Chapter 26

Of course I woke up in front of my apartment because the cab driver, who smelled like curry, was poking my shoulder and saying, “Lady. Lady!” I was seriously skeeved to get pushed to the sidelines, but common sense won, so I passed out in my own bed and let Tucker take over.

I woke up for good at 7:20 a.m., with funky teeth and a growling stomach. Over a bowl of cereal, I confirmed that I had a sweet note from Ryan, no messages from Tucker, palliative care in the morning, and my family medicine clinic that afternoon. I’d forgotten to quiz Elvis about his allergies, but I knew he might be in the middle of rounds, and I had to hustle, myself, so I just texted Archer about it before brushing my teeth.

The morning passed relatively quickly, with two consults in the emergency room. I didn’t see the pharmaceutical guy’s mother, but Dr. Huot assured me that Mary Kincaid was already ensconced very comfortably upstairs in room 5656. Then a shadow crossed her smiley face, and she lowered her voice, leaning forward on the nursing station counter so that no one else would overhear. “I also spoke to the pathologist, but I was unable to obtain permission for you to attend the autopsy, since it was a criminal matter.” She recovered her twinkle. “However, next Wednesday, we will have pathology rounds based on another case, and everyone will benefit from that.”

“Wonderful,” I said, trying not to yawn. I’d gotten over eight hours of sleep. What was wrong with me? As if to punctuate the point, my ER chair suddenly lost its pneumatic pressure and lost and sank down three inches of height, so I was now looking up at Dr. Huot like she was my mommy. I stifled a curse.

Dr. Huot continued to beam. “Mrs. Bérubé was hoping to speak to you. Perhaps you could call her before you go to lunch?”

“Of course,” I said, and took the number from her, since Mr. and Mrs. B were no longer in residence. I ducked into the emerg resident’s sleep room to call Mrs. Bérubé, but it just rang and rang until I was forced to leave a message. I checked my cell phone and pager, and even popped into the library to log on to my e-mail, but Tucker still hadn’t contacted me. Jerk.

After a quick rowing work-out and a lunch of reheated spaghetti, I hurried to the FMC. At least today I had Dr. Levine instead of Dr. Callendar, and that alone was worth a few bonus points. Dr. Levine was a heavy, curly-haired, soft-spoken doctor who mostly worked at a CLSC (centre local de services communautaires, or public health care clinic) downtown, but did Friday afternoons with us twice a month. My mood improved when my first two relatively pleasant patients just needed their ten thousand medications renewed. One more patient, and I’d sprint to UC Hospital and check on Elvis.

I knocked twice on the thin, oak door and stepped into the cramped, square examining room. Then I spotted the give-me-pills-or-give-me-death thirteen-year-old, Kameron, pouting by the broken window blind on the far side of the room.

I sucked in my breath and double-checked my appointment sheet to make sure I hadn’t misread it. No Kameron. I was scheduled to see Kaitlyn Rosenberg. Was she changing her name now?

“Relax, it’s for my sister,” said Kameron. She raised her hand and pointed beyond the desk, behind the door that I was still holding ajar.

“Yikes,” I said, jerking back involuntarily, which is not exactly professional, but who expects a patient to lurk behind the door, where she might get smacked by a sheet of solid wood?

The girl stepped out from behind the still-open door. She crossed her arms over her chest and lowered her eyes. She had the same round mouth and little nose like Kameron. She was wearing similar clothes, too—for Kaitlyn, it was an oversized, grey shirt and loose skinny jeans. The main difference was that Kaitlyn seemed a third of Kameron’s size, the kind of skinny that makes you want to put your arm around her and say “It’s okay” while force-feeding her a chocolate bar.

I said, “Kaitlyn?”

She nodded, still staring at her immaculate, sparkly white sneakers, while I took stock of the dark circles under her eyes—les yeux cernés, as French parents often point out in their sick children. The air in the room felt heavy and humid. The silence in my room was magnified when Stan started joking with his patient next door and we could hear them laughing through the cardboard walls.

“How can I help you?” I asked. I closed the door and sat down at the desk so I was now located between Kaitlyn and her sister. I opened up the brand new FMC file and uncapped my pen, swiveling my torso toward Kaitlyn, trying to establish rapport with the patient of the day.

