Lara stepped into the break room and leaned over a chair, stretching her back and shoulder blades. She had felt listless all day, and the baby must have sensed her mood. He kicked more than usual, landing one particularly effective jab at her kidneys in the middle of a consultation with a new patient. Lara had to excuse herself and visit the ladies’ room—not a particularly auspicious way to establish the professional/patient relationship.
She glanced up and sighed when she read the clock on the wall. Four o’clock. She could go home in another half hour unless an emergency arose.
Gaynel walked by, a chart in her hand. She smiled when she saw Lara. “New patient in room two.”
“OB case?”
“Migraine headache.”
Lara pressed her hand to her back and straightened, then girded herself with resolve. Just one more patient, maybe two, then she and Junior could go home and collapse on the couch. Maybe Connor would stop by with something to eat, or maybe he’d suggest going out to grab a bite . . .
No. She’d rather eat peanut butter and jelly than go out again.
She moved to the exam room, then lifted the chart from the receptacle on the door. The new patient was Natasha Hendricks, age forty-one, presenting with throbbing at the left temple, extreme nausea, and photosensitivity. BP was 130 over 90; high/normal, but so much depended upon the severity of the migraine . . .
Lara gathered the energy for a professional smile, then opened the door. “Ms. Hendricks?” She extended her hand to the woman sitting on the exam table. “I’m Lara Godfrey, the clinic’s physician’s assistant.”
“I wanted to see a doctor.” The woman frowned and swiped a hand through her shoulder-length blonde hair. “I’ve already spoken to the nurse.”
“I’m qualified to do everything the doctor does except surgery.” Lara leaned against the wall and folded her arms, ready to do battle but thoroughly tired of the struggle. Most women accepted her without complaint, but once in a while she encountered this kind of prejudice against PAs . . .
Apparently Ms. Hendricks was in no mood to argue. “Whatever.” She pressed her hand to her left temple and spoke in the slow accent common to northern Virginians. “I don’t care who helps me as long as somebody does. My head is killing me.”
Lara peeled herself off the wall and took a pen from her lab coat pocket. “When did the headache begin?”
The woman winced. “I woke up with it this morning.”
“Would you describe it as a constant or pulsing pain?”
“Throbbing. I’m dying here.”
“Nausea?”
“Some.”
Lara made a note on the chart. “Do you have these headaches often?”
“Nearly every month, right before my period. My family doctor tells me to take aspirin with caffeine, but I’m away from home right now.”
“Does the aspirin usually work?”
“Not really. I go to bed and try to sleep it off, but I can’t do that now. I need to feel better in a hurry.”
Lara checked the chart for a home address and found none. “That’s odd. The nurse didn’t finish filling in the chart.”
Ms. Hendricks closed her eyes. “Can we worry about the file later? I need something for the pain.”
Lara pressed her lips together and studied her patient. There were no tests to confirm migraine, but the woman exhibited all the classic signs. And the pain, Lara knew, could be debilitating.
“Ms. Hendricks, have you ever taken sumatriptan succinate? The brand name is Imitrex.”
The woman shook her head. “It doesn’t sound familiar.”
“The nasal spray works quickly in most cases, but one of our nurses will have to monitor your blood pressure for at least an hour after you take it for the first time. We want to be certain there are no adverse effects.”
The woman opened one blue eye and squinted at Lara. “Are you insane?”
Lara sighed. The full moon must be approaching.
“There are other drugs, but they don’t work as well. If you want immediate relief, I’d go with the Imitrex. I could give you an injection of Demerol, but it tends to make people drowsy.”
The woman’s brows pulled into an affronted frown. “No shots.”
Rapidly running out of options, Lara scratched her head. “I could give you a dose of ergotamine. It won’t work as well or as quickly, but you should feel better before too long.” She cut a look from her patient to her watch. “It’s four fifteen. I can give you a sample now and write you a prescription if you’d like to have it filled tomorrow.”
“That would be great.” The woman gave her temple one last circular massage, then lowered her hand and gazed at Lara through watery eyes. “You’re very kind.”
“Thanks.” Lara moved to the counter and buzzed the intercom. “Gaynel, could you bring in a single dose of ergotamine with caffeine? And a cup of water.”
“So you’re a physician’s assistant.” More talkative now, Ms. Hendricks tilted her head and held Lara in a long and interested search. “This is a first for me. I usually see a general practitioner in my hometown.”
“That reminds me.” Lara sank to the stool, then opened the chart and poised her pen over the space for the home address. “The nurse failed to finish your chart. Can I have your address, please?”
“20473 Logan Lane, Falls Church, Virginia.” The woman’s eyes closed as she began to massage her left temple again. “My physician’s name is Jarred Smith.”
