Critical Judgment (1996) (10 page)

Lew glanced up at the monitor.

“I like your style, Doctor,” he said. “Let’s do it. But let’s not let anyone know we’re both scared stiff.”

With Hazel Cookman grousing at them almost continuously, Abby and Lew completed the temporary-pacemaker insertion without a hitch. Abby numbed up the area beneath Hazel’s collarbone and disinfected it. Then, guided by landmarks she could only feel, she smoothly inserted the large-bore needle through the skin beside the bone, and into the subclavian vein. Lew handled the electrocardiograph machine, calling out directions and encouragement as Abby slid the fine wire
through the needle, along the subclavian vein and the superior vena cava into the heart, then across the right atrium and tricuspid valve, and finally into place, wedged in the right ventricle.

“Hold it,” he said. “You’re there. You’re there.”

He hooked the wire to the small pacer box. The capture of Hazel’s heartbeat was instant.

Abby angled her body to shield her hands until they stopped shaking. If Lew hadn’t been there, she doubted she would even have attempted the insertion, much less completed it.

“Fine job,” he said as she sutured the wire to Hazel’s skin to keep it from dislodging. “The capture threshold is excellent. You can put one of these in me anytime.”

“Dr. Price just called,” the head nurse announced. “He was seeing a consultation at the state hospital in Caledonia. He’ll be here in half an hour.”

“Okay, Mrs. Cookman,” Abby said, “I’m ready to fix your arm now. After that Dr. Price, the heart doctor, will admit you to the hospital. Even though the pacemaker Dr. Alvarez and I just put in is working fine, I’m sure he’ll want you in the coronary-care unit until he can put in one of those permanent pacers I told you about. Do you understand all that?”

“Oh, yes. I certainly do, dear. You’ve done a wonderful job explaining everything to me. And I really would be happy to come into your coronary unit.”

“Great.”

“But, unfortunately, I can’t.”

“But—”

“At least not until I turn off that chicken I left simmering. It would be a terrible waste of chicken and an even worse waste of my house when it burns down.”

Abby glanced at Lew but managed not to react to his amusement.

“Aren’t there relatives who could do it?” she asked.

“None.”

“How about a neighbor or the police?”

“I don’t think Holly and Alex would like that very much at all.”

“Well, couldn’t one of them do it?”

The woman patted Abby’s hand.

“My dear, Holly is a one-hundred-pound German shepherd. I don’t know exactly what Alex is, but he’s bigger and meaner than Holly. Since my husband died, I’ve always had big dogs. These two are wonderful friends, and I certainly don’t have to worry about locking up at night. But unless I’m there, no one could get inside the house without being attacked or having to harm my babies. I would never allow either thing to happen.”

“I see.… Mrs. Cookman, I’ll be right back.”

“Just don’t be long, young lady. I really do have to get home.”

Once again Abby motioned Lew to the far corner of the room.

“This is crazy,” she said. “Can she do this?”

“Sign out against medical advice to turn off her chicken? I believe so.”

“But—”

“Listen, her pacemaker’s working fine, and her heart’s totally protected,” he said. “She lives just a mile or so from here. I think you should have her sign out AMA, then just load up on a few cardiac meds, call the ambulance, and go home with her.”

“Actually, since I’m on and you’re done, I was thinking—”

“No, no. Please. I’ll do my part by staying here. She’s your patient. I’ll call my vet, Hank Tarver. He tends to my animals. He’ll meet you at Hazel’s house and take the dogs to his kennel.”

“I can’t believe I’m going home with an eighty-four-year-old in complete heart block to turn off the gas under a chicken.”

“Welcome to Boondocks General, Professor. Wait until you start getting
paid
in chickens.”

Abby returned via ambulance from Hazel Cookman’s bungalow prepared to tell someone—anyone—that her mission to turn off Hazel’s chicken had gone like cluckwork. Actually, she couldn’t remember ever feeling more energized about being a doctor.

Hazel, her stove turned off and her dogs on their way to the kennel, took Abby’s hand as they were hooking her back up to the monitor.

“Thank you,” she said. “Thank you for being so kind.”

“Nonsense,” Abby replied. “You’ve fought the good fight for eighty-four years. You deserve the best any of us can give you.”

Abby wrote admission orders that would hold until the cardiologist took over in the critical-care unit. Then she sought out Lew. He was in the office, finishing up a dinner that dietary had sent up. Even after a tough fourteen hours in the ER, he looked fresh.

“You’re all caught up,” he said. “And I am ready to pour a glass of Chianti, turn my stereo on, put my feet up, and fall asleep to Villa-Lobos. I’ve decided paying my bills can wait for another day. I don’t know if you’ve looked at the schedule or not, but tomorrow morning I’m your relief.”

“I hadn’t looked,” she said. “Come on. I’ll walk you out.”

As they passed by the waiting room, a woman was just registering at the intake desk. Abby recognized her as one of the diagnostic problems she had seen—the redhead who, someone had told Abby, had once danced with the Rockettes. The woman caught Abby’s eye, waved sheepishly, embarrassed at being back, and immediately began scratching her arm.

Abby motioned that she would see her shortly, then walked with Lew across the ambulance bay and into the
parking lot. The night was the sort never seen in the city—a glimmering full moon low in the northeast, a velvet star-laden sky to the west. The Milky Way was easily visible.

“Just beautiful,” Lew said.

A car stopped at the patient drop-off space, and a man pulled himself up on crutches and hobbled in through the front ER entrance. Abby waited until the car had driven off and it was quiet once again.