Kameron walked over to her sister and hooked her arm through hers, so my body language was now facing both of them.

Kaitlyn didn’t move. Her arm hung limply.

Kameron hugged the arm to her own side and said, “This is my sister. Kaitlyn should be on the pill, too.”

Oh, no. We just did that movie. I tried to channel Dr. Callendar and channel joy that a young girl was acting responsibly. I set my pen down. “Kaitlyn? Hi.” I held out my hand.

Kaitlyn glanced at me and at my hand like she’d never seen one before. Kameron squeezed her right arm, so Kaitlyn touched my fingers quickly with her left, not clasping my hand, and muttered, “Hi.”

Comparing the two sisters standing side by side, the silent beanpole and the angry hot air balloon, I noted that Kaitlyn was a few inches taller. I checked the chart just to be sure. She was fourteen-and-a-half, the older sister, but she seemed younger and less confident. “I only have one chair, but do you want to sit down?” I asked Kaitlyn.

She glanced at Kameron for permission. Kameron shrugged, and Kaitlyn hesitated before she pointed at the black examining bed pushed against the opposite wall.

I nodded and turned my chair around to face her. She climbed up on the bed, making the paper crinkle, while Kameron dropped into the single chair by the desk, near the window, with a sigh and said, “Can we get this over with? We’re supposed to be at school.”

“Your mother can write you two a note.” Kameron snorted a little, and I said, “Your mother knows you’re here, right?” I swung around to ask Kaitlyn, who’d crossed her jean-clad legs like she was sitting at a desk instead of having her feet dangle in the air. She’d also folded her hands neatly. But her pale blue eyes were wide and frightened. If she were a video game, she’d be flashing the ABORT, ABORT sign.

Kameron jumped out of the chair to stand between us. “Of course she can write a note. God! What’s with the third degree? We just need some more pills.”

I kept my eyes on Kaitlyn. If anyone was going to crack, the older, frailer sister would. “If I called your mom, would she come to the next appointment with you two?”

“No. She’s working,” said Kameron. “We know how to take the bus. She writes us a note to get us off school. What is your problem?”

“What kind of work does she do?” I asked Kaitlyn.

Her cheeks flared red. She swung her legs in the air.

“Hello. What does this have to do with birth control?” Kameron snapped her fingers in front of my face. “We need some toute suite.”

“You need some manners tout de suite,” I said, under my breath.

Kaitlyn smiled faintly. So she was alive in there, and had a sense of humor, even if she didn’t show it much.

“Maybe I should talk to Kaitlyn alone,” I said.

“No! We’re a team!” said Kameron, and Kaitlyn jerked up her head, alarmed enough to make eye contact with me and shake her head.

“Then you need to be the quiet member of the team,” I said.

“Fine. God!” Kameron pulled out her phone and pushed some buttons. “I wanted to play Angry Birds anyway!”

“Quietly,” I repeated.

Kaitlyn smiled slightly again. Then she answered my medical questions in a whisper. She’d had her period for the past two years. She turned red and mumbled that yes, she was sexually active. No contraindications to the pill. But she’d never had any STI testing, either.

“You’ll have to come back for that,” I said.

Kaitlyn shook her head. Her hands dug into the padded edge of the examining table. “I can’t miss any more school.”

I tried to infuse gentleness into my voice. “I don’t have time to do a pelvic exam unless you make an hour-long appointment, so I can’t do one today. I explained this to your sister before.”

“I can’t!” Her fingers jerked on the examining table, crunching the paper cover under her palms. She glanced at Kameron, who said, “Look. You can do all the weird exams you want on me. I don’t care. But she doesn’t want one. Too scary.”

“Nobody likes them,” I assured Kaitlyn, “but they sound worse than they are. Really, it’s just using a big Q-tip to take cultures from the cervix, which is the bottom end of the uterus, and the vaginal wall.”

“I can’t. Please! He’ll—” She bit off the rest of the sentence.

The last syllable hung in the air.

Kameron shot her a killing look.

Kaitlyn looked mortified. She clamped her hands over her mouth and squeezed her eyes shut.

