.

“He didn’t go in to visit her,” Rachel said in a hollow voice.

“No.” Garrett wiped a hand over his face. “And he treated you with disrespect. I’m sorry about that.”

She shrugged. “He doesn’t seem to value women very highly.”

“I guess not. It’s no wonder Lena was getting into trouble. She was crying out for attention.”

“A kid needs her parents at a time like this,” Rachel said fiercely. “Who’s going to look after this abandoned teenaged girl?”

Garrett swallowed hard. “You heard her father. He made me responsible.”

But the doctor shook her head. “Being a teenager with diabetes is tough—physically, mentally and emotionally. Lena has to have a stable support system to help her understand the healthy life she should try to live. You can’t possibly accomplish that on a ranch in the middle of a summer camp!”

Chapter Two

Spine straight, shoulders square, Garrett met her gaze with narrowed eyes. “I think you’re jumping to conclusions. With your help—”

“Even with my help,” Rachel said before he could finish, “it would be quite a challenge, especially when you have so many kids to deal with. These first few weeks are going to be confusing for Lena, but also very important. She’ll have to absorb a lot of information very quickly.”

“I’m sure there are resources available. We do get the internet out here in the wild, wild West.” His grin invited her to smile with him.

But she didn’t cooperate. “Lena will need appointments with a team of doctors and nurses who’ll supervise her treatment on a regular basis. That’s a significant time commitment.”

He shrugged. “There’s no other option. Without a family, who else will take care of her?”

“That’s for us to figure out.” Rachel got to her feet. “For the moment, let’s see how she’s doing.”

In the emergency room cubicle, Lena looked better—her eyes had brightened and a rosy color tinted her cheeks. “Where’s my dad?”

Garrett cleared his throat. “We talked, but he couldn’t stay.”

“He doesn’t handle it when other people are sick.” The girl shook her head. “He wouldn’t pay attention to my mother, either. And he wasn’t at the hospital when she passed.”

“Well, I’m here,” the minister said after a stunned pause. “Dr. Vale is here. And you’re getting better. That’s good enough for me.”

Later in the afternoon, Lena was moved to a bed in the acute care ward of the hospital. Dr. Stevens reappeared when she had settled in. “Sorry about all the tests,” he said. “We have to acquire as much information as possible so we can plan your treatment.” He brought forward a woman with short white-blond hair who’d accompanied him into the room. “This is Kim Kaiser. She’s a nurse who specializes in diabetes education. She’ll help you understand how to deal with diabetes.”

“You should sit in on this,” Rachel told Garrett. “If you’re responsible for her, you have to understand her medications.”

He made a wry face. “I’m suddenly wishing I’d paid more attention in biology class.”

Kim’s visit lasted about an hour. She explained the cause of diabetes, much as Dr. Stevens had done, but then proceeded to discuss the treatment, which would involve Lena taking enough insulin through the day to balance her blood sugar. Fortunately, she’d brought printed materials along, and Rachel loaned Garrett a pen so he could make notes on the pages.

“The doctors are still working out what kind of insulin you’ll need,” Kim told Lena. “So I’ll be back tomorrow and we can go over that. But are there any questions you want to ask now?”

Lena nodded. “Is that all I have to do, take pills?” She glanced at Justino. “That doesn’t seem so hard.”

“I’m sorry to say that insulin can’t be made into pills,” Kim said. “It’s a liquid that has to be injected under your skin. With a needle.”

“Shots?” Lena’s dark eyes went round with horror. “I have to take shots?”

Justino looked equally distressed. “She hates needles.”

Kim took the protests in stride. “Then maybe you will want to use an insulin pump, which is similar to the IV you have right now. With a pump, the needle goes in once and stays for several days.”

“For how long? How long do I have to do this?”

“For the rest of your life, Lena.” A gentle voice, but a harsh piece of news.

The girl shook her head. “I can’t. No way.”

With a glance at Rachel, Garrett took a deep breath and stepped over to the bed. “Try not to get upset, Lena.” He grabbed the end rail with both hands. “We’ll figure out how to make it all work for you. Maybe the pump is what you need. Or...or maybe you’ll have to get used to taking shots. But not right this minute. Right this minute all you have to do is relax.”

She glared at him through the tears running down her cheeks. “It isn’t fair!”

He shook his head. “No, it’s not. You shouldn’t have to deal with diabetes. Nobody should.” He shrugged. “But it’s happened. And in the long run you will be happiest and be able to enjoy your life if you learn to take care of yourself.”