“Lew, I really appreciate your helping things go so smoothly tonight,” she said.

“No problem. I really enjoyed our pacemaker adventure. Besides, I actually feel as if I owe you more than just a little help in the ER. I owe you an apology. When you first got here, I found you a bit intimidating and standoffish. You’re neither, and I’m sorry for thinking so.”

“You know, that’s really funny, because I found you standoffish and intimidating, too.”

“I heard from the nurses that you’ve been going up to Sam Ives’s hut to tend to his leg. That’s a very kind thing to do.”

“He’s got a deep fungal infection, maybe osteomyelitis. The cultures grew out aspergillus. I’ve been going up there because there’s not much chance he’d come back here.”

“Not after the way he was treated the other night by Martin Bartholomew, there isn’t.”

“Bartholomew’s got big problems. But in general I’ve been really impressed with most of the staff. The town is growing on me, too. When I first moved here, I had serious doubts. I only left my job at St. John’s and came to Patience to be with my …”

Her voice trailed off.
My what?
“Fiancé” seemed a more remote possibility than ever.

“Yes, I know. The man in charge of new-product design at Colstar.”

“My, this
is
a small town.”

She found herself a bit peeved that personal information about her would be making the rounds. But the truth was, even in the big city everyone was curious about everyone else—especially new docs.

“So how about you?” she asked. “Do you like it here?”

“I do. Most things, anyhow.”

“Most things? What do you have problems with?”

She could tell immediately that he was having difficulty answering the question. He turned and looked away toward the east. When he spoke, it was in a harsh whisper.

“I have problems with
them,”
he said with unexpected force.

Abby followed his line of sight. There, silhouetted against the full moon, was the Colstar cliff. Perched atop it, illuminated by dozens of floodlights, looking somewhat like a penitentiary, was the company. The letters of its name, filling much of the west-facing wall, were done in red neon.

“But why?” she asked.

At that moment another car drove up to the entrance. An older woman hauled out a wheelchair from the trunk and spread it open. Lew and Abby helped her move her husband from the passenger seat.

“It’s his chest pain,” the woman explained. “It’s all right now, but Dr. Robbins is on the way in to check him over.”

She hurried through the sliding doors and into the ER.

“I’d better get in there just to keep an eye on things,” Abby said to Lew. “If it’s not too late when I finally get caught up, could I call you to finish our conversation?”

“No calls about this,” he said, too quickly. He realized she was taken aback and added, “Tell you what. I’ll come in an hour early if you’d like, and we can talk.”

“If you don’t mind getting up that early,”

“I work a farm, Abby. I’m
always
up that early. Meet
me right out here at seven. If you’re busy, I’ll wait. And, please, don’t say a word to anyone about all this until we’ve talked.”

“O-okay,” she said, bewildered by the precautions and by his tone.

“Abby, I’m sorry if I seem paranoid,” he said in his near whisper. “But I have every right to be.”

The woman’s name was Claire Buchanan. She had been born and raised in the Midwest and had gone to New York City at eighteen to make it in show business. Her hair was colored flame-red.

“I was a damn good dancer,” she said, talking almost nonstop as Abby carefully examined her skin, eyes, and ears. “At least for Sioux City I was. But New York is a different story. Thankfully, though, I got lucky. I met Dennis Buchanan, and he took me the hell out of there. A few years later we were living outside of LA and Dennis was selling carpeting. He has a gift. Like they say, he could sell refrigerators to Eskimos. Anyhow, one day we were just driving around up here and we found this town on a map. Dennis liked the name. We decided to spend the night, and we weren’t here fifteen minutes when he saw the For Sale sign on the John Deere tractor place. ‘Claire,’ he told me, ‘this is it. This is as far as we need to go.’ That was almost ten years ago. Now I’m beginning to wonder if maybe I’ve developed an allergy to the damn place or something. Or maybe I’m allergic to Dennis. I’ll tell you this, I can’t stand this itching anymore.”

“Mrs. Buchanan—”

“It’s okay to call me Claire. Everyone does.”

“Claire, tell me. Did your itching get at all better with the cortisone pills I gave you?”

“Maybe for a little while. The Benadryl might have helped a little, too. Then it just got bad again. Especially
at night. I went to see Dr. Oleander, but he said he couldn’t find much. He was very complimentary about you, though. He said that you had done a very thorough workup on me.”

“Except I can’t figure out what’s wrong.”

“He thinks it’s nerves.”

“Are you the nervous type?”

“I don’t think so, except that I’m very claustrophobic. My mother and sister are, too. Dr. Oleander did one of those MRI tests on me for some stomach trouble I was having. If he hadn’t given me a tranquilizer and a blindfold, I would have never made it into that tube.”

“What stomach trouble? When?”

“I don’t know. Six, eight months ago. The tests were all negative and my indigestion went away. But, Dr. Dolan, I can’t sit around waiting for this itching to go away. You’ve got to do something to help me before I just throw myself into one of Dennis’s combines.”

“I don’t know what’s going on with you, Claire, but I don’t think it’s in your head. I can sort of feel a fullness in places beneath your skin, a thickening, but I just can’t see anything. And I can’t tell if the thickness is from your scratching so much. I think the next step is a dermatology consult and maybe a biopsy.”

“Whatever you say.”

“Actually, it’s whatever Dr. Oleander says. He’s your primary-care physician, and we try to defer making any referrals to him. But I’m sure he’ll be happy to send you to the dermatologist.”