“He’ll what?” I asked, as calmly as possible. There was no man in the room.

Kaitlyn shook her head, still in a mute, “speak no evil” position

“Are you talking about your boyfriend?”

“No!” Kaitlyn said, disgusted, and Kameron snorted.

What other “he” would she be worried about? I said, “Would you and your partner like to come in for testing together? You could have a Pap test and you could both have HIV and Hepatitis testing before I vaccinate you two against Hepatitis B.”

Kaitlyn covered her whole face with her hands this time and started rocking back and forth. The paper crackled with every move

Kameron gave a short, sharp laugh. “That’ll never happen.”

“Who is your partner? Or partners,” I asked, remembering to use the politically correct word this time.

Kaitlyn’s shoulders jerked, but she rocked without answering.

Kameron cleared her throat. “I told you. We don’t want the human lie detector machine. Why are you asking all this stuff? We just want the pill.” But her voice rang hollow.

I didn’t like any of this.

I said, as calmly as possible, “Actually, it is my job to ask these questions. Now the age of consent is sixteen in Canada, and neither of you is sixteen yet.” I’d looked it up after my last clinic.

Something flashed in Kameron’s face, a hard kind of triumph. I stared at her, but the microexpression vanished, and she just shrugged and said, “You’re a real barrel of laughs.”

Kaitlyn kept rocking. She was the one who was sexually active. She was the one I had to reach, so I focused on her. I pulled my chair closer to her, so that if she opened her eyelids and raised her head a fraction, she could make eye contact with me. I made my voice as gentle as possible. “Is there something you want to tell me?”

Kameron butted in. “Yeah, she doesn’t want a Pap test. Can’t you just do what you did for me? Give her a few boxes of pills and bring her back later?”

Kaitlyn’s body stilled. She waited for me to answer.

“I can,” I said slowly, “but she still needs a Pap test. And—”

Kameron cut in again. “Well, she can’t have one. But she needs the pill, like, pronto. God! I knew I should have just waited for the CLSC.”

I considered throwing Kameron out of the room, but Kaitlyn said suddenly, “Can you knock me out?”

I blinked at her.

She lowered her hands away from her mouth and kept her eyes pinned to the floor, but she mumbled, “You know. While you do…that. So I don’t feel anything.”

“That’s a great idea,” said Kameron. “I bet you’ve got nice drugs. Okay. Hey, maybe I’ll take some, too.”

“You mean, you want me to put you to sleep while you have your Pap tests?” I asked, a few steps behind them.

“Yeah. Exactly! Can you do that?” said Kameron.

“I can’t,” I said. “We do conscious sedation in the emergency room—that’s where we put an intravenous in your arm and give you drugs to put you to sleep, but you’re still breathing—”

“Yeah, yeah, yeah!” said Kameron.

Kaitlyn nodded vigorously at the ratty floor carpet and bit her lower lip.

“—but I’ve never heard of that for a Pap test. And we wouldn’t do that in the family medicine centre.” Hell, we barely checked blood glucose levels at the FMC. For conscious sedation, we’d call the respiratory therapist, get the patient on a cardiac monitor, follow their oxygen saturation and blood pressure (“Take a deep breath, Mr. Lalonde. Big, big breath! Big! That’s better.”), and have everything ready to intubate in case they lose their airway completely and we have to breathe for them. A big deal for a pelvic exam. Not impossible, but you’d have to have a good reason.

Kameron threw her arms in the air. “So useless. You’re, like, not even a real doctor, are you?”

I ignored her. I talked to Kaitlyn. “Is there some reason you’re scared of a Pap test?”

Tears sprang into her pale blue eyes. She blinked.

Kameron put her hand on the examining table, crunching the paper cover while she stared at Kaitlyn.

But Kaitlyn was making eye contact with me.

The moment was so delicate. I knew it could blow any second, especially with Kameron the tank in the room.

“Just give us the fuckin’ pills,” Kameron said, on cue, but I ignored her and fixed on Kaitlyn.

Tell me, tell me, tell me, I silently commanded her.

Kaitlyn shook her head, eyes filling with tears.