Lena had broken into sobs. Justino put his arms around her but looked at Garrett. “I think she wants to be by herself.”

“We’ll step out for a few minutes.” He picked up his hat, held the door for Kim and Rachel, and then followed them into the hall. “I guess you have to expect an emotional reaction. It’s a pretty serious diagnosis.”

“Yes, it is.” Kim gave him a calm smile. “As her father—”

He cleared his throat. “I’m not her dad. I’m acting in his place.”

“Oh.” Her brows drew together as she turned to Rachel. “Are you her mother?”

“No, I’m the physician in Bisons Creek, where Lena lives.”

“I just assumed...” The nurse took a breath. “Well, if you are Lena’s guardians, you’ll have to help her overcome her resistance. Her very life depends on it.”

As Kim left them, Garrett rubbed the nape of his neck. “Acceptance is a hard enough lesson for an adult to learn, much less a teenager. This kind of situation poses a real test of faith.”

“Faith isn’t the solution here.” Rachel took a deep breath, trying to curb her impatience at his approach to the problem. “We have to convince her that medical science can’t be ignored. It’s a fact that she has diabetes, a fact that she has to take insulin or suffer serious consequences. Faith won’t change those facts. There’s no other reasonable choice.”

His brows drew together in a worried frown. “Easier said than done.”

“It is a daunting prospect.” His obvious concern softened her mood, and she put her hand on his upper arm. “But you’ll take it a day at a time. An hour at a time.”

The frown cleared and then he smiled at her. “That’s all we ever have to manage, in fact. This moment. Thanks for reminding me.”

For a moment, she returned his smile, surrendering to the attraction she’d been resisting all day.

Then she remembered his vocation and disconnected her gaze from his. “We should check on Lena. I hope she’s calmed down by now.”

In fact, the girl had fallen asleep, curled on her side toward Justino, who sat next to the bed, holding her hand. When Rachel and Garrett entered, he eased his fingers free and came across the room to face them.

“Tell me the truth,” he said, his young face set in grim lines. “Will Lena die from this diabetes?”

When Garrett glanced at her, Rachel tilted her head to indicate that he should field the question.

“The effects of untreated diabetes can be life threatening,” he told the boy. “What we have to do is convince Lena to take the medicine that will prevent those effects. It won’t be easy—at first anyway. But with care she can live to be a grandmother. Or a great-grandmother!”

Justino sighed. “She has always hated getting shots at the doctor. But somehow she will manage. She’s strong. And I’ll help her.”

Garrett gripped his shoulder. “I know you will. We’ll all be on Lena’s side, supporting her as she gets used to a new routine. And we have Dr. Vale here in town as an added bonus. She’ll be great backup.”

Justino gave Rachel one of his rare smiles. “Maybe you will be more than backup,” he told her. “Maybe you will be the mother Lena doesn’t have.”

* * *

A
FTER
CALLING
THE
ranch to give everyone a report on Lena’s condition, Garrett sat down beside Rachel in the waiting room. He leaned over and spoke in a low voice. “You look terrified.”

She stared straight ahead. “I have no idea what you’re talking about.”

“When Justino said you could be the mother Lena lost. You went pale.”

“I was startled, that’s all. Teenagers are usually more suspicious of adults.”

“I think these two are grabbing at whatever resources they can reach. You’re going to be one of them.”

Her expression relaxed slightly. “I’m glad to be Lena’s doctor. But I can’t step in as her mother. There’s a reason doctors don’t treat their own family—it’s called objectivity.”

“Do you want kids some day?”

Now she frowned at him. “I don’t know. Do you?”

He nodded. “Definitely. Kids are fun.” Then he reconsidered. “But also scary. I guess I have to get past that somehow, to be useful to Lena.”

“That’s the point of remaining objective,” Rachel said. “When you’re taking care of somebody, you focus on the facts and what can be done, not the emotions involved. It’s called equanimity—staying calm in the midst of a high-pressure situation. As one of my teachers suggested, ‘First, take your own pulse.’”

“So that’s how you doctors manage. Must take lots of practice.”

“Internship and residency are all about equanimity. The more cases you see, the better your control.”

Garrett cocked his head. “And you like being in control.”

“Are we still talking about medicine?”

He grinned. “That’s up to you.”

“Well, then, I admit I’m pretty much a control freak, professionally and personally. Life runs smoother that way.”

“You’ve never encountered circumstances you couldn’t control?”