Lara jotted down the information, then glanced at her watch again. Gaynel was dragging her heels, but it was nearly time to go home. Lara’s buzz had probably interrupted a late-breaking gossip session in the break room.
“What brings you to town?” Lara asked, trying to be polite.
Ms. Hendricks smiled. “Business. I breed quarter horses and I’m supposed to hold a seminar tonight.” She cracked a wry smile. “Some job I’ll do, feeling like this.” Her eyes narrowed as she lowered her gaze toward Lara’s abdomen. “Speaking of breeding, you’re pregnant, right? I know some folks would say it’s rude to ask, but it’s a perfectly natural thing, whether it’s horses or people. I thought you might be pregnant, but sometimes you can’t be too sure what’s going on under a loose-fitting top.”
Lara smiled. She’d answered a thousand questions about her pregnancy, many from women a lot less tactful than Ms. Hendricks. “Yes, I’m in my thirty-third week. It’s a boy.”
“I’m sure you’re happy.”
Lara looked up and gave the woman a smile. “I’m thrilled.”
The woman’s fingers drummed distractedly on her crossed knee. “I imagine your husband is just about to bust his buttons. Every man wants a son.”
Lara’s gaze fell to the wedding band on her left hand. She had thought about taking it off, but since becoming pregnant she’d decided to continue wearing it. The ring stopped a lot of questions she didn’t want to answer.
“My husband . . . well, I’m sure he’s thrilled too,” Lara answered, her voice quiet. “We always wanted a child, boy or girl. It really didn’t matter.”
Her patient’s gaze softened. “Honey, is something wrong? Don’t think you can fool me. I know pain when I see it, ’cause I’ve worn that look myself.”
Lara looked up, surprised again by the unpredictable woman. “I’m fine. Really.”
Ms. Hendrick’s fingertips flew to her lips. “Don’t tell me—your husband’s divorced you.”
Against her will, Lara’s chin trembled. “He’s deceased.”
“I’m so sorry.” Sympathy dripped from Ms. Hendricks’s voice as her eyes blazed with earnestness. “Honey, I know exactly what you’re feeling. I lost my husband two years ago, and for the longest time I didn’t care about anything. If it weren’t for my babies, I wouldn’t have even been able to get out of bed.”
Lara glanced at the woman’s chart. “You have small children?”
Ms. Hendricks snorted with the half-choked mirth of a woman in pain. “I meant my equine babies, my horses. I had to get up and take care of them, so that’s how I got through the grief. Apparently you’re getting through pretty well. You’ve got your job and you’ve got your baby.”
“Yes.” Lara’s hand fell to her rounded tummy. “I’ve got a lot, really.”
A staccato rap broke the silence, then Gaynel came in with the medication and a glass of water. While her patient took the pill and the cup, Lara pointed to the chart. “Gaynel, Ms. Hendricks’s chart was incomplete. Who was the admitting nurse?”
Twin stains of scarlet appeared on Gaynel’s cheeks. “I got all the information I could. She, um, wasn’t in a cooperative mood.”
“Don’t you blame the nurse for my reluctance to chat,” Ms. Hendricks said, again massaging her temple. “I’m afraid I wasn’t in much of a mood for conversation when I came in. Your nurse tried to get me to write down all my particulars, but I can’t stand the thought of answering questions when it feels like someone is trying to gouge out my eyeball from the inside.”
Lara sighed and looked back to Gaynel, knowing the nurse would not appreciate what she was about to ask. “I’d like you to monitor Ms. Hendricks for half an hour, just to be sure the ergotamine helps. If it doesn’t—”
“I’m not sticking around.” The woman slid off the exam table, then slipped her stockinged feet into a pair of discarded pumps. “I feel much better. I’m not about to keep you all here just to watch me.”
“I’d really like to monitor you,” Lara protested. “If the ergotamine doesn’t ease your symptoms in half an hour, we should consider another approach—”
“Thank you, dear, but no.” The woman picked up her purse, then smoothed her skirt and gave Lara a sincere smile. “I like you, Doc. If you’re ever in Falls Church, look me up and let’s have lunch. I could tell you some of my battle stories, honey, and maybe they’d help you cope. The first year is the hardest ’cause some things get easier with time. But you’re lucky to have a baby to take your mind off things.”
Lara shifted uneasily beneath the woman’s piercing gaze. “I’d feel better if you’d stay and let us watch you for a while.”
“Can’t stay.” The woman moved briskly out into the hall, then looked right and left until Gaynel pointed to the check-out desk. “Thank you, dear,” she called, moving toward the receptionist like a yacht in full sail. “I’ll recommend you.”