“Great, now you made her cry. Is that what they teach you in med school?” Kameron said.

“Kameron, could you step outside for a minute?” I asked, still holding Kaitlyn’s eyes with mine, but the older sister’s mouth opened in a silent O and she shook her head from side to side before grabbing Kameron’s hand, so I said, “Never mind.”

Kameron patted Kaitlyn’s hand in a few short, hard strokes, the way you might pet a cat you didn’t really care about.

Kaitlyn gulped and sniffed. Her mouth opened and closed, her thyroid cartilage (Adam’s apple) bobbed up and down, and then her eyes just kind of blanked out. Like she was a mannequin.

“Kaitlyn?” I said. It was so abrupt, I almost thought I was imagining it. We all zone out, but this was on another order of magnitude.

Kameron swore and stood up, hugging her sister, but also blocking her from my view. “She’s fine. She’s just, like, catatonic because you’re taking so long.”

I tried to make eye contact with Kaitlyn, behind Kameron’s bulk, but the glimpse of her eyes were the same no-go-zone.

“Huh,” I said. “Does she do that often?”

“What? No,” said Kameron. She let go of her sister with one arm so she could snap her fingers in my face. “Pills. Pills, s’il vous plaît. What, do I have to get them myself?”

She was trying to rile me up, and damned if it wasn’t working a bit, but in my gut, I knew there was something really wrong.

“Just a second,” I said, and slipped out of the room, letting her think that I was obeying her commands. Instead, I hurried back to the conference room to talk to Dr. Levine.

Even as I closed the examining room door firmly behind me, my ears pricked with the sound of a male voice singing a somewhat familiar song. He was a bit loud for an iPod, and as I stalked toward the conference room, the singing grew louder.

I stepped into the room, where Dr. Levine was standing, his back to the blackboard, facing the table, his profile to me in the doorway. His eyes were closed and his head was thrown back as he sang in a high, thin voice.

His hands conducted an invisible orchestra, swishing through the air. His voice broke slightly, but he held the last note, giving it his everything, before his hands dropped to his side and his eyes opened.

Wow. Dr. Levine knew how to let loose on a Friday afternoon.

Stan started a slow clap from the other side of the conference room, so I joined in, still shell-shocked from my encounter with the Rosenberg sisters.

Stan said, “Way to go, man.” When I glanced at him, one of his eyelids dropped in a barely perceptible wink, but all Stan said aloud was, “Did you know Dr. Levine used to be a tenor in the Montreal Jazz Choir?”

“Ran out of time,” said Dr. Levine, breathing a bit hard, “but once in a while, I still perform.”

I glanced at Stan the Mouth, who smirked and said, “I always enjoy a little ‘Con Te Partiro’ on a Friday afternoon.”

For a second, I almost wished for the despicable Dr. Callendar. At least I could count on bilious insults instead of Canada’s Got Talent. I said, “Uh, I have a patient to review. It’s kind of a strange one.”

“Of course, of course!” Dr. Levine pulled out a chair for me near the door.

I closed the door and sat. “Well, it’s hard to explain. I had a thirteen-year-old sister come in for the birth control pill last week, even though she hasn’t even had menarche yet. She’s planning to be sexually active, though, so at Dr. Callendar’s request, I gave her two months’ worth and booked her another appointment for her Pap. Only today, it’s her fourteen-year-old sister who showed up. This one, Kaitlyn, is actually sexually active and has regular periods, with no contraindications, but...”

“But what?” asked Dr. Levine.

“I don’t know,” I said. “She’s terrified of a Pap test. Started to cry and then just kind of...blanked out. Her sister swore at me.”

“Hm,” said Dr. Levine. “Well, lots of young girls don’t like Pap tests. Has she ever had one before?”

I shook my head.

“If they feel very uncomfortable, I refer them to a gynecologist.”

“Okay,” I said slowly, “but I’m concerned about this. She actually asked for conscious sedation for a Pap.”

“Well, they’re more likely to give that. We certainly can’t do it in the FMC.”

I rotated slowly to look at him. Sweat matted a few curls to his temple, and he was breathing a little fast from his performance. He smiled at me while I said, “Do you really think any gynecologist is going to do a conscious sedation on her for a Pap smear?”