“Of course I have,” she said, her tone sharp. Then she drew a deep breath. “Everybody does,” she said more calmly.

“That’s good. For a minute there, I thought you were perfect.” When she laughed, he nodded. “There you go. I knew you’d have a great laugh.”

Her lips parted in surprise, and her cheeks flushed. He wondered if he might get a flirtatious comeback.

But in the next moment, she stood up abruptly. “I’m going to stretch my legs. I’ll be back in a few minutes.”

Before Garrett could say another word, she’d hurried out the door.

* * *

B
ETWEEN
A
TRIP
to the restroom and a walk around the entire hospital, Rachel managed to waste half an hour she might have otherwise spent sitting with Garrett Marshall. Flirting with Garrett Marshall.

Not that flirting was a skill she’d had much practice with—medical school and training hadn’t left a lot of time for romance.

But Garrett wasn’t someone she wanted to think of in a romantic context anyway. She wasn’t going to fall for the cowboy type, no matter how ruggedly handsome he might be. Of course, Garrett was more than a cowboy. He was also a minister.

And that was the real issue between them, one that couldn’t be resolved with any amount of flirting or getting better acquainted. As a pastor, Garrett Marshall counted on the effectiveness of prayer and the possibility of miracles. He led a church—a congregation of people who shared his convictions.

But during her mother’s illness, Rachel had witnessed the damage such groups and their beliefs could do. In the wrong hands, religion became a tool for deception and greed. If it weren’t for her unquestioning faith in a corrupt con man, Sarah Vale might still be alive. While Rachel didn’t question the right of others to their devotion, she certainly didn’t intend to join them.

By the time she returned to the waiting room, Lena had awakened. She was calm, though Rachel saw the fear of an uncertain future in her eyes. When her dinner arrived, she ate a few bites, which was a good sign. After a night on insulin, she would probably wake in the morning ready to finish her entire breakfast and more. Rachel said as much to Garrett on their way back to Bisons Creek.

“I’m glad to hear her appetite will improve,” Garrett said. “She’s always been slender, but I didn’t realize until today that she was losing weight. I should have noticed.”

“You wouldn’t necessarily recognize the signs,” Rachel assured him. “Unless something brought it to your attention.”

“I hate leaving Lena in the hospital alone,” Justino said from the backseat. “She looked so scared.”

Garrett blew out a breath. “I know. But she’s got the television for a diversion. She’ll probably fall asleep pretty fast.”

“Can we go see her early in the morning?”

“We’ll leave after breakfast.”

Though Rachel didn’t have her bearings yet about locations in and around Bisons Creek, she was surprised when Garrett turned onto the Circle M Ranch drive before taking her to the clinic. He stopped the truck at the house to let Justino out.

“Miss Caroline will have saved you some dinner,” he told the boy. “Try to take it easy tonight and not worry too much. Lena’s being well cared for and she’s getting better.”

“I hope so.”

“He doesn’t sound convinced.” Garrett drove back toward the ranch entrance. “I guess I can’t blame him.”

“He would have stayed with her all night if you had let him,” Rachel said. “They’re very close for such a young couple.” She paused for a moment. “Did you want to talk to me about something? You could have dropped me off first.”

He shrugged one shoulder. “It occurred to me that neither of us has had lunch or dinner. I thought maybe you’d be interested in getting something to eat.”

“Oh.” The suggestion should have been simple enough, except for the combination of excitement and reluctance ambushing her brain. Garrett Marshall was way too appealing for her to spend a lot of time with. The last thing she wanted to do was get closer to him.

“Is that a yes or a no?”

Still, she was hungry. “Um, okay. Sure. Food sounds like a good idea.”

“Great. We’ve got a diner here in town—the only restaurant, actually—where the cooking is really excellent. You might as well get familiar with it on your first day here.”

“It is still my first day, isn’t it?” She sighed. “I haven’t even unpacked the car. Or gone to my apartment. That’s the way medicine is sometimes.”

“We appreciate your being here for what was clearly an emergency.” He pulled the truck into a parking space beside a building with the sign Kate’s Diner. Then he looked over in the dim light and grinned. “The least I can do is buy you dinner on your first night in town.”

Alarms went off in Rachel’s head—he made it sound way too much like a date. But she could hardly retreat at this point. Maybe she could talk him into splitting the check.

Garrett opened the door for her, a courtesy that upped her discomfort level. Then he pulled out a chair at the table and invited her to sit. Short of staging a fight, there wasn’t much she could do other than take the seat he offered.