By four thirty, Lara had moved to the records desk. She was in the midst of dictating a report for Natasha Hendricks’s file when Gaynel peered at her from around the corner. “Guess what I found in exam room two?”
Lara snapped off the Dictaphone. “What?”
Gaynel thrust her fist toward Lara and opened her fingers. One thick brown pill, emblazoned with the letter C, sat in the center of her palm— Cafergot, a brand name for ergotamine tartrate.
Lara picked up the tablet and ran her thumbnail over the initial. “Natasha Hendricks didn’t swallow it?”
“I thought she did.” Gaynel leaned against the doorframe. “She did a good job of faking it.”
Lara crinkled her brow. “Why would a woman only pretend to take the medicine that would make her headache go away?”
Gaynel shrugged. “Maybe she’s mental and only wanted attention.”
Lara stared at the pill, thinking. “Could anyone else have dropped this?”
Gaynel shook her head. “The room was swept clean last night, and that woman was the only migraine patient we saw all day.”
Lara’s thoughts moved from the improbable to the incredible. “Maybe she tossed it in her mouth and missed. Maybe she was too embarrassed to tell us she dropped it.”
“She didn’t complain, though,” Gaynel added, “and she paid the bill in cash; I checked. She paid ninety bucks without attempting to file an insurance claim.”
Lara leaned back in her chair and stared at the pill in her palm. The world was full of eccentrics, and she’d seen her fair share. Once she spent an hour interviewing a patient who claimed to be in labor with a full-term pregnancy, only to discover through ultrasound that the woman’s womb was empty—she had enlarged her belly by swallowing air. Another pregnant patient had come in with stomach pain that resulted from ingesting more than a dozen watch batteries. In a world of such possibilities, one woman’s aversion to needles and unfamiliar medication didn’t seem terribly strange.
Lara dropped the tablet back into Gaynel’s hand. “Flush it. We’ll probably never see her again.”
“She was kind of nice.” Gaynel sighed wistfully. “I love those country blue-bloods. They sound so cultured.”
“They do, don’t they?” Lara tilted her head, trying to remember where she’d heard a similar accent, but at that moment Sharon walked around the corner. “Excuse me, ladies, but have you checked the time? It’s five o’clock and my husband’s Christmas party begins in two hours.”
“We’re finishing up.” Lara glanced down at Natasha Hendricks’s chart one last time, then shook her head and placed it in the “to be filed” bin. Just one more adventure in a day, one more crazy story to share with Connor. If she was lucky, he’d have a few funny library stories to tell too.
She pushed herself up from her chair, slipped her stethoscope from around her neck, and waddled slowly down the hall.
Nadine Harrington smoothed her hair into a clasp, then pulled a small notebook from her purse. The limo moved at a stately pace through the street, and Nadine was grateful for the darkened windows. Tomorrow she’d tell Sloane to find a rental car or truck for Costello’s use. This vehicle was far too conspicuous in a midsized town like Charlottesville.
She bit her lip and sorted through her thoughts, measuring one impression of Lara Godfrey against another. The young woman was professional and competent, no doubt about it. A marked camaraderie existed between the women in the clinic; Nadine had noted the exchange of smiles and lots of friendly comments between the nurses, the receptionist, and Lara Godfrey, PA. At work, at least, Sloane’s surrogate seemed to have a firm grip on reality.
That reality seemed to shift, however, when she talked about the child in her womb. “I’m thrilled,” she’d said when Nadine asked how she felt, and she consistently referred to the child as “my baby.” And Sloane was right—the woman still struggled with grief over the dead husband. Nadine had seen the quivering chin and the hint of tears in Lara Godfrey’s eyes. Most alarming was the woman’s contention that her dead husband was thrilled about the child too. How could she know such a thing? Was she in denial about his death?
Subject does not refer to surrogate arrangement, she wrote. Is this discretion or denial?
She brought her pen to her lips and held it there, like a cigarette, as she remembered Sloane’s probing eyes across the lunch table. “Lemuel also learned that that you have not attempted to see your son in six years,” he’d said. “I have to believe you know what is best for him—and I admire all you have sacrificed for his benefit.”
What she had sacrificed ? You couldn’t sacrifice what you never had to give.
Weary of that train of thought, she tossed her pen and notebook onto the upholstery, then dug through her handbag for her cigarettes. She found them, shook out a slender stick, and pressed it to the limo’s cigarette lighter. Trembling, she brought the cigarette to her lips and inhaled deeply, then crossed one arm over her body and stared out the window as Christmas lights and festooned houses slid by beyond the swirling smoky haze.