“No,” he admitted, “but if they do decide to do it, they’ve got access to an OR.” He shrugged. “You’re welcome to try and do the Pap yourself, Hope. I’m just telling you what I would do.”

I liked the man. I mean, he was singing opera in the FMC on a Friday afternoon. But I had a bad feeling about this that went beyond “Pap tests are yucky.” Still, I slowly walked around the room for a referral form and began filling it out.

Stan said, “Atta girl. One of these days, you’re going to figure out how to make your life easier.”

I stopped laboriously copying out my patient’s date of birth and address, since they were too cheap to buy us an addressograph that would enable us to stamp the patient’s information on the form. “What are you talking about?”

Stan grinned. “You know. Instead of walking uphill both ways in the snow, you could just say, ‘Oh, someone just offered me a ride. I’ll take it.’” He sighed when I still looked blank. “Isn’t that what the Tao of Pooh is talking about? You should go with the flow instead of fighting all the time?”

“I wouldn’t know. I’ve never read it,” I snapped.

“You should. It’s a good book.”

Dr. Levine called out, “Now, now, Stan. Someone’s got to stand up for the poor and the indigent.”

“That’s right, Dr. Levine,” he shot back, but under his breath, he added and said, “As long as it’s not me, as soon as I’m out of the FMC.”

I couldn’t think with all the hoo-hah going on in here. I finished writing up the slip and walked back in the room, wondering if I was just imagining everything.

I threw open the examining room door. Kaitlyn gasped and glanced at me, terrified, from where she still perched on the examining room table. Kameron crossed her arms and tapped her foot, glaring at me.

No. I hadn’t imagined the weird vibe here.

Who was having sex with Kaitlyn? Was it the same person who might have sex with Kameron soon?

My first instinct was to run and call Children’s Aid, or whatever the Montreal equivalent was. But if the sisters would tell me exactly what was going on, I’d have a stronger case.

I smiled at Kaitlyn, even though tears stung my eyes. I blinked extra hard and said, “I’m going to refer you to a gynecologist, in case they’re able to do conscious sedation.”

Her lower lip wobbled and her eyes slid away. “Thanks.”

“Thank God,” Kameron burst out. “I was, like, going to die of old age before you got back here.”

I ignored that. “It seems like there’s a lot of stuff going on in your lives. Do you think you two could come back for counselling?”

“No way,” Kameron shot back. “Just give us the pills, and we’re out of here.”

I held up my finger. “I’ll look. Do you think you could come back in two weeks, when our drug rep might have some more for you?” I didn’t quite cross my fingers behind my back, but I had no idea when, or if, drug reps bothered to make it to the FMC to drop off free samples.

“We can’t miss school,” said Kameron.

“Yes, we can,” Kaitlyn said suddenly.

Kameron goggled at her.

Kaitlyn said, “If it’s important.” She held my eyes for a second before she glanced back down at her lap again.

This was almost too good to be true. Maybe I had made some inroads after all.

Kameron stood up, fisting her hands on her hips. “Oh, great. You can’t be serious.”

Kaitlyn shrugged without meeting Kameron’s eyes. “You don’t have to come.” Up until now, she’d acted so meek, so much more like the younger sister.

“I’ll write you a note for school,” I said, eager to build on this fragile bridge, just as Kameron said, “Oh, I’m coming, all right. You better believe I’m coming.”

“Is there anything else you want to tell me? Anything else going on at home, or at school, that you need help with?” I made eye contact with Kaitlyn.

She dropped her eyes immediately and swung her legs. She banged her heels against the metal examining table, making a hollow boom. She jumped before she shook her head in a violent no.

I turned to Kameron. After a long moment, she shrugged. “Whatever.”

Now there’s a ringing endorsement.

“I need to check on one more thing,” I said.

Kameron rolled her eyes. “You might be able to find another box of pills hidden in a drainage pipe somewhere?”

“Something like that,” I said. “Hey, are these the right phone numbers in your chart?” They said the home number was right, and neither of them had cell phones. They’d only listed one next of kin, Verna Rosenberg, with the same home number. I tapped their mother’s work number. “That’s our hospital number. She works here, at St. Joe’s?”

