Critical Judgment (1996) (11 page)

“I don’t think so,” Claire said. “The last time you saw me here, you suggested I see a dermatologist. But Dr. O said this itching was either nerves or hives, and that all I would be doing was traveling thirty miles each way to have a so-called specialist tell me the same thing.”

“Well, now that you’re no better after a course of oral cortisone, I think Dr. Oleander might be ready to
change his mind,” Abby said, certain that would be the case.

For an area its size Patience had excellent specialty coverage. Cardiology, pulmonology, neurology, even rheumatology, as well as most of the surgical specialties like urology, ENT, and orthopedics. But no dermatologist. Actually, Abby did not disagree with Oleander. Treating many of the common skin problems was a matter of applying common sense. The old and useful maxim regarding the specialty was:
If it’s dry, wet it, if it’s wet, dry it, and when in doubt, use steroids
. But from what Abby could tell, Claire Buchanan’s skin problem went beyond the bounds of common.

“I’ll tell you what,” she said. “It’s only a quarter of ten, and Dr. Oleander is my medical backup for tonight anyway. Would you feel better if I gave him a call?”

“Oh, I would. Thank you, Doctor. Thank you very much.”

Abby never liked encountering patients who were overawed by their physicians, although she did acknowledge that some patients seemed to be genetically bred to be so. It seemed to her to be the doctor’s responsibility to break down such barriers to communication. From all she could tell, George Oleander was a damn fine primary-care doctor. As chief of medicine, he unquestionably ran a tight ship. But he did have an air of confidence that might inhibit some patients from questioning his decisions or from asking for a second opinion.

She sent off another series of routine blood studies on Claire, just in case, and went back to the doctors’ office. Oleander answered before the second ring.

“George, hi, it’s Abby Dolan. Sorry to call you at this hour, especially since this isn’t about an emergency.”

“No problem, Abby. I was just reading and wondering why the hospital seemed so quiet.”

“Actually, it hasn’t been. But our one admission was a unit case, and Brian Price is in with her.”

At Oleander’s request she reviewed her odyssey with Hazel Cookman.

When she finished, the medical chief laughed roundly.

“I know those dogs of hers,” he said. “And they are tough. But I think I’d prefer a run-in with them to one with Hazel. It sounds like you did a great job, Abby. And you can bet that within a day or two everyone in Patience will have heard about it—or at least some
version
of it. It’s exactly what this community needs.”

“Thank you.”

Community
. Abby tried to remember how many times Lyle Quinn had invoked the word.

“I’m glad to hear this story, too,” Oleander continued, “because I’d been meaning to speak with you.”

“Again?”

“I’m afraid Dr. Bartholomew and just about everyone else has heard about what you did the other night, replacing the sutures he put in old Sam Ives.”

“Ives isn’t that old,” Abby said, feeling her temper begin to build. “And Dr. Bartholomew’s suture job was unacceptable.”

“He didn’t think so. Abby, Marty Bartholomew’s been a part of this community for years. At times he can be a bit of a horse’s behind, I’ll give you that. But he’s been available to folks in snowstorms at three in the morning. He delivered babies before our obstetricians came on board. He’s very much loved here.”

Abby knew that there was nothing to be gained by arguing her case in this court. Still, she had to choose her words and maintain her composure carefully.

“I did what I thought was best for the patient.”

“I understand, Abby. But as I said last week in my office, sometimes things in a community hospital work a little differently than in the big city. Now, what do you have for me tonight?”

His tone left no room for retort. The discussion was over. The point Abby had scored for her treatment of
Hazel Cookman had offset the one she had lost for her abuse of the ego of Martin Bartholomew. It was time to move on.

Picking her way through her presentation so as not to say anything Oleander might interpret as inflammatory or confrontational, Abby reviewed Claire Buchanan’s case. Her hope was that Oleander would come to the conclusion himself that a dermatology referral was in order.

“Sounds like classic neurodermatitis to me,” he said when she had finished, employing the diagnosis given to any and all skin symptoms believed to have an underlying emotional cause.

“I was wondering about some unusual kind of vasculitis. She’s quite uncomfortable.”