Kaitlyn nodded without looking at me. Kameron flashed me a grin that was more teeth than lips and nodded her head.

Her smile bothered me, but triggered another memory of her not looking quite as cheery. “Is that why you came to church last weekend?” I asked Kameron.

She jerked her head up, startled now. I said, “I saw you in Peter the Preacher’s video. You were with a man in a leather jacket. Is that your father?”

Kameron’s blushed progressed all the way down to her upper chest before she managed to say, “No, that’s Jeremy.”

“Oh. Well, it was nice of Jeremy to take you to church at work with your mom, anyway. I guess he’s a friend of the family?”

The breath hitched in Kaitlyn’s throat. When I turned to look at her, she’d grown very still, but she didn’t lift her eyes to mine or make any other sound.

Kameron crossed over to the window. The sky was cloudy with rain. I didn’t speak, and finally, she mumbled, “Our mother’s boyfriend.”

Huh. “What’s Jeremy’s last name?”

“Theroux,” said Kaitlyn.

I made sure she spelled it out for me before I headed back into the FMC conference room, Dr. Levine was packing up his papers and humming under his breath. Stan was scribbling notes in what was no doubt his final chart, since he was the first one out the door, any given day. Omar smiled at me from where he was filling out his patient records.

Dr. Levine looked over his shoulder at me. “Hope, I’ve got to get hopping. I’ve got a date tonight. We’re going to the opera.”

“Dr. Levine, I’m so sorry, but I have a bad feeling about the two girls in there. I think they’re being abused, probably by their mother’s boyfriend.”

“Oh, hell,” he said, and sank down into his seat.

“I’m calling Children’s Aid, or whatever it’s called in Montreal.”

“The DYP. Director of Youth Protection,” said Dr. Levine, like he was on autopilot.

“I don’t have a strong case, but I don’t like the story. The younger one asked for the pill, even though she’s a premenarchal virgin. The older one won’t tell me who her partner is. She’s under the age of consent unless it’s someone less than five years older than her, and she’s petrified to have a Pap test.”

Dr. Levine rubbed his forehead and nodded. “That’s good enough for them to investigate. They’ll decide what they want to do. Could I have the chart?”

I hadn’t had time to write much, but he scanned it. “That’s funny. The mother’s work number is St. Joe’s.”

“I know.”

Dr. Levine shook his head. “Well, our duty is to report and activate the DYP. They’ll decide about interviewing them and gathering information. Do you want me to come in to tell the patients what’s going on?”

I looked at him. To me, he was a teddy bear of a man, maybe fifty years old, a bit overweight, tanned, with lots of laugh lines. To them, he might represent the enemy, assuming Jeremy was around the same age. “I think I’m okay. I appreciate the support, though.”

It turned out that Dr. Levine wasn’t too familiar with child abuse reporting. “Let’s check online,” he said, which was code for “I have no clue,” but I was down with that. Dr. Callendar would have made it seem like my fault. Through the government website, I saw that yes, indeed, Quebec’s child protection was lined up through different “youth centres” or Centres jeunesses scattered across the province and within the city of Montreal. By now, I was getting used to this decentralized/fragmented care. But when I found the actual provincial website, first of all, it was in unilingual French, so I was glad that I understood the language. Secondly, it broadcasted its mandate and mission and even its library services in the sidebar, but I had to go to submenu to find out how to actually report a child, and then it depended on the area of Montreal. By the time I’d navigated that, Dr. Levine frowned and said, “I think for English Montrealers, you can go through Frukshank.”

“Frukshank?” I repeated. It sounded like a swear word to me.

He smiled. “Try searching for Frukshank Montreal. I bet that’ll do it.”

This time, the website was in English and I quickly spotted the “NEED HELP?” bar at the top and bottom of the webpage. There, they listed a single phone number. Phew. I called it.

“Frukshank Child and Youth Services, how may I direct your call?” said a wispy woman’s voice.

“I’d like to report a potential case of child abuse.”

“I’ll page one of our agents, who will get back to you as soon as possible. Could I have your name and phone number, please?”

“I’ll give you two.” I gave both the phone extension and my pager, just in case the agent was slow getting back to me.

I hung up. Stan shoved his last chart aside, stretched, and shook his head. “You’re always getting into trouble, eh?”

I stared at him for a second. “I think these children are in trouble. That’s our job, to report it.”

He held up his hands. “I’m just saying. You know how some people are sh—uh, magnets for trouble?”

“Yes,” I said. My tone was not inviting. I did not look at Dr. Levine, not wanting to attract his attention to Stan’s take.

“Well.” Stan spread his hands out, scooping the air with his big palms like that said everything.

“And you’re not?” I said.

He shook his head. “I’m the opposite of trouble. I see the patients, I do my best, and then I’m home free.”

“And if you saw a potential case of child abuse?”

His eyes flickered toward Dr. Levine, but he didn’t actually turn to look at him. “I’d report it. But I wouldn’t go looking for murderers on my day off.”

“You’ve made that very clear.” I remembered the time I asked him for help with the first murder, and he told me to call the cops instead.

“Look. I’m just saying, Hope. There’s a fine line between helping people and getting enmeshed in their troubles, you know what I’m saying? I’m just looking out for you.”

“Thanks,” I said, and turned away. It hurt that Stan, who’d always been…well, not a big brother, exactly, but someone who kind of pointed me in the right direction—okay, a big brother figure—was telling me it was my fault. I knew it kind of was. I’d gotten a few e-mails and Facebook messages and a call from my med school friend, Ginger, basically saying, WTF? Aren’t you tired enough from your residency without risking your life twice?

But this had nothing to do with murder. It was my job as a doctor, and maybe as a citizen, to step up. One of the surgeons at Western had pointed out that before ultrasound and CT, we used to take patients to the OR for appendicitis and, when we opened them up, seven out of ten actually had appys. So we were overcalling it, but that was better than missing a few, letting them rupture and cause pelvic abscesses. We had to overcall instead of undercall.

Now I had to risk overcalling instead of undercalling child abuse.

Tori’s quiet voice cut through the room. “Stan, you know it’s our duty to report it if we have any suspicion of child abuse.”

I glanced up at her, grateful. I hadn’t heard her enter the room, but now she stood in the doorway, holding a chart, before she closed it behind her. Tori does not mess around, but when she speaks, people tend to listen. Dr. Levine was nodding in agreement. He said, “If you didn’t report it, Hope, I would have to.”

Stan smacked his chart on the table and made a big show of pulling on his lined windbreaker. “I’d report it. But if anything else happened—if the girl ran away, if she asked for help defending her against the stepfather—I wouldn’t start running around with a gun, you know what I’m saying?”

“Loud and clear,” I said coldly. I’ve never touched a gun in my life.

“Good work, doctor,” he said, and stomped out of the conference room. He slammed the door behind him.

“I think you’re brave,” said Dr. Levine, before Stan’s footfalls had faded down the hallway.

I turned to look at Dr. Levine, startled.

“It’s much easier to stand on the sidelines and point your finger instead of jumping into the fray.” He smiled faintly. “You wouldn’t catch me doing it.”

Brave. I thought about that. It sounded a lot better than stupid. “Thank you, Dr. L.”

“No, thank you for standing up for the people who have no voice.”

I considered that, too. Of course the murdered people had been silenced, and children—well, they have voices. Kameron is really quite loud. But does anyone listen to them? My spine straightened. “You just made my day.”

“You’re saving people’s lives,” he said, so softly that I almost wasn’t sure I’d caught it properly.

It’s funny. When I dreamed about becoming a doctor, I imagined doing CPR and shocking people’s hearts. I knew about the boring bits like taking blood pressure and writing prescriptions. I considered delivering babies, providing abortions, and even pronouncing people dead. But I’d never pictured myself intervening in a case of child abuse.

Dr. Levine finished flipping through the other pages of my nearly blank chart. “Are there any other children at home who might be at risk?”

I blanched. “I never asked. I’d better go do that right now.”

Dr. Levine tried not to look at his watch. I felt guilty. “What time is your show?”

“We don’t have to be there until 7 p.m., but I rented a tux. I have to go pick it up.”