“I can tell you want me to send her to Dr. O’Brien in Caledonia, Abby. And I might. But I like to be certain we’ve done all we can for our people here in Patience before shipping them off to doctors elsewhere.”

“I understand,” Abby said, though, in truth, she didn’t.

“Well, then, why don’t you go ahead and put Claire on some mild tranquilizer like Valium or Xanax and tell her to give me a call in the office tomorrow? I’ll see her. If she needs a little punch biopsy, we can do that here. If we’re absolutely stumped, I’ll call O’Brien. We’re trying to get him to open an office here in Patience. Our case is weakened if he believes our people can just pull up and drive thirty miles each way to see him.”

“I’ll be anxious to know what you think.”

“I’ll send you a copy of my office note, Abby. That Bartholomew business notwithstanding, you’re doing an excellent job. Keep up the good work.”

“Thank you.”

“Oh, and Abby, tell Claire she really ought to be calling me before she runs to the emergency ward. You folks have enough to worry about. I’ll be here all night if you need me.”

He hung up without waiting for a reply. Somehow he had read and deflected Abby’s agenda before she had even presented it. As a result, Claire Buchanan would be treated according to the wishes of her regular doctor, not Abby’s. It was the downside of the medical specialty she had chosen. Abby returned to her patient feeling vaguely uneasy that she hadn’t battled harder on her behalf.

T
he flow of patients through the ER remained steady throughout the night, though never close to overwhelming. With a little over an hour to go before the end of her shift, Abby showered in the on-call room and took the chance of putting on her street clothes and clinic coat, rather than scrubs. She had been awake since treating a three-year-old with an earache at five-thirty and had spent most of that time thinking about Lew and the concerns he had offered to share with her about Colstar.

She made one quick pass around the deserted ER, then told the night nurse where she’d be and headed out into an overcast morning. To the east the Colstar cliff was still in shadow, but sprawled above it, the massive plant glowed in the pale morning haze. Lew was right where he had said he would be, standing beside an isolated low bench on the far side of the tarmac. Even at a distance she sensed his tension.

“Hi,” she said.

“Morning. How was your night?”

“Manageable. Two NIWWs. But otherwise not much.”

“NIWWs?”

“The abbreviation for ‘no idea what’s wrong.’ My chief resident taught it to me. Lately, it seems, I’ve been seeing more of them than I’m used to.”

“NIWWs. I like that. I really do.”

Lew’s expression and ironic laugh suggested he knew something she didn’t.

“So,” she said, “what’s this all about?”

Lew stopped her with a finger raised to his lips and glanced about warily.

Thirty yards away two nurses crossed the parking lot, clearly—to Abby at least—out of earshot. He shook his head, warning her not to continue the conversation until they had entered the hospital.

“I’d like your promise not to share this discussion with anyone,” he whispered finally. The intensity in his eyes was startling.

“Lew,” she replied, just as softly, “nobody can hear us.”

“Don’t be so sure. I think my home phone may be tapped. I don’t know what else they might have done.”

“Who?”

Lew turned his gaze toward Colstar.

“The same people who built this place—them.”

“Lew, I’m sorry, but I don’t understand.”

“Those patients you’ve been seeing—the NIWWs?”

“What about them?”

“What sorts of symptoms do they have? Headache? Rash? Fatigue? Chronic cough? Insomnia? Mood swings? Low-grade fevers?”

She looked at him queerly. He wasn’t asking her, he was telling.

“Those kinds of things,” she said. “Yes.”

“Well, I’ve got news for you. Patients with those kinds of unexplained symptoms are all over the place here. Far more than one would expect.”

“Maybe I’m just dense, Lew. But I still don’t get it.”

He glanced around again.

“Look, this isn’t a good time or place to talk. I don’t
trust anyone in this hospital. In fact, I don’t even trust the building. That’s why I want you to be very careful what you say in the doctors’ room. It might be bugged, or worse.”

“Cameras?”

Abby was sickened by the thought. She was also wondering about Lew. “Believe it or not, it’s possible,” he said, seeing the doubt in her face. “I’ve looked all over for microphones or cameras with no luck, but I’m no secret agent.”

“Maybe you’d better get to the point.”

“Abby, listen. We really shouldn’t stay out here like this too much longer. They already know I’m the enemy. Pretty soon, if they see us together too much, it will be guilt by association for you. I may sound paranoid about Colstar, but believe me, I have every right to be. You’ll understand if you give me the chance to explain.”

“Go on.”

“Okay. There’s a group of committed people who are trying to do something about all this. Trying to do something about your NIWWs. I’d like you to come to our next meeting.”

Abby looked toward the cliff and then back at Lew. Were the “committed people” in his group the ones Lyle Quinn had warned her about? It certainly seemed that way. Being asked to choose sides between Quinn and Lew Alvarez would pose no problem for her. But she was still very new in town, and she had enough problems of her own at home.

“Oh, Lew, I don’t know,” she said. “I’m not much of a crusader, and I’ve never been a joiner.”

“At least come and hear what we have to say,” he said. “We call ourselves the Alliance. We meet every three or four weeks at one member’s house or another. Tomorrow night it will be at mine.” Lew handed her an envelope with directions. “Whether you come or not, please don’t tell anyone about this, especially your friend.”

“Well, the truth is, Josh has been very tense lately. Pressures at work, I think. So I don’t know that there’s much to be gained by telling him I’ve been approached by people who want to cause problems for his company.”

“No more problems than they’re causing for all of us,” Lew interjected.

“Lew, I just can’t tell you yes or no right now. What I said about not being a crusader is really true. I’m not proud of it, but I was on duty in the ER during the last election, and I never even made the effort to vote.”

Lew’s expression was deadly serious.

“Believe me, Abby,” he said, “your involvement with the Alliance and what we’re determined to do would more than balance that.”

“I understand that’s how you feel. I’ll just have to see.”

“Fine. Meanwhile, you might start keeping a log of those NIWW patients. I do.”

Before leaving the hospital Abby called Claire Buchanan. The tranquilizer had given her a few hours of sleep, but the profound itching persisted. She would be calling Dr. Oleander in an hour or so, she said. Abby encouraged her to give herself a break for at least one day by taking the sedation as often as was safe. She set the receiver down, still feeling as if she hadn’t done all she could have on the woman’s behalf.

With Josh already at work there was no need to rush home. And as usual following a night shift, even those when she got
no
sleep, Abby was reluctant to go right to bed. If she did, she would be asleep in minutes and would have trouble waking up no matter what the time. Further, she had found that ten or eleven hours of sleep often left her feeling logier than her usual seven. It was better to try to put at least part of the morning to some use before surrendering to Morpheus.

She drove through the park for a time, then stopped for a brief walk down to the lake. It was all so peaceful, so picture-perfect. On the way back to her car she stopped and gazed across the ball field at the spot where Angela Cristoforo had stood, her blood cascading onto the sparkling, manicured grass. Abby had followed up on Angela and learned that soon after her lacerations were repaired, she was transferred to a locked ward at the state hospital in Caledonia. A long-term, competent, dependable Colstar employee one minute, then suddenly a pathetic self-mutilator. It did not make a great deal of sense, but mental illness in its many guises often didn’t.

It was after nine when she started up the Mazda and headed home. There were some letters she wanted to write. And if, by some miracle, she was still awake, there was the book on making the most of the passage into midlife that she had been reading so slowly, her midlife might be over by the time she finished it. She had always loved the eeriness, the unpredictability, and the strange characters she encountered working the night shift in the ER. But she invariably had trouble reconnecting with life outside the hospital when she did.

The moment she turned into the drive and saw Josh’s Jeep, she knew there was trouble. He should have been at work hours ago. She pulled up behind the Wrangler and became even more convinced something was wrong. Josh was in love with his car and was obsessive about caring for it. Now it was an absolute mess. There were thick streaks of dried and still-drying mud all over it, as if he had been off-roading in and out of quagmires. The tires were caked. The windshield was splattered as well. There were three empty beer bottles and crumpled-up food wrappers on the floor. Even the driver’s seat was smeared with dry mud, as if he had fallen someplace and then, sodden, had crawled back behind the wheel.