I tapped my fingers on the table. I’m no good at sitting around doing nothing, and last time, Kameron had done a runner. “Let me tell them what’s going on. If Frukshank calls back here, can you forward the call to my room?”

Dr. Levine cracked a smile. “Will do.”

I made a detour before I walked back in the examining room and shut the door. “Okay. I have one more question. Do you have any other brothers or sisters or other children at home with you?”

They exchanged a look. “Yeah. Our baby sister,” said Kameron. “Why, what’s up?”

I made a point of sitting down, since I was breaking the worst news around. “How old is she?”

Kameron shrugged. “Well, she was born on Valentine’s Day, so that’s…what, almost nine months? Yeah. Something like that.”

I closed my eyes for a second. A baby. A baby at home. “Is anyone hurting her?”

Kaitlyn twisted on the examining room table, making the paper rustle again. I turned toward her, but started to wind a lock of hair around her finger, blocking her face.

“What are you saying?” Kameron burst out.

I turned back toward the louder sister. “I think you know what I’m getting at, but there’s no easy way to say this.”

“You’re a dork?” burst out Kameron. “You’re wasting our time? We just want the fuckin’ pill.”

I handed Kaitlyn the box of pills I’d shoved under my arm. “That’s the good news.”

“Amen to that!” said Kameron, standing up. “C’mon, Kay, let’s go. She can’t hold us here anymore.”

“What’s the bad news?” said Kaitlyn, breaking her silence. She didn’t move. The way her big, pale blue eyes tracked me, I felt even more guilty, even though this was the ultimate “I’m doing this for you own good.” I took a deep breath before I said, “I’ve paged the Director of Youth Protection, the Frukshank Centre.”

“You’ve got to be kidding me,” said Kameron.

Kaitlyn burst into tears and covered her face.

Kameron shook her elbow. “We outta here. C’mon! Kaitlyn. Katie. Kay-kay. We gotta go!”

Kaitlyn cried and cried.

The phone on my desk rang. I picked it up. “Dr. Hope Sze.”

“Did you call Frukshank Child and Youth Services?”

“Yes.”

“Do you have something to report?”

“Yes. Two girls and a baby. I’m afraid they’re being abused.”

“How old are they?”

“Fourteen, thirteen, and nine months.”

“All right. Well, let me take the details. You’re a doctor?”

“Yes. I’m a resident doctor in family medicine at St. Joseph’s Hospital.”

Kaitlyn burst into a fresh round of tears. Kameron yelled, “This is bullshit!”

“Excuse me, I can’t hear you,” said the woman.

I winced. “I’m sorry, I’m with the patients right now. Could I call you back from another line?”

In the seconds it took me to get off the phone with Frukshank, Kameron dragged Kaitlyn off the examining table, gave me the finger, and slammed the door shut behind them.

I rushed down the hall, but I could already hear them clattering down the stairs. I couldn’t force them to stay. The smart thing to do would be to head right back into the office and call Frukshank back.

But one thing stood out in my mind.

I’d asked if anyone was hurting the baby, and they hadn’t answered.

I didn’t even know the baby’s name.

I hesitated, but the baby’s name decided me. I sprinted down four flights of stairs, sailed down the hall, and surveyed the parking lot for two brunettes.

No sign of them.

I craned my neck. They were too young to drive, so I might be able to catch them if they hadn’t hopped on a bus already. But what if they’d taken the métro? And would they have headed east or west on the blue line?

Sucks.

Dr. Levine had already packed up his briefcase when I returned, out of breath and miserable.

He placed a heavy, slightly sweaty hand on my shoulder. “Don’t take it too hard, Hope. You did the right thing.”

Hard to feel that way when a baby and two other girls might be at risk. I didn’t answer him.

“You okay?” he asked, but I knew he really wanted to get to that opera.

“Sure,” I said. “I’ve got to get down to the University College anyway for a fundraiser.”

“I heard about that!” said Dr. Levine, cheering up. “So you’re all right?”

“Righty-o,” I said. I was being sarcastic, but that was all he needed. He hoofed it out of the door pretty fast for a guy with a spare tire. I dialed the number for Frukshank.